Senate Health Committee Votes To Repeal Written Informed Consent In HIV Testing Bill

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HIV Testing Bill

AIDS Healthcare Foundation lauded the California State Senate Health Committee for its vote in favor of Assembly Bill 682, California's Routine HIV Screening Bill.

It which will now move on to the Senate Appropriations Committee. AHF and other public health advocates cheered the news that the repeal of an existing requirement for written informed consent for HIV testing was a key component of the version of the bill that cleared the Senate Health Committee today.

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 a major barrier to HIV testing by requiring a patient to give simple consent, rather than informed consent, before an HIV test can be administered.

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"Today's vote was momentous and we thank the Chair and Members of the 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 AHF. "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."

Engeran added, "Opponents to the bill, mostly public interest lawyers, sought to load the bill with new requirements that would have increased the barriers to testing. The committee sided with medical and public health officials and rejected the opponents' effort."

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 may unknowingly be 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.

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 medical care providers in the state to incorporate CDC guidelines in their standards of care.

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."

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