In the United States, HIV testing is governed by a range of federal and state laws, common law principles, constitutional provisions, and various codes of ethics. State laws vary widely in the degree of protection provided. The concept of informed consent, achieved through the process of physician-patient communication, is a legal and ethical obligation spelled out by statute and case law in every state. Informed consent is a legal concept, not a medical concept, and it is central to values of individual autonomy and dignity. Informed consent is characterized by a process of communication between a patient and physician that results in the patient's authorization or agreement to undergo a specific medical intervention.
Results are fairly meaningless unless a patient actually receives their results. Further, providers may also forgo post-test counseling for those patients with a negative result, therefore surrendering a key opportunity to reach patients with critical prevention information. Other studies indicate that over half of new infections are caused by people who are unaware of their HIV status and who have been infected themselves for less than Consent hiv testing years. In this instance, state law does not permit strict implementation because the legislature has already spoken on the matter of HIV testing, Consent hiv testing created its own laws Consrnt regulations to govern testing. With any plan or proposal introduced to routinize HIV testing, there is always a discussion of the efficacy and the cost of the rapid HIV test. The association between living in countries where laws allow younger adolescents independent access to HIV testing tsting higher rates of testing among adolescents was stronger in teenage girls than in teenage boys, according to the report. Written informed consent is the Gallery hot india sexy woman in New York and not one study or report has indicated that such a requirement acts as a barrier to testing. Greater outreach and the routinization of HIV testing can occur under both.
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Do Lohan ex nude know your country's policies regarding confidentiality of information related to services provided to adolescent giv by health care providers? By Disease or Condition. Code Regs. Tennessee state law table HIV-specific criminalization T. Arizona state law table Adolescent consent R. Depending on the laws of the country, adolescents who have reached the legal age of consent or are considered as mature minors can consent for an HIV Naruto witch dr. CodeAppendix B. Providers can obtain patient consent for HIV testing through any Consent hiv testing the following ways: Documented Consent hiv testing consent Written consent is no longer required, except in correctional facilities. Health care providers should offer adolescents an opportunity to discuss their own assent to HIV testing and counselling in private, without the presence or knowledge of his or her Consent hiv testing or legal guardians. OA funds local health departments in the jurisdictions with the highest burden of HIV to provide confidential and anonymous hlv HIV testing in a variety of non-healthcare, community-based settings. Wyoming state law table Adolescent consent W.
The findings, across 15 sub-Saharan countries, could have important implications not just for increasing rates of HIV diagnosis among teenagers, but by opening access to both treatment and counseling for an underserved population, potentially lowering incidence of the virus among the most vulnerable age group, the researchers note.
- In California, the majority of HIV testing takes place in medical care settings, and the majority of new cases of HIV are identified in physician's offices, community clinics and other health care settings.
- The Required Points.
- In the United States, HIV testing is governed by a range of federal and state laws, common law principles, constitutional provisions, and various codes of ethics.
- All adolescents must make their own decision to have an HIV test, without being coerced or pressured.
- The information presented here does not constitute legal advice and does not represent the legal views of the Centers for Disease Control and Prevention or the Department of Health and Human Services, nor is it a comprehensive analysis of all legal provisions relevant to HIV.
Don't miss out! Create your free JWatch. JAMA Aug All U. What happens when patients cannot provide informed consent? All 53 U. According to Halpern, the main arguments against testing for HIV without patient consent relate to discrimination, patient autonomy, and the fear that at-risk patients will avoid the healthcare system so as to avoid being tested.
At the same time, proponents of testing argue that it could improve the care of individual patients. In this commentary, Halpern provides convincing arguments that HIV testing without consent should be possible in specific circumstances.
Halpern SD. HIV testing without consent in critically ill patients. JAMA Aug 10; Get Your Copy. Comment In this commentary, Halpern provides convincing arguments that HIV testing without consent should be possible in specific circumstances. Citation s : Halpern SD. By continuing to use our site, you accept the use of these cookies. To learn more, please visit our Cookie Information page.
Adolescents from key populations often face additional legal and policy barriers. Depending on the laws of the country, adolescents who have reached the legal age of consent or are considered as mature minors can consent for an HIV test. In order to reduce age-related barriers to access to HTC , WHO guidance encourages countries to examine and potentially revise their current age of consent policies. Code 41A. Many countries include concessions in their policies allowing adolescents in specific groups or situations to be considered 'mature minors'.
Consent hiv testing. Promoting and Protecting the City's Health
Numerous barriers to HIV testing exist. Patients have fears, misconceptions, and misgivings about HIV testing that dissuade them from getting tested. Doctors and health care providers face time constraints, lack of access to testing technologies, and a dearth of proper testing environments.
