I 112th CONGRESS 1st Session H. R. 1774 IN THE HOUSE OF REPRESENTATIVES May 5, 2011 Mr. Hastings of Florida (for himself, Mr. Conyers, Mr. Grijalva, Ms. Lee of California, Mr. McGovern, Mr. Jackson of Illinois, Ms. Wasserman Schultz, Mr. Brady of Pennsylvania, Mr. Hinchey, Ms. Norton, Mr. Deutch, Mr. Payne, Mr. Serrano, Mr. Rush, Mrs. Christensen, Ms. Moore, Mr. Clay, Mr. Johnson of Georgia, Mr. Quigley, Mr. Frank of Massachusetts, Ms. Schakowsky, Mr. Rangel, Mr. Polis, Mr. Cicilline, Mr. Davis of Illinois, and Ms. Baldwin) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and the Workforce, Ways and Means, 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; table of contents

(a)

Short title

This Act may be cited as the Increasing Access to Voluntary Screening for HIV/AIDS and STIs Act of 2011. (b)

Table of contents

The table of contents for this Act is as follows: Sec. 1. Short title; table of contents. Sec. 2. Findings. Sec. 3. Purpose. Sec. 4. Definitions. Title I—Coverage of HIV/AIDS and STI screening under public health care programs and group health plans; Coverage of care under Medicaid. Sec. 101. Coverage of routine HIV/AIDS and STI screening tests under Medicaid. Sec. 102. Coverage of HIV/AIDS and STI screening tests under Medicare. Sec. 103. Coverage for routine HIV/AIDS and STI screening under group health plans. Sec. 104. Optional Medicaid coverage of low-income HIV/AIDS infected individuals. Title II—Increased data collection and education for historically under-represented populations Sec. 201. People living with disabilities. Sec. 202. Women who have sex with women. Sec. 203. Transgender community. Sec. 204. Report.

2.

Findings

Congress finds the following: (1)Almost 19,000,000 new sexually transmitted infections (STIs) occur each year in the United States, and 50 percent of sexually active Americans will contract a 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)HIV/AIDS and STIs are syndemics. HIV infection can increase a person’s risk for acquiring certain STIs, as well as affect their frequency, severity, and healing time, while STIs increase the risk of HIV transmission, impaired fertility, reproductive tract cancer, and adverse pregnancy outcomes. (4)Many common long-term and initially asymptomatic STIs such as chlamydia, gonorrhea, herpes, syphilis, inflammatory pelvic disease, viral hepatitis, and HIV/AIDS remain undiagnosed, or diagnosed at later stages, leading to increased rates of mortality, morbidity, disability, and transmission. (5)In fact, an estimated 4.4 million Americans are living with chronic hepatitis and most do not know they are infected. Chronic hepatitis B can remain asymptomatic for years and, left undiagnosed and untreated, can lead to serious complications. Additionally, individuals infected with hepatitis C virus (HCV) are at risk for chronic liver disease or other HCV-related chronic diseases decades after infection. (6)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. (7)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. (8)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. (9)The CDC also recommends that all unvaccinated, uninfected persons being evaluated for a STI should receive hepatitis B vaccination. Furthermore, anti-HCV testing is recommended for routine screening of asymptomatic persons based on their risk for infection or based on a recognized exposure. (10)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. (11)Health equity and disparities remain a significant public health challenge, with the burden of HIV/AIDS and STIs falling disproportionately on different populations. (12)Although African-Americans account for about 12 percent of the United States population, they account for nearly half of all HIV/AIDS cases and 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. (13)HIV/AIDS continues to be most prevalent among men who have sex with men (MSM). 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. (14)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. (15)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. (16)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 access to equipment. (17)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, sexual orientation, gender identity, or disability. (18)The Congress supports the goals of the National HIV/AIDS Strategy and, in particular, the goal of 90 percent of individuals knowing their HIV/AIDS status.

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, viral hepatitis, 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 United States Virgin Islands, Guam, the Commonwealth of Puerto Rico, the Commonwealth of the Northern Mariana Islands, and American Samoa. (8)

STI

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

WSW

The term WSW means women who have sex with women.