HIV/AIDSPOLICY AND PROCEDURE MANUAL

TABLE OF CONTENTSPAGE

SECTION 1 A. Standing Orders………………………………………………………. 1

B. Consent………………………………………………………………... 3

C. Language Barriers……………………………………………………. 5

SECTION 2 Types of HIV Antibody Collection…………………………………………... 6Viral Load Testing………………………………………………………. 6Antibody Testing………………………………………………………… 6Blood Test………………………………………………………………... 6Oral Mucosal Transudate Test…………………………………………… 7

SECTION 3 Protocols Regarding HIV Confidentiality, Release of Information and Discrimination………………………………………………………………… 8

Intra-Departmental Communication…………………………………… 8Contact Information……………………………………………………. 8Medical Records……………………………………………………….. 8Record Security………………………………………………………... 9Annual HIV Confidentiality In-service for Employees………………... 9Release of HIV Information in General……………………………….. 9Release of Information (If Patient Name Changes)…………………… 9Release of HIV Information to Patient………………………………… 10Release of HIV Related Information to Medical Providers and AIDS Care/AIDS Community Services of Western NY………………... 10

Release of HIV Related Information Via Fax…………………………. 10Release of HIV Related Information to Non-Medical Persons………... 11Subpoenas and Court Orders…………………………………………... 11Discrimination…………………………………………………………. 11

SECTION 4 HIV Pre-Test Counseling……………………………………………………... 12Opening the Counseling Session………………………………………... 12HIV Transmission and Prevention……………………………………… 12Reducing the Risk of HIV ……………………………………………… 13Discussing the HIV Test………………………………………………... 15Counseling and Testing Options………………………………………... 16Disclosure……………………………………………………….………. 16Discrimination…………………………………………………………... 17Closure………………………………………………………………….. 17Documentation………………………………………………………….. 18

SECTION 5 INTERPRETING TEST RESULTS…………………………………………. 19Interpretation of Rapid Tests and Confirmatory Testing………………… 20

SECTION 6 A. Post-Test Counseling – Seronegative/Nonreactive………………….... 25Test Result………………………………………………………. 25Meaning of Negative Test Result……………………………….. 25Develop a Preventive/Risk Reduction Plan…………………….. 25

Individual Preventive Strategy………………………………….. 27Literature/Brochures……………………………………………. 27Referrals………………………………………………………… 27Discrimination…………………………………………………... 27Documentation………………………………………………….. 27Disclosure……………………………………………………….. 27

SECTION 6 B. Post-Test Counseling – Indeterminate………………………………… 28Test Result………………………………………………………. 28Meaning of Negative Test Result……………………………….. 28Prevention/Risk Reduction……………………………………… 28Documentation…………………………………………………… 28

SECTION 6 C. Post-Test Counseling – 29Helping the Patient Cope with the Preliminary Positive Test… 29Test Result……………………………………………………….. 29Helping the Patient Cope with the Test Result………………….. 29Meaning of Positive Test Result………………………………..... 30Medical Follow-up and Support Services……………………….. 30Transmission Reduction…………………………………………. 31Reporting Requirements………………………………………..... 32Partner Notification…………………………………………….... 32Discrimination………………………………………………….... 33Documentation…………………………………………………… 33Disclosure………………………………………………………... 33

SECTION 7 Failure to Return for Test Results…………………………………………... 34

SECTION 8 HIV Partner Notification Assistance Program……………………………... 35

SECTION 9 Laboratory Services and HIV Testing………………………………………. 36

SECTION 10 Court Ordered HIV Testing…………………………………………………. 38

SECTION 11 Pre-Exposure Prophylaxis for HIV………………………………………… 42

PART I. HIV/AIDS

Appendices

Appendix A Informed Consent to Perform HIV Testing (DOH-2556)

Appendix B Authorization for Release of Confidential HIV Related Information Form (DOH-2557)

Appendix C Sample HIV Antibody Test Requisition Form

Appendix D Sample Orasure HIV Antibody Test Requisition Form

Appendix E Public Health Personnel Authorized to Access HIV Related Information (by county)

Appendix F HIV/AIDS Pre- & Post-Test Counseling Form

Appendix G Sample HIV Risk Assessment Form

Appendix H HIV Contact Information Form

Appendix I Medical Provider HIV/AIDS and Partner/Contact Report Form (DOH-4189)

Appendix J Employee Attestation of Confidentiality

Appendix K Title 10 Health Part 63 and Public Health Law Article 27F and Article 21, Section III

Appendix L Disclosure Statement

Appendix M Support Services (by county)

Appendix N Suggested Literature/Brochures

Appendix O Rapid HIV Antibody Test Result Form

Appendix P Sample Test Results Log

Appendix Q HIV Counseling & Testing/Reporting/Partner Notification Algorithm (includes Domestic Violence(DV) Screening Algorithm)

Appendix R Missed Appointment Letter (by county)

Origination Date: January 2002Latest Update: 03/24/15

SECTION 1

STANDING ORDERS, CONSENT FOR TESTING, AND

LANGUAGE BARRIERS

A. STANDING ORDERS:Chapter 429 of the Laws of 2005 amends both the Public Health and Education Laws to permit license physicians and certified nurse practitioners to issue non-patient specific orders for registered professional nurses who may be involved in directly providing HIV counseling and testing to patients (see Standing Orders and NYSDOH/NYSED Memorandum on following pages).

A registered nurse must obtain a patient-specific order from the Medical Director or Nurse Practitioner in order to deliver the final confirmatory HIV positive test result.

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PUT ON LETTERHEAD

STANDING ORDERS FOR HIV COUNSELING AND TESTING

The following standing orders are to be effective for the time period: (Month, day, year) through (Month/day/year) .

As per the HIV Policy and Procedure Manual; Registered Professional Nurses employed by or under contract with County Health Department are hereby authorized to provide confidential and/or anonymous HIV Counseling and Testing to those clients requesting such services.

RN’s employed by or under contract with County Health Department will: have successfully been in-serviced regarding HIV Counseling and Testing and be familiar

regarding HIV testing supplies and equipment prior to performing these functions. be knowledgeable regarding current NYSDOH regulations pertaining to HIV confidentiality,

consent, testing and reporting. be knowledgeable regarding HIV supportive services and treatment available to individuals

who have a positive or indeterminate result. maintain infection control practices as per agency Infection Control Exposure Plan.

At the Pre-Test Session, the client will be provided a copy of NYSDOH form Informed Consent to Perform HIV Testing (DOH-2556) and allowed the opportunity to have questions answered. Clients who then choose to have an HIV test will be asked to sign the consent form.

If a client’s HIV tests results are confirmatory positive, the County Health Department Medical Director will be contacted prior to Post-Test session and a patient-specific order to deliver the results to the client will be obtained. In accordance with NYSDOH law, the County Health Department HIV Coordinator/Designee will report new cases of HIV and the names of the client’s known sex and/or needle-sharing partners to the New York State Department of Health.

At the Post-Test session, the client will be provided with test results. Those with negative test results but identified risks will be provided with relevant information, and these individuals will be encouraged to access HIV prevention programs and services appropriate to their risks. Those individuals with positive results will receive assistance with accessing medical care and referrals to other supportive services. In addition, education will be provided to reduce risk of HIV transmission to others and information regarding partner notification options.

Medical Director License Number Date

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B. CONSENT:

Informed Consent for HIV Antibody Confidential and Anonymous Testing

Prior to testing for HIV antibodies, you must receive the patient's informed consent. The patient must be offered the information contained in the Informed Consent to Perform an HIV Test (DOH-2556) (Appendix A), available in English and alternate languages, and be given sufficient opportunity to have any questions addressed. The person must give voluntary consent to testing and sign the written consent form. If patient is requesting anonymous testing, patient will sign using identifying code numbers rather than signature. The Informed Consent to Perform an HIV Test then becomes part of the medical record. If performing Rapid HIV Testing, documented oral consent is acceptable unless testing occurs in a correctional facility.

Capacity to consent means an individual, regardless of age, has the ability to understand and appreciate the nature and consequences of a proposed health care service (HIV Antibody Testing), and to make an informed decision regarding the HIV Antibody Test and the results and meaning of the test results.

If there is any doubt whether the patient has the capacity to consent (due to mental incompetence, lack of understanding, altered mental status due to medication, effects of anesthesia, intoxication) or is consenting due to external pressures (involuntary), do not perform the test at this time. It is important to be aware of the patient’s emotional or cognitive state, since this may have an impact on capacity to consent.

If you believe that the patient temporarily lacks capacity to consent, defer the discussion to a later time. In the patient’s medical record, document the fact that a test was not done at this time.

If the patient legally lacks the capacity to consent, the person lawfully authorized to consent to health care for the patient should be contacted. In this circumstance, counseling should be provided to the patient and the person lawfully authorized to consent to health care for the patient.

Minors (persons under age 18) may receive HIV counseling and testing without parental consent.

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Protocol for Withdrawing Consent for HIV Testing and for Disclosure of HIV Related Information

Policy: Under NYS Public Health Law, the patient has the right to withdraw consent for HIV testing and for disclosure of confidential HIV-related information at any time.

Procedure:

Withdrawal of consent may be done orally or in writing, but must be done in person;

For withdrawal of consent for testing: The following information must be written in red on the Informed

Consent to Perform an HIV Test (DOH-2556) (Appendix A)

Patient has withdrawn consent for HIV testing effective (date) .

For withdrawal of consent for disclosure of HIV-related information: The following information must be written in red on the Authorization to

Release Confidential HIV-Related Information (DOH-2557) (Appendix B)

Patient has withdrawn consent for disclosure of HIV-related information Effective (date) .

Encourage patient to sign applicable statement.

If patient chooses to withdraw consent for disclosure for only specific individuals, specify these individuals in statement above.

Explain to the patient that subsequent requests for release of HIV-related information will require that the patient sign a new Authorization for Release of Confidential HIV-related Information (DOH-2557) (Appendix B) in order for the LHD to release any information.

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C. LANGUAGE BARRIERS:

HIV Antibody Testing requires informed consent. This requirement presumes that the patient be offered HIV pre and post test counseling in a language they clearly understand. If the HIV counselor is unable to speak the language, it will be necessary to have an interpreter assist. (See LHD Administrative Manual, Interpretive Services Policy)

An acceptable interpreter will be clinic, agency staff, subcontract agency, clergy, or volunteer who speak the language. It is suggested that the interpreter be approved by the individual receiving services. Family members or significant others should be used with caution as an interpreter, as bias may interfere with counseling.

If it is necessary to utilize a translator during a HIV Test Counseling session, the following steps must be taken:

1) Patient/Client to be HIV counseled signs Authorization for Release of Confidential HIV Related Information form (DOH-2557) to authorize release of information to translator. Use form that is in the patient’s language, if applicable. (See Appendix B for form.)

2) On the authorization form the “Reason for release of HIV information” is listed as “Translation purposes”.

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SECTION 2

TYPES OF HIV COLLECTION

VIRAL LOAD TESTING

This test measures any HIV in the body. It is obtained through venipuncture. It can detect HIV before antibodies have developed, and are therefore more accurate if infection has occurred in the last month. It may take up to seven days from exposure before virus can be detected Viral load testing is conducted for court ordered testing in conjunction with antibody testing (see Section 10).

ANTIBODY TESTING

The HIV antibody test does not: l) detect the virus itself; 2) give any information about the stage of HIV infection; 3) detect the presence or absence of illness or disease.

Antibodies are substances produced by the immune system in white blood cells (lymphocytes) in response to the presence of infectious agents, such as viruses or bacteria, or other substances foreign to the body. Substances that cause the production of antibodies are called antigens. The virus, HIV, is the antigen that stimulates the immune system to produce HIV antibodies.

Most people with healthy immune systems will produce antibodies to HIV in response to HIV infection. Antibody production begins as soon as the immune system recognizes the presence of HIV.

The point at which the body produces enough anti-body so that it can be detected by available HIV antibody tests is called seroconversion. The period of time between infection and seroconversion is known as the "window period”. The “window period” is defined as three weeks to three months.

There are two types of samples for HIV antibody testing used by the LHD and have been approved by the New York State Department of Health (NYSDOH). They are a blood sample and an oral mucosal transudate sample.

See S2AY Network Equipment/Supplies Manual for Rapid HIV Test policy and procedure.

Both types of samples are tested for the presence of HIV antibodies, not the virus itself, using Enzyme-linked Immunosorbent Assay (ELISA) technology. Samples found to be repeatedly reactive by ELISA screening are confirmed with Western Blot testing.

BLOOD TEST

There are two methods of Blood Test: A rapid test via fingerstick or a diagnostic HIV blood test via venipuncture.

Rapid HIV tests allow for a different approach to specimen collection and HIV testing. Results are available in 10 to 30 minutes after specimen collection. Only workforce that have been

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trained in the use of the CLIA-waived test may assume responsibility for both specimen collection and for the testing.

For Rapid HIV Test via fingerstick procedural methods, see Tabs 5 & 6 of the S2AY Network Equipment/Supplies Manual: Rapid HIV Testing – Chembio® HIV 1/2 STAT-PAK®, OraQuick Advance® and Uni-Gold™.

The Rapid HIV Test is not considered a confirmatory test for HIV. The diagnostic HIV blood test via venipuncture must be performed to confirm a positive Rapid HIV Test result.

For venipuncture test, ten (10) cc’s of blood are drawn, usually from a vein in the arm, into a plastic vacuum blood collection tube. (See S2AY Network Nursing Procedures Manual for Peripheral Venous Blood Draws policy). Label the tube with ID#/ client name, date of specimen collection and site name. This amount is sufficient to complete the entire HIV antibody testing process.

The laboratory approved requisition should be completed. (See Appendix C for sample contact information for requesting requisition kits) If anonymous test, put ID code number in place of name; Leave the patient street address blank to protect confidentiality; Fill in medical record number and/or DIN number if applicable. Indicate possible exposure to Type 2, if indicated. May need to follow up with call to the

lab.

The blood sample is then sent to an approved laboratory for serological testing. NOTE: Wadsworth Laboratory will only do confirmatory venipuncture.

Oral Mucosal Transudate Test

There are two types of HIV tests using oral mucosal transudate. Orasure which is processed at a lab and Rapid HIV testing which is CLIA waived. For Rapid HIV Test via oral mucosal transudate procedural method, see Section 5 of the S2AY Network Equipment/Supplies Manual: Rapid HIV Testing – OraQuick Advance®.

OrasureOrasure was licensed by the FDA in 1997.

The collection pad is designed to collect oral mucosal transudate which contains antibodies. The health care professional must follow package instructions for testing. The collection pad attached to a plastic handle is then placed in a vial of preservative and sent to a designated laboratory. Submit original requisition slip with Orasure sample to the laboratory. (See Appendix D for sample Orasure HIV Antibody Test Requisition Form.) A copy of the requisition form will be part of the client record.

A single sample is adequate for the entire antibody testing procedure.

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SECTION 3

Protocols Regarding HIV Confidentiality, Release of Information and Discrimination

Intra-Departmental Communication

Ordinarily, HIV-related information about a client will only be shared with other employees within the department who need to know the information in order to provide health care and/or health-related services to that client or for administrative, supervisory, or reimbursement purposes. Employees in the following job titles who may need confidential HIV-related information in order to perform the following job functions are authorized to have access to confidential information without needing to obtain the client’s consent: (see Appendix E for Public Health Personnel Authorized to Access HIV Related Information.)

In all other circumstances, department staff may not have access to or disclose HIV-related information about any client unless the client first signs the required special written consent form.

Contact Information

Concerns or questions regarding HIV Confidentiality can be addressed by calling:

NYSDOH AIDS Institute 1-800-962-5065NYSDOH AIDS Institute- Rochester 1-585-423-8115Legal Action Center 1-212-675-0286Legal Assistance 1-800-962-5065NYSDOH Western Regional Office 1-716-847-4500

Medical Records

Forms to be used:

Every patient record should contain the following: Informed Consent to Perform an HIV Test (DOH-2556) (Appendix A)

HIV Pre- & Post-Test Counseling Form (Appendix F) HIV Risk Assessment (see Appendix G for samples) Lab Results Copy of Test Requisition Form optional (Appendix C or D) HIV Contact Information Form (see sample Appendix H) If applicable, Authorization for Release of Confidential HIV-Related Information

(DOH-2557) (Appendix B) If applicable, Medical Provider HIV/AIDS and Partner/Contact Report Form

DOH-4189 (Appendix I)

Record Security

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All records must be located in a safe and secure place which is locked.

Computer databases, including HIV information, must include a security system so that unauthorized personnel cannot access stored information. HIV related information must be coded in such a way as to not be recognized by unauthorized personnel.

See LHD Administrative Manual for additional information regarding security of information. See NYS Education Department record retention law (Records Retention and Disposition Schedule (CO-2)) for more guidance regarding record storage.

Annual HIV Confidentiality In-service to Employees

Upon hire and annually thereafter, all employees working for the Local Health Department will receive mandatory in-servicing on Confidentiality and will sign an Employee Attestation of Confidentiality (See Appendix J).

Release of HIV Information in General

HIV related information will only be released in written form. All correspondence or records that include HIV related information must be accompanied by the disclosure statement except for those listed in Title 10: Part 63 Appendix K-Section 63.[5]6 and including the following changes:

A health care provider or health facility when knowledge of the HIV related information is necessary to provide appropriate care or treatment to the protected individual, a child of the individual, a contact of the protected individual, or a person authorized to consent for health care for such a contact.

Third party reimbursers or their agents to the extent necessary to reimburse health care providers for health services; provided that, where necessary, an otherwise appropriate authorization for such disclosure has been secured by the provider.

See Appendix L for HIV/AIDS Disclosure Statement.

Release of Information (if Patient Name Changes)

Patient must fill out a new Authorization for Release of Confidential HIV Related Information (DOH-2557) (Appendix B), signing both new name and previous name in signature space. Staff should compare signature with prior signature in medical record.

Release of HIV Information to Patient

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Patients will be verbally told test results in person during the Post-Test Counseling Session. A registered nurse must obtain a patient-specific order from the Medical Director or Nurse Practitioner in order to deliver the final confirmatory HIV positive test result.

If the patient requests written test results, the patient will be counseled regarding the LHD’s policy on release of written test results.

With patient’s written consent, parent/partner/legal guardian may view test results.

Release of HIV Related Information to Medical Providers and AIDS Care or AIDS Community Services of Western NY

The patient must fill out the Authorization for Release of Confidential HIV Related Information (DOH-2557). (Appendix B) The Agency’s Privacy Officer should be consulted prior to any release of information.

Post-test counselor shall make copies of Authorization for Release of Confidential HIV Related Information (DOH-2557), and label result with patient’s name if necessary, and send with Confidentiality Disclosure Statement (Appendix L) with the exceptions listed in Title 10: Part 63 Appendix K-Section 63.[5]6 and including the changes listed above. Write or stamp confidential on envelope.

Document the fact in the patient’s record that the information as requested was sent. Retain the original copy of Authorization for Release of Confidential HIV Related Information (DOH-2557) and maintain in medical record.

Release of HIV Related Information Via Fax

If the need arises to fax HIV related information the following steps will be taken.

It must be determined that the need is absolutely essential for continued medical care of the client (e.g. case of Labor & Delivery, continue primary care.)

The client has signed an Authorization for Release of HIV Related Information (DOH-2557) that includes that the information will be faxed.

The agency representative that is to receive the faxed information is given prior notification by phone that requested information is coming.

Post-test Counselor shall fax copies of the Authorization for Release of HIV Related Information (DOH-2557) (Appendix B), test result including Confidentiality Disclosure Statement (Appendix L) with the exceptions listed in Title 10: Part 63 Appendix K-Section 63.[5]6 and including the changes listed above, and will write/stamp confidential on fax cover sheet.

Document the fact in the patient’s record that the information was requested and sent. Retain the original copy of the Authorization for Release of HIV Related Information (DOH-2557) and fax cover sheet, and maintain in medical record.

Release of HIV Related Information to Non-Medical Persons

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Non-medical agencies requesting HIV information will be referred to the individual’s primary care provider. HIV information will not be released to non-medical persons other than designated HIV support organizations.

Subpoenas and Court Orders

If any program receives a subpoena, it will be forwarded to the LHD’s designated Privacy Officer. See Section 10 of this manual for court ordered HIV Testing.

Discrimination

People have been discriminated against because of disclosure of HIV-related information. If the patient experiences discrimination because of disclosure of HIV-related information, the patient should call the NYS Division of Human Rights at 1-800-523-2437.

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SECTION 4

HIV PRE-TEST COUNSELING

HIV counseling and testing may only be performed by staff who have successfully been in-serviced regarding HIV Counseling and Testing and are familiar regarding HIV testing supplies and equipment prior to performing these functions. Detailed face-to-face counseling is not required by Public Health Law, Article 27F. Pretest counseling should be conducted with individual patient only. Inclusion of others is discouraged except in cases where an individual cannot consent on their own behalf or needs an interpreter. Ensure that privacy statement and patient bill of rights is made available to patient and may be documented on the HIV Contact Information Form (Appendix H).

