HIV Testing Is Now a Routine Part of Health Care in New York

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HIV Testing Is Now a Routine Part of Health Care in New York

Change in state law requires health professionals to offer voluntary HIV tests to patients 13 to 64 years old. New law also simplifies informed consent process, allowing for verbal consent in some circumstances

September 1, 2010 – Voluntary HIV testing is now part of routine medical care in the state of New York. As of today, due to a change in New York’s State Public Health Law, New York residents receiving health services at most medical facilities should now expect to be offered a voluntary HIV test. With limited exceptions, the new State law requires health care professionals to offer all patients between the ages of 13 to 64 a voluntary HIV test. The law applies to anyone receiving treatment for a non-life-threatening condition in a hospital, a hospital emergency department or a primary care setting, such as a doctor’s office or outpatient clinic.

The new law also simplifies the process for consenting to a voluntary HIV test. Under the state’s old law, patients had to provide specific written consent before receiving a test. The newly amended law lets patients give oral consent if the test will produce results within an hour. The patient’s consent must be documented in the patient’s medical record, and the provider must share seven specified points of information about HIV. Patients must still provide written consent for HIV tests that don’t yield results within an hour, but the process has been simplified. Consent for HIV testing can now be included in a patient’s general consent for routine medical care, as long as the consent form lets patients opt out of HIV testing.

“This State law will have its greatest impact here in New York City, where more than 107,000 residents are living with HIV/AIDS and thousands more do not know they are infected,” said Dr. Thomas Farley, New York City Health Commissioner. “These people may not be receiving the care they need and may be unknowingly infecting their partners. If you are not offered an HIV test the next time you visit a health care provider and you want to know your status, ask for it.”

Statewide, a third of HIV-positive people learn their status only after reaching advanced stages of infection. In 2006, the federal Centers for Disease Control and Prevention recommended routine testing so that infected people could get diagnosed earlier and take steps to preserve their own health and protect others. With this revision of the State Public Health Law, New York joins the 45 states that have acted on this important recommendation.

Under the new law, providers must link people with positive test results to care and treatment if they consent. The requirements apply to physicians and physician assistants, internal medicine providers, family medicine and pediatric practitioners, primary care obstetrician-gynecologists, nurse practitioners and midwives.

“Past New York City initiatives have highlighted the benefits of routine HIV testing,” said New York State Senator Thomas K. Duane, the legislation's prime sponsor. “The Health and Hospitals Corporation’s pilot testing project and the Health Department’s “Bronx Knows” initiative both showed that when HIV testing becomes a routine part of medical care, the number of people who know their status increases and the stigma surrounding HIV and HIV testing declines. With this law now in effect, the whole state of New York should start to experience those benefits.”

“We hope New Yorkers will take advantage of this law and view HIV testing as part of routine, quality medical care,” said Dr. Monica Sweeney, assistant commissioner for the Health Department’s Bureau of HIV/AIDS Prevention and Control. “We all need to know our status, and the only way to know it is to get tested.”

Governor David Paterson signed S8227 into law on July 30, 2010. The legislation amended New York State Public Health Law Articles 21 and 27-F that govern HIV testing and confidentiality in the state. People under 18 donot need parental consent to be tested for HIV or other sexually transmitted infections. Physicians in New York City are required to report positive diagnoses to the NYC Health Department, and laboratories are required to report HIV-positive cases to the New York State Health Department. But like all other medical information, HIV tests results – whether positive or negative – are kept strictly confidential in accordance with the law.

Any New York City resident can get a free HIV test at one of the Health Department’s STD or TB clinics. For a complete list of locations throughout the city, call 311 or visit www.nyc.gov/health./hivtesting.

Regards,

Aletha Maybank, MD, MPH

Assistant Commissioner, New York City Department of Health and Mental Hygiene

Director, Brooklyn District Public Health Office (DPHO)

Walk It Out-- for Health!

By Gladys M. Yensi
Gladys was an undergraduate premedical student at The City College of New York in 2010.

Since the first week of June I have been a leader of a walking group at Mt. Sinai Medical Center. This walking group is part of a larger city-wide initiative: "The 16-Week Walking Challenge." This initiative was developed by Mentoring in Medicine, Inc. and is sponsored by the Amercian Heart and Stroke Association to mobilize the community to get out there and get active. By becoming active in this endeavor, I have not only made an effort to become a little more active than I used to be, but I have also realized the underlying importance of what the walking challenge represents.

