This study aims to identify where and how the criminalization of HIV exposure has influenced health department policies, protocols, programs, and procedures, both formal and informal, involving staff interactions with persons who have or are at increased risk of contracting HIV. It will also examine how staff members at various levels within public health departments resolve (or leave unresolved) the tensions between criminal law, public health authority, and patient-centered care when considering the prospect of an HIV-positive client knowingly exposing others to HIV.
Criminal law and public health have markedly different—at times mutually exclusive—philosophies and approaches to HIV prevention. Attempts of public health personnel to anticipate and accommodate the demands of the criminal law (or their perceptions of the demands of the criminal law) create a significant potential for public health goals and activities to be compromised. On the other hand, health department decision-makers may avoid taking action that is within their power because they fear legal liability. Both responses could result in persons choosing not to be tested, individuals who have HIV remaining unaware of their infection, and onward transmission occurring that could have been prevented. After a review of the literature, the investigators found that there has never been a study that addresses even the most basic questions about the criminalization of HIV exposure and public health departments.