States Act to Save Lives and Money Lost to Infectious Disease

States Act to Save Lives and Money Lost to Infectious Disease

A new NCSL database tracks bills addressing disease screening, prevention and more.

State Legislatures NewsPolicyHealthHuman Services

The preventive medication PrEP, or pre-exposure prophylaxis, can reduce the risk of acquiring HIV by about 99%.

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 infections each year. The lifetime cost to treat just one person with HIV infection is $501,000. Moreover, about 2.4 million people in the U.S. live with the hepatitis C virus, or HCV, with the cost of a 12-week course of treatment averaging more than $77,000.

The good news is that HIV, hepatitis C and many other infectious diseases, and their associated treatment costs, are preventable.

Legislative approaches to mitigating the spread of infectious diseases vary by state, and NCSL is tracking them in the new State Public Health Legislation Database. The database sorts bills into five categories: 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.

Better Screening

Improving screening for infectious diseases, including sexually transmitted diseases, 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 a mother to her fetus, can cause miscarriage, stillbirth or early infant death, and infected infants can experience lifelong physical and neurologic problems.

Recent 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.

Stronger Prevention

Lawmakers are also considering ways to strengthen infectious disease prevention. Harm reduction strategies, for example, allow drug users to reduce 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 programs such as syringe services programs also connect people to care and treatment. People who use syringe services programs are five times more likely to enter drug treatment and three times more likely to stop using drugs.

Eighteen states introduced bills on syringe services programs in 2021 and '22. New Jersey permitted the use of harm reduction services to reduce disease transmission related to personal drug use. Arizona allowed local governments or nongovernmental organizations to provide and dispose of supplies such as needles and syringes. New Mexico also expanded supplies available at harm reduction centers. North Dakota exempted syringes and other sterile equipment provided by syringe services programs from the state's drug paraphernalia laws.

Reducing Criminalization

Eleven states have introduced bills to change HIV-specific laws that criminalize or control behaviors that could expose another person to HIV. The laws may increase stigma, exacerbate disparities and discourage HIV testing. In 2021, Illinois 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 would clarify the role of intentionally versus unintentionally exposing a partner to HIV.

At least five states are considering legislation that would improve access to HIV prevention drugs. PrEP (pre-exposure prophylaxis) can reduce the risk of acquiring HIV 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 allowed pharmacists to prescribe these medications in 2021. Maine recently authorized pharmacists to prescribe and dispense HIV prevention drugs, requiring health plans to cover at least one prevention drug and preventing preauthorization for the drugs.

In addition to infectious disease bills, the State Public Health Legislation 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.