HIV Reporting and Partner Notification Questions and Answers
This document includes questions received at the May 3, 2000 and May 12,2000 statewide videoconferences and subsequent training sessions.
- HIV Reporting
- Partner Notification (PN)
- Domestic Violence (DV)
- HIV Counseling and Testing/Consent
- Adolescent Issues
- Occupational Exposure
- Impact on Immigrants
- Numbers to Call for More Information
- Addendum to HIV Reporting/Partner Notification Qs (9/00)
- What value is considered positive viral load for purposes of reporting? Any detectable HIV viral load is reportable.
- Are PCR and p24 tests considered diagnostic and therefore reportable? Yes.
- How are CD4s and viral loads supposed to be reported? The regulations specifically require laboratories to report positive viral load tests or CD4<500 results (in addition to confirmed HIV positive antibody test results). These two types of test results define "HIV-related illness" for the purpose of reporting. To alleviate the burden of reporting such tests by providers, the Department will rely on reporting from laboratories for HIV-related illness.
- In cases of CD4 testing for reasons other than HIV disease, will these lab tests be reported to DOH? Will the provider need to notify every patient that this test will be reported? Laboratories will report CD4<500 tests unless they have been informed by the ordering provider that the test is known not to be HIV-related. Tests reported in error will be removed from the HIV Registry. Consequently, providers do not need to inform patients undergoing non-HIV related CD4 testing about the HIV registry.
- Are other HIV retroviruses reportable? For the purpose of this legislation, HIV infection is defined as infection with the human immunodeficiency viruses that are the cause of AIDS or as the term may be defined from time to time by the Centers for Disease Control and Prevention of the United States Public Health Service. This includes HIV-1, HIV-2 and all subgroups within these categories.
- If a patient is tested anonymously, does it have to be reported? Anonymous testing is available only at State and New York City Department of Health and Mental Hygiene approved sites. The names of persons tested anonymously are not reported unless they choose to convert their test to a confidential (named) test result.
- Should providers report HIV+ persons whom they know have been seen at other facilities and are now receiving treatment at their facility but do not yet meet the CDC case definition of AIDS? Reporting of CD4<500 and positive viral loads indicating HIV related illness will occur via laboratory reporting. Physicians are asked to complete a report form for newly diagnosed cases of HIV and AIDS. If in doubt about whether the patient has been previously reported, complete a report; duplicate reports will be deleted.
- If patient is known to be HIV+ and comes for a confirmatory HIV test, is the physician responsible for completing the provider report form? Report forms should be completed for initial diagnosis of HIV by the physician. If in doubt, complete a report form. If the patient had been reported earlier by another provider, the duplicate report will be removed from the registry.
- Do the new regulations provide for any exceptions to HIV reporting in the case of an occupational bloodborne pathogen exposure? Concern relates to possible reluctance to be HIV tested by source patients who will be informed that a positive HIV test must be reported to the DOH. The regulations do not provide any exceptions to HIV reporting in the case of an occupational bloodborne pathogen exposure. As in all cases, the provider should encourage all at-risk individuals to test by emphasizing the benefits of early detection of HIV infection.
- Will individuals who live out of state, i.e., NJ, but receive care in NYS be reported? All HIV infected individuals receiving care in NYS will be reported. The names of those individuals living out of state but receiving care in NYS will be added to the NYS HIV/AIDS registry but will not be shared with the state of residence. However, any contacts of that individual that are identified during partner notification who live out of state will be forwarded to the appropriate health officer of that state to be notified.
- For tissue banks, if the screening ELISA test is positive, is a confirmatory Western Blot required to be done and reportable? Tissue banks are routinely conducting confirmatory Western Blot tests for living tissue donors and the positive Western Blot results are reportable.
- Will participants in research studies or clinical trials be reported? If HIV testing is not being done for diagnostic purposes and is being done purely for research purposes in an IRB-approved research protocol, the HIV positive individual will not be reported. Individuals in research studies generally receive primary care; their primary care provider is required to report initial diagnosis of HIV and AIDS, and CD4<500 and positive viral load results done as part of primary care are reportable.
- Why are patients who test HIV+, who are part of research vaccine trials, not being reported? Testing in research studies is technically non-diagnostic; such patients will be reported by their primary care providers. Vaccine recipients who may develop a positive HIV test but are not HIV infected, don't meet the requirements for reporting.
- If a pregnant woman takes a confidential HIV antibody test and the result comes back positive, does she have to be reported? Yes.
- Will the HIV tests conducted as part of Newborn HIV Screening be reported? No, neither the mother or the infant will be reported as a result of the newborn HIV screening. If a mother enters care and receives an HIV-related test, she will be reported. If the infant is later confirmed to be HIV infected through PCR testing, he/she will be reported.
- How will home testing be affected by the new reporting law? Home testing using an FDA approved specimen collection kit is not affected by the law. Use of this kit does not involve a medical provider and requires the specimen to be coded (name is not provided) when it is sent in for laboratory analysis.
- In an HIV counseling and testing setting, is the counselor responsible for HIV reporting? No. The physician, under whose license the testing is being ordered, is responsible to report. The counselor is acting as the physician's agent.
