090.020 Model Policies for Handling, Caring and Treating Persons Infected with a Sexually Transmitted Disease (Including HIV/AIDS) While in the Custody, Supervision or Care of Correctional, Law Enforcement, or Emergency Services Entities
| Policy Number | 090.020 |
| Effective Date | August 23, 2002 |
| Revision Date | May 24, 2024 |
| Subject Matter Expert | Communications and Policy Group |
| Approval Authority | HIV/STD Section Director |
| Signed by | D’Andra Luna |
1.0 Purpose
This policy outlines the various laws, rules, and guidelines as well as policies the Department of State Health Services (DSHS) HIV/STD Section (Section) developed, which affect entities such as correctional facilities, law enforcement agencies, fire departments, emergency medical service providers, and district probation departments that may be responsible for the custody or supervision of people with HIV/AIDS. The policy outlines the extent to which the Section works with affected entities in the adoption of the model policies and guidelines and provides information on how these entities may obtain copies of the model policies and guidelines.
2.0 Authority
Health and Safety Code (HSC) §81.041, §81.042, §81.044, §81.048, §81.050, §81.051, §81.102, §81.107, §81.109, §§81.301-81.304 §85.003, §85.111, §§85.141-85.143 and §97.144; Government Code, §501.054, §507.023, Local Government Code §361.901; Criminal Procedure Code Art. 21.31, Art., Art. 56.02, 25 Texas Administrative Code (TAC) Chapter 96; 25 TAC §97.135; 25 TAC §97.146; 37 TAC §157.49; 37 TAC 163.41; Updated U.S. Public Health Service guidelines for the management of occupational exposures to HIV and recommendations for postexposure prophylaxis; DSHS Infection Control Manual; Center for Disease Control’s (CDC) Recommendations for Correctional and Detention Settings; and HIV/STD Universal Standards.
3.0 Background
The laws listed in Section 2.0 Authority direct correctional facilities, law enforcement agencies, fire departments, emergency medical providers, and district probation departments to adopt policies to facilitate the handling, care, and treatment of people with HIV/AIDS in their custody or under their supervision. HSC §85.141 directs DSHS to develop model policies based on state law and accepted clinical standards to assist the affected entities as they develop their own policies and procedures to care for people with HIV. The Section is the primary resource in the state for HIV/AIDS prevention and develops model policies and guidelines regarding HIV/AIDS and STD treatment and prevention.
4.0 Who Must Use Model Policies
4.1 State or local entities
HSC §85.142 requires correctional facilities, law enforcement agencies, fire departments, emergency medical service providers, and district probation departments who may be responsible for the custody, care, and supervision of people with HIV/AIDS to use these policies.
5.0 Development of Policy Content
DSHS determined the following subsections as the core components from which correctional and law enforcement agencies, fire departments, and emergency medical service providers may further develop comprehensive HIV/AIDS policies specific to their facilities.
5.1 Model Education Program used to educate employees about the HIV disease and its progressive stages
HSC §85.111 provides direction for the education of state employees and requires the dissemination of an educational pamphlet each year.
Furthermore, each entity affected by this policy, according to Government Code §501.054 and §507.023, conducts educational programs for employees at least once each calendar year. Training includes infection control procedures.
The Section provides model educational materials regarding HIV/AIDS, including an educational video, HIV in the Workplace. The video focuses on the behavior and activities of employees at work and the impact the disease has on them. Upon request, the Section provides the latest medical information available on HIV/AIDS.
5.2 Education programs for inmates of the Texas Department of Criminal Justice (TDCJ)
Government Code §501.054 and §507.023 provide required education for inmates dealing with issues relevant to HIV/AIDS during confinement and after release from a correctional facility. The information must take cultural and other differences into account.
In addition, the agency must present the information in a manner to ensure that the inmate comprehends the materials. Therefore, the information must be in English or another language, sign, Braille, telecommunications devices for the deaf, vernacular, or presented using appropriate teaching methods aimed at low literacy or impaired skills (see also HSC §85.114).
5.3 HIV/AIDS model workplace guidelines for state agencies and state contractors
DSHS encourages state agencies and their contractors to establish workplace policies concerning people with HIV/AIDS. The Section’s Model Workplace Guidelines webpage provides a uniform approach to developing policies addressing HIV/AIDS in the workplace. This model is the minimum standard for the development of guidelines for state agencies and their contractors. These guidelines are the standard for health care facilities licensed by DSHS, as stated in HSC §85.113. Employers may adapt this model to fit the needs of their organization and work force. However, the content and intent must remain consistent with the model guidelines and the Texas Health and Safety Code.
