تمييز

Other HIV-Related Laws (القفز إلى القسم)

Testing & Privacy (القفز إلى القسم)

HIV/AIDS | Discrimination | Rhode Island 

What laws protect people with HIV from discrimination in Rhode Island?

Rhode Island has enacted two separate laws that prohibit discrimination against people with HIV or AIDS.

• First, Rhode Island has an anti-discrimination law that explicitly relates to HIV. This law provides that “[n]o person, agency, organization, or legal entity may discriminate against an individual on the basis of a positive HIV test result, or perception of a positive test, in housing, education, employment, the granting of credit, public accommodation, or delivery of services. . .” (RI ST 23-6.3-11)
• Second, people with HIV are protected under laws that prohibit discrimination on the basis of disability. This includes the federal Americans with Disabilities Act (ADA), and analogous Rhode Island disability & antidiscrimination laws. (42 U.S.C. § 12101)

Disability antidiscrimination laws protect people with AIDS or who are HIV-positive, even if they are asymptomatic and have no outward or manifest signs of illness. They also protect people who are regarded or perceived as having HIV.

Under the ADA, but not Rhode Island law, these laws also prohibit discrimination against a person who does not have HIV, but who “associates” with a person with HIV— such as friends, lovers, spouses, roommates, business associates, advocates, and caregivers of persons with HIV.

The Rehabilitation Act of 1973 prohibits discrimination on the basis of disability in programs conducted by federal agencies, in programs receiving federal financial assistance, in federal employment and in the employment practices of federal contractors.

For more information about employment discrimination in Rhode Island, see: Discrimination | Employment | Rhode Island

What do these anti-discrimination laws prohibit in employment?

An employer may not take adverse action against an applicant or employee simply on the basis that the person has a disability such as HIV or AIDS. This means that an employer may not terminate, refuse to hire, rehire, or promote, or otherwise discriminate in the terms or conditions of employment, based on the fact that a person is HIV-positive or has AIDS.

يركز هذا المقال على ما إذا كان الشخص المصاب بالإيدز أو فيروس نقص المناعة البشرية قد تم التعامل معه بشكل مختلف عن المتقدمين الآخرين أو الموظفين في مواقف مماثلة.

وفيما يلي أمثلة على التمييز غير القانوني:

• لا يجوز لصاحب العمل أن يرفض توظيف شخص مصاب بفيروس نقص المناعة البشرية بناءً على الخوف من انتقال الفيروس إلى موظفين آخرين أو إلى العملاء.
• لا يجوز لصاحب العمل أن يرفض توظيف شخص ما أو يتخذ قرار توظيف بناءً على احتمال أو حتى احتمالية أن يصاب الشخص بالمرض ولن يتمكن من القيام بالعمل في المستقبل.
• لا يجوز لصاحب العمل أن يرفض توظيف شخص ما لأن ذلك من شأنه أن يؤدي إلى زيادة أقساط التأمين الصحي أو تعويضات العمال.

Can an employer in Rhode Island ever require an applicant or employee to take an HIV test?

Under Rhode Island law, an HIV test shall not be required as a condition of employment (RI ST 23-6.3-11).

ما هي الأسئلة التي يمكن لصاحب العمل أن يسألها عن صحة الموظف أثناء عملية التقديم والمقابلة؟

Under the ADA and Rhode Island law (42 U.S.C. 12112; RI ST 28-5-7(4)(i)), prior to employment, an employer cannot ask questions that are aimed at determining whether an employee has a disability. Examples of prohibited pre-employment questions are:

• هل سبق لك أن دخلت المستشفى أو كنت تحت رعاية طبيب؟
• هل سبق لك أن كنت مستفيدًا من تعويضات العمال أو تلقيت إعانات العجز؟
• ما هي الأدوية التي تأخذها ؟
• ومع ذلك، يجوز لصاحب العمل أن يسأل ما إذا كان المتقدم للوظيفة لديه المعرفة والمهارة والقدرة على أداء مهام الوظيفة.

بعد عرض العمل، هل يحق لصاحب العمل طلب فحص طبي؟ ما هي الإرشادات المطبقة؟

After a conditional offer of employment, an employer may require a physical examination or medical history solely for the purpose of determining if an employee can perform the essential job functions with reasonable accommodation. The job offer, however, may not be withdrawn unless the results demonstrate that the person cannot perform the essential functions of the job with or without reasonable accommodation. The same medical inquiries must be made of each person in the same job category.  In addition, these physical examination and medical history records must be segregated from personnel records, and there are strict confidentiality protections.

