The CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention recently published a new webpage related to public health laws. This webpage includes various legal tools and resources that can help public health practitioners understand the laws and regulations that might be facilitators or barriers to HIV, STD, and TB program effectiveness.
Public health departments strive to effectively treat communicable diseases like sexually transmitted diseases and tuberculosis, but co-infection of communicable diseases can have a negative impact on health. When a person has more than one communicable disease at the same time, it is important for departments to collaborate and share information regarding care and treatment. State laws designed to protect patient confidentiality can sometimes make it challenging for health departments to effectively coordinate care for a person with multiple diseases.
The CDC's new clearinghouse includes various legal and policy resources, assessments, public health research, and policy reviews regarding TB, HIV, and other STDs. Regarding HIV, the site includes a general overview of HIV and the law as well as 50-state surveys of HIV testing laws, criminal laws related to HIV, state laboratory reporting, and adolescent consent laws in relation to HIV prevention and treatment. The site also collects information about school health policies and practices including school health policies, practices, and profiles. The CDC also compiled a 50-state survey of policies for school staff and students with HIV. The site also connects to the CDC's Community Guide: Interventions for Adolescents. The site links to a 50-state survey of state statutes related to STDs, a report on minors’ access to STI services, a discussion of insurance billing for sensitive health topics, and the CDC's research on the legal status of treatment of the sex partners of persons with STDs. The compilation includes links to the CDC's information on TB laws and policies, the National Tuberculosis Controllers Association's TB law resources, and the CDC's information on legal authorities for isolation and quarantine.
Significant differences exist in state laws, policies, and available resources. Laws and policies are structural interventions that can be facilitators or barriers to effective HIV prevention and care activities. Examples of these laws and policies that facilitate HIV prevention and care include:
- 48 states plus D.C. now have HIV testing laws that are consistent with the CDC’s 2006 recommendations, nearly twice as many as when the recommendations were released.
- 22 states have Medicaid programs that reimburse for routine HIV screening in all settings and populations.
- 40 states plus D.C. require reporting of all CD4 and viral load laboratory data to HIV surveillance programs.
An example of the confusion in state laws is that one state’s laws may require that health care providers report cases of HIV to the HIV/AIDS division of the state health department and indicate that the personally identifiable information (PII) in that report is confidential and cannot be shared outside of the HIV/AIDS division. If a patient later contracts tuberculosis, the information about his or her case of HIV may be inaccessible — either for the purpose of treating that particular patient or for the purpose of monitoring common risks. The law that protects patients’ personal information may inadvertently interfere with efforts to provide and/or improve comprehensive care.
During the early years of the HIV epidemic, a number of states implemented HIV-specific criminal exposure laws. These laws impose criminal penalties on people living with HIV who know their HIV status and who potentially expose others to HIV. In 1990, the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, which provides states with funds for AIDS treatment and care, required every state to certify that its criminal laws were adequate to prosecute any HIV-infected individual who knowingly exposed another person to HIV. The National HIV/AIDS Strategy, released by the White House in July 2010, provides some guidance regarding the issue of criminalization, noting that in some instances, existing HIV exposure laws may need to be re-examined.
An analysis by CDC and Department of Justice researchers found that, by 2011, a total of 67 laws explicitly focused on persons living with HIV had been enacted in 33 states. These laws vary as to what behaviors are criminalized or result in additional penalties. In 24 states, laws require persons who are aware that they have HIV to disclose their status to sexual partners and 14 states require disclosure to needle-sharing partners.
Efforts to provide clinical care to minors may be complicated by a lack of clarity regarding parental consent requirements with respect to medical services. The CDC’s Public Health Law Program staff collected all statutes and regulations pertaining to an adolescent’s ability to consent to HIV diagnostic testing and treatment and sexually transmitted infection (STI) diagnostic testing, treatment, and prevention. No state expressly prohibits minors’ access to HIV prevention methods. All jurisdictions expressly allow some minors to consent to medical care for the diagnosis or treatment of STIs, but only eight jurisdictions allow consent to preventive or prophylactic services. Thirty-four states either expressly allow minors to consent to HIV services or allow consent to STI or communicable disease services and classify HIV as an STI or communicable disease. Seventeen jurisdictions allow minors to consent to STI testing and treatment, but they do not have an express HIV provision nor classify HIV as an STI or communicable disease.
Counsel and practitioners are advised to review the CDC’s clearinghouse for this significant resource on laws, policies, and tools.
See the CDC Resource
See also Medical Law Perspectives, November 2012 Report: Liability for Electronic and Other Medical Record Information Disclosure