- In some settings, HIV counselors order HIV tests and also provide HIV pre- and post-test counseling; must they report? Only physicians, nurse practitioners, physician assistants and nurse mid-wives are authorized to order an HIV test. These individuals are required to report. An HIV counselor can be designated by the physician who ordered the test to complete and submit the report form, but the form must be signed by the physician.
- Non-clinical staff do not report. How about social workers? Psychologists? And other licensed professionals? Only physicians and others authorized to order HIV tests such as Nurse Practitioners, Physician Assistants, Nurse Midwives, coroners and medical examiners should report.
- At clinics where PNAP staff deliver HIV results, who is responsible for filling out the medical provider forms? Clinics may establish their own protocols for counselors or other staff to complete report forms. The diagnosing physician is the responsible party and must sign the completed form.
- If a health care employee has a needlestick and tests positive, will this result be reported by the lab, employee health service or the person's primary care doctor? The results should be reported by the laboratory and by the physician who ordered the test.
- If a hospital sends out an HIV antibody test to a lab, who is required to report - the hospital lab that sent the report out or the lab that did that test? The lab that performs the confirmatory Western Blot test is required to report. The referring hospital laboratory must provide the patient's identifying information, including name, as well as the provider information to the laboratory performing the confirmatory test.
- Will out of state labs notify NYS of positive HIV results? For example, some tests go to Kentucky. All laboratory testing on New York State residents must be performed at a NYS-permitted laboratory, including out of state laboratories. Such laboratories are required to report to the DOH.
- Are tests done on military bases and sent to labs outside of NYS, reportable? By whom? Lab or provider? HIV testing and diagnosis done by the U.S. Military is not reportable to NYS.
- How should the provider report form be sent to the Department of Health? In all areas outside of NYC the reports are sent by regular mail to the address noted on the provider form. The mailing address is: Division of Epidemiology, P.O. Box 2073, ESP Station, Albany, NY 12220-0073. The hard copy form that is sent to the DOH does not contain any reference to HIV or AIDS. Therefore, if the form was inadvertently sent to the wrong address, the receiver would not know that the information contained on the form was HIV-related. In NYC the provider must call the New York City Department of Health and Mental Hygiene to arrange to have the forms picked up. The telephone number for the New York City Department of Health and Mental Hygiene is (212) 442-3388.
- For providers based in NYC, how is the pick-up of the "Medical Provider HIV/AIDS and Partner/Contact Report" forms arranged? Who should be contacted to arrange for this pick-up? How frequently are pickups arranged (daily, weekly, monthly)? The pick-up of report forms in NYC will be done by the New York City Department of Health and Mental Hygiene Public Health Advisor (PHA) liaison assigned to enrolled providers, according to a schedule that will be determined by volume. A PHA liaison will be assigned to newly enrolled providers, and pick-up determined on an individual basis based on volume of reports. Providers not yet enrolled with the New York City Department of Health and Mental Hygiene who have not already received an enrollment package should call 212/442-3388 to arrange for enrollment in the provider reporting program and for pick-up of report forms.
- The regulations indicate reports have to take place within 21 days...is that business days or calendar days? Calendar days.
- How is the 21-day reporting period calculated? If a provider needs more than 21 days to contact patient with results or work with patient to solicit names of partners, should he or she wait beyond the 21 days or send an incomplete form? What if a provider takes longer than 21 days to send in form? The 21-day reporting period is calculated from the day test results are received by the provider. If the post-test counseling has not been done within 21 days, the provider should complete and submit the form, indicating "No" in section "f" ("Has this patient been informed of his/her HIV positive status?"). If a pattern of late submission of forms is noted for a particular provider, DOH staff will work with this provider to explain the rationale for reporting and the provider's responsibilities.
- Who is using electronic reporting - is it just laboratories? Can hospital laboratories report electronically? Electronic reporting is conducted only by laboratories, as it has been done to report CD4<200 test results since 1992. Hospital, commercial and public health laboratories that conduct confirmatory Western Blot, PCR, p24, viral load and CD4 tests can report electronically. If a laboratory is not able to report electronically, it should complete a paper report. Physicians are required to use the paper report form: "Medical Provider HIV/AIDS and Partner/Contact Report."
- Does electronic laboratory reporting include faxing? How is confidentiality protected when faxing is used? No. Faxing is not allowed to report HIV/AIDS cases. Electronic reporting is accomplished via a highly secure encrypted system designed specifically for this purpose.
- Do labs report positive HIV results through the patient's county health department or directly to the State DOH? Directly to the State DOH.
- How will a Black, Caribbean born, non-African American be reported? The race/ethnicity of an individual will be reported as it is noted by the provider reporting the case (as it has been for 15 years of AIDS reporting). The country of birth will be obtained from the surveillance follow-up if it is documented in the medical chart.
- What will be required to report teens in foster care who test HIV+ and their contacts? The same general procedures for reporting and PN are followed for youth in foster care, with sensitivity to the specific circumstances. The health care provider plays a key role in working with young persons in foster care.
