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Subject 511-2-5 ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)

Rule 511-2-5-.01 Definitions

Unless a different meaning is required by the Context, the following terms as used in this Chapter shall have the meaning hereinafter respectively ascribed to them:

(a) "Acquired Immunodeficiency Syndrome" (AIDS) is an illness characterized by one or more of the opportunistic diseases diagnosed by methods considered reliable, which are at least moderately indicative of underlying cellular immunodeficiency, and the absence of all known underlying causes of cellular immunodeficiency (other than HIV infection) and absence of all other causes of reduced resistance reported to be associated with at least one of those opportunistic diseases; or any current scientifically accepted definition as approved by the Director, Division of Public Health.
(b) "Ancillary services" means services provided after test results are given to the individual, including counseling and, if needed, repeat testing and referral to other medical support services.
(c) "Approved laboratory" means a laboratory that has been designated by the Department as an approved facility to conduct HIV testing.
(d) "Convicted of prostitution" means an individual, male or female, within the bounds of this State who has pled nolo contendere to, has pled guilty to, or has been found guilty of, prostitution in a court of this State, or in a court outside this State.
(e) "Department" means the Georgia Department of Public Health.
(f) "Health care provider" includes, but is not limited to, clinics (public and private), hospitals, or physicians.
(g) "Human Immunodeficiency Virus", hereinafter referred to as HIV, means the agents which cause AIDS.
(h) "Person" means any individual, partnership, corporation, or association and may extend and be applied to bodies politic or corporate.
(i) "Prostitute" means an individual, male or female, who performs or offers or consents to perform an act of sexual intercourse for money.

Rule 511-2-5-.02 Preamble

(1) Prevention of Perinatal Infection. The reason for voluntary HIV testing of high-risk pregnant women and women who may become pregnant is to reduce perinatal transmission of AIDS and the accompanying human suffering that could result. It is believed that HIV infection is transmitted from infected women to their fetuses or off-spring during pregnancy, labor and delivery, or perhaps shortly after birth.
(2) Mandatory Testing of Individuals Convicted of Prostitution. The reason for mandatory testing of convicted prostitutes is to develop a surveillance system to utilize this epidemiologic instrument to track the spread of HIV infection that is present in this high-risk group. Even though HIV transmission through prostitution has not been conclusively demonstrated, it is believed that contact between bisexual men and prostitutes (male and female) is a probable means of transmission of AIDS to the heterosexual population.
(3) Nonanonymous HIV Reporting. The reason for nonanonymous reporting of HIV is to describe adequately the epidemic in Georgia. Understanding the epidemiology of HIV serves as the cornerstone of public health's efforts to prevent transmission of HIV and to provide excellent care for those already infected.

Rule 511-2-5-.03 Applicability of Chapter

These rules establish a uniform statewide procedure for the Department or its authorized agent or agents or health care providers engaged in any of the following: identifying; testing; counseling; and/or providing ancillary services regarding the prevention of the transmission of the HIV agent for the following:

(a) On a voluntary basis of high risk pregnant women, and high risk individuals who might become pregnant.
(b) Mandatory testing of convicted prostitutes.
(c) The date on which the Department shall begin requiring non-anonymous confirmed positive HIV reporting.

Rule 511-2-5-.04 Prevention of Perinatal Infection

(1) Pregnant women and individuals who may become pregnant in the following groups shall be offered counseling, HIV testing, and ancillary services:
(a) Those who have evidence of HIV infection themselves, or whose offspring have evidence of HIV infection;
(b) Those who have used any drug intravenously or parenterally for nonmedical purposes since 1978;
(c) Those who were born in areas where heterosexual transmission of HIV is considered by the Department to play a major role;
(d) Those who are or have engaged in prostitution;
(e) Those who are or have been sex partners of men who have evidence of HIV infection, IV drug abusers, bisexual men, men with hemophilia, or men who were born in areas where heterosexual transmission of HIV is considered by the Department to play a major role;
(f) Those who have received blood or blood products after 1978 and prior to April, 1985; and
(g) Those who have received artificial insemination after 1978 and prior to January, 1986.
(2) If data become available to show that HIV infection is increased in other groups or settings, counseling and testing programs should be extended to include them. Routine counseling and testing of women who are not included in the above-mentioned groups is not currently recommended due to low prevalence of infection and concern about interpretation of test results in the low prevalence population. However, if a woman requests it, the service should be provided.
(3) Counseling and testing for HIV to prevent perinatal transmission are recommended in the setting of any medical service in which women at increased risk of HIV infection (as described in Paragraph (1) above) are encountered. These include, but are not limited to, clinics for services related to IV drug abuse (i.e., detoxification and methadone maintenance), hemophilia care, sexually transmitted disease, prenatal and obstetric care, family planning, infertility, gynecological, premarital, and preconceptual care. Testing for HIV should be performed with the individual's permission after counseling is provided regarding risk factors for infection, the interpretation of test results, the risks of transmission, and the possible increase of disease exacerbation among women infected with HIV in association with pregnancy. The counseling and testing must be conducted in an environment in which confidentiality can be assured.

