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WHAT ARE HIV AND AIDS

Effective HIV prevention and treatment occurs across a continuum of care. This comprehensive approach spanning from HIV screening to treatment can help reduce new HIV infections and improve health outcomes among people with HIV.


The Human Immunodeficiency Virus, which is commonly referred to as HIV, is a virus that directly attacks certain human organs, such as the heart or kidneys, as well as the human immune system.   The immune system is made up of cells, which work to protect the body from infections and some cancers. HIV attacks the cells which are required for a proper immune system function. When HIV destroys enough of these cells, the immune system fails to protect the individual from certain opportunistic infections.

Acquired Immunodeficiency Syndrome or AIDS refers to an individual with very advanced HIV disease and whose immune system has been significantly damaged.

According to The Centers for Disease Control, the conditions that mark a progression from HIV disease to AIDS are:

*Certain infections, such as repetitive pneumonia

*Certain cancers, such as cervical cancer, Kaposi sarcoma, and central nervous system lymphoma

*CD4+ count less than 200 or 14% of lymphocytes

 

CLINICAL PRESENTATION

As many as 90% of people will recall experiencing symptoms during the acute phase of HIV infection. Acute HIV infection can present as an infectious mononucleosis-like or influenza-like syndrome, but the clinical features are highly variable. Symptoms typically begin a median of 10 days after infection and can include fever, maculopapular rash, arthralgia, myalgia, malaise, lymphadenopathy, oral ulcers, pharyngitis, and weight loss. The presence of fever and rash has the best positive predictive value.

The only way to determine for sure whether someone has HIV/AIDS is to be tested for HIV infection. Someone cannot rely on symptoms to know whether or not they are infected with HIV. Many people who are infected with HIV do not have any symptoms at all for many years. The potential symptoms include:

  • rapid weight loss  

  • dry cough

  • recurring fever or profuse night sweats

  • profound and unexplained fatigue

  • swollen lymph glands in the armpits, groin, or neck (lymphadenopathy)

  • diarrhea that lasts for more than a week

  • white spots or unusual blemishes on the tongue, in the mouth, or the throat (thrush)

  • pneumonia

  • red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids (Kaposi Sarcoma)

  • memory loss, depression, and other neurological disorders. 

 

PREVALENCE

HIV and AIDS remain persistent problems for the United States and countries worldwide. While great progress has been made in preventing and treating HIV, there is still much to do. There are 37.9 million people globally living with HIV.  There are 1.1 million people in the United States; about 14% of those don’t know they are infected.

Advances in HIV have led to dramatic declines in AIDS deaths and slowed the progression from HIV to AIDS. Better treatments have led to a rise in the number of people in the United States who are living with AIDS. This growing population represents an increasing need for better understanding, empathy, support, continued HIV prevention services, and treatment.

 

DIAGNOSIS

HIV can be diagnosed with laboratory-based or point-of-care assays that detect anti-HIV antibodies, HIV p24 antigen, or HIV-1 RNA. In the United States, the recommended laboratory-based screening test for HIV is a combination of antigen/antibody assay that detects antibodies against HIV and p24 antigen. The combination antigen/antibody assay becomes reactive approximately 2–3 weeks after HIV infection. It is estimated that 99% of people will develop a reactive combination antigen/antibody result within six weeks of infection, but in rare cases, it can take up to 6 months to develop a reactive test result. Point-of-care HIV antibody tests performed on oral fluid (instead of blood) have been associated with a lower sensitivity during early HIV infection. The earliest time after exposure that HIV infection can be diagnosed is approximately nine days when HIV-1 RNA becomes detectable in blood. 

  

 PREVENTION

The first step in controlling HIV is to prevent new infections.

Although scientists have yet to find a cure or an effective vaccine, AIDS, unlike many other life-threatening illnesses, is completely preventable. We have the knowledge, technology, and resources to halt the spread of the epidemic. 

Promoting widespread awareness of HIV and how it can be spread, counseling and testing, and providing antiretroviral treatment. This treatment enables people living with HIV to enjoy longer, healthier lives, and as such, it acts as an incentive for people to volunteer for HIV testing. It also brings people into contact with healthcare workers who can deliver prevention messages and interventions.

 

Pre-exposure Prophylaxis

Pre-exposure prophylaxis (or PrEP) with tenofovir-emtricitabine is highly effective in preventing HIV infection and is recommended as a prevention option for adults at substantial risk of HIV acquisition. 

 

Post-exposure Prophylaxis

Post-exposure prophylaxis (or PEP) with antiretroviral medications is another method to prevent HIV infection. PEP is recommended as a prevention option after a single high-risk exposure to HIV during sex, through sharing needles or syringes, or from a sexual assault. The PEP must be started within 72 hours of possible exposure.

 

Prevention of Occupational Exposure

Many strategies can be used to reduce the risk of occupational exposure.

The primary means of preventing the healthcare worker’s occupational exposure to HIV and other blood-borne pathogens is to follow infection control precautions with the assumption that all patients’ blood and other body fluids are potentially infectious. These precautions include:

  • Routinely using barriers (such as gloves and/or goggles) when anticipating contact with blood or body fluids

  • Immediately wash hands and other skin surfaces after contact with blood or body fluids.

  • Carefully handling and disposing of sharp instruments during and after use.

  • Safety devices also have been developed to help prevent needle-stick injuries.

These devices may reduce occupational HIV exposure risk if used properly. Furthermore, because many percutaneous injuries are related to sharps disposal, strategies for safer disposal, including safer design of disposal containers and placement of containers, are being developed.

Although the most important strategy for reducing the risk of occupational HIV transmission is to prevent occupational exposure, plans for post-exposure management of healthcare workers should be in place. The administration of antiretroviral drugs as post-exposure prophylaxis (PEP) should be considered. Using zidovudine as PEP is safe and associated with decreased risk for occupationally related HIV infection. Newer antiretrovirals also may be effective, although there is less experience with their use as PEP. CDC recently issued guidelines for managing HCW exposures to HIV and recommendations for PEP. These guidelines outline several considerations in determining whether or not an HCW should receive PEP and in choosing the type of PEP regimen. The recommendations will be updated if ongoing data collection and analysis show increased effectiveness of newer drug treatments.

As mentioned, all healthcare workers should use universal precautions. These precautions should include the routine use of gloves and or goggles when contact with blood or body fluids is possible, washing hands and other skin surfaces immediately after contact with blood or body fluids, and using extra care when handling or disposing of sharp instruments.

 

Precautions Regarding Sex

To reduce the transmission of HIV, the CDC recommends abstinence, monogamy with a safe, tested significant person, or, at a minimum, the use of latex or polyurethane condoms.

 

Injectable Drug Use

Abstinence from IV drug use is also a necessary component of the reduction in the transmission of HIV. If drug use is an issue, the user should only use clean needles and syringes and seek the aid of a substance abuse rehabilitation program.

 

Education

The strongest weapon against HIV is education. As a society, each individual must conquer the fear through knowledge and education rather than allowing the fear to postpone testing and participate in unsafe practices such as unprotected sex.

 

 The CDC provides the following to dispel popular misconceptions:

* There is no known transmission of HIV by contact with an environmental surface. (Public accommodations, transportation, etc.)

* There is no evidence of HIV transmission through mosquitoes or other insects.

* There is no known risk of HIV transmission to co-workers, clients, or consumers from contact in industries such as food-service establishments.

* Casual contact through closed-mouth kissing is not a risk for transmission of HIV. The CDC recommends engaging in French or open-mouth kissing, although the risk of acquiring HIV during this practice is believed to be very low.

* Contact with saliva, tears, or sweat has never been shown to result in the transmission of HIV.

* Natural membrane condoms have been shown to allow viruses to pass through them. For condoms to provide maximum protection, they must be latex or polyurethane and be used every time and correctly.

 

SCREENING AND DIAGNOSTIC TESTS

HIV screening is recommended for all adolescents and adults 13-64 years of age. Testing can reduce HIV transmission, and early diagnosis can improve medical outcomes.

The Centers for Disease Control and Prevention has recommended that HIV testing and HIV screening be part of routine clinical care in all healthcare settings. The CDC also has stated it suggests that the patient’s right to refuse be preserved to facilitate a good working relationship between patient and doctor. 

Diagnosing HIV quickly and linking people to treatment immediately are crucial to further reducing new HIV infections.

The Centers for Disease Control and Prevention (CDC) recommends:

  • Routine HIV screening at least once for everyone.

  • Frequent screenings for patients at greater risk for HIV

  • All patients who test positive for HIV should be linked to medical treatment, care, and prevention services

 

Benefits of Early HIV Diagnosis

People with HIV who know their status should be prescribed Antiretroviral therapy (ART).  By achieving and maintaining an undetectable (<200 copies/mL) viral load, patients can remain healthy for many years.  ART is now recommended for all people with HIV, regardless of CD4 count.  Studies show that the sooner people start treatment after diagnosis, the more they benefit from ART. Early diagnosis followed by prompt ART initiation:

  • Reduces HIV-associated morbidity and mortality

  • Greatly decreases HIV transmission to others

  • May reduce the risk of serious non-AIDS‒related diseases

 

Patients in all Health-Care Settings

  • HIV screening is recommended for patients in all healthcare settings after the patient is notified that testing will be performed unless the patient declines (opt-out screening).