Opening the Counseling Session Explain to the patient that you would like to discuss something very important to the

patient’s health, something you discuss routinely with all your patients: HIV and AIDS. Using the HIV Risk Assessment Form (see samples in Appendix G) determine the patient’s individual risk factors for HIV.

Explain that this discussion, like all your discussions with the patient, will be kept confidential.

Encourage the patient to discuss knowledge of, and any concerns about HIV/AIDS; set a supportive, nonjudgmental atmosphere in which the patient will feel comfortable.

Discuss patient support mechanisms. Ask the patient about any history of HIV counseling and testing.

Proceed with a discussion of HIV transmission and prevention. Explain that anonymous HIV testing is available and explain the difference between

anonymous and confidential HIV testing. If the patient has never been tested or has tested negative, proceed with counseling

and HIV testing. If the patient has previously tested HIV positive, determine whether they are

receiving appropriate medical care and support services. If the patient is not receiving care or needs additional services advise patient of services available and methods to access these services.

If the patient was tested anonymously in a NYSDOH Anonymous Testing Program and still has their identifying code number slip, anonymous results can be converted to confidential results through the NYSDOH testing site. Ask the patient if they would like to convert from anonymous to confidential. If not, explain that a retest is necessary to document test results. Offer HIV re-testing.

HIV Transmission and Prevention Provide Basic Information on HIV and AIDS

Ask what the patient knows about HIV/AIDS. Explain that Human Immunodeficiency Virus (HIV) is believed to cause Acquired

Immune Deficiency Syndrome, most commonly known as AIDS. HIV infection causes a breakdown in the body’s immune system. When the immune system is

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weakened, the body cannot fight off infections. The most serious consequences of HIV infection is AIDS.

A person with AIDS gets illnesses that are of little or no threat to someone with a healthy immune system.

It can take as long as 10 years or perhaps longer, for a person with HIV infection to become symptomatic and develop AIDS. It is still unknown whether all persons with HIV infection will eventually develop AIDS.

Most people who are infected with HIV do not appear or feel ill and may be unaware of their infection. However, any HIV infected person, whether asymptomatic or symptomatic can transmit the HIV virus to others.

HIV antibody testing is recommended to all patients because it is difficult to know if the patient was ever exposed, and because there are treatments available to HIV infected persons that can prolong good health.

Explain that HIV is transmitted when an infected person engages in specific behaviors with an uninfected person. Anyone who is infected can infect others by: Unprotected vaginal or anal intercourse (without a latex or polypropylene condom); Using condoms incorrectly; Having unprotected vaginal or penile oral sex, particularly in the presence of genital

or oral sores/lesions, bleeding gums, or menstrual blood; Sharing drug injection paraphernalia (needles, works, straws, cotton, cookers, water

glass); Women to their babies during pregnancy, birth, and breastfeeding; Other blood to blood transmission such as sharing razors, toothbrushes, nail care

apparatus, etc.; Occupational exposure.

Explain that having multiple sexual partners may increase the potential for exposure to HIV and other sexually transmitted diseases. However, exposure to just one infected partner can result in HIV infection.

Explain that having an STD increases the risk of contracting HIV. STD’s cause inflammation on the surface of the mucous membranes of the genitals. HIV infects types of white blood cells called CD-4 lymphocytes and

monocyte/macrophage cells. If a person has an STD, more of these target cells are available on the surface of the

vagina, urethra, rectum, etc., thus facilitating reception of HIV. If the person with an STD also has HIV the infected target cells are more easily

available to transmit HIV to an uninfected person. Discuss patient’s risk for other STDs and Hepatitis A, B and C. Offer immunization for

Hepatitis A and/or B, and refer for testing, if appropriate.

Reducing the Risk of HIV Explain that the risk of HIV infection through sexual contact can be reduced:

Best Choice (Safest) - no HIV risk abstinence mutual masturbation mutual monogamy with an HIV negative partner

Best Alternative - effective when used correctly use a male condom for vaginal and anal intercourse.

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use a male condom for penile oral sex use a dental dam or latex or polypropylene barrier for vaginal oral sex

Second Best Alternative use a female condom

Worst Choice- very risky use no protection at all

The NYS Department of Health recommends that additional or separate applications of a spermicide called nonoxynol-9 (N-9) not be used. Studies show that the spermicide N-9 may irritate the vagina and promote HIV infection during sexual intercourse. A study conducted at several locations in Africa studied the effectiveness of N-9 inserted intravaginally and used with a condom to prevent the spread of HIV. While the study results are not yet conclusive, they seem to suggest that N-9 may not protect against HIV infection and may have caused a higher rate of HIV transmission among the women in the study. N-9 may be particularly irritating to the lining of the rectum and therefore should not be used during anal intercourse.

Patients should be advised that not using a spermicide increases the risk of pregnancy.

Considerations regarding STD’sRegular screening and early treatment of STD’s can be important in reducing the risk of HIV.

Considerations regarding male/female condomsCondoms can deteriorate over time and under adverse conditions. Counsel patients to observe expiration dates. Counsel patients to use latex or polypropyline condoms and not natural skin condoms, avoid exposing condoms to extreme heat/cold, and/or friction (i.e. storing in back pants pockets), and avoid exposing condoms to petroleum-based lubricants, which will cause latex condoms to deteriorate. Condoms cannot be reused. Discuss proper disposal of used condoms. If dispensing condoms, inquire as to patient latex sensitivity.

Instruct regarding proper application of condoms.

Explain that the risk of HIV infection through drug use can be reduced:

Best Choice* Attend a treatment program; get ongoing support; remain drug free

Second Best Choice* Use a syringe exchange program to obtain clean needles; don’t share “works”

Third Best Choice* Clean “works” using bleach and water or boil “works” for 10 minutes, even if you are told the works were never used; do not share “works”

Fourth Best Choice* If sharing “works”, clean with bleach or boiling water between each person’s use

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* Use alternative to injection, e.g., smoking or ingestion

Dual Risk of Substance Use and Sexual ActivityIf an individual engages in sexual activity when “high”/intoxicated, it is important to review approaches to reducing sexual risk. Discuss with the individual that when under the influence of drugs and/or alcohol they are at increased risk of not taking appropriate precautions. Some drugs such as cocaine and crack increase libido.

Explain that HIV cannot be spread by casual contact, including:* shaking hands* eating or drinking from common utensils* sneezing or coughing using public toilets* being around an infected person

There has been no documentation of HIV transmission from saliva, urine, or tears. Contact with these body fluids is considered safe unless there is blood present in them.

Dry kissing, except in the presence of open sores or lesions on the mouth, is considered safe. Deep kissing poses a risk if sores, lesions, or blood are present in the mouth.

Discussing the HIV Test Explain to the patient that all sexually active or drug-using persons are encouraged to be

tested for HIV as routine standard of care. Tell the patient the benefits of being tested.

If the test result is negative and the patient has not engaged in any activity that could result in infection in the past three months, the patient is probably not infected. Discuss retesting, if appropriate.

If not infected, the patient can take precautions to prevent infection by following the risk reduction steps. Repeat the ways in which infection occurs and can be prevented.

If the confirmatory test is positive, it means the patient is infected with HIV. Since the test only detects antibodies it cannot determine where in the disease continuum the patient is. Only a medical evaluation can determine that.

If the confirmatory test is positive, there are many new treatments that can prevent illness and the progression of disease.

If the confirmatory test is positive, the patient can take steps to prevent transmitting the virus to others or reinfecting themselves which has been shown to be a cofactor in disease progression.

Advise pregnant women or women considering pregnancy that, if confirmatory test is positive, there are medications available that can significantly reduce the chances of a woman transmitting the virus to her child.

Advise women that if the confirmatory test is positive, their partner(s) and children may be infected and should be tested.

Advise breastfeeding women who have engaged in HIV risk behaviors in the past three months that they should consider discontinuing breast-feeding until they receive a negative test result.

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Review Psychological and Emotional Consequences of Receiving the Test Result Inform the patient that anxiety about the HIV test result is a common feeling. Assure

the patient that you will assist with identifying psychological and emotional supports if needed.

Review HIV Antibody Test and Procedure Explain that the HIV test is an antibody test. While it can reveal if an individual has

been infected with HIV, it cannot show if a person has or will develop AIDS. Explain to the patient the timeframe for receiving test results. Results are only given

in person at the post test session.

HIV Counseling and Testing Options

Explain the Difference Between Confidential and Anonymous Counseling and Testing Confidential: Explain that the advantage of confidential counseling and testing is that

necessary medical care and support services can be arranged immediately if needed. HIV counseling and testing information, including the test results, is recorded on the patient’s medical record; the result is protected by state law from unauthorized disclosure. The patient’s name will be reported to the health department if there is a confirmed positive HIV antibody test result received through a confidential test, other HIV-related results, a diagnosis of AIDS, or if they have chosen to attach their name to a positive test result at an anonymous site. The health department will use this information to track the epidemic and to better plan prevention, health care and other services.

Anonymous: Anonymous counseling and testing may be available through the local health unit and is available through the NYS Department of Health. No personal identifying information is asked at any time. Records, including blood specimens when applicable, are identified by code numbers.

If available at site, explain the methods of testing for HIV antibody which may include: Diagnostic HIV blood test via venipuncture OraQuick Advance® – oral or fingerstick method. Uni-Gold™ Orasure

Disclosure

Explain to the patient why it is important for medical providers to have information about HIV status. Medical care early in the course of HIV infection may prevent some infections and improve overall health status. For some illnesses, such as syphilis and tuberculosis, medical treatment is different for people infected with HIV. (See agency Tuberculosis Manual for details on Tuberculosis and HIV infection).

Restate that HIV-related information is confidential. Per LHD policy, HIV-related information can only be given to persons the patient identifies in writing on the HIV release form. For persons tested at an HIV/STD clinic, only those identified on the HIV release form and a Partner Notification Assistance Program (PNAP) representative will be provided HIV test results. Under law, the patient has the right to withdraw consent for disclosure of HIV-related information at

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any time. Explain that if someone discloses confidential HIV-related information about the patient to others without permission, that person can be fined, imprisoned, or both.

All disclosures of confidential HIV-related information, except disclosures made to the patient, to individuals authorized to consent for care for the patient, or to known contacts as permitted by law, must be accompanied or followed by a written disclosure statement (See Appendix L for Disclosure Statement.)

Complaints of HIV testing conducted without consent, without pre or post test counseling or disclosures made without consent can be reported to the New York State HIV Confidentiality Law Hotline at (800) 962-5065.

Discrimination

Advise the patient to be careful telling other people about having been tested for HIV. If the patient experiences discrimination because of disclosure of HIV-related information, the patient should call the NYS Division of Human Rights at 1-800-523-2437.

Consent

Obtain consent for testing (see Section 1. B. for procedure for obtaining consent).

Closure Pre-Test Counseling Session

If a patient agrees to be tested: Review the benefits of knowing HIV status:

If the test is negative and no risk is identified during the past three months, the patient is probably not infected and can take steps to remain uninfected.

If the confirmatory test is positive, the patient, partners, and children can receive early medical evaluation and treatment.

Remind the patient that the post test appointment for confirmatory test results, if applicable, is very important in order to: get the HIV test results; arrange for medical evaluations, as appropriate; get help with referral to services, as necessary; get information about care for partners and children; answer any questions and clarify information.

Review HIV Contact Information Form (Appendix H) with patient and complete. Explain that if the patient misses the post test appointment they may call to reschedule.

Anxiety is a common feeling while waiting for HIV test results. Explore resources the patient may have to help cope. Ask the patient: if there is a close friend or family member the patient trusts and can talk to about

personal information; about past and present experience with anxiety, depression, postpartum depression,

suicidal thoughts or attempts; to identify past and current coping mechanisms, how the patient handles difficult

situations;

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how the patient anticipates coping with waiting for the test result; what the patient thinks the test result will be; how the patient anticipates coping with a positive test result; a negative test result.

Give the patient feedback: reinforce positive coping mechanisms used in the past and suggest new ways to cope.

Discuss support services available to persons who test HIV positive. AIDS Care, 259 Monroe Ave., Rochester, NY (585) 545-7200See Appendix M for additional Support Services.

Encourage the patient to discuss HIV transmission, risk reduction and availability of counseling and testing with partner(s).

Offer the patient an information packet in a non-identifying manner (i.e. manila envelope,

paper bag) See Appendix N for list of suggested literature to include in information packet.

Documentation

Document that HIV pre test counseling was provided and the patient’s decision about testing on the HIV Pre & Post-Test Counseling Form (see Appendix F for form). If the patient is tested, include the signed informed consent and any signed release of HIV-related information forms in the medical record along with HIV Risk Assessment form (Appendix G) and the HIV Contact Information Form (Appendix H).

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SECTION 5INTERPRETING TEST RESULTS

Interpretation of Rapid Screening Tests and Confirmatory Tests

Rapid Screening Tests

Results can only be one of the following: Nonreactive (negative) Reactive (preliminary positive) Invalid (the test result can not be interpreted)

Please see Chembio® HIV 1/2 STAT-PAK®, OraQuick® Rapid Test Result Panel, and Uni-Gold™ (attached) for examples of test interpretation. When the result is read, document the result on a Lab Slip Result (see Appendix O for sample form), and log the result into the Test Results Log (see Appendix P for sample log).

Rapid test results are documented on a Lab Slip Result, and test results are recorded and logged each day of testing. Logs include the date and time of testing, an identifier for the person being tested, a test kit log number and expiration date, test result, action taken if the result was invalid, identification of the person who performed the test, whether confirmatory testing was requested, and the confirmatory test results when they are available.

Please see Rapid Testing Decision Tree (attached) for procedure on delivering test results to the client.

Confirmatory Testing

If the HIV rapid test or Orasure result is reactive, the test result is a preliminary positive. A confirmatory (diagnostic) blood test then must be performed via venipuncture. Follow the procedure guidelines for administering a venipuncture test.

After collecting a venipuncture specimen, the specimen must be labeled, and documented in the Test Results log (Appendix P). When the diagnostic result is received, the result is to be documented on the Test Results log. Please follow the policy and procedure guidelines for administering the test results to the patient.

Diagnostic HIV tests include: Antibody differentiation test, which distinguishes HIV-1 from HIV-2. Examples are

o HIV-1/2/O enzyme immunoassay (EIA) o HIV-1/HIV-2 discriminatory rapid test

The results for these tests are either reactive or nonreactive, meaning that HIV-1 and/ or HIV-2 were detected or not detected.

HIV nucleic acid test, which looks for virus directly. Examples are:o Qualitative HIV-1 RNA detection by transcription mediated amplification (TMA)o Qualitative HIV-2 RNA detection by real-time PCR

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The results for these tests are either reactive or nonreactive, meaning that HIV-1 and/ or HIV-2 were detected or not detected.

HIV-1 Western blot, which detect antibodies. Results for the Western blot test are:

o Positive, meaning the HIV-1 antibody was detected o Negative, meaning the HIV-1 antibody was not detectedo Indeterminate, which means that there was evidence of some viral proteins but not

in band position or number sufficient to report the result as positive. Indeterminate HIV-1 antibody by Western blot patterns can be due to many causes, including early HIV-1 infection, cross-reactive antibodies produced from recent non-HIV infections, hypergammaglobulinemic states, connective tissue disorders, and pregnancy (alloantibodies). Individuals suspected of having acute or early HIV-1 infection should undergo detection of qualitative HIV-1 RNA.

CDC has issued revised recommendations(http://www.cdc.gov/hiv/testing/laboratorytests.html) for laboratory testing for the diagnosis of HIV infection because of evidence that many persons infected with HIV at the time of testing were not detected by some antibody tests or the Western blot.

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Interpretation of Results for Chembio® HIV 1/2 STAT-PAK®

Nonreactive Result One pink/purple line in the CONTROL (C) area, with no line in the Test area is a

Nonreactive result. A nonreactive result at 15 minutes means that HIV antibodies were not detected in the

sample.

Reactive Result Two pink/purple lines – one in the Test area and one in the Control area indicate a

Reactive result.NOTE: The line in Test area may not look like the line in the Control area. One may be darker than the other.

If any visible line appears in both the Test area and in the Control area, the result is Reactive.

Invalid Result A control line must always be present in the control area for the test to be valid. If there is no control line after 15 minutes, the test is Invalid. Repeat the test with a new device. Be sure that the sample and 3 drops of Running Buffer are added correctly An Invalid test result means there was a problem running the test, either related to the

specimen or to the device. An Invalid test result cannot be interpreted. Contact Chembio if you are unable to get a valid test result upon repeat testing.

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21

Uni-Gold ™

INTERPRETATION FOR WHOLE BLOOD SAMPLE

FOR A TEST TO BE VALID A CONTROL LINE MUST BE PRESENT AND THE SAMPLE PORT MUST CONTAIN FULL RED COLOR

Invalid Results

24

Uni-Gold ™

Invalid Results Valid Results

25

Rapid Testing

Invalid

Retest

Invalid

Additional RiskAssessment

Conduct Confirmatory

Testing

Rapid Testing Decision Tree

HIV non-reactive HIV reactive

Venipuncture(preferredmethod)

WB Indeterminate

Provide post testin person

Follow policy recommendationsfor retesting client, if recent risk

HIV Positive

Oral Fluid

Provide Rapid TestResult to Client

Follow policy recommendationsFor retesting client, if recent risk

STOP OfferConfirmatory test

HIV Negative

Contact supervisor

Conduct controlsPrior to any additional

rapid testing26

POST TEST COUNSELING(When HIV Rapid Testing is performed and the result is negative, pre test and post test

counseling occur at the same visit.)

SECTION 6A SERONEGATIVE/NONREACTIVE

Test Result

All patients will receive the HIV antibody test result in person.

Begin post test counseling session by providing the test result. Show the patient the rapid test device or the confirmatory lab slip with the recorded test

result. Give the patient time to react to the test result and encourage the patient to express feelings

and concerns. Address the patient’s immediate concerns.

Meaning of a Negative Test Result

A Seronegative/Nonreactive Test Result means that there were no antibodies detected the day the blood was drawn.

Explain that: If the patient has not engaged in any risk behavior in the past three months, the patient is

most likely not infected with HIV. This means the patient was either not exposed to HIV or if the patient was exposed they did not become infected. If the patient is a new mother and is not infected, the baby is not infected. All newborns in NYS are tested for HIV as part of the Newborn Screening Program

and the mother is given the test results in the hospital or at the newborn’s first pediatric visit.

Explain the window period. If the patient has engaged in HIV risk behaviors in the past three months, the patient may be infected with HIV but may have not yet had an immune response that produced HIV antibodies. People usually produce antibodies within 3-12 weeks after infection (very few individuals take longer or never develop antibodies). Discuss retesting for HIV if the patient’s risk history reveals the need. Explain to the new mother, that if she is breastfeeding she should discontinue until

being retested. Explain that a negative test result does not mean that the person is immune to HIV

infection. Exposure to HIV always presents a risk for infection.

Develop a Prevention/Risk Reduction Plan

Help the patient to identify and understand their risk for HIV infection in relation to their personal risk.

Sexual Risk BehaviorIf appropriate, offer to include the patient’s partner in risk reduction counseling.

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The sexual or drug use history of one’s partner is often not reliably ascertained. Therefore, patients should be counseled to avoid sexual intercourse without a condom unless they are certain of their partner’s behavioral risk history and HIV serostatus. The only way to be certain that neither partner is infected is if both partners are tested, are negative, and have not engaged in risk behavior.

Talk about sexual behaviors that may put people at risk (if they are uncertain about their partner’s risk history and HIV serostatus):

Vaginal intercourse without using latex or polypropylene condoms; Oral-penile or anal intercourse without the male partner using latex or polypropylene

condoms; Oral-vaginal sex, particularly in the presence of genital or oral sores, lesions, bleeding

gums, or menstrual blood.

Drug Risk BehaviorThe discussion of needle drug behavior (intravenous and skin-popping) is appropriate when counseling patients who use drugs, or are suspected of using drugs.

Explain that not using drugs can greatly reduce the potential for acquiring HIV. Although abstinence from all drugs should be strongly encouraged, all drug users

should be made aware of the importance of:* Not sharing needles, “works”, cookers and other drug-injecting/snorting

paraphernalia;* Cleaning all injecting equipment before each use (flush needle and syringe two

times with bleach, then with water).* Advise regarding the availability of needle exchange programs and Expanded

Syringe Access Program (ESAP) which permits the purchase of syringes from participating pharmacies without a prescription. (See website www.health.state.ny.us/nysdoh/hivaids/esap/regover.htm for more information)

Encourage the patient to enroll or stay in a drug treatment program. Make referrals as appropriate.