Exercise and healthy diet has been shown to prevent and/or alleviate some of the symptoms of cardiovascular diseases, such as heart disease, stroke, and hypertension, as well as diabetes. Other lifestyle changes, like the cessation of a smoking habit, also help to ward off some complications of these diseases. Sadly, quitting smoking and not putting those extra two pinches of Goya® Adobo while cooking, are habits that are difficult to get people to change quickly. Perhaps engaging people to participate in low impact exercise is a habit that could be adapted and maintained more easily, especially when encouraged over 16 weeks. Such has been the challenge this summer.

This walking challenge is pertinent to the fundamental values of the Minority Association of Pre-health Students (MAPS). MAPS at CCNY not only has an affiliation with Mentoring in Medicine through Dr. Lynne Holden, but is also associated with the communities that the walking challenge targets; those in urban settings which are underserved-- Harlem and Washington Heights to name a couple. Not only do some of our MAPS members come from similar communities, but some of us may even be afflicted by diabetes or hypertension, or have family members, friends, and neighbors who struggle with these diseases. All members of MAPS aspire to become health care professionals and combat health disparities as leaders in our communities.

It has been fourteen weeks since I committed myself to leading the Mt. Sinai Medical Center group of the walking challenge. During these recent weeks I have worked with old friends and made new friends. We have enjoyed the scenic views of Central Park during our walks on beautiful summer afternoons, and have shared smiles and laughs as I instructed them in basic belly dance moves. There are only four weeks left of the challenge, but it's never too late to start making walking a habit. Furthermore, at the end of the walking challenge in mid-September, there will be a closing ceremony which will acknowledge the walkers and offer the opportunity for a raffle and giveaways. There will also be a free concert for the walking challenge participants. The details of this event has yet to be announced.

There are six walking groups in total from all five boroughs of New York City. The two most conveniently located near CCNY are those stationed at Harlem Hospital and at Mt. Sinai Medical Center. To learn more, please email WalkwithMIM@gmail.com. I hope to see my fellow MAPS members in the upcoming walks :-)

An International Dilemma: Barriers to Sexual and Reproductive Rights

By Alexa Mieses

Picture taken from Nature.com

The New York Times reported today that a vaginal microbicidal gel has given women in one study a 39% chance of protection from the HIV virus. The microbicide contains a nucleotide reverse transcriptase inhibitor, which prevents the virus from reproducing. The study involved a double-blind, randomized controlled trial which compared tenofovir gel (the microbicide) with placebo gel in sexually active, HIV-uninfected 18- to 40-year-old women in urban and rural parts of South Africa. The study involved 30 months of follow-up with each of the women to assess their HIV serostatus, safety, sexual behavior, and gel and condom use. Read the original journal article here.

If such a microbicide is approved, to what extent will African women have access to the vaginal gel? One issue is cost. As the New York Times article mentions, each dose of gel is cheap, however, the patented applicators are rather expensive (forty cents each). Also, men have the authority in most African sexual relationships. While the microbicide may allow an African woman to decrease her chances of contracting HIV without the man's knowledge, will the fact that many physicians are male create a barrier to access of the gel? As of 2006, 70% of all physicians registered with the Health Professions Council of South Africa were male. Will a male dominated world serve as a barrier for African women to obtain the gel? I ask this question because in other countries like Chile and the United States, religious beliefs or political agendas, not whether one is male or female, has created barriers to certain reproductive rights.

The recent history of the emergency contraceptive pill in Chile is more of a flip-flop story of conflicting ideals. In 2006, first female and former Chilean president, Michelle Bachelet, began to more firmly advocate for women's contraceptive rights. By 2007, a presidential mandate made authorities ensure that public health centers made emergency contraception, or the morning-after pill, available. By 2008, courts ruled to only make the pill available in pharmacies and required a prescription. Read more here. Pharmacists would often refuse to sell the pill to women, even with a prescription, sometimes claiming the pill was "out of stock." In reality, religious beliefs instilled in many of the country's people (and pharmacists), often served as the basis for such behavior. Nearly 100 pharmacies were found failing to stock the pill altogether. In early 2010, at the end of her presidency, Bachelet once more was able to sign legislation that allowed the pill to be distributed freely throughout Chile. However, women in Santiago still report a stigma surrounding the purchase of the morning-after pill.

Africa and South America are not the only continents in which access to certain reproductive rights has been an issue. Abortion, while it is a very sensitive subject to some, has been the center of American media and political debate for some time. Since the Supreme Court ruling of Roe v. Wade in 1973, abortion has been legal. However, despite the fact that it is not illegal in many states, there are many barriers that sometimes make it impossible to have an abortion. While most restrictions regarding length of gestation are put in place for good reason, many states create certain restrictions which make it difficult for a woman to undergo an abortion. Also, women with little money or no health insurance often cannot pay for abortions. Additionally, in some places there is limited availability for medical training on abortion. The Association of Reproductive Health Professionals reported that although the Accreditation Council on Graduate Medical Education now requires that training in abortion be made available to all Ob/Gyn residents, as of 2008 only half of Ob/Gyn residency programs offer routine training in abortion care. Finally, violence and harassment of women seeking abortion and/or health care professionals that perform abortions, has created a barrier to the procedure.

