At the start of 2018, something really exciting happened in the world of HIV treatment and prevention: After more than 20 years without any substantive changes, North Carolina amended our HIV control measures to reflect modern science and the world we currently live in. These changes place North Carolina in the position of being a true public health leader in the South and could not have come at a better time. Although it has been widely reported, some people are often surprised to discover that there is a real HIV crisis in the South that urgently needs to be addressed. The South has the highest HIV diagnosis rate of any U.S. region, with almost half (49 percent) of all new HIV diagnoses occurring in the region. In addition to the prevailing stigma that people living with HIV regularly face, it became apparent that the public health community needed to do more in order to engage and incentivize people living with HIV to get into care and on HIV medication.
You are certainly excused if this is the first time you have heard about HIV control measures. These policies are often not known to the general public. In the early years of the HIV and AIDS epidemic, HIV was a deadly disease that was quickly spreading without any available treatment. There was limited science and facts surrounding HIV and that lack of knowledge was accompanied by widespread fear surrounding HIV transmission. In an attempt to curb the startling spike in HIV transmission, states across the country enacted HIV control measures and criminal laws that prohibited various behaviors by people living with HIV. The laws varied from state to state, but included restrictions on spitting and biting along with mandating certain behavior for those engaging in sexual activity.
At the time, we did not know that spitting or biting does not transmit HIV, nor did we have the scientific breakthroughs at our disposal that we do today. Fortunately, we have come leaps and bounds from the early years of the HIV epidemic and HIV is no longer a death sentence. With advancements in HIV science and treatment, it has now been established that if a person is virally suppressed and in HIV care and treatment, that person has virtually no chance of transmitting HIV to another person. Given the changing landscape, it was long past time to adjust our HIV control measures.
Last November, after significant advocacy by people living with HIV and their allies, the North Carolina Commission for Public Health voted in support of modernizing the state’s HIV control measures, and the new law went into effect early this year. Prior to the recent changes, North Carolina’s HIV control measures imposed the threat of criminal charges for behaviors and actions that posed little to no risk of HIV transmission, while also failing to consider the use of preventative measures that substantially reduce the risk of HIV transmission, such as antiretroviral therapy or PrEP. The new updates now reflect the advancements made in the current medical science related to HIV transmissions and treatment and is exciting news for our state.
North Carolina’s new control measures made three significant changes:
1. If a person living with HIV is in medical care, adherent to their clinician’s HIV treatment plan and has been virally suppressed for at least six months, they are no longer legally required to disclose their status to sexual partners. Their medical provider is required to counsel them that they should notify partners about their HIV positive status. Of course, as public health advocates, we should encourage all individuals to have open and honest conversations about sexual history and risk. We should also be able to agree that the consequence of engaging in activity that bears no risk of transmitting HIV should not be jail time. It is important to note that people who do not follow their clinical treatment plan must still disclose their HIV status to their partners.
2. Condom usage is not legally required if the person living with HIV has been virally suppressed for at least six months, if their partner is also HIV positive or if the negative partner is on PrEP. Of course, condom use is still strongly encouraged in order to provide protection from other STIs.
3. North Carolina law has been brought into compliance with the federal HOPE Act, which allows organ donation for research purposes and organ transplantation between HIV-positive individuals.
The state of North Carolina has a vested interest in ensuring that the state’s control measures are conducive to achieving the state’s public health goal of addressing the HIV and AIDS epidemic by encouraging individuals to get tested, know their status and adhere to HIV treatment. By updating the state’s control measures to reflect current science, we have rejected stigma and the misconceptions about HIV transmission. The recent updates made to North Carolina’s HIV control measures will significantly improve the overall public health in our state and will play a major role in positioning our state as a national leader in the fight against HIV and AIDS, and will push us one step closer to eradicating the HIV epidemic in North Carolina.
info: Christina Adeleke is the communications and development coordinator at the NC AIDS Action Network.