Other Drug Use BehaviorExplain that the use of any of the following substances may put the patient at risk because it makes it more difficult to practice safer sex: alcohol, marijuana, barbiturates/other sedatives (downers), amphetamines/other stimulants (uppers), hallucinogens, cocaine, crack, heroin, steroids

Several factors implicate the emergence of cocaine use, by injection, snorting and smoking, as a risk factor for HIV. Studies show that, compared to heroin, needle sharing in cocaine injection is more strongly related to HIV infection, possibly due to more frequent injections in cocaine use. Those who smoke cocaine in the form of “crack” may also risk HIV

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infection due to unsafe sexual practices, including the exchange of sex for drugs. Crack users may also inject cocaine and/or heroin to counteract the extreme effects (highs and lows) of crack.

Individual Prevention Strategy

Help the patient to develop a strategy to reduce personal risk of exposure to HIV. Help the patient prepare to use the prevention strategy. Discuss any difficulties anticipated in carrying it out. Provide information about the proper use of condoms. If the last risk for HIV was within three months, encourage the patient to be retested. If

possible, offer to retest the patient. Encourage the patient to discuss testing with sexual or needle-sharing partner(s) who are at

risk for HIV. Explain the importance of partner(s) knowing their HIV serostatus. If both the patient and the partner are negative and without past or current risk, there

is no risk of HIV transmission between them. If the partner is positive, referral for medical evaluation and treatment is available.

Provide Literature/Brochures as appropriate: See Appendix J.

Referrals

Discuss services the patient needs (i.e., medical, mental health, drug treatment, social services, legal). (See Appendix M for referral sources.) Make referrals as indicated.

Discrimination

Advise the patient to be careful of telling other people about having been tested for HIV. People have been discriminated against because of disclosure about confidential HIV-related information. If the patient experiences discrimination because of disclosure of HIV-related information, the patient should call the NYS Division of Human Rights at 1-800-523-2437.

Documentation

Document that post counseling was provided and any referrals made on Appendix F, HIV Pre-Test/Post-Test Counseling form. Keep the test result with the HIV Pre- & Post-Test Counseling Form (Appendix F).

DisclosureRestate that HIV-related information is confidential. Per LHD policy, HIV-related information can only be given to those people the patient identifies in writing on the Authorization for Release of Confidential HIV Related Information form (See Appendix B). However, individuals tested at an LHD HIV/STD Clinic are exempt from the requirement to release HIV related information to persons listed on the HIV Consent Form. Under law, the patient has the right to withdraw consent for disclosure of confidential HIV-related information at any time. Explain that if someone discloses confidential HIV-related information about the patient to others without permission, that person can be fined, imprisoned, or both. See Section 4 of this manual for further information regarding disclosure.

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POST TEST COUNSELING

SECTION 6B INDETERMINATE

You may have indeterminate results with a HIV venipuncture blood test or an Orasure test.There are no indeterminate results from HIV rapid tests.

Test Result

All patients will receive the HIV antibody test result in person. Begin post test counseling by providing test results. Show the patient the lab slip with the recorded test result. Give the patient time to react to the test result and encourage the patient to express feelings

and concerns. Address the patient’s immediate concerns.

Meaning of Indeterminate Test Result

An indeterminate HIV test result means that the patient’s HIV status is questionable at this time. Explain that: An ELISA test was positive. The ELISA test is very sensitive and may be positive for

other reasons than HIV infection. That is why the Western Blot test is done on any positive ELISA test. In this case the Western Blot test shows evidence of some viral proteins but not in band position or number sufficient to report the result as positive.

An indeterminate test may be caused by the process of seroconversion during the “window period”, or other medical conditions. A second test should be done immediately. If the second HIV antibody test is also indeterminate, repeat in one month. If the third test is indeterminate, consult with the NYS DOH regional representative for a medical consult with the STD Bureau Director.

Risk ReductionThis person should receive risk reduction counseling similar to a person who has a positive HIV result. It is important for the person to practice this risk reduction behavior until the possibility of HIV infection is ruled out. (Refer to Section 6C – Transmission Reduction included in Post Test Counseling – Seropositive.)

DocumentationDocument that post counseling was provided on the HIV Pre- & Post-Test Counseling Form (Appendix F). Keep the test result with the HIV Pre- & Post-Test Counseling Form.

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POST TEST COUNSELING

SECTION 6C PRELIMINARY POSITIVE AND CONFIRMATORY POSITIVE/REACTIVE

PRELIMINARY POSITIVE/REACTIVE

Explain to the patient that a positive/reactive rapid HIV test result must be followed by confirmatory testing.

Helping the Patient Cope with the Preliminary Positive Test Result Set a supportive and encouraging tone. Be prepared to deal with the patient's emotions about having to wait for confirmatory test

results. Provide your name and phone number for the patient to contact at a later date while waiting

for confirmatory test results. Reinforce support services available as provided in pre test counseling.

Draw confirmatory test specimen.

Provide risk reduction counseling similar to a person who has a confirmatory positive HIV result. It is important for the person to practice risk reduction behavior until the confirmatory results are received. (See below – Transmission Reduction)

Schedule an appointment for patient to return to receive confirmatory test result and post test counseling.

CONFIRMATORY POSITIVE/REACTIVENOTE: LHD must obtain patient specific physician order to release positive HIV test result to patient.

Be prepared to work with an anxious or distressed patient. Crisis and HIV-related services are listed in Appendix M. Whenever possible, the post test counseling should be done by the same person who did the pre-test counseling, and a representative from the NYS DOH regional office along with an AIDS Care representative should be present. Test ResultAll patients will receive the HIV antibody test result in person. Begin post test counseling by providing the test result. Show the patient the lab slip with the recorded test result. Give the patient time to react to the test result and encourage the patient to express feelings

and concerns. Address the patient's immediate concerns.

Helping the Patient Cope with the Test Result

Set a supportive and encouraging tone.

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Be prepared to deal with the patient's emotions which may include: disbelief, anxiety, anger, guilt, depression, apathy, and fear of death.If the patient becomes distressed: Stay with the patient and respond to the situation; listen to the patient's concerns; Help sort out the issues; Help identify coping mechanisms used in other crisis situations; If necessary, call for guidance from a mental health professional; Provide telephone numbers for 24-hour crisis services (see Appendix M); Offer to assist the patient in contacting crisis support services and provide a

confidential place for the patient to use the telephone. Discuss the patient's feelings about the test result and how the patient anticipates handling

this information during the next 48 hours and over time. Provide your name and phone number for the patient to contact at a later date regarding referral for support services.

Remind the patient about supports identified in the pre test session. Ask who the patient can talk to about the test result, such as a family member, friend, mental health professional, or a member of the clergy. If the patient identifies someone, discuss how the patient might tell that person and what their reaction might be.

Meaning of Positive Test Result

The test showed that antibody to HIV was present. A positive HIV test result means:

The patient is infected with HIV and antibodies to the virus were produced; A positive test result does not mean the patient has AIDS.

Medical Follow-Up and Support Services

Explain the importance of getting into medical care as soon as possible. Laboratory tests can tell how the immune system is functioning and show if HIV-

related infections or cancers are present. Treatments are available that may slow the progression of HIV disease and prevent

opportunistic infections. Make a referral to AIDS Care, patient’s primary care provider and an HIV primary care

facility as the patient wishes. (Refer to Appendix M for potential sources.) Explain that the first medical appointment will include a complete physical and lab work so that the patient and physician can make decisions regarding the best therapy.

Emphasize the importance of following good health care practices. Stress that it is important to stay in a medical treatment program to have regular medical

checkups as well as information about new treatments. Explain that a positive test result may mean that sexual or needle sharing partners could be

infected with HIV. Explain to women with children that their children should be tested if born before

February 1, 1997 (All newborns in NYS are tested for HIV in the Newborn Screening Program since February 1, 1997).

Encourage the patient to refer current partner(s) or children for HIV antibody testing. Provide the patient with referrals.

Because HIV makes individuals susceptible to tuberculosis, offer Tuberculin Skin Testing at this time. (See LHD tuberculosis manual for additional guidance.)

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Transmission Reduction (May want to schedule second visit to discuss transmission reduction to improve understanding and retention.)

Emphasize that although the patient may not have any signs or symptoms of HIV infection, the patient can transmit infection by:* Having sex without a condom, or incorrectly using a condom;* Sharing intravenous needles, works, and other drug paraphernalia;* Passing it to the baby during pregnancy, birth, and breastfeeding.

Stress that HIV is not spread through casual, household transmission. Discuss risk reduction strategies, based on a review of the patient's sexual and/or drug use behaviors. Explain that the steps below may keep the patient from getting other infections and from passing HIV infection on to others. Offer to explain the following risk reduction strategies to both the patient and partner.

Sexual Risk Reduction HIV transmission can be prevented by not having vaginal, oral, or anal sex. The risk of HIV transmission can be reduced during vaginal-, anal-, and oral-penile

sex by preventing contact with body fluids (semen, blood, and vaginal secretions) through the male partner's use of latex or polypropylene condoms every time they have sex. Condoms reduce but do not eliminate risk. Demonstrate how to properly use condoms. Advise the patient never to reuse a condom.

If patient’s partner is also HIV positive, they should use safe sex practices since continuous exposure to the HIV virus may enhance the progression of the disease.

There is no scientific research to demonstrate the effectiveness of dental dams or plastic wrap in preventing or reducing the risk of HIV transmissions during oral sex.

The risk of HIV transmission from partner to partner during oral sex (vaginal or penile) increases when oral or genital sores/lesions are present.

If appropriate, discuss birth control methods with the HIV positive woman. Provide information about the increased risk of infection (e.g., pelvic inflammatory disease) associated with using an IUD. Remind the patient that some birth control devices, such as the contraceptive pill, offer no protection against the transmission of diseases, including HIV. The effectiveness of diaphragms or cervical caps as barriers to HIV has not been demonstrated. Make referral to family planning services, as appropriate.

Drug Use Risk ReductionThe discussion of needle drug use behavior (intravenous and skin popping) is appropriate when counseling patients who use drugs or are suspected of using drugs. Explain that: HIV transmission can be prevented by not sharing drug-injecting/snorting equipment. Stress the importance of cleaning all injecting/snorting equipment before each use

(flush needles and syringes two times with bleach, then with water).Encourage the drug-using patient to abstain from drug use and to enroll or stay in a drug treatment program.

Explain to the patient that use of the following substances may put HIV negative partner(s) at risk, if the patient or partner is unable to adhere to safer sex behaviors: alcohol marijuana,

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barbiturates/other sedatives (downers), amphetamines/other stimulants (uppers), hallucinogens, cocaine, crack, heroin, steroidsSeveral factors implicate the emergence of cocaine use, by injection, snorting and smoking, as a risk factor for HIV. Studies show that, compared to heroin, needle sharing in cocaine injection is more strongly related to HIV infection, possibly due to more frequent injections in cocaine use. Those who smoke cocaine in the form of "crack" may also risk HIV infection due to unsafe sexual practices, including the exchange of sex for drugs. Crack users may also inject cocaine and/or heroin to counteract the extreme effects (highs and lows) of crack.

Additional Risk ReductionPatients testing HIV positive should be advised:

not to donate blood or blood products, organs, tissue, breast milk, or sperm; not to share toothbrushes, razors, nail implements or other items that could become

contaminated with blood; this measure is recommended even though these items have not been shown to transmit HIV;

to clean and disinfect surfaces on which blood or other body fluids which may contain blood have spilled ( a solution of 1/4 cup bleach to one gallon of water is effective);

to discontinue breastfeeding, if applicable.

Individual Risk Reduction Strategy

Discuss options and strategies to reduce the risk of HIV transmission to partners. Discuss any difficulties the patient anticipates in carrying out the risk reduction plan. Offer to help practice how the patient will handle difficult situations.

Reporting Requirements

Discuss with the patient that their name will be reported to the health department if they have a confirmed positive HIV antibody test result received through a confidential test, other HIV-related test results, a diagnosis of AIDS, or if they have chosen to attach their name to a positive test result at an anonymous site. The health department will use this information to track the epidemic and to better plan prevention, health care and other services.

Partner Notification

The New York State Department of Health endorses voluntary partner notification to assist HIV positive persons in notifying their sexual and/or needle-sharing partners.

The patient who tests positive for HIV will be referred to NYS State Partner Notification Assistance Program (PNAP) at the Rochester Regional Office (585) 423-8103 or the Western Regional Office at (716) 847-4500. It is advisable to contact PNAP prior to the Post-test Counseling appointment and request their presence.

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Ask if the patient discussed the risk of HIV exposure and testing with partner(s). Explain why it is important for partner(s) to know their HIV status: If positive, referral for medical evaluation and treatment is available; Early treatment may slow down HIV disease and prevent the onset of some infections. Explain the NYS PNAP program. Offer the services of PNAP representative (via personal

contact or telephone) at this appointment, if available. If PNAP representative is not available at Post-test Counseling session, advise patient that they will be contacted by the PNAP state representative. Complete Medical Provider HIV/AIDS and Partner/Contact Report Form (DOH-4189) (See Appendix I for form).

Offer to provide counseling and testing for the partner(s). Otherwise, encourage the patient to refer partner(s) for HIV counseling and testing at other sites.

Screen for domestic violence. Make referrals as appropriate. Advise PNAP Representative that there are domestic violence issues and any referrals made. (See Appendix Q for domestic violence screening guidance.)

Provide Literature/Brochures as appropriate.

Discrimination

Advise the patient to be careful of telling other people about having been tested for HIV. People have been discriminated against because of disclosure of confidential HIV-related information. If the patient experiences discrimination because of disclosure of HIV-related information, the patient should call the NYS Division of Human Rights at 1-800-523-2437.

Documentation

Document that post counseling was provided and any referrals made on the HIV Pre- & Post Test Counseling Form (Appendix F). Keep the test result with the pre/post test counseling form.

Disclosure

Restate that HIV-related information is confidential. Per LHD policy, HIV-related information can only be given to those people the patient identifies in writing on the HIV release form. For persons tested at a HIV/STD Clinic, only those identified on the HIV release form and a PNAP representative will be provided HIV testing results. Under law, the patient has the right to withdraw consent for disclosure of confidential HIV-related information at any time. Explain that if someone discloses confidential HIV-related information about the patient to others without permission, that person can be fined, imprisoned or both. See Section 4 of this manual for further information regarding disclosure.

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SECTION 7

FAILURE TO RETURN FOR TEST RESULTS(Does not apply to Negative Rapid HIV Tests)

FAILURE TO RETURN FOR NEGATIVE RESULT:

Test results will be discussed during the patient’s next scheduled visit. If patient does not return to scheduled visit, no follow-up is required, but will be attempted based on patient’s selection on the HIV Contact Information Form (Appendix H). If patient selects mail contact, utilize Missed Appointment Letter (Appendix R). Avoid inference to HIV or testing results.

Document efforts made to contact patient on bottom of Contact Information Form (Appendix H).

FAILURE TO RETURN FOR POSITIVE RESULT:

In the event that the patient does not return for post appointment, the following steps may be taken:

Contact with the patient will be attempted based on patient’s selection on the HIV Contact Information Form (Appendix H). If patient selects mail contact, utilize Missed Appointment Letter (Appendix R). Avoid inference to HIV or testing results.

Following 2 weeks of unsuccessful contact, a referral will be made to PNAP Program. See Section 8.

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SECTION 8

HIV PARTNER NOTIFICATION ASSISTANCE PROGRAM (PNAP)

Any HIV positive results must be reported to NYS Department of Health Regional Representative designated for PNAP assistance.

Contact information for the NYS DOH Regional Offices is as follows:

Rochester Regional Office (585) 423-8103

Complete and submit to Regional PNAP Representative, Medical Provider HIV/AIDS and Partner/Contact Report Form (DOH-4189) (Appendix I). Note “CONFIDENTIAL” on outside of envelope.

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SECTION 9

Laboratory Services and HIV Testing

The State Health Department’s Wadsworth Center for Laboratories and Research provide HIV Antibody test kits upon request to Local Health Departments in NYS, performs ELISA and Western Blot analyses, and oversees the conduct of testing at other authorized sites in NYS.

Requests for information and test kits should be directed to:

Blood: Wadsworth Centers for Laboratory and Research using HIV Test Mailer (DOH-49 (M)) Kit Request Form (see Appendix C). For Wayne County, utilize protocol established with local laboratory;

Orasure: Call Erie County Public Health Laboratory at (716) 898-6100For Wayne County, call Lab One at 1-800-646-7788

Rapid Test: For OraQuick: Fax Order Form (see attached) to: (610) 882-3572Email: customerservice@orasure.com

For Uni-Gold: Contact Trinity Biotech at 1-800-325-3424 and fax a purchase order to them.

For Chembio HIV 1/2 STAT-PAK® Assay: Contact Michelle LatzenChembio Diagnostic Systems, Inc, 3661 Horseblock Road, Medford, NY 11763Phone: 631-924-1135 ext. 186; Fax: 631-924-2065

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SECTION 10

Court Ordered HIV Testing

BackgroundAs of November 1, 2007, New York Criminal Procedure Law 210.16 allows for the testing of defendants indicted for certain sex offenses, for human immunodeficiency virus (HIV), upon the request of the survivor. According to the law the testing is to be conducted by a state, county or local public health officer. This protocol is meant to provide local public health departments who will be conducting this testing with a guideline to follow in order to provide services for the survivor and the defendant.

The victim must apply to the court to initiate the process of testing. PPE should not be delayed.

Policy Local Health Department (LHD) staff will provide confidential counseling to the survivor of

sexual offense pre and post the defendant HIV testing. LHD staff will draw blood from the defendant for HIV related tests within 48 hours from the

date of the signed court order. LHD staff will notify survivor and defendant of HIV test results and conduct appropriate

counseling and follow-up investigations. LHD will notify court testing completed, survivor notified. LHD will NOT disclose results

to the court.

PurposeThe purpose of this protocol is to delineate the steps in implementing court ordered HIV testing of persons who were indicted of sexual assaults. The protocol establishes guidelines on requesting defendant HIV testing, counseling of the survivor pre and post defendant HIV testing, coordination of services with the various entities involved and follow-up on HIV positive results. The protocol will be used in conjunction with the PNAP or LHD protocols for Case Investigation and Partner Services.

Objectives Carry out court ordered HIV test of a person indicted for sexual assault within 48 hours from

the date on which the order was signed. Provide counseling to the survivors of sexual assault pre and post defendant HIV testing. Conduct appropriate HIV case investigation and partner services on HIV positive defendants.

(Partner Notification services may be done through PNAP).

Program Responsibilities

Local Health Department (LHD)

LHD staff will be responsible for coordinating the court ordered defendant testing and all associated services from the LHD to the survivor and the defendant. Specifically, the LHD will: Assign staff to offer to meet with the survivor at a prearranged site for pre-test (defendant)

HIV counseling prior to filing a court order, and to offer to meet again for post test counseling once results are available.

Contact Wadsworth Lab at (518) 474-2163 to request an HIV specimen mailing kit.

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Receive court order from the District Attorney’s Office. Review court order and confer with the Commissioner/Director of Health on staff assignment

to various tasks, including but not limited to: Survivor counseling Defendant delivery/shipment and follow-up Delivery of HIV test results to survivor and to defendant Ensuring the initiation and completion of all tasks by appropriate staff within appropriate

timeframes. Assign staff to conduct a pre and post-defendant HIV test counseling with the survivor. Arrange with the District Attorney’s Office and other agencies, as appropriate (i.e.

Corrections Office) to bring the defendant to a pre-arranged medical area at an agreed upon time for testing and counseling.

Assign staff to test defendant. If applicable, assign staff to assure packaging and shipment of specimen to the NYSDOH

Wadsworth Lab. If applicable, receive HIV test result from Wadsworth and share, as appropriate, with staff

assigned to conduct post test counseling with survivor and/or defendant. Ensure that defendant receives post testing counseling if he/she consents. If test is positive

ensure that staff attempt HIV case investigation including names of other exposed persons and that partner notification is performed (can be done by or in conjunction with PNAP).

Refer out-of-jurisdiction post defendant test counseling and results delivery to the New York State Partner Notification Assistance Program (PNAP).

Obtain verification that PNAP delivered result and/or post test counseling to the defendant.

Pre-test Counseling with Survivor The LHD will assign staff to offer to meet with the survivor at a predetermined location for

pre-test (defendant) counseling prior to filing an application form or court order. On scheduled date, staff will:

Provide identification and explain the role of the LHD; Verify survivor’s identity; Explain purpose of meeting; Emphasize confidentiality.

Information and education exchange Review any previous HIV counseling and/or treatment and discuss the implications of

defendant testing including medical and psychological benefits for the survivors. Provide the following information to the survivor, to the extent available:

o The limitations on the information to be obtained through an HIV test on the proposed subject;

o Current scientific assessments of the risk of transmission of HIV from the exposure he or she may have experienced; and

o The need for the applicant to undergo HIV related testing to definitively determine his or her HIV status.

