Topic:
AID TO DEPENDENT CHILDREN; MARRIAGE (GENERAL);
Location:
MARRIAGE;

OLR Research Report


10/14/2003 98-R-0995

FROM: Matthew Ranelli, Associate Attorney

RE: Mandatory Premarital HIV Testing

You asked how many states require human immunodeficiency virus (HIV) blood testing for marriage licenses.

SUMMARY

No states require HIV testing as a condition of granting marriage licenses (most states do not require any blood tests). At least four states, Illinois, Louisiana, Missouri, and Texas, passed laws requiring premarital HIV testing, but all repealed them shortly thereafter because they were very ineffective compared to HIV surveillance programs that target high risk populations.

At least 13 states have laws requiring marriage license applicants to receive HIV information and the location of testing facilities when they apply for a license.

Connecticut does not require premarital HIV testing; it requires blood tests for syphilis (and rubella in women). The state has considered bills regarding mandatory HIV testing for couples and HIV informational requirements, but none have passed.

HIV TESTING

According to information provided by the National Counsel of State Legislatures (NCSL), no states currently require HIV testing as a condition of receiving a marriage license. Many states, including Connecticut, have considered requiring HIV testing for marriage licenses, but only two, Illinois and Louisiana, adopted and implemented such laws. Two others, Texas and Missouri, adopted laws that triggered mandatory HIV testing based on prevalence in the general population or a recommendation of the Centers for Disease Control (CDC). According to a study reported in the American Journal of Public Health (AJPH) fewer than 20 states require any blood testing for marriage license applicants (Lyle RP, Premarital Screening for Antibodies to HIV Type I in the United States, AJPH 1990, p.1087).

The arguments in favor of such a testing requirement include (1) benefits associated with identifying and informing HIV-positive people, (2) informing prospective marital partners of each other's HIV status and the associated risks, and (3) informing couples of HIV risk factors and prenatal risks. The arguments against such testing include (1) the high cost of testing relative to the expected low number of cases identified given the low risk factors of most couples, (2) discouraging couples from marrying or encouraging them to travel to other states to do it, (3) the individual and social costs of false-positives, and (4) the right of people to decide whether to have an HIV test.

Illinois and Louisiana

Illinois and Louisiana passed laws requiring mandatory premarital HIV testing in 1987. Illinois PA 935 required both prospective marital partners to be tested for HIV infection within 30 days before applying for a license. They physician must certify that both parties have been informed of each other's results. Louisiana PA 830 required couples to be tested within 10 days before applying for a license. If one partner tests positive, the couple may not marry unless their physician certifies that both have been informed of the results and counseled on AIDS. In both states, the applicants must pay the cost of testing.

Louisiana repealed its requirement in 1988, six months after it was implemented. The state repealed the law because it only identified a handful of HIV positive results in approximately 15,000 people tested. Illinois repealed its law in 1989. According to a study in the Journal of the American Medical Association, of 70,846 people tested in the program's first six months only eight tested positive (Turnock BJ, Mandatory Premarital Testing for Human Immunodeficiency Virus; The Illinois Experience, JAMA 1989, 261:3415). The study estimated the cost of testing to be $2.5 million or $312,000 per HIV infected case identified compared with $2,000 per case identified through the public health department's counseling and testing program.

According to the study reported in the AJPH, the number of marriage licenses issued declined in both states while the number issued in their neighboring states increased correspondingly.

Texas and Missouri

Texas passed a law that would have required testing if the incidence of HIV in the general population reach a certain prevalence rate (0.83%). The state never reached the prevalence rate and repealed the law in 1989 in favor of an informational requirement (Tex. Fam. Code 1.07).

Missouri passed a similar law that would have required such testing if the CDC recommended mandatory premarital testing. According to Sharon Aires of the Missouri health department, the law is no longer in effect.

HIV INFORMATION REQUIREMENTS

At least 13 states require marriage license applicants to receive information regarding HIV infection and testing. Most of the states require their Departments of Public Health to prepare the material and have it distributed by officials authorized to issue marriage licenses.

Table 1: States with Mandatory Premarital HIV Information Requirements

State

Public Act

Description

California

N/A

Requires applicants to sign an affidavit stating they received a brochure containing HIV infection information and the availability of testing. It also requires physicians to offer HIV testing to marriage license applicants.

Georgia

88-1440

Requires the probate judge's office to provide applicants with a brief description of AIDS and HIV infection including high-risk populations and behavior.

Hawaii

87-98

Requires the Department of Public Health to provide applicants with HIV information and testing sites.

Idaho

88-123

Requires applicants to receive information on HIV infection and a confidential risk assessment, and to certify they have read the materials provided.

Illinois

89-884

Requires county clerks to give applicants a brochure on sexually transmitted diseases (STDs) including HIV.

Indiana

N/A

Requires applicants to certify that they have received information on STDs and a list of HIV testing sites.

Kansas

N/A

Requires applicants to receive HIV educational materials including transmission modes and risk factors.

Michigan

90-46

Requires local health directors, their designees, or an appropriate physician to counsel applicants on STDs including HIV. It also requires applicants to (1) certify they received such counseling or (2) submit a written objection stating such counseling violates their religious beliefs.

Rhode Island

88-405

Requires applicants to certify that they have received HIV testing information.

South Dakota

N/A

Requires the registrar of deeds to provide applicants with information on STDs including HIV transmission and a list of testing centers.

Texas

Tex. Fam. Code 1.07

Requires clerks to provide AIDS and HIV information packets to applicants. The packets must include information on (1) transmission modes and rates, (2) testing sites and availability, and (3) counseling services.

Virginia

87-42

Requires applicants to receive HIV information and test sites.

West Virginia

N/A

Requires applicants to receive AIDS and HIV informational brochures.

CONNECTICUT

Connecticut does not require HIV testing or provision of information for marriage license applicants, but they must submit to premarital blood tests for syphilis (and rubella for women). They must provide the test results to their town clerk when they apply for a license (CGS 46b-26(a) and (e)). The tests cost approximately $30 and $70 respectively.

Connecticut, Massachusetts, and New Hampshire are the only northeast states that require blood tests for marriage licenses (see OLR Report 97-R-0638, Attachment 1).

Connecticut has considered bills to require premarital HIV testing. The latest was HB 6217 in 1993 (Attachment 2). The bill was never raised and died in the Public Health Committee. The state has also considered, but never acted on, bills to requiring town clerks to provide HIV information and testing sites to applicants (1997 HB 5643 and HB 6126, Attachment 3).

MR:lc