Current through Register Vol. 48, No. 9, September 27, 2024
A.
Definitions
(1) Sexually transmitted diseases
or STDs -Any of a diverse group of infections caused by biologically dissimilar
pathogens and transmitted by sexual contact. Sexual transmission is the only
important mode of spread of some of the infections in the group while others
can also be acquired by non-sexual means. These infections include but are not
limited to: syphilis, gonorrhea, granuloma inguinale, lymphogranuloma venereum,
chancroid, genital herpes, chlamydia infection, nongonococcal urethritis,
hepatitis B, hepatitis C, pelvic inflammatory disease, and human
immunodeficiency virus infection.
(2) AIDS -Acquired Immunodeficiency Syndrome;
that medical condition that meets the most recent AIDS case definition of the
Centers for Disease Control (CDC).
(3) Department -The South Carolina Department
of Health and Environmental Control.
(4) CDC -The Centers for Disease Control of
the United States Public Health Service.
(5) HIV -Human Immunodeficiency Virus,
identified as the cause of HIV infection and AIDS.
(6) HIV Test -Any diagnostic test or series
of tests generally accepted by medical, laboratory or public health authorities
for determining infection of an individual with HIV.
(7) HIV Infection or HIV Infected -Infected
with HIV, as evidenced by a positive HIV test validated by an approved
confirmatory HIV test or other test or combination of tests considered valid by
the Department.
(8) Contact
(referring to a person) -A person who has been exposed or has been reported to
have been exposed to semen, vaginal fluids, blood, or body fluids containing
blood, or other body fluids designated as infectious for HIV by the CDC or the
Department.
(9) Contact (referring
to a behavior) -A behavior that may result in exposure to another person's
semen, vaginal fluids, blood, or body fluids containing blood, or other body
fluids designated as infectious for HIV by the CDC or the Department. These
behaviors include but are not limited to sexual activity, needle/drug
paraphernalia sharing activities, or perinatal transmission which may result in
such exposure.
(10) Expose -To
present or subject another person to direct contact with semen, vaginal fluids,
blood, tissue, organs or body fluids containing blood, or other body fluids
designated as infectious by the Department. For purposes of determining sexual
exposure to HIV, the proper use of condoms and nonoxynol-9 or other chemical
agents recommended by public authorities reduces but does not eliminate the
risk of exposure of a sexual partner to HIV infection. The use of bleach to
clean needles and/or IV drug equipment reduces but does not eliminate the risk
of exposure to a needle-sharing partner to HIV infection.
(11) Suspected STD infection or person
suspected of being infected with STD -Person who has had an exposure to STD
infection or has been identified as a contact to an STD infected person and
whose STD status is unknown.
(12)
Lay healthcare giver -Person who is not a licensed health professional and who
is or soon will be providing direct hands on healthcare, which poses a
significant risk of exposure that may result in HIV or Hepatitis B transmission
to the lay healthcare giver from the infected person.
B. Sexually transmitted diseases declared
dangerous to the public health. Sexually transmitted diseases are declared to
be contagious, infectious, communicable, and dangerous to the public health.
Sexually transmitted diseases include all diseases or infections spread through
person-to-person sexual contact which are included in the annual Department of
Health and Environmental Control List of Reportable Diseases.
C. Reporting of sexually transmitted
diseases.
(1) Any physician or other health
professional who diagnoses or treats a case of sexually transmitted disease,
and any administrator, superintendent, manager or Infection Control
Practitioner of a hospital, dispensary, health care related facility, blood
bank, plasma center, or charitable or penal institution in which there is a
case of sexually transmitted disease shall report to the Department the case by
name, date of birth, address, county of residence, sex, race, the probable date
of onset of infection and the name of the physician of record. In addition, the
Department may require reporting to the health authorities of the probable risk
behavior leading to infection, the probable stage of infection if appropriate
and other necessary information according to the form and manner as the
Department directs.
