September 22, 2007

Honorable Arnold Schwarzenegger
Governor of California
California State Capitol
Sacramento, CA 95814
FAX (2 PAGES): 916-445-4633

RE: SIGN A.B. 682 (BERG): FACILITATES HIV TESTING, CAN SAVE LIVES

Dear Governor Schwarzenegger:

Beyond AIDS urges that you sign Assembly Bill 682, authored by Patty Berg and related to HIV testing..  It is an excellent public health measure, in line with recommendations of the Centers for Disease Control and Prevention. 

California’s enactment of this legislation will be a stimulus to other states and put our state in the lead in making it easier to test the population for HIV.  Currently, similar legislation is being considered in New York and several other states.

The primary mission of Beyond AIDS is to improve control of the HIV epidemic through sound public health policy. AB 682 is a prime example of such sound policy.  Elimination of barriers to more routine HIV testing is an important part of our strategy.

Sections 1 and 2 of AB 682 replace the current requirement for informed written consent with a new simpler requirement, which requires informing of the test subject and an opportunity to opt out. This should help to promote HIV testing in doctors’ and dentists’ offices and ERs. 

As one of us (Dr. Hattis) has learned from 20 years of experience in charge of HIV testing at a large state facility that many patients are deterred by having to review and sign a legalistic consent form.  There is no such requirement for any other blood test, and it is hard to present an HIV test as being a routine and generally recommended screening procedure when it requires such non-routine prerequisites.  Elimination of written consent in healthcare settings is a major new recommendation of the Centers for Disease Control as of 2006 (see below).

Although the ACLU has complained that the bill lowers the level of consent, under this bill consent for HIV would actually remain at a higher level than for almost any other diagnostic test.  A physician is not required to inform a patient of each component of a chemistry panel or blood count, or to announce a right of refusal for that component.

Sections 3 and 4 of AB 682 amend legislation which Beyond AIDS helped to develop and support (AB 1676, Dutra), relating to prenatal HIV testing.  Therefore, it may be helpful for you to know that we and other backers of the earlier legislation do support this change in the law.  The elimination of a written statement of acceptance for a pregnant woman will help avoid one barrier to routine testing, and will facilitate inclusion of the test with panels of other prenatal tests, such as Rh factor and hepatitis B which are mentioned in the bill. 

As mentioned above, the Centers for Disease Control and Prevention issued a new policy on September 22, 2006 ( http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm ), supporting and
urging routine, opt-out HIV testing in health care settings, as consistent with your bill.  That is because the public health leaders of our country are concerned that an estimated quarter million Americans
(including probably in excess of 30,000 Californians) are infected with HIV but do not know it because they have not been tested.  Encouraging more routine testing in the course of medical care is critical to achieving earlier treatment and prevention of transmission, and we believe that the nation’s HIV epidemic cannot be adequately controlled without it.

Once again, thank you favorably considering this legislation, which (if you sign it) would be a great step forward for public health in California that should help save many lives. 

Sincerely,

Cary Savitch, MD
President, Beyond AIDS
Infectious Diseases, Ventura, CA

Ronald Hattis, MD, MPH
Secretary, Beyond AIDS
Family and Preventive Medicine/Public
Health, Redlands, CA

Yvonne W. Pover
Treasurer, Beyond AIDS
Dental Hygienist

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