- How will homeless persons be reported? As with AIDS case reporting, homeless persons who are reported will have residence listed as their current temporary residence (homeless shelter) or location of reporting provider if no address information is available.
- For NY Blood Center that covers New York City as well as many other counties, can all reports be sent to the State DOH or must they be sent to the City DOH for city residents? Reporters with special circumstances can contact the State Health Department Bureau of HIV/AIDS Epidemiology for further discussion.
- Please explain how the carbonless copy report form will work. It is a two-part form. The top sheet, which is the provider's copy, contains all the labels on the boxes and lines that need to be filled in. As the provider fills in the top sheet of the form, the information is transferred to the bottom sheet. The bottom sheet, which is sent to the Department of Health, contains only the boxes and lines but no labels or any reference to HIV or AIDS.
- What measures do laboratories have in place for confidentiality? All laboratories conducting HIV-related testing must have written confidentiality protocols in place before they are certified to conduct HIV testing for NYS residents. The DOH Wadsworth Center has provided all laboratories with confidentiality guidelines.
- How will duplicates be sorted out without sharing of identifying information with CDC or another state to determine duplicates? CDC does not receive names and must depend on the cooperation of the states to sort out duplicates. Cases reported in NYS that reside out of state will be added to the NYS HIV/AIDS registry but their actual county and state of residence will be noted. CDC and states of residence will receive non-identifying information about the existence of such cases. Names of HIV infected cases reported to the NYSDOH will not be shared with CDC or other states.
- What action should an M.D. take if the patient does not want to be reported? Reassure the patient that the report will be kept strictly confidential and explain the purposes of reporting. Explain that participation in partner notification is voluntary and the benefits to the partner in learning their HIV status. The physician may also refer the patient to anonymous testing or provide information on the home specimen collection kit.
- If a woman is tested confidentially during prenatal care in an OB's office and she does not want her HIV status disclosed, what should the provider do? A confidential HIV antibody test is one in which the name of the person being tested is available and is submitted with the test specimen. All patients being confidentially tested in prenatal care settings should be aware from pre- and post-test counseling that her name will be reported to the Health Department if the test is positive. Providers should reassure patients about the purposes of reporting and the law protecting data that is reported.
- Will reported persons be penalized at some point in the future, i.e., segregated, quarantined, etc.? The law states that the name of the reported individual can only be used for the purposes of the law, i.e., surveillance and partner notification. New York has had reporting of AIDS cases for over 15 years without such measures being implemented.
- Please clarify how reports will be unduplicated by DOH? Each report received will be matched to the list which contains identifying information on all reported individuals. Duplicate reports will be removed and newly identified reports will be added to the list. This is a standard process which has been done for AIDS Surveillance since the mid-1980s.
- Why are you putting partner names on the same sheet with the patient's name? The information on index cases and their partners needs to be placed together on one page so that public health staff will be able to verify the reported information with the provider. Putting them on one page minimizes the chances of the information getting separated. Follow-up steps, such as confirming the domestic violence screening has been performed, require linking index and partner names. A single form also simplifies reporting for providers.
- Will there be a mechanism for determining false positive test results? Only positive HIV tests that have been confirmed are reportable. In the rare event that a provider determines that a previously confirmed positive HIV test is a false positive (person is not HIV infected) and state or county staff are provided documentation of this when following up with the provider, the case will be deleted from the HIV registry.
- How much additional time will counseling and reporting take per patient? How will physicians be compensated for their time? The additional time in pre- and post-test counseling to discuss the new law will vary depending on the patient's needs and the experience of the provider. Physicians may bill Medicaid for multiple post-test counseling visits for patients enrolled in Medicaid when they document in the medical record that the purpose is for continued post-test counseling and discussion of partner notification.
- How is HIV reporting different from the system to report TB or syphilis concerning the duty of the M.D.? Essentially the same, except with HIV, physicians are required to report known contacts, including spouses.
- What are the penalties to physicians if they refuse to report? How can it be known if a physician refuses? As with reporting of AIDS cases in the past, refusal to report is a violation of the Public Health Law punishable by fine of up to $2,000 per occurrence and possible one year imprisonment. Such cases might come to light through laboratory reports and follow-up surveillance when the physician consistently refuses to provide epidemiologic and partner information. The Health Department will work with such physicians to explain the rationale for reporting and the provider's responsibilities.
- If the law is intended to be non-retroactive, what is the purpose of CD4 reporting? Won't the reporting of CD4 levels eventually achieve the retroactive reporting of all HIV positive persons? Won't this undermine partner notification since long time survivors won't recall partners of many years ago? Only positive viral load and CD4<500 tests conducted after June 1, 2000 are reportable. HIV infected individuals diagnosed before June 1, 2000 who have undetectable viral loads and a CD4>500 are not reportable. Partner notification assistance activities are prioritized for persons newly diagnosed with HIV.
- How would you address the issue of the patient/provider relationship when HIV+ patients have been diagnosed prior to June 1st? A provider should inform their patients that they will be reported to the DOH at the time of their first detectable viral load or CD4 < 500 test conducted after June 1, 2000.
- Should the provider tell his/her patients that a CD4 below 500 is automatically reported? Yes, along with detectable viral loads. The fact sheet described in #49 can assist in the process.
