New York State Assembly
Notice of Public Hearing

Committee on Health
Richard N. Gottfried
Chair

Wednesday, December 20, 2006
10:00 AM
250 Broadway, Assembly Hearing Room 1923
New York City

SUBJECT:

New York's HIV testing and confidentiality law (Public Health Law Article 27-F) requires written informed consent prior to the administration of an HIV test, as well as pre- and post-test counseling. Since the law was enacted in 1988, HIV testing and treatment modalities have advanced significantly, making knowledge of one's HIV status more important so that individuals can get appropriate treatment. Many people with HIV still do not know their HIV status and many people are still receiving their first HIV diagnosis when they have already advanced to AIDS.

In 2005 the New York State Department of Health (NYSDOH) updated its "Guidance for HIV Counseling and Testing and New Laboratory Reporting Requirements" with the intention of easing HIV counseling and consent to testing and entry into care. The new guidance streamlined counseling, simplified written informed consent, sought to integrate HIV testing in medical care settings and encourage the adoption and use of rapid test technology.

New York City Commissioner of Health Thomas Frieden has advocated statutory changes to Article 27-F intended to expand testing, improve linkages between patients and the care they need, and make testing more accessible and focus provider efforts on care of those who test HIV-positive. Among Commissioner Frieden's proposed statutory changes are: elimination of written informed consent; revisions to pre- and post-test counseling requirements; and authorization for disclosure to public health officers of a person's positive status for purposes of linking to care and case management services. Elements of Commissioner Frieden's proposals are contained in A. 11075 (Mayersohn) and A.11958 (Towns) introduced in the Assembly during the 2006 session but not acted upon.

In September 2006, the U.S. Centers for Disease Control and Prevention issued "Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings." The document replaced 1993 recommendations. Key differences include "routine" testing for patients in all health care settings unless declined (opt-out), elimination of separate written consents, and elimination of prevention counseling in health care settings.

These actions and proposals are intended to promote more testing, assure individuals are aware of their HIV status and provide linkages to care. Proposals for statutory amendments to Article 27-F, however, have raised concerns regarding erosion, in actual practice, of informed consent and understanding of HIV test results.

There is widespread support for expanding individual awareness of one's HIV status and linking persons to appropriate care. The purpose of this public hearing is to determine what are the actual barriers to appropriate HIV testing and the consequences of proposed actions. Specifically, witnesses may direct their testimony (but need not limit it) to the following points:

• Has NYSDOH's "2005 Guidance for HIV Counseling and Testing and New Laboratory Reporting Requirements" improved the counseling and testing process and promoted more testing?

• Do the statutory requirements for written informed consent and counseling in Article 27-F create a real barrier to testing?

• Are outreach and education programs appropriately targeted, designed and culturally sensitive so as to promote the importance of knowing one's HIV status?

• Are there models that have successfully expanded testing in accordance with the standards of Article 27-F that can be replicated in other settings?

• Are adequate programs and funding in place to assure that individuals who test HIV-positive have access to necessary health care and case management services?

• Are there particular concerns about the proposed statutory amendments to Article 27-F in A.11075 and A.11958?

Persons wishing to testify or attend should complete the hearing reply form below and return as indicated as soon as possible, but no later than Friday, December 15th. It is important that the form be fully completed and returned so that persons may be notified in the event of emergency postponement or cancellation.

Oral testimony will be limited to ten minutes in length. All testimony is under oath. In preparing the order of witnesses, the Committee will attempt to accommodate individual requests to speak at particular times in view of special circumstances. This request should be made on the reply form or communicated to Committee staff as soon as possible. Ten copies of any written statement should be submitted at the hearing registration table.

In order to meet the needs of those who may have a disability, the New York State Assembly, in accordance with its policy of non-discrimination on the basis of disability, as well as the Americans with Disabilities Act (ADA), has made its facilities and services available to all individuals with disabilities. For individuals with disabilities, accommodations will be provided, upon reasonable request, to afford such individuals access and admission to Assembly facilities and activities.

Questions about this hearing may be directed to Richard Conti of the Assembly Health Committee staff at 518-455-4941 or contir2@assembly.state.ny.us.

HIV testing, Counseling and Informed Consent
Public Hearing Reply Form
Respond by December 15, 2006

Mail or fax to: Dick Gottfried, 822 LOB, Albany, NY 12248; fax: 518-455-5939

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