  • Persons at high risk for HIV infection should be screened for HIV at least annually.

  • Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient and imply consent for HIV testing.

  • Prevention counseling should not be required with HIV diagnostic testing or as part of HIV screening programs in healthcare settings.

 

Pregnant Women  

  • HIV screening should be included in the routine panel of prenatal screening tests for all pregnant women.

  • HIV screening is recommended after the patient is notified that testing will be performed unless the patient declines (opt-out screening).

  • Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient for HIV testing.

  • Repeat screening in the third trimester is recommended in certain areas with elevated rates of HIV infection among pregnant women.

 

Diagnostic Tests

HIV tests have improved substantially over the years and are now easier and less expensive, with a more rapid turnaround time for results.

Three types of HIV tests are available:

  • Nucleic acid tests (NATs) — detects HIV ribonucleic acid (RNA)

  • Antigen/antibody combination tests — detects HIV p24 antigen as well as HIV immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies

  • Antibody tests — detects HIV IgM and/or IgG antibodies

Following an exposure that leads to HIV infection, the time during which no existing diagnostic test can detect HIV is called the eclipse period.

The time between potential HIV exposure and an accurate test result is referred to as the window period. Improvements in testing technology continue to reduce the detection window period and, therefore, the time to diagnosis and treatment of early HIV infection. As seen in the figure, each type of HIV test has its testing window, with the NAT capable of detecting HIV the earliest, followed by the antigen/antibody combination test, and lastly, the antibody test.

We know how HIV is and is not spread. Educating everyone about how to protect him or herself is the only way to halt the spread of this disease. Prevent HIV infection, and you will prevent AIDS.

 

TREATMENT

Prompt medical care and effective treatment with antiretrovirals can partially reverse HIV-induced damage to the immune system and prolong life. Effective treatment also substantially reduces the risk of HIV transmission to others. 

Keeping patients in regular care improves their health and reduces their risk of HIV transmission to others. The benefits of ongoing care can include addressing and supporting ART adherence, maintaining decreased viral load and increased CD4 count, lowering progression rates to AIDS, decreasing hospitalization rates, and improving overall health.

Poor retention in HIV care is more common in people with substance use disorders, serious mental health problems, unmet socioeconomic needs such as housing, food, or transportation, limited financial resources or health insurance, or schedules that complicate adherence to HIV medication.

Coinfections

  • Patients with HIV are at an increased risk of acquiring STDs, viral hepatitis, and opportunistic infections such as tuberculosis (TB). Coinfections can hurt their health and HIV treatment. Viral suppression can reduce a patient’s risk of coinfection, but providers should discuss regular screening and prevention measures with their patients.

  • STD preventive services are an essential component of HIV prevention and care. At every visit, providers should engage patients in regular conversations about STDs, including a review of sexual history and STD symptoms. Patients with HIV should be screened for STDs at least annually and more frequently if they or their sexual partners have multiple or anonymous sex partners. Certain STDs can increase HIV viral load and genital HIV shedding, increasing the risk of sexual and perinatal HIV transmission. Correct and consistent condom use should be advised to prevent STDs and can reduce HIV transmission risk in those with an STD or unsuppressed viral load. Learn more about STD treatment and care with the STD Treatment Guidelines and Updates.

  • Because of shared modes of transmission, a high proportion of adults with HIV are also at risk for coinfection with the hepatitis B virus or, more commonly, the hepatitis C virus. People with these coinfections are at increased risk for serious, life-threatening complications. Anyone with HIV should be tested for hepatitis B and hepatitis C, and treatment or vaccinations, when appropriate, should be considered. 

  • People with HIV are also at risk for various opportunistic infections, such as TB. These risks can be reduced by viral suppression and several other prevention behaviors.

 

 

TRANSMISSION

As we continue researching how to control and eventually eradicate this disease, our efforts have focused on identifying how HIV can be transmitted.

According to The Centers for Disease Control and Prevention:

HIV is transmitted by:

  • Sexual contact with an infected person sharing needles and/or syringes with someone infected

  • Less commonly (and now very rare in countries where blood is screened for HIV antibodies), through transfusion of infected blood or blood clotting factors

  • Babies born to HIV-positive women may become infected before or during birth or through breastfeeding after birth

  • In healthcare settings, workers may become infected after being stuck with needles containing HIV-infected blood

  • Less frequently, workers have been infected after HIV-positive blood gets into a worker’s open cut, eyes, or inside of the nose

  • Sexual contact with an infected person

  • Sharing needles and/or syringes with someone infected 

  • Less commonly (and now very rare in countries where blood is screened for HIV antibodies), through transfusion of infected blood or blood clotting factors

  • Babies born to HIV-positive women may become infected before or during birth or through breastfeeding after birth

  • In healthcare settings, workers may become infected after being stuck with needles containing HIV-infected blood.

  • Less frequently, workers have been infected after HIV-positive blood gets into a worker’s open cut or a mucous membrane (eyes or inside of the nose) 

 

Perinatal Transmission of HIV

The perinatal transmission of HIV each year in the United States by approximately 6,000 to 7,000 HIV-infected women giving birth results in 280 to 370 new perinatal infections. Approximately 40% of the HIV-infected women who pass their HIV to their children never knew they were HIV-infected or were never tested for HIV during their pregnancy.

Effective prevention of mother-to-child transmission (PMTCT) requires a three-fold strategy.

  • Preventing HIV infection among prospective parents

  • Avoiding unwanted pregnancies among HIV-positive women

  • Preventing the transmission of HIV from HIV-positive mothers to their infants during pregnancy, labor, delivery, and breastfeeding.

For HIV-positive women in well-resourced countries, the advice from national health agencies is straightforward: they should avoid breastfeeding altogether because the risk of HIV transmission far outweighs the risks associated with replacement feeding.

Many women do not know that perinatal transmission of HIV is preventable. Only about 33% of all hospitals offer rapid HIV testing to women in labor, and only 50% of them have policies to test women whose HIV status is unknown.

 

CONFIDENTIALITY

Under most circumstances, HIV testing is voluntary. Unless there are special circumstances, most states require a person to give informed consent before he or she can be tested for HIV. Many options are available for anonymous testing at clinics and at home. Most states have laws that protect the confidentiality of HIV testing and diagnosis.

Confidentiality is a complex issue. The need for confidentiality is paramount to further testing and treatment efforts. However, most, if not all, states carry the requirement of disclosing HIV status to a prospective sexual or needle-sharing partner. In some states, failure to do so is a misdemeanor; in others, it is a felony.   The challenge lies in defining an identifiable sexual or needle-sharing partner while respecting the rights of the HIV-infected individual to confidentiality.

 

REPORTING HIV AND AIDS 

As part of informed consent, it is important to verbalize and write your responsibilities as a professional before beginning assessments and treatment. Also, it is always best to seek supervision through a supervisor and mentor in your field if you are unsure. 

The Centers for Disease Control and Prevention (CDC) published its first surveillance case definition for Acquired Immune Deficiency Syndrome (AIDS) in September 1982. 

AIDS surveillance data has provided critical information for tracking this disease and targeting prevention and treatment resources. In recent years, however, AIDS surveillance data has been less reflective of the epidemic due to the success of antiretroviral therapy. Individuals infected with HIV are doing better, and the progression from HIV to AIDS is much longer. People are living longer, healthier lives. Consequently, the number of AIDS cases has dropped. With fewer cases and longer progression from HIV to AIDS, it is difficult to know where new infections are occurring and where to target resources.

CDC HIV and Perinatal HIV Exposure Reporting Case Report Forms

Please refer to the appropriate state or local health department HIV surveillance program for specific guidance on reporting requirements in your local area. Completed case reports should be forwarded to the health departments and not be sent directly to CDC.

Adult HIV Confidential Case Report Form (Patients >13 Years of Age at Time of Diagnosis

Pediatric HIV Confidential Case Report Form (Patiens< 13 Years of Age at Time of Diagnosis

 

HIV & AIDS  Guidelines

While we have made every effort to ensure that this information is correct and current, the law is regularly changing, and we cannot guarantee the accuracy of the information provided. This information may not apply to your specific situation and is not and should not be relied upon as a substitute for legal advice.  Laws and policies are structural interventions that can be facilitators or barriers to effective human immunodeficiency virus (HIV) prevention and care activities.  Examples of these laws and policies include:

  • All 50 states require both physicians and laboratories to report to local or state health departments the names of persons newly diagnosed with AIDS.
  • Approximately half of the states in the United States have HIV-specific criminal laws.
  • All states now have HIV testing laws that are consistent with CDC’s 2006 recommendations.

Please follow this link to the Center For Disease Control State Laws regarding the HIV map.

 

WORKING WITH PATIENTS WITH HIV/AIDS

The patient with HIV/AIDS is facing not only a life-threatening and often fatal illness but also social stigma, public fear, and concerns about transmitting the illness to loved ones. In many circumstances, they often face isolation, discrimination, loss of career, and abandonment by family and friends. They are financially threatened by medical expenses and fear for their benefits. In many situations, they also are faced with grief and loss from friends and loved ones who have died from AIDS. Medical professionals must address this illness’s psychological, biological, and social aspects.

With the advances made in treatment, HIV-positive clients should not be treated as hospice patients. Many HIV-infected clients live normal lives for years to come. For this reason, it is important to help the client to establish coping mechanisms for long-term well-being.

