CITY COUNCIL MAY 16, 2016 CONSENT CALENDAR SUBJECT: INITIATED BY: A RESOLUTION IN SUPPORT OF AB 2640 ( GIPSON) PUBLIC HEALTH: HIV. MAYOR LAUREN MEISTER PREPARED BY: ( Hernan Molina, Governmental Affairs LiaisonQ STATEMENT ON THE SUBJECT: The City Council will consider adopting a resolution in support of AB 2640 ( GIPSON), which will require medical staff or persons administering a test for HIV to provide written information to individuals who have tested negative for HIV that pre and post exposure prophylaxes is a proven, available medical alternative to preventing HIV infection. RECOMMENDATIONS: 1. Adopt Resolution No. 16 - A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF WEST HOLLYWOOD IN SUPPORT OF AB 2640 GIPSON) PUBLIC HEALTH. HIV" 2. Direct staff to send copies of the adopted resolution to Assemblymembers Richard Bloom and Mike Gipson, Senator Ben Allen, other key legislators and statewide partners. BACKGROUND / ANALYSIS: Despite ongoing prevention campaigns, HIV/AIDS continues to affect communities like West Hollywood. Thousands of gay men/ men who have sex with men continue to get infected and test positive for HIV every year. These increasing infection rates reflect the limitations of education and prevention campaigns and that the prevention messages are failing to reach some of the most at-risk populations. Over the last several years, experts in the field of HIV/AIDS have discussed alternative and innovative ways to reduce HIV transmission and prevent new infections. One of these new HIV prevention approaches includes the use of existing medicines currently used to treat HIV. Known as Treatment as Prevention or TasP, this new prevention modality includes the use of medicines like Truvada, which combines two different anti- retroviral drugs ( tenofovir / emtricitabine). This " prevention approach" commonly referred to as PrEP ( Pre- Exposure Prophylaxis) or PEP ( Post-Exposure Prophylaxis) has been reviewed by the research community and the Centers for Disease Control & Prevention ( CDC). The CDC has issued guidelines for daily use of PrEP. PrEP with the use of Truvada is considered to be one of the most powerful prevention strategies available, reducing a person' s risk of becoming infected by up to Page 1 of 4 AGENDA ITEM 2. BB.
92 percent when it is taken as directed. While no single prevention strategy is appropriate for everyone, PrEP could benefit thousands of men and women who are at high risk. When combined with condoms and other prevention methods, PrEP provides even greater protection than when used alone. In the 2015-2016 Budget Act, the California Legislature appropriated $ 2 million annually General Fund, $ 1. 764 million in local assistance, $ 236, 000 for state support) to DPH to establish a PrEP Navigator Services Program to ensure access for and serve the most vulnerable Californians at high risk for HIV. The primary client target for the PrEP Navigator Services Programs are gay, bisexual, transgender, or other MSM, transgender women who have sex with men, and partners of HIV- positive people with a detectable viral load and/ or inconsistent antiretroviral use. On March 3, 2016, the State of California Office of AIDS (OA) announced nine applicants that were selected to receive funding for the PrEP Navigator Services. Zero HIV Transmission As City Policy: According to a statistical figures provided by the Los Angeles County Department of Public Health, Division of HIV and STD Programs 4, 712 individuals have tested positive in West Hollywood ( Cumulative number of persons reported with an HIV diagnosis as of June 30, 2015. In January of 2015 the City Council adopted an official policy goal to make the City of West Hollywood the first city in the nation to reach zero-transmission status. In collaboration with non- profit agency partners and medical providers, the City drafted the HIV Zero Strategic Plan. The strategic plan sets priorities in addressing a full- range of prevention strategies that include PrEP, PEP, treatment as prevention; as well as access to care and co- factors that lead to transmission such as mental illness, substance abuse and HIV stigma. In collaboration with AIDS Project Los Angeles and the Los Angeles LGBT Center' s WeHo Life program, the City has released a new slate of printed materials in English and Spanish with PrEP information targeted to multiple communities, such as gay men and transgender people. Included in these materials are pocket cards instructing users to " Text PrEP" to obtain location based information about local PrEP providers. The City makes the materials available to all collaborative HIV testing providers, substance use disorder treatment facilities, and HIV prevention and education programs for each nonprofit agency/ organization' s distribution and outreach efforts. In 2015, the City allocated $ 9, 000 to APLA for the development of the Text PrEP campaign. In addition, the City's Social Services Division has enhanced the campaign by augmenting the allocation with existing Division' s funds and monies from the WeHo Life Social Services contract. AB 2640 was introduced by Assemblymember Mike A. Gipson ( D-Carson). Current statutes require medical staff and persons conducting an HIV test to inform patients about the need to test periodically ( at least every six months) and the many treatments available for HIV infection. AB 2640 would specifically require medical staff and persons administering an HIV test to provide written information about pre and post-exposure prophylaxes to patients who test negative for HIV, consistent with guidelines established Page 2 of 4
