Safety, Stigma Arguments Aired Over HIV Testing Bill

A blood sample being held with a row of human samples for analytical testing including blood, urine, chemistry, proteins, anticoagulants and HIV in lab

Photo: Getty Images

BOSTON (State House News Service) - Patients in Massachusetts could be tested for HIV without their consent if a health care worker or first responder comes in contact with their blood, under a bill heard on Thursday, a practice that LGBTQ+ advocates say is discriminatory and would add to stigma around the virus.

A Rep. Denise Garlick and Sen. John Cronin bill would allow health care providers, first responders, police officers, firefighters, prison guards or other public officers that come in contact with a person's blood or bodily fluid to test them for the virus, "despite the inability or refusal of the patient or person to give written consent."

Under current state law, patients who do not agree to an HIV test cannot be tested, even if family members or a health care proxy gives permission to check them for the virus. This includes patients who may be unconscious, in a coma, or die in health care settings.

Hospital employees argued before the Joint Committee on Public Health on Thursday that this law puts health care workers at risk.

Lynze Franko, a surgical resident at Massachusetts General Hospital, said that while treating patients, workers can be injured by needles or other sharp objects that could leave them exposed to a patients' blood or other fluids, which can lead to the transmission of infections such as HIV and hepatitis.

If the patient does not or cannot consent to testing their blood, these potentially exposed workers begin a treatment of post-exposure prophylaxis (PEP), antiretroviral drugs that reduce the likelihood of HIV infection.

Franko said the 20-day treatment causes nausea, vomiting and diarrhea, and carries the less common but possible risks of liver failure, kidney failure and potential birth defects.

She told the story of one of her co-residents at Massachusetts General Hospital emergency department who, in trying to save the life of a patient who had been in a car accident, cut her hand on one of the patients' exposed ribs. She was unable to test him for infectious diseases before he died, and he nor his family could consent after his death, Franko said.

"This introduced a tremendous burden to my co-resident. She and her husband had been trying to have a child for some time and she thought she might be pregnant. So now, because this patient could not be tested because of the law, she had to take the medication to try to prevent a possible infection. This was a difficult decision because of the heavy emotional burden she had, at the possible effect of causing a birth defect in her child," Franko said.

Craig Hardy, a legislative agent for the Professional Firefighters of Massachusetts, called the bill "just common sense."

Contracting HIV through occupational exposures is rare. According to the CDC, 58 health care personnel have reported HIV transmission due to exposure in the workplace in the U.S. An additional 150 possible transmissions have also been reported to the CDC.

Based on the most recent data available in December 2013, of these 58, only one confirmed case has been reported in the U.S. since 1999, when a laboratory technician sustained a needle puncture while working with a live HIV culture in 2008.

LGBTQ+ advocates appeared before the committee Thursday to oppose the bill, saying that it reinforces stigma against a community that has historically been disproportionately affected by the virus and faced discrimination associated with the epidemic.

Co-chair of the committee Sen. Julian Cyr, who is openly gay, responded to Franko's testimony.

"The reason why this law is in place is because of the deep stigma that existed around HIV transmission, particularly related to men who have sex with men, gay men, queer men, like myself, like many people serving here" Cyr said. "This is sort of the history of how we got here. It may be time to sort of look at it in a different way, but I want to raise that up as sort of why the law is this way. Massachusetts has among the strongest protections around HIV, informed consent in part because of that really sad history."

The bill would "undermine important public health objectives in fighting the HIV epidemic," Ben Klein, senior director of litigation and HIV law with GLTBQ Legal Advocates and Defenders, said.

Klein added that PEP medication has significantly advanced over the past two decades and now "is well tolerated" and there are "few side effects." It has to be taken by a tablet once a day for a month, he said, as opposed to a much harsher version of the medication that had to be taken more frequently and had worse side effects in the early 2000s.

Tanya Neslusan, executive director of MassEquality, called the bill and a similar Rep. Bruce Ayers and Sen. Paul Mark bill (H 2127 / S 1409) to allow for testing of HLTV 111 without patient consent "discriminatory on their face by signaling out HIV as the only blood-borne pathogen identified."

Neslusan said residents have a right to privacy when it comes to their blood.

"Blood sample is search and seizure for constitutional purposes," she said. "Anyone who is particularly concerned about their potential risk for exposure can go on [preventative HIV medication] as a long term treatment protocol to prevent -- to decrease their risk. Beyond that, occupational HIV transmission is very rare... There is absolutely no reason for anyone to violate someone's constitutional right to medical privacy to increase stigma, which would actually have no verifiable result."

Written By Sam Drysdale/SHNS

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