Background In the context of routine medical care, health care providers (HCPs) may uncover that a known and appropriately counseled HIV-infected patient is intentionally exposing sexual contacts to HIV. Some nondisclosing infectors (NDIs) are habitual (HNDIs). In Louisiana, intentional sexual exposure of HIV without disclosing and obtaining consent is a felony. During routine care, we became aware of at least 5 women in our viral diseases clinic who became infected with HIV by two known HNDIs. The infected victims were counseled on existence of the crime committed against them, yet none wished to prosecute.
Purpose To determine HCPs' legal obligations and options in regard to reporting NDIs to law enforcement authorities.
Methods The Louisiana criminal code was researched to reveal all laws pertaining to confidential HIV testing and disclosure and requirements for HCP mandatory reporting of potential crimes. The city police and district attorneys' office were interviewed to clarify the current criminal statutes.
Summary Strict laws specifically detail circumstances where HCPs can disclose HIV test results to at-risk contacts (eg, spouses) yet prohibit HCP disclosure to law enforcement agencies except in compliance with a court order. Hence, enforcement of the intentional exposure law requires the victims to inform on their NDI. Louisiana state law mandates HCPs report gun shot wounds (GSW); burns in the setting of suspected arson; physical or sexual abuse or neglect of children, elderly, or disabled; and infections due to agents of bioterrorism to the appropriate agency in order to protect public health. Futhermore, affected patients are exempt from physician-patient privilege and failure of HCPs to report GSW, abuse, or bioterrorism is a misdemeanor crime. Yet when it comes to NDIs, HCPs have no legal recourse.
Conclusions The public health can suffer greatly from actions of nondisclosing infectors of HIV (actions that have already been deemed criminal). Although a patient's right to privacy is a very serious matter, sometimes sacrifice of confidentiality is warranted to protect society.
Recommendation A change in our criminal statutes should be considered to release HCPs from physician-patient privilege and mandate report of this felony to law enforcement.
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