HIV Status Disclosure Requirements
D) Disclosure requirements vary state by state is the correct answer—there is no uniform federal law mandating HIV disclosure to sexual partners, and legal obligations differ substantially by jurisdiction. 1, 2
Legal Framework for HIV Disclosure
Disclosure laws are state-specific, not uniform across the United States. The majority of states and some cities or localities have their own laws and regulations related to informing partners about HIV exposure, but these requirements vary significantly by jurisdiction. 1, 2
Key Legal Distinctions
No federal mandate exists requiring patients to disclose their HIV status to sexual partners—this is a state-level determination. 1
Many states have "duty to warn" laws, but these typically apply to physicians in specific circumstances (when patients refuse disclosure and continue placing partners at risk), not to patients themselves as a blanket requirement. 1, 2
Some jurisdictions require clinician reporting to health departments of partners even if the patient refuses to provide names, but again, this varies by location. 2
Viral load thresholds do not determine legal disclosure requirements—no state bases mandatory disclosure on whether HIV RNA is above or below 200 copies/mL or any other specific viral load cutoff. 1, 2
Clinical Guidance for This Patient
Why the Other Options Are Incorrect
Option A is false: Not all states require disclosure—requirements vary substantially. 1, 2
Option B is misleading: States don't categorize disclosure requirements based on "risk of transmission being high"—laws are jurisdiction-specific, not risk-stratified in this manner. 1
Option C is incorrect: No state uses a viral load threshold of 200 copies/mL (or any specific number) to determine legal disclosure obligations. 1, 2
Practical Counseling Approach
Your patient should understand that while she has achieved excellent viral suppression (20 copies/mL), which makes transmission risk extremely low, her legal obligations depend entirely on where she lives. 1, 2
Recommend she familiarize herself with her specific state's HIV disclosure legislation, as requirements vary by jurisdiction and may include criminal penalties for non-disclosure in some states. 1, 2
Offer confidential partner notification services through the local or state health department, which can notify partners without revealing her identity—many patients prefer this approach due to the confidentiality advantage. 2
Emphasize the clinical reality: With undetectable viral load (<50 copies/mL), the risk of sexual transmission is effectively zero (U=U: undetectable equals untransmittable), though this scientific fact does not override legal requirements in states with disclosure laws. 2
Critical Pitfall to Avoid
Don't assume that excellent viral suppression eliminates legal disclosure obligations—while her viral load of 20 copies/mL means she poses essentially no transmission risk, legal requirements are independent of viral load status and vary by state. 1, 2