Removing Legal Barriers to High-Quality Care for HIV-Infected Patients (New Eng Jour Med)
Great piece on HIV care and the legal issues involved. 
~ pinto
Removing Legal Barriers to High-Quality Care for HIV-Infected Patients
Lara E. Szent-Gyorgyi, M.P.A., Sonali Desai, M.D., M.P.H., Daniel Kim, B.A., Paul E. Sax, M.D., and Jeffrey O. Greenberg, M.D., M.B.A.
N Engl J Med April 5, 2012
When AIDS emerged in the 1980s, fear and misunderstanding about the disease prevailed. Patients with AIDS faced a grim prognosis, with no effective treatments. They confronted discrimination in the workplace and throughout society and had little legal recourse for combating it. Simply getting tested for human immunodeficiency virus (HIV) could be incriminating. Throughout the United States, AIDS activists, politicians, and physicians joined forces to enact state laws that created special provisions for HIV testing and protecting patients' privacy. Several states passed laws requiring specific written informed consent for testing and disclosure of results.
Thirty years later, the HIV landscape has completely changed. Progress in HIV treatment since the mid-1990s has converted a rapidly fatal condition into a chronic, treatable disease. Whereas an AIDS diagnosis in the 1980s meant a median survival of 12 to 24 months,1 life expectancy for a patient newly diagnosed with HIV infection today is measured in decades.2
Furthermore, HIV transmission is readily preventable through behavioral changes and treatment, so infected persons are far less likely to pass the virus on to others. In 2006, the Centers for Disease Control and Prevention, faced with the fact that a substantial minority of HIV-positive Americans were unaware of their HIV status, recommended expanding HIV screening and eliminating any requirements for written or oral informed consent beyond what is required for testing for other conditions. Most states have changed their HIV-testing laws to comply with these recommendations,3 and there is widespread support for changing the testing laws in the remaining states.
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One major change is that federal laws now offer all patients protection that was not available in the 1980s. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that all personal health information be kept confidential, regardless of the medical conditions to which it refers. Employees of health care organizations who violate the law face fines, imprisonment, and termination. The Americans with Disabilities Act (ADA) prohibits discrimination based on HIV status. Thus, HIV-positive patients now have the force of two federal laws protecting them.
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