Conclude the session and arrant post-test (defendant) counseling session with survivor.

Defendant Testing and Specimen Handling (Rapid HIV Testing may not be used)Testing must take place within six months of occurrence of the crime. Testing will only occur at a designated facility, preferably during regularly scheduled LHD hours of operation. LHD staff should be informed at least 1-2 working days prior to the date on which testing

will occur;

39

LHD staff will verify logistics with other appropriate agencies (i.e. date, time, location); LHD staff will report to the location and prepare for appropriate testing.

If 7-30 days after incident: standard ELISA with NAAT If 30 days to 6 months after incident: standard ELISA. Rapid HIV Testing should not be

used. If the defendant does not submit to testing, LHD staff should stop the attempt and ensure that

the District Attorney’s Office is notified that the defendant refused to comply with court order. The appropriate agency should inform the survivor of delay in obtaining sample and planned follow-up.

If venipuncture was performed, the LHD will arrange for shipping of the sample to the Wadsworth Laboratory, and provide: A copy of the court order for HIV Labeled vials of blood samples of the defendant.

Post-test Counseling with Survivor LHD staff will contact the survivor within one business day from the date the HIV test result

is received to schedule post-defendant HIV test counseling. If the defendant’s HIV test result is negative, LHD staff will notify the survivor. If the

survivor is receiving post-exposure prophylaxis, staff should strongly recommend that survivor consult with is/her health care provider as to the risks and benefits of continuing the regimen.

If the defendant’s HIV test is positive, staff will: Inform the survivor that he/she may have been exposed to HIV. Inform the survivor that all patients seeking care after HIV exposure should be tested for the

presence of HIV antibodies at baseline, 4-6 weeks, 3 months, and 6 months after exposure to determine whether HIV infection has occurred. Staff will strongly recommend that survivor consult with their health care concerning testing, and if appropriate prophylaxis/treatment of sexually transmitted infections and other blood- borne pathogens such as hepatitis B and hepatitis C.

If the survivor is currently receiving post-exposure prophylaxis, strongly recommend that he/she consult with their health care provider and continue regimen. If not receiving prophylaxis, strongly recommend that the individual discuss the risks and benefits with their health care provider and ensure that he/she has access to timely and appropriate medical care.

Provide the survivor with the telephone number of the LHD in case of future questions or concerns.

Delivering HIV Test Result to Defendant LHD staff will directly deliver the HIV negative test result to the defendant if he/she

consents to the receipt. LHD staff will directly deliver HIV positive test result to the defendant and initiate HIV case

investigation and partner elicitation if he/she consents to the interview (this may be done in conjunction with PNAP).

LHD will provide referral to an HIV specialist for medical care. LHD staff will provide appropriate counseling and assistance to the defendant according to

NYSDOH protocols for case investigation and partner services.

If appropriate, LHD staff will forward HIV test result for out of jurisdiction defendants to NYSDOH PNAP.

40

Disclosure of Confidential InformationTest results shall be disclosed subject to the following limitations: Disclosure of confidential HIV related information shall be limited to that information which

is necessary to fulfill the purpose for which the order is grants; and Disclosure of confidential HIV related information shall be made to the defendant upon his

or her request, and disclosure to a person other than the defendant shall be limited to the person making the application; redisclosure shall be permitted only to the victim, the victim’s immediate family, guardian, physicians, attorneys, medical or mental health providers and to his or her past and future contacts to who there was or is a reasonable risk of HIV transmission and shall not be permitted to any other person or the court.

41

SECTION 11 Pre-Exposure Prophylaxis for HIV

Background

In 2012, after a series of clinical trials, the FDA approved the use of a fixed dose combination of tenofovir disoproxil fumarate (TDF) 300 mg and emtricitabine (FTC) 200 mg, known as Truvada, for pre-exposure prophylaxis (PrEP) for HIV.

New York State Clinical Guidance suggests that medical providers discuss PrEP as an HIV/STD prevention option for patients who:

Are a gay man or trans-woman who has unprotected anal intercourse; Are in a sexual relationship with a partner who has HIV; Are a trans-person who has unprotected anal or vaginal sex; Sometimes trade sex for money, drugs or housing; Inject drugs or share injection equipment; Use stimulant drugs such as methamphetamine and have unprotected sex; Have had more than one STD in the last year; or, Have taken HIV post-exposure prophylaxis more than twice in the last year.

HIV PrEP is a six-point program that includes taking one pill once a day to prevent an uninfected person from becoming infected with HIV. Clinical trials have shown that when an uninfected person takes the medication consistently, his or her chance of becoming infected with HIV is greatly reduced.

The six-point PrEP program for people who are HIV negative includes the following:

HIV testing - to make sure the person was not recently infected with HIV; Taking one Truvada pill, once a day, every day for a specific period of time; Using condoms to prevent STDs; Periodic STD screening; Education about how to reduce the risk of getting HIV and STDs through sex; and, Counseling and support for taking the medication regularly (adherence)

Policy

Public Health staff will be familiar with available community resources for the prevention of HIV infection. Patients presenting or contacting the LHD seeking Pre-Exposure Prophylaxis for HIV will be educated on available resources and referred to a local provider. Community outreach and education on PrEP is also recommended.

A list of state wide providers offering PrEP is attached and available on the NYSDOH website at: http://www.health.ny.gov/diseases/aids/general/prep/provider_directory.htm

Patient education resources are available from the CDC and NYSDOH, see attached.

42

Appendix A

Informed Consent to Perform HIV Testing

DOH-2556

NEW YORK STATE DEPARTMENT OF HEALTH AIDS Institute HIV CONSENT FORM

Informed Consent to Perform HIV Testing My health care provider has answered any questions I have about HIV/AIDS. I have been provided information with the following details about HIV testing:

HIV is the virus that causes AIDS and can be transmitted through unprotected sex (vaginal, anal, or oral sex) with someone who has HIV; contact with blood as in sharing needles (piercing, tattooing, drug equipment including needles), by HIV-infected pregnant women to their infants during pregnancy or delivery, or while breast feeding.

There are treatments for HIV/AIDS that can help an individual stay healthy. Individuals with HIV/AIDS can adopt safe practices to protect uninfected and infected

people in their lives from becoming infected or being infected themselves with different strains of HIV.

Testing is voluntary and can be done anonymously at a public testing center. The law protects the confidentiality of HIV test results and other related information. The law prohibits discrimination based on an individual’s HIV status and services are

available to help with such consequences. The law allows an individual’s informed consent for HIV related testing to be valid for

such testing until such consent is revoked by the subject of the HIV test or expires by its terms.

I agree to be tested for HIV infection. If the results show I have HIV, I agree to additional testing which may occur on the sample I provide today to determine the best treatment for me and to help guide HIV prevention programs. I also agree to future tests to guide my treatment. I understand that I can withdraw my consent for future tests at any time. If I test positive for HIV infection, I understand that my health care provider will talk with me about telling my sex or needle-sharing partners of possible exposure.

I may revoke my consent orally or in writing at any time. As long as this consent is in force, my provider may conduct additional tests without asking me to sign another consent form. In those cases, my provider will tell me if other HIV tests will be performed and will note this in my medical record.

Patient Name: __________________________________________________________

Signature: _____________________________________________________________ (Patient or person authorized to consent)

Date: __________________________

DOH-2556 (1/11)

Appendix B

HIPAA Compliant Authorization for Release of Medical Information and Confidential HIV* Related Information

DOH-2557

Appendix C

HIV – Antibody Test Requisition

Request

Call Wadsworth State Order Desk at:

518-474-4175

Wadsworth will mail appropriate mailer kit

For Wayne County – follow protocol for local laboratory

Appendix D

Sample Orasure HIV Antibody Test Requisition

SAMPLE

Appendix E

Public Health Personnel Authorized to Access HIV

Related Information

Chemung County Health Personnel Authorized to Access HIV Related Information

Medical Director

Public Health Director

Clinical Director

Nurse Practitioner

Nurses certified for testing

Ontario County Public Health Personnel Authorized to Access HIV Related Information

Medical Director

Public Health Director

Director of Preventive Health Services

Nurses certified for testing

Director of Quality Improvement/QI Team

Privacy Officer

Livingston County Health Department Personnel Authorized to Access HIV Related Information

Medical Consultant

Public Health Director

Director of Preventive Health Services

Director of Patient Services

Nurse Practitioner(s)

Supervising Public Health Nurse(s)

Nurses certified for testing

Nurses providing care

Quality Improvement Team

Privacy Officer

Schuyler County Public Health Personnel Authorized to Access HIV Related Information

Medical Director

Director of Public Health

Nursing Coordinator(s)

RNs

Public Health Specialists

Medical Records personnel

QI Coordinator/QI Team

Seneca County Health Department Personnel Authorized to Access HIV Related Information

Medical Director

Director of Public Health

Deputy Director of Public Health

Clinical Nursing Staff

Quality Improvement Team

Steuben County Public Health Personnel Authorized to Access HIV Related Information

Medical Director

Correctional Facility Medical Director

Director of Patient Services/Public Health

Public Health Coordinator

Primary and Prevent Staff Nurses

QI Team

Wayne County Public Health Personnel Authorized to Access HIV Related Information

Public Health Director

Supervising Public Health Nurses

Home Care and Prevent Staff Nurses

Nurse(s) and/or Therapist(s) providing care to patient

Senior Account Clerk

Account Clerk

Privacy Officer

Yates County Public Health Personnel Authorized to Access HIV Related Information

Medical Director

Director of Patient Services/Director of Public Health

Supervising Public Health Nurse

Administrative Assistant

Senior Account Clerk Typist

Account Clerk Typist

Public Health Nurses

QI Coordinator/QI Team

Appendix F

HIV/AIDS Pre- & Post-test Counseling Form

HIV/AIDS PRE & POST-TEST COUNSELING FORM

NAME_________________________________DATE______________ID# STD# if

applicablePRE-TEST:Please check each item when completed.Transmission Anonymous/ConfidentialBenefits of Testing Consent Obtained/TestedRisk Reduction Reporting Requirements

PNAPPregnancy Guidance Meaning of +/- Test ResultSafe Sex/Condom usage Support SystemsNeedles (cleaning) Offered HepB/HepA

If not tested, please give reason:

Comments___________________________________________________________________ Staff Signature: Sample #_____________

POST TEST:Please check each item when completedResults Reviewed Prevention ReviewedDisclosure/Discrimination Reviewed Safe Sex/Condoms

ReviewedPartner Notification Program Needles ReviewedDetermination of Need for Retesting TST, if applicable

REFERRALSAIDS Care Social ServicesECMC/Ivy Clinic/Strong MemorialCircle one

OtherSpecify:

NYS Partner Notification OtherSpecify:

Date of Post Test________________________Sample#__________________________

Staff Signature: ________________________________________________________

For positive results, NYS PNAP form completed and submitted.

By: Date: Printed Name and Title

Signature__________________________________________

HIV Risk Assessment SAMPLE

Appendix G

HIV Risk Assessment

HIV Risk Assessment SAMPLE

Appendix H

HIV Contact Information

HIV CONTACT INFORMATION

NAME:

ADDRESS:

PHONE:

In the event that you miss your scheduled appointment with our agency for HIV Post-test counseling, we need to be able to contact you.

Please indicate below how you would prefer this agency to contact you.

by mail in an envelope with the Local Health Department’s return address

by mail in plain envelope with NO RETURN ADDRESS

by telephone at the number listed above (only if you have an answering machine)

I choose to contact the Local Health Department to schedule an appointment for post-test counseling in the event that I miss my scheduled appointment.

New York State law mandates that we make every possible attempt to assure that you receive your test results.

NO results will be given over the telephone.

** I have been offered the Notice of Privacy Act & Patient Bill of Rights

Signature

For office use only

Letter sent

Phone call made

Message left

Date:

Signature:

Appendix I

Medical Provider HIV/AIDS and

Partner/Contact Report Form

DOH-4189

Appendix J

Employee Attestation of Confidentiality

GUARANTEE OF EMPLOYEE / CONTRACTED STAFF

MEMBER RETAINING CONFIDENTIALITY

It is your responsibility to know the agency’s administrative policies explaining confidentiality. The policies are titled:

Confidentiality of PHIRelease of InformationDisclosure of PHI

The policy titled Release of Information is used by the Privacy Officer/Designee as a reference guide to release records. ONLY a Privacy Officer/Designee can release patient/client records.

EMPLOYEE CONFIDENTIALITY STATEMENT

As an employee of: ______________________________, I understand and agree to the following:1. I am required, when necessary to perform the specific tasks of my job, to have access to and am

involved in the processing of personal health related information.2. I am obligated to maintain the confidentiality of this information at all times, both at work and off

duty.3. I may not remove from the unit or copy documents or computer data containing health related

information unless acting within the scope of my assigned duties.4. I may not discuss the content of such documents or computer data with any person unless that

person is authorized to have said access. In addition, I will maintain my user ID and password against unauthorized use.

5. I may not discriminate, abuse or take any adverse action directed toward a person to whom personal health related information applies.

I have read the above and understand my responsibilities in maintaining the confidentiality of personal health related information. I understand that violation of confidentiality statutes and rules may lead to disciplinary action or criminal prosecution.

Furthermore, I understand that this form will be placed in my personnel file.

EMPLOYEE ATTESTATION OF HIV / AIDS CONFIDENTIALITY

As an employee and/or contractor of the ______________________, I hereby acknowledge that I have received and reviewed a copy of Public Health Law Title X Part 63 HIV/AIDS Testing, Reporting and Confidentiality of HIV-related Information. I will abide by the appropriate laws, regulations and agency protocols regarding the confidentiality of protected information. I further agree to respect the confidentiality and security measures that apply to HIV/AIDS surveillance and electronic records and will in no way jeopardize the security of the data collected.

I, swear, (or affirm) that I have read and do understand the Health Department Regulations 50-4.3 (b), 50-4.7 (b) and 50-4.8 of the New York State Department of Health titled “Intra-agency Access To and Disclosure of Personal Health Related Information”. I further understand that said regulations apply to any position(s) that I might hold with the S2AY Rural Health Network, Inc.

Therefore, I do further swear and attest that I will faithfully adhere to the above regulations in the execution of my responsibilities as an employee/agent of the __________________________ I further attest that I understand that a violation of confidentiality statutes and rules may lead to disciplinary action, or criminal prosecution.

I further acknowledge review and understanding of code of ethics and Mission, Vision & Values Statement.

Name: Date:

Signature:

Appendix K

PART 63HIV/AIDS TESTING, REPORTING AND CONFIDENTIALITY OF

HIV-RELATED INFORMATION

And

Public Health Law, Article 27F, section 2780-2787

And

Public Health Law, Article 21, Title 3, section 2130-2139

Effective Date: 02/22/2012

Title: Section 63.1 - Definitions

63.1 Definitions (a) "HIV-infection" means 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.

(b) "AIDS" means acquired immune deficiency syndrome, as may be defined from time to time by the Centers for Disease Control and Prevention of the United States Public Health

Service.

(c) "HIV-related illness" means any clinical illness that may result from or be associated with HIV infection.

(d) "HIV-related test or HIV-related testing" means any laboratory test, tests or series of tests approved for the diagnosis of HIV.

(e) "Rapid HIV test or testing" means any HIV-related test or tests approved for detecting antibodies or antigens to HIV, that produce results in sixty minutes or less, and encompasses a

supplemental test to confirm the HIV-related test if the screening test is reactive. The sixty minutes does not include the time needed for confirmation or delivery of results to the patient.

(f) "Capacity to consent" means an individual's ability, determined without regard to the individual's age, to understand and appreciate the nature and consequences of a proposed

health care service, treatment, or procedure, or of a proposed disclosure of confidential HIV-related information, and to make an informed decision concerning the service, treatment,

procedure or disclosure.

(g) "Protected individual" means a person who is the subject of an HIV related test or who has been diagnosed as having HIV infection, AIDS or HIV-related illness.

(h) "Confidential HIV-related information" means any information, in the possession of a person who provides health or social services or who obtains the information pursuant to a release of confidential HIV-related information, concerning whether an individual has been

the subject of an HIV-related test, or has HIV infection, HIV-related illness or AIDS, or information which identifies or reasonably could identify an individual as having one or more

of such conditions, including information pertaining to such individual's contacts.

(i) "Health or social service" means any care, treatment, clinical laboratory test, counseling or educational service for adults or children, and acute, chronic, custodial, residential, outpatient, home or other health care; public assistance, including disability payments available pursuant to the Social Security Act; employment-related services, housing services, foster care, shelter,

protective services, day care, or preventive services; services for the mentally disabled; probation services; parole services; correctional services; detention and rehabilitative services;

and the activities of the Health Care Worker HIV/HBV Advisory Panel (see Public Health

Law Article 27-DD), all as defined in section 2780(8) of the Public Health Law.

(j) "Health facility" means a hospital as defined in section 2801 of the Public Health Law, blood bank, organ procurement organization, tissue bank, clinical laboratory, or facility

providing care or treatment to persons with a mental disability.

(k) "Health care provider" or "provider" means any physician, nurse, licensed or certified provider of diagnostic medical services, including a nurse practitioner, a midwife and

physician assistant, provider of services for the mentally disabled or other person involved in providing medical, nursing, counseling, or other health care or mental health service including

those associated with, or under contract to, a health maintenance organization or medical services plan. Diagnostic providers include physicians, nurse practitioners, physician

assistants and midwives who are authorized to order diagnostic tests and to make clinical diagnoses. 

(l) "Primary care" means the medical fields of family medicine, general pediatrics, primary care, internal medicine, primary care obstetrics, or primary care gynecology, without regard to

board certification or setting where primary care is provided.

(m) "Contact" means an identified spouse or sex partner of the protected individual or a person identified as having shared hypodermic needles or syringes with the protected

individual, or a person whom the protected individual may have exposed to HIV under circumstances that present a risk of transmission of HIV, as noted in section 63.8(m) of this

Part.

(n) "Contact tracing" shall mean the process of notifying known contacts of protected individuals as reported by the physician or as disclosed by the protected individuals

themselves, and of seeking the cooperation of protected individuals to name contacts, as described in section 63.8 of this Part. For the purposes of this Part, the terms "contact

notification", "partner notification", "partner assistance" and "partner counseling and referral services" shall be synonymous with "contact tracing". In all cases of contact tracing

authorized in this Part, the name or other identifying information regarding the protected person shall not be disclosed to contacts and the name of contacts shall not be disclosed to

other contacts.

(o) "Person" includes any natural person, partnership, association, joint venture, trust, public or private corporation or state or local government agency.

(p) "Release of confidential HIV-related information" means a written authorization for disclosure of confidential HIV-related information which is signed by the protected

individual, or if the protected individual lacks capacity to consent, a person authorized pursuant to law to consent to health care for the individual. Such release shall be dated and shall specify to whom disclosure is authorized, the purpose for such disclosure and the time

period during which the release is to be effective. A general authorization for the release of medical or other information shall not be construed as a release of confidential HIV-related information, unless such authorization specifically indicates its dual purpose as a general

authorization and an authorization for the release of confidential HIV-related information and complies with this definition.

(q) "Insurance institution" means any corporation, association, partnership, reciprocal exchange, interinsurer, fraternal benefits society, agent, broker or other entity in the business

of providing health, life and disability coverage including, but not limited to, any health maintenance organization, medical service plan, or hospital plan which:

(1) is engaged in the business of insurance; 

(2) provides health services coverage plans; or

(3) provides benefits under, administers, or provides services for, an employee welfare benefit as defined in 29 U.S.C. 1002(1).

(r) "Municipal health commissioner" shall mean, for purposes of this Part, a county health commissioner, except, in New York City, the term shall mean the New York City health

commissioner. Such county health commissioner and New York City health commissioner shall conduct reporting, counseling and contact notification activities consistent with

guidelines acceptable to the commissioner in compliance with Article 21, Title III and Article 27-F of the Public Health Law.

(s) "District health officer" shall mean, for the purposes of this Part, the commissioner or his/her designee.

(t) For the purposes of this Part, "commissioner" shall mean the New York State Commissioner of Health.

(u) For the purposes of this Part, "authorized public health official" shall mean New York State Commissioner of Health, a municipal health commissioner or a district health officer, or

their designee. 

Volume: A-1a

Effective Date: 06/01/2000

Title: Section 63.2 - Application

63.2 Application. These regulations apply to physicians and other persons authorized by law to order laboratory tests or to make medical diagnoses, laboratories, blood banks, tissue banks

and organ procurement organizations, to persons who receive confidential HIV-related information in the course of providing any health or social service and to persons who receive confidential HIV-related information pursuant to a release. These regulations do not apply to information which was received by the Commissioner under Subpart 24-1 of this Title and

protected from disclosure pursuant to Public Health Law section 206(1)(j). These regulations do not apply to insurance institutions and insurance support organizations, except as noted in section 63.6(a)(9), (10) and (12) of this Part. Health care providers associated with or under contract to a health maintenance organization or other medical services plan are subject to

these regulations.

