AIDS Healthcare Foundation commends the passing of HIV testing bill

AIDS Healthcare Foundation (AHF), the US' largest provider of HIV/AIDS healthcare, prevention and education, and operator of the largest non-government HIV testing program in California which conducts more than 15,000 HIV tests annually, today lauded the California Assembly Health Committee for its unanimous vote (12/0) in favor of Assembly Bill 682, California's Routine HIV Screening Bill, which will now move on to the Assembly Appropriations Committee.

The bi-partisan bill, jointly authored by Assembly Members Patty Berg, Bonnie Garcia and Jared Huffman and co-sponsored by AIDS Healthcare Foundation, the California Medical Association (CMA) and the Health Officers Association of California, streamlines the HIV testing process, so that medical providers can identify Californians who are unaware of their HIV-positive status and bring them into care and treatment, while sustaining the fundamental voluntary nature of HIV screening. The bill removes barriers currently impeding California's ability to conform to recent Centers for Disease Control and Prevention (CDC) recommendations to implement routine HIV screening of the general population from ages 13 to 64.

"We commend the Assembly Health Committee for recognizing the urgent public health need to ensure that HIV screening becomes truly routine," said Whitney Engeran III, Director of Prevention and Testing for AIDS Healthcare Foundation, co-sponsor of the bill. "Too many people are still learning of their HIV status when they present themselves to a healthcare provider due to an illness, often too late to fully benefit from treatment. In line with recent CDC recommendations to make HIV screening a routine part of medical care, AB 682 will ensure more Californians get access to care and treatment and interrupt their unwitting exposure of others."

Current California state law, enacted early in the epidemic, requires informed or written informed consent, depending on the setting, before an HIV test can be conducted. This law makes it difficult for medical providers to routinely screen patients for HIV infection and contributes to the fact that nearly 40,000 Californians do not know that they are HIV positive and, hence, are not getting treatment and are unknowingly exposing others. AB 682 will change California law from informed consent to simple consent, with a requirement that a patient be given information about the test and be informed that he or she can decline the test. It will also streamline some of the procedures a physician must follow in testing a pregnant woman.

"This bill will save lives. Nearly 40,000 Californians are unaware they are HIV-positive, which means they could be unknowingly transmitting HIV to their loved ones," said Anmol S. Mahal, M.D., president of the California Medical Association, a co-sponsor of the measure. "AB 682 will remove a major roadblock to routine HIV screening so doctors can locate infected individuals, educate them about how to protect their partners and get them the care they need to manage the disease."

On September 22, 2006, the Centers for Disease Control and Prevention issued its "Revised Recommendations for HIV Testing." In that document, the CDC strongly urged routine HIV screening of all persons in a health care setting. AB 682 will serve to modernize California law and enable the state to meet CDC expectations.

"When we normalize HIV testing, we should see two results: we'll help slow the spread, and we'll help people get treatment sooner," said Assembly Member Berg, D-Eureka. "A lot of good can come from a simple blood test. Current law has outlived its usefulness when it is no longer a protection but an impediment to screening people who do not know that they are at risk of exposure."

"It's time we took an aggressive approach to further helping people get tested for this terrible disease by eliminating barriers to early diagnosis of HIV infection and increasing access to quality medical care, treatment and ongoing prevention services -- AB 682 is a significant step in that direction," said Assembly Member Garcia, R-Cathedral City.

Assembly Member Huffman, D-San Rafael, added, "This bill is an important preventative health care reform that will increase the number of people who are tested for HIV leading to a decrease in the number of people who are unknowingly spreading the disease."

A recent study published in the Journal of the American Medical Association (JAMA) "Association Between Rates of HIV Testing and Elimination of Written Consents in San Francisco," (March 14, 2007-Vol. 297, No. 10) revealed the potential for increased HIV testing rates when certain barriers to testing are removed. The research letter, (authored by Jeff D. Klausner, MD, MPH and Mitchell H. Katz, MD of the San Francisco Department of Public Health (SFPHD), and Nicola M. Zetola, MD, Barbara Haller, MD, PhD and Patricia Nassos, PhD of the University of California, San Francisco) examined the rate of HIV testing after the San Francisco Department of Public Health, in May 2006, replaced written consent with verbal consent for testing through its facilities. The results show a major increase in the rate of HIV testing after this move to streamline the testing process. For example, San Francisco General Hospital Medical Center went from diagnosing 20 cases of HIV a month to over 30.

According to the CDC, "HIV infection is consistent with all generally accepted criteria that justify screening: HIV infection is a serious health disorder that can be diagnosed before symptoms develop; HIV can be detected by reliable, inexpensive, and noninvasive screening tests; Infected patients have years of life to gain if treatment is initiated early, before symptoms develop; and the costs of screening are reasonable in relation to the anticipated benefits."

HIV screening is on a par with other screening that can lead to prevention, treatment and survival. Physicians routinely screen for cholesterol, diabetes, and breast cancer because intervention saves lives.