Prenatal Syphilis Screening

Policymakers in Louisiana are considering legislation that reinforces testing requirements during pregnancy for HIV and syphilis. Current state law mandates both syphilis and HIV screenings during pregnancy, but only after the first prenatal visit for individuals who are deemed “higher risk” per CDC recommendations. SB174 would shift to an “opt-out” model, notifying patients during the third trimester and again at delivery that they will be tested, with consent presumed unless the patient declines. Louisiana had the seventh-highest congenital syphilis rate in the nation in 2023 with 193 cases per 100,000 live births, according to the CDC.

In Nebraska, Governor Jim Pillen (R) signed LB41 into law on April 10. The bill, which passed unanimously in the state’s unicameral chamber, will now expand testing for syphilis during pregnancy to include the third trimester and at delivery. Similar to SB174 in Louisiana mentioned above, the bill clarified that the pregnant patient would have the right to opt out of testing.

Meanwhile, Rhode Island lawmakers considered legislation (SB796) that would have expanded requirements to include syphilis screening in the third trimester. The Senate Committee for Health and Human Services recommended holding the measure for further study.

Syphilis Testing in Emergency Rooms

Oregon may become one of the first states to pilot a program that requires syphilis testing in emergency room (ER) departments. HB2943 was introduced by state representative and former ER nurse Travis Nelson (D – Portland) and directs the Oregon Health Authority to pilot a program for conducting syphilis, HIV, and hepatitis C testing at the ER when a person visits and has blood collected for other purposes. Any hospital that voluntarily participates within the program would screen patients for syphilis, HIV, and hepatitis C unless the individual refuses. Furthermore, the bill would require health insurance coverage of all STI tests conducted within the pilot program.

While many ER personnel navigate high patient volume and face challenges with implementing new testing protocols, research from the National Institutes of Health demonstrates that STI testing in ERs more than doubles the detection of syphilis.

Last year, California lawmakers failed to pass AB2960, which would have required ERs to perform syphilis testing on anyone over the age of 15 who is sexually active; the bill faced opposition from multiple organizations, including the California Emergency Nurses Association, California Medical Association, and America’s Physician Groups.

HIV Prevention

Representative Tarik Khan (D – Philadelphia) introduced legislation in the Pennsylvania General Assembly along with 21 co-sponsors that would ban health insurance companies from implementing discriminatory practices against enrollees or applicants who have used pre-exposure prophylaxis (PrEP) medications to prevent HIV transmission. The Prohibiting Insurance Discrimination for Persons on PrEP and PEP Act would specifically prohibit insurance carriers from using claims data to take any “adverse action” on an individual solely because they were prescribed PrEP or post-exposure prophylaxis, also known as PEP. Adverse actions include limiting or denying coverage and charging the applicant a rate that is different for non-PrEP/PEP users on the same insurance policy.

In New York, Senator Brad Hoylman-Sigal (D –Manhattan westside) introduced legislation that would authorize pharmacists to dispense either PrEP or PEP through a standing order with a physician or nurse practitioner. SB7435 would further allow pharmacists to independently execute a standing order to dispense PrEP within specific parameters. The pharmacist must meet a variety of requirements and would be limited to furnishing one 60-day supply every two years to the same patient.

HIV Criminalization

North Dakota policymakers repealed section 12.1-20-17 of the North Dakota Century Code, which categorized “willfully transferring body fluid containing HIV” as a felony. HB1217 passed 34-13 in the Senate and 50-43 in the House; it became law when it was signed by Governor Kelly Armstrong (R) on March 21. Lindsey VanderBusch, Director of the Division of Sexually Transmitted and Bloodborne Disease at North Dakota Health and Human Services, was quoted by KFYRTV on the drawbacks of criminalized STI transmission, stating, “if we’re punishing people when they know their status, that discourages testing and treatment, and that doesn’t necessarily make us safer. It actually does the opposite.”