Infectious diseases carry a high cost for the health of communities and state budgets. The Centers for Disease Control and Prevention estimates that 1.2 million Americans are infected with HIV, with about 38,000 new HIV infections annually. The lifetime cost to treat just one person with HIV infection is $501,000.
Moreover, it’s estimated that 2.4 million people in the U.S. live with the hepatitis C virus, and the average cost of a 12-week course of curative treatment is about $77,083. The good news is that HIV, hepatitis C and many other infectious diseases, and their associated treatment costs, are preventable.
States have taken a variety of legislative approaches to mitigate the spread of infectious diseases. NCSL is tracking these actions in the new State Public Health Legislation Database, which includes five categories related to infectious diseases: HIV and STD Criminalization Reform; School-Based Prevention; Screening; Syringe Service Programs; and Prevention and Treatment. In 2021, at least 32 states considered 105 such bills, with 15 states eventually enacting 22 of them.
Screening for Disease
Improving screening for infectious diseases, including those spread through sex, is one approach state legislatures are taking. Chlamydia and gonorrhea are among the most common STDs in the U.S., and new cases of syphilis increased by 261% from 2013 to 2018. Congenital syphilis, passed from mother to fetus, can cause miscarriage, stillbirth or early infant death, and infected infants can experience lifelong physical and neurologic problems.
Recent infectious disease screening legislation includes an enrolled Florida bill that creates a targeted outreach and STD screening program for high-risk pregnant women. California enacted legislation this year that requires hepatitis B and C screening to be offered to adults receiving primary care. Kentucky is considering legislation that would require health plan coverage of hepatitis C testing and treatment.
Lawmakers are also considering ways to prevent the spread of infectious diseases. Harm reduction strategies, for example, allow people who use drugs to reduce the associated negative consequences, such as overdose deaths and transmission of infectious diseases. Many new HCV and HIV infections are due to injection drug use. One harm reduction strategy provides sterile injection equipment to reduce the transmission of these infections. Locally led harm reduction efforts such as syringe programs offer a range of services, including linkages to care and treatment. People who use syringe programs are five times more likely to enter drug treatment and three times more likely to stop using drugs.
Eighteen states introduced legislation regarding syringe services programs in 2021 and 2022. New Jersey enacted a bill permitting the establishment of harm reduction services to reduce disease transmission related to personal drug use. Arizona enacted a measure allowing local governments or nongovernmental organizations to provide and dispose of supplies such as needles and syringes. New Mexico enacted legislation that expands supplies available at harm reduction centers. And North Dakota exempted syringes and other sterile equipment provided by syringe service programs from their drug paraphernalia laws.
Rethinking HIV Laws
Regarding HIV, 11 states have introduced legislation to change laws that criminalize HIV. These HIV-specific laws criminalize or control behaviors that can potentially expose another person to HIV and may increase stigma, exacerbate disparities and discourage HIV testing. In 2021, Illinois passed legislation that ended criminal penalties for those living with HIV. This year, New Jersey repealed statutes criminalizing sexual activities by people with certain infections under certain circumstances. Georgia is considering a bill that clarifies the role of intentionally versus unintentionally exposing a partner to HIV.
At least five states are considering legislation that improves access to HIV prevention drugs. PrEP (pre-exposure prophylaxis) can reduce the risk of HIV infection by about 99%, and PEP (post-exposure prophylaxis), if taken within 72 hours of exposure, can reduce the risk of acquiring HIV by 80% or more. Utah enacted legislation in 2021 allowing pharmacists to prescribe these medications. Maine recently enacted a measure authorizing pharmacists to prescribe and dispense HIV prevention drugs, requiring health plans to cover at least one prevention drug and preventing pre-authorization for these drugs.
To learn more about infectious disease legislation or other public health topics, check out the NCSL State Public Health Legislation Database. In addition to infectious disease bills, the database includes legislation on a dozen public health topics such as reporting, workforce and vaccine registries and requirements.
Shannon Kolman is a policy specialist in NCSL’s Health Program.
This project is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services as part of a financial assistance award totaling $100,000, with 100% funded by the CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, the CDC/HHS or the U.S. government.