A bill on its way to Gov. Arnold Schwartzenegger's desk may encourage more Californians to get routine HIV testing. If signed into law, health insurers operating in California would be required to cover routine HIV screening.

Assembly Bill 1894 — the first bill of its kind in the U.S. — passed out of the Assembly after concurrence in Senate amendments (on a bipartisan vote of 47-29) late last month, and awaits Schwartzenegger's signature to become law.

"We continue to move forward in the fight against HIV and AIDs, but there is so much more work to be done," said Assembly Member Paul Krekorian (D-Burbank). He said an important next step is to ensure that every segment of the population has access to HIV testing.

Krekorian told Diagnostics & Imaging Week and one other media source during a press teleconference last week that he wants to make HIV testing as routine as testing for cholesterol or high blood pressure. He estimates the cost to do so would be less than 1 cent per member per month in terms of premium insurance increases.

The AIDS Healthcare Foundation (AHF; Los Angeles) sponsored the bill. A spokesman for the organization told D&IW that the governor has until the end of the month to either sign or veto the bill or it becomes law automatically.

"Most people who I talk to about this legislation are surprised that insurance companies don't already pay for this and that you have to have some indication that you might have HIV in order to get the HIV test," Michael Weinstein, president of AHF, said during the teleconference.

According to the California Office of AIDS, roughly 40,000 people in California who are infected with HIV don't know they have the disease. The lack of routine HIV testing results in a lack of treatment to tens of thousands of people who need it, and puts many more people at risk of infection, the AHF says.

"This important bill creates an environment in which testing will become routine and more Californians will know their HIV status, get linked to care as needed, and have an overall better quality of life," Krekorian said. "Studies have shown that when individuals know their HIV status, those found to be positive take steps to decrease the risk of passing their HIV infections on to others."

He added, "AB 1894 is a straightforward solution to a growing public health dilemma. It helps pave the way to encourage widespread and routine HIV testing throughout California — something the CDC first recommended nationwide nearly two years ago. It is prudent legislation that will save lives."

Krekorian represents the cities of Burbank and Glendale, and the Los Angeles communities of Atwater Village, Los Feliz, North Hollywood, Silver Lake, Toluca Lake, Valley Glen, Valley Village and Van Nuys. He is a board member of the AIDS Community Action Foundation.

The Centers for Disease Control and Prevention (Atlanta) recently revised its annual estimates of HIV incidence in the U.S. up to 56,000 new HIV cases a year — up from roughly 40,000 cases each year. The CDC explained this 40% increase as a result of better data collection and tracking; however, the AHF said, the original case number has remained static at 40,000 cases a year for the past 10 years — "a statistic that already underscored the need for stepped-up HIV testing."

The CDC also reported that only 40% of the U.S. population had ever received an HIV test, and that at least a quarter of the estimated one million people in the U.S. living with the virus are unaware of their HIV-positive status.

The CDC had previously issued revised recommendations for its HIV testing guidelines in September 2006. In a departure from its previous guidelines, the CDC recommended that "opt-out" HIV screening become a part of routine clinical care in all healthcare settings for every person ages 13 to 65.

However, this recommendation has not yet been widely implemented on a national scale. One factor may be the issue of who pays for these tests — which can cost as little as $20 per test. By requiring insurers to cover the cost of routine HIV testing, AB 1894 will help move California closer toward implementing the CDC's Revised 2006 HIV Testing Guidelines.

"I think that to not promote HIV testing or to not pay for it sends us back many, many years. It also allows people to sit in the dark about their healthcare and to be ashamed of their healthcare," said Byron Williams, MD, head of infection control at White Memorial Hospital (Los Angeles) and an infectious diseases specialist. "I think that by not doing this we will be sending the wrong message, we will be heading backwards, and I think in terms of cost you will pay more on the back end by not being proactive now."

If the bill is passed into law in California, Weinstein told D&IW that it could have a domino effect on other states. He noted that Medicare is in the same situation as most private insurers in that it only pays for HIV screening if there is an indication that the patient may be infected.

"AB 1894 provides an ideal opportunity to break the chain of new infections by compelling insurers operating in California to cover the cost of routine HIV testing in medical and health settings like ERs and community clinics," he said. "As with any disease, the most effective public health strategy to combat HIV/AIDS is to identify those who are infected, provide treatment, and minimize the spread of new infections."

Weinstein added, "AB 1894 will help us identify more people who are already living with HIV, but who may not know their status because they've never been tested. HIV is a treatable — but not curable — infection. With the lifetime cost of care for just one individual living with HIV/AIDS now estimated at more than $600,000, we need to do everything possible to normalize the process for HIV testing in order to identify all those who are infected, link them to treatment and reduce the spread of new infections."