Advocates struggle to reach those most at risk for contracting HIV and who have never been tested. Upon reviewing various studies on barriers to HIV testing, from the point of view of every stakeholder involved, written informed consent has not presented itself as an obstacle to HIV testing. New York's statutes on HIV testing, as outlined in article F of the public health law, seek to encourage greater testing while protecting patients' rights and doctors' against liability.
The CDC guidelines should act as a floor in a solution to expanded testing, not a ceiling. State laws, by design, seek to tackle societal problems in a manner appropriate to the state, as they best see fit.
What works in one state may not work in another and differing tactics may be the most appropriate response to a complex public health epidemic. Written informed consent is the law in New York and not one study or report has indicated that such a requirement acts as a barrier to testing. Indeed, this report points to a number of real barriers to testing -- attitudes, waiting periods, lack of offering, or lack of access to rapid tests to name a few. Written informed consent is doing what it was designed to do -- protect patients and protect health care providers.
It is not a barrier to testing and no one has proven as much. The CDC guidelines and written informed consent need not be mutually exclusive. Instead, the application of both could work to significantly bridge the gap in the awareness of an individual's HIV status.
Greater outreach and the routinization of HIV testing can occur under both. However, implementation of routine testing is extremely complicated and raises numerous concerns.
This is a matter subject to much debate from City Hall to the State Capitol to the White House, from local sexually transmitted disease STD clinics to large hospitals, and from medical records to law books.
Answers vary, stakeholders collide, and embroiled debate reaches every corner of the argument. Some in the debate would like to see anyone visiting a doctor's office or hospital tested for HIV without their consent and without counseling.
Others wish for patients to be well informed and affirmatively consent to testing, first knowing full well what they are entering into. Yet others seek to have HIV tests offered universally and accompanied by pre- and post-test counseling. Defenders of civil liberties want to protect patients' rights and ensure consent remains a key prerequisite to testing.
And yet others disagree on what consent itself even entails -- a nod, the simple act of giving one's blood or saliva, or a signature. Some debate the universality of testing -- should we test everyone or only those in high-risk categories?
Testing is complex and the debate surrounding it is heated. We know this means that HIV infection had occurred in the individual many months or years prior to discovery. Early detection of HIV serves to move people into proper care sooner and set them on a path to manage their HIV infection. Early detection also serves to make one aware of his or her own HIV status.
Some studies suggest that individuals who test positive are more likely to curb behavior that can spread HIV. Other studies indicate that over half of new infections are caused by people who are unaware of their HIV status and who have been infected themselves for less than two years. The number could be as high as 70 percent. Many such New Yorkers are in higher risk categories, such as men who have sex with men MSM and intravenous drug users.
Other communities, such as black and Latina women and low-income New Yorkers are also at elevated risk. Consistent with its prior recommendations the CDC maintains that 1 testing must be voluntary, 2 testing must not be conducted without the knowledge of the patient, and 3 obtaining written informed consent is an ethical obligation.
New York State has a number of guidelines and statutes governing HIV testing and written informed consent, most of which are outlined in Article F of the public health law. The recommendations by the CDC, a federal agency, are not legally binding and therefore do not supersede state and local law. Currently in New York State, written consent must be obtained from an individual undergoing an HIV test, and proper pre-test and post-test counseling must be provided.
Some have cited written consent as a barrier to testing, and have further claimed that having different requirements for HIV testing contributes to the stigma that surrounds HIV and AIDS. Stigma associated with HIV and AIDS is directly related to homophobia, racism, and the fear of being associated with drug users and low-income individuals.
Simply requiring written consent does nothing to reinforce such discriminatory attitudes. Instead, many believe that the routine offering of HIV tests in diagnostic settings could help to decrease stigma by effectively reaching every individual regardless of one's characteristics, community, or behavior. Patients being tested for HIV will be freed from revealing personal behaviors that they are uncomfortable discussing with their doctor.
Similarly, doctors will no longer fear asking patients about behaviors that may not be readily apparent. However, as professionals, it is critical that physicians receive training to overcome such fears which serve to perpetuate stigma.
Over the past seven years epidemiological data has shown an increase in the incidence of syphilis cases among gay men. However, cases of syphilis continue to rise because testing is not being routinely offered in diagnostic settings. Another argument to maintain written informed consent is an assurance that pre- and post-test counseling will be performed.
Physicians have complained about having a lack of time to conduct proper counseling related to HIV testing. Without government guidelines to safeguard and properly inform the public, there is a risk that health care providers may skip pre-test counseling altogether, particularly for those patients considered to be in a low risk category for HIV transmission.