The treatment plan should address medical compliance, and social services should develop a plan, including issues relating to prejudice, support issues, concerns about relationships, depression, anxiety, suicide risk assessment, and education.

Universal precautions should be used with HIV-positive clients, just as they should be used with all patients.

 Several states criminalize one or more behaviors that pose a low or negligible risk for HIV.  Several require persons who know they have HIV to disclose their status to sexual partners, and many states require disclosure to needle-sharing partners.  It is helpful for you to be a resource for clients with HIV.

 

State HIV Laws State Health Department Statements
Alabama Ala. Code § 22-11A-21(c)
Class C Misdemeanor
Anyone afflicted with an STD who knowingly transmits assumes the risk of transmitting or doing any activity that will probably or likely transmit such disease to another person and is guilty of a class C misdemeanor. (HIV is included among STDs, see Al. Admin. Code r. 420-4-1-.03.)
The criminalization of certain acts by those infected with sexually transmitted diseases that do or are likely to transmit the disease to others is a matter best determined by the state’s legislature. The prosecution of such crimes is within the discretion of those with prosecutorial authority. The Alabama Department of Public Health encourages those infected with diseases that can be sexually transmitted to abstain from sexual contact with others or to utilize safe practices to prevent transmission.

Dr. Thomas Miller
Deputy Director for Medical Affairs
Alabama Department of Public Health
Alaska Alaska Stat. § 12.55.155(c)(33)
Sentence Enhancement
The sentencing court may impose a sentence above the presumptive range if the offense was a felony sexual offense specified in Alaska Stat. §§ 11.41.410-11.41.455, and the following factors are proven by this section: the defendant had been previously diagnosed as having or having tested positive for HIV, and the offense either (A) involved penetration or (B) exposed the victim to a risk or a fear that the offense could result in the transmission of HIV.
Our Public Health section has chosen not to provide a quote at this time.

Clay Butcher
Director of Communications
Alaska Department of Health and Social Services
Arkansas Ark. Code Ann. § 5-14-123
Class A Felony
It is a class A felony for a person who knows that he or she has tested positive for HIV to expose another to HIV (1) through the transfer of blood or blood products or (2) by engaging in sexual intercourse, cunnilingus, fellatio, anal intercourse, or any other intrusion, however slight, of any part of a person’s body or any object into the genital or anal openings of another person’s body, without first having informed the other person of the presence of HIV. The emission of semen is not a required element of the crime.

Ark. Code Ann. § 20-15-903
Class A Misdemeanor
A person who is HIV positive must, before receiving any health care services from a physician or dentist, advise such physician or dentist that the person has HIV. Failure to do so is a class A misdemeanor.
We are sorry, but we do not feel that we have sufficient objective data to make a statement on this issue.

Ed Barham
Public Information Officer
Arkansas Department of Health
California Cal. Health and Safety Code § 120291
Felony
Any person who exposes another to HIV by engaging in unprotected sexual activity (anal or vaginal intercourse without a condom) when the infected person knows at the time of the unprotected sex that he or she is infected with HIV, has not disclosed his or her HIV-positive status, and acts with the specific intent to infect the other person with HIV, is guilty of a felony. Without additional evidence, a person’s knowledge of HIV-positive status is insufficient to prove specific intent.

Cal. Health and Safety Code § 120290
Misdemeanor
Any person afflicted with any contagious, infectious, or communicable disease who willfully exposes him/herself to another person (and any person who willfully exposes another person afflicted with the disease to someone else) is guilty of a misdemeanor.

Cal. Health and Safety Code § 1621.5
Felony
It is a felony for any person who knows that he or she has HIV to donate blood, body organs, or other tissue, semen, or breast milk to any medical center, breast milk bank, or semen bank. (Does not apply if a person is mentally incompetent, donates blood for autologous donation, or self-defers his or her blood under Cal. Health & Safety Code § 1603.3(b). Also, does not apply to sperm donors covered by Cal. Health & Safety Code § 1644.5(c).)

Cal. Penal Code § 12022.85
Sentence Enhancement
Any person who commits a sexual offense listed in this statute with the knowledge that he or she is infected with HIV at the time of commission shall receive a three-year enhancement for each violation in addition to the sentence provided for the sexual offense itself.

Cal. Penal Code § 647f
Penalty Enhancement
Any person who is charged with soliciting or engaging in prostitution under Cal. Pen. Code § 647(b) shall be also charged with a previous conviction(s) and with having been informed of positive blood test result(s) if: (1) the prior conviction(s) was for violating Cal. Pen. Code § 647 or any other offense listed in Cal. Pen. Code § 1202.1(d); (2) the person was tested for HIV in connection with the prior conviction(s) with positive test results; and (3) the person was informed of that positive test result(s). If the previous conviction and informed test results are found to be true by the trier of fact or are admitted by the defendant, the defendant is guilty of a felony.
We are aware of national efforts by the Center for HIV Law and Policy and the Positive Justice Project to highlight state laws that, under specified conditions, consider the transmission of HIV from an HIV-positive individual to another individual a criminal offense.

CDPH protects the public health of Californians while following state and federal laws and regulations. CDC regulations and federal law do not allow CDPH to provide a statement regarding the impact of the California Health and Safety Code or Penal Code on HIV-positive individuals.

Ken August
Risk Communication Chief
California Department of Public Health
Colorado Colo. Rev. Stat. § 18-3-415.5
Sentence Enhancement
If it is proven beyond a reasonable doubt that a person had notice of his or her HIV infection before the date that he or she committed a sexual offense, the judge shall sentence the person to a mandatory term of incarceration of at least three times the upper limit of the presumptive range for the level of offense committed, up to the remainder of the person’s life. (“Sexual offense” refers to sexual offenses consisting of sexual penetration as defined in Colo. Rev. Stat. § 18-3-401(6).) (See also Colo. Rev. Stat. § 18-1.3-1004.)

Colo. Rev. Stat. § 18-7-205.7
Class 6 Felony
Any person who, with knowledge of being infected with HIV, patronizes a prostitute is guilty of a class 6 felony. (“Patronizing a prostitute” is defined in Colo. Rev. Stat. § 18-7-205.)

Colo. Rev. Stat. § 18-7-201.7
Class 5 Felony
Any person who, in exchange for money or any other thing of value, performs or offers or agrees to perform, with any person not his/her spouse, any act of sexual intercourse, oral sex, masturbation, or anal intercourse and does so with knowledge of having tested positive for HIV, is guilty of a class 5 felony. (“Anal intercourse” is defined in § 18-7-201(2).)
We won’t be sending a comment.

Mark Salley
Communications Director
Colorado Department of Public Health and Environment
Florida Fla. Stat. Ann. § 381.0041(11)(b)
Third Degree Felony
Any person who knows he or she has HIV and has been informed that by donating blood, organs, or human tissues, he or she may communicate HIV to another person, and with this knowledge donates blood, organs, plasma, skin, or human tissue is guilty of a felony of the third degree.

Fla. Stat. Ann. §384.24(2)
Third Degree Felony (First Degree if multiple violations, § 384.34(5))
It is unlawful for any person who has HIV, with knowledge of such infection and having been informed that he or she may communicate it to others through sexual intercourse, to have sexual intercourse with any other person unless the other person has been informed of the presence of HIV and has consented to the sexual intercourse.

Fla. Stat. Ann. § 775.0877
Third Degree Felony
A person who pleads guilty or nolo contendere to, or is convicted of, committing or attempting to commit one of the crimes that is listed in subsection (1) of this statute and involves the transmission of bodily fluids from one person to another, who subsequently tests positive for HIV and is informed of that test result, and who then again commits one of the crimes listed in subsection (1) is guilty of criminal transmission of HIV, a felony of the third degree. The offenses listed in subsection (1) include, among others, sexual assault, incest, child abuse, indecent assault upon a minor child, sexual performance by a minor, and donation of contaminated blood. It is an affirmative defense that the person exposed knew the infected person was infected with HIV, knew the action could result in infection, and consented with that knowledge.

Fla. Stat. Ann. § 796.08(5)
Third Degree Felony
A person who has tested positive for HIV and knew or had been informed that he or she tested positive and could transmit HIV through sexual activity commits the crime of criminal transmission of HIV if that person commits prostitution offers to commit prostitution or (by engaging in sexual activity likely to transmit HIV) procures another for prostitution.
The Florida Department of Health, Bureau of HIV/AIDS helps improve Floridians’ quality of life by offering various confidential HIV/AIDS services. New treatments, medications, and support mean longer, healthier lives for individuals living with HIV. The more people know about this chronic illness, the more they will be able to manage their health care.

The Florida Department of Health is monitoring the national HIV conversation to determine the impact of these laws on HIV stigma and discrimination. The Department has guidelines for providing services to persons with HIV, which enable it to fulfill its responsibility to protect the public’s health.

Sheri Hutchinson, Interim Press Secretary
Florida Department of Health
Georgia Ga. Code Ann. § 16-5-60(c)
Felony (punishable by imprisonment for not more than 10 years)
Any person who knows that he or she is HIV infected is guilty of a felony if he or she, without first disclosing his or her HIV status, (1) knowingly has sexual intercourse or performs or submits to any sexual act involving the sex organs of one person and the mouth or anus of another person; (2) knowingly shares a hypodermic needle or syringe with another person; (3) offers or consents to perform an act of sexual intercourse for money; (4) solicits another to perform or submit to an act of sodomy for money; or (5) donates blood, blood products, other body fluids, or any body organ or body part.

