Bay Area Reporter - July 19, 2007
Heather Cassell, h.cassell@ebar.com

Assemblywoman Patty Berg (D-Eureka) introduced AB682, the California Routine HIV Screening Bill, in February, in response to the Centers for Disease Control and Prevention's 2006 HIV testing recommendations.

AB682 originally repealed prohibition against HIV testing in most health care settings and strict requirements for medical professionals to have patient-signed documentation for requests for HIV tests. In place of written informed consent the bill required health care providers prior to giving an HIV test to a patient to "inform the patient that the test is planned," provide information about the test, and advise the patient about their right to decline the test.

According to HIV/AIDS and public health and civil rights legal experts, the bill didn't follow the CDC's recommendations entirely, making the language of the bill too simple by not being specific enough in regards to documentation, patients' rights, and evaluation. Some also said that the bill didn't recognize the stigma HIV continues to carry and the discrimination HIV-positive people continue to face.

On July 11, the Senate Health Committee approved three amendments to the bill. The amended bill now requires health care providers to inform patients - prior to being tested - about available HIV prevention and treatment options; requires health care providers to note if a patient declines to take the test; and that clinics and mobile testing sites will still be required to provide written informed consent, according to Rand Martin, lobbyist for the AIDS Health care Foundation.

While the amendments are improvements, according to members of organizations that lobbied for the changes, they continue to want to see more. The informed consent portion of the amendments doesn't go far enough, some experts said.

"Without consent there is no way of proving that there was consent or no consent," said William "Trip" Oldfield III, acting executive director of the HIV & AIDS Legal Services Alliance in Los Angeles. "We are just concerned that if people are tested without their knowledge, because the bill doesn't explicitly [state to] note in the medical file that the person must have said that it was okay."

Oldfield added, "That's one addition that we are going to be fighting for over the next month."

It is that one notation, experts state, which leaves health care providers administering the tests open to medical liability and the potential for people being tested without their knowledge.

"Our main overriding concern is that people, when they are being tested for HIV, they know that they are being tested," said Mary Sylla, director of policy and advocacy for the Center for Health Justice.

Sylla added, "It's not like a cholesterol test. People have said that it will reduce HIV stigma, but it's not going to turn it around overnight. We wish that we were that far down the line."

The CDC recommended reducing current written informed consent policies and practices for HIV testing by not requiring separate written consent by doctors and patients. Instead of written consent, health care providers would only note in patients' medical charts if they decline, or "opt out," of taking the HIV test. According to the CDC, "general consent for medical care should be considered sufficient to encompass consent for HIV testing" and it recommended separating required prevention counseling from HIV testing and screening programs. The recommendations are attempts to make testing a part of people's routine medical check-ups in order to identify HIV-positive individuals earlier to prevent the spread of the disease and get people into care and treatment.

The bill also cited results from the San Francisco Department of Public Health's 2006 pilot test to remove patient consent forms for HIV testing from health care settings. The test, published in March, resulted in a monthly increase from 20 identified HIV-positive adults to 30, compared to 2005, according to Dr. Jeffrey Klausner, director of STD Prevention and Control for the health department.

According to Dana Van Gorder, director of state and local affairs at the San Francisco AIDS Foundation, there are an estimated 40,000 people in California who have either never been tested or haven't tested recently enough for HIV. Van Gorder told the Bay Area Reporter that he believes the bill provides a good "balancing act" between the burdens of paperwork on medical providers and patients' rights. According to Van Gorder, health care providers are not inclined to offer HIV testing due to the current written informed consent process.

"It's clear that medical providers aren't offering medical testing because the current laws in California are too cumbersome," said Van Gorder.

The SFAF endorsed AB682 along with the AIDS Health care Foundation, California Medical Association, and the Health Officers Association of California.

"What you don't know can hurt you in this case," said Maria Aliferis-Gjerde, spokeswoman for Berg. "The bill is about reducing the spread of HIV and catching HIV in its earliest stages. We still have about 39 percent of people learning that they are HIV-positive less than a year of being diagnosed with AIDS. The bill would make HIV screening routine in the medical exam that a person takes."

Elected officials and advocates in support of the bill want it to focus solely on HIV testing. They see it as an entry point for prevention and getting people into care.

"The goal of this law and the CDC's goal is to help us really make sure we are testing the entire adult population for HIV," said Van Gorder.

Assemblyman Mark Leno (D-San Francisco) added, "We have also come to learn that 70 percent of those who know they are HIV-positive take steps from spreading the virus further. So testing becomes one of the most effective tools in stopping the epidemic."

The bill is now being sent back to the Senate Appropriations Committee for approval before being returned to the Assembly for concurrence later this month.

070719
BR070708

Always watch for outdated information. This article first appeared in 2007. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2007. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .