POSITIONS ON CALIFORNIA AND NEW YORK STATE HIV-RELATED LEGISLATION, 2017-2026

As a 501(c)3 charitable organization, the Beyond AIDS Foundation (BAF) is not primarily political, and an insignificant proportion of our income is devoted to activities that could be considered lobbying. Nevertheless, from time to time, we discover legislation that impacts the public health approach to HIV/AIDS and related diseases, and decide that an educational approach to legislators and their staff, from a perspective based on our expertise, could have a beneficial effect. Over the past decade, we have predominantly paid attention to state legislation in California, and to a lesser extent, New York State. Here are bills on which that our Board has expressed recommendations: 2017: BAF opposed California SB 239 (Wiener), which removed some criminal penalties for exposing others to HIV or other communicable diseases. When the bill passed the legislature, we asked for a veto, but it was signed. 2017/2019: BAF suppported California AB 1534 (Nazarian). This was to permit an HIV specialist to also be the patient's primary care provider. It passed but was vetoed in 2017. It was reintroduced in a different version in 2019 as AB 993, and again passed but was vetoed, apparently to prevent separate billing for the same day of service. 2019: BAF asked unsuccessfully for amendments to California SB 159 (Wiener), which permitted temporary dispensing of pre-exposure prophylaxis (PrEP) by pharmacist. This bill passed and was signed into law. We supported a proposed New York bill to make HIV testing more routine. This was part of a preliminary initiative, which did not become serious legislation that year. 2024: BAF initially opposed unless amended California AB 2960 (Lee), which would have called for syphilis screening of all women (but not men) of childbearing age to help prevent neonatal syphilis. We pointed out that prenatal screening was more cost-effective for that. We changed to a support position after the bill was amended. The bill did not pass. BAF supported SB 1333 (Eggman), which permitted public health staff to disclose HIV information to providers for purposes of linkage to or coordination of care, but did not permit disclosures in the reverse direction from providers to public health. We requested an amendment to that effect, but instead were promised collaboration the following year on a new bill (see SB 504 below). The bill passed and was signed into law. BAF was supportive of New York S7809 (Hoylman-Sigal) to simplify patient informing requirements for opt-out HIV testing. 2025: This was an active year for involvement in California legislation. BAF initiated the concept that became California bill SB 504 (Laird), to permit disclosures of HIV case information without liability among public health workers. We were successful in obtaining inclusion of wording to permit providers to disclose HIV information to public health staff for purposes of reducing transmission. Prior to this bill, providers could only disclose HIV information at the time of case reporting. This bill passed and was signed into law. BAF also supported California SB 278 (Cabaldon), which allowed disclosure of HIV information from public health to providers and to Medicaid Managed Care and quality improvment staff for improvement of care (we unsuccessfully requested an amendment to allow communications from a provider to public health staff). This bill also passed and was signed into law. BAF supported California AB 309 (Zbur), which permitted indefinite continuation of authorization for pharmacists to dispense syringes and needles without prescription. This bill also passed and was signed into law. BAF supported California AB 554 (M. Gonzalez), which would have prohibited prior authorization or cost-sharing for HIV medications. This passed but was vetoed. Two additional California bills were supported by BAF but did not pass the Legislature: AB 551 (Krell) would have provided grants to emergency departments for reproductive health. SB 608 (Menjivar) would have prohibited age restrictions for purchase of OTC contraceptives, and would also have permitted condom distributions in schools for grades 7-12. 2026: At this writing, the BAF Board is following, and tentatively supporting, Califonia AB 1843 (Elhawary) to eliminate prior authorization for hepatitis C medications. This represents an expansion of our interest beyond HIV to another disease that can be transmitted by injections or blood.

BEYOND AIDS FOUNDATION PUBLISHES LETTER SUPPORTING PARTNER SERVICES FOR HIV

 

. Author manuscript; available in PMC: 2024 Aug 1.

Published in final edited form as: Sex Transm Dis. 2023 May 2;50(8):553–554. doi: 10.1097/OLQ.0000000000001824

Additional Public Health Benefits of HIV Partner Services and More Opportunities for Improvement

Ronald P Hattis ¹, Gary A Richwald ², Jeffrey D Klausner ³, Deanna Stover ⁴

 

PMCID: PMC10524523  NIHMSID: NIHMS1896091  PMID: 37155624

The publisher's version of this article is available at Sex Transm Dis

See the article "HIV Diagnoses through Partner Services in the United States in 2019 and opportunities for improvement" on page 74.

To the Editor:

As leaders of the Beyond AIDS Foundation,¹ a strong supporter of HIV partner services (including contact tracing, partner notification and testing, result-specific follow-up, and other appropriate services), we applaud the article by Williams et al.²

The article highlighted partner services as a means of detecting undiagnosed HIV infections. We would like to point out four additional public health benefits of HIV partner services, not mentioned in that article:

1. Most identified partners of a newly diagnosed person with HIV infection are likely not only to be undiagnosed but also to be recently infected. Initiating treatment for such individuals can both provide the earliest opportunity to prevent additional infections, and achieve the best clinical outcomes.³

2. One of the contacts may be the source of infection, likely an undiagnosed and untreated person with a high viral load, and capable of causing further infections. Testing and treating such an individual is a high priority for prevention.

3. Contacts who test negative for HIV infection have been exposed and may continue to be, without intervention. They, too, are a high priority for prevention. Increased attention to at-risk HIV-uninfected individuals, including safer sex counseling and referrals for PrEP, is consistent with CDC’s new “status neutral” initiative.⁴

4. Partner services can also be expanded or linked with other services for newly-diagnosed persons with HIV infection. Those individuals can be guided through the HIV Care Continuum aimed at viral suppression,⁵ and assisted to achieve other beneficial outcomes. An example is a pilot project in four counties of North Carolina. “Disease intervention specialists” went beyond usual partner services and linkage to care for persons testing positive for HIV or syphilis, by assisting access to primary care, housing assistance, Medicaid navigation, food insecurity, and other needs.⁶ Such expanded services could be implemented nationwide.

The Beyond AIDS Foundation conducted a survey of U.S. state and territorial HIV/AIDS directors or their designees found substantial discrepancies among jurisdictions in methods, content, and consistency of outreach for partner services and linkage to care. ⁵ As the Williams article noted,² partner services activities are currently required for all CDC-funded health departments, applying the shared guidelines for HIV, syphilis, gonorrhea, and chlamydia.⁷ However, our survey suggests that CDC does not monitor jurisdictions for details on whether and how this is done. We have recommended that uniform standards for public health outreach after newly reported diagnoses be established and written into CDC grant requirements, with appropriate compliance monitoring.⁵ CDC could require that a portion of grant funds be specifically designated for partner services.

State requirements can supplement federal grant stipulations. In New York State, for example, a law authored by one of our founding officers, the late Nettie Mayersohn, has required since 1998 that the names of any known sexual or needle-sharing partners be included as a part of reporting of new HIV diagnoses, and that local health departments perform contact tracing and partner notification along with HIV education, which may also be done by physicians.^8,9 Other states could consider similar legislation.

California, the state with the highest number of new HIV diagnoses in 2020,¹⁰ is missing from the Williams article because of incomplete data. That state delegates most public health functions to 58 counties and to 3 cities with public health departments. Some of the counties are rural with small populations and limited resources for partner services. Our unpublished 2013 survey, representing 95% of California’s public health jurisdictions, found that 5% were not performing any partner services for HIV or other STIs, and 66% were performing them but not for all four designated diseases.⁷ Then-current CDC guidelines were not being followed by 39%, and 27% were receiving no specific funding for the performance of partner services.

State public health departments have a responsibility to assure that essential public health programs, including partner services, are available and adequately maintained in all cities and counties. Partner services are valuable components of HIV prevention with multiple benefits, and policy changes could improve their uniformity, quality, and impact.

Footnotes

Conflict of Interest and Sources of Funding: None declared.

Contributor Information

Ronald P. Hattis, Loma Linda University School of Medicine, Loma Linda, CA; California University of Science and Medicine Colton, CA; Beyond AIDS Foundation, Redlands, CA.

Gary A. Richwald, Beyond AIDS Foundation, Redlands, CA; University of Southern California, Los Angeles, CA.

Jeffrey D. Klausner, Beyond AIDS Foundation, Redlands, CA; University of Southern California, Los Angeles, CA.

Deanna Stover, University of Southern California, Los Angeles, CA.

REFERENCES

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