Ga. Code Ann. § 16-5-60(d)
Felony (punishable by imprisonment for between 5 & 20 years)
A person who knows he or she is HIV infected who commits an assault with the intent to transmit HIV, using his or her body fluids (blood, semen, or vaginal secretions), saliva, urine, or feces upon peace or correctional officer while the officer is engaged in the performance of his or her official duties or on account of the officer’s performance of his or her official duties is guilty of a felony.
Criminal statutes are entrusted to the discretion of the legislature and are not the purview of public health.

Ryan Deal
Georgia Department of Public Health
Communications Director
Idaho Idaho Code § 39-608
Felony (punishable by imprisonment in the state prison for a period not to exceed 15 years, by a fine not over $5000, or both)
Any person who exposes another in any manner with the intent to infect or, knowing that he or she has HIV, transfers or attempts to transfer any of his or her body fluid, tissue, or organs to another person is guilty of a felony. It is an affirmative defense that the sexual activity took place between consenting adults after full disclosure by the accused of the risk of HIV transmission. It is also an affirmative defense that the transfer of body fluid, tissue, or organs occurred after advice from a licensed physician that the accused was non-infectious. (“Body fluid” means semen, blood, saliva, vaginal secretion, breast milk, and urine. “Transfer” means engaging in sexual activity by genital-genital contact, oral-genital contact, or anal-genital contact; or permitting the use of an unsterilized hypodermic syringe, needle, or similar device; or giving blood, semen, body tissue, or organs for purposes of transfer to another person.)
The Idaho statute 39-608 dealing with knowingly exposing persons to HIV was passed into law by the 1988 Idaho legislature at a time when there was less known about the virus, the disease was viewed as inevitably fatal, and the first antiretroviral medication had only recently been approved by the FDA.

Before this law, exposing persons to sexually transmitted diseases had already been classified as a misdemeanor. Our review of 1988 legislative documents to date indicates the bill sponsor was interested in making it a felony punishment to knowingly expose persons to what was considered a fatal disease at that time, and with a disregard for consequences or intent to infect with HIV. The statute was not introduced as a public health prevention measure, and to our knowledge, its effectiveness in that regard has not been studied, nor has its effect on testing, risk, stigma, or care-seeking behaviors of persons living with HIV.

The statute has been used sparingly in Idaho, with fewer than six convictions to our knowledge. Persons with HIV in Idaho enrolled in case management can receive assistance with disclosure skills and resources from their case managers. The Department of Health and Welfare’s desire is for Idahoans to be tested for HIV infection according to current guidelines, for those at risk for infection to adopt behaviors that reduce risk, and for those infected to enroll in medical care.

Thomas Shanahan
Public Information Manager
Idaho Department of Health and Welfare
Illinois 720 Ill. Comp. Stat. § 5/12-16.2
Class 2 Felony
A person who knows that he or she is infected with HIV commits criminal transmission of HIV if he or she (1) engages in contact with another person involving the exposure of the body of one person to a bodily fluid of another in a manner that could result in HIV transmission; (2) transfers, donates or provides his or her blood, tissue, semen, organs or other potentially infectious body fluids for administration (e.g., transfusion) to another person, or (3) in any way transfers to another any nonsterile IV or intramuscular drug paraphernalia. The actual transmission of HIV is not a required element of this crime. It is an affirmative defense that the person exposed knew the infected person was infected with HIV, knew the action could result in infection, and consented with that knowledge.
Most of the literature I’m familiar with would say that the vast majority of those folks who know their status or who know they’re positive are more likely to disclose or be careful in terms of practicing barrier methods.

Here in Illinois, what we try to do is focus on the prevention and education aspects of it. When you’re looking at African Americans, and Spanish-speaking Latinos, at the core, there’s already kind of a disproportionate representation in the legal system, to begin with. So now you take an infection that disproportionately affects them, then you have a double whammy.

We want to make sure that any statute on the books will enable people to, number one: learn their status; number two: disclose their status, be responsible for their intimate behavior, and go get care. States should start looking at it, analyze the impact in-state, and see how their laws may need to be amended.

Dr. LaMar Hasbrouck
Director
Illinois Department of Public Health
Indiana Ind. Code § 35-42-1-7
Class C Felony, Class A Felony
A person who recklessly, knowingly, or intentionally donates, sells, or transfers blood, a blood component, or semen for artificial insemination that contains HIV commits a class C felony, but if it results in the transmission of HIV, it is a class A felony. (This does not apply to a person who, for reasons of privacy, donates blood to a blood center after the person has notified the blood center that the blood must be disposed of or who transfers HIV-positive body fluids for research purposes.)

Ind. Code § 35-42-2-6(e)
Class D Felony, Class C Felony, Class A Felony
A person who knowingly or intentionally, in a rude, insolent, or angry manner, places (or coerces another to place) blood or another body fluid or waste on a law enforcement or corrections officer, firefighter, or first responder (identified as such and engaged in the performance of official duties) commits a class D Felony. If the person knew or recklessly failed to know that the blood, bodily fluid, or waste was infected with HIV, it is a class C felony. If the person knew or recklessly failed to know that the blood, bodily fluid, or waste was infected with HIV and the offense results in transmission of HIV, it is a class A felony.

Ind. Code § 35-42-2-6(f)
Class A Misdemeanor, Class D Felony, Class B Felony
A person who knowingly or intentionally, in a rude, insolent, or angry manner, places human blood, semen, urine, or fecal waste on another person commits a class A misdemeanor. If the person knew or recklessly failed to know that the blood, semen, urine, or fecal waste was infected with HIV, it is a class D felony. If the person knew or recklessly failed to know that the blood, semen, urine, or fecal waste was infected with HIV and the offense results in transmission of HIV, it is a class B felony.

Ind. Code § 35-45-16-2(a) & (b)
Class B Misdemeanor, Class D Felony, Class B Felony
A person who recklessly, knowingly, or intentionally places human blood, semen, urine, or fecal waste in a location with the intent that another person will involuntarily touch it commits malicious mischief, a class B misdemeanor. If the person knew or recklessly failed to know that the blood, urine, or waste was infected with HIV, it is a class D felony. If the person knew or recklessly failed to know that the waste was infected with HIV and the offense results in the transmission of HIV to the other person, it is a class B felony.

Ind. Code § 35-45-16-2(d)
Class A Misdemeanor, Class D Felony, Class B Felony
A person who recklessly, knowingly, or intentionally places human blood, body fluid, or fecal waste in a location with the intent that another person will ingest it commits malicious mischief with food, a class A misdemeanor. If the person knew or recklessly failed to know that the blood, fluid, or waste was infected with HIV, it is a class D felony. If the person knew or recklessly failed to know that the blood, fluid, or waste was infected with HIV and the offense results in the transmission of HIV to the other person, it is a class B felony.

Ind. Code Ann. §§ 16-41-7-1, 35-42-1-9
Class B Misdemeanor, Class D Felony
Persons who know of their status as a carrier of HIV must warn – or cause to be warned by a third party – any past, present, or planned future sexual or needle-sharing partners of the following: both the carrier’s disease status and the need to seek health care such as counseling and testing. This statute only applies to sexual or needle-sharing contact that has been demonstrated epidemiologically to transmit HIV. A person who recklessly violates or fails to comply with this law commits a Class B misdemeanor, and a person who knowingly or intentionally violates or fails to comply with this law commits a Class D felony.

Ind. Code § 16-41-14-17
Class C Felony, Class A Felony
A person who, for artificial insemination, recklessly, knowingly, or intentionally donates, sells, or transfers semen that contains HIV antibodies commits a Class C felony. The offense is a Class A felony if the offense results in the transmission of the virus to another person. (This does not apply to a person who transfers semen that contains HIV antibodies for research purposes.)
We would be happy to provide you with any statistics you need; however, we are unable to provide you with a statement.

Kenneth Severson
Media Relations Coordinator
Indiana State Department of Health
Iowa Iowa Code § 709C.1
Class B Felony
A person who knows that he or she is infected with HIV commits criminal transmission if he or she: (1) engages in intimate contact with another person; (2) transfers, donates, or provides blood, tissue, semen, organs, or other potentially infectious bodily fluids for administration (e.g., transfusion) to another person; or (3) in any way transfers to another person any nonsterile intravenous or intramuscular drug paraphernalia previously used by the person infected with HIV. “Intimate contact” means the intentional exposure of one person’s body to another person’s bodily fluid in a manner that could result in the transmission of HIV. The actual transmission of HIV is not a necessary element of this crime. It is an affirmative defense that the person exposed to HIV knew the other person had HIV, knew the action could result in the transmission of HIV, and consented to the action with that knowledge.
Our viewpoint is that the laws should be reviewed in the context of recent changes. We have a lot of new tools, and we think that we probably have enough tools now to change the course of the epidemic, but we need some help to do that, and we feel that the laws may be impeding what we’re trying to do in Iowa to address the HIV epidemic.