Applicable entities whose employees risk exposure to bloodborne pathogens in the course of doing their work, as outlined in HSC §§81.301-81.304 relating to the development of minimum standards for a Bloodborne Pathogen Exposure Control Plan, must also adopt such a plan. 25 TAC, Chapter 96, outlines the components of this plan.
5.4 Prevention activities provided to state agencies by contractors of the Section
HIV/STD Policy 110.002, HIV and STD Prevention Activities in State Prisons and Jails, State Juvenile Justice Facilities, Municipal and County Jails, Federal Prisons, and Private Prisons, establishes the extent of HIV/STD prevention activities in which the Section and its contractors participate with other state agencies and their contractors. A Memorandum of Understanding may provide other prevention activities between the Section, its contractors, and the affected entities. 37 TAC §157.49 (6), as outlined, requires collaborative efforts to address the HIV/AIDS disease in correctional facilities.
5.5 Standard precautions for preventing the spread of HIV
The U.S. Department of Health and Human Services Standard Precautions for All Patient Care, the CDC’s Recommendations for Correctional and Detention Settings, and the most current version of the DSHS Infection Control Manual help maintain standard clinical precautions in the prevention of the spread of communicable diseases, including HIV/AIDS. HIV compromises the immune system of some individuals. These individuals are at a higher risk of contracting communicable diseases such as tuberculosis or hepatitis B than the general population. Affected entities should follow the standard precautions when providing services to them.
In addition, facilities comply with 25 TAC Chapter 96, Bloodborne Pathogen Control, which includes policies relating to occupational exposure to bloodborne pathogens, training and educational requirements for employees, measures to increase vaccinations of employees, and increased use of personal protective equipment (PPE).
5.6 Clinical practice guidelines for persons with HIV disease
Clinicians providing care and services to persons with HIV disease follow treatment guidelines from nationally recognized experts. These guidelines are available by visiting HIVinfo or by calling 800-448-0440.
5.7 Required reporting
HSC §81.042 requires an administrator or health official of a penal or correctional institution to report a suspected case of a reportable disease, including HIV/AIDS and information known concerning the person who has, or who they suspect has, the disease, to the local health authority or DSHS.
5.8 Confidentiality
Information pertaining to the HIV/AIDS status of an individual is confidential and is not a public record obtainable upon request. This information is a medical record. As such, the transmission or sharing of this information cannot jeopardize or compromise confidentiality. HSC §85.115 directs state agencies to develop and implement guidelines regarding the confidentiality of HIV/AIDS-related medical information for employees, clients, inmates, patients, and residents served by an agency. These guidelines must be consistent with guidelines published by DSHS as well as with state and federal law and regulations.
The Section developed policies and procedures for dealing with the methods of sharing confidential information with appropriate entities to afford the greatest security for that information. The Section provides these HIV/STD Security Policies and Procedures on the Section’s website. (Also see 25 TAC §97.146.) Affected entities may review these policies to determine if they may use portions of the policies in their own jurisdiction.
37 TAC 163.41 also provides direction for dealing with confidentiality issues.
5.9 HIV serological testing Informed and general consent HIV/AIDS testing in county and municipal jails
Except as the law otherwise provides, a person may not perform a test designed to identify HIV or its antigen or antibody without first obtaining the informed consent of the person they intend to test. The medical record of the individual receiving the test must contain documentation that the tester explained the test and obtained consent.
When a person has a current, signed general consent form allowing medical tests or procedures in effect, the law does not require that person to sign another form for tests or procedures to determine HIV infection, antibodies to HIV, or infection with any other probable causative agent of AIDS. Unless the law otherwise provides, agencies may only use the result of a test or procedure for diagnostic or other purposes related to medical treatment.
5.9.1 Testing pregnant women for HIV/AIDS
State law defines the requirements and timing for testing a pregnant woman for, among other things, HIV/AIDS. The requirement pertains to the first examination of the woman and the delivery of the child. The requirement applies to every physician or other person permitted by law to attend to a pregnant woman during gestation or at the delivery of the child. The institution or jail must comply with this law as it pertains to HIV/AIDS when dealing with an incarcerated, pregnant woman. For more information, see HIV/STD Policy 120.100 and 25 TAC §97.135.
