Human immunodeficiency virus (HIV) is a progressively debilitating disease, but proper treatment can significantly delay the onset of acquired immunodeficiency syndrome (AIDS). The Department for Community Based Services (DCBS) has a responsibility to clients and strives to provide services to HIV infected individuals while maintaining awareness of agency risk and liability to other clients and personnel. DCBS has the responsibility to respect HIV/AIDS client’s confidentiality. DCBS also advocates for the rights of an infected individual to attend day care, preschool, school, adult day care, nursing care, or any other needed services under medically and psychosocially appropriate circumstances.
Diagnostic Testing and General Case Management
- Should actively encourage clients who are at risk for infection to be tested;
- Consults the regional attorney and the medical support section to test a client without their permission for reasons concerning the client’s health or another individual’s safety;
- Consults with the regional attorney, the medical support section, and the child when age appropriate, when a prospective adoptive parent requests to have the child tested for HIV/AIDS but does not meet any of the high risk indicators;1
- Makes arrangements for re-testing when appropriate;
- Completes the assessment that includes questions regarding any high risk behaviors in which the client or family may have been involved for any HIV positive client;
- Completes a case plan for an HIV infected client that considers the following:
- Presence of behaviors likely to transmit the HIV infection;
- Potential needs of the client;
- Medical status, history, and symptomatology; and
- Availability of needed services.
- Clearly documents the regional attorney’s and the medical support section’s decision and reason for any disclosure of information regarding the outcome of a test made without the client’s approval.
- HIV testing may not be required of any client. Testing may be considered only for individuals for whom the Cabinet is legally responsible if any of the following risk factors are known:
- Multiple blood or blood product transfusions between 1978-1985;
- Children born to a mother known to be HIV infected;
- Children born to a mother who meets the criteria for HIV exposure;
- Use of intravenous (IV) drugs;
- Exhibits symptoms of possible HIV infection. Symptoms include, but are not limited to:
- Swollen lymph nodes;
- Weight loss;
- Cough and shortness of breath;
- Soaking night sweats;
- Shaking chills or fever higher than 100 F for several weeks;
- Dry cough and shortness of breath;
- Chronic diarrhea;
- Persistent white spots or unusual lesions on your tongue or in your mouth;
- Blurred and distorted vision; or
- Rare cancer or fungal infections associated with HIV.
- A person has been sexually abused/assaulted by anyone who:
- Has had multiple sexual partners;
- Has known use of intravenous (IV) drug use;
- Has hemophilia and has received clotting factor products prior to April 1985; or
- Has had sexual partners known or suspected to be infected with HIV or have the above high risk factors.
- Client’s request.
- Testing of children who are voluntarily committed to the Cabinet requires parental consent.
- Testing of a child in temporary or emergency custody requires a court order.
- When a minor is tested of their own accord and refuses to disclose test results, KRS 214.185(6) allows the medical professional to inform the parent or legal guardian of the minor regarding any treatment given or needed where, in the judgment of the professional, informing the parent or guardian would benefit the health of the minor.
- Testing for infants and young children may be performed by a pediatric specialist. All other HIV testing may only be performed at testing facilities that offer pre and post-test counseling by specially trained staff.
- Pre/post-test counseling services are offered at all local health departments.
Disclosure of HIV/AIDS Status
- No DCBS personnel who has obtained or has knowledge of a positive HIV/AIDS test result may disclose or be compelled to disclose the identity of any person upon whom a test is performed, or the results of the test in a manner which permits identification of the subject of the test without the written consent of the client. This includes documentation of a positive HIV/AIDS test result within DCBS documents.
- The decision to disclose the HIV/AIDS status without the consent of the client may be made on a case-by-case basis in consultation with the regional attorney and the medical support section when it is deemed absolutely necessary for the safety and care of the client.
- KRS 214.181 allows the information to be released to the following persons:
- The subject of the test or the subject's legally authorized representative;
- Any person designated by the client or their legally authorized representative through a DCBS-1A Informed Consent and Release of Information and Records Supplement;
- A physician, nurse, or other health care personnel who has a legitimate need to know the test result in order to provide for his protection and to provide for the patient's health and welfare;
- A health facility or health care provider which procures, processes, distributes, or uses:
- Human body part from a deceased person, with respect to medical information regarding that person; or
- Semen provided for the purpose of artificial insemination;
- A parent, foster parent, or legal guardian of a minor;
- Persons allowed access by court order.
- Disclosure of the confidential HIV status to DCBS personnel may be made on a need to know basis, which is based on the optimal care of the client.
- DCBS staff that are responsible for disclosing a client’s HIV status or allowing the HIV status of a client to go beyond those with a legitimate need to know are subject to disciplinary action up to and including dismissal.