Rule 511-2-5-.05 Testing of Individuals Convicted of Prostitution

(1) Every prostitute convicted within this State after the effective date of this Chapter shall submit to HIV testing as prescribed by the Department. Further, every individual convicted of prostitution outside this State after the effective date of this Chapter and found within this State, shall submit to HIV testing if on probation.
(2) Every clerk of a court of record in this State with jurisdiction of the offense of prostitution; every administrative head of a probation, parole or similar supervisory agency; and every administrative head of a penal institution or other detention facility shall promptly report or cause to be reported to the local Board of Health when he or she receives custody, supervision or other notice of an individual convicted of prostitution. Such report shall identify the individual by name and whereabouts, and will be used to facilitate HIV testing of the individual.
(3) Before sentencing a convicted prostitute, the courts of this State are requested to have a designated representative, appointed by the court and approved by the Department, contact the Division of Public Health of the Department. The purpose of the contact is to ascertain whether or not the prostitute has been previously found to be positive by HIV testing and such information may be taken into consideration by the judge upon sentencing.
(4) Where permitted by law, every judge sentencing a convicted prostitute in this State may include as a condition of any probation, suspension of sentence or other leniency, that the convicted individual report to the local Board of Health for HIV testing as directed. Further, where the convicted individual appears able to do so without undue hardship, every such judge is requested to order the individual to reimburse the health care provider for the cost of any testing and/or ancillary services provides.

Rule 511-2-5-.06 Notification of Test Results

(1) The approved laboratory for HIV testing shall report test results in writing to the Department or its designated representative, or both, as required by the Department. The Department or its designated representative shall notify the individual of test results in a manner prescribed by the Department.
(2) Test results and ancillary services shall be provided only upon the individual's presentation of the proper identification as prescribed by the Department.

Rule 511-2-5-.07 Laboratories

All laboratories shall comply with Chapter 111-8-10 "Licensure of Clinical Laboratories" of the Department of Community Health, and in addition be approved by that Department for HIV testing. The laboratories shall comply with reporting requirements as prescribed by the Department of Public Health.

Rule 511-2-5-.08 Ancillary Services

(1) Post-Test Counseling - The results of the tests shall be discussed with the individual in a private setting during a prescheduled return visit. The individual shall be advised of the interpretation and implications of the test results and, if warranted, the need for repeat testing.
(2) Referral for Other Medical and Support Services - An individual whose test results or post-test counseling assessment indicate a need for further evaluation or support services shall be referred to the appropriate providers of such services.

Rule 511-2-5-.09 Confidentiality

(1) All information and records held by the Department and its authorized representatives or any other person relating to HIV infection or cases of AIDS shall be strictly confidential. Such information shall not be released or made public by the Department or its authorized representatives, or by any other person, except that release may be made under the following circumstances:
(a) When made with the consent of the individual, parent or legal guardian, as appropriate, to which the information applies;
(b) When made for statistical purposes, if the medical or epidemiologic information is summarized so that no names or other individually identifying details are revealed;
(c) When made to health care personnel, appropriate state or local agencies, or courts of appropriate jurisdiction, to carry out or enforce the provisions of this Chapter and related rules.
(2) If disclosure is made pursuant to an order of the court, such information shall be sealed and delivered directly to the requesting court. Nothing herein waives the Department's right to contest the validity of any discovery process or order, or to seek protective or limiting orders.
(3) All information given the Department pursuant to this Chapter shall be incorporated in to the Department's public health investigations, studies and reports. The Department specifically invokes its privilege to refuse to disclose the identity of any person furnishing such information, without specific authorization from the individual tested.

Rule 511-2-5-.10 Non-anonymous HIV Reporting

Non-anonymous confirmed positive HIV tests shall be reported to the Department.