(2) Each
hospital, dispensary, health care related facility, blood bank, plasma center,
penal or charitable institution required to report must designate to the
Department at least one person, hereinafter referred to as Reporting
Coordinator, who must coordinate reporting and will be responsible for ensuring
that the reporting requirements of the Department are met. Written inquiries
from the Department to physicians, health professionals, Reporting
Coordinators, Infection Control Practitioners, and administrators regarding
reporting must be answered in writing and must be mailed to the Department
within fifteen days.
(3) In
addition, for purposes of reporting of HIV, a completed confidential disease
report form, including the positive HIV test result, is required. For purposes
of reporting cases of AIDS, a completed AIDS case report form is required. For
other sexually transmitted diseases, reporting is required in the form or
manner specified by the Department. All information and reports in connection
with persons infected with sexually transmitted diseases shall be kept strictly
confidential in accordance with state law.
D. Laboratory reporting.
Any laboratory performing tests for a sexually transmitted
disease shall submit a report of all positive laboratory test results for
sexually transmitted diseases to the Department in the form and manner as the
Department directs. For purposes of reporting sexually transmitted diseases,
the positive test result, the patient's name, the name and address of physician
of record, clinic, hospital, or other health care provider submitting the
specimen for testing, the date the specimen was received, and the sex and race
of the patient shall be reported to the Department in the form and manner that
the Department directs. When accompanying the specimen, the age or date of
birth of the patient, the patient's address and county of residence must also
be reported. All information and reports in connection with test results
indicating sexually transmitted disease shall be kept strictly confidential in
accordance with state law.
E. Use of HIV test reports, AIDS case
reports, and other STD reports.
The Department may utilize the reports of HIV, AIDS and other STD
cases for the following purposes: partner notification services, counseling
services, referral for medical management and social services, epidemiologic
surveillance, protection of the public health, control of the spread of the
disease, and offering laboratory services for monitoring disease progression.
To the extent resources are available, the Department may develop cooperatively
with the reporting physician or other health professional a plan for providing
the above services.
F.
Verification of HIV test reports, AIDS case reports, other STD reports and
Epidemiological Surveillance.
For purposes of report verification and epidemiological
surveillance, the Department may conduct appropriate follow-up of HIV test
reports, AIDS case reports, and other STD reports. Such follow-up may include,
but is not limited to, confirmation of HIV or other STD test results,
collection and confirmation of other information required to be reported,
review of hospital and physician medical records, interviews of physician and
other appropriate staff, interviews of patient, interviews of contacts who may
have been exposed to HIV. If the patient is incompetent or deceased, the
Department may interview the patient's physician, guardian, next of kin,
spouse, or contacts, and follow the CDC or the Department protocols for
conducting "No Identified Risk" (NIR) investigations.
G. Confidentiality.
(1) Records kept confidential. All
information and records held by the Department or its agents shall be strictly
confidential. The information must not be released or made public, upon
subpoena or otherwise, except in accordance with Section
44-29-135
and these regulations. Release may be made of medical or epidemiological
information to the extent necessary to notify contacts (partner notification)
as provided in Section
44-29-90
and
44-29-146.
(2) Disclosure to medical personnel to
protect health or life of any person.
(a) If
disclosure or release of STD information is allowed to medical personnel to
protect the health or life of any person pursuant to Section
44-29-135(d),
that relevant portion of the person's STD record may be released to the
person's physician if the physician needs to know the information in order to
plan and develop a course of treatment necessary for the treatment of the
person's medical condition. Whenever the Department releases confidential,
identifying STD information pursuant to this subsection (2)(a), the Department
will first make an attempt to obtain the consent of the patient to release the
information. If consent cannot be obtained, and the release is made, the
Department will make an attempt to inform the patient of what information was
released and to whom.
(b) When a
person who has tested positive for an STD accepts a referral from the
Department to a physician and/or health professional for medical care, the
Department may provide the STD information to the physician and/or health
professional directly involved in the medical care of the patient if the
physician and/or health professional has a need to know the information in
order to plan and develop a course of treatment necessary for the patient. In
the case of a pregnant patient who is referred by the Department to a physician
and/or health professional for medical care, the Department may provide the STD
information to the physician and/or health professional directly involved in
the medical care of the pregnant patient if the physician and/or health
professional has a need to know the STD information in order to plan and
develop a course of treatment necessary for the pregnant female and/or her
newborn(s). Whenever the Department releases confidential, identifying STD
information pursuant to this subsection (2)(b), the Department will first make
an attempt to obtain the consent of the patient to release the information. If
consent cannot be obtained, and the release is made, the Department will make
an attempt to inform the patient of what information was released and to
whom.
