States Take Legislative Action to End the HIV Epidemic

February 19, 2020|10:32 a.m.| ASTHO Staff

Each year, tens of thousands of Americans are diagnosed with HIV. While the annual number of new HIV diagnoses has declined in recent years, the impact of the disease varies among populations. For example, in 2018, the two groups with the most new HIV diagnoses in the U.S. were among black, Hispanic and Latino men who have sex with men. In addition, over one-third of the new diagnoses overall occurred in the 25-34 age range. In February 2019, the federal government announced a goal to end the HIV epidemic by 2030.

Meanwhile, states are taking things into their own hands by introducing and implementing evidence-based policies to prevent HIV cases. Policy trends include improving access to pre-exposure prophylaxis (PrEP) and establishing programs to prevent the spread of infectious diseases, like syringe services programs. In 2020, ASTHO expects states will continue to adopt laws aimed at preventing new HIV cases. These may include:

  • Increasing access to preventive treatment and services for minors.
  • Amending state criminal laws to reduce stigma and encourage HIV testing.
  • Expanding routine testing and service programs to high-prevalence areas and key populations.

Below are examples of state legislation to address the HIV epidemic that are being considered during the 2020 state legislative session so far. For more information please refer to ASTHO’s State 2020 Legislative Prospectus on HIV.

Pre-exposure Prophylaxis (PrEP)
Pre-exposure prophylaxis (PrEP) is a daily medication for people at risk of getting HIV that can reduce their chance of infection. PrEP is recommended for anyone who is at risk of acquiring HIV from sex or injection drug use. While an estimated 1.2 million Americans are at a high risk for HIV infection, fewer than ten percent use PrEP. State policies to increase PrEP access include allocating funds for the medication, authorizing pharmacists to provide PrEP, and eliminating barriers for minors to access PrEP.

New York proposed several bills increasing coverage for and access to PrEP. One bill (A22) would prohibit insurance companies from denying coverage for individuals who have taken or are currently taking PrEP, while companion bills (A4962 and S34) would require insurance coverage for PrEP. Similar bills (A7281 and S6779) would prohibit health insurers from requiring prior authorization for PrEP. Similarly, a bill in Colorado (HB 20-1061) would prevent health insurance carriers from requiring a covered person to undergo step therapy or to receive prior authorization before receiving HIV infection prevention drugs. The bill would also allow pharmacists to prescribe and dispense HIV infection prevention drugs if they fulfill specific requirements and requires insurance coverage if prescribed or dispensed by pharmacists.

Four additional states—New Hampshire (HB 1404), New Jersey (A687 and S1039), New York (A9013 and S7704), and Utah (HB 307)—expanded the scope of practice for pharmacists allowing them to prescribe and/or dispense PrEP. The New Hampshire bill would also allow for minors to access prophylaxis treatment without parental consent. Washington State is also considering companion bills (SB 5562 and HB 1551) that would allow minors to consent to treatment to avoid HIV infection.

Syringe Services Programs (SSPs)
Syringe services programs (SSPs) are evidence-based prevention programs that provide access to and disposal of sterile syringes and injection equipment, as well as vaccination, testing, and linkage to infectious disease care and substance use treatment. Comprehensive SSPs are safe, effective, and cost-saving and can reduce the spread of STIs and HIV. State legislative trends include authorizing the establishment of SSPs and excluding SSP employees or volunteers dispensing or possessing sterile needles or syringes from criminal penalties. Three states—Iowa (SF 105), Missouri (HB 1667), and Oklahoma (SB 1346) are considering bills establishing SSPs or SSP pilot programs.

Amending State Criminal Laws
HIV disclosure laws--laws aimed at decreasing HIV transmission by requiring people living with HIV to disclose their HIV status to sexual partners--may perpetuate misconceptions about HIV risk and transmission, as well as stigmatize those living with HIV. Instead of protecting public health these laws may actually discourage individuals from seeking testing and treatment for HIV. Two states—Georgia (HB 719) and Missouri (HB 1691 and HB 1692)—are considering bills that would amend their criminal statutes. The bills would change the knowledge of infection and intent to transmit requirements and reduce the criminal penalties.

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 about and implement evidence-based interventions and policies to prevent future HIV cases, such as increased access to PrEP, SSPs that encourage safe practices and reduce the spread of HIV, and amending state criminal laws that discourage HIV testing. ASTHO will continues to monitor legislative activity on this important public health issue.