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HIV Prevention Act of 1997
(H.R. 1062):
Talking Points

National Organizations Responding to AIDS (NORA)
A coalition convened by AIDS Action Council

April 16, 1997

A note from The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

On March 12, 1997, Representative Tom A. Coburn, (R-OK) introduced H.R. 1062, the HIV Prevention Act of 1997. While Rep. Coburn asserts that this bill is a comprehensive plan designed to refocus public health efforts on HIV prevention, in fact, the bill is a series of coercive measures that have been renounced by national public health and health care provider associations. These groups include the Association of State and Territorial Health Officials (ASTHO), the National Alliance of State and TerritorialAIDS Directors (NASTAD), the American Public Health Association (APHA), and the American Nurses Association (ANA). In addition, the National Governors' Association (NGA) has expressed strong opposition to the bill indicating that it "places Medicaid funding at risk in order to advance testing requirements of dubious merit".

The bill amends Title XIX of the Social Security Act, stipulating that in order to receive federal Medicaid funds, States must demonstrate that laws or regulations are in effect to assure compliance with the provisions of H.R. 1062. In effect this bill would jeopardize the federal and state Medicaid partnership which finances health care services for over 37 million low income and disabled individuals, including 53% of the adults and 90% of the children living with AIDS. The provisions of H.R. 1062 are unfunded mandates for States and impose "one size fits all" solutions on state and local governments. The bill would also undermine the partnership between state and local health departments and communities in the development of tailored approaches which respond to the characteristics of the epidemic at the local level.

National Mandatory Names Reporting

H.R. 1062 is not about HIV prevention; it is about testing people to identify their HIV status. Identification of people who are HIV positive does not in of itself prevent others from becoming infected. A comprehensive strategy that uses multiple approaches, tailored to the needs of different populations is needed to prevent HIV infection in the first place. These approaches include the widespread and consistent provision of information which helps people to learn what behaviors place them at risk and how they can modify those behaviors to reduce their risk of HIV infection. The provisions in the HIV Prevention Act of 1997 would lead to the elimination of anonymous HIV testing and the newly approved HIV home sample collection kits.

Under the pretense of improved measurement of the HIV epidemic, Rep. Coburn calls for States to report the identities of HIV positive persons. This provision would create an unnecessary burden on the States, and tax their already scarce HIV prevention resources. In order to comply, States would be forced to divert a huge proportion of these resources away from community based HIV behavioral interventions which have been proven to be effective and to invest them in HIV testing, names reporting, contact tracing and partner notification.

HIV names reporting is only one method used to track the course of the HIV epidemic, and States are already employing other, less costly methods such as anonymous HIV reporting, and seroprevalence studies to achieve the same goals. Mandatory names reporting may in fact discourage people from coming forward to be tested. While confidentiality laws are in effect and discrimination on the basis of HIV status is prohibited, the potential for discrimination still exists. Many people still fear breaches in confidentiality and others have experienced HIV discrimination in the form of denial of insurance, housing, and employment, despite existing laws.

A national survey on people's willingness to get tested found that a large percentage of individuals with risk factors for HIV would get tested "if no one could find out the results". The adoption of Coburn's proposals would serve as a deterrent for many people with confidentiality concerns to get tested.

Partner Notification

Representative Coburn's bill claims to protect partners of people with HIV by mandating that States implement partner notification programs which can be used by the CDC to set up a national partner notification program. The CDC has never called for such a system. In fact, States and localities must currently have in place partner notification programs as a condition of receipt of funds through the CDC's HIV prevention cooperative agreement, . In order to receive funding under the Ryan White CARE Act, States must certify to the CDC that they have partner notification programs in place. Mandating a uniform, nationally based system will only undermine local efforts already in place and do nothing to actually decrease HIV transmission.

The bill also requires States to seek and recall any individual who tests positive for HIVand does not seek the results of the test. Mandating States to follow up with every such person and to notify every individual who may have been exposed to HIV infection is unnecessary and extremely burdensome. Such notification is very labor intensive and expensive. Partner notification, in of itself, is not a panacea. Even in those areas of public health, such as syphilis and gonorrhea, where aggressive partner notification and contact tracing have been used, these sexually transmitted diseases have not been totally eliminated. In fact, today, the United States still faces a serious epidemic of sexually transmitted diseases. Therefore, these methods should not be imposed on States who have chosen to pursue HIV prevention activities that are proven more effective in their communities. Instead of mandating a national partner notification program, greater HIV prevention resources should be provided to the States and localities to implement strategies that work for their communities which focus on controlling the spread of HIV infection through tailored behavioral change interventions; encouraging voluntary partner notification, and providing assistance for those who request it in notifying their partners.

