United States

The United States of America was, as far as we are aware, the first country in the world to prosecute people living with HIV and to enact HIV-specific criminal laws, commencing in 1986/7.

In addition to the federal law – which is summarised below – each US state and territory, as well as the US military, has its own approach to the criminalisation of alleged HIV non-disclosure, ‘exposure’, and transmission.

Although some states began to adopt HIV-specific or general disease laws, or apply general criminal law to HIV cases in the 1980s, measures implemented by the federal government encouraged this further, particularly the passage of the Ryan White Care Act in 1990. This law – which made available significant amounts of federal funding for HIV treatment – made some funding contingent on the ability to prosecute intentional HIV exposure at the state level. Since then, only a minority of states opted not to introduce HIV-specific criminal laws and/or have not applied general criminal laws to HIV non-disclosure, ‘exposure’, or transmission. Where HIV-specific or general disease laws were introduced, they almost never required an intent to transmit or actual transmission, and instead criminalised conduct which carried little to no risk of transmission.

The latest data gathered by the Center for HIV Law and Policy – on which much of the information in the US profile in this Database is based – found that as of February 2025:

• 32 states have offences that criminalise ‘exposure’ to and/or transmission of HIV.
• 10 states have penalty enhancements for people living with HIV who engage in sex work.
• 11 states have penalty enhancements that target bodily fluid exposure by people living with HIV.
• 11 states have penalty enhancements for people living with HIV who violate a general criminal law.
• 10 states have penalty enhancements for people living with HIV who share used needles/syringes.

Furthermore, twenty states allow for ‘civil commitment’ of people convicted under HIV laws, essentially permitting the continued imprisonment of people living with HIV who have served out their prison sentences. Perhaps the most high profile case of civil commitment for HIV offences in the USA, is that of Nushaun Williams in New York.

Despite the ongoing prevalence of HIV laws, since 2010 there has been a growing movement towards repeal or reform state HIV laws. The tenacious efforts of civil society organisations, activists, and people living with HIV, in collaboration with medical experts, public health officials, and receptive politicians, have led to at least 16 states repealing or modernising their HIV laws.

In terms of reported cases, the United States is by some distance the country with the highest number of known HIV criminalisation cases in the world. Numbers vary drastically by state, but the vast majority of states (all but 10) have enforced HIV-specific and/or general laws to prosecute HIV non-disclosure, ‘exposure’, or transmission. While media-reporting of HIV criminalisation in the US is extensive, in-depth research by state-level civil society organisations, as well as the Williams Institute, has unearthed hundreds of previously unreported cases, revealing the true extent of HIV criminalisation in the US.

Within this Database, we provide an overview of the law and cases relating to HIV non-disclosure, ‘exposure’, and/or transmission in each state, the District of Columbia, four overseas territories, and the military. We highlight the most pertinent provisions capable of criminalising people living with HIV based on HIV-positive status in each jurisdiction, including HIV-specific laws, general disease laws, and general criminal laws that we know to have been enforced against people living with HIV, and include relevant extracts from some of these laws. However, these overviews do not outline every single relevant law – such as health laws which regulate the conduct of people living with HIV – in full detail; they instead signpost to the US-based Center for HIV Law and Policy’s report, HIV Criminalization in the United States: A Sourcebook on State and Federal HIV Criminal Law and Practice, which contains a full analysis of all laws in depth.

Federal law

The only HIV-specific criminal provision under the federal law relates to the donation of blood or other fluids and tissues. The law makes it an offence for someone knowingly living with HIV to donate or sell blood or other ‘potentially infectious’ fluids or tissues, except where necessary for medical research or testing. Neither intent to transmit or actual transmission are required, nor is any risk of transmission, which it should be noted is highly unlikely in the United States due to routine screening of blood donations (see our report, Bad Blood, for more on this). This law was enacted in 1994, however there have been no reported prosecutions under this provision.

On rare occasions HIV status has been used as the sole or primary basis for imposing enhanced sentences for criminal offences at the federal level. In an unusual federal case in Maine in 2009, a pregnant woman living with HIV received an enhanced penalty due to her HIV status. The woman had been convicted for having counterfeit social security documents, and at sentencing the federal judge imposed a sentence double the 114 days recommended by both the prosecutors and defence. The judge openly stated that this was due to the defendant’s HIV status but intended to ‘protect’ her unborn baby from HIV transmission during birth, as in his view the defendant was more likely to receive medical treatment in a federal prison than outside. Following significant backlash and an appeal, the woman was released on bail to give birth outside of prison before having her sentence reduced to the recommended level. Notwithstanding the supposed good intentions of the judge to prevent transmission of HIV to the child, this paternalistic approach demonstrates how people living with HIV can face harsher punishments purely on the basis of their health status.

People in federal prisons have also received enhanced sentences for assaults on correctional officers on the basis of their HIV status. In a 1995 case, the teeth of a man living with HIV were considered a ‘deadly weapon’ after allegedly biting two correctional officers. In a similar case in 2006, a man living with HIV was given a ten year prison sentence for allegedly biting a correctional officer during an assault (see Center for HIV Law and Policy report for case details).