Early detection of HIV: assessing the legislative context

Early detection of HIV has important implications for both prevention and treatment. Promoting HIV testing, and thereby early detection, however, is a complicated task that must balance the interests of public health, personal privacy, and legislative efforts to curb transmission. This article assesses the legislative context within which public health officials must operate to promote early HIV identification. Specifically, the article reviews United States laws regarding HIV testing passed over the course of 3 years, 1997 to 1999, at the state-not the federal-level. The new laws demonstrate such major themes as limiting confidentiality of HIV test results, mandating name-based HIV reporting, partner notification and newborn testing, and criminalizing nondisclosure of HIV status in sexual and needle-sharing situations. The article evaluates these new laws and their potentially negative impact on early detection, and assesses implications for practices such as informed consent for HIV testing. Outcome evaluations of newly implemented state laws are recommended. Policy makers must be aware that these policy changes can either encourage or discourage HIV testing.