(c) The Department may share
with health departments located in other states and which are responsible for
the control of STD's all information necessary for those health departments to
carry out their public health mandates.
(d) If a person infected with HIV, Hepatitis
B or syphilis informs the Department, or the Department learns, that he/she
has, during a period of probable infection, donated or sold blood, semen,
tissue, organs or other body fluids determined to be infectious by the
Department, the Department may disclose or release the name of the donor only
to the entity which collected the infected blood or body product. The
information may be given to the collecting entity to protect the recipient
and/or the blood or body product supply. The entity which collected the blood
or body product must not release to any other person the information
identifying the donor provided by the Department and such information must be
kept strictly confidential. Whenever the Department releases confidential,
identifying STD information pursuant to this subsection (2)(d), the Department
will first make an attempt to obtain the consent of the patient to release the
information. If consent cannot be obtained, and the release is made, the
Department will make an attempt to inform the patient of what information was
released and to whom.
(3) Notification of Public Schools of minors
infected with HIV. When disclosure of a minor's HIV infection is reported to a
public school superintendent, school nurse, or other health professional
assigned to the public school pursuant to Section
44-29-135(e),
the information released must be kept strictly confidential by the school
superintendent, school nurse, or other health professional assigned to the
public school and should only be revealed to public school personnel who have a
bona fide need to know. All persons receiving the information must keep the
information strictly confidential. Violation of this regulation may result in
imposition of penalties as set forth in Sections
44-1-150
and
44-29-140
South Carolina Code of Laws and other applicable penalties. The method for
notification of public schools is contained in Section H. (3)(a).
(4) Notification of biological parents,
foster parents, persons in loco parentis, adoptive parents or guardians,
functioning in a direct supervising role, of the HIV and/or Hepatitis B
infected status of minors under age sixteen, persons with intellectual
disability, or mentally incompetent persons. When in the judgement of the
Department or the attending physician, it is necessary to protect the health or
well-being of persons listed in (a), (b), or (c) below, or persons serving in a
direct supervising role to persons listed in (a), (b), or (c) below or to
protect the public health, the Department or the attending physician may
inform, if they function in a direct supervising role, biological parents,
foster parents, persons in loco parentis, adoptive parents, or guardians of the
HIV and/or Hepatitis B infected status of the following persons:
(a) IV and/or Hepatitis B infected minor
under age sixteen,
(b) HIV and/or
Hepatitis B infected person with intellectual disability, or
(c) HIV and/or Hepatitis B infected mentally
incompetent person. Any disclosure made by the Department shall only be made
when in the judgment of the Department it is necessary to protect the health or
well-being of the persons listed in (a), (b), or (c) above, or persons serving
in a direct supervising role to persons listed in (a), (b) or (c) above, or to
protect the public health.
If the Department or the attending physician discloses the HIV
and/or Hepatitis B infected status of persons listed in (a) through (c) above
to any of the persons serving in a direct supervising role, counseling must
also be provided. Such counseling should include education regarding modes of
transmission, health care needs of the particular person, recommended
precautions in handling blood and body fluids and information on available
community resources. Whenever the Department releases confidential, identifying
STD information pursuant to this subsection4(a)(b)(c)(a)(b)(c), the Department
will first make an attempt to obtain the consent of the patient to release the
information. If consent cannot be obtained, and the release is made, the
Department will make an attempt to inform the patient of what information was
released and to whom.
(5) Notification of lay healthcare givers of
the HIV and/or Hepatitis B infected status of persons to whom they are
providing health care which may result in HIV and/or Hepatitis B exposure.
