Another step forward for harm reduction in NC

More good news from our friends at the NC Harm Reduction Coalition! A bill that will reduce the risk of transmission of HIV and hepatitis has passed the house and is on it's way to the Senate. Here's what they have to say about this great bill and how you can support it:

The NC House [has] passed HB 850, a partial syringe decriminalization/ needle stick prevention bill which NCHRC supports. The bill basically decriminalizes possession of syringes and other sharps if a law enforcement officer asks a person if he or she is carrying syringes or sharp objects prior to a search, and the person gives them up. This is a goodbipartisan bill and we need your continued support!  The bill will now go to the senate. We are asking our members to call their Senate members to ask them to support the bill.  To find out who represents you, please go to:  http://www.ncleg.net/representation/WhoRepresentsMe.aspx If you make a call please let me know.  Please ask them to support the bill and needle stick prevention efforts in NC.  Please send me a quick email to robert@nchrc.net if you can make a call.   Thank you,   Robert Childs Executive Director North Carolina Harm Reduction Coalition (NCHRC)

Up to the Challenge

We did it.

We stopped the bill that would have made NC the only state in the nation to require parental consent for an HIV test and any other prevention, testing or treatment related to STDs, pregnancy, mental health or substance abuse – House Bill 693.

When the clock ticked over to midnight last night, the parental consent bill had still not come up for a vote in the General Assembly. Yesterday was the crossover deadline in the NC General Assembly. If a bill didn’t pass either the House or the Senate by yesterday, it won’t become law this year. We won.

We just proved that when thousands of committed people stand together, we can stop our lawmakers from making a dangerous, shortsighted decision. Action Team members sent a record number of emails and personal notes, made phone calls, wrote letters to the editor, blogged, tweeted, and went to the General Assembly in person to defeat this bill. As doctors, counselors, parents, students, and advocates, they spoke out about why the bill was bad for their clients, their families, and the young people of our state. 

We were joined by an amazing set of partners and friends: Planned Parenthood Action Fund of Central NC, Covenant with North Carolina's Children, ARC of NC, ACLU-NC, NARAL NC, the NC Psychiatric Association, Adolescent Pregnancy Prevention Campaign of NC, The North Carolina Chapter of the National Association of Social Workers, and others.

The legislative session isn’t over. We still have the state budget fight ahead of us. We’ll need to protect funding for the AIDS Drug Assistance Program, which is threatened with huge cuts. We’ll need to fight for the basic voting rights of the people who are most affected by HIV in our state. And we’ll need to keep building power.

It’s sad that our state’s lawmakers would even consider a bill like HB 693. It’s scary that a bill like HB 693 would pass through committee and be scheduled for a floor vote. I don’t know what we’ll face next. But I know we are up to the challenge.

Not Broken: Why NC's parental consent bill is bad for teens

Guest Columnist Kevin Varner

My father had a saying, “If it ain’t broke, son, don’t fix it.”

House Bill 693 is an attempt to tinker with something that isn’t broken. North Carolina law already requires parental consent for teenagers to get an abortion. The new House Bill 693 would require parental consent for a minor to receive, among other things, testing or treatment for HIV and STDs. If passed, it would be the first law of its kind in the United States.

As Director of Prevention, Education and Testing at Triad Health Project in Greensboro, I see firsthand what a difference it makes for teens to have access to confidential health care. All the teens I counsel have two things in common: they are scared, and they are ignorant of their risks. They’re scared to go to Mom and Dad for fear of being judged, or thrown out of their homes. Many don’t know how STDs are transmitted.

In my first six months on the job, a 17-year-old boy tested positive for Gonorrhea, and a 15-year-old girl tested positive for Chlamydia. Both shared that without confidential testing and treatment, they would not have known where to turn. I scheduled appointments for treatment at the health department, counseled them on how to use condoms correctly and how to prevent STDs. I encouraged them to wait until they were older and in a monogamous relationship before having sex.

This week, a mother came with her daughter to get test results. The daughter had come for confidential testing three weeks prior by herself, concerned about HIV and STD risks.  Admittedly, I was surprised to see a mother and daughter for test results, so after giving the daughter good news that she was not infected, I asked them what prompted them to come together. The mother said, “I can’t always be around, and I don’t always know what my daughter is doing. I came to support her, but sometimes she won’t tell me everything she does because I’m her mother and I worry. I also don’t know all the facts about HIV like you do. I don’t feel as comfortable talking about sex and STDs. She doesn’t want to listen to her mother all the time.  But, Mr. Varner, she came on her own, and she listened to you. You didn’t judge her. You helped her. You tested her, educated her and gave her condoms.” The daughter added, “If my mom were to give me condoms, I’d be too embarrassed to take them. But taking them from you seemed easier. When you told me how proud you were that I came to get tested on my own, I got the strength to talk with my mom, and that’s why I wanted her here. I wanted her support. I feel more comfortable talking with her now. But, if I had to go to my mom first, instead of being able to come to you first, I would have been too afraid.”