Volume: A-1a

Effective Date: 02/22/2012

Title: Section 63.3 - HIV-related testing

63.3 HIV-related testing. (a) Except as noted in subdivision (d) of this section, no physician or other person authorized pursuant to law may order an HIV-related test without first having obtained written or, where authorized by this section, oral informed consent. When the test

being ordered is a rapid HIV test, such informed consent may be obtained orally, and shall be documented in the subject of the test's record including where a confirmatory test was

performed. Oral consent cannot be obtained in facilities operated under the Correction Law. A physician or other person authorized pursuant to law to order an HIV-related test to be used for patient care shall provide to the laboratory the name and address of the person who is the

source of the specimen and other such information as specified by the commissioner except in the case of anonymous testing as provided for in this Part. Certification of consent does not

have to be provided to the laboratory.

(b) Informed consent shall include providing information to the person to be tested or, if such person lacks capacity to consent, to the person lawfully authorized to consent to health care

for such person. In situations in which a person other than the test subject consents for the test, information shall also be provided to the test subject to the extent that the person responsible for ordering the test deems that the test subject will benefit from the information. Information

necessary to obtain informed consent may be provided through electronic, written or oral means and shall include:

(1) HIV causes AIDS and can be transmitted through sexual activities and by needle-sharing, by pregnant women to their fetuses, and through breastfeeding infants;

(2) there is treatment for HIV that can help an individual stay healthy;

(3) individuals with HIV or AIDS can adopt safe practices to protect infected and uninfected people in their lives from becoming infected or multiply infected with HIV; 

(4) testing is voluntary and can be done anonymously at a public testing center; 

(5) the law protects the confidentiality of HIV-related test results; 

(6) the law prohibits discrimination based on an individual's HIV status and services are available to help with such consequences; and

(7) the law allows an individual's informed consent for HIV-related testing to be valid for such testing until such consent is revoked by the subject of the HIV test or expires by its terms.

(c) In situations where written consent is being obtained, it must be executed on a form that contains information consistent with standardized model forms approved by the department.

Such forms based on department models do not require departmental review. General consent

forms for medical care may be used to obtain consent, provided that they include information consistent with the state’s model forms and a clearly marked place adjacent to the signature

where the subject of the HIV-related test, or when the subject lacks the capacity to consent, a person authorized pursuant to law to consent to the health care for such individual, shall be

given an opportunity to decline in writing such testing. Consent may be for a single test, for a period of time determined by the subject of the test, or be open-ended, so long as the subject of the test may revoke consent for future tests at any time. Each additional time that an HIV

test is being ordered, the physician or other person authorized to order an HIV test shall orally notify the subject of the test or, if the subject is not able to consent, the person authorized to

consent for the subject that the test will be conducted and this notification will be noted in the subject's medical record.

(d) Informed consent is not required in the following situations:

(1) for court-ordered testing pursuant to Civil Practice Law and Rules, section 3121;

(2) when testing without informed consent is otherwise specifically authorized or required by State or Federal law, including under Public Health Law section 2994-g;

(3) for testing related to procuring, processing, distributing or use of a human body or human body part, including organs, tissues, eyes, bones, arteries, blood, semen or other body fluids for use in medical education, medical research or therapy, or for transplantation to persons, provided that if the test results are communicated to the tested person, post-test information for negative results or counseling for positive, indeterminate/inconclusive and preliminary

positive results is required;

(4) for research if the testing is performed in a manner by which the identity of the test subject is not known and may not be retrieved by the researcher;

(5) for testing of a deceased person to determine cause of death or for epidemiological purposes; 

(6) for comprehensive newborn testing pursuant to PHL section 2500-f; and

(7) for anonymous testing of a person who is the source of an occupational exposure under Section 63.8(n) of this Part, who is deceased, comatose, or otherwise unable to provide

consent, and no person authorized to consent on behalf of the source patient is immediately available, as provided in Public Health Law section 2781(6)(e).

(e) With respect to positive and indeterminate/inconclusive results, and for preliminary positive results obtained pursuant to Subpart 58-8 of this Title, in addition to explaining the

test result to the person who consented to the test, the person who orders the test shall be responsible, directly or through a representative, for ensuring post-test counseling, referrals

and linkage to care as appropriate. Blood banks and tissue banks may report results as

specified in Subparts 58-2 and 52-3 of this Title, respectively. When confirmed positive

results are being provided, with the consent of a person who tests positive, or if such person lacks the capacity to consent, with the consent of the person authorized to consent to health care for such person, the person ordering the test or his or her representative shall provide or arrange for an appointment for follow-up care for HIV. In situations in which a person other

than the test subject consents for the test, results, post-test counseling and referrals should also be provided to the test subject, to the extent the person responsible for ordering the test deems

that the test subject will benefit from counseling. For persons who test positive, post-test counseling shall address:

(1) strategies for coping emotionally with the test results;

(2) discrimination issues relating to employment, housing, public accommodations, health care and social services;

(3) the importance of taking precautions to prevent HIV transmission to others;

(4) the ability to release or revoke the release of confidential HIV-related information; 

(5) HIV reporting requirements for the purposes of epidemiologic monitoring of the HIV/AIDS epidemic;

(6) the importance of contacts' being notified to prevent transmission, and allowing early access of exposed persons to HIV testing, health care, and prevention services, and a

description of notification options and assistance available to the protected individual;

(7) an assessment of the risk of domestic violence in conformance with a domestic violence screening protocol developed by the commissioner pursuant to law;

(8) the requirement that known contacts, including a known spouse, will be reported and that protected persons will also be requested to cooperate in contact notification efforts of known contacts and may name additional contacts they wish to have notified with the assistance of

the provider or authorized public health officials; 

(9) non-disclosure of the protected individual's name or other information about them during the contact notification process;

(10) the provider's responsibility for making an appointment for newly diagnosed persons to receive follow-up HIV medical care;

(11) the availability of medical services and the location and telephone numbers of treatment sites, information on the use of HIV chemotherapeutics for propyhlaxis and treatment and peer group support, access to prevention, education and support services and assistance, if

needed, in obtaining any of these services; and

(12) prevention of perinatal transmission. 

(f) In the case of a test not indicating evidence of HIV infection, the person who orders the test shall be responsible, directly or though a representative, for providing the result to the

subject of the test, or for a person lacking capacity to consent, the person authorized to consent for the health care for the subject. The person ordering the test or his or her

representative must also provide, in a manner that may consist of oral or written reference to materials previously provided, information concerning the risks of participating in high risk

sexual or needle-sharing behavior. The negative result and required information may be provided in-person, by mail, electronic messaging, or telephone provided that patient

confidentiality is reasonably protected.

(g) Every individual between the ages of thirteen and sixty-four years (or younger or older if there is evidence or indication of risk activity) who receives health services as an inpatient or

in the emergency department of a general hospital defined in subdivision ten of section twenty-eight hundred one of the Public Health Law or who receives primary care services in

an outpatient department of such hospital or in a diagnostic and treatment center licensed under article twenty-eight of the Public Health Law or from a physician, physician assistant, nurse practitioner, or midwife providing primary care in any office, clinic, facility or other

setting shall be offered an HIV-related test unless the health care practitioner providing such services reasonably believes that:

(1) the individual is being treated for a life threatening emergency; or 

(2) the individual has previously been offered or has been the subject of an HIV-related test (except that a test shall be offered if otherwise indicated); or

(3) the individual lacks capacity to consent to an HIV-related test.

(h) Nothing in this Part or Part 58 of this Title shall be construed to prohibit a person from directly ordering an HIV test on a specimen taken from his/her own body and directly

receiving the results of such HIV test. The test must be performed by a New York State licensed laboratory using a specimen collection kit which has been approved for home HIV

specimen collection by the U.S. Food and Drug Administration and which is available without a prescription, or as provided by Section 576-b of the Public Health Law.

Volume: A-1a

Effective Date: 02/22/2012

Title: Section 63.4 - Filing of reports

63.4 Filing of reports.

(a)(1) All determinations or diagnoses of Human Immunodeficiency Virus (HIV) infection, HIV-related illness and Acquired Immune Deficiency Syndrome (AIDS) shall be reported to

the commissioner by physicians and other persons authorized to order diagnostic tests or make medical diagnoses or their agents as soon as possible after post-test counseling but no later

than 14 days after the provider's receipt of a positive laboratory result or after diagnosis, whichever is sooner.

(2) All determinations or diagnoses of HIV, HIV-related illness and AIDS shall be reported to the commissioner by blood banks as defined in Article 5, Title V of the Public Health Law, by

tissue banks and organ procurement organizations as defined by Article 43-B of the Public Health Law as soon as possible after post-test counseling but no later than 14 days after

receipt of a confirmed positive laboratory result or after diagnosis, whichever is sooner. Such banks and organizations shall report confirmed positive HIV antibody test results.

(3) Pathologists, coroners and medical examiners or other persons determining from examination of a corpse or from the history of the events leading to death, that at the time of death the individual was apparently affected with HIV infection, HIV-related illness or AIDS shall also make such report to the commissioner within 14 days after receipt of a test result or

determination.

(4) Laboratories performing tests for screening, diagnosis or monitoring of HIV infection shall report to the Commissioner cases of determinations or diagnoses of HIV infection, HIV-

related illness and AIDS on a schedule to be specified by the Commissioner. Laboratories shall report the following: any antigen or antibody tests or combination of tests indicative of HIV infection, HIV nucleic acid (RNA or DNA) detection test results, all CD4 lymphocyte counts unless the test was known to be performed for reasons other than HIV infection or

HIV-related illness, HIV subtype and antiviral drug resistance testing in a format designated by the Commissioner, and the results of other tests as may be determined by the

Commissioner to indicate a diagnosis of HIV infection, HIV-related illness or AIDS.

(b) Reports, including names and addresses of the protected individual, all contact and locating information and other information including demographic, and identifying

information as may be specified by the commissioner, shall be made in a manner and format as prescribed by the commissioner. Information reported shall also include names and

addresses, if available, of contacts, including spouses, known to the physician or other person authorized to order diagnostic tests or make medical diagnoses, or provided to them by the protected person, and the date each contact was notified if contact notification has already

been done; and information, in relation to each reported contact, required by an approved

domestic violence screening protocol. After receiving the report, the commissioner or his/her authorized representative may request the individual making the report or the person who ordered the diagnostic tests to provide additional information as may be required for the

epidemiologic investigation, case finding and analysis of HIV infection, HIV-related illness and Acquired Immune Deficiency Syndrome (AIDS) and to implement Public Health Law

Article 21, Title III. Notwithstanding this subdivision, test results from New York State approved anonymous test sites shall not be reported to the commissioner unless the test

subject chooses to supply identification and convert the anonymous test result to a confidential test result.

(c) Confidentiality. Such reports and additional information maintained by the commissioner or his/her designated representative, including all information generated by contact

notification and domestic violence screening activities, shall be kept confidential as required by Public Health Law, Article 21, Title III, and shall not be disclosed except when in the

judgment of the public health official, necessary to other authorized public health officials for conducting accurate and complete epidemiological monitoring of the HIV/AIDS epidemic and

for conducting contact notification activities, except that information may be disclosed to public health officials in other jurisdictions when necessary to notify the contact or for

purposes of de-duplication; no information about the protected individual will be released to any person in the contact notification process. Reports and information may be used in the

aggregate in programs approved by the commissioner for the improvement of the quality of medical care provided to persons with HIV/AIDS; or with patient identifiers when used within the state or local health department by public health disease programs to assess co-morbidity or completeness of reporting and to direct program needs, in which case patient identifiers

shall not be disclosed outside the state or local health department. Nothing contained herein shall prevent the department, municipal health commissioner or district health officer from

informing physicians and other persons authorized to order diagnostic tests or make medical diagnoses or their agents that there is no need for additional follow-up by such provider for

such individual.

Volume: A-1a

Effective Date: 02/22/2012

Title: Section 63.5 - Disclosure pursuant to a release

63.5 Disclosure pursuant to a release. (a) No confidential HIV-related information, including such information as related to domestic violence screening, shall be disclosed pursuant to a

general release except to insurance companies as noted in section 63.6(a)(9) of this Part. Disclosure is permitted pursuant to a release of confidential HIV-related information. The

release must be signed by the protected individual, or if the protected individual lacks capacity to consent, by a person specified in section 63.6(a)(1) of this Part.

(b) All written disclosures of confidential HIV information must be accompanied by a statement prohibiting redisclosure. The statement shall include the following language or

substantially similar language: "This information has been disclosed to you from confidential records which are protected by state law. State law prohibits you from making any further disclosure of this information without the specific written consent of the person to whom it

pertains, or as otherwise permitted by law. Any unauthorized further disclosure in violation of state law may result in a fine or jail sentence or both. A general authorization for the release of

medical or other information is not, except in limited circumstances set forth in this part, sufficient authorization for further disclosure. Disclosure of confidential HIV information that occurs as the result of a general authorization for the release of medical or other information

will be in violation of the state law and may result in a fine or a jail sentence or both."

(c) If oral disclosures are necessary, they must be accompanied or followed as soon as possible, but no later than 10 days, by the statement required by subdivision (b).

(d) The statement required by subdivisions (b) and (c) of this section is not required for disclosures made in accordance with paragraphs (1), (4) or (9) of subdivision (a) of section 63.6 of this Part, for releases made by a physician or their agent or public health officer to a contact; or for releases made by a physician or their agent to a person authorized pursuant to law to consent to the health care of the protected person when the person has been counseled

and has refused to disclose and the disclosure is medically necessary. For disclosures of confidential HIV-related information from the patient's medical record to persons who are

permitted to access this information pursuant to sections 63.6(a)(3), (5), (6), (7), and (10) (e) and (f) of this Part, it shall be sufficient for the statement required by subdivisions (b) and (c)

of this section to appear as part of the medical record when a medical record is disclosed.

Volume: A-1a

Effective Date: 02/22/2012

Title: Section 63.6 - Confidentiality and disclosure

63.6 Confidentiality and disclosure. (a) No person who obtains confidential HIV-related information in the course of providing any health or social service or pursuant to a release of

confidential HIV-related information may disclose or be compelled to disclose such information, except to the following:

(1) the protected individual or, when the protected individual lacks capacity to consent, a qualified person under section 18 of the Public Health Law, a person the protected individual

has authorized to access records relating to the provision of health care under General Obligations Law Article 5, Title 15, or person authorized pursuant to law to consent to health

care for the individual;

(2) any person to whom disclosure is authorized pursuant to a release of confidential HIV-related information in accordance with section 63.5(a);

(3) an agent or employee of a health facility or health care provider if (i) the agent or employee is authorized to access medical records; (ii) the health facility or health care

provider itself is authorized to obtain the HIV-related information; and (iii) the agent or employee provides health care to the protected individual, or maintains or processes medical

records for billing or reimbursement;

(4)(i) a health care provider or health facility when knowledge of the HIV-related information is necessary to provide appropriate care or treatment to the protected individual or a child of

the individual;

(ii) a health care provider or health facility when knowledge of HIV-related information is necessary to provide appropriate care or treatment to a contact or exposed individual, provided the requirements in section 63.8(m) of this Part are followed for disclosures

involving exposures in risk situations;

(iii) in circumstances when consent for health care is necessary, disclosure may also be made to a person authorized to consent to health care for such contact or for such protected

individual, provided that if disclosure is to a person authorized to consent to the health care of a contact or to a contact when such contact has been exposed to HIV under circumstances

which present a risk of transmission, the requirements in subdivision (m) of section 63.8 must be followed;

(5) a health facility or health care provider, in relation to the procurement, processing, distributing or use of a human body or a human body part, including organs, tissues, blood,

semen, or other body fluids, for use in medical education, research, therapy, or for transplantation to individuals;

(6) health facility staff committees, or accreditation or oversight review organizations

authorized to access medical records, provided that such committees or organizations may only disclose confidential HIV-related information:

(i) back to the facility or provider of a health or social service;

(ii) to carry out the monitoring, evaluation, or service review for whcih it was obtained; or 

(iii) to a federal, state or local government agency for the purposes of and subject to the conditions provided in paragraph (e) of this section;

(7) a federal, state, county or local health officer when such disclosure is mandated by federal or state law, including reporting and contact notification processes authorized pursuant to

Article 21, Title III, or pursuant to Article 27-F; 

(8) authorized agencies as defined by Social Services Law, Section 371 and corporations incorporated or organized to receive children for adoption or foster care, in connection with

foster care or adoption of a child. Such agency shall be authorized to redisclose such information only pursuant to the provisions of Article 27-F of the Public Health Law or in

accordance with the provisions of Social Services Law Section 373-A and regulations promulgated thereunder;

(9) third party reimbursers or their agents to the extent necessary to reimburse health care providers, including health facilities, for health services, provided that, an otherwise

appropriate authorization for such disclosure has been secured;

(10) an insurance institution, for other than the purpose set forth in paragraph (9) of this subdivision, provided the insurance institution secures a dated and written authorization that indicates that health care providers, health facilities, insurance institutions, and other persons

are authorized to disclose information about the protected individual, the nature of the information to be disclosed, the purposes for which the information is to be disclosed and

which is signed by:

(i) the protected individual;

(ii) if the protected individual lacks the capacity to consent, such other person authorized pursuant to law to consent for such individual; or

(iii) if the protected individual is deceased, the beneficiary or claimant for benefits under an insurance policy, a health services plan, or an employee welfare benefit plan as authorized in

Article 27-F of the Public Health Law;

(11) to a funeral director upon taking charge of the remains of a deceased person when such funeral director has access in the ordinary course of business to HIV-related information on

the death certificate of the deceased individual, as authorized by Public Health Law Section

4142;

(12) any person to whom disclosure is ordered by a court of competent jurisdiction pursuant to Public Health Law Section 2785;

(13) an employee or agent of the Division of Probation and Correctional Alternatives, Division of Parole, Commission of Correction, or any local probation department, to the

extent the employee or agent is authorized to access records containing such information in order to carry out functions, powers and duties with respect to the protected person and in

accordance with regulations promulgated pursuant to Public Health Law Article 27-F;

(14) a medical director of a local correctional facility in accordance with regulations promulgated pursuant to Article 27-F to the extent the medical director is authorized to access

records to carry out his/her functions relating to the protected person. Redisclosure by the medical director is prohibited except as permitted under Public Health Law Article 27-F,

Article 21, Title III and implementing regulations;

(15) an employee or agent of the New York City Board of Corrections so that the board may continue to access records of inmates who die while in the custody of the New York City

Department of Corrections when necessary for the board to carry out its duties, functions, and powers with respect to the protected individual, pursuant to the New York City charter; or

(16) a law guardian, appointed to represent a minor pursuant to the social services law or the family court act, for the purpose of representing that minor. If the minor has the capacity to

consent, the law guardian may not redisclose confidential HIV related information without the minor's permission. If the minor lacks capacity to consent, the law guardian may redisclose

confidential HIV-related information for the purpose of representing the minor; or

(17) an executor or administrator of an estate of a deceased person as needed to fulfill his or her responsibilities/duties as an executor or administrator.

(b) A state, county or local health officer may disclose confidential HIV-related information when:

(1) disclosure is specifically authorized or required by federal or state law including, but not limited to Public Health Law, Article 21, Title III and Public Health Law, Article 27-F; or 

(2) disclosure is made pursuant to a release of confidential HIV related information; or

(3) disclosure of information regarding a contact is requested by a physician pursuant to section 63.8 of this Part; or if the contact resides outside the jurisdiction of the authorized

public health official, the official shall inform the public health official in the contact's jurisdiction in order to confidentially inform such contact; or 

(4) disclosure is authorized by court order pursuant to the provisions of Public Health Law Section 2785.

(c) A physician or his/her agent may disclose the confidential HIV-related information to a contact and to a public health officer for the purpose of making a disclosure to the contact.

(d) A physician or his/her agent may, upon the consent of a parent or guardian, disclose confidential HIV-related information to a state, county, or local health officer for the purpose

of reviewing the medical history of a child to determine the fitness of the child to attend school.

(e) Confidential HIV-related information of a protected person may be disclosed to authorized employees or agents of a governmental agency pursuant to the regulations of the

governmental agency when the person providing health or social services is regulated, supervised or monitored by the governmental agency or when the governmental agency administers the health program or a social service program and when such employees or

agents have access to records in the ordinary course of business and when access is reasonably necessary for regulation, supervision, monitoring, administration or provision of services. Such authorized employees or agents may include attorneys authorized by a government

agency when access occurs in the ordinary course of providing legal services and is reasonably necessary for supervision, monitoring, administration or provision of services. Such authorized employees or agents may also include public health officers as needed for

conducting epidemiological or surveillance investigations pursuant to applicable law, rule or regulation. Such surveillance or investigational data shall also be disclosed by the public

health officer to the State Department of Health as required by the State Sanitary Code or this Part .

