I 111th CONGRESS 1st Session H. R. 4140 IN THE HOUSE OF REPRESENTATIVES November 19, 2009 Mr. Hastings of Florida (for himself, Mrs. Christensen, Ms. Clarke, Mr. Cleaver, Mr. Conyers, Mr. Al Green of Texas, Mr. Grijalva, Ms. Jackson-Lee of Texas, Mr. Meeks of New York, Mr. Rangel, Ms. Roybal-Allard, Mr. Rush, Mr. Towns, Ms. Wasserman Schultz, Ms. Waters, Ms. Watson, and Mr. Wexler) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Labor, and Oversight and Government Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To provide for an evidence-based strategy for voluntary screening for HIV/AIDS and other common sexually transmitted infections, and for other purposes.

1.

Short title

This Act may be cited as the Increasing Access to Voluntary Screening for HIV/AIDS and STIs Act of 2009.

2.

Findings

Congress finds the following: (1)Over 15,000,000 sexually transmitted infections are reported each year, and 50 percent of sexually active Americans will contract an STI at some point in their lives, the majority of which may be asymptomatic for an extended amount of time. (2)Over 1,000,000 people in the United States are living with HIV, and someone is infected with HIV in the United States every 9.5 minutes. (3)Many common long-term and initially asymptomatic STIs such as chlamydia, gonorrhea, herpes, syphilis, inflammatory pelvic disease, and HIV/AIDS remain undiagnosed, or diagnosed at later stages, leading to increased rates of mortality, morbidity, disability, and transmission. (4)Stigma, culture, language, lack of education, lack of insurance, limited time, cost and resources in medical settings, and an inaccurate perception of risk among communities and providers all contribute to insufficient rates of screening for HIV/AIDS and STIs. (5)The Centers for Disease Control and Prevention and the United States Preventive Services Task Force recognize screening as an effective public health tool that allows providers to administer treatment before symptoms develop and implement interventions that will reduce the likelihood of HIV/AIDS and STI transmission and reduce the development of adverse outcomes. (6)The CDC recommends that voluntary screening for HIV/AIDS be integrated into routine clinical care while preserving patient confidentiality and the right of the patient to decline testing and screening. (7)Nearly 25 percent of persons living with HIV/AIDS are age 50 years or older, and the overall HIV/AIDS population is aging due to life-extending anti-retroviral drugs. (8)Inaccurate perceptions of risk among health care providers and patients, misdiagnosis, ageism, generational mind-sets, and biological factors have contributed to increased rates in transmission and late detection of HIV/AIDS and STIs over the past decade. (9)Although African-Americans account for about 13 percent of the United States population, they account for nearly half of all HIV/AIDS infections and have higher instances of mortality and morbidity for most STIs and HIV/AIDS. Also, African-American women who have sex with men account for the majority of HIV/AIDS infections among all women in the United States. (10)HIV/AIDS continues to be most prevalent among men who have sex with men. Continued support and increased funding for community-based programs and behavioral interventions that are culturally competent are key to reaching MSM, especially young MSM of color. (11)Transgender persons are particularly vulnerable to contracting HIV/AIDS and STIs due to high rates of survival sex among trans-females, discrimination in education, employment, and housing, and the absence of education and prevention methods culturally relevant to the transgender community. (12)Health care providers must be properly educated to treat groups, such as MSM, transgender persons, African-Americans, and Latinos who are disproportionately affected by HIV/AIDS and other STIs, and also improve interventions for groups that have been historically under-represented in health interventions for STIs, such as women who have sex with women, individuals over the age of 50, Asian and Pacific Islander Americans, Native Americans, and persons living with disabilities. (13)Women living with mobility impairments often lack access to screening for STIs and other women’s health services such as pelvic examinations and mammograms due to, among other factors, the lack of provider awareness, experience, and inaccessible equipment. (14)All individuals engaging in oral, anal, or genital sexual contact must have access to voluntary screening for HIV/AIDS and other STIs. Screening must be confidential, rapid, accurate, and medically appropriate. Screening must be offered regardless of age, race, class, sexual behavior, gender identity, or disability.

3.

Purpose

The purposes of this Act are as follows: (1)Increase access, quality, and affordability for voluntary and medically appropriate screening for HIV/AIDS and other STIs, including chlamydia, gonorrhea, syphilis, and human papillomavirus, for all persons engaging in various forms of sexual activity, including oral, genital, or anal sex. (2)Reduce the spread, morbidity, and mortality of HIV/AIDS and other STIs. (3)Reduce the disproportionate incidence of HIV/AIDS and other STIs in certain groups through early detection and treatment and comprehensive education for health care providers, centers, and communities. (4)Support the execution of other scientifically based interventions that are culturally competent and age appropriate and are proven to reduce the incidence of HIV/AIDS and other STIs.

4.

Definitions

In this Act: (1)

CDC

The term CDC means the Centers for Disease Control and Prevention. (2)

CMS

The term CMS means the Centers for Medicare & Medicaid Services. (3)

Director

The term Director means the Director of the Centers for Disease Control and Prevention. (4)

HIV/AIDS

The term HIV/AIDS means infection with the human immunodeficiency virus and includes acquired immune deficiency syndrome and any condition arising from such syndrome. (5)

MSM

The term MSM means men who have sex with men. (6)

Secretary

The term Secretary means the Secretary of Health and Human Services. (7)

State

The term State means each of the 50 States, the District of Columbia, the Virgin Islands, Guam, and Puerto Rico. (8)

STI

The term STI means a sexually transmitted infection that is recognized by the CDC, including chlamydia, gonorrhea, syphilis, and human papillomavirus. (9)

WSW

The term WSW women who have sex with women.