BILL ANALYSIS Ó
AB 2640
Page 1
ASSEMBLY THIRD READING
AB
2640 (Gipson)
As Amended April 21, 2016
Majority vote
------------------------------------------------------------------
|Committee |Votes|Ayes |Noes |
| | | | |
| | | | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Health |12-5 |Wood, Bonilla, Burke, |Maienschein, |
| | |Campos, Chiu, |Lackey, Olsen, |
| | |Dababneh, Gomez, |Patterson, |
| | | |Steinorth |
| | | | |
| | |Roger Hernández, | |
| | |Nazarian, Rodriguez, | |
| | |Santiago, Waldron | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Appropriations |14-6 |Gonzalez, Bloom, |Bigelow, Chang, |
| | |Bonilla, Bonta, |Gallagher, Jones, |
| | |Calderon, Daly, |Obernolte, Wagner |
| | |Eggman, Eduardo | |
| | |Garcia, Roger | |
| | |Hernández, Holden, | |
| | |Quirk, Santiago, | |
| | |Weber, Wood | |
| | | | |
| | | | |
AB 2640
Page 2
------------------------------------------------------------------
SUMMARY: Requires a medical care provider or person
administering a test for human immunodeficiency virus (HIV) to
provide patients who test negative for HIV infection, yet are at
high risk for HIV infection, with written information about the
effectiveness and safety of all methods that prevent or reduce
the risk of contracting HIV, including, but not limited to,
pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis
(PEP), consistent with guidance of the federal Centers for
Disease Control and Prevention (CDC).
FISCAL EFFECT: According to the Assembly Appropriations
Committee, to the extent this bill raises awareness of drug
therapy for people at high risk for HIV, this bill could
potentially increase demand for and utilization of drug
treatment for HIV prevention, particularly PrEP. According to
the New York State Department of Health, Truvada, the drug used
in PrEP therapy, costs between $8,000 and $14,000 per year.
Medi-Cal prices for the drug are unknown, but even assuming
significant discounts are available, costs to Medi-Cal could be
in the millions annually if even a few hundreds more people a
year take the medication (General Fund/federal). To the extent
increased utilization with PrEP among high-risk populations
reduces the number of HIV infections, there would be offsetting
cost savings for less HIV/AIDS treatment in Medi-Cal and the
AIDS Drug Assistance Program.
Costs to the California Department of Public Health to produce
updated written material, and to modify HIV counselor training,
are minor and absorbable.
COMMENTS: According to the author, this bill seeks to reduce
the spread of HIV and save the lives of individuals at high risk
of HIV exposure by providing them with information about
AB 2640
Page 3
preventive medications during HIV post-test counseling. The
author notes that in 2013, California was second among the 50
states in the number of new HIV diagnoses, with approximately
5,000 new HIV diagnoses, and a 2015 survey of individuals at
risk for HIV by the California HIV/AIDS Research Program found
that only one in 10 respondents had ever used PrEP. The author
concludes, considering the high volume of new HIV infections
being diagnosed in the state of California and the low awareness
of these medications, it is critical that those being tested are
aware of PEP and PrEP medications.
Treatment as Prevention (TasP), PrEP, and PEP. In TasP, people
living with HIV/AIDS use anti-retroviral (ARV) medications to
reduce their viral load (the amount of HIV in the body) to
undetectable levels. With an undetectable viral load, the
amount of HIV in the body is so small it greatly reduces the
likelihood of passing the virus to another person. Strict
adherence to TasP reduces the likelihood of transmission by up
to 96%. PrEP is a new intervention that uses an established ARV
medication, Truvada to protect at-risk HIV-negative individuals
from HIV infection. PrEP is different from PEP; the medication
is taken before, not after possible exposure. Daily PrEP use
can lower the risk of getting HIV from sex by more than 90% and
from injection drug use by more than 70%. Missing doses reduces
PrEP effectiveness. Truvada is currently the only FDA drug
approved for HIV PrEP. PEP uses ARV medications to prevent HIV
from replicating and spreading through the body after an
exposure to the virus. PEP is a short-term (28-day)
intervention and must be started within three days of an
exposure - sooner, if possible - to be effective. PEP was
originally developed for occupational exposures, such as
needle-sticks in hospitals, but is also effective for sexual
exposures.
In 2015, the CDC estimated that one in four sexually active gay
and bisexual men, one in five people who inject drugs, and one
in 200 sexually active heterosexual adults meet the criteria for
AB 2640
Page 4
PrEP. In 2015, the California HIV/AIDS Research Program
conducted a survey of 602 young gay and bisexual men and found
that only one in 10 had ever taken PrEP. Although awareness of
the intervention was high among those who had never taken PrEP,
awareness was significantly lower among Black and Latino
respondents compared to white respondents. In addition, the
large majority of respondents indicated they had never talked to
their doctor or healthcare provider about PrEP.
In its November 24, 2015 Morbidity and Mortality Weekly Report,
the CDC estimated that 1.2 million Americans could benefit from
PrEP, including 492,000 men who have sex with men, 115,000
injection drug users, and 624,000 heterosexuals. The report
concludes that clinical organizations, health departments, and
community-based organizations should raise awareness of PrEP
among persons with substantial risk for acquiring HIV infection
and their health care providers.
AIDS Project Los Angeles and the Los Angeles LGBT Center are the
cosponsors of this bill and they state that awareness and use of
PrEP and PEP among Californians at risk for HIV remain extremely
low. They conclude it remains vital to ensure that all
individuals at risk for HIV receive accurate information about
PrEP and PEP, particularly highly-impacted communities of color.
The AIDS Healthcare Foundation (AHF) states in opposition that
HIV screening is intended to mirror other screening tests, which
require simple consent only and which do not burden the process
with additional activities that may or may not be necessary.
AHF asserts that its experience as the largest private tester in
the state is that the more time and demands placed on the person
it is encouraging to be tested, the more likely the person is to
decline. The California Medical Association (CMA) is opposed to
this bill stating, increased awareness of preventative treatment
options for HIV should be a public health goal, however, it is
AB 2640
Page 5
concerned that the increased medical resources required to
accomplish the goal of this bill are not worth the benefit of
the mandate. CMA notes that many preventative treatment options
are not appropriate for every patient, and this bill would
require a physician to inform the patient of a treatment option
the physician might actually recommend against.
Analysis Prepared by:
Lara Flynn / HEALTH / (916) 319-2097 FN:
0003267