By Mark R. Kerr
IF THE ARIZONA Medical Association and Republican state legislators from Phoenix have their way, being tested for HIV in Arizona could wreck your life.
They're pushing HB 2085, which would allow caregivers to obtain oral consent from people wishing to be tested for HIV. The oral consent would be noted in the subject's medical records.
Tucson-based AIDS service organizations oppose this move, stating it would:
• Prevent people from having control over test results information;
• Lead to denial or loss of health insurance for those found to have the disease;
• Place a greater burden on local health departments and alternative testing sites;
• Create a climate of fear, resulting in fewer people getting tested.
But the bill's sponsor, Rep. Susan Gerard, R-Phoenix, says the Arizona Medical Association stated doctors have had problems with current guidelines due to the "burdensome paperwork and the perception the consent form violates a person's privacy."
The Medical Association, according to spokesperson David Landrith, believes, "The current guidelines present a barrier to testing. The consent form is an intrusion, breaking down the physician/patient relationship, mitigating the ability to discover who has the virus and offer counseling and treatment. AIDS is an epidemic killing a lot of people, and these guidelines impede medicine."
Currently, there are two ways a person can be tested for HIV--confidentially or anonymously. In both methods those being tested are informed of the ramifications. Under the confidentially method, the subject signs a written consent form and his or her name is reported to the State Health Department--only if the test comes back positive. Under the anonymous method, the subject is assigned an identification number and only a demographic profile, sans name, is reported if the test is positive.
But have current guidelines for consent presented a "barrier" to testing, as the Medical Association would like you to believe?
According to figures obtained from county and state health departments, there's been a steady increase in the number of people tested. (See graph.)
David Hoover, Pima County's AIDS program manager, said, "Before AIDS Omnibus (the law creating confidential and anonymous testing), figures show that fewer people were getting tested because they didn't have control over the results. AIDS Omnibus created a system people trusted, resulting in more people getting tested."
But what about a patient's right to privacy under the proposed bill?
According to Gerard, "It keeps written, informed consent at hospitals and blood banks. It doesn't change confidentiality. But there's nothing to prevent testing for HIV if permission is given for standard blood tests."
When it comes to medical records, according to Tucson Medical Center spokesman Tom Reavis, "If a person signs a consent for admission form, a physician or an insurance company can obtain information regarding HIV testing, following state guidelines. If the person refused, they can still obtain the information through a court order."
However, county health officials, who requested anonymity, warn state guidelines aren't always followed, and that "persons who have access to records, as well as others unofficially searching, could get someone's records and check."
Of the Arizona AIDS service organizations, a consortium of Phoenix AIDS groups tentatively support the bill, calling it "the best of a bad situation."
Meanwhile, Tucson's AIDS groups are adamantly opposed and lobbying hard to defeat it. Craig Snow, Tucson AIDS Project executive director, said, "Allowing oral, rather than written, consent for confidential HIV testing removes one of the basic protections of AIDS Omnibus."
Anne Maley, executive director of the Shanti Foundation, commented, "I've known too many people who have lost insurance and have been treated harshly because it's now in their medical records that they were tested."
Tucson's mayor and council recently joined the fight to defeat HB 2085 by unanimously adopting a memorial condemning the bill and calling on Southern Arizona legislators to work to defeat it.
But Tucson's efforts are falling on deaf ears. The bill has had smooth sailing, receiving approval from the House Health and Rules committees so far. Capitol sources expect the bill may be approved soon.
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