(f) Confidential HIV-related information of a protected person may be disclosed to authorized employees or agents of a provider of health or social services when such provider is either

regulated, supervised or monitored by a governmental agency or when a governmental agency administers the provider's health or social service program, and when such employees or

agents have access to records in the ordinary course ofbusiness and when access is reasonably necessary for regulation, supervision, monitoring, administration or provision of services. Such authorized employees or agents may include

attorneys authorized by persons providing health services when access occurs in the ordinary course of providing legal services and is reasonably necessary for supervision, monitoring,

administration or provision of services.

(g) A physician or his/her agent may disclose confidential HIV-related information pertaining to a protected individual to a person, known to the physician or his/her agent , authorized

pursuant to law to consent to the health care for the protected individual when the physician reasonably believes that:

(1) disclosure is medically necessary in order to provide timely care and treatment for the

protected individual; and

(2) after appropriate counseling as to the need for such disclosure the protected individual will not inform a person authorized by law to consent to health care; provided, however, that the

physician shall not make such disclosure if, in the judgment of the physician:

(i) the disclosure would not be in the best interest of the protected individual; or 

(ii) the protected individual is authorized pursuant to law to consent to such care and treatment. A physician's decision to disclose pursuant to this paragraph, and the basis for that

decision shall be recorded in the medical record.

(h) No person to whom confidential HIV information has been disclosed shall disclose the information to another person except as authorized by law, (including, but not limited to,

disclosure authorized by PHL Article 21, Title III), except that this provision shall not apply to:

(1) the protected individual;

(2) a natural person who is authorized pursuant to law to consent to health care for the protected individual;

(3) a protected individual's foster parent, subject to Department of Social Services regulations, for the purpose of providing care, treatment or supervision to the protected individual; or

(4) a prospective adoptive parent, subject to Department of Social Services regulations, with whom a child has been placed for adoption.

(i) Nothing in this section shall limit a person's or agency's responsibility or authority to report, investigate, or redisclose child protective and adult protective services information in accordance with title six of article six and titles one and two of article nine-b of the Social

Services Law, or to provide or monitor the provision of child and adult protective or preventive services.

(j) Confidential HIV-related information shall not be disclosed to a health care provider or health care facility for the sole purpose of implementing infection control precautions when such provider or facility is regulated under the Public Health Law and required to implement

such precautions with all individuals pursuant to this Title. This restriction shall not limit access to HIV-related information by a facility's infection control personnel for purposes of

fulfilling their designated responsibilities in the facility.

(k) Confidential HIV-related information shall not be released pursuant to a subpoena. A court order pursuant to Public Health Law section 2785 is required for release of confidential HIV-

related information.

(l) Confidential HIV related information shall be disclosed upon the request of the Health Care Worker HIV/HBV Advisory Panel (see Public Health Law Article 27-DD) to the Panel or its designee(s) only when the Panel considers the information reasonably necessary for the

evaluation and monitoring of a worker who has voluntarily sought the Panel's review.

Volume: A-1a

Effective Date: 06/01/2000Title: Section 63.7 - Documentation of HIV-related information and disclosures

63.7 Documentation of HIV-related information and disclosures. (a) Confidential HIV-related information shall be recorded in the medical record such that it is readily accessible to provide

proper care and treatment.

(b) All disclosures of confidential HIV-related information must be noted in the record, except:

(1) only initial disclosures to insurance institutions must be noted;

(2) notation is not required for disclosure to agents or employees of health facilities or health care providers authorized under section 63.6(a)(3);

(3) notation is not required for persons engaged in quality assurance, program monitoring or evaluation, nor for governmental payment agents acting pursuant to contract or law.

(c) Confidential HIV-related information shall be noted, as appropriate, in a certificate of death, autopsy report or related documents prepared pursuant to Public Health Law, Article 41

or other laws relating to documentation of cause of death.

(d) The protected person shall be informed of disclosures of HIV information upon request of the protected person.

(e) Confidential HIV-related information shall not be disclosable pursuant to Public Officers Law, Article 6 (the Freedom of Information Law).

Volume: A-1a

Effective Date: 02/22/2012

Title: Section 63.8 - Contact notification

63.8 Contact notification. (a) When contact notification is conducted based on the mandated reporting of cases of HIV infection, HIV-related illness and AIDS and the reporting of known contacts of such cases, and/or provided by the protected individual, all information collected

in the course of these contact notification activities, including screening to assess risk of domestic violence, shall be kept confidential as required by Public Health Law, Article 21,

Title III, and shall not be disclosed except when in the judgment of the public health official necessary to other authorized public health officials for conducting accurate and complete

epidemiological monitoring of the HIV/AIDS epidemic and for conducting contact notification activities except that contact names and locating information may be disclosed to

public health officials in other jurisdictions when necessary to notify the contact; no information about the protected individual will be released to any person in this process.

Disclosures and notifications shall be made as follows:

(1) Physicians and other persons required to report as provided for in section 63.4 must indicate on the reporting form whether they have conducted post-test counseling and an

assessment of the risk of domestic violence in conformance with a domestic violence screening protocol developed by the commissioner, whether they plan to undertake contact notification activities, have completed notification of contacts or are making a referral for

partner notification assistance to authorized public health officials. If the physician or other mandated reporter chooses to conduct notification, the results of those activities, including information specified by the commissioner on forms supplied by the commissioner, or their equivalent, must be forwarded to the appropriate authorized public health official within 60

days of the initial report, pursuant to section 63.4.

(2) The commissioner shall forward initial reports from physicians and other mandated reporters, including the names and addresses of the reported case and of the known contacts,

and/or contacts provided by the protected person, the status of provider initiated contact notification activities and the determination of risk of domestic violence, if any, to the

authorized public health official in the county where the reported case resides.

(3) Consistent with guidelines acceptable to the commissioner in conformance with Article 21 of the Public Health Law, authorized public health officials, upon determination that the reported case, reported contacts, or any other case merits contact notification in order to

protect the public health, shall make a good faith effort to seek the cooperation of the protected individual to name contacts they wish to have notified, to notify the known contacts and to inform the public health official in the jurisdiction where any additional contacts reside, when necessary to notify such contacts. No information about the protected individual will be

released to any person in this process.

(b) Authorized public health officials shall consider the following as important factors in determining the priority for which cases merit contact notification in order to protect the

public health:

(1) reported contacts, including spouses known to the reporting physician or other diagnostic provider, or who the protected person wishes to have notified, unless the provider certifies

that these known contacts have already been notified; and 

(2) protected persons who are newly diagnosed with HIV infection.

(c) In cases which merit contact notification, if an indication of risk of domestic violence has been identified, pursuant to a protocol acceptable to the commissioner, the authorized public

health official, in consultation with the reporting physician, must be satisfied in his/her professional judgment that reasonable arrangements, efforts or referrals to address the safety

of affected persons have been made if and when the notification is to proceed. Such consultation shall also consider information, if available, requested from the protected person,

or from a domestic violence service provider pursuant to a signed release.

(d) Authorized public health officials shall conduct contact notification activities consistent with guidelines acceptable to the commissioner which will recognize the special needs of

adolescents, individuals in residential and institutional settings, and other vulnerable populations.

(e) Authorized public health officials will respond to all requests from HIV infected individuals and their health care providers for assistance in notifying contacts.

(f) When contact notification is conducted by authorized public health officials, such officials shall:

(1) confirm that post-test counseling of the protected person is completed;

(2) when communication with the protected person is necessary, communicate with the protected person in a confidential, private and safe manner to seek cooperation in contact notification activities, to verify the information about the identity or location of known

contacts, to conduct or confirm a screen for domestic violence and if applicable, to make referrals regarding domestic violence, prior to any notification of contacts. If communication

cannot be made in aconfidential, private and safe manner, it shall be deferred until these requirements can be met;

and

(3) in circumstances where the protected individual cannot be contacted for post-test counseling or declines to be assessed for risk of domestic violence in relation to known

contacts, the authorized public health official shall make the determination of whether to proceed with notification of known contacts, in consultation with the reporting physician.

(g) All persons notifying contacts shall provide counseling or make referrals or appointments

for counseling and testing as appropriate. Such counseling must address coping emotionally

with potential exposure to HIV, domestic violence issues, an explanation regarding the nature of HIV infection and HIV-related illness, availability of anonymous and confidential testing, information on preventing exposure or transmission of HIV infection, information regarding

discrimination problems that might occur as a result of disclosure of HIV-related information, and legal protections against such disclosures. All notifications shall be in person, except

where circumstances reasonably prevent doing so, e.g., at the request of the contact.

(h) If a protected person is now deceased, contacts (e.g., spouse) are known to the physician and the physician believes the protected person had not informed such contacts, the physician or his/her agent may notify such contacts or shall request the authorized public health official

to notify the contacts, without identifying the protected individual to the contact.

(i) A physician or authorized public health official shall have no obligation to identify or locate any contact, except as provided pursuant to Public Health Law Article 21, Title III. No

criminal sanction or civil liability shall arise against a physician, his/her employer or designated agent, health facility, health care provider or authorized public health official for the disclosure of confidential HIV-related information to a contact or to a person consenting

to health care for the contact when in compliance with Article 27-F, or for the failure to disclose such information to a contact or to a person consenting to health care for the contact.

(j) Municipal health commissioners must provide HIV contact notification services and shall forward to the department, summary data and all identifiable information related to

notification activities upon completion of such activity unless otherwise determined by the commissioner. Information identifying the contact collected in the course of contact

notification activities by authorized public health officials shall not be maintained at the state or local level for more than three years following completion of such activity.

(k) For the purposes of notifying contacts under Public Health Law section 2782(1)(d), blood transfusion and organ and tissue transplantation present a risk of HIV transmission. Notifying

contacts potentially exposed to HIV through tissues, organs, or transfused blood under a federally mandated recipient notification program or guidelines acceptable to the

commissioner shall be sufficient to meet the notification requirements of Article 21, Title III and Article 27-F. Blood banks, organ procurement organizations, and tissue banks may disclose the HIV status of a donation to a donor's provider for the purposes of notifying

known contacts of a donor.

(l) When contact notification is initiated by a physician not related to reporting mandates or Article 21, Title III, but based on authority to notify an identified spouse, sex partner,

hypodermic needle and syringe partner under Public Health Law section 2782(4), physicians or their agents and authorized public health officials may conduct contact notification as

follows:

(1) a physician or his/her agent may, without the protected person's consent, notify such

contact or report such contact to the authorized public health official for the purpose of

notifying a contact when:

(i) the physician believes disclosure is medically appropriate and a significant risk of infection may exist to the contact; and

(ii) the protected person has been counseled to notify his/her contacts or the physician has taken all reasonable efforts to attempt to counsel the person; and

(iii) domestic violence screening in accordance with the screening protocol has been applied;

(2) the physician must inform the protected person of the physician's intent to notify such contacts and of their responsibility to report the case and such contacts to the commissioner,

and inform the protected person that he/she may express a preference whether contact notification shall be made by the physician or authorized public health official, and that the protected individual's name or other information about them is not disclosed to any person

during the contact notification process;

(3) if the protected person's preference is for the authorized public health official to notify contacts or if the protected person's preference is for the physician to notify contacts but the physician chooses not to do so, he/she shall notify the protected person of his/her decision to

contact the authorized public health official and shall forward names and addresses of the case and contacts to the authorized public health official, who shall take reasonable measures to

notify such contacts. If the protected person's preference is for the physician to notify contacts and the physician elects to do so, the physician or his/her agent may then notify contacts; and

(4) the physician must report to the authorized public health official regarding the success or failure of such efforts, including the names and addresses of the cases and contacts. If contacts

have not been notified or notification cannot be verified by the physician or his/her agent, public health officers shall take reasonable measures to inform the contact as set forth in

subdivisions (b) through (g) of section 63.8.

(m) When the requirements of this section have been met, physicians and other diagnostic providers may disclose HIV-related information, without a release of confidential HIV-related

information, to physicians or other diagnostic providers of persons whom the protected individual may have exposed to HIV under the circumstances noted below that present a risk of transmission of HIV, except that disclosures related to exposures of emergency response

employees governed by federal law shall continue to be governed by such law:

(1) the incident must involve exposure to blood, semen, vaginal secretions, breast milk, tissue or the following body fluids: cerebrospinal, amniotic, peritoneal, synovial, pericardial and

pleural; and

(2) a person has contact with the body substances, as noted in paragraph (1) above, of another

to mucus membranes (e.g., eyes, nose, mouth), non-intact skin (e.g., open wound, skin with a dermatitis condition, abraded areas) or to the vascular system. Examples of such contact may

include needlesticks, puncture wound injuries and direct saturation or permeation of non-intact skin by potentially infectious substances. These circumstances shall not include those

delineated in subdivision (d) of section 63.10; and

(3) the exposure incident occurred to staff, employees or volunteers in the performance of employment or professional duties:

(i) in a medical or dental office; or

(ii) in a facility regulated, authorized or supervised by the Department of Health, Office of Mental Health, Office of Mental Retardation and Developmental Disabilities, Office of

Children and Family Services, Office of Alcoholism and Substance Abuse Services, Department of Correctional Services; or

(iii) involved an emergency response employee, paid or volunteer, including an emergency medical technician, a firefighter, a law enforcement officer (e.g., police, probation, parole

officer) or local correctional officer or medical staff; and

(4) an incident report documenting the details of the exposure, including witnesses to the incident, if any, is on record with supervisory staff; and

(5) a request for disclosure of HIV status is made to the provider of the source or to the medical officer designated by the facility by the exposed person or by the provider of the exposed person as soon as possible after the alleged exposure if a decision relating to the

initiation or continuation of post-exposure prophylactic treatment is being considered; and

(6) documentation of the request is placed in the medical record of the exposed person; and

(7) if the provider of the source or the medical officer designated by the facility determines that a risk of transmission has occurred or is likely to have occurred in the reasonable exercise of his/her professional judgment, the provider or medical officer may release the HIV status of

the source, if known. The provider or medical officer may consult with the municipal health commissioner or district health officer to determine whether a risk of transmission exists. If

consultation occurs, both the provider and the local health officer must be in agreement if the HIV information is to be disclosed. In the disclosure process the name of the source shall not be provided to the exposed person. Redisclosure of the HIV status of the source is prohibited

except when made in conformance with Public Health Law Article 21, Title III.

(n) In cases of anonymous testing of an occupational exposure source patient who is deceased, comatose or otherwise unable to provide consent, and no person authorized to consent on behalf of the source person is immediately available, as provided for in Public Health Law Section 2781(6)(e), the results of such anonymous test, but not the identity of the source

person, shall be disclosed only to the attending health care professional of the exposed person

solely for the purpose of assisting the exposed person in making appropriate decisions regarding post-exposure medical treatment. The results of the test shall not be disclosed to the

source person or placed in the source person’s medical record.

Volume: A-1a

Effective Date: 02/22/2012Title: Section 63.9 - Health care provider and health facility policy and procedures

63.9 Health care provider and health facility policy and procedures. Each health care provider and health facility employing persons or contracting with persons to perform any activity

related to such provider's or facility's rendering of health services shall develop and implement policies and procedures to maintain the confidentiality of confidential HIV related information. Such policies and procedures shall assure that such information is disclosed to

employees or contractors only when appropriate under this Part. Such policies and procedures shall include:

(a) initial employee education inservice education of employees regarding the legal prohibition against unauthorized disclosure in Public Health Law Article 27-F and provisions

of Article 21, Title III. Updates should be provided to all employees in cases of changes to relevant laws or regulations. A list of all employees who have had such training must be

maintained by health care providers and health facilities. Health care providers and health facilities contracting with others for services in which HIV-related information may be disclosed to such contractors, must document evidence that such contractors have been

informed of the confidentiality and disclosure requirements of this Part;

(b) maintenance of a list of job titles and the specific employee functions within those titles for which employees are authorized to access such information. This list shall describe the

limits of such access to information and must be provided to the employees during employee education sessions;

(c) a requirement that only full-time or part-time employees, contractors and medical, nursing or health-related students who have received such education on HIV confidentiality, or can

document that they have received such education or training, shall have access to confidential HIV-related information while performing the authorized functions listed under paragraph (2).

(d) protocols for ensuring that records, including records which are stored electronically, are maintained securely and used for the purpose intended;

(e) procedures for handling requests by other parties for confidential HIV-related information;

(f) protocols prohibiting employees/agents/contractors from discriminating against persons

having or suspected of having HIV infection; and

(g) review of the policies and procedures on at least an annual basis.

Volume: A-1a

Effective Date: 02/22/2012Title: Section 63.10 - Significant risk

63.10 Significant risk. (a) The three factors necessary to create a significant risk of contracting or transmitting HIV infection are:

(1) the presence of a significant risk body substance;

(2) a circumstance which constitutes significant risk for transmitting or contracting HIV infection; and

(3) the presence of an infectious source and another person.

(b) "Significant risk body substances" are blood, semen, vaginal secretions, breast milk, tissue and the following body fluids: cerebrospinal, amniotic, peritoneal, synovial, pericardial, and

pleural.

(c) Circumstances which constitute "significant risk of transmitting or contracting HIV infection" are:

(1) sexual intercourse (vaginal, anal, oral) which exposes another individual to blood, semen or vaginal secretions of an infected individual;

(2) sharing of needles and other paraphernalia used for preparing and injecting drugs between infected and other individuals;

(3) the gestation, birthing or breast feeding of an infant when the mother is infected with HIV;

(4) transfusion or transplantation of blood, organs, or other tissues from an infected individual to an another, provided such blood, organs or other tissues have not tested conclusively for

antibody or antigen and have not been rendered non-infective by heat or chemical treatment;

(5) other circumstances not identified in paragraphs (1) through (4) of this subdivision during which a significant risk body substance (other than breast milk) of an infected individual

contacts mucous membranes (e.g., eyes, nose, mouth), non-intact skin (e.g., open wound, skin

with a dermatitis condition, abraded areas) or the vascular system of another person. Such

circumstances include, but are not limited to needlestick or puncture wound injuries and direct saturation or permeation of these body surfaces by the infectious body substance.

(d) Circumstances that involve "significant risk" shall not include:

(1) exposure to urine, feces, sputum, nasal secretions, saliva, sweat, tears or vomitus that does not contain blood that is visible to the naked eye;

(2) human bites where there is no direct blood to blood, or blood to mucous membrane contact;

(3) exposure of intact skin to blood or any other body substance;

(4) occupational settings where individuals use scientifically accepted barrier techniques and preventive practices in circumstances which would otherwise pose a significant risk and such

barriers are not breached and remain intact. 

Volume: A-1a

Effective Date: 10/11/2006Title: Section 63.11 - Separability

63.11 Separability. If any section, subsection, clause or provision of this Part shall be deemed by any court of competent jurisdiction to be unconstitutional, ineffective or otherwise legally

invalid or unenforceable, in whole or in part, to the extent that it is not unconstitutional, ineffective or otherwise legally invalid or unenforceable, it shall be valid and effective and no other section, subsection, clause or provision shall, on account thereof, be deemed invalid or

ineffective.

Volume: A-1a

Public Health ARTICLE 27-F HIV AND AIDS RELATED INFORMATION Section 2780. Definitions. 2781. HIV related testing. 2781-a. Required offering of HIV related testing. 2782. Confidentiality and disclosure. 2783. Penalties; immunities. 2784. Applicability to insurance institutions and insurance support organizations. 2785. Court authorization for disclosure of confidential HIV related information. 2785-a. Court order for HIV related testing in certain cases. 2786. Rules and regulations; forms; report. 2787. Separability.

