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State HIV/AIDS Legislation

The 10th Amendment of the U.S. Constitution provides states the authority to establish laws and regulations to protect the health, safety and welfare of their citizens. Each state has unique regional and demographic factors that impact the health of its citizen. State law will reflect these differences. This section will focus on Florida as an example of state regulation and legislation regarding the management of the HIV epidemic.

In 2006, Florida ranked third in the nation in the number of AIDS cases. There were approximately 125,000 people who are infected with HIV in the state of Florida. About 25% of these persons are unaware of their HIV infection and are not receiving medical care that could prolong and improve the quality of their lives, as well as lower the risk of spreading the infection to others. In addition, according to the Florida Department of Health, there are more than 5,000 new cases each year, with a disproportionate number of cases among African American and Hispanics.

The State of Florida Statewide Coordinated Statement of Need (SCSN) has identified several HIV trends within Florida:

Increases in both males having sex with males (MSM) and heterosexual transmission
Disparities in HIV/AIDS prevalence associated with race/ethnicity & economic status
Individuals coming into treatment later, resulting in sicker patients
Increase in death rate
Disproportionate impact on MSMs, women, and minorities
Emerging populations include seniors, migrating populations (farm workers, tourists, aliens) and teenagers

In summary, SCSN notes that the HIV/AIDS epidemic in Florida is shifting to new populations with women, persons of low socioeconomic class, minority populations, incarcerated and other marginalized groups becoming infected in disproportionate numbers.

Instant feedback:

The HIV/AIDS epidemic in Florida is shifting to new populations.

The Florida Omnibus AIDS Act of 1988 and amendments

The foundation for HIV/AIDS services is found in the Omnibus AIDS Act of 1988. It contains a number of key provisions, including the requirement that all health professionals take a course on HIV tailored to their professions. Other key provisions include:

HIV testing and results must be informed, voluntary, and confidential.
Patients must be notified of their right to anonymous testing
People must consent to testing, and the consent must be documented.
Post-test results must be given face to face, and if results are positive, people must receive information about social and health care services.
People can authorize release of information to a third party.
In a few specific situations, health care facilities and providers can disclose a persons' HIV status without consent, such as to providers who transport body parts, to authorized medical researchers, or for one-time followup if the person had no opportunity to sign a release.
HIV testing without consent may be done in specified instances, when court-ordered or specified by law.

A 1996 amendment to the Omnibus AIDS Act added requirements:
All physicians and laboratories to report HIV positive tests results to state health authorities.
All health care providers attending a woman related to pregnancy must offer HIV testing as part of routine blood tests.

A 1998 amendment streamlined some provisions of the original act:
Eliminated pre-test counseling requirements.
Allowed repeated testing without further consent, to monitor treatment and progress of the disease, after consent for an initial test.
Post-test counseling requirement applies only to the local health departments and registered HIV testing sites.
All health providers must make every effort to notify patients regarding test results.

In general, under the Omnibus AIDS Act and its amendments, health care providers testing for HIV must ensure 4 things:

An HIV test will not be done without documentation of informed consent.
A positive test will be corroborated by additional testing before results are released.
Test results must be maintained confidential.
Patients must be informed of their test results. If unable to inform the patient, healthcare providers must notify the county health department.

Instant feedback:

The Omnibus AIDS Act has been amended in 1996 and 1998 to eliminate some counseling provisions of the original act.

One of the primary goals in the state of Florida is to link all of those with HIV to care. The Florida Department of Health has accepted the CDC initiative: Advancing HIV Prevention, and has established 4 statewide teams to implement strategies for achieving the goals outlined in the initiative.

The teams have identified 7 key activities to implement the four CDC strategies:

CDC Initiatives	Florida Dept. of Health Activities
1. HIV testing as part of routine medical care in all settings. Removal of barriers to testing including the elimination of pre-test counseling requirements.	Routinely recommend voluntary HIV testing as part of regular medical care.
2. Encourage use of "Rapid Tesing"	Rapid testing in non-traditional settings. Routine testing of inmates in correctional facilities. HIV partner counseling & referral services.
3. Prevention of new infections by reaching with people with HIV and their partners.	o Prevention case management. o Prevention in medical care settings.
4. Further decrease in mother-to-child HIV transmission.	o Achieving universal HIV testing of pregnant women.

Guidelines for sharing confidential information

Florida recognizes the importance of maintaining the privacy and confidentiality of people with HIV in all decisions related to their care. By Florida statute, the Health Insurance Portability and Accountability Act (HIPAA) Business Associate Agreement (BAA) of 1996 is the vehicle used for sharing confidential information on a limited basis.

Instant feedback:

Florida recognizes the importance of maintaining the privacy and confidentiality of people with HIV in all decisions related to their care.

Sharing confidential information through the BAA:

When?	When the medical provider and ASO* have jointly signed the HIPAA Business Associate Agreement for the purpose of assisting the individual to return to medical care. Clients who want a different medical provider must sign a Consent to Release Information, allowing their names to be shared with a third party.
What?	The client's name, last known address, phone number, alias or nickname, and any hangouts where the client may be found.
What NOT?	DO NOT SHARE: Information about specifics of medical care, such as viral load or opportunistic infections, emergency phone numbers for friends and relatives, employment information, risk factors, and sex or needle-sharing partners that were disclosed by the client.
To whom?	The ASO should identify 1 or 2 key staff that will be the point of contact with the medical provider and are trained in the information transfer protocol. These staff must complete the security training that is provided for health department employees or complete the security training electronically that may be obtained through the Bureau of HIV/AIDS. These staff must take care to protect this information within the ASO and share information only with those who need to know.
How?	Hard copies of the client names should be placed in a double envelope with the inside envelope marked "confidential" and be physically picked up by the identified ASO staff. If there are multiple names on a list, the list should have no indication that it is a list of HIV-infected persons. Confidential information should never be sent over the internet. Once the list is in custody of the ASO staff, it should be kept in a locked brief case during transport. In the office, the identifying information should be kept in a locked drawer in a locked office with limited access.

Instant feedback:

Information about specific medical details, such as viral load, can be shared with third parties.

Instant feedback:

It's permitted under the law to release clients' names to the ASO, if they were asked to sign a consent to release their names but declined to do so.

Floridashealth.com Bureau HIV/AIDS Homepage

Crisis in Black community	HIV Surveillance
Men who have sex with men (MSM)	Corrections Programs
Guidelines Confidential Info	Trends & Statistics
Patient Care Services	2007 Fact Sheets
Women & Children (Perinatal)	Hepatitis Prevention

Please click here to see Consent Form (Consent to Share Confidential Information), referred to above

*AIDS Service Organization