In 1988 Florida became one of the first states with high rates of HIV infection to enact comprehensive legislation to address the AIDS epidemic. The Florida Omnibus AIDS Act stipulates that all licensed healthcare providers must take a course on HIV/AIDS and licensed healthcare facilities must educate their entire workforce on HIV infection. It also sets standards for testing, confidentiality, informed consent, reporting requirements, and discrimination (FDOH, 2013). For more information, click here.
Testing, Informed Consent, and Confirmation
The Florida Omnibus AIDS Act stipulates that HIV testing must be “informed, voluntary, and confidential” and “shall be preceded by an explanation of the right to confidential treatment of information identifying the subject of the test and the results of the test to the extent provided by law” (Florida Senate, 2010).
Consent does not have to be in writing but an explanation of the test and an indication that consent was obtained must be recorded in the medical chart. In addition, the person tested must be informed that a positive test will be reported to the county health department with sufficient information to identify the test subject. “All reasonable efforts” must be made to inform the subject of a positive test result. In addition, healthcare providers are required to confirm positive test results through corroborating tests before informing the test subject of the result (FDOH, 2013).
There are some exceptions in Florida law to the requirement to obtain informed consent prior to conducting a test for HIV (Florida Senate, 2013):
- When testing for sexually transmissible diseases is required by state or federal law, or by rule including the following situations:
- When a person is convicted of prostitution or procuring another to commit prostitution
- When an inmate is released from prison
- When deemed necessary by a medical examiner
- When a woman is pregnant (see Pregnancy below)
- Exceptions provided for blood, plasma, organs, skin, semen, or other human tissue
- During bona fide medical emergencies when needed to provide appropriate care
- When obtaining informed consent would be detrimental to the patient
- When performed as part of an autopsy for which consent was obtained
- When done at a victim’s request in a prosecution for any type of sexual battery where a blood sample is taken from the defendant voluntarily
- When mandated by a court order
- For epidemiologic research
- When human tissue is collected lawfully without the consent of the donor for corneal removal or enucleation of the eyes
- When a healthcare worker has had significant exposure to a patient’s blood, and a blood sample is already available that was given voluntarily for other purposes
- When a hospitalized infant is determined to be abandoned
- When done on a person already determined to be HIV positive and for repeat testing
The Florida Omnibus AIDS Act also directs the Florida Department of Health to conduct epidemiologic studies and provide testing and patient care services throughout the state. In 2010 there were 405,757 HIV tests performed in Florida by county public health departments, with 1.1% of the tests being positive (FDOH, 2010a).
In Florida, all patient medical records are confidential, but to encourage voluntary testing the Omnibus AIDS Act makes HIV test results superconfidential. The superconfidentiality applies only to the results of laboratory reports and does not extend to clinical observations regarding symptoms associated with AIDS. Breach of confidentiality of sexually transmitted disease information is a third-degree felony.
Florida law requires that during pregnancy every person—including physicians and midwives—attending a pregnant woman for conditions relating to pregnancy during the period of gestation and delivery must offer the woman tests for sexually transmissible diseases, including HIV. In 2005 the law was amended to mandate “opt-out” testing for pregnant women. Pregnant women are advised that they will be tested for HIV but they have the right to refuse. Any refusal must be obtained in writing and placed in the woman’s medical record (FDOH, 2013).
Minors under the age of 18 do not need parental consent for HIV and STD testing. Florida law specifically forbids informing the parents of the minor’s HIV test, results, or treatment, even indirectly (FDOH, 2013).
The Florida Omnibus AIDS Act prohibits discrimination against those who are HIV-positive in employment, housing, public services, health and life insurance, and public accommodations.
HIV and AIDS are notifiable diseases in Florida. In 1996 Florida began requiring physicians and laboratories to report HIV-positive test results to local health authorities with patient identifiers. Failure to do so can result in a $500 fine and disciplinary action by their licensing board. Under Department of Health (DOH) rules, practitioners must report HIV-positive diagnoses of all people to their local county health department within 2 weeks, and infants born to HIV-positive women must be reported the next day. In 2006 the DOH expanded its reporting requirements to include CD4 and viral load data (FDOH, 2013).