Randy Mayer
Chief, Bureau of HIV, STD, and Hepatitis
Iowa Department of Public Health
Kansas Kan. Stat. Ann. § 21-3435
Severity Level 7, Person Felony
It is unlawful for a person who knows he or she is infected with a life-threatening communicable disease knowingly to engage in sexual intercourse or sodomy with another individual, to sell or donate one’s blood, blood products, semen, tissue, organs, or other body fluids, or to share with another individual a hypodermic needle, syringe, or both with the intent to expose that individual to that life-threatening communicable disease. (HIV is not specified in the statute, but “communicable disease” is defined as a life-threatening disease or condition that is spread in the same ways as HIV – for example, sexual intercourse or needle sharing.)

Kan. Stat. Ann. § 65-6005
Class C Misdemeanor
A dental health care worker who is HIV positive or otherwise knows or should know that he or she is capable of transmitting HIV shall not perform or participate directly in an exposure-prone procedure unless counsel has been sought from an expert review panel.
It is the responsibility of KDHE to enforce those laws enacted by the Kansas Legislature, including KSA § 21-3435 and 65-6005. Therefore, the agency’s role is only to act as a regulator on these topics.

Aimee Rosenow
Public Information Officer
Kansas Department of Health and Environment
Kentucky Ky. Rev. Stat. § 311.990(24)(b)
Class D Felony
Any person infected with HIV – knowing that he or she is infected and having been informed of the possibility of communicating the infection by donating human organs, skin, or other human tissues – who donate organs, skin, or another human tissue is guilty of a class D felony.

Ky. Rev. Stat. § 529.090(3) & (4)
Class D Felony
Any person who commits, offers, agrees to commit, or procures another to commit prostitution by engaging in sexual activity in a manner likely to transmit HIV and who, before the commission of the crime, had tested positive for HIV and knew or had been informed that he or she had tested positive and could communicate the disease to another through sexual activity, is guilty of a class D felony.
Purely from a public health perspective, imposing harsher sentences on individuals with HIV or treating HIV-positive patients differently in the eyes of the law may impact the effectiveness of the Department for Public Health’s HIV prevention efforts.

DPH has done considerable outreach and education to de-stigmatize HIV, including:
  • Incorporating HIV testing as part of comprehensive services and events, including primary care and other general health services, general health fairs, community festivals, sporting events, other annual community events, community block parties, university clinic services, student orientation processes, etc.
  • Mandating training courses for law enforcement students and certified peace officers includes HIV education. The DPH HIV branch works with law enforcement trainers to ensure pertinent information, including HIV transmissibility and issues around HIV-related stigma and discrimination, are included.
  • Requiring HIV continuing education program for all healthcare professionals licensed in Kentucky. In addition to providing HIV treatment and care competency, the certification courses must address cultural competency, stigma, and discrimination issues related to HIV. The CEP Administrator conducts workshops at the annual conference for the Department of Corrections.
  • Conducting public awareness campaigns to promote testing and fight against HIV stigma and discrimination.
  • Participating in many community mobilization efforts through education and awareness events for the general population and key stakeholders. Conferences and meetings are also used for community mobilization, including the Kentucky Conference on HIV and Viral Hepatitis.

Jill Midkiff
Director of Communications
Kentucky Cabinet for Health and Family Services
Louisiana La. Rev. Stat. Ann. § 14:43.5
It is unlawful for any person to intentionally expose another to HIV through sexual contact or any contact (including spitting, biting, stabbing with an HIV-contaminated object, or throwing blood or other bodily substances) without the knowing and lawful consent of the victim. (If the victim is a police officer, and the offender has reasonable grounds to believe the victim is a police officer performing his or her duty, the fine can be not more than $6000, and imprisonment can be not more than 11 years or both.)
Having HIV is not a crime, but knowingly infecting others with HIV is. We work with community-based partners and other health professionals to educate the public about how to avoid contracting HIV and to help those living with HIV to manage their illness and live full lives.

Christina Stephens
Communications Director
Louisiana Department of Health and Hospitals
Maryland Md. Code Ann., Health-General § 18-601.1
Misdemeanor (punishable by a fine not exceeding $2,500 or imprisonment not exceeding 3 years, or both)
A person with HIV who knowingly transfers or attempts to transfer the virus to another individual is guilty of a misdemeanor.
It is not possible to quantify how HIV laws impact HIV transmission. Sound advice for everyone over age 13 is to get tested for HIV, get treatment if needed, and talk openly with families and partners about HIV.

Frances Phillips
Deputy Secretary for Public Health Services
Maryland Department of Health and Mental Hygiene
Michigan Mich. Comp. Laws § 333.5210
Felony
A person who knows he or she has HIV and who engages in sexual penetration with another person without informing that person of his or her HIV status is guilty of a felony. “Sexual penetration” means sexual intercourse, cunnilingus, fellatio, anal intercourse, or any other intrusion, however slight, of any part of a person’s body or any object into the genital or anal openings of another person’s body; emission of semen is not required.
Our first and foremost concern at the Michigan Department of Community Health is to protect every Michigander’s health, wellness, and safety, including those who are HIV-infected or at risk for infection. Under current Michigan law, it is a felony for an HIV-infected person to engage in sexual penetration without first informing the other person of the HIV infection. With that in mind, our goal is to educate Michiganders about their risks and the steps they can take to learn their status and receive testing and treatment as appropriate. We firmly believe that knowledge and education are crucial to protecting our residents’ health by encouraging them to learn their status.

Dr. Matthew Davis
Chief Medical Executive
Michigan Department of Community Health
Minnesota Minn. Stat. § 609.2241
Felony or Misdemeanor
A person who knowingly harbors an infectious agent commits a crime – which may be prosecuted as an assault, murder, attempted assault, or attempted murder – if the person transfers that infectious agent by: (1) sexual penetration with another person without having first informed the other person that the person has a communicable disease; (2) transfer of blood, sperm, organs or tissue (with some specified exceptions); or (3) sharing non-sterile syringes or needles to inject drugs. It is an affirmative defense that the infected person took practical means to prevent transmission as advised by a physician or other health professional or is a health care provider who was following professionally accepted infection control procedures. (HIV is not specified in the statute, but “communicable disease” is defined as a serious disease or condition that is spread in the same ways as HIV – for example, sexual intercourse or needle sharing.)
Any statement regarding the effect of the law on HIV treatment, HIV prevention, and stigma in Minnesota would be speculation, as the Minnesota Department of Health has not researched or studied the question.

Peter Carr
Section Manager, HIV/STDs
Minnesota Department of Health
Mississippi Miss. Code Ann. § 97-27-14(1)
Felony (punishable by a fine not exceeding $10,000 and imprisonment of 3 to 10 years, or both)
It shall be a felony for any person to knowingly expose another person to HIV. Prior knowledge and willing consent to the exposure is a defense to a charge brought under this statute.

Miss. Code Ann. § 97-27-14(2)
Felony (punishable by a fine not exceeding $10,000 and imprisonment of 3 to 10 years, or both)
It is a felony if a person attempts to cause or knowingly causes a corrections employee, a visitor to a correctional facility, or another prisoner or offender to come into contact with blood, seminal fluid, urine, feces, or saliva if the person knows that he or she is infected with HIV.
As a health agency for the state, our focus is on identifying people with HIV infection and getting them into the appropriate course of care and supplemental services they might need.

Dr. Nicholas Mosca
Director, STD/HIV Office
Mississippi State Department of Health
Missouri Mo. Rev. Stat. § 191.677
Class B Felony, Class A Felony
It is unlawful for a person knowingly infected with HIV to be (or attempt to be) a donor of blood, blood products, organs, sperm, or tissue, except as deemed necessary for medical research. It is also unlawful for a person knowingly infected with HIV to act recklessly by exposing another person to HIV without the knowledge and consent of that person in any of the following manners: (1) through contact with blood, semen, or vaginal secretions during oral, anal or vaginal sex, (2) by sharing needles, or (3) by biting another person or purposely doing anything else which causes the HIV infected person’s semen, vaginal secretions, or blood to come into contact with the mucous membranes or nonintact skin of another person. The use of a condom is not a defense. A violation of these provisions is a class B felony unless the victim contracts HIV from the contract, in which case it is a class A felony. (Statute provides examples of “reckless” conduct.)

Mo. Rev. Stat. § 565.085
Class C Felony
A prisoner (or a person otherwise in the custody of the department of corrections) who is knowingly infected with HIV commits a class C felony if he or she attempts to cause or knowingly causes a corrections employee, a visitor to a correctional facility, or another prisoner to come in contact with blood, saliva, seminal fluid, urine, or feces.

Mo. Rev. Stat. § 567.020
Class B Felony
Performing an act of prostitution, which is normally a class B misdemeanor, becomes a class B felony if the prostitute knew before performing the act of prostitution that he or she was infected with HIV. The use of a condom is not a defense.
This law was passed by the Missouri General Assembly in 1988, and the Department of Health and Senior Services provides information about Missouri Revised Statute 191.677 to clients to ensure that they are aware of state laws about their HIV status.

Ryan Hobart
Communications Director
Missouri Department of Health and Senior Services
Montana Mont. Code Ann. §§ 50-18-112, 50-18-113
Misdemeanor
A person infected with an STD (defined to include HIV in § 50-18-101) may not knowingly expose another person to infection.
At this time, we would not be interested in commenting.

