Much has changed regarding HIV screening, testing, prevention and prognosis since the epidemic was identified in the 1980’s. People living with HIV (PLWH) now can expect normal life-spans due to the advancements in anti-retroviral therapy over the last decade. Pre- and post-exposure prevention regimens are limiting transmission, and the recent understanding of “Undetectable = Untransmissible” (U=U) has greatly enhanced the quality of life for partners. HIV disease, once an acute, terminal illness, has been transformed to a manageable chronic disease.
In late 2018, in order to update laws originally enacted in the 1980’s at the beginning of the HIV epidemic, the HIV/STD program at the Michigan Department of Health and Human Services (MDHHS) worked with many community and clinical partners. This update was made to six laws that have become outdated due to changes in clinical practice, enhanced scientific knowledge, improved diagnostics and the implications of U=U.
A recent article in this publication (February 13, 2020) noted the new laws for third trimester testing for congenital syphilis and HIV; however, five other law changes in December 2018 are worth noting as they have implications for clinical practice. You can read about all five laws here but two are of special interest to clinical practice.
HB 6018/ PA 535 2018 reduces pre- and post-HIV testing counseling requirements; now the law is consistent with CDC’s recommended “opt-out” testing. Providers must inform the patient (verbally or in writing) that an HIV test will be performed; provide an opportunity for questions; provide an opportunity to decline; the provider must document any refusal in the medical record. Consent is inferred from the general consent to medical care, and no separate consent form required; of note, pre- test counseling not required.
HB 6020/ PA 537 makes a significant change to previous HIV disclosure laws which made it a felony to not disclose a positive HIV status to a partner, even if HIV was not transmitted. This current law separates non-disclosure of a positive HIV status into the following: If a person is not medically suppressed, does not disclose their status but does not transmit HIV to their partner (and did not intend to), a misdemeanor is possible. If a person is not medically suppressed, does not disclose and transmits HIV (intentionally or unintentionally), this could be a potential 4-year felony. However, if a person is medically suppressed (has an undetectable HIV viral load) and does not transmit HIV to their partner, and did not intend to, this is not prosecutable. The updates to the former law are important in light of the knowledge that U=U: Undetectable = Untransmissible.
These laws have been in place since December 2018 but are just now being absorbed into the day-to-day clinical practices across Michigan. The Division of HIV and STD Programs at MDHHS is happy to provide you more information. You can find their contact information and various resources at www.michigan.gov/hivstd or via email at MDHHS-HIVtraining@michigan.gov
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