HIV testing is understood to be a cornerstone in effective HIV prevention policy. Yet too many women are not tested because they or their healthcare provider do not perceive that they are “at risk,” says the HIV Law Project.
HIV testing should be routine for all women, as it is during pregnancy. To achieve this goal, the federal and state governments should provide incentives for increased HIV testing, while maintaining important patient protections in the testing process.
“In order to increase testing rates, health care providers must be reimbursed by insurance providers for all HIV tests, regardless of the perceived risk of the person being tested,” says HIV Law Project’s Executive Director, Tracy Welsh.
Yet in most parts of the country, she notes, providers are only reimbursed for HIV tests given to patients who fall within established categories of risk for HIV. Women are most harmed by this policy. While 80 percent of women who test positive contracted HIV from a male sexual partner, heterosexual sex does not fall within established reimbursable risk categories. Rather, for heterosexual women, risk is assessed only based on known risk factors of their partner – a risk many women are unable to assess accurately.
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Some creative solutions to this problem have been put forward. In 2008, California passed landmark legislation that required all health insurers, public and private, to reimburse routine HIV screening. Other states should follow suit. Also, United States Senator Gillibrand of New York has introduced a bill (S. 1446) that would offer financial incentives to Medicaid providers to screen for HIV. Unfortunately this bill links reimbursement with opt-out style HIV testing, which is contrary to voluntary opt-in testing currently required in NYS.
“As we push to increase testing rates, particularly among women and girls, we must be sure that we do not sacrifice individual rights,” says Welsh.
Testing schemas that require a provider offer an HIV test create the foundation of a strong patient-provider relationship, while those that require a provider to perform an HIV test (even where the patient has the opportunity to decline the test) risk patient confusion, fear, and alienation. If providers are given incentives to encourage routine HIV testing of all their patients, particularly women, the vast majority of women will accept testing as has been shown in the prenatal context in NYS. When women know their HIV status, they can be connected with appropriate care and services, so that they can continue to care for themselves and their families.
“The HIV Law Project believes that all people deserve the same rights, including the right to live with dignity and respect, the right to be treated as equal members of society, and the right to have their basic human needs fulfilled,” said Welsh. “These fundamental rights are elusive for many people living with HIV/AIDS. Through innovative legal services and advocacy programs, HIV Law Project fights for the rights of the most underserved people living with HIV/AIDS.”