BOSTON — Lawmakers want to mandate HIV tests in cases where first responders might have been infected, but the effort faces pushback from those who say the changes are based on fear and misinformation about how the disease is spread.
Several proposals scheduled to be heard by the Legislature's Joint Committee on Public Health on Tuesday would require HIV antibody or antigen tests for anyone — even against their will — suspected of infecting someone else by exposing them to blood, semen or other bodily fluids.
Rep. Tram Nguyen, D-Andover, the bill's primary sponsor, said the legislation is intended to help protect firefighters, police and other first responders who come into contact with HIV, hepatitis C and other infectious diseases.
"When a firefighter, EMT or police officer is trying to save someone's life, the last thing they're worried about is exposure to bodily fluids, but the nature of their work puts them at risk every day," she said. "And often they aren't able to find out if they've been infected."
That's because the state's informed consent law requires first responders to get the written permission of the person who is potentially infected in order to test for HIV, she said.
First responders take precautions such as wearing gloves and protective gear, and if exposed they take antiretroviral medicines to block the virus. But the precautions aren't enough, said Nguyen, and the post-exposure drugs can cause liver and kidney problems.
In cases where they do get permission, it could be weeks until the person is well enough to sign the consent forms.
"If they are responding to someone who is a know drug user, the chance of them being infected is even higher," Nguyen said. "I've spoken to firefighters who've had to take administrative leave while they're waiting for the consent to go through to find out if they're infected."
Another proposal that will be heard by the public health panel would allow first responders to get a court order requiring testing of an individual suspected of infecting them if consent isn't granted. Both proposals would restrict the testing information to the affected individuals.
The proposals face resistance from LGBT actvists, civil liberties groups and others who say HIV-exposure laws are ineffective in preventing the disease from spreading.
"These kinds of proposals are based in ignorance, fear and really outdated assumptions about how the disease is spread, not current science," said Carl Sciortino, a former state representative and executive director of the AIDS Action Committee of Massachusetts. "The fact is that nobody is getting HIV in occupational settings."
Besides fire and police organizations, the HIV testing mandate has bipartisan support, with Reps. Christina Minicucci, D-North Andover, and Brad Hill, R-Ipswich, and Sen. Diana DiZoglio, D-Methuen, among the dozen lawmakers backing it.
To be sure, a 2015 White House report concluded that HIV exposure laws do little to influence behavior or prevent infection. It cited studies showing said that many of those policies "run counter to scientific evidence about routes of HIV transmission and effective measures of HIV prevention."
Overall, Massachusetts has seen declining HIV infections in recent years, a shift largely attributed to the success of public health campaigns and needle exchange programs. From 2000 to 2016, new HIV diagnoses in the state declined 46 percent, from 1,196 to 641, according to the state Department of Public Health.
Many new cases are among men who have sex with men, the population still most impacted by the HIV epidemic.
Health officials say they've seen an increase in the virus among intravenous drug users that threatens to undo years of hard-fought gains in reducing the number of infections.
At least 29 states have HIV-specific exposure laws where a variety of acts — ranging from having sex or sharing needles without disclosing one's status to intentionally exposing others to bodily fluids — are illegal if a person has been diagnosed with HIV, according to the New York-based Center for HIV Law & Policy.
Massachusetts doesn't have such laws but judges can impose stiffer sentences in sexual assault cases or for other crimes for those who fail to disclose their HIV status.
And activists note the state is also one of 24 that has in the past prosecuted individuals for intentionally spreading the disease.
Many states have taken steps to repeal laws enacted at the height of the AIDs epidemic that were panned as ineffective and discriminatory.
In 2018, California repealed a law that made it a felony to intentionally expose others to HIV without their knowledge, rolling back a law that mostly affected sex workers.
Catherine Hanssens, executive director of Center for HIV Law & Policy, said HIV exposure laws are a relic of late '80s hysteria over the spread of the illness.
Even if someone tests positive for HIV, she said, the chances of them passing the disease to someone else by spitting or biting them are negligible.
"There has never been a documented case of anyone transmitting HIV to a police officer, firefighter or emergency medical technician," Hanssens said. "It has never happened."
Christian M. Wade covers the Massachusetts Statehouse for North of Boston Media Group’s newspapers and websites. Email him at email@example.com.