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 requires all licensed healthcare providers to take a course on HIV/AIDS, and licensed healthcare facilities must educate their workforce on HIV infection. It also set standards for testing, informed consent, confidentiality, and reporting requirements (FDOH, 2019).
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.
Testing and Informed Consent
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” (FDOH, 2013).
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. 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 (FDOH, 2013).
A doctor discussing an HIV test result with a patient. Source: CDC.
“All reasonable efforts” must be made to inform the person of a positive test result. In addition, healthcare providers are required to confirm positive test results through corroborating tests before informing the 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. Informed consent may be waived when deemed necessary by a medical examiner, during medical emergencies, when mandated by a court order, or 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 (FDOH, 2013).
The Florida Omnibus AIDS Act also stipulates the waiving of informed consent when a person is convicted of prostitution or procuring another to commit prostitution, when an inmate is released from prison, or 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 (FDOH, 2013).
Additionally, informed consent may be waived when a blood test is performed as part of an autopsy for which consent was obtained, for epidemiologic research, or when human tissue is collected lawfully without the consent of the donor for corneal removal or enucleation of the eyes Exceptions may be provided for blood, plasma, organs, skin, semen, or other human tissue (FDOH, 2013).
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.
Florida law requires that during pregnancy every healthcare professional, 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 (FDOH, 2013).
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 in the state of Florida. Florida law specifically forbids informing the parents of the minor’s HIV test, results, or treatment, even indirectly (FDOH, 2013).
Instances in which informed consent may be waived:
- When a woman is pregnant
- When obtaining informed consent would be detrimental to the patient
- When a hospitalized infant is determined to be abandoned
- When done on a person already determined to be HIV positive and for repeat testing (FDOH, 2013).
With confidential HIV testing, information about the testing is maintained in a client’s medical records and results are confidential. Results and testing information are not released except when medically necessary or under special circumstances, including when a release is signed for the results to be given to another person or agency.
All patient medical records are confidential, but to encourage voluntary testing the Florida Omnibus AIDS Act makes HIV test results super confidential. The super confidentiality 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.
Anonymous HIV antibody testing is available. Clients do not give their name and the person who orders or performs the test maintains no record of the name of the person being tested. As part of the informed consent process, clients must be given information on the availability and location of anonymous test sites. Each Florida county health department maintains a list of available anonymous test sites (FDOH, 2021, July 16).
Acquired immune deficiency syndrome (AIDS) is a reportable disease in Florida. Facilities providing healthcare services must submit case reports for reportable diseases and conditions, in line with the Health Care Practitioner Reporting Guidelines, to the appropriate county health department contact. Medical records must be made available for epidemiologic investigations (FDOH, 2021, October 4).
The reporting requirement can be fulfilled in 2 ways:
- Electronic case reporting (eCR)
- Fax reporting
Electronic case reporting is now automated. Traditionally, healthcare providers communicated with public health agencies about cases by manually compiling and sending case reports to health departments via FAX, phone call or email. eCR makes it possible to automatically generate case reports from electronic health records and transmit them via a secure, web-based platform (FDOH, 2021 October 4).
Entities that provide both healthcare and laboratory services (e.g., physicians providing point of care lab testing) must fulfill the requirement for healthcare providers and laboratory providers (FDOH, 2021 October 4).