- What is the purpose of the New York City Department of Health and Mental Hygiene Office of AIDS Surveillance (OAS)? The New York City Department of Health and Mental Hygiene OAS conducts HIV/AIDS surveillance for New York City, which includes collecting case reports, compiling statistics to monitor the HIV epidemic, and providing information for planning and directing resources for prevention, care and support services.
- Have the number of HIV tests declined since HIV has been reported in other states? This question has been looked at in a number of states with HIV reporting. No other states have reported a large or long lasting decline in the number of HIV tests after the implementation of HIV reporting. Several states reported minor, temporary changes in HIV testing rates among subpopulations which subsequently increased.
- Due to the decrease in AIDS cases, has CDC changed the AIDS case definition relating to CD4<200? CDC has not changed the National Surveillance Case definition for AIDS since 1993. The definition still includes HIV infection with a CD4 count less than 200.
- If a CD4 count of less than 200 is not an AIDS-determining condition in pediatric cases, how will NYSDOH classify children under 13 with CD4 counts less than 200? Surveillance staff will conduct a review of the child's medical chart to determine if the child is HIV infected and if they meet the CDC AIDS case definition for children under 13 years of age.
Partner Notification (PN)*
- Does reporting of partners take place at initial HIV diagnosis only? Partner notification (PN) should be
discussed by medical providers with their HIV infected patients, periodically throughout care. The PN regulation prioritizes
newly diagnosed persons with HIV for PN activities. Follow-up by PNAP/CNAP staff will occur primarily in these cases.
Providers should report partners of newly diagnosed HIV cases using the medical provider report form (No. 4189).
For initial diagnosis of HIV-related illness, providers should be aware that the first positive viral load or CD4<500 after June 1, 2000, will be reported by laboratories to the Health Department. Providers do not need to complete a report form. If there are known contacts, including spouses, who need to be notified, providers should contact PNAP/CNAP or use a report form to report them.
For initial diagnosis of AIDS, providers should complete a report form. If there are known contacts, including spouses, who are to be notified, providers should use a report form to report them, or give their names to surveillance staff who will be actively following-up to obtain surveillance information.
- If a client chooses to notify partners alone or with PNAP/CNAP, is information on contacts still collected and reported? Yes, if contacts are known to the reporting physician.
- Is a "contact" limited to a sexual partner or needle sharing partner? Could a "contact" be someone who had a significant risk exposure during an accident, i.e., correction worker being bit? The regulations define a contact as a spouse or sexual contact, a needle sharing partner, or a person who may have been exposed to HIV in defined occupational settings under circumstances that present a risk of transmission. Depending on the circumstances of exposure, a correctional worker could be a contact.
- What recommendations/requirements exist about notification of known needle sharing partners? Needle sharing partners are included in the definition of contacts; they should be notified concerning exposure to HIV so they can be tested and access treatment, if needed. If negative, they can learn how to stay that way.
- What if a patient who says s/he will notify a partner and does not follow through? Providers should work closely with patients who choose self-notification as support may be required. Providers should explore any issues that may prevent the patient from notifying the partner, for example, fear of domestic violence. PNAP/CNAP are available to provide coaching and support to the index patient or provider upon request. The physician or DOH will notify reported contacts if the patient does not, after the domestic violence (DV) screen is completed.
- Pregnant women are HIV pre-and post-test counseled during prenatal care and may not reveal partners' names. After delivery a paternity acknowledgment is signed. What is the provider's responsibility if the father is not a spouse? Providers should report contacts known at the time a case is reported. Contacts identified at other times are not required to be reported. However, discussion regarding the importance of notifying partners should be incorporated into ongoing care and other services such as case management and counseling. If needed, PNAP/CNAP assistance can always be requested.
- If a patient has an idea of who exposed him to HIV, should he report that person as a contact? Patients are asked to cooperate in naming their sexual and needle sharing partners. There is no emphasis on trying to identify the possible source of infection.
- If an anonymous gamete donor tests HIV positive and refuses to name a spouse or partner(s), does the physician have to "track down" this information to report? Physicians are required to report known contacts, including spouses. The Department does not prescribe any specific procedure to identify spouses.
- In the Question and Answer Sheet for Providers (#9348), it states, "the responsible local public health officer will determine which cases merit partner notification by public health staff." How will the public health officer determine this? Based on what criteria? The regulations indicate that local public health officials shall consider the following as important factors in determining the priority for which cases merit notification: a) reported contacts, including spouses known to the provider or those whom the infected person wishes to have notified, unless they have already been notified or are in process; and b) persons who are newly diagnosed with HIV infection.
- To what extent will patients be interrogated regarding partners and especially spouses? Patients will be asked to name partners voluntarily. This will not be done in a coercive manner.
- Can you describe the process of finding the partner to be notified and what happens if they cannot be located? PNAP/CNAP staff use identifying and locating information provided by the physician and infected individual and attempt to contact the partners in the most effective, safe and confidential manner; there are program guidelines to close cases where partners cannot be located after three attempts.