(a) The Department or the attending physician
may inform a lay healthcare giver who is or soon will be providing health care
to an HIV or Hepatitis B infected person of the HIV and/or Hepatitis B
infective status of the person to whom the lay healthcare giver is providing
health care, if in the opinion of the Department or the attending physician,
the nature of the contact resulting from the care:
(1) poses a significant risk of exposure that
may result in HIV and/or Hepatitis B transmission to the lay healthcare giver,
and
(2) if the Department or the
attending physician has reason to believe that the infected person, paraite the
Department or physician's encouragement, has not told or will not tell the lay
healthcare giver of his HIV and/or Hepatitis B infection.
(b) Before notifying the lay healthcare
giver, the Department or the attending physician must notify the HIV and/or
Hepatitis B infected person that the disclosure will be made and to whom it
will be made. If the disclosure is made to the lay healthcare giver the
Department or attending physician must notify the HIV and/or Hepatitis B
infected person of the disclosure and to whom it was made. When the information
is disclosed to the lay healthcare giver, counseling must also be provided.
Such counseling must include education regarding health care needs of the
infected person and recommended precautions in handling blood and body fluids
and the necessity for confidentiality.
(6) No access to the Department STD/HIV/AIDS
Records. No institution, facility, organization, agency, other entity or person
shall have access to the Department STD/HIV/AIDS Records under any
circumstances other than those outlined in Section
44-29-135
or Section G of these regulations.
H. School Attendance Considerations and
Notification Requirements.
(1) Attendance
considerations. In general, most children with HIV infection or disease should
be allowed to attend school without restrictions and without fear of spread of
the virus to their classmates, teachers, or other personnel in the school
environment. Infected children should be permitted to participate in all
regular school activities, provided their health status allows it. Medical
evaluation by the child's primary health care provider should be ongoing to
evaluate changes in the child's health. As appropriate, the child's health
status may be monitored periodically by the child's parent/guardian, personal
physician, appropriate public health professional and/or appropriate school
personnel. Evaluation of the child's potential for transmitting the virus
should be made by the health care professional(s) evaluating the child's health
status. Information shared during this monitoring process shall be held
strictly confidential, and release of this information shall be strictly
limited to those persons who have a need to know.
(2) Requirement to notify public schools. In
accordance with Section
44-29-135
S.C. Code of Laws, as amended, if a minor has AIDS or is infected with HIV and
is attending a public school in kindergarten through fifth grade, the
superintendent of the school district and the school nurse or other health
professional assigned to the school the minor attends must be notified. The
information given to the district superintendent and/or the school nurse or
other health professional must be kept strictly confidential and should only be
revealed to school personnel who have a bona fide need to know. All persons
receiving this information must keep the information strictly confidential.
Violation of this regulation may result in imposition of penalties as set forth
in Sections
44-1-150
and
44-29-140
South Carolina Code of Laws and other applicable penalties.
(3) Method of notification of public schools:
(a) The Department shall notify the school
superintendent and school nurse or other health professional assigned to the
public school of the minor's HIV infection in a confidential meeting. During
this meeting, the Department will provide either in writing or verbally to the
superintendent and school nurse or other health professional the following
information: name, date of birth of minor, and address, if known, name of
public school which minor attends, if known, and the medical status of the
minor, if known.
(b) The Department
shall provide to the superintendent and school nurse or other health
professional current Department recommendations concerning school attendance of
HIV infected minor students.
(c)
The Department may make available to the superintendent the services of
Department personnel and/or appropriate educational materials to assist the
superintendent in providing HIV/AIDS education for staff and
students.
I.
Day Care.
(1) Infants, children, adolescents
and adults with HIV infection/disease should be admitted to day care if their
health, behavior and immune status are appropriate. The decision to admit or
retain an infected person should be made on a case-by-case basis. This decision
should be made by the person's physician and/or appropriate public health
professional, and appropriate day care personnel. The day care personnel will
evaluate and monitor the person's health in the setting and the potential
threat of infecting others.
(2) The
day care personnel must keep all information regarding the person's HIV status
strictly confidential and such day care personnel should reveal the information
only to those day care workers who have a bona fide need to know.
J. Handling of Blood and Body
Fluids in Schools and Day Care Centers. Blood and body fluids should be handled
in accordance with the most current Department recommendations for the handling
of blood and body fluids in schools and day care centers.