كيف تعاملت المحاكم مع المخاوف من أن موظفي الرعاية الصحية الذين يقومون بإجراءات جراحية جراحية، مثل الجراحين، قد ينقلون فيروس نقص المناعة البشرية إلى المرضى؟

The risk of HIV transmission from a health care worker to a patient is considered so small that it approaches zero. Nevertheless, in cases where hospitals have sought to restrict or terminate the privileges of HIV-positive health care workers who perform invasive procedures, courts have reacted with tremendous fear and have insisted on an impossible “zero risk” standard. As a result, the small number of courts that have
addressed this issue under the ADA have upheld such terminations. The employment provisions in the ADA provide that an employee is not qualified to perform the job if he or she poses a “direct threat to the health or safety of others.” To determine whether an employee poses a “direct threat,” a court analyzes:

• طبيعة ومدة وشدّة المخاطر؛
• احتمالية المخاطرة؛ و
• ما إذا كان من الممكن القضاء على المخاطر من خلال توفير الإقامة المعقولة.

However, in the case of HIV-positive health care workers, courts have ignored the extremely remote probability of the risk and focused on the nature, duration and severity of the risk. The following excerpt from a recent case is typical of courts’ approach: “We hold that Dr. Doe does pose a significant risk to the health and safety of his patients that cannot be eliminated by reasonable accommodation. Although there may presently be no documented case of surgeon-to-patient transmission, such transmission clearly is possible. And, the risk of percutaneous injury can never be eliminated through reasonable accommodation. Thus, even if Dr. Doe takes extra precautions… some measure of risk will always exist…” (Doe v. University of Maryland Medical Systems Corporation, 50 F.3d 1261 (1995)).

It is important to note that only a small number of courts have addressed the rights of HIV-positive health care workers. The AIDS Law Project believes that these cases have been incorrectly decided and are inconsistent with the intent of Congress in passing the ADA. Because of the unsettled nature of the law in this area, a health care worker who is confronted with potential employment discrimination should consult a lawyer or public health advocate.

Assessing Discrimination in Employment

While it may be useful to consult with a lawyer, the following steps can be helpful in beginning to consider and assess a potential employment discrimination problem:

1. Consider the difference between unfairness and illegal discrimination. The bottom line of employment law is that an employee can be fired for a good reason, bad reason, or no reason at all. A person can be legally fired for a lot of reasons, including a bad “personality match.” What they cannot be fired for is a discriminatory reason specifically outlawed by a statute.

2. لإثبات دعوى التمييز (أي أنك طُردت من وظيفتك أو تم تخفيض درجتك الوظيفية وما إلى ذلك بسبب التمييز وليس بسبب سبب مشروع)، يجب أن تكون قادرًا على إثبات ما يلي:

• كان صاحب العمل يعرف أو يستنتج أنك مصاب بفيروس نقص المناعة البشرية أو تعاني من الإيدز؛
• لقد كنت مؤهلاً لأداء الوظائف الأساسية للوظيفة مع أو بدون توفير التسهيلات المعقولة؛ و
• لقد تم اتخاذ إجراء سلبي ضدك بسبب إصابتك بفيروس نقص المناعة البشرية أو الإيدز والسبب الذريع الذي قدمه صاحب العمل لاتخاذ الإجراء السلبي هو سبب كاذب.

٣. إذا كان صاحب العمل يعلم بإصابتك بفيروس نقص المناعة البشرية أو الإيدز، فحدد بدقة من يعلم، وكيف علم، ومتى علم. إذا لم تخبر صاحب العمل، فهل هناك أي طريقة أخرى قد تجعله يعلم أو يشك في إصابتك بفيروس نقص المناعة البشرية؟

4. فكر في الأسباب التي تجعلك تعتقد أنك تتلقى معاملة مختلفة بسبب إصابتك بفيروس نقص المناعة البشرية، بما في ذلك المجالات التالية:

• هل تم التعامل مع الموظفين الآخرين في مواقف مماثلة بشكل مختلف أو بنفس الطريقة؟
• هل اتبع صاحب العمل سياساته المتعلقة بالموارد البشرية؟
• هل بدأ العلاج الضار بعد فترة وجيزة من علم صاحب العمل بوضعك المتعلق بفيروس نقص المناعة البشرية؟
• هل كنت خارج العمل بسبب المرض لفترة من الوقت وهل بدأ العلاج الضار عند عودتك إلى العمل؟
• ما هي رواية صاحب عملك للأحداث؟ كيف ستثبت زيفها؟