§ 2780. Definitions. As used in this article, the following terms shall have the following meanings: 1. "AIDS" means acquired immune deficiency syndrome, as may be defined from time to time by the centers for disease control of the United States public health service. 2. "HIV infection" means infection with the human immunodeficiency virus or any other related virus identified as a probable causative agent of AIDS. 3. "HIV related illness" means any illness that may result from or may be associated with HIV infection. 4. "HIV related test or HIV related testing" means any laboratory test, tests or series of tests approved for the diagnosis of HIV. 4-a. "Rapid HIV test or testing" means any laboratory screening test or tests approved for detecting antibodies to HIV, that produce results in sixty minutes or less, and encompasses a confirmatory HIV related test if the screening test is reactive. 5. "Capacity to consent" means an individual's ability, determined without regard to the individual's age, to understand and appreciate the nature and consequences of a proposed health care service, treatment, or procedure, or of a proposed disclosure of confidential HIV related information, as the case may be, and to make an informed decision concerning the service, treatment, procedure or disclosure. 6. "Protected individual" means a person who is the subject of an HIV related test or who has been diagnosed as having HIV infection, AIDS or HIV related illness. 7. "Confidential HIV related information" means any information, in the possession of a person who provides one or more health or social services or who obtains the information pursuant to a release of confidential HIV related information, concerning whether an individual has been the subject of an HIV related test, or has HIV infection, HIV related illness or AIDS, or information which identifies or reasonably could identify an individual as having one or more of such conditions, including information pertaining to such individual's contacts. 8. "Health or social service" means any public or private care, treatment, clinical laboratory test, counseling or educational service for adults or children, and acute, chronic, custodial, residential, outpatient, home or other health care provided pursuant to this chapter or the social services law; public assistance or care as defined in article one of the social services law; employment-related services, housing services, foster care, shelter, protective services, day care, or preventive services provided pursuant to the social services law;

services for the mentally disabled as defined in article one of the mental hygiene law; probation services, provided pursuant to articles twelve and twelve-A of the executive law; parole services, provided pursuant to article eight of the correction law; corrections and community supervision, provided pursuant to the correction law; detention and rehabilitative services provided pursuant to article nineteen-G of the executive law; and the activities of the health care worker HIV/HBV advisory panel pursuant to article twenty-seven-DD of this chapter. 9. "Release of confidential HIV related information" means a written authorization for disclosure of confidential HIV related information which is signed by the protected individual, or if the protected individual lacks capacity to consent, a person authorized pursuant to law to consent to health care for the individual. Such release shall be dated and shall specify to whom disclosure is authorized, the purpose for such disclosure and the time period during which the release is to be effective. A general authorization for the release of medical or other information shall not be construed as a release of confidential HIV related information, unless such authorization specifically indicates its dual purpose as a general authorization and an authorization for the release of confidential HIV related information and complies with the requirements of this subdivision. 10. "Contact" means an identified spouse or sex partner of the protected individual, a person identified as having shared hypodermic needles or syringes with the protected individual or a person who the protected individual may have exposed to HIV under circumstances that present a risk of transmission of HIV, as determined by the commissioner. 11. "Person" includes any natural person, partnership, association, joint venture, trust, public or private corporation, or state or local government agency. 12. "Health facility" means a hospital as defined in section two thousand eight hundred one of this chapter, blood bank, blood center, sperm bank, organ or tissue bank, clinical laboratory, or facility providing care or treatment to persons with a mental disability as defined in article one of the mental hygiene law. 13. "Health care provider" means any physician, nurse, provider of services for the mentally disabled as defined in article one of the mental hygiene law, or other person involved in providing medical, nursing, counseling, or other health care or mental health service, including those associated with, or under contract to, a health maintenance organization or medical services plan. 14. "Child" means any protected individual actually or apparently under eighteen years of age. 15. "Authorized agency" means any agency defined by section three hundred seventy-one of the social services law and, for the purposes of this article, shall include such corporations incorporated or organized under the laws of the state as may be specifically authorized by their certificates of incorporation to receive children for the purposes of adoption or foster care. 16. "Insurance institution" means any corporation, association, partnership, reciprocal exchange, interinsurer, fraternal benefits society, agent, broker or other entity including, but not limited to, any health maintenance organization, medical service plan, or hospital plan which: (a) is engaged in the business of insurance; (b) provides health services coverage plans; or (c) provides benefits under, administers, or provides services for, an employee welfare benefit plan as defined in 29 U.S.C. 1002(1). 17. "Insurance support organization" means any person who regularly engages, in whole or in part, in the practice of assembling or collecting information about natural persons for the primary purpose of

providing the information to an insurance institution for insurance transactions, including: (a) the furnishing of consumer reports or investigative consumer reports to an insurance instititution for use in connection with an insurance transaction; or (b) the collection of personal information from insurance institutions or other insurance support organizations for the purpose of detecting or preventing fraud, material misrepresentation, or material non-disclosure in connection with insurance underwriting or insurance claim activity. The following persons shall not be considered "insurance-support organizations" for the purposes of this article: government institutions, insurance institutions, health facilities and health care providers.

§ 2781. HIV related testing. 1. Except as provided in section three thousand one hundred twenty-one of the civil practice law and rules, or unless otherwise specifically authorized or required by a state or federal law, no person shall order the performance of an HIV related test without first having received informed consent of the subject of the test who has capacity to consent or, when the subject lacks capacity to consent, of a person authorized pursuant to law to consent to health care for such individual. In order for there to be informed consent, the person ordering the test shall, prior to obtaining informed consent, at a minimum advise the protected individual that an HIV-related test is being performed. 2. Informed consent for HIV related testing pursuant to this section shall be valid for such testing until such consent is revoked. Each time that an HIV related test is ordered pursuant to informed consent in accordance with this section, the physician or other person authorized pursuant to law to order the performance of the HIV related test, or such person's representative, shall orally notify the subject of the test or, when the subject lacks capacity to consent, a person authorized pursuant to law to consent to health care for such individual, that an HIV related test will be conducted at such time, and shall note the notification in the patient's record. 3. A person ordering the performance of an HIV related test shall provide either directly or through a representative to the subject of an HIV related test or, if the subject lacks capacity to consent, to a person authorized pursuant to law to consent to health care for the subject, an explanation that: (a) HIV causes AIDS and can be transmitted through sexual activities and needle-sharing, by pregnant women to their fetuses, and through breastfeeding infants; (b) there is treatment for HIV that can help an individual stay healthy; (c) individuals with HIV or AIDS can adopt safe practices to protect uninfected and infected people in their lives from becoming infected or multiply infected with HIV; (d) testing is voluntary and can be done anonymously at a public testing center; (e) the law protects the confidentiality of HIV related test results; (f) the law prohibits discrimination based on an individual's HIV status and services are available to help with such consequences; and (g) the law allows an individual's informed consent for HIV related testing to be valid for such testing until such consent is revoked by the subject of the HIV related test. Protocols shall be in place to ensure compliance with this section. 4. A person authorized pursuant to law to order the performance of an HIV related test shall provide directly or through a representative to the person seeking such test, an opportunity to remain anonymous through use of a coded system with no linking of individual identity to the test request or results. A health care provider who is not authorized by the

commissioner to provide HIV related tests on an anonymous basis shall refer a person who requests an anonymous test to a test site which does provide anonymous testing. The provisions of this subdivision shall not apply to a health care provider ordering the performance of an HIV related test on an individual proposed for insurance coverage. 5. At the time of communicating the test result to the subject of the test, a person ordering the performance of an HIV related test shall, directly or through a representative: (a) in the case of a test indicating evidence of HIV infection, provide the subject of the test or, if the subject lacks capacity to consent, the person authorized pursuant to law to consent to health care for the subject with counseling or referrals for counseling: (i) for coping with the emotional consequences of learning the result; (ii) regarding the discrimination problems that disclosure of the result could cause; (iii) for behavior change to prevent transmission or contraction of HIV infection; (iv) to inform such person of available medical treatments; and (v) regarding the need to notify his or her contacts; and (b) in the case of a test not indicating evidence of HIV infection, provide (in a manner which may consist of oral or written reference to information previously provided) the subject of the test, or if the subject lacks capacity to consent, the person authorized pursuant to law to consent to health care for the subject, with information concerning the risks of participating in high risk sexual or needle-sharing behavior. 5-a. With the consent of the subject of a test indicating evidence of HIV infection or, if the subject lacks capacity to consent, with the consent of the person authorized pursuant to law to consent to health care for the subject, the person who ordered the performance of the HIV related test, or such person's representative, shall provide or arrange with a health care provider for an appointment for follow-up medical care for HIV for such subject. 6. The provisions of this section shall not apply to the performance of an HIV related test: (a) by a health care provider or health facility in relation to the procuring, processing, distributing or use of a human body or a human body part, including organs, tissues, eyes, bones, arteries, blood, semen, or other body fluids, for use in medical research or therapy, or for transplantation to individuals provided, however, that where the test results are communicated to the subject, post-test counseling, as described in subdivision five of this section, shall nonetheless be required; or (b) for the purpose of research if the testing is performed in a manner by which the identity of the test subject is not known and may not be retrieved by the researcher; or (c) on a deceased person, when such test is conducted to determine the cause of death or for epidemiological purposes; or (d) conducted pursuant to section twenty-five hundred-f of this chapter; or (e) in situations involving occupational exposures which create a significant risk of contracting or transmitting HIV infection, as defined in regulations of the department and pursuant to protocols adopted by the department, (i) provided that: (A) the person who is the source of the occupational exposure is deceased, comatose or is determined by his or her attending health care professional to lack mental capacity to consent to an HIV related test and is not reasonably expected to recover in time for the exposed person to receive appropriate medical treatment, as determined by the exposed person's attending health care professional who would order or provide such treatment;

(B) there is no person available or reasonably likely to become available who has the legal authority to consent to the HIV related test on behalf of the source person in time for the exposed person to receive appropriate medical treatment; and (C) the exposed person will benefit medically by knowing the source person's HIV test results, as determined by the exposed person's health care professional and documented in the exposed person's medical record; (ii) in which case (A) a provider shall order an anonymous HIV test of the source person; and (B) the results of such anonymous test, but not the identity of the source person, shall be disclosed only to the attending health care professional of the exposed person solely for the purpose of assisting the exposed person in making appropriate decisions regarding post-exposure medical treatment; and (C) the results of the test shall not be disclosed to the source person or placed in the source person's medical record. 7. In the event that an HIV related test is ordered by a physician or certified nurse practitioner pursuant to the provisions of the education law providing for non-patient specific regimens, then for the purposes of this section the individual administering the test shall be deemed to be the individual ordering the test.

§ 2781-a. Required offering of HIV related testing. 1. Every individual between the ages of thirteen and sixty-four years (or younger or older if there is evidence or indication of risk activity) who receives health services as an inpatient or in the emergency department of a general hospital defined in subdivision ten of section twenty-eight hundred one of this chapter or who receives primary care services in an outpatient department of such hospital or in a diagnostic and treatment center licensed under article twenty-eight of this chapter or from a physician, physician assistant, nurse practitioner, or midwife providing primary care shall be offered an HIV related test unless the health care practitioner providing such services reasonably believes that (a) the individual is being treated for a life threatening emergency; or (b) the individual has previously been offered or has been the subject of an HIV related test (except that a test shall be offered if otherwise indicated); or (c) the individual lacks capacity to consent to an HIV related test. 2. As used in this section, "primary care" means the medical fields of family medicine, general pediatrics, primary care, internal medicine, primary care obstetrics, or primary care gynecology, without regard to board certification. 3. The offering of HIV related testing under this section shall be culturally and linguistically appropriate in accordance with rules and regulations promulgated by the commissioner. 4. This section shall not affect the scope of practice of any health care practitioner or diminish any authority or legal or professional obligation of any health care practitioner to offer an HIV related test or to provide services or care for the subject of an HIV related test.

§ 2782. Confidentiality and disclosure. 1. No person who obtains confidential HIV related information in the course of providing any health or social service or pursuant to a release of confidential HIV related information may disclose or be compelled to disclose such information, except to the following: (a) the protected individual or, when the protected individual lacks capacity to consent, a person authorized pursuant to law to consent to health care for the individual;

(b) any person to whom disclosure is authorized pursuant to a release of confidential HIV related information; (c) an agent or employee of a health facility or health care provider if (1) the agent or employee is permitted to access medical records, (2) the health facility or health care provider itself is authorized to obtain the HIV related information, and (3) the agent or employee provides health care to the protected individual, or maintains or processes medical records for billing or reimbursement; (d) a health care provider or health facility when knowledge of the HIV related information is necessary to provide appropriate care or treatment to the protected individual, a child of the individual, a contact of the protected individual or a person authorized to consent to health care for such a contact; (e) a health facility or health care provider, in relation to the procurement, processing, distributing or use of a human body or a human body part, including organs, tissues, eyes, bones, arteries, blood, semen, or other body fluids, for use in medical education, research, therapy, or for transplantation to individuals; (f) health facility staff committees or accreditation or oversight review organizations authorized to access medical records; provided that such committees or organizations may only disclose confidential HIV related information: (1) back to the facility or provider of a health or social service; (2) to carry out the monitoring, evaluation, or service review for which it was obtained; or (3) to a federal, state or local government agency for the purposes of and subject to the conditions provided in subdivision six of this section; (g) a federal, state, county or local health officer when such disclosure is mandated by federal or state law; (h) an authorized agency in connection with foster care or adoption of a child. Such agency shall be authorized to redisclose such information only pursuant to this article or in accordance with the provisions of subdivision eight of section three hundred seventy-two and section three hundred seventy-three-a of the social services law; (i) third party reimbursers or their agents to the extent necessary to reimburse health care providers for health services; provided that, where necessary, an otherwise appropriate authorization for such disclosure has been secured by the provider; (j) an insurance institution, for other than the purpose set forth in paragraph (i) of this subdivision, provided the insurance institution secures a dated and written authorization that indicates that health care providers, health facilities, insurance institutions, and other persons are authorized to disclose information about the protected individual, the nature of the information to be disclosed, the purposes for which the information is to be disclosed and which is signed by: (1) the protected individual; (2) if the protected individual lacks the capacity to consent, such other person authorized pursuant to law to consent for such individual; or (3) if the protected individual is deceased, the beneficiary or claimant for benefits under an insurance policy, a health services plan, or an employee welfare benefit plan as defined in 29 U.S.C. 1002(1), covering such protected individual; (k) any person to whom disclosure is ordered by a court of competent jurisdiction pursuant to section twenty-seven hundred eighty-five of this article; (l) an employee or agent of the department of corrections and community supervision, in accordance with paragraph (a) of subdivision two of section twenty-seven hundred eighty-six of this article, to the extent the employee or agent is authorized to access records containing such information in order to carry out the department's functions, powers and duties with respect to the protected individual, pursuant to section two hundred fifty-nine-a of the executive law; (m) an employee or agent of the office of probation and correctional

alternatives or any local probation department, in accordance with paragraph (a) of subdivision two of section twenty-seven hundred eighty-six of this article, to the extent the employee or agent is authorized to access records containing such information in order to carry out the office's or department's functions, powers and duties with respect to the protected individual, pursuant to articles twelve and twelve-A of the executive law; (n) a medical director of a local correctional facility as defined in section forty of the correction law, in accordance with paragraph (a) of subdivision two of section twenty-seven hundred eighty-six of this article, to the extent the medical director is authorized to access records containing such information in order to carry out his or her functions, powers and duties with respect to the protected individual; or (o) an employee or agent of the commission of correction, in accordance with paragraph (a) of subdivision two of section twenty-seven hundred eighty-six of this article, to the extent the employee or agent is authorized to access records containing such information in order to carry out the commission's functions, powers and duties with respect to the protected individual, pursuant to article three of the correction law. (p) an attorney appointed to represent a minor pursuant to the social services law or the family court act, with respect to confidential HIV related information relating to the minor and for the purpose of representing the minor. If the minor has the capacity to consent, the minor's attorney may not redisclose confidential HIV related information without the minor's permission. If the minor lacks capacity to consent, the minor's attorney may redisclose confidential HIV related information for the sole purpose of representing the minor. This paragraph shall not limit the ability of the minor's attorney to seek relief under section twenty-seven hundred eighty-five of this chapter. (q) an executor or an administrator of an estate shall have access to the confidential HIV information of a deceased person as needed to fulfill his or her responsibilities/duties as an executor or administrator. 2. A state, county or local health officer may disclose confidential HIV related information when: (a) disclosure is specifically authorized or required by federal or state law; or (b) disclosure is made pursuant to a release of confidential HIV related information; or (c) disclosure is requested by a physician pursuant to subdivision four of this section; or (d) disclosure is authorized by court order pursuant to the provisions of section twenty-seven hundred eighty-five of this article. 3. No person to whom confidential HIV related information has been disclosed pursuant to this article shall disclose the information to another person except as authorized by this article, provided, however, that the provisions of this subdivision shall not apply: (a) to the protected individual; or (b) to a natural person who is authorized pursuant to law to consent to health care for the protected individual; or (c) to a protected individual's foster parent as defined in section three hundred seventy-one of the social services law and subject to regulations promulgated pursuant to paragraph (a) of subdivision two of section twenty-seven hundred eighty-six of this article, for the purpose of providing care, treatment or supervision of the protected individual; or (d) a prospective adoptive parent as specified in section three hundred seventy-three-a of the social services law and subject to regulations promulgated pursuant to paragraph (a) of subdivision two of

section twenty-seven hundred eighty-six of this article with whom a child who is the protected individual has been placed for adoption; or (e) to a relative or other person legally responsible to whom a child who is the protected individual is to be placed or discharged pursuant to section ten hundred seventeen or ten hundred fifty-five of the family court act and subject to regulations promulgated pursuant to paragraph (a) of subdivision two of section twenty-seven hundred eighty-six of this article, for the purpose of providing care, treatment or supervision of the protected individual. 4. (a) A physician may disclose confidential HIV related information under the following conditions: (1) disclosure is made to a contact, to a public health officer for the purpose of making the disclosure to said contact and pursuant to section twenty-one hundred thirty of this chapter; or (2) the physician believes disclosure is medically appropriate and there is a significant risk of infection to the contact; and (3) the physician has counseled the protected individual regarding the need to notify the contact; and (4) the physician has informed the protected individual of his or her intent to make such disclosure to a contact, the physician's responsibility to report the infected individual's case pursuant to section twenty-one hundred thirty of this chapter and has given the protected individual the opportunity to express a preference as to whether disclosure should be made by the physician directly or to a public health officer for the purpose of said disclosure. If the protected individual expresses a preference for disclosure by a public health officer, the physician shall honor such preference. (5) If a physician chooses to make a notification pursuant to this section, he or she shall report to the municipal health commissioner of district health officer on his or her efforts to notify the contacts of the protected individual. Such report shall be in a manner and on forms prescribed by the commissioner and shall include the identity of the protected individual and any contacts as well as information as to whether the contacts were successfully notified. (6) Within a reasonable time of receiving a report that a physician or his or her designated agent did not notify or verify notification of contacts provided by the protected individual, the health commissioner or district health officer of the municipality from which the report originates shall take reasonable measures to notify such contacts and otherwise comply with the provisions of this chapter. (b) When making such disclosures to the contact, the physician or public health officer shall provide or make referrals for the provision of the appropriate medical advice and counseling for coping with the emotional consequences of learning the information and for changing behavior to prevent transmission or contraction of HIV infection. The physician or public health officer shall not disclose the identity of the protected individual or the identity of any other contact. A physician or public health officer making a notification pursuant to this subdivision shall make such disclosure in person, except where circumstances reasonably prevent doing so. (c) A physician or public health officer shall have no obligation to identify or locate any contact except as provided pursuant to title three of article twenty-one of this chapter. (d) A physician may, upon the consent of a parent or guardian, disclose confidential HIV related information to a state, county, or local health officer for the purpose of reviewing the medical history of a child to determine the fitness of the child to attend school. (e) A physician may disclose confidential HIV related information pertaining to a protected individual to a person (known to the physician) authorized pursuant to law to consent to health care for a protected individual when the physician reasonably believes that: (1)

disclosure is medically necessary in order to provide timely care and treatment for the protected individual; and (2) after appropriate counseling as to the need for such disclosure, the protected individual will not inform a person authorized by law to consent to health care; provided, however, that the physician shall not make such disclosure if, in the judgment of the physician: (A) the disclosure would not be in the best interest of the protected individual; or (B) the protected individual is authorized pursuant to law to consent to such care and treatment. Any decision or action by a physician under this paragraph, and the basis therefor, shall be recorded in the protected individual's medical record. 5. (a) Whenever disclosure of confidential HIV related information is made pursuant to this article, except for disclosures made pursuant to paragraphs (a), (d) and (i) of subdivision one of this section or paragraph (a) or (e) of subdivision four of this section, such disclosure shall be accompanied or followed by a statement in writing which includes the following or substantially similar language: "This information has been disclosed to you from confidential records which are protected by state law. State law prohibits you from making any further disclosure of this information without the specific written consent of the person to whom it pertains, or as otherwise permitted by law. Any unauthorized further disclosure in violation of state law may result in a fine or jail sentence or both. A general authorization for the release of medical or other information is NOT sufficient authorization for further disclosure." An oral disclosure shall be accompanied or followed by such a notice within ten days. (b) Except for disclosures made pursuant to paragraph (c) of subdivision one of this section, or to persons reviewing information or records in the ordinary course of ensuring that a health facility is in compliance with applicable quality of care standards or any other authorized program evaluation, program monitoring or service review, or to governmental agents requiring information necessary for payments to be made on behalf of patients or clients pursuant to contract or in accordance to law, a notation of all such disclosures shall be placed in the medical record of a protected individual, who shall be informed of such disclosures upon request; provided, however, that for disclosures made to insurance institutions such a notation need only be entered at the time the disclosure is first made. 6. (a) The provisions of this subdivision shall apply where a provider of a health or social service possesses confidential HIV related information relating to individuals who are recipients of the service, and a federal, state or local government agency supervises or monitors the provider or administers the program under which the service is provided. (b) Confidential HIV related information relating to a recipient of such service may be disclosed in accordance with regulations promulgated pursuant to paragraph (a) of subdivision two of section twenty-seven hundred eighty-six of this article to an authorized employee or agent of such provider or government agency, when reasonably necessary for such supervision, monitoring, administration, or provision of such service. The term "authorized employee or agent", as used in this subdivision shall only include any employee or agent who would, in the ordinary course of business of the provider or government agency, have access to records relating to the care of, treatment of, or provision of a health or social service to the protected individual. 7. Nothing in this section shall limit a person's or agency's responsibility or authority to report, investigate, or redisclose, child protective and adult protective services information in accordance with title six of article six and titles one and two of article nine-B of the social services law, or to provide or monitor the provision of child and adult protective or preventive services.