by the CDC. In addition, AB 2640 designates the OA within the State' s Department of Public Health ( DPH) to coordinate state programs, services, and activities related to HIV/AIDS. AB 2640 establishes the AIDS Drug Assistance Program ( ADAP) to subsidize the cost of currently approved anti- retroviral drugs used with PrEP and PEP, as recommended by the CDC, for persons who do not have private health insurance, are not eligible for Medi- Cal coverage and cannot afford the price of the recommended anti- retrovirals. Why is AB 2640 needed? In 2013, California was second among 50 states in the number of new HIV infections with approximately 5, 000 individuals testing positive for HIV. A 2015 survey of individuals at risk for HIV by the California HIV/AIDS Research Program found that only 1 in 10 respondents had ever used PrEP. In addition, the study found that the level of awareness of PrEP and PEP among African Americans and Latinos gay and bisexual men was significantly lower than their Caucasian counterparts. Therefore, AB 2640' s requirement to provide written information about the effectiveness of PrEP and PEP to at-risk individuals who test negative for HIV to further reduce transmission rates seems to be an appropriate strategy. Organizations Supporting AB 2640: AB 2640 is co sponsored by AIDS Project Los Angeles (APLA) and Los Angeles LGBT Center. The bill is supported by a broad base of community partners including Bienestar Human Services, Black AIDS Institute, Equality California, Friends Community Center, Desert AIDS Project, San Francisco AIDS Foundation, Tarzana Treatment Center, California Primary Care Association, Community Clinic Association of Los Angeles County, Free Speech Coalition, Project Inform, Positive Women' s Network, Access Support Network, JWCH Institute, Gender Health Center, Our Family Coalition, and UCLA Center for Behavioral and Addiction Medicine. Organizations Opposed to AB 2640: AB 2640 is currently opposed by AIDS Healthcare Foundation (AHF), the California Hospital Association ( CHA) and the California Medical Association ( CMA). AHF is currently opposing this bill as it finds the requirement for all practitioners to provide written information to individuals who test negative for HIV to be burdensome. In addition, AHF contends that this additional requirement prolongs the time for a person to be tested and that this additional time becomes a deterrent for testing. The CHA opposes codifying standards of practice and interfering in the physicianpatient relationship by legislating what information a physician should provide to a patient. In addition, CHA argues that AB 2640 would eliminate the physician' s medical judgment as to what treatment is in the best interest of the patient. The CMA opposes AB 2640 as it considers the requirement to provide additional, written information further stretching its already strained medical resources and is not worth the benefit of the mandate. Page 3 of 4
CONFORMANCE WITH VISION 2020 AND THE GOALS OF THE WEST HOLLYWOOD GENERAL PLAN: This item is consistent with the Primary Strategic Goal( s) ( PSG) and/or Ongoing Strategic Program( s) ( OSP) of: OSP- 5: Support People through Social Services. OSP- 12: Actively Participate in Regional Issues. In addition, this item is compliant with the following goal( s) of the West Hollywood General Plan: G- 1: Ensure that the community is active and engaged in the decision- making process. HS- 1: Maintain and pursue humane social policies and social services that address the needs of the community. EVALUATION PROCESSES: City staff, along the City's Sacramento Lobbyist will monitor the progress of this legislative initiative as it moves through the legislative process. ENVIRONMENTAL SUSTAINABILITY AND HEALTH: The City of West Hollywood has been, and continues to be at the forefront in the fight against the transmission of HIV and to support, through social services, individuals living with HIV/AIDS. The legislative goals and intent of AB 2640 are consistent with the City' s goals and policies. COMMUNITY ENGAGEMENT: City staff will proactively communicate with the different community- based organizations supporting AB 2640 as well as with the members of the City' s commissions and Advisory Boards, whose work programs include HIV prevention/ education and support of people living with HIV/AIDS. OFFICE OF PRIMARY RESPONSIBILITY: ADMINISTRATIVE SERVICES DEPARTMENT / CITY LOBBYIST FISCAL IMPACT: None ATTACHMENTS: A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF WEST HOLLYWOOD IN SUPPORT OF AB 2640 ( GIPSON) PUBLIC HEALTH: HIV" Page 4 of 4