٥. هل تواجه صعوبة في أداء واجبات وظيفتك بسبب أي مشكلة صحية أو طبية متعلقة بفيروس نقص المناعة البشرية؟ هل تمنعك حالتك من العمل بدوام كامل، أو تتطلب إجازة لمواعيد طبية، أو مهام أخف، أو وظيفة أقل إرهاقًا؟ قد ترغب في مناقشة حلول مناسبة يمكنك اقتراحها على صاحب العمل. إليك بعض النقاط التي يجب مراعاتها:

• كيف تعمل الشركة وكيف سيتم العمل على الإيواء عملياً؟
• ضع نفسك مكان مشرفك. ما هي الاعتراضات التي قد تُثار على التسهيلات المعقولة المطلوبة؟ على سبيل المثال، إذا كنتَ بحاجة إلى المغادرة في وقت محدد لمواعيد طبية، فمن سيتولى مهامك؟

What laws prohibit discrimination in housing?

It is illegal under Rhode Island’s HIV-specific antidiscrimination law (RI ST 23-6.3-11), Rhode Island’s disability antidiscrimination law (RI ST 34-37-4), as well as the National Fair Housing Amendments of 1989 (42 U.S.C. §§ 3601-3619), to discriminate in the sale or rental of housing on the basis of HIV status. A person cannot be evicted from an apartment because of his or her HIV or AIDS status, or because he or she is regarded as having HIV or AIDS.

For more information about housing discrimination in Rhode Island, see: Discrimination| Housing | Rhode Island

Are there any exceptions to the housing laws?

There are no exceptions to housing discrimination on the basis of HIV status under Rhode Island’s HIV-specific law (RI ST 23-6.3-11). Rhode Island’s disability antidiscrimination law exempts residences where there are three or fewer apartments and the owner occupies one of the units (RI ST 34-37-4). In addition, the federal Fair Housing Act exempts, in some circumstances, ownership-occupied buildings with no more than four units, single-family housing sold or rented without the use of a broker, and housing operated by organizations and private clubs that limit occupancy to members (42 U.S.C. § 3604).

Do Rhode Island’s laws protect against discrimination by health care providers, businesses, and other public places?

Yes, under Rhode Island’s HIV-specific antidiscrimination statute (RI ST 23-6.3-11), Rhode Island’s disability antidiscrimination law (RI ST 11-24-2), as well as the ADA (42 U.S.C. § 12182), it is unlawful to exclude a person with HIV from a public place (what the law refers to as a “public accommodation”) or to provide unequal or restricted services to a person with HIV in a public place. Under both statutes, the term “public accommodation” includes any establishment or business that offers services to the public.

Therefore, people with HIV are protected from discrimination in virtually every public place or business, including bars, restaurants, hotels, stores, schools, vocational or other educational programs, taxi cabs, buses, airplanes, and other modes of transportation, health clubs, hospitals, and medical and dental offices, as long as these facilities are generally open to the public.

For more information about public accommodations discrimination in Rhode Island, see Discrimination | Public Accommodations | Rhode Island

هل لا تزال التمييز الذي يمارسه العاملون في مجال الرعاية الصحية ضد الأشخاص المصابين بفيروس نقص المناعة البشرية يمثل مشكلة؟

Believe it or not, people with HIV still face discrimination by hospitals, doctors, dentists, and other health care providers. This discrimination can take the form of an outright refusal to provide medical services or an illegal referral because of a patient’s HIV status.

What types of arguments do doctors who discriminate against people with HIV make, and are they legitimate?

يحاول الأطباء عادة تبرير التمييز ضد الأشخاص المصابين بفيروس نقص المناعة البشرية بإحدى حجتين:

1. “Treating People with HIV is Dangerous” (Some doctors refuse to treat people with HIV based on an irrational fear of HIV transmission); and

2. “Treating People with HIV Requires Special Expertise” (Some doctors referpatients to other medical providers based on an inaccurate belief that general practitioners are not qualified to provide care to patients with HIV). Both an outright refusal to provide medical treatment and unnecessary referrals on the basis of a person’s disability are unlawful under the ADA and Rhode Island law.

كيف استجابت المحاكم والخبراء الطبيون لهذه الحجج؟

Courts have responded to these arguments in the following ways:

1. “Treating People with HIV is Dangerous.”