5.9.2 Institutional or state jail testing
Facilities operated by the Texas Department of Criminal Justice and corrections institutions may test an inmate for HIV/AIDS. The facility may segregate an inmate with a positive test result from other inmates according to Government Code §501.054 and §507.023. Affected entities base their policies regarding mandatory testing of persons in custody on the judgment of the attending physician, admitting physician, or health authority, or when ordered by the court. In addition, testing of inmates is mandatory upon intake, release, when clinically driven, or upon the inmate’s request, as often as every six months.
5.9.3 HIV/AIDS testing in county and municipal jails
A county or municipality may test an inmate confined in the county or municipal jail or in a contract facility to determine the proper medical treatment of the inmate or the proper social management of the inmate or other inmates in the jail or facility. The county or municipality may segregate an inmate who has a positive test result for HIV/AIDS (Local Government Code §361.901). Neither the county nor the municipality has the duty to test for HIV/AIDS.
5.9.4 Mandatory testing of persons suspected of exposing certain other persons to reportable diseases, including HIV infection
A paid or voluntary law enforcement officer, firefighter, emergency medical service employee or paramedic, correctional officer, or other emergency response employee or volunteer may request DSHS or a health authority order testing of another person for HIV infection. The affected individual, under HSC §81.050, may make such a request only if the individual believes that such exposure to HIV infection occurred while caring for another person while in the course of employment or volunteer service. The affected individual must send the request for testing to DSHS or a health authority with an affidavit that outlines the reason for the request.
A qualified DSHS designee determines if the request meets the criteria of the United States Public Health Service, which determines what activities pose a risk of infection. When the DSHS designee approves the request, the DSHS designee issues a confidential written notice of the order to the person receiving the test and provides other information regarding their rights.
Once the test is complete, the DSHS designee notifies the person who requested the test of the results and provides any follow-up to that person and the person tested if the test is positive.
5.9.5 Counseling required for positive test results
Agencies may not reveal a positive test result to the person tested without giving that person the immediate opportunity for individual, face-to-face post-test counseling to include:
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The meaning of the test result;
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The possible need for additional confirmatory testing;
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Measures to prevent the transmission of HIV and change behavior conducive to HIV transmission;
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The benefits of partner notification, and
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The availability and use of partner notification programs.
5.9.6 Partner notification
A health care professional must inform a partner notification program when the health care professional knows the HIV positive status of a patient and has actual knowledge of the possible transmission of HIV to a third party. Therefore, when a person with HIV voluntarily discloses the name of a partner, the health care professional in an institutional or jail setting must inform the local health authority. Inform the patient that notifying the local health authority is not negotiable but assure the patient that partner notification programs and local health authorities may only use partner names for field investigation and notification, and partner notification programs and local health authorities do not disclose the name of the HIV-positive person.
The local health authority must notify the partner of an HIV-infected person, whether the person with HIV infection does or does not consent to the notification. The entity authorized to provide partner notification may not disclose the name (or other identifying information) of the person who gave the partner's name or the date or period of the partner's exposure.
6.0 Section Responsibilities
The Section does not directly deliver HIV/AIDS prevention activities to correctional facilities, law enforcement agencies, fire departments, emergency medical services providers, or district probation offices unless specified to do so by law or through memoranda of understanding with such entities. The Section reviews these policies as necessary with representatives from the following affected entities to ensure that they contain up-to-date information:
- Texas Department of Criminal Justice;
- Texas Commission on Law Enforcement;
- Texas Commission on Fire Protection; and
- DSHS EMS and Trauma Systems.
7.0 Contacting the Section for Information
Direct questions regarding the model policies to hivstd.policy@dshs.texas.gov.
8.0 Other Resources
Employers may contact hivstd.policy@dshs.texas.gov for information, pamphlets, and other educational materials. Employers may call 2-1-1 for information about education resources in the local community. Information and educational materials are also available on the Section's website. The Section's website includes links to local HIV/STD service agencies and all Section policies.
National resources include the CDC National Prevention Information Network (NPIN), found online at npin.cdc.gov.
9.0 Revision History
| Date | Action | Section |
|---|---|---|
| 5/24/2024 | Made changes to reflect changes in Texas Statutes, Federal and State guidelines, and Section policies. | All |
| 9/1/2017 | Changed "TB/HIV/STD Unit" to "TB/HIV/STD Section" to reflect new program designation | - |
| 9/4/2014 | Converted format (Word to HTML) | - |
| 12/30/2002 | Date of last review | All |