If state legislators pass the new parental consent bill into law, they are not only taking away the choices and voices of our young people, they are taking away the voices and helping hands of the medical professionals, behavioral health professionals and health educators in our state.

That, finally, would be something broken that would need fixing for years to come.

___

An Open Letter to the NC General Assembly: Stop HB 693

Guest columnist Julie Nielsen Lindsey, M.D., responds to NC House Bill 693, which would require notarized parental consent for teens who seek a doctor's care for testing, prevention, or treatment related to STDs, pregnancy, mental illness, and substance abuse.

Dr. Lindsey practices family 
medicine at Cary Healthcare 
Associates in Cary, NC.

As family medicine physician who works with teenagers and as a parent of preteens,  I reject the notion that HB 693 would improve communication in families. Rather, HB 693 would undermine the helpful relationship teenagers have with their physicians and expose teens to increased health risks and pregnancy. HB 693 will also adversely affect physicians who work with teens and fundamentally undermine the therapeutic relationship between teenagers and their medical providers.

As a physician to teens, I strive to be an objective, non-judgmental, caring adult resource whom teenagers can consult about very personal health care needs, including sexual health and mental health. I can assure you that neither I nor any medical colleague I know advocates teen sexual activity, however offering confidentiality opens the door for teens to address sexual and mental health concerns. While we encourage teens to discuss all health matters with their parents including sexual health, we know that sexuality is a difficult topic for teens to discuss with parents, even supportive parents. I am most concerned with how this bill will harm teens in troubled homes. How will HB 693 affect the girl who is raped by her father or her mother’s boyfriend and becomes pregnant or contracts an STD? How will HB 693 affect teens who are depressed and having PTSD due to emotional abuse and neglect by a parent with substance abuse? These are not rare exceptions. Sadly, we see these troubling situations all too often in healthcare settings. If HB 693 passes, teenagers in both supportive homes and troubled homes will be less likely to seek medical care for sexual and mental health care needs, and as a result more teenagers will get pregnant, get STDs, spread STDs, have severe pelvic infections, and there will be more suicides and untreated mental health conditions. 

 In addition to harming teenagers, HB 693 will intrude on physicians’ clinical judgment and professional ethics. Ever since medical school, physicians have been taught to respect teens’ confidentiality in regards to sexual health and mental health, as these are sensitive personal issues fraught with challenges for teenagers. HB 693 would impose a fundamental change in how medicine is practiced, without a full understanding of the harms and without endorsement of the medical community. Such a fundamental change in medical care should originate within the medical community after careful research on benefits and harms.

Furthermore, HB 693 will increase legal liability and confusion for physicians who work with teens. If HB 693 passes, I will not be able to offer my teenage patients STD testing, prescribe birth control or conduct mental health evaluations without first consulting a parent. If it is my clinical judgment that these are needed services and a teen won’t discuss this with their parent, I will either incur liability for offering the service or I will neglect my medical duty by denying the teen the service. To add confusion, HB 693 will not apply to facilities which receive Federal Title X funding or to patients with Medicaid. So before addressing a teen’s concerns, a physician will need to verify what kind of insurance a teen has, and then alter what medical services are offered. There seems to be an element of discrimination, as some teens will be offered more rights and services than other teens, simply based bureaucratic concerns.

Since I work in a private practice, with mostly commercially insured patients, I will be unduly limited in the scope of care that I can offer teenagers compared to what is offered in a federally funded clinic or hospital system. Simply put, teenagers would not have the right to confidential healthcare in my practice, and they will go elsewhere. This will be a boon for facilities that receive Federal Funds. Teens are smart, and they will preferentially seek out health care where they are afforded the confidentiality they need.

 As a family physician, I love working with families, and I cherish the opportunities I have to improve communication between teens and parents. I try to walk that fine line between encouraging teens to delay the onset of sexual activity but still educating them about sexual health, and I always encourage teens to talk with their parents. Typically, parents choose a health care provider whom they trust, and that doctor is an extension of the support the parent offers the teen. There is no adversarial relationship between physicians’ and parents as some proponents of this bill suggest. Rather physicians, parents, and teens typically collaborate in a helpful way. HB 693 would undermine the positive relationship that teenagers have with the family’s health care provider, and teens will get delayed and fragmented care in settings more removed from their family.  

