HIV criminalization laws
HIV criminalization laws impose penalties on people living with HIV (PLWH) for actual or perceived HIV exposure or transmission to others. These laws criminalize engaging in sexual activity, exchanging bodily fluid, needle sharing, or blood/organ donation without disclosing known HIV status, often regardless of any intent to harm. Most states with these types of HIV laws criminalize non-disclosure behaviors regardless of whether the virus is actually transmitted to another individual. Some states also have laws that increase penalties for PLWH who are convicted of other offenses such as prostitution or solicitation. There is no federal law criminalizing HIV exposure and transmission1, 2, 3.
What does the research say about effectiveness?
There is strong evidence that HIV criminalization laws do not prevent HIV transmission or reduce risky sexual behaviors4, 5, 6. Laws that criminalize HIV pose a barrier to HIV prevention and treatment by discouraging people living with HIV (PLWH) and individuals at high risk from getting tested and seeking treatment7, 8.
HIV criminalization laws are linked to a reduced likelihood of seeking treatment among PLWH7 and HIV testing among men having sex with men (MSM)8. In states with HIV criminalization laws, frequent media reporting on criminalization of HIV exposure is associated with decreases in the number of people getting tested5. Public health experts argue that the fear created by HIV criminalization leads to delayed testing, increasing the number of individuals who are HIV positive but unaware of their health status and missing timely treatment5. In California, reform of HIV criminalization laws (i.e., criminal charges only for actual transmission or specific intent to transmit the disease) increased HIV testing among individuals who engage in behaviors with high risk of getting or transmitting HIV4.
HIV criminalization laws do not appear to affect beliefs about risky sexual behaviors (e.g., unprotected sex or not disclosing HIV status to a partner) among PLWH and individuals at high risk of HIV6, and awareness of the laws is not associated with a reduction in risky sexual behavior9. PLWH are less likely to disclose HIV status to partners in states with strict HIV criminalization laws and more aggressive prosecutions than in states with less strict HIV criminalization laws3.
HIV criminalization laws increase stigma (e.g., being treated as a sex offender) and discrimination toward PLWH10, 11, 12, 13, 14 and undermine their health and safety13, 15, 16; such harm caused by the laws often outweighs intended public health benefits for PLWH17. A national survey of PLWH suggests HIV criminalization laws decrease trust in public health officials14. Black MSM living in states with HIV criminalization laws report higher levels of stigma and discrimination from communities compared to Black MSM in states without the laws18. HIV criminalization laws may increase stigma toward PLWH involved in the justice system10 and endanger the health and safety of survivors of intimate partner violence who live with HIV16. Experience of HIV stigma can lead to poorer health outcomes and reduced engagement in medical treatment19.
In the U.S., state HIV criminalization laws were enacted mostly during 1980s and 1990s, and they do not reflect current biomedical advancements that enable treatment and prevention of transmission of HIV20, 21. For example, sexual HIV transmission risk is very low for PLWH who are treated with antiretroviral therapy22, 23. Experts and researchers indicate that many behaviors HIV laws charge criminal offenses for (e.g., being exposed to spitting) have zero risk of HIV transmission13, 21, 24, 25, 26.
Experts and researchers recommend repealing or modernizing HIV criminalization laws to reflect current science and medical advancements, substantially limiting HIV-related prosecution, and enacting laws that protect the human rights of PLWH27. Other recommendations include implementing programs that help PLWH share their status with their partners and families and provide counseling28; training and education of judges, prosecutors, and law enforcement on HIV transmission risk and negative impact on PLWH27; engaging nurse practitioners for HIV-related policy change and advocacy29; and campaigns for HIV law reform30. Researchers also recommend a multicomponent approach of education, community engagement, counseling, supportive groups, and HIV specialists to effectively reduce internalized HIV-related stigma and discrimination in healthcare settings12.
States with HIV criminalization laws tend to have higher HIV incidence rates31, larger Black populations32, and greater structural stigma related to sexual orientation33.
How could this strategy advance health equity? This strategy is rated potential to increase disparities: supported by strong evidence.
There is strong evidence that HIV criminalization laws increase disparities in arrest and prosecution for people living with HIV (PLWH), particularly for individuals from racially minoritized backgrounds, women, and LGBTQ+ communities13, 36, 37, 38. Other groups disproportionally charged and convicted under HIV criminalization laws include sex workers, immigrants, and Indigenous populations36, 37, 38.
In the U.S., HIV criminalization laws disproportionately affect sexual and gender minorities and individuals from racially minoritized backgrounds39, 40, 41, 42, including women43 and queer and transgender individuals who are Black44. For example, women and individuals who are Black are over-represented in HIV-related arrests in Ohio41. In California, individuals living with HIV who are Black, Hispanic, or female are over-represented in those who had contact with the criminal justice system; they are also less likely to be released without charges compared to men living with HIV who are white45. A Michigan-based study of HIV-specific criminal convictions indicates that women who are white and men who are Black with female partners are at the greatest risk of conviction46.
HIV criminalization laws increase the risk of deportation for immigrants47. Additionally, men who have sex with men (MSM) who are Black and live in states with HIV criminalization laws are more likely to experience discrimination and stigma from their communities compared to those who are white, and compared to MSM who are Black and live in states without HIV laws18.
What is the relevant historical background?
When the AIDS epidemic began in the U.S., federal response was slow to acknowledge and respond, in part because AIDS primarily affected gay men in a time when many states still criminalized homosexuality. While the first case of HIV/AIDS in the U.S. was reported in 198148, 49, major federal funding wasn’t allocated until 198549.
Starting with New Jersey, public fear of HIV led many states to establish HIV criminalization laws in the 1980s and 1990s, long before pharmaceuticals were available to treat or prevent transmission2, 50, 51. The Ryan White CARE Act in 1990 forced all U.S. states to prove they had a legal proceeding to prosecute people living with HIV (PLWH) who may expose others to HIV, in order to qualify for federal funding2. Supporters of HIV criminalization have claimed that such criminalization laws can deliver a clear message to PLWH about what is right and wrong and can make them change their risky behaviors6. Opponents of HIV criminalization have made efforts to educate lawmakers and advocates about how HIV is transmitted and how the laws do not reflect current science (e.g., low transmission risk of behaviors and the development of effective treatment), along with stigma and discrimination for PLWH52, 53.
Experts and researchers emphasize the importance of social and structural interventions for HIV prevention, such as increasing access to HIV testing, removal of legal barriers to safer injection practices, health care coverage, stable housing, and education to better train individuals like police officers54, 55. In 2018, $19 billion in federal funds allocated to U.S. cities for local public health efforts prevented 57,000 deaths from HIV/AIDS56.
Equity Considerations
- Does your state have HIV criminalization laws? If yes, how many people living with HIV have been prosecuted so far? Which groups are disproportionately affected?
- What training and public education are available for law enforcement, judges, and the public to address stigma and biases toward people living with HIV in your state? Are there resources and/or funding to protect the rights of PLWH, support treatment, and ensure they live full lives?
- Who are your key partners for repealing or modernizing HIV criminalization laws in your state? How can public health departments, community organizations, legislators, and people living with HIV work together to drive these reforms?
Implementation Examples
As of November 2025, 32 states have laws that impose criminal penalties on people living with HIV (PLWH) for actual or perceived HIV exposure and/or transmission. Fourteen states criminalize blood or organ donation by PLWH. Ten states impose heightened criminal penalties on PLWH who engage in sex work, and 11 states impose longer sentences for PLWH who are accused of violating a general criminal law34.
More than ten states have repealed or modified their HIV criminalization laws. Texas (in 1994), Illinois (2021), New Jersey (2022), North Dakota (2025), and Maryland (2025) repealed laws that exclusively and solely criminalized HIV. Five states (Iowa, California, Washington, Nevada, and Georgia) have modified their laws to focus exclusively on intentional transmission for HIV transmission offenses35.
Implementation Resources
‡ Resources with a focus on equity.
CHLP-Toolkit‡ - The Center for HIV Law and Policy (CHLP). (2013). A toolkit for community advocates, volume 3.
CHLP-PJP‡ - Positive Justice Project (PJP) Steering Committee. (2015). Guiding principles for eliminating disease-specific criminal laws. The Center for HIV Law and Policy (CHLP).
HIV Justice Academy-Resource‡ - HIV Justice Academy. (2026). Resource library. Retrieved March 21, 2026.
Footnotes
* Journal subscription may be required for access.