Further, providers may also forgo post-test counseling for those patients with a negative result, therefore surrendering a key opportunity to reach patients with critical prevention information. This would be an extremely dangerous practice that could lead to the further transmission of HIV due to a clear deficiency of information.
Additionally, assurance must be made that patients are aware of the true meaning of an HIV test and its results. An opt-out provision, as recommended by the CDC, is not ideal.
An opt-in provision would give greater choice to people wishing to be tested for HIV, and would better enable patients to consent to an HIV test, while preventing physicians from testing without the patient's knowledge. However, many advocates concede that opt-in testing in a general environment will result in fewer people being tested. The opt-out version, while not optimal, could yield a higher rate of those getting tested.
Pre- and post-test counseling are key components of consent requirements. This is essentially the "informed" portion of written informed consent. Many doctors have complained that they simply do not have time to provide the information required. However, neither the CDC nor the State of New York has outlined specific time parameters, staffing, or media for imparting such information.
Doctors must ensure that patients are provided with information necessary to decide to take an HIV test. This is a critical part of a doctor's obligation to their patient and can be done by either the doctor or by proxy. Despite the need for their medical expertise, physicians may not be in the best position to actually perform counseling for HIV testing.
Many opportunities exist to shorten the time and lessen the staffing required for such counseling. Neither the CDC nor the State of New York requires that a physician must administer the totality of pre- and post-test counseling. Such requirements can be fulfilled by a variety of health care professionals -- nurse practitioners, registered nurses, HIV counselors, or physician's assistants, among others.
Pre- and post-test counseling is important for an array of reasons, not all related to medical implications. Such information is held in confidence by the State. Proper pre-test counseling makes patients aware of important legal obligations and apprises them of the option of testing at an anonymous testing site. Since mandatory names reporting became law in in New York State, fewer anonymous testing sites exist. Through such awareness, an individual can begin to make decisions about personal behavior and treatment options.
Further, counseling is needed to make patients aware of the true meaning of an HIV test. Unlike most diseases, HIV has a window period in which a typical antibody test will not detect the presence of HIV antibodies. This period can extend for three months after infection. Therefore a negative result does not accurately reflect the HIV status of a patient on the day the test is administered, but only reflects the patient's status approximately three months prior to the test.
In the event of a positive HIV antibody test, whether the test is administered orally or through the drawing of blood, a confirmatory test must be administered. An HIV diagnosis has not been considered a death sentence for well over a decade, thanks to the advent of antiretroviral drugs in the mids. However, such notions remain prevalent among the general public.
Health care providers must counsel patients on treatment options and explain that, thanks to advances in HIV medications, people can live with HIV for many years. Hospitals and other health care facilities that have attempted to independently routinize HIV testing have often relied on the distribution or display of HIV testing education materials to adequately inform patients who consent to testing.
Pamphlets, brochures, and posters have significantly lessened the staff time dedicated to disseminating information essential to proper testing. This passive form of pre-test counseling allows patients to absorb information at their own pace and permits a greater rumination for the formulation of questions a patient may have.
Another distinct aspect of the process of receiving test results includes post-test counseling. A study reveals that among those utilizing the standard blood test, which typically requires one to two weeks for a lab result, slightly less than 70 percent of individuals returned to receive their results, and therefore did not complete the necessary counseling.
Of those who utilized the rapid test, 99 percent stayed for their results and counseling. The importance of counseling cannot be overstated. There continues to be a lack of basic information about HIV transmission throughout the general public.
In fact, HIV is generally transmitted primarily through unprotected sex or the sharing of injection drugs or needles. Similar numbers were reported for those who tested confidentially. Two out of five people getting tested for HIV continue to not receive sufficient information regarding the laws that govern HIV testing, names reporting, and its full implications.
Additionally, a study by the CDC found that certain counseling tactics that encourage specific and tailored prevention strategies to the individual are more effective than other tactics that only seek to lecture the patient.
The study was updated in and revealed some notable findings regarding attitudes and practices surrounding HIV testing. The population also included those who tested positive, those who have tested within the past year, and those who have never been tested. Overwhelmingly, most consumers of HIV testing cite the belief that they are not at risk for contracting HIV as the biggest deterrent to getting a test. Other concerns include the fact that their doctor did not recommend the test, which often means that the doctor does not consider the individual to be in a high risk category for contracting HIV.
Further, people express worries of confidentiality, as well as a simple aversion to needles and giving blood as a barrier to testing. A small segment is fearful that they will test positive. However, those same people did not view written consent to be a barrier to testing.