- How will partners be informed; is it through mail, telephone, person-to-person or all of the above? Partners are informed in person; rare circumstances may dictate telephone notification (e.g., at the request of the partner).
- IV drug users and street people often have multiple sex partners. How often will you check on them to do PN or will it only be done when a new diagnosis is made? PN is prioritized for persons with a new HIV diagnosis. PNAP/CNAP staff do not recontact persons after partner notification is complete.
- What methods will be used to "weed out" partners who are named, but not really partners, i.e., if a client lies about a partner? This is handled on a case-by-case basis.
- What is the New York State Department of Corrections' responsibility regarding partner notification when an inmate is HIV positive and his crime was rape, sodomy or other sex-related offense? Does DOCS notify the victim or family of victim? DOCS medical staff would not have access to criminal record information. If the inmate names the victim as a contact, PNAP/CNAP would be available to conduct the notification.
- How is partner notification done to notify partners of state inmates? Who does the notifying? PNAP staff with responsibility in the jurisdiction of the partner's residence will conduct PN, as has been done in the past.
- How will HIV infected inmates access PN assistance services in state prisons? All inmates found to be HIV infected will be offered access to PN assistance services. This access will be offered whether the inmate tested with DOCS Medical Services, the AIDS Institute Counseling and Testing Program, or with a community-based organization that is part of the Criminal Justice Initiative sponsored by the AIDS Institute.
- What will public health workers do if a patient refuses to name partners? There is no penalty for not naming partners. PNAP/CNAP staff will remind the patient that public health PN assistance remains available in the future if he/she wishes to have partners notified.
- Does someone who tests HIV positive have the option of not revealing partner names? If so, will they be told HIV test results? Yes, counseling on HIV test results occurs before discussion of PN in post-test counseling. There is no penalty for not naming partners.
- Regulations require M.D.s to report names of contacts but do not require the patient to provide names. Why not? There is no precedent in public health for requiring persons to name their partners. This highlights the collaborative nature of partner notification. Coercion and requiring names to be provided would be counterproductive.
- What will happen to providers if they do not report known contacts? Are there sanctions? This is a violation of the Public Health Law. However, the Department will first provide technical assistance to the provider and work with him/her to achieve reporting.
- Are PNAP/CNAP staff liable if a partner figures out who the index client is even though identifying information was not given? The law relieves from liability persons acting in good faith who conduct partner notification assistance activities.
- Is spousal notification mandatory? The only mandatory component is for physicians to report known contacts; a spouse is defined as a contact. Domestic violence screening is required. The patient and physician should consider options for how notification of the spouse proceeds once it is determined there is no risk of domestic violence.
- If an HIV positive person is married and does not name a spouse, will DOH seek information through marital records? No.
- What is required to "prove" that a self-notification has taken place? Confirmation by the HIV infected individual, the physician, or the partner, e.g., partner comes to physician's office for counseling and testing; partner confirms notification with physician or PNAP/CNAP. The physician can report a self-notification has taken place by entering the partner name and date of the notification on the medical provider report form. In some cases, counselors, social workers or case managers involved with an HIV positive person may be able to confirm that a spouse or known partner has been notified. If the patient consents to release of information for this purpose, the provider may be able to verify to the M.D. that the known partner has been notified.
- How far back in time should known partners be reported? This is determined on a case by case basis depending on such factors as the approximate dates the patient was believed to have been exposed and become infected, willingness/ability of patient to name past partners, etc. PNAP/CNAP staff will prioritize current and recent partners. The Federal Ryan White Care Act requires states to make a good faith effort at PN for spouses within the last 10 years. Therefore, spouses within the last 10 years, if known, should be reported.
- How do clinicians contact partners outside of the State? The clinician should report the out-of-state partners to DOH. PNAP/CNAP procedures exist for notifying partners outside of New York by contacting cooperating public health authorities in those jurisdictions.
- Why is Partner Notification associated with an anonymous test which is converted to a confidential test handled differently than any other confidential test? It is not handled differently. Partner Notification assistance is discussed with and offered to all persons testing HIV positive anonymously. The decision to convert the test result to confidential is a separate issue.
- In the small counties not directly participating in implementing the regulations, how will PN take place? State PNAP staff will assure access to PN assistance in these counties.
- What provisions are being made for training staff that have yet to be hired for PNAP programs around the state? All new staff will be trained as they are hired.
- Why is the determination of risk of domestic violence (DV) falling solely in the hands of the public health staff? The determination of risk of DV should be made by the medical provider (or his/her designee) providing the HIV post-test counseling and DV screening. Public health staff will rely on the determination of risk of DV made by the medical provider, based on the DV screening conducted with the client. Public health staff will conduct the DV screen before proceeding with PN if the provider has not conducted the screening. The regulations require the responsible public health official to consider whether or not partner notification should proceed. The public health officer will make such decisions in consultation with the responsible physician, and when possible, with the infected individual and the domestic violence service provider (when a signed release is present). This decision involves balancing the potential risks of domestic violence with the benefits of partner notification.
