The NCSL Blog


By Charlie Severance-Medaris

As the economic downturn caused by the COVID-19 pandemic begins to affect state budgets, many lawmakers are making hard choices about state spending.

hiv strainFor some lawmakers, this may mean looking to allocate money or enact policies “upstream” to prevent greater spending down the road. New research from the Centers for Disease Control and Prevention (CDC) highlights the cost of treating infectious diseases, such as viral hepatitis and HIV, while detailing promising strategies to control their spread and avert future spending on treatment.

The costs to states resulting from the treatment of infectious diseases are impressive. The estimated cost of providing health care services to people living with hepatitis C, for example, is $15 billion annually and recent hepatitis A outbreaks have cost at least $270 million since 2016. In 2019, HIV care and treatment cost the U.S. more than $20 billion.

In a special supplement edition of the Journal on Public Health Reports, researchers have evaluated the impacts of public policy on the prevalence, mortality and disparities of infectious diseases, including HIV, viral hepatitis, sexually transmitted diseases and tuberculosis.

The authors note that policies can have powerful effects on the complex, multisectoral factors, like access to treatment, stigma and other health barriers, that influence health and the prevalence of these and other diseases. The research intends to guide the development and implementation of health-promoting policy strategies that are both effective as public health measures and feasible for policymakers.

For instance, the authors review recent policy changes in Washington, D.C., and New York that have led to improvements in HIV prevention. In the District of Columbia, the authors reviewed multiple changes to the way the district addresses HIV prevention including moving away from grant-based funding for provider organizations towards a fee-for-service model. This allowed funds to flow to communities most in need of services by responding to consumer demand.

In 2014, New York became the first state to launch a statewide initiative to end AIDS by reducing the number of persons living with HIV. The state’s initiative prioritized identifying and linking undiagnosed persons with HIV to care, retaining people with HIV in care and improving access to preexposure prophylaxis (PrEP) for persons at risk for acquiring HIV. Studies have shown PrEP reduces the risk of getting HIV from sex by about 99% when taken daily. Among people who inject drugs, PrEP reduces the risk of getting HIV by at least 74% when taken daily.

As a result of this reprioritization, computer simulation modeling shows New York state to be on track to decrease the number of new HIV cases by the end of 2020. The estimated lifetime cost of treating just one person living with HIV is near $450,000.

In the supplement, U.S. Surgeon General Jerome M. Adams reviews the evidence of successful state implementation of syringe service programs (SSPs). His commentary notes the successful collaboration between the CDC, the state of Indiana, public safety, the faith community and others to open an SSP in Scott County, Indiana during an HIV outbreak.

These efforts contributed to a 96% reduction in new HIV infections and a 76% reduction in new hepatitis C (HCV) infections. The authors note the outbreak cost the local, state and federal governments more than $100 million.

According to the CDC, SSP utilization is associated with a 50% decrease in the risk of HIV transmission and individuals who use SSPs are more than three times as likely as non-users to stop injecting drugs. Moreover, when SSP usage is combined with medication-assisted therapy (MAT) for opioid use disorder, risk of transmission is reduced by more than two-thirds.

Other policies included in the researchers’ discussion include laws that reduce barriers to HIV testing, the removal of cost barriers to curative therapy for hepatitis C and requiring routine syphilis screening and treatment for pregnant women.

While each of these infectious diseases brings its own challenges for policymakers to address, this new research highlights that these diseases are preventable, providing policymakers with an opportunity to avoid greater treatment costs down the road.

The full supplement is available on the Journal on Public Health Reports website.

Charlie Severance-Medaris is a policy associate in NCSL’s Health Program.

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About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.