Bay Area Reporter

Published 09/27/2007

by Kris Larson

A year ago, the federal Centers for Disease Control and Prevention recommended that HIV tests become part of routine medical care for all patients ages 13 to 64. This week, Assemblywoman Patty Berg (D-Eureka) urged Governor Arnold Schwarzenegger to sign her bill, which would implement the guidelines in California.

Major components of the CDC recommendations called for the screening of all patients for HIV, regardless of risk; retention of a voluntary "opt-out" option for those who object to being tested; the elimination of special consent and its incorporation into general medical consent; and a recommendation – but not a requirement – for pre- and post-test counseling on HIV.

On September 21, almost a year after the CDC released its recommendations, the California legislature passed AB682, which would implement the CDC's recommendations. Berg's bill received bipartisan support, and only needs a signature from the governor to be put into law.

The primary component of Berg's bill would streamline the HIV testing process by requiring simple consent, rather than informed consent.

The bill's proponents said in a conference call September 25 that they hope that implementing the recommendations will help to identify Californians who are unaware that they are infected with HIV, and perhaps slow some of the estimated 40,000 new infections that appear in this country each year. There are an estimated 250,000 people in the country who are infected with HIV but do not know it.

"Patients who get treatment while they're still healthy live longer than those who get it when they're already sick. Only those people who start with a CD4 count above 200 are gaining the full benefit" of the drugs, Dr. Michael S. Saag, director of the HIV clinic at the University of Alabama at Birmingham, said last year following the CDC's announcement.

"In practical terms, the written informed consent is one of the biggest barriers [to emergency room testing]," said Michael Weinstein, president of the AIDS Healthcare Foundation, during Tuesday's conference call.

Not everyone has embraced the recommendations. The American Civil Liberties Union, among other groups, last year expressed concern that the new regulations could lead to patients being tested without their knowledge or consent.

However, "the language of the [state] bill is very clear that in order to test an individual for HIV, the provider needs to inform them they will receive the test and they need to make it clear to the patient they have a right to decline the test, so I think the ACLU's concern is unfounded," said Dana Van Gorder, director of state and local policy at the San Francisco AIDS Foundation. "It would be illegal to test somebody without their knowledge."

Some groups have also worried that an increase in positive diagnoses without an increase in funding for treatment and counseling problems could leave newly-diagnosed people in the lurch. In particular, San Francisco has experienced severe cuts under the Ryan White CARE Act, seeing its funding go from $28 million in the 2006-2007 fiscal year to $19 million this fiscal year.

Proponents of the bill anticipate that the governor will sign it into law. The next step will be coming to an agreement with the insurance companies to fund the tests, which can cost as little as $15 each.

"Part of what's so important about the CDC guidelines is they begin to change the standard of care from risk-based testing strategies to having tests be routine healthcare," said Teresa Stark of the California Medical Association. "As the standard changes, the health coverage generally changes along with that. Certainly if there's any issue with the health insurance, we'll want to work with that to make sure that's not a barrier in the way of this other goal."