Routine HIV test: it must be offered to you and your plan covers it

It is the law that makes the HIV test part of routine medical care in Puerto Rico, rather than a test the patient has to request. The statement of motives gives the scale of the problem: in Puerto Rico, through December 31, 2014, 46,686 HIV infection cases had been reported, of which 36,788 were diagnosed at the most advanced stage of infection. The law defines a "person at high risk" as those more exposed to the possibility of infection, including intravenous drug users and their sexual partners, people who exchange sex for money or drugs, sexual partners of people carrying HIV, people who have had more than one sexual partner since their most recent HIV test, and any other category the Department of Health provides by regulation.

Adolescents and adults between thirteen (13) and sixty-five (65) years of age for the routine screening every five years based on clinical criteria; annually for all people at high risk per the law’s definition. For coverage, everyone insured under a health plan, coverage, policy or health services contract in Puerto Rico, public or private. Pregnant women have their own rule: two tests during pregnancy.

• For routine screening: being between 13 and 65 years old, per the physician’s clinical criteria.Verified against the official source
• For coverage: being insured under any health plan, coverage, policy or health services contract in Puerto Rico, public or private.Verified against the official source

• The informational brochure about the HIV test every provider must offer you, which may be requested from the Department of Health, including electronically.

1. 1

   Step 1: Know it must be offered to you, not requested by you

   The law reverses who takes the first step. Every health service provider is responsible for informing the patient that the HIV test may be included in the routine laboratory order, and the physician shall orient the patient about the various risk facets that may expose a person to infection, and about the need and advisability of voluntarily having the screening test as part of the routine tests.

2. 2

   Step 2: Ask for the informational brochure

   Every provider must offer the patient an informational brochure about the HIV test, which may be requested from the Department of Health and may be supplied electronically. It is a concrete right and easy to claim on the spot.

3. 3

   Step 3: If you decline, know what you are signing

   The test is voluntary, but the refusal leaves a documented trail. If the patient declines the test, the provider shall document the refusal in the patient’s clinical record, and the patient must sign it as evidence of their refusal and of having been duly oriented about the HIV test by the provider. Read what you sign: it certifies two things, that you declined and that you were oriented.

4. 4

   Step 4: Count the frequency that applies to you

   At least once every five (5) years, based on clinical criteria, for adolescents and adults between thirteen (13) and sixty-five (65) years of age at low risk; and annually for all people at high risk. The law defines high risk openly and includes, among others, intravenous drug users and their sexual partners, those who exchange sex for money or drugs, sexual partners of people carrying HIV, and those who have had more than one sexual partner since their most recent test.

5. 5

   Step 5: If you are pregnant, it is two tests

   Basic coverage includes one HIV test per year as part of the routine studies, except for pregnant women, who must have two HIV tests during pregnancy: in the first and in the third trimester. The type of test and the required age follow the CDC recommendations.

6. 6

   Step 6: If the result is positive, you must be informed in writing and oriented

   The physician shall inform, in writing, every person with a positive diagnosis of the test results, and shall orient the person about the existence of specialized clinics for HIV patient health care, whether from the Department of Health or the private sector. That orientation must be clearly detailed in the patient’s medical record. Positive results, final or preliminary, are reported electronically to the Department of Health’s HIV/AIDS Surveillance Program by confidential name-based report, within the next five calendar days, with the confidentiality safeguards required by state and federal law.

The test is requested — or accepted when offered — with your physician or health service provider. The Department of Health runs the HIV/AIDS Surveillance Program, supplies the informational brochure and, in consultation with the Office of the Insurance Commissioner and the Health Insurance Administration, established the regulation and forms required for compliance with this law. For entities excluded under Article 1.070 of the Insurance Code, the law provides that the Department of Health itself oversees them.

• Waiting to request the test: the law places on the provider the duty to inform you it may be included in the routine lab order.
• Not asking for the informational brochure every provider must offer you.
• Signing the refusal without reading it: it certifies that you declined and that you were oriented.
• Believing it is a mandatory test: it is voluntary; what is mandatory is that it be offered.
• Using the five-year frequency if you are at high risk: in that case the law says annually.
• Not knowing pregnancy means two tests: first and third trimester.
• Thinking it only applies to private plans: the law covers every plan, public or private, in Puerto Rico.
• Accepting a positive result without the orientation about specialized clinics, which the law requires and which must appear in your record.

These are the government pages this guide is based on.

• Departamento de Salud de Puerto Rico

  Salud

  bvirtualogp.pr.gov