As technology develops and new procedures and drugs are created, the political milieu of countries across the globe and women's rights also evolve. Regardless of the moral foundation upon which you stand, it is important to always remain well-informed of scientific developments to better take care of your health.

Flashblood: Part of the Cycle

By Alexa Mieses

Today I read a rather disturbing article in the New York Times. Recent reports indicate that in some parts of Africa, intravenous drug users are injecting other addicts' blood in order to get high. This practice has been coined "flashblood." The first thing that popped into my mind was the effect this practice has on the transmission of HIV. While the spread of HIV is dangerous and a serious matter, I could not help but wonder about the socio-econimic factors that may explain why one uses drugs in the first place.

Published in Addiction, a cross-sectional study was conducted in Tanzania with 169 female intravenous drug users. The study found that the women who used flashblood were more likely to live in short-term housing, to have been raped by a family member as a child, to have smoked marijuana at a younger age, and to have contaminated water.

Poverty often has many implications that stretch beyond contaminated drinking water. Poverty is an umbrella for a vicious cycle in which it is hard to determine which comes first. Does a child live in a broken home because he or she is impoverished, or is it difficult to rise out of poverty because he or she lives in a broken home? The answer is both are sometimes true. Perhaps a woman started using heroin because she smoked marijuana at a younger age. Perhaps she smoked marijuana at a younger age to numb the pain of her rape. Perhaps her father raped her because he was drunk. Perhaps her father was an alcoholic because he could not find a job. But why can't he find a job? You can see how the cycle continues.

Even here in Santiago, Chile, where I am spending my summer volunteering with VE Global (VE), the issue of poverty comes up every day. According to the CIA Chilean country-profile, the richest 10% of Chileans possess 41.7% of Chile's wealth, while the poorest 10% possess just 1.6%. The children with whom VE volunteers work often come from poverty and broken homes. Many have been sexually, physically and emotionally abused by their family members, or their families are unable to care for them due to a lack of resources. These children often go on to use drugs and have children at a very young age, thus proliferating the cycle. How can we break this vicious cycle? Even if the work of VE is not the "cure-all" answer, I believe it is a step in the right direction.

Image from www.maryscomfort.org

Greetings from Santiago, Chile!

By Alexa Mieses

The tangerine sun paints streaks of pink in the sky as it sets behind the snow-covered mountains. I am staring out of my window in Santiago, Chile as I write this post! This summer (this winter, if you're Chilean), I am interning with an organization called VE Global (VE). VE is a non-profit organization that works to protect at-risk children in Santiago. VE not only trains and places volunteers for free, but works with eight diverse institutions which include hogares (orphanges), community centers and schools. Additionally, VE also implements various educational programs for the children.

I am lucky enough to see two sides of VE. I spend half of my week in the office, working alongside VE's directors to complete needs analysis work and compose reports for the board of directors, and I spend the other half of my week volunteering as a teacher's assistant at a school for children with special needs called Colegio Anakena. I've only been here for about three weeks and I already feel at home!

Check out another recent blog post on the VE website. More to come from Santiago-- stay tuned!

Minor Strokes Can Lead to Major Problems

By Mohammad Shamim
Mohammad was an undergraduate premedical student at The City College of New York in 2010.

According to the National Institute of Health (NIH), three out of ten people never get the medical attention they require while having a mini or minor stroke. If left without proper medical care, these minor strokes become full-on strokes which lead to major health issues such as permanent brain damage. A major stroke occurs when the brain does not properly receive oxygen because of a blocked or ruptured blood vessel. People often do not get the help they require simply because they may not recognize the warning signs.

According to NIH the number of reports by hospitals and primary care doctors, of mini-stroke incidents have increased over the past year. Doctors refer to these strokes as Transient Ischemic Attacks (TIA). Doctors and hospitals all over the world should educate their patients about the symptoms of TIA. In addition, patients should be aware of the signs themselves. According to NIH, the symptoms of TIA are:

-weakness or an inability to move all or part of one side of the body

-feelings of numbness or tingling on one side

-visual disturbances

-trouble speaking and understanding others

-dizziness and fainting

Age and gender do not affect whether or not you are susceptible to TIA. Anyone experiencing symptoms similar to the ones listed above, should contact their physician. The earlier these signs are noticed, the easier it is for one to seek medical attention and possibly prevent a major stroke-- so spread the word!

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