1 CDC HIV-Exposure - Centers for Disease Control and Prevention (CDC). (2023, March 3). HIV and STD criminalization laws. Retrieved April 7, 2026.
2 Harsono 2017 - Harsono, D., Galletly, C. L., O'Keefe, E., & Lazzarini, Z. (2017). Criminalization of HIV exposure: A review of empirical studies in the United States. AIDS and Behavior, 21(1), 27–50.
3 NBER-Delavande 2007 - Delavande, A., Goldman, D., & Sood, N. (2007). Criminal prosecution and HIV-related risky behavior. NBER Working Paper 12903.
4 Keralis 2024 - Keralis, J. M., Bourbeau, A., Delaney, K. P., Odunsi, S., & Valentine, S. S. (2024). HIV: California's 2018 criminalization reform and testing among those reporting risk behavior. Journal of Public Health Policy, 45(4), 673-686.
5 Lee 2014 - Lee, S. G. (2014). Criminal law and HIV testing: Empirical analysis of how at-risk individuals respond to the law. Yale Journal of Health Policy, Law, and Ethics, 14(1), 194-238.
6 Burris 2007 - Burris, S., Beletsky, L., Burleson, J. A., Case, P., & Lazzarini, Z. (2007). Do criminal laws influence HIV risk behavior? An empirical trial. Arizona State Law Journal, Temple University Legal Studies Research Paper No. 2007-03.
7 Bonett 2020 - Bonett, S., Meanley, S., Elsesser, S., & Bauermeister, J. (2020). State-level discrimination policies and HIV pre-exposure prophylaxis adoption efforts in the U.S. Health Affairs, 39(9), 1575-1582.
8 Dibble 2022 - Dibble, K. E., Murray, S. M., Wiginton, J. M., Maksut, J. L., Lyons, C. E., Aggarwal, R., Augustinavicius, J. L., Al-Tayyib, A., Sey, E. K., Ma, Y., Flynn, C., German, D., Higgins, E., Anderson, B. J., Menza, T. W., Orellana, E. R., Flynn, A. B., Wermuth, P. P., Kienzle, J., … Baral, S. D. (2022). Associations between HIV testing and multilevel stigmas among gay men and other men who have sex with men in nine urban centers across the United States. BMC Health Services Research, 22, 1179.
9 Galletly 2012 - Galletly, C. L., Pinkerton, S. D., & DiFranceisco, W. (2012). A quantitative study of Michigan's criminal HIV exposure law. AIDS Care, 24(2), 174-179.
10 Sykes 2016 - Sykes, B. L., Hoppe, T. A., & Maziarka, K. D. (2016). Cruel intentions? HIV prevalence and criminalization during an age of mass incarceration, U.S. 1999 to 2012. Medicine, 95(16), e3352.
11 Fulham 2025 - Fulham, K. (2025, October). Punishment without principle: HIV criminalization and the sex offender registry. Brooklyn Law School, Research paper, no. 803.
12 Ferguson 2023 - Ferguson, L., Gruskin, S., Bolshakova, M., Rozelle, M., Yagyu, S., Kasoka, K., Oraro-Lawrence, T., Motala, A., Stackpool-Moore, L., & Hempel, S. (2023). Systematic review and quantitative and qualitative comparative analysis of interventions to address HIV-related stigma and discrimination. AIDS, 37(13), 1919-1939.
13 NACCHO 2020 - National Association of County and City Health Officials (NACCHO). (2020, April). Statement of policy: Stigma, discrimination, and criminalization against persons with infectious diseases.
14 Sero Project-Survey 2021 - Sero Project. (2023). The National HIV Criminalization Survey 2021. Accessed April 7, 2026.
15 Breslow 2020 - Breslow, A. S., & Brewster, M. E. (2020). HIV is not a crime: Exploring dual roles of criminalization and discrimination in HIV/AIDS minority stress. Stigma and Health, 5(1), 83–93.
16 Cross 2020 - Cross, C. K. (2020). The dangers of disclosure: How HIV laws harm domestic violence survivors. Washington Law Review, 95(1), 83.
17 Csete 2011 - Csete, J., & Elliott, R. (2011). Criminalization of HIV transmission and exposure: In search of rights-based public health alternatives to criminal law. Future Virology, 6(8), 941-950.
18 Baugher 2021 - Baugher, A. R., Whiteman, A., Jeffries, W. L. IV, Finlayson, T., Lewis, R., Wejnert, C., & NHBS Study Group. (2021). Black men who have sex with men living in states with HIV criminalization laws report high stigma, 23 U.S. cities, 2017. AIDS, 35(10), 1637-1645.
19 Williams Institute-Sears 2020a - Sears, B., & Goldberg, S. K. (2020). HIV criminalization in Florida: Evaluation of transmission risk. UCLA School of Law, The Williams Institute.
20 CDC-HIV Criminalization 2023 - Centers for Disease Control and Prevention (CDC). (2023, January). HIV criminalization and ending the HIV epidemic in the U.S. Retrieved March 21, 2026.
21 CHLP-Transmission - The Center for HIV Law and Policy. (2017). Routes, risks and realities of HIV transmission and care: Current scientific knowledge and medical treatment.
22 Gram 2025 - Gram, E. G., Biering, I. E., Olsen, O., & Gram, G. J. (2025). Evidence of zero-risk transmission of HIV in the era of antiretroviral therapy: A systematic review and meta-analyses. Public Health, 239, 149-155.
23 Lehman 2014 - Lehman, J. S., Carr, M. H., Nichol, A. J., Ruisanchez, A., Knight, D. W., Langfrd, A. E., Gray, S. C., & Mermin, J. H. (2014). Prevalence and public health implications of state laws that criminalize potential HIV exposure in the United States. AIDS and Behavior, 18, 997-1006.
24 Williams Institute-Cisneros 2024a - Cisneros, N., Foote, C., Schlebecker, P., & Sears, B. (2024, November). HIV criminalization in Indiana: Evaluation of transmission risk. UCLA School of Law, The Williams Institute.
25 Mayer 2018 - Mayer, K. H., Sohn, A., Kippax, S., & Bras, M. (2018). Addressing HIV criminalization: Science confronts ignorance and bias. Journal of the International AIDS Society, 21(7), e25163.
26 ANAC 2015 - Association of Nurses in AIDS Care (ANAC). (2015). Position statement: HIV criminalization laws and policies promote discrimination and must be reformed. Journal of the Association of Nurses in AIDS Care, 26(2), 215-217.
27 Foote 2018 - Foote, C., Bernard, E., & Mykhalovskiy, E. (2018). Solutions to ending the global social problem of HIV criminalization. In G. W. Muschert, K. M. Budd, M. Christian, B. V. Klocke, J. Shefner, & R. Perrucci (Eds.), Global Agenda for Social Justice (pp. 31-40). Bristol University Press.
28 Chenneville 2015 - Chenneville, T., Lynn, V., Peacock, B., Turner, D., & Marhefka, S. L. (2015). Disclosure of HIV status among female youth with HIV. Ethics & Behavior, 25(4), 314-331.
29 Herndon 2025 - Herndon, V., McGee, K., Waldrop, J., & Walton, A. M. (2025). Decriminalizing HIV in Indiana: A policy analysis. The Journal for Nurse Practitioners, 21(6), 105396.
30 Hoppe 2025 - Hoppe, T., & Hall, E. (2025). How did they do it? Analyzing the landscape of HIV criminalization reform in the USA. Sexuality Research and Social Policy. Advance online publication.
31 Keralis 2023 - Keralis J. M. (2023). HIV criminalization laws and enforcement: Assessing the relationship between HIV criminalization at the state level, policing at the county level, and county-level HIV incidence rates. AIDS and Behavior, 27(11), 3713-3724.
32 Kay 2017 - Kay, E. S., & Smith, B. D. (2017). State-level HIV criminalization laws: Social construction of target populations? Journal of Policy Practice, 16(2), 133-146.
33 Tran 2019 - Tran, N. K., Hatzenbuehler, M. L., & Goldstein, N. D. (2019). Potential relationship between HIV criminalization and structural stigma related to sexual orientation in the United States. Journal of Acquired Immune Deficiency Syndromes, 80(5), e106-e108.
34 CHLP-Map 2025 - The Center for HIV Law and Policy (CHLP). (2025, November). Mapping HIV criminalization laws in the U.S.
