Pennsylvania enters the modern age of HIV prevention

You may not have heard much about a Pennsylvania law that Gov. Corbett signed in July, but just about everyone will experience its impact in the privacy of their doctor's office.

Act 59, which became effective in September, amends the state's antiquated HIV testing regulations and aligns state policy with guidelines issued by the Centers for Disease Control and Prevention back in 2006 that call for all patients ages 13 to 64 to be tested in all health-care settings.

I asked the folks at The Health Federation of Philadelphia, which represents community health centers in Southeastern Pennsylvania, to explain this change—and what it means for doctors, patients, and the public's health.

What does the change in law do?

Act 59 makes HIV testing a part of standard clinical care. While physicians still need to verbally notify patients that they are being tested for HIV and document their consent, they no longer need to obtain separate written consent specific for HIV. Physicians can also now offer opt-out testing, where patients are told they'll be routinely tested for HIV unless they otherwise decline. Act 59 also changes the extent to which physicians are required to provide patients with pre-test counseling and what they need to do when telling patients "positive" or "negative" HIV results.

What's the purpose of these changes?

The point of Act 59 is to better integrate HIV testing into routine medical care (i.e., regular doctor visits )— and thus promote the early detection of HIV.  An estimated that 20% of people living with HIV aren't aware of that they are infected. Knowing your HIV status has significant benefits for both you and the public's health.  It allows you to start getting medical treatment and reduces the likelihood that you will transmit the virus to someone else.  An analysis of published research studies found that, on average, learning one's HIV positive status reduced unprotected intercourse with non-HIV positive partners by 68%.  HIV prevention can be achieved by informing people of their positive status.

There is also hope that integrating testing into routine doctor's visits will help normalize the test and reduce stigma associated with HIV.

Why was the original law different?

Back in the late 1980s, HIV was highly stigmatized — much more so than it is today (as long as admissions criteria to Milton Hershey High School doesn't serve as the barometer).  Back then, a positive test result could mean losing your job, your friends and all the other things The Boss sings about in "Streets of Philadelphia."  (Remember Tom Hanks' Oscar-winning turn in "Philadelphia"?)  To protect the rights of people diagnosed with HIV, the a state legislature in Harrisburg passed the Confidentiality of HIV-Related Information Act, known as Act 148, in 1990.  Act 148 served a very important purpose when it was passed, but as the circumstances surrounding HIV evolved in the city and elsewhere (e.g., more treatment options, greater public understanding of the virus, stronger legal protections for people with HIV) the written informed consent provision became more of a barrier than a benefit.

Will physicians be penalized if they don't alter their clinical practice to reflect the policy change? 

No. Physicians are not breaking the law if they continue to require written informed consent for HIV testing.  Routine screening for HIV, however, is now the new standard of clinical care.  Thus, it's possible that physicians could face malpractice suits if they don't test for HIV when they are supposed to.

Have physicians adopted the new changes? What's being done to promote compliance?

Since the change in the law only took effect in September; it will take time for physicians to change their consent forms and clinical habits. It's really just a matter of getting the information out there — and a lot is being done to achieve this.

In December, Philadelphia Health Commissioner Donald F. Schwarz issued a letter to clarify the meaning of Act 59 and call on health professionals to integrate regular HIV testing into routine clinical care. The Health Federation of Philadelphia, in collaboration with the City and the Pennsylvania/MidAtlantic AIDS Education and Training Center have centralized answers to frequently asked questions about changes to Act 148 and will be hosting a free information session, mainly for physicians, with the city health commissioner  on April 3.

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