State Legislation to Increase Access and Fund HIV Prevention Strategies

July 25, 2019|3:39 p.m.| ASTHO Staff

In 2017, 38,739 people received an HIV diagnosis in the United States. While the annual number of new HIV diagnoses has remained stable in recent years, annual new diagnoses have increased among some groups. For example, between 2012 and 2016, HIV diagnoses increased 12 percent among Hispanic and Latino gay and bisexual men. Building on these successes in reducing the spread of HIV, as well as facing the challenges of such an undertaking, President Trump announced during the 2019 State of the Union address the new “Ending the HIV Epidemic: A Plan for America,” a ten-year initiative to reduce new HIV infections to less than 3,000 per year by 2030.

Strategies to prevent HIV include abstinence, limiting the number of sexual partners, never sharing needles, and using condoms. There are also newer HIV prevention medicines, such as pre-exposure prophylaxis (PrEP). PrEP is a way for people who are at very high risk of getting HIV to prevent HIV infection by taking a pill every day. When taken daily, PrEP is highly effective for preventing HIV. Federal guidelines recommend that PrEP be considered for people who are HIV-negative and at a very high risk for HIV, including anyone who is in an ongoing sexual relationship with an HIV-positive partner. PrEP is also recommended for people who’ve injected drugs in the past six months and have shared needles or people who work or have been in drug treatment in the past six months. Studies have shown that PrEP, when taken daily, reduces the risk of getting HIV from sex by about 99 percent and reduces the risk of getting HIV among people who inject drugs by at least 74 percent.

While an estimated 1.2 million Americans are at a high risk for HIV infection, fewer than ten percent use PrEP. In addition to responding to and treating HIV outbreaks, states are also taking policy approaches that focus on prevention of HIV infection, including the use of PrEP. Below is an overview of recent state legislative activity aimed at increasing access to and funding for PrEP.

Two states recently considered bills increasing access to PrEP. Earlier this month, Connecticut’s governor signed House Bill 6540, which increases access to preventative and prophylactic interventions for minors at risk of exposure to HIV. In addition to the provision of treatment, any licensed physician or advanced practice registered nurse may now examine and provide prophylaxis for HIV infection for a minor without parental consent. In California, the legislature is considering a bill that would authorize a pharmacist to furnish a 60-day supply of PrEP (increased from a 30-day supply) and would require a pharmacist to furnish those drugs if certain conditions are met. The bill would also require the pharmacist, before furnishing PrEP, to complete a training program approved by the board of health.

Several states enacted legislation addressing funding for PrEP. For example, California’s governor signed Senate Bill 78 requiring the department of public health, upon an appropriation in the annual budget, to award funding to community-based organizations or local health jurisdictions to provide comprehensive HIV prevention and control activities, including PrEP-related activities, for vulnerable and underserved individuals living with or at high risk for HIV infection. The governor of New Mexico signed Senate Bill 536 appropriating $364,000 to the University of New Mexico to support the extension for community healthcare outcomes program (Project ECHO) and provided that $107,0000 of this appropriation be for the HIV PrEP program. Finally, Washington’s governor signed Senate Bill 5602 requiring the department of health to develop recommendations for increasing awareness about financial support that is available for PrEP. The department of health is also required to consult with the state board of health, healthcare authority, and health benefit exchange in developing recommendations related to outreach and education to affected populations.

In addition to surveillance and response to HIV outbreaks, state health agencies play an important role in advocating for effective policies that prevent outbreaks and reduce the number of new HIV diagnoses. State health agencies have an opportunity to increase awareness among policymakers and the community about PrEP and implement programs that make PrEP available and affordable for individuals at a high risk of contracting HIV. ASTHO will continue to monitor legislative activity on this important public health issue.