Nevada HIV Modernization Laws

SB211 and LCB file R002-22

11/3/2022 UPDATE: This NAC update in LCB #R002-22 has gone back and forth several times this year for changes presumably due to error(s) in either content or in process. It has been amended a 2nd time and is now awaiting the Public Workshop, which the health department not yet been scheduled but which they show as probable on 12/16/22.

The Nevada Legislature passed SB211 which “establishes requirements relating to testing for sexually transmitted diseases” on May 30, 2021. It was signed by Governor Sisolak on June 4, 2021 and went into effect on July 1, 2021. The changes were made to the existing NRS 441A:240-336 INFECTIOUS DISEASES; TOXIC AGENTS. Main points:

• Requires all providers of emergency and primary medical care to offer HIV and Sexually Transmitted Infection (STI) testing to every patient age 15 and over, at every encounter (with very few exceptions). Medical providers must also facilitate or assist with the test if the patient wishes to be tested.

• Defines sanctions against medical providers who fail to offer HIV & STI testing to every patient. Providers “may” be subject to “disciplinary action” from their licensing boards.

• Makes fiscal appropriation to the Division of Health Care Financing and
  Policy of the Department of Health and Human Services from the state’s general fund for the cost of providing tests for persons who are covered by Medicaid, for whom the state must pay for the tests.

That’s it. That is what the new Nevada law says about HIV. But now the Nevada Division of Public & Behavioral Health (DPBH) has put forth their recommendations for changes to the Nevada Administrative Code (NAC) prompted by this new law with LCB-R002-22 . And it takes things a whole lot further. These un-elected bureaucrats are trying to hijack what was actually passed by our elected lawmakers. And what they are proposing here is not good for Nevadans. The main points:

• Adds HIV to the existing list of specific infections (chancroid, Chlamydia trachomatis, gonococcal infection, granuloma inguinale, lymphogranuloma venereum, [and] infectious syphilis) defined as STIs.

• Requires all Nevada medical providers to follow the United States Centers for Disease Control (CDC) testing and treatment guidelines.

• Requires medical providers to document in patient files if testing was offered and whether or not the patient accepted the offer of an HIV and/or STI test.

• Requires medical providers to follow federal cultural and linguistic standards as set forth in the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care

Here are the CDC Sexually Transmitted Infections Treatment Guidelines, 2021 which the proposed NAC code specifically references in the updated code as the authority to which Nevada will refer to and defer to as the official testing and treatment guidelines for HIV and STIs. The “bible” that Nevada will have to follow if these proposed changes to code are adopted. Incidentally this document was quietly published by the CDC on July 23, 2021. While everybody was watching Covid. Here are just some of the concerning items detailed in these updated guidelines.

Informed Consent:

• HIV screening should be voluntary and free from coercion. Patients should not be tested without their knowledge.

• Opt-out HIV screening (notifying the patient that an HIV test will be performed, unless the patient declines) is recommended in all health care settings. CDC also recommends that consent for HIV screening be incorporated into the general informed consent for medical care in the same manner as other screening or diagnostic tests.

• Requirement of specific signed consent for HIV testing is not recommended. General informed consent for medical care is considered sufficient to encompass informed consent for HIV testing.

The first bullet point is directly contradicted by the 2nd and the 3rd. The first bullet point uses the word “should”. Should is not must. Points two and three literally provide a guide to getting right around the first point. Rendering the first point moot.

Minor children and adolescents:

“CDC assessed the statutes and regulations (laws) addressing a minor’s legal right to provide informed consent to receive STD and/or HIV services without the consent, knowledge, or involvement of a parent  or guardian, in each of the 50 states and the District of Columbia (jurisdictions). Jurisdictions have different types of laws, and the age at which the minor has the legal right to provide informed consent to receive STD or HIV services varies by jurisdiction”

In this section, the document links to another, titled CDC Minors’ Consent to Treatment Law Summary By State . Which sure looks reads like a guide to help circumvent parents and guardians.

Pregnant Women:

• All pregnant women in the United States should be tested for HIV at the first prenatal visit.

• Retesting in the third trimester (preferably before 36 weeks’ gestation) is recommended for women at high risk for acquiring HIV infection.

• Rapid HIV testing should be performed for any woman in labor who has not been tested for HIV during pregnancy or whose HIV status is unknown.

Who is considered “high risk” according to the CDC? IV drug uses and anyone who has sex. And infants born to mothers who had sex. Mark my words, the CDC and pharma will have every single person classified as “high risk”.

Treatment:

We are told in the original CDC document that providers should assess eligibility of all persons seeking STI services for HIV PrEP (Pre-Exposure Prophylaxis) and PEP (Post Exposure Prophylaxis).

AKA Expensive Pharmaceutical Drugs.

In the cases of positive tests, the Guideline 2021 document links to CDC Updated Guidelines for Antiretroviral Postexposure Prophylaxis After Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV-United States, 2016 . If these proposed NAC regulations are approved, the Nevada DPBH will have our state adopting and thereby requiring adherance to CDC pharmaceutical treatments. Expensive anti-retroviral drugs. Which lack long term safety and efficacy data. (Sound familiar?)

• Pages 33-37 highlight the pharmaceutical treatments. **Spoiler alert Zidovudine (ZDV) is the rebranded name for 1980s AIDS drug Azidothymidine (AZT) that may or may not have been responsible for millions of “AIDS” deaths. Same exact drug. New name and here they talk about giving it to infants and pregnant women.

As of this writing the required Public Workshop has already taken place. Next, DPBH must hold a public hearing on the proposed changes. This has not yet been scheduled. Any movement on the proposed NAC updates will be publicly posted HERE.

Please share this information with your fellow Nevadans and ask them to keep an eye on this. This has the potential to create a whole new level of medical tyranny and I’m guessing that this entire HIV update was brought to our state compliments of the CDC and their pharmaceutical sponsors. And for readers outside of Nevada, please search your state’s laws to see if similar legislation and administrative code has been ushered in already or if it’s in process where you are. And please comment n this article with any information you have about similar legislation in other states. I strongly suspect that they are attempting to pass HIV testing and treatment laws like this in all 50 states.

We need to stop Nevada from signing our citizens up for federal CDC protocol medicine and we have to fight to keep our healthcare responses local and our personal medical choices between us and our own doctors. Not federal “one size fits all” protocol pharmaceutical medicine that is forced on us.

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