PROJECT INFORM IN OTHER MEDIA ... 2008

News in Brief

California Progress Report, September 16, 2008
by Dana Van Gorder, Executive Director, Project Inform

The Centers for Disease Control and Prevention (CDC) recently found that the United States has been under-estimating HIV infections by more than 40 percent (per year) for the past decade.

Here in California, the State Office of AIDS estimates that over 40,000 Californians are HIV positive and do not know it. The CDC estimates that these individuals are responsible for 50-70% of all new infections, and every day, nearly three times as many people become newly infected with HIV as those who start taking antiretroviral therapy. We must take action now to do something to reduce the rate of new infections.

Many seem to believe that the AIDS crisis is only occurring in the developing world. Clearly that is not the case. HIV/AIDS continues to be a major threat in the United States with some areas having prevalence rates on a comparable scale to Sub Saharan Africa. According to a new report by the Black AIDS Institute, the number of African-Americans living with HIV in the United States exceeds the number of HIV-infected people in seven of the 15 countries in the President's Emergency Plan for AIDS Relief (PEPFAR) initiative.

Indeed, the new CDC data confirmed the disproportionate impact HIV/AIDS is having on minorities, women and youth here at home:

• African-Americans suffer seven times the infection risk as whites. In 2006, African-Americans accounted for 20 percent of the HIV/AIDS cases, although they made up just 7 percent of California’s population (California Department of Health Services).
• Latinos suffer three times the infection risk as whites. In 2006, Latinos constituted 22 percent of HIV/AIDS infections — but only made up 15.3 percent of the US population.
• In 1992, women accounted for an estimated 14 percent of adults and adolescents living with AIDS — by the end of 2005, that number had grown to 23 percent. In 2004, the only diseases causing more deaths among women were cancer and heart disease.
• In 2006, more infections occurred among young people under 30 (aged 13–29) than any other age group (34 percent), followed by persons 30–39 (31 percent).

It’s clear that the time for action is now, and until there’s a vaccine, HIV testing is one of the most effective prevention tools we have.

Originally, the CDC recommended that high risk people (along with those suffering symptoms) be routinely tested for HIV/AIDS. However the agency rejected that philosophy in 2006 recognizing that doctors often didn't know which of their patients were at highest risk, and more people outside the standard risk groups (including women, minorities, and people living outside cities) were becoming infected.

However, CDC’s recommendations didn’t address the question of how universal screening would be paid for. For example, Medicare doesn’t cover routine testing under the health plan for 8.5 million federal employees or the 7.1 million disabled people under the age of 65 in Medicare.

California has influenced the evolution of this standard by removing critical barriers to HIV screening. In 2007, Governor Schwarzenegger signed into law AB 682 (Berg). AB 682 streamlined the HIV testing process, so that medical providers could identify Californians who were unaware of their HIV- positive status and bring them into care and treatment, while sustaining the fundamental voluntary nature of HIV screening. The bill removed a major barrier to HIV testing by eliminating the requirement of written informed consent, and it changed the HIV testing process in California from an opt-in system to a voluntary opt-out system as recommended by the CDC.

This year’s AB 1894 is the critical next step to make HIV testing routine practice — which is critical in HIV prevention, treatment and care efforts. AB 1894 will make California’s response to the CDC recommendations the most proactive in the nation by supporting an environment that requires all group and individual health insurance plans to pay for an HIV test regardless of whether the testing is related to a primary diagnosis or the patient is showing symptoms.

According to the California Department of Health, rapid HIV testing may help to substantially reduce the number of people with HIV who do not know they are infected. We also know that when people learn they are HIV positive, they are much less likely to engage in behaviors that will cause further transmissions.

AB 1894 passed the Assembly on August 19, 2008 (47-29) and the Senate on August 14, 2008 (21-15).

If we are serious about preventing HIV/AIDS and reducing new transmissions in California, we must implement AB 1894. A South Carolina Department of Health and Environmental Control study in 2006 showed that most “late testers” (defined by CDC as people who progress to AIDS within a year of their initial HIV diagnosis) had up to five doctor visits within the previous year or longer before being tested for HIV. We simply cannot allow these missed opportunities within our health care system to continue.

California is known around the country and the globe as being a leader in important policy matters — and this issue should be no different. Signing this legislation will encourage more providers to screen their patients, which will help diagnose more individuals as early as possible when treatment is most effective. It will also help California create an environment that reduces the tragic stigma associated with HIV/AIDS.

Project Inform urges the Governor to sign AB 1894 to equip doctors and other health care providers with this necessary tool to help all Californians know their HIV/AIDS status, access treatment if needed, and reduce the risk of transmission.