Jon Ebelt
Public Information Officer
Montana Department of Public Health and Human Services
Nebraska Neb. Rev. Stat. § 28-934
Class IIIA Felony
Any person who knowingly and intentionally strikes any public safety officer with any bodily fluid is guilty of a Class IIIA felony if the person committing the offense strikes the eyes, mouth, or skin of a public safety officer and knew the source of the bodily fluid was infected with HIV, hepatitis B, or hepatitis C at the time the offense was committed.
The Nebraska HIV Prevention Program’s vision and mission are to lower HIV infection, illness, and death rates to result in healthier Nebraskans and to create an environment of leadership, partnership, and advocacy that fosters HIV prevention and the provision of services.

There are no requirements in this law specific to the Nebraska Department of Health and Human Services public health efforts around HIV prevention, testing, and treatment; therefore, the law has not affected the daily work we do with HIV.

Leah Bucco-White
Public Information Officer
Nebraska Department of Health and Human Services
Nevada Nev. Rev. Stat. § 201.205
Category B Felony (punishable by imprisonment for at least 2 years but not more than 10, or by a fine of not more than $10,000, or both)
A person who has received notice that he or she is HIV positive and who intentionally, knowingly, or willfully engages in conduct in a manner that is intended to or is likely to transmit the disease to another person is guilty of a category B felony. It is a defense that the person subject to exposure to HIV knew that the defendant was HIV positive, knew the conduct could result in exposure to HIV and consented to engage in that conduct.

Nev. Rev. Stat. § 441A.300
Sentence Enhancement
A person diagnosed with HIV who fails to comply with a written order of a health authority or who engages in behavior through which the disease may be spread to others is subject to confinement by order of a court, in addition to any other penalty imposed under state statute.

Nev. Rev. Stat. § 441A.180
Misdemeanor
A person who conducts himself or herself in any manner likely to expose others to a communicable disease in an infectious state or engages in any occupation in which such a disease will likely be transmitted to others after service upon him or her of a warning from a health authority, is guilty of a misdemeanor.

Nev. Rev. Stat. § 201.358
Class B Felony (punishable by 2 to 10 years imprisonment, or a fine of not more than $10,000, or both)
A person who works as a prostitute in a licensed house of prostitution after testing positive for HIV and after receiving notice of that fact is guilty of a category B felony.
According to the State Health Officer, Dr. Tracey Green, enforcement of criminal offenses is a law enforcement issue. The Health Division supports all patient rights. Our goal is to ensure all Nevadans are healthy and not discriminated against. Our goal is also to assist HIV/AIDS-positive Nevadans whenever possible. We also provide prevention outreach and education, including encouraging all Nevadans to get tested to know their status.

Martha Framed
Public Information Officer
Nevada State Health Division
New Jersey N.J. Stat. Ann. § 2C: 34-5
Crime of the Third Degree
A person is guilty of a crime of the third degree if, knowing that he or she is infected with HIV, he or she commits an act of sexual penetration without the informed consent of the other person.
New Jersey focuses on prevention and treatment for those who test positive. Early detection is key to getting into treatment, managing HIV, and having the best quality of life. Highly effective treatments can dramatically improve longevity and quality of life for those living with HIV. I encourage everyone to get tested and learn their status. More than 140 rapid HIV test sites are available around New Jersey. Approximately 100,000 HIV tests were performed at these sites last year. Testing sites include community-based organizations, hospitals, health departments, federally qualified health centers, and other health facilities that make getting tested easy and convenient. The U.S. Centers for Disease Control and Prevention recommends that all healthcare providers offer HIV testing to patients between the ages of 13 and 64 as part of routine medical care.

Donna Leusner
Director of Communications
New Jersey Department of Health
North Carolina N.C. Gen. Stat. Ann. § 130A-144
Misdemeanor (imprisonment for not more than 2 years)
All persons infected with HIV must comply with control measures for communicable diseases specified in the state administrative code, 10A NCAC 41A.0202(1). That section a) prohibits sexual intercourse without the use of condoms and requires the exercise of caution when using condoms due to possible condom failure; b) prohibits the sharing of needles, syringes, or any other drug-related equipment, paraphernalia, or works that may be contaminated with blood through previous use; c) prohibits the donation or sale of blood, plasma, platelets, other blood products, semen, ova, tissues, organs, or breast milk; d) requires a skin test for tuberculosis; e) requires the notification of future sexual intercourse partners of the infection; f) if the date of initial infection is known, requires the notification of persons who have been sexual intercourse and needle partners since the date of the infection; and, g) if the date of initial infection is unknown, requires the notification of persons who have been sexual intercourse and needle partners for the previous year. Violation of the control measures is a misdemeanor, and special provisions related to sentencing and release apply (see N.C. Gen. Stat. Ann. § 130A-25).
The law gives the authority to local health directors, not to NCDHHS.

The majority of HIV resources are used to assist people with HIV in getting the care they need. North Carolina recognizes that stigma can be a barrier to care for people living with HIV and makes many efforts at the state and local level to reduce stigma and increase the number of HIV-positive individuals in care, on treatment, and virally suppressed.

Julie Henry
Assistant Communications Director
North Carolina Department of Health and Human Services
North Dakota N.D. Cent. Code § 12.1-20-17
Class A Felony
Knowing that he or she has HIV, a person who willfully transfers any of his or her body fluid to another person is guilty of a class A felony. It is an affirmative defense that, if the transfer was by sexual activity, the activity took place between consenting adults after full disclosure of the risk of the activity and with the use of an appropriate prophylactic device. (“Body fluid” means semen, blood, or vaginal secretion. “Transfer” means to engage in sexual activity by genital-genital contact, oral-genital contact, or anal-genital contact, or to permit the reuse of a hypodermic syringe, needle, or similar device without sterilization.)
We do have a law on the books that states that it is unlawful to knowingly transfer bodily fluids that may contain HIV to another person without appropriately informing them that this is a risk to them.

When we have cases of HIV diagnosed here in the state, we provide services to each of those clients, informing them of the resources available here in North Dakota and also informing each of those persons about the law and what the law means, and how they can protect themselves from it.

We approach people living with HIV about the law to inform them that it exists, the implications, and their responsibility to protect themselves from it. Our laws are not such that spitting on somebody or salivary contact would bring criminal charges under that law – it does have to be semen, and blood – it is written such that it doesn’t open it up to a wide plethora of unsubstantiated things.

I don’t know why we needed the law first, but we’re doing our best to inform our HIV-positive people of it and provide the necessary resources to protect themselves and protect others and not get themselves into trouble.

Lindsey VanderBusch
HIV/STD/Hepatitis/TB Program Manager
North Dakota Department of Health
Ohio Ohio Rev. Code § 2903.11
Second Degree Felony, First Degree Felony
No person with knowledge that the person has tested positive for HIV shall knowingly do any of the following: (1) Engage in sexual conduct with another person without disclosing his or her HIV-positive status to the other person before engaging in the sexual conduct, (2) Engage in sexual conduct with a person whom the offender knows or has reasonable cause to believe lacks the mental capacity to appreciate the significance of the knowledge that the offender is HIV positive, or (3) Engage in sexual conduct with a person under 18 who is not the spouse of the offender. Violation of this provision is a felony of the second degree. If the victim is a peace officer or an investigator of the criminal identification and investigation bureau, it is a felony in the first degree. (“Sexual conduct” is defined in § 2903.11(E)(4) and § 2907.01 and includes anal intercourse, vaginal intercourse, fellatio, cunnilingus, or the insertion, however slight, of any part of the body into the anal or vaginal opening of another.)

Ohio Rev. Code §§ 2907.24, 2907.25
Third Degree Felony
No person with knowledge that the person has tested positive for HIV shall engage in, or solicit another person to engage in, sexual activity for hire.

Ohio Rev. Code § 2907.241
Fifth Degree Felony
A person who commits “loitering to engage in solicitation” commits a fifth-degree felony if the person commits the offense with the knowledge that he or she has tested positive for HIV.

Ohio Rev. Code § 2921.38
Third Degree Felony
No person with knowledge that the person is HIV positive and with intent to harass, annoy, threaten, or alarm another person, shall cause or attempt to cause the other person to come into contact with blood, semen, urine, feces, or another bodily substance by throwing the bodily substance at the other person, by expelling it upon the other person, or in any other manner. (Section does not apply to persons in a mental health or developmental disabilities department facility.)

Ohio Rev. Code § 2927.13
Fourth Degree Felony
No person with knowledge that he or she is HIV positive shall sell or donate his/her blood, plasma, or a product of his/her blood if he or she knows or should know the blood, plasma, or product of his/her blood is being accepted for transfusion to another individual.
The Ohio Department of Health is aware of the concerns raised by some about criminal statutes related to HIV transmissions. The mission of the Ohio Department of Health is to protect and improve the health of all Ohioans and does not directly comment on criminal matters. Therefore, we defer to other Ohio entities to comment on these statutes’ overall benefit to society.

Tessie Pollock
Public Information Officer
Ohio Department of Health
Oklahoma Okla. Stat. tit. 21, § 1031
Felony (punishable by imprisonment for not more than five years)
Any person who engages in prostitution with the knowledge that he or she is infected with HIV shall be guilty of a felony.

