Effort To Drop New York State HIV Testing Written Consent Requirement Causing Split Between Physicians, Advocates

An effort over the past year by New York City Health Commissioner Thomas Frieden to align a New York state law with CDC's revised recommendations on HIV testing in the U.S. has created a "sharp rift" between the medical community and HIV/AIDS advocates, the New York Times reports (Chan, New York Times, 12/25/06). CDC's revised recommendations advise that HIV tests become a routine part of medical care for residents ages 13 to 64 and that requirements for written consent and pretest counseling be dropped. A New York state law passed in the 1980s requires a physician or anyone ordering an HIV test to have the individual receiving the test read and sign an informed-consent form. The form -- which is separate from the general-consent form usually used to authorize a wide range of medical tests -- explains the test and patients' rights. The law also requires that before the form is signed, the care provider ordering the test must provide an "explanation of the nature of AIDS- and HIV-related illness, information about discrimination problems that disclosure of the test result could cause and legal protections against such discrimination, and information about behavior known to pose risks for transmission and contraction of HIV infection." Under the law, if an individual tests positive, the person giving the test results is required to provide "counseling or referrals for counseling" on the emotional effects associated with an HIV diagnosis, possible discrimination, sexual behaviors and other areas. Frieden since December 2005 has attempted to change the state law (Kaiser Daily HIV/AIDS Report, 10/02/06). According to the Times, most of Frieden's proposal is contained in a bill (A 11958) sponsored by state Assembly member Darryl Towns (D). After months of talks between city health officials and advocates, Frieden's proposal was addressed on Wednesday at a state Assembly Health Committee hearing in New York City.

Comments
"New York is an epicenter of this epidemic, and we're very far from being an epicenter of care and control," Frieden said last week, adding that if a written consent form is a noticeable obstacle to routine testing, it should be dropped. "Frankly, there are a lot of misconceptions about what's being proposed, and, frankly, there are some who term themselves AIDS advocates who are very comfortable with the current situation," he said. State Sen. Thomas Duane (D) said Frieden's proposal is "well intentioned but grossly misguided," adding that it fails to address "doctors' discomfort with addressing HIV/AIDS." State Assembly member Richard Gottfried (D), chair of the Assembly Health Committee, said, "I remain convinced that written consent is extremely important," adding, "There may well be ways we can further simplify the counseling process." Some attorneys at the hearing testified that written consent is the best way to confirm a client's preferences for HIV testing. Marcelo Venegas-Pizarro -- chief medical officer at the AIDS advocacy group Housing Works, which opposes Frieden's proposal -- said, "Pretest counseling and informed consent have forced me to take the time to ensure that a patient understands what is being done." Some physicians and the Greater New York Hospital Association testified in support of Frieden's proposal. A survey released this summer by the New York City Department of Health and Mental Hygiene of 137 primary care doctors in South Bronx, Central Brooklyn, East Harlem and Central Harlem found that 38% answered yes when asked, "If written consent were no longer required, would you offer more patients an HIV test?" The administration of Gov. George Pataki (R) has not supported Frieden's proposal, and it is unclear whether Gov.-elect Eliot Spitzer (D) will back it, the Times reports (New York Times, 12/25/06).