While this legislation falls short of a true opt-out approach to HIV screening in New York, we are confident that it will advance our efforts to make HIV screening a routine part of care, most particularly with a required offer of an HIV-related test in all health care settings. In addition to the “required offer” provision, the legislation will:

• Provide durable consent. Written consent for an HIV test will be part of the general consent to medical care with an opt-out for HIV testing. This will be durable unless patient changes providers or revokes the consent;
• Allow for oral consent in settings when rapid technology is used (except for correctional facilities);

The legislation brings New York State closer to the Centers for Disease Control and Prevention’s (CDC) 2006 HIV testing guidelines. Twenty states required separate, signed consent before the 2006 recommendations were issued. To date, 19 states have changed their laws to be more compatible with CDC’s recommendations for oral or written informed consent that may be incorporated into a general consent for medical care. Legislation is pending in Pennsylvania (to eliminate requirements for written consent, as well as Michigan and Massachusetts. Although New York’s legislation removes requirements for written consent specifically for rapid tests it also permits the required written consent to be incorporated into the general medical consent, with a space adjacent to the signature specifically reserved for written declination of HIV testing, intended to streamline the process.

Speaking strictly to the basics, you need to know four things to make a decision about becoming sexually active.

• First, you should know what it means to have sex with some one and what the potential consequences of your sexual acts might be. In comparison, sex doesn't last nearly long enough to justify what may lie ahead for a lifetime.
• Second, you need to know what your sexual attraction is. This is not imperative, but it will make all the difference.
• Third, you need to know the truth about contraceptives and how to use them to protect yourself, including what your options are to meet your needs without using your body.
• Finally, it is essential that you know whether you have HIV or another sexually transmitted infection. If so, you need to consider whether or not you should be having sex and at minimum you should have a conversation with your partner about your results.

For this reason, getting to know your HIV status should be accessible, economical, and accurate. Fortunately, HIV screening technology continues to improve - making the time you wait for your result shorter, the result of your HIV test more reliable, and the tests' ability to diagnose the virus in your system more sensitive. And, fortunately, organizations such as the Sexuality Information and Education Council of the United States (SIEC-US) continue to repudiate abstinence-only-untilmarriage programs that are proven ineffective for more than half of those who acquire HIV every year. Age-appropriate and comprehensive sex education provides maturing adolescents with the information that they need to make healthy decisions. All these things add up to a less intimidating testing experience with accurate information that you can use to make decisions about your health - almost immediately.

Around 40% individuals that are diagnosed with HIV each year progress to an AIDS diagnosis within one year; approximately 5% of them will die within one month. “The evidence is clear. Routine HIV screening in clinical settings helps to avert new HIV infections and saves lives,” says Patrick McGovern, President & CEO of Harlem United Community AIDS Center, Inc. “New York State is currently working to remove longstanding barriers faced by individuals who want to know their status. Everyone should receive an HIV test regardless of their ability to pay for it or whether their health care provider believes they are at risk.”

Less than one year ago, Department of Health and Human Services Secretary Kathleen Sebelius announced an expansion of Medicare preventive coverage for HIV screening for beneficiaries who are at increased risk, including women who are pregnant and Medicare beneficiaries of any age who voluntarily request the service. This decision was supported by the U.S. Preventive Services Task Force (USPSTF) which scored subjective risk based testing as an “A”; the Secretary has discretion to expand access to any preventive services with a USPSTF score of “A” or “B”. The USPSTF maintains that the evidence is insufficient to support coverage of routine HIV screening. The CDC asserts that HIV testing should be routinely offered in clinical settings on an opt-out basis to all persons ages 13 – 64. Both the USPSTF and the CDC are under the auspices of the Department of Health and Human Services.

Senator Kirsten Gillibrand, Congressman Joe Crowley, and Congresswoman Maxine Waters each have legislation that will expand access to and reimbursement for routine HIV screening. Community advocates continue to urge legislators to co-sponsor the bills and move them forward, but little progress has been made to date. Early access to routine screening is highly associated with improved opportunities for improved health outcomes and reduced health disparities and HIV transmission for newly identified HIV-positive individuals. In commemoration of National HIV Testing Day, Harlem United is releasing its’ updated white paper (HIV Testing Policy) urging greater access to routine HIV screening in clinical settings for all persons between the ages of 13 and 64 and targeted HIV testing to populations at greatest risk.

Harlem United, founded in 1998, provides a full range of medical, social, and supportive services to predominantly African-American and Latino individuals living with HIV/AIDS, whose diagnoses are often complicated by addiction, mental illness, and homelessness. Harlem United’s prevention program employs a bifurcated strategy to educate the Harlem community about their HIV status. One track targets HIV testing to populations that are disproportionately at-risk for HIV, while a second track offers HIV screening and other preventive services block by block to persons who may be at risk but don’t know it.

The panel was moderated by Stephen Lewis, Co-Director, AIDS-Free World. Other participants included Dr. Wafaa El-Sadr, Director, International Center for AIDS Care and Treatment Programs, C. Virginia Fields, President & CEO, National Black Leadership Commission on AIDS, Lee Bollinger, President, Columbia University and Linda P. Fried, Dean, Mailman School of Public Health.

Pictured from left to right: Stephen Lewis, President William J. Clinton; Wafaa El-Sadr; C. Virginia Fields, and Kali Lindsey