RESOLUTION NO. 16 - A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF WEST HOLLYWOOD IN SUPPORT OF AB 2640 ( GIPSON) PUBLIC HEALTH: HIV THE CITY COUNCIL OF THE CITY OF WEST HOLLYWOOD DOES HEREBY RESOLVE AS FOLLOWS: WHEREAS, HIV continues to be a very serious public health concern in California and the United States; according to recent statistics, more than 1. 2 million people in the United States are living with HIV, and almost 12. 8% of those individuals are not aware of their HIV status; and WHEREAS, the State of California Office of AIDS ( OA) estimates that approximately 126, 000 Californians are living with HIV, and of these, 23, 000 or 18% are unaware of their status; In addition, an estimated 6, 000 Californians test positive for HIV, every year; and WHEREAS, in 2013, California was second among 50 states in the number of new HIV infections with approximately 5, 000 individuals testing positive for HIV; and WHEREAS, according to a statistical figures provided by the Los Angeles County Department of Public Health, Division of HIV and STD Programs 4, 712 individuals have tested positive in West Hollywood ( Cumulative number of persons reported with an HIV diagnosis as of June 30, 2015); and WHEREAS, these staggering numbers have real consequences not only on those that are living with HIV/AIDS and their families, it also has a strong negative financial impact on the State as resources must be allocated to treat HIV and eventually AIDS; and WHEREAS, it is well known and documented that it makes sense to invest resources on prevention and education campaigns to stop the spread of HIV; unfortunately, despite ongoing campaigns, the prevention message is not always effective and does not always reach at risk populations; and WHEREAS, one of the new strategies to prevent the spread of HIV and new infections is known as " Treatment as Prevention" or TasP and includes prescribing anti- retroviral drugs to at- risk individuals who test negative for HIV. This prevention modality is also known as PrEp ( pre-exposure prophylaxis) and PEP ( post-exposure prophylaxis); and
Resolution No. 16 - Page 2 WHEREAS, in the 2015-2016 Budget Act, the California Legislature appropriated $ 2 million annually ( General Fund, $ 1. 764 million in local assistance, $ 236, 000 for state support) to DPH to establish a PrEP Navigator Services Program to ensure access for and serve the most vulnerable Californians at high risk for HIV; and WHEREAS, a 2015 survey of individuals at risk for HIV by the California HIV/AIDS Research Program found that only 1 in 10 respondents had ever used PrEP; and WHEREAS, the level of awareness of PrEP and PEP, among African- Americans and Latino gay and bisexual men was significantly lower than their Caucasian counterparts; and WHEREAS, studies have shown that individuals receiving available HIV therapeutic medicines like Truvada for PrEP / PEP, reduce the likelihood of infection by 92%; and WHEREAS, despite the availability of this new prevention modality, not all individuals who could take advantage of these prophylactic approaches are aware of their availability or have enough information to make an informed decision; and WHEREAS, AB 2640 ( GIPSON) would require that medical practitioners and staff administering an HIV test, provide written information on PrEP and PEP to those individuals who test negative for HIV; and lead agency WHEREAS, AB 2640 would also make the State of California' s OA the to coordinate state programs, services and activities related to HIV/AID; in addition, AB 2640 charges the AIDS Drug Assistance Program ADAP) to subsidize the cost of AIDS drugs like Truvada for those without private health insurance, Medi- Cal coverage or who cannot afford purchasing such medicines; and WHEREAS, in January of 2015 the City Council adopted an official policy goal to make West Hollywood the first city in the nation to reach zerotransmission status; and WHEREAS, in collaboration with non- profit agency partners and medical providers, the City drafted the HIV Zero Strategic Plan. The strategic plan sets priorities in addressing a full- range of prevention strategies that include PrEP, PEP, TasP; as well as access to care and co- factors that lead to transmission such as mental illness, substance abuse and HIV stigma; and
Resolution No. 16 - Page 3 WHEREAS, in 2015, the City allocated $ 9, 000 to APLA for the development of the Text PrEP campaign. In addition, the City' s Social Services Division has enhanced the campaign by augmenting the total funding amount, tapping on existing Division' s funds and funding from the WeHo Life Social Services contract; and WHEREAS, AB 2640' s requirement for medical staff to distribute written information about the effectiveness of PrEP and PEP to at- risk individuals who test negative for HIV to further reduce transmission rates is an appropriate strategy; and WHEREAS, AB 2640 is consistent with the City of West Hollywood' s existing policy and ongoing HIV prevention efforts; and WHEREAS, the City of West Hollywood has always been at the forefront in the fight against HIV and AIDS, and has committed resources to educate its constituency and support it through social services; and NOW THEREFORE BE IT RESOLVED that the City Council of the City of West Hollywood supports AB 2640 ( GIPSON) PUBLIC HEALTH: HIV. PASSED, APPROVED AND ADOPTED THIS day of 20_. MAYOR ATTEST: City Clerk