Sample Healthcare Paper on STD policy in North Carolina


Testing for HIV and AIDS is one of the most critical elements in the control and management of the disease. Like other Sexually Transmitted Diseases (STDs) HIV is best manageable when it is detected at the earliest stage possible. Global health and humanitarian agencies have made big strides in the effort to create awareness on the importance of voluntary testing for HIV. Communities where there is sufficient and effective HIV/AIDS awareness are likely to record lower morbidity rates as a result of AIDS diagnosed at high-risk stages. Most importantly, health departments within the community are mandated with the responsibility of ensuring that voluntary testing resources are available as one way to encourage more people to know their status. In the state of North Carolina, the HIV/STD/Hepatitis Surveillance Unit analyzes STD data and reports appropriately to the State and National Health Departments. The availability of these state data is important in identifying areas where HIV poses the greatest risk. Consequently, the North Carolina Administrative Code 10A NCAC 41A.0202 encourages the implementation of routine testing as a strategy to minimize barriers limiting the access and willingness of community members to get tested or seek consolation from a physician.

The purpose of this research paper is to review the existing policies for HIV testing in the State of North Carolina. Existing data on HIV prevalence and success rate of existing policies in the state will be used to create recommendations on additional responses and interventions. The overall purpose of this research is to create an action plan for reducing patient-physician barriers, reducing new infections, and increasing universal access to care.



Problem Statement

There is an apparent need for the state of North Carolina to improve the healthcare response mechanisms addressing HIV-related cases. The State is ranked eighth in the list of the largest number of HIV diagnoses in the United States (Center for Disease Control, 2013).  Voluntary and routine testing are the critical areas that need to be given priority when implementing control measures for HIV prevalence. However, there is also a need to understand the significance of routine testing in the objective of reducing barriers to HIV testing. Particularly, how can the health department and healthcare centers increase HIV awareness, eradicate stigmatization, and convince patients to accept voluntary testing?

Background of Policy Analysis

Acquired Immunodeficiency Syndrome (AIDS) is a late stage of HIV (Human Immunodeficiency Virus) infection which causes the body to be incapable of fighting diseases. Sexual activities are the most common means through which AIDS spreads. However, HIV /AIDS can also be spread through shared needles and from an infected mother to a child. HIV/AIDS infection can be prevented by appropriate use of protection during sexual intercourse or abstinence. Still, testing for HIV is the surest way to know one’s status and take the necessary steps to protect spouses and sexual partners from infection. HIV morbidity reports from the State of Carolina present statistics on HIV and other STD-related trends in the state. According to the 2018 report North Carolina HIV/STD Quarterly Surveillance Report, most of the cases were reported with only the HIV infection (HSSU, 2018).  However, the HIV/STD Surveillance Unit (HSSU) also found that about one-quarter of the HIV cases were persons with both HIV and AIDS. These reports portray an urgent response with the core objective of increasing the efficiency of routine testing and the diagnosis of HIV in the earliest stages.

The escalating problem of HIV-related morbidity has prompted universal policies to ensure that people have access to HIV/AIDS-related care. Universal healthcare plans aim to provide reimbursement for free testing and appropriate reporting on statistics and trends from the local to national levels (White, Carter, Records, and Martin, 2013). In the United States, the Department of Health has a network of agencies reporting from the local and state levels so that the data is used to understand trends and create courses of action. HIV testing is a core intervention that takes center stage in this objective due to the important role it plays in the control and management of HIV/AIDS. Over the recent past, states in the U.S have modified their healthcare policies to accommodate the measures that have been proved to support the universal objective of interrupting the transmission of HIV (Center for Disease Control, 2013). Access to testing is a predominant approach that is seen to actively help to further this course. The overall objective for these adjustments is to eliminate the barriers such as pretest counseling and written consents which often interfere with the patient’s decision to test for HIV.

