HIV and ID Observations

So the New York City Public Health Department would like to have every adult living in the Bronx tested for HIV.  The  Times coverage of the effort cites the best reason for reason for such a move — the high death rates from the disease, and the cause:

Public health officials attribute this [the deaths] to people not getting tested until it is too late to treat the virus effectively, thus turning a disease that can now be managed with medication into a death sentence.

I confess whenever I see the word “Bronx” in the New York Times, my first association has absolutely nothing to do with HIV and frequently makes me unpopular here in Boston.

Baseball connections notwithstanding, this move in the Bronx makes abundant sense, and suggests that we in Massachusetts could learn a thing or two from our neighbors/rivals to the South beyond how to play winning baseball.

(Which the Red Sox have learned very well recently, thank you very much.)

One barrier to expanded testing is the requirement for written informed consent.  Dr. Thomas Frieden, the New York Health Commissioner, said the New York HIV consent law is among the “toughest in the nation.”  It’s arguably even tougher here in Massachusetts, where the requirement for written consent for HIV testing is embedded in the same law that protects HIV confidentiality — the famous Chapter 111, Section 70F law:

Massachusetts General Law Chapter 111, Section 70F provides that a physician, health care provider, or health care facility may not without first obtaining a person’s written informed consent:  1) Test a person for HIV; 2) reveal to third-parties that a person took an HIV test; or 3) disclose to third-parties the results of a person’s HIV test.

When I’ve suggested that these be separated — written consent for testing and disclosure of HIV-related test results are not the same thing, after all — legal experts roll their eyes, saying it just can’t be done (“there he goes again …thinking like a doctor”).  Sorry, can’t help myself, but I don’t see why this law can’t be changed.

So my advice to Massachusetts:  pay attention to what’s going on in the Bronx, and the rest of New York City; and even more importantly, see what’s recently happened in California, Illinois, and Maryland, all of which eliminated the requirement for written informed consent for HIV testing.  The goal?  Make it easier to find the undiagnosed so that they can receive life-saving treatment.  In California, published data already show that this works.  

And may the best team win.

Which is (remarkably as of July 6, 2008), The Tampa Bay Rays.