Physicians and AIDS advocates are split on the yearlong push to end a 1988 state requirement of separate, written patient consent for HIV testing. New York City Health Commissioner Dr. Thomas R. Frieden has championed the change to remove testing barriers he says end in late diagnoses and AIDS mortality.

More than 1,400 city residents died from AIDS last year, and about one-fifth of the more than 100,000 residents living with HIV do not know they are infected. One-fourth of HIV diagnoses are simultaneously AIDS diagnoses, representing missed opportunities to intervene and begin therapy.

On Dec. 20, the state Assembly heard Frieden's proposal to allow verbal consent for voluntary HIV testing, which would be documented in the patient's records. It is unclear whether Governor-elect Eliot Spitzer supports the change. But the hearing was split over the matter.

The proposal is "well-intentioned but grossly misguided," failing to deal directly with doctors' discomfort with HIV/AIDS, said state Sen. Thomas K. Duane (Manhattan), who is HIV-positive.

"Without a signed informed-consent form, there is no way for practitioners in busy health care settings to prove that a patient's consent to HIV testing was acquired," said Elisabeth Ryden of the New York Civil Liberties Union.

"Pretest counseling and informed consent have forced me to take the time to ensure that the patient understands what is being done," Dr. Marcelo F Venegas-Pizarro, chief medical officer of the AIDS advocacy group Housing Works, testified.

"Frankly, there are a lot of misconceptions about what's being proposed, and, frankly, there are some who term themselves AIDS advocates who are currently very comfortable with the current situation," said Frieden. "New York is an epicenter of this epidemic, and we're very far from being an epicenter of care and control." With 38 percent of 137 city doctors surveyed by the Department of Health and Mental Hygiene reporting they would offer more HIV tests if counseling and paperwork barriers were removed, the law should be amended, he said.

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