The North Carolina Communicable Disease Manual provides a detailed illustration of the testing policies in HIV care. Particularly, the North Carolina Administrative Code (NCAC) provision for HIV testing provides that local health departments have the responsibility of conducting non-risk routine testing and counseling for HIV infection. Non-risk testing entails the observation of all safety procedures, such as the use of fresh needles and kits for each patient (Harmon, Collins-Ogle, Bartlett,Thompson, and Barroso, 2014). Routine testing covers the broader context whereby multiple measures are taken to encourage patients to consent to testing. Routine testing policies address demographic factors such as age and ethnicity as a strategy to ensure that social and cultural influences are considered in the issuance of this service. For instance, the NCAC provides that an infant delivered by a woman who has not been tested for HIV should create suspicion of HIV infection and, thus, this should create reasonable basis for testing. However, a written consent is required for a mature patient. As a measure to encourage voluntary resting in adults, the NCAC recommends that barriers such as the written consent and pre-testing counseling be scrapped.

Landscape of Policy Analysis

Routine testing for HIV has been identified as an efficient measure in the prevention of HIV infection. Routine testing aims to interrupt the transmission and reduce risk factors of HIV infection. Clinical care is also identified as a critical point of contact for people with HIV/AIDS because it offers an efficient and convenient setting for diagnosis, treatment, and education (White, Carter, Records, and Martin, 2013). However, it is evident that for such routine testing to be effective, there must be appropriate measures put in place to enable physicians have access to their patients. Similarly, the implemented policies should be able to provide patients with the information they need before agreeing to voluntary testing. Policy makers at the state and national levels also have a critical role to play in this objective of enforcing effective routine testing. In this regard, the state’s health departments are responsible for an all-inclusive campaign for HIV awareness and the need for timely diagnosis. The objective should be to eliminate stigmatizations and fears that people have regarding positive diagnosis (NCAIDSACTION , 2018). Also, the state government should encourage local media channels to slot HIV awareness campaigns in their broadcastings. In this regard, media houses and advertisement companies will contribute to the cause of HIV prevention and management and, consequently, this level of accountability will spread to the local communities.

Consistent reporting of HIV statistics and trends is an effective measure in the management and control policies. In the State of North Carolina, the HIV/STD Surveillance Unit (HSSU) is responsible for reporting to the State and National Health Ministries. The reports act as early indicators of sexual behavior and can play a crucial role in designing manuals for testing and counseling (HSSU, 2018). With such relevant data available to the relevant agencies, it becomes easier to identify critical areas where further measures of treatment should be implemented. The balance of patient rights versus the interest of protecting the population is an important aspect to consider when implementing control measures for HIV. Patients’ rights in this context include the requirement of consent to testing. Adult patients are granted this right by the North Carolina Administrative Code (NCAC) which provides that a patient may decline to a test (The Center for HIV Law and Policy, 2018). At the same time, the physician has a mandate to promote the cause of understanding the trends of HIV infection in their local setting. Therefore, it is within their jurisdiction to encourage and convince patients to test for HIV by using their authority as professional care givers and community servants. While physicians are not allowed to perform tests without the patient’s consent, they can advise them on the importance of early diagnosis and the risk of not knowing their HIV status.

Government insurance programs such as Medicaid are facilitators of a universal healthcare system and a responsive action plan for HIV prevention. Government reimbursements cover the costs for HIV awareness campaigns and the availability of HIV-related care. In some cases, these government insurance problems fail to cover patients’ healthcare costs as per the provision of each program. In HIV-related cases, such insurance programs are critical for high-risk patients (White, Carter, Records, and Martin, 2013). Still, patients who do not meet the criteria are exposed to the threat of escalated illness, especially if they do not have alternative sources of funds to cover their treatment costs and purchase of medicines. Medicaid reimburses for the provision of HIV patients with antiretroviral drugs.

Response and Recommendations 

The significant high rate of HIV diagnosis in the late high-risk stages is a clear indication of the existing barriers to HIV testing. There exist critical failures in HIV-related healthcare interventions, mainly due to the inability of existing policies to close the gap between the patient and access to healthcare (Harmon, Collins-Ogle, Bartlett,Thompson, and Barroso, 2014). HIV testing has been seen to be critical in the observation of trends and the prevention of HIV infection. However, many people are unwilling to take voluntary tests because of the various barriers limiting their access to knowledge and healthcare. While diagnosis and treatment are inarguably very important interventions in this cause, testing sets the pace for these subsequent measures and, thus, more stakeholders need to identify the most efficient interventions for eliminating these barriers. High-risk HIV/AIDS patients are easy to eliminate if routine testing policies are actually monitored and improved.

