GMHC Statement on Expanding HIV
Counseling and Testing
Good morning. My name is Gina Arias; I am the Assistant
Director of HIV Prevention Policy at Gay Men's Health Crisis. I
want to thank the Assembly for this opportunity to testify. GMHC
is the nation's oldest AIDS service organization. Last year, we
served more than 15,000 New Yorkers living with or at risk of HIV
and AIDS. GMHC's staff provides comprehensive services that
include testing, financial advocacy, meals, legal assistance,
permanency planning, mental health counseling and public
education. I am here today to speak on HIV testing, counseling
and informed consent.
As New York City, and the entire world, commemorates the
25th year of the beginning of the HIV/AIDS epidemic, Gay Men's
Health Crisis joins others in the community in focusing on what
must be done to stop the spread of HIV infection and to move us
towards a city and a world without HIV/AIDS.
There are many challenges that must be addressed and
overcome in order to stop the spread of HIV/AIDS. One
immediate challenge is the number of people who are already
infected with HIV but who do not know their status — this
is as many as 1 in 3 HIV positive Americans, according to the
Centers for Disease Control and Prevention and 1 in 4 HIV positive
New Yorkers.
Here in New York City, we see very high rates of city
residents who are diagnosed concurrently with HIV and AIDS.
Each year, 1/4 of all people who test positive for HIV, or
an average of slightly more than 1,000 people, are concurrently
diagnosed. 2/3 of these people will die prematurely. Being
diagnosed with HIV only after AIDS has developed is much more
common among African American and Latino New Yorkers than among
white New Yorkers.
Given these realities, we have a collective responsibility
to do more and to do it better. GMHC wholeheartedly supports
the goals of reducing the number of people who do not know
their HIV status, increasing the early detection of HIV infection,
and assuring that all New Yorkers living with HIV promptly receive
the best medical care available.
Last year the NYS Department of Health introduced guidelines
to streamline the HIV testing process, guidelines which maintain
written informed consent. Since the guidelines were issued there
has been an almost 50% increase in HIV testing within hospitals,
health clinics, and jails in New York City. The New York City Health
and Hospital Corporation report indicates the "the steep increase
in HIV testing in New York City" was aided by the use of rapid HIV
tests and by the adoption of the New York State Department of Health
new guidelines that streamline the HIV testing process. Clearly,
this guidance has served to promote more testing and demonstrates
that this can be accomplished within existing law.
In fact, New York State offers another compelling example of
increased HIV testing that does not involve removing written informed
consent. That is the case of testing among pregnant women. Over 93%
of pregnant women in NYS voluntarily choose to be HIV tested during
pregnancy—understanding that it is the ideal time to initiate
treatment that can significantly reduced mother-to-child transmission
of HIV.
Despite these examples of success in HIV testing, the New
York City Department of Health has been determined to do away
with Article-27F. This is a move in the wrong direction. There
is absolutely no scientific evidence that the statutory requirements
for written informed consent and counseling pose an actual barrier
to testing.
GMHC supports developing new approaches to HIV counseling and
testing. We believe strongly that counseling and testing must be
voluntary and must include meaningful written informed consent. Finally
it must provide for linkage to counseling, care and prevention for
both those who test positive and negative.
At GMHC we know too well that access to comprehensive, culturally
competent health care is central to early diagnosis and treatment of
HIV. Many people from marginalized communities who lack this access
are the same people whose social and economic conditions push them
directly into the path of HIV/AIDS.
Anti-stigma and Structural Issues
It is essential to understand that increasing early detection of HIV
will not yield a decrease in HIV infection until we effectively address
structural issues.
HIV stigma impedes efforts to make HIV testing compelling. Article
27-F was established in recognition of this enormous stigma at a time when
the face of the epidemic was much whiter and much more male than it currently
is. Twenty-five years into the epidemic there is still a significant amount
of HIV stigma and discrimination. Now that this disease has exploded in
the African-American and Latino communities, with women in ever rising
numbers, can we so quickly jump to do away with the protections that
others were granted?
GMHC recommends greatly increased efforts to develop creative
strategies to reduce homophobia, which is among the root causes of
HIV stigma. In addition, more needs to be done to make the environment
supportive of HIV testing, including the promotion of the voices and
leadership of HIV positive people.
In our efforts to increase HIV testing we must remember that
without confronting what propels HIV risk we will never break
the back of this epidemic. GMHC calls for interventions that
focus on the structural drivers of HIV infection including:
poverty, gender inequalities, homelessness, violence, substance
abuse, incarceration, homophobia, and transphobia. We must move
away from our reliance on mass imprisonment as an attempt at
addressing social problems. Prisons tear apart the fabric of
communities. We must prioritize the economic and social
well-being of people of color and low-income communities. We
must aggressively work to challenge and transform the inequality
and social marginalization that leave communities at risk for
HIV. These systemic issues must be addressed if we are to make
real progress in this fight against HIV/AIDS.
Alongside these interventions greater efforts must be
made to restructure HIV testing procedures so that more people
will be aware of their HIV status and have a chance at accessing
HIV prevention, treatment and care.
Restructuring HIV Testing and Counseling Procedures
in Health Care Settings
GMHC recommendations to this end are as follows:
GMHC supports efforts to make HIV testing and counseling a
routine component of medical care. However, we feel that the
emphasis should be on health care providers routinely offering
HIV counseling and testing. Routine offering of HIV testing in
health care settings should include sufficient information and
if necessary, counseling, for the patient to make an informed
decision.
Over and over again it has been said that doctors are
notoriously resistant to change, including the change necessary
to make HIV tests routinely offered in medical settings. Pretest
discussions with patients are viewed as time-consuming, burdensome
and awkward. But patients' needs for more information not less,
more support not less, must trump the comfort level of providers.
The routine offering of HIV counseling and testing in
health care settings will require greatly increased education
and training of providers. For example, as a practical matter,
physicians do not routinely engage in conversations with patients
about their sexual activities, substance use, and other behaviors
that may put them at risk of infection.
GMHC recommends that medical providers be given sufficient
training with regard to issues of sexuality, substance use,
and HIV/AIDS to have meaningful discussions with their patients
about their health and safety. We should be asking ourselves,
"What will it take to effectively train more providers to offer
HIV counseling and testing routinely?" We believe that enhancing
the provider-patient communication around issues of sex and risk
behaviors will produce the results we all are seeking — increased
patient willingness to be tested leading to more people becoming
aware of their HIV status and a resulting reduction in HIV
transmission.
Moving to make the offer HIV counseling and testing a
routine component of medical care should also include moving
beyond a focus on doctors. GMHC recommends that special efforts
be made to promote and encourage nurses, nurse practitioners, and
others on the health care team to offer HIV counseling and testing
on a routine basis.
GMHC recommends that procedures be instituted to assure that
those with positive test results are referred and linked to appropriate
medical care at the point of diagnosis. Upon receiving their results, all
individuals should have access to HIV prevention education and
services, including prevention counseling as needed, to help enable
those who test negative to remain negative.
The communities being devastated by the AIDS epidemic, at
once a political and a public health crisis, require genuine solutions
which foreground people's need for health and justice and which go
beyond discussions on testing. GMHC calls for the routine offer of
HIV counseling and testing; an increased role for various health care
providers; increased provider education and training; and most
importantly, the development of structural interventions that go
to the heart of what is driving this epidemic. These are among
the changes that would demonstrate a true commitment to moving
us toward a city and a world without HIV/AIDS. Thank you.
© 2006 Gay Men's Health Crisis
|
home 