8. Confidential HIV related information shall be recorded in the medical record of the protected individual. The provisions of this section shall not prohibit the listing of acquired immune deficiency syndrome, HIV related illness or HIV infection in a certificate of death, autopsy report or related documents prepared pursuant to article forty-one of this chapter or other applicable laws, ordinances, rules or regulations relating to the documentation of cause of death, nor shall this section be construed to modify any laws, ordinances, rules or regulations relative to access to death certificates, autopsy reports or such other related documents. Under no circumstances shall confidential HIV related information be disclosable pursuant to article six of the public officers law. Notwithstanding the foregoing, confidential HIV information obtained pursuant to section 390.15 of the criminal procedure law or section 347.1 of the family court act by either court order or consent of the protected individual shall not be recorded in the medical record of the protected individual unless he or she consents to the recording of such information in a written statement containing the relevant information specified in subdivision two of section two thousand seven hundred eighty-one of this article. 9. Confidential HIV related information shall be disclosed upon the request of the health care worker HIV/HBV advisory panel, established pursuant to article twenty-seven-DD of this chapter, to the panel or its designee only when reasonably necessary for the evaluation of a worker who has voluntarily sought the panel's review.

§ 2783. Penalties; immunities. 1. Any person who shall: (a) perform, or permit or procure the performance of, an HIV related test in violation of section twenty-seven hundred eighty-one of this article; or (b) disclose, or compel another person to disclose, or procure the disclosure of, confidential HIV related information in violation of section twenty-seven hundred eighty-two of this article; shall be subject to a civil penalty not to exceed five thousand dollars for each occurrence. Such penalty may be recovered in the same manner as the penalty provided in section twelve of this chapter. 2. Any person who willfully commits an act enumerated in subdivision one of this section shall be guilty of a misdemeanor and subject to the penalties provided in section twelve-b of this chapter. 3. There shall be no criminal sanction or civil liability on the part of, and no cause of action for damages shall arise against any physician, his or her employer, or a physician's designated agent, or health facility or health care provider with which the physician is associated, or public health officer, on account of: (a) the failure to disclose confidential HIV related information to a contact or person authorized pursuant to law to consent to health care for a protected individual; or (b) the disclosure of confidential HIV related information to a contact or person authorized pursuant to law to consent to health care for a protected individual, when carried out in compliance with this article; or (c) the disclosure of confidential HIV related information to any person, agency, or officer authorized to receive such information, when carried out in good faith and without malice, and in compliance with the provisions of this article; or (d) the municipal health commissioner or district health officer's failure to notify contacts pursuant to this chapter. 4. Any cause of action to recover damages based on a failure to provide information, explanations, or counseling prior to the execution of a written informed consent, or based on a lack of informed consent in the ordering or performance of an HIV related test in violation of this

article shall be governed by the provisions of section two thousand eight hundred five-d of this chapter.

§ 2784. Applicability to insurance institutions and insurance support organizations. Except for disclosure to third party reimbursers and insurance institutions pursuant to paragraphs (i) and (j) of subdivision one of section twenty-seven hundred eighty-two of this article and except for disclosures pursuant to section twenty-seven hundred eighty-five of this article, the provisions of this article shall not apply to insurance institutions and insurance support organizations, except that health care providers associated with or under contract to a health maintenance organization or other medical services plan shall be subject to the provisions of this article.

§ 2785. Court authorization for disclosure of confidential HIV related information. 1. Notwithstanding any other provision of law, no court shall issue an order for the disclosure of confidential HIV related information, except a court of record of competent jurisdiction in accordance with the provisions of this section. 2. A court may grant an order for disclosure of confidential HIV related information upon an application showing: (a) a compelling need for disclosure of the information for the adjudication of a criminal or civil proceeding; (b) a clear and imminent danger to an individual whose life or health may unknowingly be at significant risk as a result of contact with the individual to whom the information pertains; (c) upon application of a state, county or local health officer, a clear and imminent danger to the public health; or (d) that the applicant is lawfully entitled to the disclosure and the disclosure is consistent with the provisions of this article. 3. Upon receiving an application for an order authorizing disclosure pursuant to this section, the court shall enter an order directing that all pleadings, papers, affidavits, judgments, orders of the court, briefs and memoranda of law which are part of the application or the decision thereon, be sealed and not made available to any person, except to the extent necessary to conduct any proceedings in connection with the determination of whether to grant or deny the application, including any appeal. Such an order shall further direct that all subsequent proceedings in connection with the application shall be conducted in camera, and, where appropriate to prevent the unauthorized disclosure of confidential HIV related information, that any pleadings, papers, affidavits, judgments, orders of the court, briefs and memoranda of law which are part of the application or the decision thereon not state the name of the individual concerning whom confidential HIV related information is sought. 4. (a) The individual concerning whom confidential HIV related information is sought and any person holding records concerning confidential HIV related information from whom disclosure is sought shall be given adequate notice of such application in a manner which will not disclose to any other person the identity of the individual, and shall be afforded an opportunity to file a written response to the application, or to appear in person for the limited purpose of providing evidence on the statutory criteria for the issuance of an order pursuant to this section. (b) The court may grant an order without such notice and opportunity to be heard, where an ex parte application by a public health officer shows that a clear and imminent danger to an individual whose life or health may unknowingly be at risk requires an immediate order. (c) Service of a subpoena shall not be subject to this subdivision. 5. In assessing compelling need and clear and imminent danger, the

court shall provide written findings of fact, including scientific or medical findings, citing specific evidence in the record which supports each finding, and shall weigh the need for disclosure against the privacy interest of the protected individual and the public interest which may be disserved by disclosure which deters future testing or treatment or which may lead to discrimination. 6. An order authorizing disclosure of confidential HIV related information shall: (a) limit disclosure to that information which is necessary to fulfill the purpose for which the order is granted; and (b) limit disclosure to those persons whose need for the information is the basis for the order, and specifically prohibit redisclosure by such persons to any other persons, whether or not they are parties to the action; and (c) to the extent possible consistent with this section, conform to the provisions of this article; and (d) include such other measures as the court deems necessary to limit any disclosures not authorized by its order.

§ 2785-a. Court order for HIV related testing in certain cases. 1. Notwithstanding any contrary provision of law or regulation, a state, county or local public health officer to whom an order or a consent for an HIV test is addressed or sent, in accordance with section 390.15 of the criminal procedure law or section 347.1 of the family court act, must cause HIV related testing to be administered to the subject named therein and, if the test is pursuant to court order, must immediately provide to the court that issued the order a written report specifying the date on which such test was completed. Such report to the court shall not, however, disclose the results of such test. Such officer must disclose the results of the testing to the victim indicated in the order or consent and must also disclose the results to the person tested, unless the person tested has been asked to but declines to authorize such disclosure to himself or herself. 2. At the time of communicating the test results to the subject or the victim, such public health officer shall directly provide the victim and person tested with (a) counseling or referrals for counseling for the purposes specified in subdivision five of section two thousand seven hundred eighty-one of this article; (b) counseling with regard to HIV disease and HIV testing in accordance with law and consistent with subdivision five of section two thousand seven hundred eighty-one of this article; and (c) appropriate health care and support services, or referrals to such available services. If at the time of communicating the test results, the person tested is in the custody of the department of corrections and community supervision, office of children and family services, office of mental health or a local correctional institution, the counseling and services required by this subdivision may be provided by a public health officer associated with the county or facility within which the person tested is confined. 3. Unless inconsistent with this section, the provisions of this article regarding the confidentiality and disclosure of HIV related information shall apply to proceedings conducted pursuant to section 390.15 of the criminal procedure law or section 347.1 of the family court act.

§ 2786. Rules and regulations; forms; report. 1. The commissioner shall promulgate rules and regulations concerning implementation of this article for health facilities, health care providers and other persons to whom this article is applicable. The commissioner shall also develop

standardized model forms to be used for informed consent for HIV related testing and for the release of confidential HIV related information and materials for pre-test counseling as required by subdivision three of section twenty-seven hundred eighty-one of this article, and for post-test counseling as required by subdivision five of section twenty-seven hundred eighty-one of this article. Persons, health facilities and health care providers may use forms for informed consent for HIV related testing, and for the release of confidential HIV related information other than those forms developed pursuant to this section, provided they contain information consistent with the standardized model forms developed by the commissioner. All forms developed or used pursuant to this section shall be written in a clear and coherent manner using words with common, everyday meanings. The commissioner, in consultation with the AIDS institute advisory council, shall promulgate regulations to identify those circumstances which create a significant risk of contracting or transmitting HIV infection; provided, however, that such regulations shall not be determinative of any significant risk determined pursuant to paragraph (a) of subdivision four of section twenty-seven hundred eighty-two or section twenty-seven hundred eighty-five of this article. 2. (a) Each state agency authorized pursuant to this article to obtain confidential HIV related information shall, in consultation with the department of health, promulgate regulations: (1) to provide safequards to prevent discrimination, abuse or other adverse actions directed toward protected individuals; (2) to prohibit the disclosure of such information except in accordance with this article; (3) to seek to protect individuals in contact with the protected individual when such contact creates a significant risk of contracting or transmitting HIV infection through the exchange of body fluids, and (4) to establish criteria for determining when it is reasonably necessary for a provider of a health or social service or the state agency or a local government agency to have or to use confidential HIV related information for supervision, monitoring, investigation, or administration and for determining which employees and agents may, in the ordinary course of business of the agency or provider, be authorized to access confidential HIV related information pursuant to the provisions of paragraphs (l) and (m) of subdivision one and subdivision six of section twenty-seven hundred eighty-two of this article; and provided further that such regulations shall be promulgated by the chairperson of the commission of correction where disclosure is made pursuant to paragraphs (n) and (o) of subdivision one of section twenty-seven hundred eighty-two of this article. (b) The department of health, in consultation with agencies referred to in paragraph (a) of this subdivision, shall submit a report to the legislature by December first, nineteen hundred eighty-nine, outlining the status and content of such regulations, their effect on the regulated facilities and the protected individuals served by them, the extent to which they conform with current medical and scientific knowledge on the transmissibility of HIV infection, and any recommendations for changes in said regulations.

§ 2787. Separability. If any section, clause or provision of this article shall be deemed by any court of competent jurisdiction to be unconstitutional or ineffective in whole or in part, to the extent that it is not unconstitutional or ineffective, it shall be valid and effective and no other section, clause or provision shall on account thereof be deemed invalid or ineffective.

Public Health TITLE III HUMAN IMMUNODEFICIENCY VIRUS Section 2130. AIDS and HIV infection; duty to report. 2131. Municipal health commissioner; duty to report. 2132. Reporting of HIV infection after death. 2133. Contact tracing of cases of AIDS, HIV related illness or HIV infection. 2134. Disclosure of medical information. 2135. Confidentiality. 2136. Liability. 2137. Domestic violence recognition. 2138. Anonymous testing. 2139. Rules and regulations.

§ 2130. AIDS and HIV infection; duty to report. 1. Every physician or other person authorized by law to order diagnostic tests or make a medical diagnosis, or any laboratory performing such tests shall immediately (a) upon determination that a person is infected with human immunodeficiency virus (HIV), (b) upon diagnosis that a person is afflicted with the disease known as acquired immune deficiency syndrome (AIDS), (c) upon diagnosis that a person is afflicted with HIV related illness, and (d) upon periodic monitoring of HIV infection by any laboratory tests report such case or data to the commissioner. 2. The commissioner shall promptly forward such report to the health commissioner of the municipality where such disease, illness or infection occurred. When cases of such disease, illness or infection occur in a municipality not having a health commissioner, such reports shall be forwarded directly to the district health officer. 3. Such report shall contain such information concerning the case as shall be required by the commissioner. Such report shall include information identifying the protected individual as well as the names, if available, of any contacts of the protected individual, as defined in subdivision ten of section twenty-seven hundred eighty of this chapter, known to the physician or provided to the physician by the infected person.

§ 2131. Municipal health commissioner; duty to report. If any contact resides in a county or district other than the one where the protected individual is found, the health officer receiving the report shall refer the contact report to the health officer in the county or district where the contact resides, who shall then make a good faith effort to notify such contact and otherwise comply with the provisions of section twenty-one hundred thirty-three of this title.

§ 2132. Reporting of HIV infection after death. If a coroner, pathologist, medical examiner, or other person qualified to conduct an examination of a deceased person discovers that at the time of death the individual was afflicted with AIDS, HIV related illness or HIV infection, he or she shall report the case promptly to the commissioner according to the manner provided in this title as if the diagnosis had been established prior to death.

§ 2133. Contact tracing of cases of AIDS, HIV related illness or HIV infection. 1. Every municipal health commissioner or the department's district health officer, upon determination that such reported case or, any other known case of HIV infection merits contact tracing in order to protect the public health, shall personally or through their qualified representatives notify the known contacts of the protected individual. Such contact tracing shall be done consistent with protocols developed pursuant to section twenty-one hundred thirty-seven of this title. 2. Such contact shall also be informed of (a) the nature of HIV, (b) the known routes of transmission of the virus, (c) as circumstances may require, the risks of prenatal and perinatal transmission, (d) actions he or she can take to limit further transmission of the virus, (e) other facilities or community based organizations which are accessible to the person that provide counseling, medical care and treatment, further information or other appropriate services for persons infected with HIV. 3. In notifying any contact identified in the course of any investigation conducted pursuant to this section, the physician or public health officer shall not disclose the identity of the protected individual or the identify of any other contact. 4. A physician or public health officer making a notification to a contact pursuant to this section shall make such notification in person except where circumstances reasonably prevent doing so.

§ 2134. Disclosure of medical information. Disclosure of medical information obtained in accordance with this title, including a diagnosis of HIV infection, may be made only to (a) the protected individual, (b) the municipal health commissioner or district health officer if such commissioner or officer is not the examining physician, and (c) without specifically revealing the identity of the protected individual, contacts as defined pursuant to subdivision ten of section twenty-seven hundred eighty of this chapter.

§ 2135. Confidentiality. All reports or information secured by the department, municipal health commissioner or district health officer under the provisions of this title shall be confidential except: (a) in so far as is necessary to carry out the provisions of this title; (b) when used in the aggregate, without patient specific identifying information, in programs approved by the commissioner for the improvement of the quality of medical care provided to persons with HIV/AIDS; (c) when used within the state or local health department by public health disease programs to assess co-morbidity or completeness of reporting and to direct program needs, in which case patient specific identifying information shall not be disclosed outside the state or local health department; or (d) when used for purposes of patient linkage and retention in care, patient specific identified information may be shared between local and state health departments and health care providers currently treating the patient as approved by the commissioner.

§ 2136. Liability. 1. Good faith reporting or disclosure pursuant to this title shall not constitute libel or slander or a violation of the right of privacy or privileged communication. 2. Any person who in good faith complies with this title shall be immune from civil and criminal liability for any action taken in compliance with its provisions. 3. No criminal or civil liability shall arise against any protected individual solely due to his or her failure to cooperate in contact tracing conducted pursuant to section twenty-one hundred thirty-three of this title.

§ 2137. Domestic violence recognition. The department shall, in consultation with the office for the prevention of domestic violence and statewide organizations and community based organizations, develop a protocol for the identification and screening of victims of domestic violence who may either be a protected individual or a contact as used in this title.

§ 2138. Anonymous testing. Nothing in this article shall be interpreted to eliminate the anonymous testing option provided for in section twenty seven hundred eighty-one of this chapter.

Appendix L

HIV Confidentiality Disclosure Statement

PUT ON LETTERHEAD

HIV Confidentiality Disclosure Statement

“This information has been disclosed to you from confidential records which are protected by state law. State law prohibits you from making any further disclosure of this information without the specific written consent of the person to whom it pertains, or as otherwise permitted by law. Any unauthorized further disclosure in violation of state law may result in a fine or jail sentence or both. A general authorization for the release of medical or other information is NOT sufficient for further disclosure.”

{NYS Public Health Law–Article 27 F - §2782 5.(a)}

CONFIDENTIAL

Appendix M

Support Services

HIV/AIDS Support ServicesAgency Address & Phone Chemung Ontario Livingston Schuyler Seneca Steuben Wayne YatesTrillium Health 259 Monroe Avenue

Rochester, NY 14607(800) 266-9292(585) 545-7200

X X X X X X X X

Southern Tier Office: 18 Buell Street Bath, NY 14810

(607) 821-7979(800) 954-2347

X X X X X

Finger Lakes Office: 605 W. Washington Street Geneva, NY 14456 (800) 422-0282

X X X X

Rochester General Infectious Disease1425 Portland AvenueRochester, NY 14621(585) 922-4091

X X X X X X X

Ivy Clinic 600 Roe AvenueElmira, NY 14905(607) 737-8188

X X X X

Strong Memorial Hospital

Infectious Disease Clinic601 Elmwood AvenueRochester, NY 14642(585) 275-0526

X X X X X X X

Catholic Charities Community Services

Suite 24 - 1945 East Ridge RoadRochester, NY 14622-2467(585) 339-9800

X X X X X X

Chemung County Dept. of Mental Hygiene

425 Pennsylvania AvenueElmira, NY 14904(607) 737-5501

X

Schuyler County Mental Health

106 South Perry StreetWatkins Glen, NY 14891(607) 535-8288

X

Steuben County Community Services

115 Liberty StreetBath, NY 14810(607) 776-7603

X

Yates County Community Services

417 Liberty Street, SuitePenn Yan, NY 14527(315) 536-5115

X

For other support services, see your agency’s copy of the NYS DOH AIDS Institute Directory of Resources and Services.

Appendix N

Suggested Literature for Information Packets

Suggested Literature for HIV Information Packets

Seven Facts To Know Before Getting An HIV Test (see next page)

Copy of Informed Consent to Perform an HIV Test (required)

Important AIDS telephone numbers

Orasure brochure, if applicable

Chembio® HIV 1/2 STAT-PAK® brochure, if applicable

UniGold™ brochure, if applicable

Injecting equipment cleaning instructions

General HIV/AIDS Information i.e. 100 Questions and Answers About AIDS/HIV

Information regarding sexually transmitted diseases

Information regarding birth control methods, including condom instructions

Optional

Health prevention topics such as breast self-exam, genital self-exam (male & female)

Domestic violence

Appendix O

Rapid HIV Antibody Test Result

Put on Letterhead

Rapid HIV Antibody Test Result

Client Name: ___________________________ Collection Date: __/__/__

Client Code Number:___________ Collection Time: ____am/pm

Counselor Initials: _________

Clients Date of Birth: ___/___/___ Race: ________ Gender: M F

Name of Authorizing Physician:

The HIV-1/2 antibody result from the Rapid HIV Antibody Test is:

Non-Reactive Reactive Invalid

Type of Specimen: Rapid Test

Meaning of the test result:

A non-reactive (negative) test result means that no antibodies to HIV-1/2 have been detected. HIV antibodies may be absent during the “window period” of infection. Follow-up testing may be necessary if indicated by risk factors.

A reactive (preliminary positive) test result suggests that antibodies to HIV-1/2 may be present in the blood obtained from a rapid, finger stick test with whole blood. A specimen will have to be sent to a laboratory for a Western Blot test prior to confirmation of the reactive test result. Precautions should be taken to avoid the chance of spreading HIV.

An invalid test result resulting from a rapid finger stick can be due to a problem running the test or an interfering substance in the specimen. A specimen using other testing technology should be collected and submitted to a laboratory for HIV testing.

Appendix P

Sample Test Results Log

SAMPLE TEST RESULTS LOG

Test Subject

ID*

Date/Time Specimen Collected

Kit Lot Number

Kit Expiratio

n Date

Actual Test Incubation

Time

Test ResultN - Non-Reactive

R – ReactiveI - Invalid Tester

Result & Time

Reported to Subject

Confirmatory Testing

Tracking Number

Specimen Type

(Blood or Oral Fluid) Result

* ID = Identification (e.g. client name, number)

Appendix Q

HIV Counseling and Testing/Reporting/Partner Notification

Algorithm (including Domestic Violence (DV) guidance)

Appendix R

Missed Appointment Letter

Put on Letterhead

You missed your appointment with us on .

Please contact me at the above number(s) to reschedule.

Sincerely,

Public Health Nurse