new bill to try to change HIV testing practices in NYS

On April 16, 2009, a new bill was introduced into the NYS Assembly arguing for a new HIV testing MO in the state of New York. The bill would require that HIV testing "to be part of a signed general consent to medical care" signed by the patient. The bill would also require that all EDs, hospitals, and doctor's offices offer HIV tests to patients on a regular basis, with some very limited exceptions (ie, they are being treated for a life-threatening illness at the time of their visit.)

But what does it mean for the HIV test to be "part" of a "signed general consent"? In an article published April 12, The Albany Democrat and Chronicle interpreted it to mean that patients "would check a box on a general medical-consent form, which would remain in force."

Advocates say that this is still too much of a barrier. C. Virginia Fields, chief executive officer and president of the National Black Leadership Commission on AIDS, is quoted in the Democrat: "What we're saying is routine testing is when you go to a doctor and get a blood work-up, and HIV should be among those (illnesses) tested."

I'm all for lowering barriers to testing for HIV, and myself have recommended several HIV (and chlamydia and herpes and gonorrhea) tests to several patients during my NP clinicals. However, I have trouble picturing HIV being added to "routine testing" because there is no such thing. That is, when a patient turns up at a clinician's office, either perfectly healthy and there for their annual exam, or with a looong list of episodic complaints, the clinician decides what tests to order based on the patient's characteristics. Admittedly, there are some tests (complete/basal metabolic panel, complete blood count, urinalysis) that are ordered for basically everyone, but these are not for diseases as such; they test organ function and indicate disease if abnormal. All of this is to say: in the absence of true "routine tests" for disease, a bill like this one is the only way to improve testing rates via legislation. Unless of course, the legislature wants to mandate that clinicians verbally offer the test for HIV to everyone on every visit. (Come to think of it, that's not a bad idea.) In the meantime, get tested.

Finally, an editorial from the NYT advocating greater awareness of HIV in the US, and more frequent testing for the disease.