In the state of North Carolina, HIV prevalence is high due to a combination of factors, including the problem of cultural-based stigmatization. Minority groups are often overlooked in policies and programs designed to be universal. For instance, the debate of meeting the criteria for Medicaid insurance cover has raised concerns over the influence of race. While racial and gender bias are not central in the discussion of HIV prevention, they are critical considerations for the state and federal health departments in the objective of offering fair and equal universal healthcare (NCAIDSACTION , 2018). Consequently, patients have certain rights that must not be overlooked in upholding the transparency of healthcare policies. These rights include the requirement for physicians to ask for consent prior to testing patients. Healthcare practice regulations are also potential areas of improvement in this cause. Reported cases of patients being infected through recycled needles should be reported and acted upon accordingly. The professional conduct of physicians plays a critical role in raising and maintaining high standards of care.

The use of routine testing is favorable among the options for addressing the policy problem related to the spread of HIV. Routine testing is a favorable course of action because it meets the objective of reducing barriers to HIV-related healthcare. In this regards, routine testing incorporates the use of patient-centered incentives to encourage voluntary testing. Routine testing would be more effective than insurance reimbursements and healthcare practice regulations because it involves the patient directly (Harmon, Collins-Ogle, Bartlett,Thompson, and Barroso, 2014). Routine testing incorporates multiple interventions, including cultural-based stigmatization and discrimination, through its creation of a point of contact between the physician and the patient. In this regard, routine tests can be administered under different scenarios where the physician is able to perform tests on patients without violating their professional code of conduct. Furthermore, routine testing enhances the knowledge of patients and health departments with regards to HIV trends and changes in sexual behavior. Routine testing is the most effective method of creating a level ground for all stakeholders in the HIV-related interventions.


The inefficiency in the control HIV/AIDS in the state of North Carolina has been attributed to a combination of factors, predominantly the existence of barriers to universal healthcare. While about one-quarter of the cases reported in the state were diagnosed at the stages where HIV had not progressed to AIDS, there is an urgent need for improvements in this front. Barriers to efficient management and prevention of HIV infection result from gaps existing in patient-centered care. However, routine tests have been identified as effective interventions that would significantly reduce these barriers to voluntary HIV-testing. Care givers must adhere to their professional code of conduct while working towards the achievement of the State’s objective to interrupt transmission and reduce risks of HIV infection. Indeed, the community should have access to appropriate knowledge of HIV/AIDS since this would be the first step in helping them take appropriate measures with regards to these objectives. Most importantly, understanding the significance of testing will go a long way in this cause since most people refuse to take tests due to stigmatizations. Government insurance programs should portray a commitment to this cause of free and fair universal care. This is important in HIV testing because free services will eliminate one of the predominant barriers to efficient patient-centered care. In the State of North Carolina, agencies such as the HIV/STD Surveillance Unit (HSSU) have a great responsibility in the provision of research-based and evidence-based care. HIV prevalence statistics and reported changes in sexual activity are critical in the designing of action plans that will interrupt the transmission and reduce the risks of HIV infection.




Center for Disease Control (CDC) (2013). Prevention Status Report. Retrieved from:

Harmon, J. L., Collins-Ogle, M., Bartlett, J. A., Thompson, J., & Barroso, J. (2014). Integrating                  routine HIV screening into a primary care setting in rural North Carolina. Journal of the                       Association of Nurses in AIDS Care, 25(1), 70-82.

HIV/STDSurveillance Unit (HSSU). (2018). North Carolina HIV/STD Quarterly Surveillance                Report: Vol. 2018, No. 2HIV/STDSurveillance Unit. Retrieved from:

NCAIDSACTION (2018). Retrieved from:

The Center for HIV Law and Policy (2018). North Carolina. Retrieved from:

White, B. L., Carter, Y. L., Records, K., & Martin, I. B. (2013). Routine HIV screening in North                  Carolina in the era of the Affordable Care Act: Update on laws, reimbursement, and              tests. Southern medical journal, 106(11).