- Please define DV deferral criteria and provide examples. Define severe negative impact. Domestic violence can take many forms. It can include physical, sexual, economic, emotional, social and/or psychological abuse. Determining "severe negative effect on physical health and safety" is a judgment made by the person conducting the DV screening. The NYSDOH Guidelines for Integrating Domestic Violence Screening into HIV Counseling, Testing, Referral and Partner Notification provides guidance for medical providers and includes some good examples.
- What are the parameters of the domestic violence protocol in terms of deferral - is actual physical harm required before deferral can be considered? Actual physical harm is not required for deferral. Deferral can be based upon the medical provider's assessment of the severity of risk of any form of DV. The NYSDOH Guidelines for Integrating Domestic Violence Screening into HIV Counseling, Testing, Referral and Partner Notification provide detailed guidance for medical providers. The Guidelines emphasize the numerous complications and range of outcomes of DV that can affect the health and well-being of individuals.
- Why isn't "any risk of domestic violence" used to defer partner notification? The Health Department recognizes that any risk of domestic violence warrants immediate attention and supports medical providers' making necessary referrals for DV services. Local health officers will consult with physicians regarding decisions to defer partner notification based on the individual circumstances. The protocol attempts to balance the need for partners to know of their exposure status and the risk of DV to clients being screened and to their named partners/contacts. That is why "any risk of domestic violence," broadly defined, is not the criteria for deferral.
- Explain what a provider should do if they suspect that a new HIV positive client is prone to DV against others. It is important for providers to remember that they may have clients who may be batterers/ abusers. Batterer Intervention Programs (BIPs) may be a part of a coordinated response to DV in some communities, but they have not been proven to be an essential or very effective part. Health care providers who have a client who is an abuser and wants to stop his/her abusive behavior should consult with their local domestic violence service program to find out if there is a BIP in their community and, if so, what the recommendations are for referrals not mandated by the courts.
- Where should gay, lesbian, homosexual, transgender victims of DV go? What resources are available to them? What are the DOH and OPDV doing to address any gaps in services for HIV positive GLBT victims of DV? Within NYS there is an extensive network of DV service providers. The network can be accessed by individuals or by medical providers, and information on how to make referrals and access DV services is being widely distributed in relation to implementation of the law. The State Health Department (DOH) and the Office for Prevention of Domestic Violence (OPDV) recognize the importance of appropriate referral resources for GLBT victims of DV. DOH and OPDV are working together to strengthen the capacity of DV service providers statewide to meet needs of all populations, including those who are GLBT, through training programs. The New York City Gay and Lesbian Anti-Violence Project (AVP) has had a domestic violence program since 1986 and is also available to serve as a resource for GLBT DV. AVP may be reached at  714-1184 (Spanish & English).
- If someone signs an authorization regarding sharing information from a domestic violence service provider, how can we reassure our client/patient(s) that this information will not be used against them in a child protective proceeding? In many cases, releases limit the use of the information for certain purposes only. The specific answer to this question would depend on the exact wording of the release. In some situations, such as situations involving suspected child abuse or maltreatment which must be reported by physicians and others, other legal and ethical obligations must be complied with. Since each situation is different and authorizations for release of information vary in accordance with specific needs, the patient/client should carefully read the release form and discuss it with the provider before signing the form.
- What training is required for physicians around DV? Although there is no specific "requirement" for training,
the DOH and OPDV are continuing to make numerous training opportunities and other materials available for physicians. Information
regarding AIDS Institute-sponsored training can be accessed as follows:
- Physician training: 518/473-8815 (Clinical Education Initiative)
- Other training: 518/474-9866 (HIV Education and Training Initiative)
- Information regarding training through the NYS OPDV may be obtained by calling: 518/486-6262. The NYS Coalition Against Domestic Violence (518/432-4864) is also a resource for training.
- In completing the HIV antibody testing requisition in confidential testing settings, is using a name now mandatory? Yes.
- Could a physician continue to order an HIV test using a numbered code and then assume the responsibility of reporting? How does that impact the laboratory obligation? Physicians must submit the individual's name to the laboratory when ordering a diagnostic HIV-related test.
- The public health educator, not an M.D., signs all the lab slips in this facility. Must this change now with the new law? Physicians have always been legally responsible for ordering HIV antibody tests. Staff may conduct the counseling and complete paperwork, per a protocol and under the physician's direction. The physician must sign the laboratory requisition. This has always been the case and has not changed with the new law.
- Will HIV test sites be responsible for verifying the identity of the positive individual? How will a false identity report be handled? HIV test sites are responsible for verifying the identity of the persons being tested in the same manner as all persons seeking health care services.
- Are private clinical laboratories performing HIV testing required to offer anonymous HIV testing? Can they tell their clients they don't offer anonymous testing? Only medical providers authorized by the State Health Commissioner may conduct anonymous testing. Laboratories cannot independently order an HIV test, and are not responsible for HIV pre- and post-test counseling. However, the provider who conducts the HIV pre-test counseling is responsible for incorporating the requirements of Article 27-F into the pre-test session, which includes informing individuals about the difference between anonymous and confidential testing and options, and where anonymous services can be obtained. Hotline numbers for the NYSDOH Anonymous HIV Counseling and Testing Program are available on the DOH website: www.nyhealth.gov or by calling the AIDS Hotline: 1-800-541-AIDS.