Lastly, I speak as a parent of preteens. Like many parents, I too am uncomfortable by the thought of teenagers having sex, and I am distressed by the highly sexualized and violent content that my children get exposed to through the media and at school. While we as parents prepare our kids the best we can and instill good values, we know that much of our teenagers’ lives are beyond our control. We can hope and pray that our children make good healthy choices, but as they get older we must let go and support rather than control. Offering a teen a confidential relationship with a healthcare provider is a loving way to extend a positive influence in areas where our parental influence is waning. As my children get older, I will take great comfort in leaving the exam room, knowing that my child can freely share any health concern. It is a risky world out there, and all the more teens need access to quality and confidential health care to support them through this challenging time of life and manage the risks. Please, let’s not make life any more difficult for teenagers or for the doctors who serve them. House Bill 693 fundamentally undermines healthcare for teens in North Carolina.

Take action to stop HB 963. Email NC Speaker of the House Thom  Tillis.

Fact Sheet: Protect the Health and Safety of Youth – Oppose HB 693

House Bill 693 would prevent minors from receiving medical treatment for sexually transmitted infections, mental health problems, pregnancy prevention and substance abuse without prior consent from their parents.

These are all serious medical issues that require time-sensitive and appropriate care. If left untreated, all of these conditions may lead to life-threatening situations.

Most youth will at some point talk to their parents about these concerns, but if they cannot or will not for whatever reason, it is still essential that they receive appropriate care. Sexually transmitted infections, mental health issues and substance abuse problems can lead to death if they are not treated in a timely nature.

Adolescents will be less likely to get tested and treated for STDs if they have to get parental consent.

•  A survey of adolescents at two pediatrics practices in North Carolina found that 92% would undergo STD testing if their parents “definitely would not” find out about the test whereas only 35% would undergo STD testing if their parents “definitely would” find out about the test.[1] 

There are compelling public health arguments for promoting STD testing among youth.

• Early diagnosis and treatment are the best hope for preventing new HIV cases. UNC-based research finds early, uninterrupted treatment with anti-retroviral medications reduces new HIV cases by up to 96%.[2]
•  In North Carolina, adolescents aged 15-19 make up the second highest rate of chlamydia and gonorrhea infection, and 23% of new HIV cases in our state are among people under age 24. [3] 
• Over 50% of youths aged 13-24 with HIV do not know they are infected. [4]

Increased STD rates in our youth lead to increased public health costs.

• Average lifetime medical costs to treat a person with HIV ranges from $567,000-618,900 with higher costs resulting when HIV is diagnosed late in the disease progression.[5]

Recognizing the time-sensitive nature of these medical issues, every state in the U.S. allows teenagers to seek confidential care for the diagnosis and treatment of sexually transmitted infections. 18 of these states allow, but do not require, a physician to inform a minor’s parents that he or she is seeking or receiving STI services when the doctor deems it in the minor’s best interests.[6]

With a parental consent requirement, many adolescents will forgo testing and medical treatment leading to greater STD transmission to their peers and greater economic costs to society.

Sometimes, parents are the reason why a young person needs to seek medical care. In cases where the minor is emotionally, physically or sexually abused by the parent, it is critical that the he or she have the ability to access care without the consent of the parent perpetrator. Each year, there are nearly 70,000 reports of abuse and neglect – it’s critical that all of these youth have access to health services.

Public health policies should always encourage adolescents to seek timely, professional health care—not impede access to confidential care. This is why the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists oppose mandatory parental consent laws.

---

[1] Carol Ford & Dana Best, Confidentiality and Adolescents’ Willingness to Consent to Sexually Transmitted Disease Testing, Archives of Pediatrics & Adolescent Medicine, Vol. 55, Sept. 2001, 1072.

[2] Cohen et al., Prevention of HIV-1 infection with Early Antiretroviral Therapy, N. Eng. J. Med.,365(6):493-505, available at www.nejm.org/doi/full/10.1056/NEJMoa1105243#t=articleTop.

[3] North Carolina HIV/STD Quarterly Surveillance Report: Vol. 2012, No. 2, Communicable Disease Surveillance Unit. 

[4] Ibid. 

[5] Schackman, et al., The Lifetime Cost of Current Human Immunodeficiency Virus Care in the United States, Med. Care., 2006 Nov.; 44(11):990-7.

[6] State Policies in Brief, Overview of Minors’ Consent Laws, Guttmacher Institute, February 2011.

ADAP Stories: Thomas

Hometown: Pinehurst, NC
Occupation: Transportation Specialist and Peer Educator

I am a native of Pinehurst and now reside in Roseboro, NC. I am employed with Commwell Health as an HIV Peer Educator.

I have been HIV positive for 15 years.

I am very grateful to the ADAP program. It has really helped my cost of medicine, which is really expensive.