by Camalot Todd, Nevada Current
A task force designed to modernize Nevada’s HIV laws has dissolved after three years.
The Advisory Task Force on HIV Exposure Modernization was formed by the Nevada Legislature in 2019, during the Sisolak administration, and renewed during the 2021 session. Stephan Page, co-chair of the task force, said members decided not to ask the 2023 Legislature to renew it “for a few different reasons.”
“Everyone was really busy and the task force was just one extra thing on everyone’s plate,” Page said. “Especially since we accomplished so much already, we felt it was best to continue addressing these needs through the other groups that are already established.”
When asked about whether there was an opportunity to reform the HIV modernization task force, member Rob Phoenix, a family nurse practitioner who owns and operates the Huntridge Family Clinic, said, “We’re still figuring out things about the governor, I’m not sure where he is on the HIV front.”
Gov. Joe Lombardo, who took office this year, pledged his administration would streamline the state government. During the regular session, he vetoed a bill that would have created a statewide children’s mental health consortium, saying it was redundant.
Page and Phoenix agreed their HIV task force saw major legislative accomplishments over the past two sessions.
Decriminalization efforts
Over the last three years, the task force heard stories of people whose lives were impacted by archaic and discriminatory laws passed at the height of the HIV/AIDs epidemic. They included someone being denied a firefighter job earlier this year, inmates being denied consistent medication at Washoe County Detention Center in 2021, or inmates segregated from other people when incarcerated in 2021.
While the HIV/AIDS laws may date to the 1980s and 1990s, only 3% of all charges fell between 1987, when Nevada’s first law was enacted and 2000, according to a UCLA report on Nevada’s HIV criminalization policies. The remaining 97% of charges happened between 2001-2020, with 64% of all charges occurring after 2011.
Almost all of the HIV convictions in Nevada did not involve any conduct that could transmit HIV, according to the UCLA report. Black people account for 10% of the population and 28% of people living with HIV in the state, but they represent 40% of people arrested for HIV crimes. Just under half (45%) of all charges for HIV crimes that resulted in a conviction were against Black people, according to the report.
The bulk of the HIV charges (61%) were related to sex work, including prostitution and solicitation, with Black people accounting for the bulk of charges at 66% with 67% of those charges resulting in convictions, according to the report. Women are also disproportionately impacted over men, according to the report.In 2021, Nevada joined at least 14 states in modernizing its HIV laws. The legislature repealed laws making it a felony to engage in illegal sex work after a positive HIV test, confinement of people living with AIDs, allowing Nevada inmates to be segregated based on HIV status, and more. State Sen. Dallas Harris, who sat on the task force, sponsored the legislation.
“We’ve modernized these laws, but as you saw in the report there’s still a lot of issues happening everywhere in the state but also in the prison system. We don’t exactly know the reason why this is happening, but I want to say stigma. The stigma against people living with HIV has been a huge issue all across the country ever since the HIV epidemic originally started, but even with modern medical advances and knowing more about HIV, that stigma still exists,” Page said.
2023 session saw mixed results
In this year’s legislative session, the task force accomplished some of its goals like giving minors the right to get tested, treated, and preventive care for STIs without parental consent. Previously, minors could not consent to receive preventive HIV medication without their parents’ consent.
Other efforts supported by the task force failed to make it out of the legislature. This included a bill introduced by Clark County School District to change Nevada’s sex education to where parents must explicitly opt their child out, a switch from the current process wherein parents must explicitly opt their child into health education.
Nevada is one of five states where parents or guardians must give permission before students can enroll in sex ed.
The task force saw this as vital because of Nevada’s high ranking in new HIV cases and the state policies that allow its spread to go undetected.
The Nevada Department of Health and Human Services Division of Public Health does not report the rate of youth between the ages 13-17 who are newly diagnosed or living with HIV, according to the report.
Despite people between 13-24 accounting for 20% of new HIV diagnoses, only 6% percent of high school students were tested for HIV, with many young people unaware that they have HIV, according to the Centers for Disease Control and Prevention (CDC).
“If you don’t test you don’t know, right?” Phoenix said. “If you don’t know your status, and you’re not on medication and you’re having sex with other people and you’re not using condoms or other strategies to prevent transmission. That’s how we continue to have new infections with HIV, hepatitis, more congenital syphilis.”
Nevada struggles with its high prevalence of STIs.
In 2019, the most recent year for reliable data, Nevada ranked 5th in the U.S. for new HIV diagnoses. Clark County was identified as one of the 48 priority jurisdictions in the U.S. targeted for the U.S. Department of Health and Human Services America’s Ending the HIV Epidemic (EHE) initiative. Since 2012, the county has continuously seen an increase in new HIV diagnoses and the number of people currently living with HIV, according to the 2021-2026 Clark County Ending the HIV Epidemic Plan.
“There’s still a tremendous amount of ignorance around how HIV is transmitted, how you get it. I had a patient whose family asked if they had to have separate forks and spoons and knives and can they [the patient] go camping with us. Can he go with us and I said yes, all of these things are fine. There’s no risk of transmission with these things,” Phoenix said. “People are still constantly discriminated against because of their positive status.”
This stigma around HIV prevents people from testing and getting care, he said.
More ambitious efforts to create health equity for people living with HIV – like banning certain insurance policies that keep patients’ out-of-pocket costs higher– received pushback, said Phoenix.
These pharmaceutical coupons and copay assistance help cover the out-of-pocket costs for HIV prevention and treatment medication which cost thousands of dollars without them. Currently, 19 states have laws regulating this practice.
But some insurance companies have “copay accumulator” policies that prevent these coupons from being applied to a person’s out-of-pocket expenses – essentially undoing the original intent of the coupons. Such policies “remove an important safety net feature in our medical system,” according to the report.
Nearly 14% of people with an HIV infection used a prescription drug cost-saving strategy like skipping doses, taking less medication, and delaying filling the prescription. People who don’t take the medication to save on costs are more likely to be hospitalized and less likely to be virally suppressed, according to a 2019 report by the CDC.
Removing barriers to care like cost and updating HIV laws to ensure people were not discriminated against in Nevada was the ethos of the now defunct task force, but Page and Phoenix both noted that the movement to progress treatment of those living with HIV will continue.
“The task force was good because it was a vehicle that we could use to get stuff in the legislature,” Phoenix said, “Now, we will have to go back to what we did in the past with that grassroots advocacy.”
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