- Will Blood Banks provide HIV C&T according to Art. 27-F? And will an informed consent be signed? The New York State Confidentiality Law, known as Article 27-F, and Part 63 regulations establish certain minimum standards for the provision of HIV pre-test counseling. Any provider, including blood banks, who provide an HIV test, must follow requirements. Blood banks have an exemption to obtaining informed consent, but must follow counseling protocols when informing blood donors of HIV positive results.
- Are providers still able to use the current consent form for post-blood exposure follow-up after June 1, 2000? No. All Informed Consent Forms (DOH #2556) for HIV testing have been revised to include the HIV surveillance and partner notification regulatory requirements. Forms are available from the New York State Department of Health by calling (212) 268-6164 or from the DOH website. The old consent form should not be used after June 1, 2000.
- How does DOH assure the identity of someone converting an anonymous to a confidential test result? What prevents someone from altering a form to receive benefits? At NYSDOH and New York City Department of Health and Mental Hygiene Anonymous HIV testing sites, all individuals who test HIV positive or indeterminate/inconclusive have the option during post-test counseling to change the test result to a confidential test for the purpose of referral to medical care and other needed services. This option follows procedures established by the program which includes verification of the client's identity (preferably by a photo identification card) and completion of NYSDOH form # 4143, signed by the client and counselor, which authorizes the test result to be attached to the client's name. In addition, the client signs an authorization to release HIV test information to a provider of choice.
- In a university health services setting, what address should be used for the student on the form? Current address at school.
- How are physicians reimbursed for HIV counseling and testing services, including discussion of partner notification and domestic violence screening? For Medicaid patients, office-based physicians can bill for office visits according to the Medicaid Fee Schedule. Legislation passed this year will increase the reimbursement for most office visits to $30. Details regarding this change will soon be available to providers. Physicians can also apply for enrollment in the Enhanced Fees for Physicians (EFP) Program which provide reimbursement for HIV counseling and testing, as well as primary care visits. Physician services provided in hospitals and clinics are reimbursed based on established HIV-specific reimbursement rates (5 and 7-tier) if the agency has signed an agreement with State DOH. For more information on these reimbursement options, call 518/473-8427. Most private insurers will cover office visits for HIV counseling and testing services.
- The US military has an agreement with the National Red Cross that states that military medical officers do post-test counseling. Are military offices required to do domestic violence assessment and partner notification? If not, will the Red Cross be required to do this portion? Are military personnel in NYS being trained on this law? The New York Law and regulations do not apply to HIV testing done by the US military.
- Please elaborate regarding specific steps or actions taken to address adolescent concerns relating to testing, reporting and PN. The Department of Health has had extensive consultations, focus groups, meetings and individual discussions with numerous individuals, agencies and organizations concerned about testing, reporting and PN as they relate to young people. Guidelines, questions and answers, new procedures and training programs have been developed or modified to reflect the unique needs and concerns of young people. The adolescent-focused Q&A document is available on the DOH website (www.nyhealth.gov).
- How will adolescent test results be kept confidential? Test results for young people will be subject to the same confidentiality protections as those for adults.
- Can adolescents consent to an HIV test? In New York State the capacity to consent to an HIV test (either confidential or anonymous) is determined without regard to age. A medical provider ordering the test must conduct an individualized assessment of every older child's or adolescent's actual ability to understand the nature and consequences of being tested for HIV and to make informed decisions about whether to be tested.
- How are adolescent partners notified by PNAP/CNAP staff if they are minors? Minors are notified without involvement of parents and with the assistance of the reporting provider and index patient, if possible. In cases of potential child abuse, staff will work with providers who have mandatory child abuse reporting responsibilities or local health officers to assure proper steps are implemented to protect the child.
- Where is the new adolescent test site in NYC?
- Adolescent STD Test Site
2238 5th Avenue, 3rd Floor
(5th Avenue and 137th Street)
New York, NY 10037
- Adolescent STD Test Site
- Is anything related to occupational exposure changed by the law? Can the status of the index patient be revealed to an exposed provider without consent of patient? Yes. The new regulations permit disclosure of HIV status to persons who have been occupationally exposed in defined circumstances. This disclosure technically does not include disclosure of the name of the index patient, which (in some cases) may not otherwise be known to the exposed person.
- Is there a specific consent form for testing relating to health care worker exposure? Yes. The form, "Informed Consent to Perform a Confidential HIV Test and Authorization for Release of HIV Related Information for Purposes of Providing Post Exposure Care to a Health Care Worker Exposed to a Patient's Blood or Body Fluids" (#4054) (PDF, 53 KB, 2pg.) has been updated per the regulations. This form is available on the DOH website at www.nyhealth.gov or by calling 212/268-6064. Appropriately completed model HIV release forms, as found in Part 63 of the regulations, may also be used.
- What is the penalty for misuse of HIV information possessed by insurance companies? Violation of Public Health Law (PHL) Article 27-F may result in a $5,000 fine and possible one year in prison, but only certain parts of Article 27-F cover insurance companies (see PHL 2784). The insurance law governs insurers, except for health maintenance organizations (HMOs) which are explicitly governed by PHL Article 27-F.
