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SPONSOR: |
Komadina |
DATE TYPED: |
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HB |
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SHORT TITLE: |
Informed Consent for HIV Testing |
SB |
805/aSPAC |
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ANALYST: |
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APPROPRIATION
Appropriation
Contained |
Estimated
Additional Impact |
Recurring or
Non-Rec |
Fund Affected |
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FY03 |
FY04 |
FY03 |
FY04 |
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NFI |
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(Parenthesis
( ) Indicate Expenditure Decreases)
Responses
Received From
Department
of Health (DOH)
Health
Policy Commission (HPC)
SUMMARY
Synopsis of SPAC Amendment
The Senate Public Affairs Committee Amendment
amends the bill to provide for the “opt out“ strategy for HIV testing of
pregnant women as opposed to “involuntary testing or mandatory testing”
strategy. The “opt out” strategy has been demonstrated to be equally
effective as “involuntary testing”. (See
Narrative below)
Synopsis of Original Bill
Senate Bill 805 amends Section 24-2B-5 NMSA 1978 to add to
the exemptions for informed consent. SB
805 proposes that informed consent is not required during the performance of a
prenatal test to determine if the human immunodeficiency virus or its antigen
is present in a pregnant woman.
Significant
Issues
Early HIV testing of pregnant women is an important
preventive strategy. Approximately
one-quarter of babies born to HIV-infected women will acquire HIV infection if
no medical intervention is provided during pregnancy. If an HIV-infected woman takes anti-HIV
medications during her pregnancy, the probability that her baby will acquire
HIV infection is reduced to approximately one percent. It is recommended that HIV treatment should
begin during the second trimester of pregnancy and continue through the time of
labor and delivery. In order to provide an
effective medical intervention that could reduce the transmission of HIV
infection from an infected woman to her newborn child, it is necessary to know
the HIV status of the pregnant woman.
The American Association of Pediatrics (AAP) and the
DOH reports that no HIV-infected babies have been born to a
CDC data indicate, according to DOH, that a testing strategy that allows a
pregnant woman to “opt out” of prenatal HIV testing is as effective as a
strategy that imposes involuntary or mandatory testing (Morbidity & Mortality Weekly Report 51: 1013-1016;
ADMINISTRATIVE IMPLICATIONS
It
is unlikely that the imposition of involuntary HIV testing of pregnant women
would significantly increase testing rates over those that have been achieved
through a strategy of voluntary testing.
Therefore, the fiscal impact of SB 805 would not be significant.
OTHER SUBSTANTIVE ISSUES
Three
major prenatal HIV counseling and testing strategies have been endorsed by
different public health and public policy officials, all with a goal of
universal testing: 1) voluntary testing with counseling regarding risks and benefits
(with or without signed consent); 2) testing with patient notification and
right of refusal; and 3) mandatory testing with no right of refusal. The strategy that is most appropriate should
be judged upon the effectiveness of that strategy in balancing individual
rights with achieving high rates of HIV testing, and the extent to which HIV
infections among newborns have been reduced as a result of adoption of that
strategy.
In
1996, the New Mexico Department of Health adopted the “opt in” strategy for
promoting HIV testing of pregnant women.
Since the implementation of that strategy, no HIV-infected babies have
been born to women who were residents of
DOH
reports that studies recently published by the CDC indicate that “opt out“
strategies for HIV testing of pregnant women are as effective as mandatory
testing strategies, and that neither strategy significantly exceeds the
efficacy of the “opt in” strategy as implemented in New Mexico (Morbidity & Mortality Weekly Report
51: 1013-1016; November 15, 2002).
Low rates of HIV
infection among pregnant women in
HPC states that:
The New Mexico Governor's Task Force on HIV/AIDS
Position Statement: HIV Counseling & Testing of Pregnant Women Originally
Adopted
·
Voluntary HIV testing to pregnant women
in
·
Enacting a cooperative, statewide effort
between DOH and representative women's groups to develop strategies and
educational materials regarding HIV testing that are culturally and linguistically
appropriate.
·
Establishing a resources to train
healthcare practitioners to provide HIV counseling and voluntary testing
(including referral information to anonymous testing sites) to pregnant women
and women considering pregnancy.
·
Providing educational materials about HIV
testing to healthcare providers who serve pregnant women.
·
Encouraging private providers to offer
voluntary HIV testing to their pregnant clients.
·
Appropriating adequate funding to support
healthcare provider education in: HIV pre- and post-test prevention counseling
and testing and the policy and procedure for obtaining informed consent to test
for HIV.
·
Creating a consumer/provider task force
to investigate and prepare a recommendation to the New Mexico Legislature
regarding adopting legislation to require healthcare practitioners in
There are 259 reported cases of female adults
and adolescents with HIV/AIDS in New Mexico.
HPC says that individuals with HIV/AIDS
generally have significant concerns about privacy and confidentiality, and
about the treatment they often receive from society. SB805 risks combining these concerns with the
State’s documented difficulty getting women prenatal care: if a woman is already concerned about seeking
care, she is likely to be even more reluctant if she knows that she will be
tested for HIV/AIDS without her informed consent. This reluctance could result in more women
simply not seeking prenatal care, which is not likely to lead to a positive
health outcome for New Mexico.