New York's Bold Move Regarding HIV Testing

In a bold and innovative move, New York State joined the other 44 states that now require health care professionals to offer routine and voluntary HIV testing to all patients aged 13 to 64. This means that anyone who enters a hospital ER, gets a routine physical, or gets a flu shot should be offered to be tested for HIV. The testing process has also been simplified to require only a verbal consent as opposed to a lengthy written consent that was previously required. Medical professionals also need to provide information on HIV risk and treatment and provide connections to care if the patient tests positive and provides consent.

This is a huge step forward in the movement to prevent and treat HIV. One of the biggest factors in the continuous spread of HIV is that thousands of people across the country do not know their status.  In New York City alone, there are currently 107,000 residents who are living with HIV and countless others who are unaware of their status. Making HIV testing part of routine medical care could help these people become aware of their status and get the care and treatment they need.

Another benefit of routine HIV testing is reducing the stigma associated with the test and HIV itself.  When the consent is more complicated and testing is primarily done at separate facilities, HIV stigma is fostered.  As the legislation's prime sponsor, State Senator Thomas K. Duane, said: "The Health and Hospitals Corporation's pilot testing project and the Health Department's 'Bronx Knows' initiative both showed that when HIV testing becomes a routine part of medical care, the number of people who know their status increases and the stigma surrounding HIV and HIV testing declines." These would be tremendous benefits for the entire state of New York.

Of course, as with any controversial new program, there are potential risks. One big issue is getting those individuals who test HIV positive connected to care upon their test result. For those who have been conducting traditional HIV testing for years, this has always been a tremendous challenge. When receiving a positive test result, a person may react in a number of ways, and often the thought of starting care and treatment may be the last thing on their minds. In addition, if there is substance use, mental health issues or other complicated factors, a person may be unable to fully access medical care. For those medical professionals who would now be providing the test there would need to be training and support around this important issue. They would also need to be armed with resources and ideally with care and treatment professionals to make more effective referrals.

Another issue that may be of concern is the overall sensitivity of the medical professionals in how they administer the results of the test. Those who have worked in this field have no doubt heard the horror stories of people finding out their positive results in completely insensitive and even unethical ways. Patients finding out over the phone while working, patients being told while still groggy from surgery, professionals inadvertently telling family members before telling the patient herself.   There may always be issues such as this, yet there would need to be standards in place to help minimize these situations.

The same goes for confidentiality. With traditional HIV testing, every measure is taken to ensure the confidentiality of the patient. Medical facilities also are held to the same standards, yet given some of the scenarios above, this is not always ensured. In fact, some studies have shown that some health care professionals need to be more "mindful" of how they respond to those patients who are HIV positive as these individuals have reported some feelings of being stigmatized.

Routine HIV testing is essential in the fight to prevent HIV. New York state is taking a big step forward in this movement. While there are certainly some issues that need to be monitored, overall this is significant progress.

Photo Credit: Rich Lombino