HIV

Q: What VA staff may have access to a patient's HIV test result or HIV status?

As with all personal health information, patients' HIV test results should be available to health care providers only on a "need to know" basis. Usually this means that only providers directly involved in the patient's health care should seek information about HIV status. Exceptions exist for certain regulatory, quality improvement, research, and public health activities. Questions about access to personal health information can be addressed to local Privacy Officers.

Q: Can HIV test results be entered in the electronic medical record?

Yes. HIV test results are important medical information and should be included in the electronic medical record.

Q: When can HIV infection information be released to someone other than the infected patient?

In addition to privacy requirements under the Health Insurance Portability and Privacy Act (HIPPA), information about HIV infection and certain other conditions are specially protected in Federal law. Release of information related to testing or treatment for HIV can only be released with the written permission of the patient. The permission for release of information must specifically state that HIV-related information will be released, and must identify the party to whom it will be released. Significant penalties exist for individuals who violate these requirements. Exceptions exist for certain regulatory, law enforcement, research and public health functions. Specific questions about release of HIV information can be address to local Privacy Officers or Regional Counsel. See the VHA Privacy Office factsheet
for more information.

Violations of these protections often occur inadvertently when health care professionals discuss HIV test results, HIV-related diagnoses or HIV treatment with patients in the presence of relatives or others who accompany patients to clinic visits or who visit them in the hospital. Health care providers should make no assumptions that patients have informed others of their HIV status.

Q: If a patient lacks decision-making capacity, can the patient's HIV status be revealed to a surrogate decision maker?

Surrogates should have all the information necessary to make decisions on behalf of the patient under the principles of substituted judgment. Federal law and VA regulations only permit this release of HIV information if the surrogate is a spouse or a legal guardian who needs the information or may reasonably want to know this information in order to make decisions for the patient. Local Ethics Committees should be consulted to help resolve situations that fall outside these authorizations.

Q: Our State Health Department has recently begun asking for information like CD4 cell counts and diagnoses of opportunistic infections in addition to HIV test results. Can we provide this information without obtaining authorization from the patient?

Yes, provided the disclosure is required by state law, has been requested in writing by a properly authorized Public Health official, and does not create undue administrative burden for the VA facility. While VA is a Federal Department and is not required to comply with state laws on this issue, it is certainly an important part of our mission to cooperate with state health departments and facilities are encouraged to provide important public health information. In cases where there are questions about whether the appropriate conditions have been met for release of protected information to state officials, consult your Regional Counsel's office for guidance.