- If no identification information about the client is shared, how was Nushawn Williams' name released? Mr. Williams name was released from his medical record, (not from the State reporting system), pursuant to a court order allowed by Article 27-F addressing the threat of imminent harm to his contacts.
- If new immigrants are identified as HIV positive within the first 5 years of their immigration, do they have the same treatment services as anybody else? If so, how would it affect the sponsor? HIV reporting does not impact an immigrant's eligibility to receive services. HIV identifying information on the index case reported to the State DOH is not shared with any other state or federal agency.
- If a person tests HIV positive after June 1, how does it impact insurance coverage, if at all? Testing positive for HIV after June 1, 2000, does not affect insurance policies any differently than testing positive for HIV prior to June 1. The State HIV reporting registry data are not shared with or disclosed to health or life insurers.
- In filling out an HMO insurance form, is it legal to give the diagnosis that the patient is HIV positive? When enrolling in an HMO, a person signs a release authorizing the disclosure of patient information to the HMO for care, treatment and reimbursement purposes. HIV information can be disclosed for such purposes to the HMO without a special HIV release. A provider may therefore rely on an initial executed release to convey HIV information about the person who signed the release to the HMO.
- What are the rights and responsibilities of health insurance plans with regard to HIV reporting? The new law requires diagnostic medical providers and laboratories to report HIV, HIV-related illness and AIDS. Medical providers, not health insurance plans, practice medicine. Consequently, insurance plans have no responsibility to report.
- What is the role of managed care organizations (MCOs) in Partner Notification (PN)? MCOs should educate their network of providers about the standard of care in treating HIV infected persons and should assure that network providers integrate PN into the on-going care and treatment plan for HIV infected persons and comply with all reporting requirements.
- Are there funds available to assist CBOs with meeting the increased workload as a result of these new
regulations? New funds were not appropriated specifically for this purpose. However, the AIDS Institute will
allow contractors to use savings, or, if they choose, to direct new funding made available through the 2000-01 State budget for
To support CBOs in their role as community educators, the AIDS Institute is offering regional training sessions to prepare CBO educators to offer presentations on the regulations to consumers and other providers. Training materials, including slides that describe the regulations and training videotapes, are also available to CBOs.
- What is the State's commitment for funding PNAP programs at the county level? The 2000-01 State budget continues the annual $4.1 million allocation for grants to the 14 local jurisdictions that are direct participants in HIV partner notification assistance services. These funds were retroactive to October 1, 1999 to cover important start-up activities, including equipment, security and staff training, as well as on-going staffing costs.
How can I obtain additional information on HIV Reporting and Partner Notification?
The following numbers can be used to obtain more information:
- HIV Reporting/Surveillance Questions
- Bureau of HIV/AIDS Epidemiology 518-474-4284
- Partner Notification Questions
- Accessing PNAP (outside NYC) 1-800-541-AIDS
- Accessing CNAP (within NYC) 212-693-1419
- How Partner Notification Assistance will work
- Bureau of Sexually Transmitted Disease Control - Lynn Hoback 518-474-3598
- Domestic Violence Screening Questions
- Domestic Violence Referrals & Services 1-800-942-6906
- (Hearing Impaired) 1-800-810-7444
- (Spanish) 1-800-942-6908
- Domestic Violence Referrals & Services 1-800-942-6906
- Questions re: the Domestic Violence Screening Protocol
- Bureau of Direct Program Operations - Mara SanAntonio-Gaddy 518-474-3671
- HIV Educational Materials/Training Sessions
- HIV Education and Training Section, AIDS Institute 518-474-9866
- Counseling & Testing
- Accessing Anonymous Counseling and Testing 1-800-541-AIDS
- Occupational Exposure Questions
Additional information is available on the DOH website (www.nyhealth.gov). Click on HIV/AIDS tab on the home page.
- If a provider know an HIV positive client's spouse from community contact only and not because the client has ever told the provider the spouse's name, is that provider obligated to include the spouse as a known contact for partner notification? The physician may use his/her discretion to report or not report someone that they know is a contact when this knowledge did not come through their medical practice. However, physicians should be taking careful contact histories on their HIV-infected patients and document whether partner notification had occurred and whether there are domestic violence issues involved.
- If a client has told the provider his/her spouse's name only before June 1, is the provider obligated to report that spouse as a known contact? The provider should report all known partners regardless of when he/she learned of them, since the law does not make a distinction about when the partners were first identified. The only exception to this is the situation in which partner names were elicited in an STD clinic for purposes of STD control, since this information is protected under another law and is not releasable under the HIV law. It should also be noted that Federal law, the Ryan White Care Act, states that contact history should include spouses for the previous ten years.
- Some HIV testing sites do not collect demographic information during their pretest counseling. If an HIV-positive person does not show up for the posttest session, should the provider send in the report form with as much information as possible, even if it is minimal? Physicians should report positive HIV results even if the patient does not return for post-test counseling. Public health staff will then contact the physician to discuss the situation and may be able to assist the provider in locating the patient and performing posttest counseling.