K. Recalcitrant HIV infected persons.
(1) For purposes of this section, a
recalcitrant person is defined as one who is infected with HIV and who either:
(a) refuses curative treatment, or
(b) if while receiving treatment continues to
be infectious and engages in behavior which exposes another person or the
public to HIV, or
(c) if no cure is
available, refuses to receive counseling or, paraite counseling, the person
continues to engage in behavior, which exposes another person or the public to
HIV.
(2) For purposes of
this section, counseling is defined as providing information about HIV
infection, the significant threat HIV infection poses to other members of the
public and methods to minimize the risk to the public.
(3) The Department must when feasible attempt
to work with the recalcitrant person to modify his or her behavior before
seeking isolation of the recalcitrant person. This requirement will be
satisfied by the Department's fulfilling the following:
(a) Attempting on at least three occasions at
various times of day, to set up an appointment for counseling or to meet the
person at a designated location and provide counseling. If the person cannot be
located, a generic appointment letter, without identifying any infection by
name, requiring the person to report to the local health department, may be
sent to the person by certified mail, return receipt requested, or may be left
at the person's residence. If counseling is obtained at a place other than the
local health department, verification of that counseling in the form of a
statement signed by the counselor must be provided to the Department.
(b) Offering counseling and/or referring to
other appropriate professional and/or agencies for support services,
(c) If the Department has been unable to
locate the recalcitrant person or the person has refused counseling, the
Department must mail to the person's last known address a certified letter
stating the behavior modifications listed below and the recalcitrant person's
obligation to follow these modifications. The letter must also state that
failure to comply with these control measures may result in the issuance of a
public health order and/or petition for isolation. If the recalcitrant person
refuses to avail himself of counseling or referral services, the Department
will have been deemed to have met its obligation to attempt to work with the
recalcitrant person to modify his or her behavior.
(4) In cases of recalcitrant persons who have
HIV infection, modification of behavior must include cessation of behaviors
that expose other persons to HIV. The Department may issue a public health
order requiring the recalcitrant person to comply with appropriate directives
to protect the public health. These directives may include, but are not limited
to, any or all of the following:
(a)
Immediately report for counseling, social work assessment, testing, or
treatment;
(b) Refrain from anal,
vaginal or oral intercourse, unless partner is informed of risk of infection
and consents to sexual activity;
(c) Always use condoms as recommended by
public authorities during anal, vaginal or oral intercourse and exercise
caution when using condoms due to possible condom failure or improper
use;
(d) Do not share needles or
syringes unless the needle and syringes have been properly cleaned after each
person uses them;
(e) Have a skin
test for tuberculosis;
(f) Notify
all sexual and/or needle-sharing partners of the infection;
(g) If the exact time or general time period
of initial infection is known, notify or request the Department to notify
sexual and/or needle-sharing partners since the date or time period of
infection;
(h) If the time of
initial infection is unknown, notify or request the Department to notify sexual
and/or needle-sharing partners for at least the previous three years;
(i) Do not donate or sell body parts or body
fluids.
(5) If the
Department has reason to believe that a recalcitrant person has failed to
comply with the specified behavior modifications, has forcibly or without
forewarning exposed another person to HIV infection, and should be isolated
pursuant to Section
44-29-115
South Carolina Code of Laws, the Department may seek isolation of that person.
Isolation may be sought after reasonable means of correcting the problem have
been exhausted. In order to protect the public health and encourage persons to
seek HIV testing and counseling, it may be necessary for the Department and
other necessary state agencies to work with persons over time to modify
recalcitrant behavior.
L. Prisons and STD/HIV infected prisoners.
(1) To the extent resources are available,
the Department may provide STD/HIV counseling and testing and educational
resources to prisoners upon the reasonable request of any individual prisoner
or prison or jail official. When the Department is asked to conduct testing in
or for prisons or jails, the Department may require pre-test and post-test
counseling to accompany HIV testing conducted by the Department.
(2) If a prisoner is suffering from HIV
infection, AIDS or any sexually transmitted disease for which there is no cure,
the prisoner's medical condition shall not be a reason for further confinement.