35 CHLP-HIV Law timeline - The Center for HIV Law and Policy (CHLP). (2025). Timeline of state reforms and repeals of HIV criminalization laws. Accessed April 7, 2026.
36 Csete 2023 - Csete, J., Elliott, R., & Bernard, E. J. (2023). So many harms, so little benefit: A global review of the history and harms of HIV criminalisation. The Lancet HIV, 10(1), e52–e61.
37 Bernard 2022a - Bernard, E. J., Symington, A., & Beaumont, S. (2022). Punishing vulnerability through HIV criminalization. American Journal of Public Health, 112(S4), S395–S397.
38 Lennon-Dearing 2024 - Lennon-Dearing, R. (2024). Criminalization of human immunodeficiency virus in the United States. Nursing Clinics, 59(2), 201-217.
39 Williams Institute-Cisneros 2022 - Cisneros, N., Sears, B., & Lennon-Dearing, R. (2022, June). Enforcement of HIV criminalization in Tennessee. UCLA School of Law, The Williams Institute.
40 Williams Institute-Cisneros 2024b - Cisneros, N., Tentindo, W., Sears, B., Macklin, M. L, & Bendana, D. (2024, January). Enforcement of HIV criminalization in Maryland. UCLA School of Law, The Williams Institute.
41 Williams Institute-Cisneros 2024c - Cisneros, N., Sears, B., & Tentindo, W. (2024, February). Enforcement of HIV criminalization in Ohio. UCLA School of Law, The Williams Institute.
42 Cann 2019 - Cann, D., Harrison, S.E., & Qiao, S. (2019). Historical and current trends in HIV criminalization in South Carolina: Implications for the southern HIV epidemic. AIDS and Behavior, 23(Suppl 3), 233–241.
43 Burris 2008 - Burris, S., & Cameron, E. (2008). The case against criminalization of HIV transmission. JAMA, 300(5), 578–581.
44 Listerud 2025 - Listerud, L., Meanley, S., Richards, A., Kosciow, B., & Bonett, S. (2025). A decarceral response to HIV criminalization in the Black LGBTQIA+ community. American Journal of Public Health, 115(7), 1157-1165.
45 Williams Institute-Hasenbush 2015 - Hasenbush, A., Miyashita, A., & Wilson, B. D. M. (2015, December). HIV criminalization in California: Penal implications for people living with HIV/AIDS. UCLA School of Law, The Williams Institute.
46 Hoppe 2015 - Hoppe, T. A. (2015). Disparate risks of conviction under Michigan’s felony HIV disclosure law: An observational analysis of convictions and HIV diagnoses, 1992–2010. Punishment & Society, 17(1), 73-93.
47 Williams Institute-Hasenbush 2016 - Hasenbush, A., & Wilson, B. D. (2016, September). HIV criminalization against immigrants in California. UCLA School of Law, The Williams Institute.
48 HIV.gov - HIV.gov. HIV and AIDS timeline.
49 Bennington-Castro 2020 - Bennington-Castro J. How AIDS remained an unspoken—but deadly—epidemic for years. History. 2020.
50 AAHIVM - American Academy of HIV Medicine (AAHIVM). (n.d.). HIV criminalization. Accessed April 7, 2026.
51 CDC HIV-Criminalization - Centers for Disease Control and Prevention (CDC). (2023). HIV criminalization and ending the HIV epidemic in the U.S. Retrieved April 7, 2026.
52 Sero Project-HINAC - Sero Project. (n.d.). HIV is Not a Crime National Training Academy (HINAC). Retrieved March 21, 2026.
53 CHLP-Toolkit - The Center for HIV Law and Policy (CHLP). (2013). A toolkit for community advocates, volume 3.
54 Kapadia 2022 - Kapadia, F. (2022). Structural interventions that reduce HIV vulnerability: A public health of consequence. American Journal of Public Health, 112, 826-827.
55 Adimora 2010 - Adimora, A. A., & Auerbach, J. D. (2010). Structural interventions for HIV prevention in the United States. Journal of Acquired Immune Deficiency Syndromes, 55 Suppl 2(0 2), S132–S135.
56 Dillender 2023 - Dillender, M. (2023). Evidence and lessons on the health impacts of public health funding from the fight against HIV/AIDS. American Economic Review, 113(7), 1825-87.
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