Okla. Stat. tit. 21, § 1192.1
Felony (punishable by imprisonment for not more than five years)
It shall be unlawful for any person – knowing he or she has HIV and with intent to infect another – to engage in conduct reasonably likely to result in the transfer of the person’s blood, bodily fluids containing visible blood, semen, or vaginal secretions into the bloodstream of another, or through the skin or other membranes of another person, except during in utero transmission of blood or bodily fluids, if the other person did not consent to the transfer or consented without first having been informed that the offender had HIV.

Okla. Stat. tit. 63, § 1-519
Felony
It is a felony for any person, after becoming infected with a venereal disease and before being pronounced cured by a physician in writing, to marry any other person or to expose any other person by the act of copulation or sexual intercourse to such venereal disease or liability to contract the venereal disease. (“Venereal disease” is defined as diseases that may be transmitted from one person to another through or by sexual intercourse and found and declared by medical science or accredited schools of medicine to be infectious or contagious, § 1-517.)
The Oklahoma State Department of Health does not have criminal enforcement capabilities, and thus we cannot comment specifically on this statute’s enforcement. Enforcement would be provided through county District Attorneys as well as the State Attorney General.

Leslea Bennet-Webb
Director of Communications
Oklahoma State Department of Health
Pennsylvania 18 Pa. Cons. Stat. Ann. § 2703
Second Degree Felony
A person who is confined in or committed to any jail, prison, or correctional or penal institution is guilty of a felony of the second degree if he or she, while so confined (or being transported to or from such a facility), intentionally or knowingly causes another to come into contact with blood, seminal fluid, saliva, urine or feces by throwing, tossing, spitting or expelling such fluid or material when, at the time of the offense, the person knew, had reason to know or should have known or believed that such fluid or material was infected with HIV.

18 Pa. Cons. Stat. Ann. § 2704
Felony (penalty shall be the same as the penalty for the murder of the second degree)
If a person sentenced to death or life imprisonment intentionally or knowingly causes another to come into contact with blood, seminal fluid, saliva, urine, or feces by throwing, tossing, spitting, or expelling such fluid or material when, at the time of the offense, the person knew, had reason to know, or should have known or believed that the fluid or material was infected with HIV, then the person is guilty of a crime.

18 Pa. Cons. Stat. Ann. § 5902
Third Degree Felony
It is a felony of the third degree for a person to commit prostitution knowing he or she is HIV positive; to knowingly promote the prostitution of one who is HIV positive; or, if the person knows him or herself to be HIV positive, to patronize a prostitute.
There are existing laws in Pennsylvania that we are currently obligated to follow, and we are not aware of any current efforts to revise them.

Christine Conkright
Director of Communications
Pennsylvania Department of Health
Rhode Island R.I. Gen. Laws 1956 § 23-11-1
Punishable by a fine of not more than $100 or imprisonment for not more than three months.
It shall be unlawful for anyone knowingly to expose another person to infection while in the infectious condition with a sexually transmitted disease.
We don’t have a particular position on the law, as we don’t have any evidence that it has an impact on HIV prevention or treatment. We do have evidence that education, confidential and anonymous HIV testing, and prompt connection to care for people who are HIV positive are highly effective strategies for preventing the spread of HIV.

Dr. Michael Fine
Director of Health
Rhode Island Department of Health
South Carolina S.C. Code Ann. § 44-29-145
Felony (punishable by a fine of not more than $5000 or imprisonment for not more than 10 years)
It is unlawful for a person who knows he or she is infected with HIV to (1) knowingly engage in sexual intercourse (vaginal, anal, or oral) with another person without first informing that person of his HIV infection; (2) knowingly commit an act of prostitution with another person; (3) knowingly sell or donate blood, blood products, semen, tissue, organs, or other body fluids; (4) forcibly engage in sexual intercourse (vaginal, anal or oral) without the consent of the other person, including one’s legal spouse; or (5) knowingly share with another person a hypodermic needle/syringe without first informing that person that the needle or syringe has been used by someone infected with HIV.

S.C. Code Ann. §§ 44-29-60, 44-29-140
Misdemeanor (punishable by a fine of not more than $200 or imprisonment for not more than 30 days)
It is unlawful for anyone infected with an STD included in the annual SC Dep’t of Health and Environmental Control List of Reportable Diseases to knowingly expose another to infection.
First of all, it is important to remember a significant mission statement that appears on our agency’s website at http://www.scdhec.gov/health/disease/stdhiv/ that reads: “DHEC provides services to prevent the spread of sexually transmitted diseases (STDs) and HIV infection, to reduce associated illness and death, and to provide care and support resources for persons with HIV disease.”

Our agency aims to reduce the spread of these illnesses as much as possible, offer assistance, guidance, and helpful resources, as well as treatment to those who contract these illnesses, and protect them to the best of our ability under the laws of the state. Of course, federal privacy laws also guide us on the type of personal health-related information that can be released to anyone. We partner with numerous non-governmental organizations to help provide the necessary disease and treatment information, as well as support for these individuals.

DHEC has received requests, court orders, and subpoenas for records protected by S.C. law.

DHEC does not release these records in the absence of authorization or compliance with the requirements of Section 44-29-136. Depending on the legal process used, DHEC may file a motion to quash a subpoena, move to set aside a court order, request a hearing, or file for supersedeas.

DHEC has one of the most stringent privacy laws affecting HIV/STD information and records. Compliance with this law is of paramount importance to our agency.

DHEC has no authority to enforce criminal laws; our state’s Solicitors have that responsibility.

The SC Legislature determines the criminal penalty associated with a specific violation of the law. Such penalties are not determined by our agency.

Jim Beasley
Public Information Director
South Carolina Department of Health and Environmental Control

South Dakota S.D. Codified Laws §§ 22-18-31, 22-18-33, 22-18-34
Class 3 Felony
It is unlawful for any person, knowing him/herself to be infected with HIV, to intentionally expose another person to infection by: (1) engaging in sexual intercourse or another intimate physical contact with another person; (2) transferring, donating, or providing blood, tissue, semen, organs or other potentially infectious body fluids or parts for administration to another person in any manner that presents a significant risk of HIV infection; (3) transferring in any way to another person any nonsterile intravenous or intramuscular drug paraphernalia that has been contaminated by him/herself; or (4) causing blood or semen to come in contact with another person to expose that person to HIV infection. The actual transmission of HIV is not a required element of this offense. It is an affirmative defense if proven by a preponderance of the evidence that the person exposed to HIV knew the infected person was infected with HIV, knew the action could result in infection with HIV and gave advance consent to the action with that knowledge.
My apologies. I thought [Health] Secretary [Doneen] Hollingsworth’s office had already indicated she would not be commenting.

Barb Buhler
Public Information Officer
South Dakota Department of Health
Tennessee Tenn. Code Ann. § 39-13-109
Class A Misdemeanor, Class C Felony
It is unlawful for a person, knowing that he or she is infected with HIV, hepatitis B, or hepatitis C, to knowingly: (1) engage in intimate contact with another; (2) transfer, donate or provide any potentially infectious body fluid or part for administration to another person in any manner that presents a significant risk of transmission; or (3) transfer in any way to another any nonsterile intravenous or intramuscular drug paraphernalia. “Intimate contact with another” means the exposure of one person’s body to another person’s bodily fluid in any manner that presents a significant risk of transmission. It is an affirmative defense if proven by a preponderance of the evidence that the person exposed to HIV, hepatitis B, or hepatitis C knew the infected person was infected, knew the action could result in infection, and gave advance consent to the action with that knowledge. Transmission is not a required element of this offense. Criminal exposure to HIV is a Class C felony. Criminal exposure to hepatitis B or hepatitis C is a Class A misdemeanor.

Tenn. Code Ann. § 39-13-516
Class C Felony
A person commits aggravated prostitution when, knowing that such person is infected with HIV, the person engages in sexual activity in a business or a house of prostitution or loiters in a public place to be hired to engage in sexual activity.

Tenn. Code Ann. § 39-13-108
Class E Felony
A person who intentionally escapes from a secure facility commits a Class E felony if the person was quarantined or isolated in that facility because he or she poses a direct threat of significant risk to the health and safety of the public regarding the transmission of HIV

Tenn. Code Ann. § 40-35-114(21)
Sentence enhancement
If a defendant is convicted of the offense of aggravated rape (§ 39-13-503), sexual battery (§ 39-13-505), rape of a child (§ 39-13-522), or statutory rape (§ 39-13-506), and the defendant knew or should have known that, at the time of the offense, the defendant was HIV-positive, the court shall consider this as an advisory factor in determining whether to enhance the defendant’s sentence.

Tenn. Code Ann. § 68-10-107, 68-10-101, 68-10-111
Class C Misdemeanor
It is unlawful for any person infected with an STD to expose another person to such infection.
Thank you for the information you provided and for your efforts to increase public awareness about the continuing importance of HIV/AIDS prevention and treatment. Both are priorities for TDH as we seek to address population health issues in our state.

A common thread among individuals who serve the public in our health departments is a commitment to compassionate care for every patient. We have several HIV/AIDS prevention initiatives in place, and we offer a variety of counseling and treatment services to those affected by HIV/AIDS.

The Tennessee statute regarding the criminal transmission of HIV/AIDS is not administered by our department, and we have no information or details about the nature of any arrests. We don’t know if the cases cited in your email refer to an individual defendant, an individual contact event, an individual victim, or something else altogether.

