A Bill To Remove Written Informed Consent For HIV Testing

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AIDS Healthcare Foundation praised Governor Arnold Schwarzenegger for signing Assembly Bill 682, California's Routine HIV Screening Bill, which cleared the two chambers of the California Legislature in late September with only a single vote against it.

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, repeals written informed consent for HIV testing, 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.

"AB 682 is the single most important change in public HIV/AIDS policy in years," said Michael Weinstein, President of AIDS Healthcare Foundation. "This landmark bill eliminates one of the remaining vestiges of a body of HIV law enacted in the mid-1980s that made HIV/AIDS exceptional among reportable diseases. The statutory shift to simple consent will catalyze a cultural shift in California among providers and consumers that will ensure that thousands of Californians with HIV get access to crucial, lifesaving care and treatment. We believe that many states will soon follow California's lead in utilizing simple consent for HIV screening."

"The California Legislature has recognized the importance of this public health legislation, which will ensure that HIV screening in California becomes more routine and widespread, and we thank Governor Schwarzenegger for signing this lifesaving bill," said Joseph Terrill, Public Policy Coordinator for AIDS Healthcare Foundation, co-sponsor of the bill. "Consistent with recent CDC recommendations, AB 682 normalizes the process of testing by making HIV screening a routine part of medical care; however, the bill also has provisions to maintain and safeguard patient confidentiality as well as an individual's right to chose whether to test or not. From a public health perspective, AB 682 allows California to get a better handle on its HIV incidence while also affording many in need the chance to access care and services for their HIV disease sooner."

"Nearly 40,000 Californians are unaware they are HIV-positive, which means they could be unknowingly transmitting HIV to their partners. In addition, too many people learn of their HIV status when they present themselves to a healthcare provider due to an illness, often when it is too late to fully benefit from lifesaving antiretroviral treatment," said Whitney Engeran III, Director of Public Health Division for AIDS Healthcare Foundation, co-sponsor of the bill. "AB 682 will help address two major hurdles in the fight against HIV/AIDS in California. First, it will ensure that more Californians learn their HIV status and, as a result, stop spreading it to their partners. Second, it will help guide those people into care and treatment. We thank the Legislature, particularly the bill's authors, Assembly Members Berg, Garcia and Huffman, for their leadership on this issue, and thank Governor Schwarzenegger for his timely signature on this crucial legislation."

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Background on HIV Testing in California

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.

Changes in Federal Guidelines on HIV Testing

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.

A study published earlier this year 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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