[Congressional Record Volume 144, Number 111 (Friday, August 7, 1998)]
[Extensions of Remarks]
[Page E1585]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


[[Page E1585]]


                     THE HIV PARTNER PROTECTION ACT

                                 ______
                                 

                           HON. TOM A. COBURN

                              of oklahoma

                    in the house of representatives

                        Thursday, August 6, 1998

  Mr. COBURN. Mr. Speaker, for over fifty years, health authorities 
have used partner notification programs to stem the spread of 
contagious diseases. Such an approach helps to identify those at risk, 
provide them with counseling and testing as well as treatment, if 
necessary, thereby breaking the cycle of transmission. During the first 
years of the AIDS epidemic, however, partner notification programs were 
suspended and replaced with extraordinary privacy protections in the 
hope that such an approach would encourage high risk individuals to 
come forward and be voluntarily tested. Because of this decision, if 
you have been unknowingly exposed to HIV, the deadly virus which causes 
AIDS, you have no right to know that your life may be in danger--even 
if public health authorities know that you are in danger.
  While every state is required to have a procedure to notify those who 
may have been exposed, only 30 states have enacted HIV notification 
laws, and most do not mandate a duty to notify. Because of this 
inconsistency, most of those exposed to HIV do not find out until they 
have been infected for some time and are already sick with AIDS-related 
disease. By this point, they have been denied the medical care that can 
prolong their lives and stave off illness and may have infected others 
unknowingly.
  Due to this abhorrent policy, it is not shocking that nearly 400,000 
Americans have died from AIDS in the short period since the disease was 
discovered in 1981 and another one million Americans are believed to be 
infected with HIV today. And despite billions of dollars spent on 
prevention and research, more than 40,000 new infections are estimated 
to occur each year in the United States and no cure or vaccine appear 
to be on the horizon.
  We do, however, know enough about the virus to prevent its spread, 
but the response of the federal government and the public health 
community has contributed to the growth of the epidemic. From its 
onset, proven public health practices which have been successful in 
helping to curtail other contagious diseases were abandoned in our 
efforts against HIV. Due to the unfair stigmas associated with the 
populations most at risk, it was decided that HIV would be treated as a 
civil rights issue instead of a public health crisis. As a result, our 
response has been based almost exclusively on the rights of those 
infected to the detriment of the uninfected.
  But times have changed. Women and communities of color are now the 
fastest growing casualties of HIV. New drug therapies have been 
developed that offer hope for many of those who are infected to lead 
longer and healthier lives, especially when they are diagnosed early. 
And federal, state and local laws, including the Americans With 
Disabilities Act have been enacted to protect the civil rights of the 
afflicted.
  Due to these changes, many who initially opposed public health 
measures such as partner notification have now reconsidered. Just this 
year, the New York Assembly overwhelming passed legislation, which is 
now state law, which would mandate notification of those who may have 
been exposed to HIV. Even civil libertarians such as Senator Ted 
Kennedy have advocated partner notification. In 1990, Senator Kennedy, 
stating that ``there is a duty to warn,'' proposed HIV partner 
notification legislation which was approved by the Senate.
  The HIV Partner Protection Act gives Congress another opportunity to 
enact this important procedure which would alert those at risk and save 
lives. This bill introduced by Rep. Gary Ackerman (D-NY) would 
guarantee that everyone who is diagnosed with HIV receives appropriate 
counseling for preventing infecting others and information regarding 
treatment to protect their own health. It would also protect those who 
seek HIV testing by forbidding insurance companies from discriminating 
against anyone who receives a test for HIV, regardless of the results. 
But most importantly, the HIV Partner Protection Act would require that 
anyone who may have been exposed to HIV by a past or present partner be 
notified.
  Partner notification is extremely important to disease control 
because it is the only timely way to alert those in danger of 
infection. It is the standard public health procedure for curtailing 
the spread of virtually all other sexually transmitted diseases and has 
been credited in part for the fact that syphilis cases in the U.S. have 
fallen to the lowest levels in U.S. history.
  Partner notification essentially requires two steps. The first is to 
counsel all infected individuals about the importance of notifying 
their partner or partners that they may have been exposed. The second 
is for their doctor to forward the names of any partners named by the 
infected person to the Department of Health where specially trained 
public health professionals complete the notification.
  In all cases, the privacy of the infected is--and must be--protected 
by withholding the name of the infected person from the partner being 
notified. Because names are never revealed, the infected retain their 
anonymity.
  Partner notification has proven to be highly effective and there is 
no evidence that partner notification programs discourage individuals 
from being tested. Between 50% and 90% of those who tested positive 
cooperate voluntarily with notification. Further, even higher 
proportions of those partners contacted--usually 90% or more 
voluntarily obtain an HIV test.\1\ But only 10% or less of people who 
have recently tested HIV-positive manage, by themselves, to notify 
their partners.\2\
  Federal law already requires spousal notification (Public Law 104-
146). Since it applies only to those partners who are or had been 
married, it makes perfect sense to expand notification to all of those 
who may have been exposed to HIV.
  Partner notification is especially important for women because many 
HIV-infected women (50% to 70% is some studies) do not engage in high 
risk behaviors but were infected by a partner who does.\3\ Recent 
studies also indicate that AIDS develops more quickly in women who 
would therefore benefit from being alerted to their condition as early 
as possible.
  In addition to saving lives, partner notification also saves money. 
The Centers for Disease Control and Prevention (CDC) has concluded that 
even if only one in 80 notifications results in preventing a new case 
of HIV-infection, given the huge medical and social costs of every case 
(liftime cost for HIV treatment is $154,402), notification pays for 
itself.\4\
  Jack Wroten, who heads the Florida partner notification program, said 
that ``I would hope that the controversy surrounding partner 
notification would cease'' because ``it works'' and ``it's very, very 
productive. And the fact is that the majority [of people], if you ask 
them, `Do you want to be notified?'--absolutely.'' \5\ A poll published 
in the New York Post \6\ supports his statement with an overwhelming 
number of Americans stating that the rights of partners of those 
infected with HIV should outweigh the privacy rights of the infected.
  Clearly, this important piece of legislation is long overdue. Every 
day we put off enacting this life saving policy, HIV will continue to 
claim more innocent victims whom could have been saved.

                               FOOTNOTES

     \1\ Chris Norwood, ``Mandated Life Versus Mandatory Death: 
     New York's Disgraceful Partner Notification Record,'' Journal 
     of Community Health, vol. 20, No. 2, April 1995. Page 164.
     \2\ Norwood, page 168.
     \3\ Tracey Hooker, HIV/AIDS Facts to Consider: 1996, February 
     1996. Page 13.
     \4\ Norwood, page 164. Lifetime treatment cost data presented 
     by the Centers for Disease Control and Prevention at the 12th 
     World AIDS Conference in Geneva, July 1998.
     \5\ Nina Berstein, ``When Women Aren't Told,'' Newsday. 
     February 3, 1996.
     \6\ ``POLL'' New York Post, May 6, 1991.

     

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