It is the recommendation of the Department that no prisoner be confined beyond
the expiration of his/her sentence simply because he/she is infected with HIV
or any other sexually transmitted disease for which there is no cure. When it
is known to the prison or jail that a prisoner to be released is infected with
HIV, or any other STD upon the release of the infected prisoner, the facility
from which the prisoner has been released shall provide the prisoner with the
telephone number and address of the local health department of the prisoner's
anticipated county of residence. Prior to the release of the prisoner, the
prison or jail must also provide the Department of Health and Environmental
Control with the name, release date, sex, date of birth, race, and, if
available, address and other locating/identifying information concerning the
prisoner. The Department may then require the infected prisoner to report for
counseling and/or other related services.
(3) In order to protect the public health,
all prisons and jails should allow during visits of prisoners and their sexual
partners to possess and use condoms recommended by public health authorities.
The prison or jail is not required by these regulations to expend public monies
to purchase condoms, for either prisoners or visitors.
M. Counseling and Testing of Persons Charged
with Crimes Involving Needle Use or Prostitution.
Any person charged with any crime involving needle use or
prostitution may be required by the Department to undergo testing for sexually
transmitted diseases, including HIV, and, if infected, shall submit to
treatment and counseling. Such testing may be conducted within the discretion
of the Department. Counseling should always be offered before and after
testing.
N. Blinded
Anonymous Epidemiological Studies Conducted by the Department.
Whenever the Department determines it appropriate, the Department
may conduct blinded anonymous epidemiological studies. As these tests and
studies cannot be performed unless blinded and anonymous, results of the tests
cannot be divulged to any person and cannot be reported, except in an
epidemiological or statistical form that would not identify any individual.
These studies are designed only for research purposes to ascertain the
prevalence of infection in various settings and points of time.
O. Notifying patients and/or
health care providers of persons co-infected with both HIV and another
reportable, communicable disease.
Periodically the Department may match its registry of HIV
infected persons with its registries of persons infected with other reportable,
communicable diseases, such as, but not limited to, tuberculosis or syphilis.
Upon finding such matches, the Department may notify those persons at increased
risk of complications from HIV co-infection with another communicable disease.
The Department may, in a strictly confidential manner, release necessary
information to the person and/or his health care provider to protect the health
of both the HIV infected individual and the public where there is an increased
risk of the communicable disease.
P. Recommendation to instruct.
It is recommended that any physician or health care professional
who examines, counsels or treats a person infected with a sexually transmitted
disease should instruct, or note that the infected person has been instructed,
in measures for preventing the spread of such infection and of the necessity
for treatment.
Q.
Prescribing, compounding or selling any drugs, medicines, or other substances
for the cure of any STD.
Persons other than licensed physicians are forbidden to
prescribe, and persons other than licensed physicians or pharmacists are
forbidden to compound or sell any drugs, medicines, or other substances for the
cure of any sexually transmitted disease.
R. Issuing certificates of freedom from
sexually transmitted diseases prohibited.
Physicians, health officers, and all other persons are prohibited
from issuing certificates of freedom from sexually transmitted disease or
infection, provided this rule shall not prevent the issuance of necessary
statements of freedom from infectious diseases written in such form as required
for bona fide medical purposes.
S. Sexually Transmitted Diseases other than
HIV.
Where these regulations specifically refer to only HIV, they
shall be applicable only to HIV/AIDS and not to other sexually transmitted
diseases. Where these regulations refer to sexually transmitted diseases
generally or HIV and other sexually transmitted diseases, they shall be
applicable to all sexually transmitted diseases.
T. Severability.
If any provision of these regulations or the application thereof
to any facility, individual or circumstance shall be held invalid, such
invalidity shall not affect the provisions or application of the regulations
which can be given effect, and to this end the provisions of the regulations
are declared to be severable.
CODE COMMISSIONER'S NOTE
Pursuant to 2011 Act No. 47, Section14(B)(B), the Code
Commissioner substituted "intellectual disability" for "mental retardation" and
"person with intellectual disability" or "persons with intellectual disability"
for "mentally retarded".