HIV Testing for Sexual Offenders

Rep. Coburn claims that his bill will protect the victims of sexual assault by requiring HIV testing for the alleged offender. The Omnibus Crime Control Act of 1994 already provides for a victim to request a court order to have the alleged perpetrator, in federal sexual assault cases, tested for HIV. In addition, states are free to pass such laws if they deem fit, and many have done so.

This provision is of great concern because testing an alleged sexual offender for HIV does not give reliable information about the HIV status of the offender nor the victim. There is a window period of up to four to five months during which the infected person may not test HIV positive because antibodies have not been produced. In addition, an HIV positive person will not necessarily transmit HIV to another individual.

This provision takes control from the victim to determine whether or not testing occurs and imposes a mandate on the States to do so. Furthermore, the provision requires that the HIV test results of the defendant be made available to the prosecuting attorneys, the attorneys of the victim and defendant, the presiding judge, and the principal public health official of the local jurisdiction. These provisions do not consider and severely undermine the victim's confidentiality rights. This so called "protective" measure may in fact create further distress and trauma for the victim.

The best way to help and protect a survivor of sexual assault is to provide counseling, free anonymous HIV testing, health care and psycho-social support services to the survivor. This bill focuses on HIV testing of the alleged sexual offender, yet it does nothing to provide services and assistance for the victim. It provides a false sense of security, unnecessary stress and a hollow promise of protection and assistance to the victims of sexual offenses.

Protection of Medical Providers From HIV Infection

The HIV Prevention Act of 1997 allows health care professionals to refuse to performmedical procedures on a patient unless the patient undergoes a test for HIV infection and the health care professionals are notified of the results. This constitutes non-consensual HIV testing of patients by health care providers. More important, the bill raises grave concerns regarding the treatment of trauma victims and patients in emergency situations. In such situations? a patient's life may be placed in jeopardy if the health care professional opts to have the patient tested for HIV and to get the results before performing a necessary medical procedure.

Furthermore, this provision is ineffective in protecting health care professionals from HIV infection because an HIV negative antibody test result will not necessarily reveal whether the patient is actually infected. There is a window period during which an infected person may not test HIV positive because antibodies have not been produced. Furthermore the provision is unnecessary since the best way to protect health care professionals from exposure to HIV is to practice universal precautions as outlined in the CDC and OSHA guidelines, which have been endorsed by the health care provider community including the American Medical Association.

Other Provisions

The HIV Prevention Act of 1997 has several other questionable and burdensome provisions regarding funeral service practitioners, health insurers and adoption agencies. In addition, the HIV Prevention Act of 1997 expresses the "sense of Congress" that States should criminalize the intentional transmission of HIV and that strict confidentiality must be observed at all times in carrying out this Act. The fact is, every State and the District of Columbia already have laws on the books that would allow the criminal prosecution of people with HIV or AIDS who knowingly attempt to infect another person. In addition, the entire bill contradicts the sense of Congress regarding confidentiality. The bill's provisions mandating HIV names reporting and a national system of partner notification would force many States to undermine and weaken their existing laws and regulations ensuring the confidentiality of a person's HIV status.

In summary, the HIV Prevention Act of 1997 is a collection of thinly veiled unfunded mandates which impose questionable HIV testing and reporting requirements on States and make compliance a condition for receipt of federal Medicaid dollars. State health officials and AIDS directors estimate that implementation of the legislation would require at least 265 statutory or regulatory changes nationwide and cost about $420 million per year. This legislation would divert precious funds away from locally planned, tailored and aggressive prevention efforts that have been demonstrated to work, in order to support these federally imposed measures. Tremendous strides have been made in the science and state of the art of HIV prevention over the past 15 years. We cannot afford to move backwards now. We must move forward and support, not undermine, the partnership of state and local governments with communities to defeat the HIV epidemic. Oppose H.R. 1062.

For further information, contact:

AIDS Action Council
1875 Connecticut Avenue NW #700
Washington DC 20009
202-986-1300, extension 3053
202-986-1345 (fax)
202-332-9614 (tty)

A note from The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

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This article was provided by AIDS Action Council.
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