A new effort to curb AIDS

Sen. Charles J. Levesque and Rep. Eileen S. Naughton

 HIV/AIDS is by far the most lethal sexually transmitted disease, and is a virus that a person may have for years without being aware of his or her infection. While the U.S. health care system has come a long way in the last three decades in encouraging preventative measures and in developing effective treatment of the disease, even today there remain stumbling blocks that prevent us from achieving our full potential in preventing new infections.

A broad coalition of advocates for AIDS patients and health care providers came together this year to help promote more routine testing for the HIV/AIDS virus among Rhode Islanders. Some served as members of the HIV and AIDS Code Study Commission, others worked alongside our commission, testifying at hearings and providing invaluable information and perspective. These tireless advocates are not all of one mind, but worked together to form a compromise piece of legislation that will decrease the spread of this preventable disease, while safeguarding the rights and needs of health care patients. We write this, in part, to pay tribute to these passionate and committed representatives of the Rhode Island medical, nursing, social work, public health, advocacy, civil liberties  and AIDS treatment communities and the Department of Health. We especially wish to thank Dr. Nicole Alexander and Dr. Brian Alverson, whose expertise and dedication were pivotal to the success of our efforts.

As a result of the hard work of these dedicated professionals and organizations, the Rhode Island General Assembly passed legislation this year ending a requirement that written consent be acquired before a patient is tested for HIV/AIDS. Instead, the new law allows for routine application and spoken consent for the test, as is permitted for all other STD testing. The change aligns Rhode Island’s statute with federal Center for Disease Control (CDC) standards, which do not recommend written consent.

This may seem like an insignificant change, but consider the message it sends. Under previous law, a doctor administering a physical could simply ask a person if he or she wanted to be tested for all other STDs. But an HIV/AIDS test, arguably the most important, required special written consent. To some patients, the implication was that an HIV test is something reserved for extraordinary circumstances. Worse, singling out that test might lead some patients to believe that there is something dangerous or shameful in being tested. Or they might fear the meaning or use of the test results. Our new law makes HIV testing more routine, while offering much tighter patient safeguards and more emphasis on patient counseling.

Consider also the results of a law we passed in 2007 that eliminated the written consent requirement for HIV/AIDS testing for expectant mothers. Women who know they are infected with HIV may receive medication during pregnancy to give them a much lower risk (less than 2 percent) of transmitting the virus to their babies. When that law took effect, Rhode Island went from testing 52 percent of expectant mothers for the disease to a 95-percent testing rate. Consequently, we also went from having babies born HIV-positive each year to having none.

That’s a notable health improvement that came from the elimination of a hurdle for both health professionals and their patients. The effect of the 2007 statute is greater even than the potential prevention of any additional HIV cases in babies each year. With increased testing, expectant mothers will now be aware of their infection, and can prevent themselves from passing it along to future babies and partners.

The new law also increases the amount of information that must be provided to those being tested, and adds educational institutions to the list of services where HIV and AIDS discrimination is forbidden. There is no question that awareness is the greatest tool in preventing the spread of HIV/AIDS. As governments and health agencies have taken steps to educate the public about prevention, the rate of new infections has decreased by 17 percent worldwide over the last eight years.

We are making significant progress in preventing HIV/AIDS. Here in Rhode Island, the number of new cases reported annually has decreased from 178 in 2004 to 118 in 2008. Still, today about 1.1 million Americans – more than the entire population of Rhode Island – are living with HIV, and about 20 percent of them are not aware of their infection. We must do everything we can to encourage everyone who is at risk to be tested. Rhode Island’s new law is a step in that direction, and we encourage health care providers to help by urging their patients to be tested.

Sen. Charles J. Levesque (D-Dist. 11, Portsmouth, Bristol) and Rep. Eileen S. Naughton (D-Dist. 21, Warwick) were the co-chairpersons of the HIV and AIDS Code Study Commission and the sponsors of the legislation to increase HIV/AIDS testing (2009-S 0245B/ 2009-H 5415B).