This case from a few years ago demonstrates the difficulty: http://www.johnsoncitypress.com/News/article.php?id=90793

One defendant, three alleged victims, and five alleged occurrences.

If a case is a “count” in an indictment, this single defendant accounts for five potential cases, or one-tenth of the fifty total cases referred to in the report. Likewise, a single prostitute with multiple arrests and charges could represent a substantial percentage of the total cases in the state during that period.

None of this gives us any particular reason to conclude Tennessee’s law about criminal charges has or has not discouraged patients from seeking treatments at the health departments or elsewhere. It is important to note that TDH respects patient records’ confidentiality and does not report HIV/AIDS cases to legal authorities.

Woody McMillin
Communications and Media Relations Director
Tennessee Department of Health
Utah Utah Code Ann. § 76-10-1309
Third Degree Felony (Enhanced Penalty)
A person who is convicted of prostitution, patronizing a prostitute, or sexual solicitation is guilty of a third-degree felony if he or she: (1) is HIV positive, (2) has actual knowledge of his or her HIV-positive status, and (3) has received written personal notice of the positive test result from a law enforcement agency.

Utah Code Ann. § 76-5-102.6
Third Degree Felony
Any prisoner or person detained who knows he or she has HIV commits a third-degree felony if he or she throws or otherwise propels his or her saliva, blood, urine, or fecal material at peace or correctional officer and it comes into contact with any portion of the officer’s face (including the eyes or mouth) or comes into contact with any open wound on the officer’s body.
We don’t have an opinion on the controversy right now. As of right now, we don’t have any plans to change the laws. [It’s] something that, if we wanted to enforce or do, we would have to have some increased funding, which appears to be a big issue right now, especially for lower incidence states.

Lynn Minor
Program Manager
Communicable Disease Prevention Program
Utah Department of Health
Virginia Va. Code Ann. § 18.2-67.4:1(A)
Class 6 Felony
Any person who, knowing he or she is infected with HIV, has sexual intercourse, cunnilingus, fellatio, “analingus,” or anal intercourse with the intent to transmit the infection to another person shall be guilty of a class 6 felony.

Va. Code Ann. § 18.2-67.4:1(B)
Class 1 Misdemeanor
Any person who, knowing he or she is infected with HIV, has sexual intercourse, cunnilingus, fellatio, “analingus,” or anal intercourse without having previously disclosed the existence of his or her HIV infection to the other person shall be guilty of a class 1 misdemeanor.

Va. Code Ann. § 32.1-289.2
Class 6 Felony
Any person who donates or sells attempts to donate or sell, or consents to the donation or sale of blood, other body fluids, organs, or tissues, knowing that the donor is or was infected with HIV and having been instructed that such material may transmit HIV infection, is guilty of a class 6 felony. (Does not apply to the donation of infected blood, other body fluids, organs or tissues, or body parts for use in medical or scientific research.)
The Virginia Department of Health prioritizes ensuring people diagnosed with sexually transmitted infections such as HIV and syphilis receive individualized counseling and referrals. These interventions focus on preventing the transmission of infections by helping the individual reduce risk behaviors and obtain medical treatment. Our disease investigation specialists are trained to educate clients about the statutes, if necessary, but the existence of the statutes does not affect our prevention, diagnosis, and treatment efforts.

Dr. David Trump
State Epidemiologist
Virginia Department of Health
Washington Wash. Rev. Code Ann. § 9A.36.011
Class A Felony
A person is guilty of assault in the first degree if he or she, with intent to inflict great bodily harm, administers, exposes, or transmits to or causes to be taken by another HIV.
The Washington State Department of Health supports public health approaches to screening for, preventing, and treating HIV and is interested in reviewing and discussing HIV criminal statutes. We understand there are many perspectives to be considered. Yet we believe it is time to look at the effectiveness of such laws, given current knowledge and understanding of HIV transmission and treatment, which have advanced a lot since most of those HIV laws were written. Laws must be grounded in public health science and avoid increasing stigma and discrimination.

Donn Moyer
Media Relations Manager
Washington Department of Health
Wisconsin Wis. Stat. § 973.017(4)
Sentence Enhancement
When making a sentencing decision concerning a person convicted of a serious sex crime, the court shall consider as an aggravating factor the fact that the crime was committed under all of the following circumstances: (1) the person being sentenced had HIV, (2) he or she knew he or she had HIV, and (3) the victim of the crime was significantly exposed to HIV by the acts constituting the serious sex crime. (“Significantly exposed”l; is defined in the statute.)
The Department has no Wisconsin data on which to base any comments on whether this statute has had any “effect on HIV treatment, prevention, and stigma.” Therefore, we are not in a position to provide a comment on your story.

Stephanie Smiley
Communications Director
Wisconsin Department of Health Services

 

LEGAL PROTECTIONS FOR THE  HIV-INFECTED PERSONS

The Americans with Disabilities Act (ADA) gives federal civil rights protections to individuals who are diagnosed with HIV/AIDS. Persons with HIV, symptomatic and asymptomatic, are protected by law against discrimination and entitled to equal opportunity in public accommodations, employment, and transportation. Additionally, the ADA protects individuals who are discriminated against because they associate with an HIV-infected person.

This protection prohibits all private employers with 15 or more employees and all public entities, regardless of their size, from discriminating in employment against qualified individuals with disabilities. This includes hiring, firing, job application procedures such as interviewing, job assignments, training, promotions, wages, benefits, leave, and all other employment-related activities. An example of this protection could include a hospital that discharged a mental health technician due to their HIV-positive status. Customer or co-worker attitudes do not constitute just cause for discharge.

The ADA mandates that an employer may not ask or require a job applicant to take a medical examination before making a job offer. It cannot make any pre-offer inquiry about a disability or the nature or severity of a disability. An employer may inquire as to whether a candidate can perform the duties of the job.

The ADA requires that medical information be kept confidential. Medical information must be kept in a separate file apart from an individual’s personnel file. All licensing boards have very strict guidelines for the maintenance of client files. Most require that client files be maintained in a locked file cabinet in a locked room. Only authorized staff is allowed to review charts. Again, it is stressed that the confidentiality policy is best defined in informed consent.

Public accommodation is also a legally protected issue. Public accommodation relates to a private entity that owns, operates, leases, or leases to a place of public accommodation. This would include places such as restaurants, shopping malls, medical practices, and others.

 

POST-EXPOSURE TO BBP

Although not a primary means of HIV transmission, occupational exposure to HIV has resulted in documented cases of HIV seroconversion among healthcare workers in the United States.

Although, as discussed in the prevention section of this course, preventing exposures to blood and body fluids is the primary means of preventing occupationally acquired HIV infection, it is also appropriate to look at post-exposure management as an important element of workplace safety.

If you experienced a needlestick or sharps injury or were exposed to the blood or other body fluid of a patient during your work, immediately follow these steps:

  • Wash needle sticks and cuts with soap and water

  • Flush splashes to the nose, mouth, or skin with water

  • Irrigate eyes with clean water, saline, or sterile irrigants

  • Report the incident to your supervisor

  • Immediately seek medical treatment

Any incident of exposure should be reported to your supervisor immediately.

 

 

References  

  1. AJ, Cambiano V, Bruun T, Vernazza P, Collins S, Degen O, et al. (June 2019). “Risk of HIV transmission through condomless sex in zero different gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study.” Lancet393 (10189): 2428–2438. doi:10.1016/S0140-6736(19)30418-0. PMC 6584382PMID 31056293.
  2. Eisinger RW, Dieffenbach CW, Fauci AS (February 2019). “HIV Viral Load and Transmissibility of HIV Infection: Undetectable Equals Untransmittable.” JAMA321 (5): 451–452. doi:10.1001/jama.2018.21167. PMID 30629090S2CID 58599661.
    Haedicke J, Brown C, Naghavi MH (August 2009). “The brain-specific factor FEZ1 is a determinant of neuronal susceptibility to HIV-1 infection”. Proceedings of the National Academy of Sciences106 (33): 14040–14045. Bibcode:2009PNAS..10614040H. doi:10.1073/pnas.0900502106PMC 2729016PMID 19667186.
  3. Weiss RA (May 1993). “How does HIV cause AIDS?”. Science260 (5112): 1273–9. Bibcode:1993Sci…260.1273W. doi:10.1126/science.8493571. PMID 8493571.
  4. Powell MK, Benková K, Selinger P, Dogoši M, Kinkorová Luňáčková I, Koutníková H, Laštíková J, Roubíčková A, Špůrková Z, Laclová L, Eis V, Šach J, Heneberg P (2016). “Opportunistic Infections in HIV-Infected Patients Differ Strongly in Frequencies and Spectra between Patients with Low CD4+ Cell Counts Examined Postmortem and Compensated Patients Examined Antemortem Irrespective of the HAART Era”. PLOS ONE11 (9): e0162704. Bibcode:2016PLoSO..1162704P. doi:10.1371/journal.pone.0162704. PMC 5017746. PMID 27611681.
  5. Rodger, A. (for the PARTNER study group) (July 2018). Risk of HIV transmission through condomless sex in MSM couples with suppressive ART: The PARTNER2 Study extended results in gay men. AIDS2018: 22nd International AIDS Conference.

 

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