Doctors and dentists may claim that a refusal to treat a patient with HIV is legitimate because they fear they might contract HIV themselves through needlesticks or other exposures to blood. However, studies of health care workers have concluded that risk of contracting HIV from occupational exposure is minuscule, especially with the use of universal precautions.

For this reason, in 1998, the United States Supreme Court ruled in the case Bragdon v. Abbott (524 U.S. 624 (1998)) that health care providers cannot refuse to treat people with HIV based on concerns or fears about HIV transmission.

بالإضافة إلى المنظور القانوني، أصدرت كل من الجمعية الطبية الأمريكية وجمعية طب الأسنان الأمريكية، والعديد من منظمات الرعاية الصحية المهنية الأخرى، سياسات مفادها أنه من غير الأخلاقي رفض العلاج لشخص مصاب بفيروس نقص المناعة البشرية.

2. "يتطلب علاج المصابين بفيروس نقص المناعة البشرية خبرة خاصة"

في هذه الحالات، تعتمد مزايا دعوى التمييز على ما إذا كانت الخدمات أو العلاج الذي يحتاجه المريض يتطلب إحالته إلى أخصائي أو يقع ضمن نطاق الخدمات واختصاص مقدم الخدمة، وذلك بناءً على أدلة طبية موضوعية.

In United States v. Morvant (898 F.Supp. 1157 (E.D. La 1995)), a federal trial court rejected a dentist’s claim that patients with HIV require a specialist for routine dental care. The court agreed with the testimony of experts who said that no special training or expertise, other than that possessed by a general dentist, is required to provide dental treatment to people with HIV. The court specifically rejected the dentist’s arguments that he was unqualified because he had not kept up with the literature and training necessary to treat patients with HIV. While this case arose in the context of dental care, it is applicable to other medical settings as well.

ما هي الأحكام المحددة في قانون الأمريكيين ذوي الإعاقة التي تحظر التمييز من قبل مقدمي الرعاية الصحية؟

Under Title III of the ADA, it is illegal for a health care provider to:

1. حرمان المريض المصاب بفيروس نقص المناعة البشرية من "التمتع الكامل والمتساوي" بالخدمات الطبية أو حرمان المريض المصاب بفيروس نقص المناعة البشرية من "فرصة الاستفادة" من الخدمات الطبية بنفس الطريقة التي يستفيد منها المرضى الآخرون.
2. إرساء "معايير الأهلية" للحصول على امتياز تلقي الخدمات الطبية، والتي تميل إلى استبعاد المرضى الذين ثبتت إصابتهم بفيروس نقص المناعة البشرية.
3. توفير خدمات "مختلفة أو منفصلة" للمرضى المصابين بفيروس نقص المناعة البشرية أو الذين يفشلون في تقديم الخدمات للمرضى في "البيئة الأكثر تكاملاً".
4. حرمان شخص معروف بوجود "علاقة" أو "ارتباط" بينه وبين شخص مصاب بفيروس نقص المناعة البشرية، مثل الزوج أو الشريك أو الطفل أو الصديق، من الخدمات الطبية المتساوية.

ما هي ممارسات الرعاية الصحية المحددة التي تشكل تمييزا غير قانوني ضد الأشخاص المصابين بفيروس نقص المناعة البشرية؟

عند تطبيق الأحكام المحددة لقانون الأمريكيين ذوي الإعاقة المذكورة أعلاه على ممارسة الرعاية الصحية، فإن الممارسات التالية تعتبر غير قانونية:

• لا يمكن لمقدم الرعاية الصحية أن يرفض علاج شخص مصاب بفيروس نقص المناعة البشرية بناءً على خطر محتمل لانتقال فيروس نقص المناعة البشرية أو لأن الطبيب ببساطة لا يشعر بالراحة في علاج شخص مصاب بفيروس نقص المناعة البشرية.
• لا يمكن لمقدم الرعاية الصحية أن يوافق على علاج مريض فقط في مكان علاجي خارج عيادة الطبيب المعتادة، مثل عيادة مستشفى خاصة، لمجرد أن الشخص مصاب بفيروس نقص المناعة البشرية.
• A health care provider cannot refer an HIV-positive patient to another clinic or specialist, unless the required treatment is outside the scope of the physician’s usual practice or specialty. The ADA requires that referrals of HIV-positive patients be made on the same basis as referrals of other patients. It is, however, permissible to refer a patient to specialized care if the patient has HIV-related medical conditions which are outside the realm of competence or scope of services of the provider.
• A health care provider cannot increase the cost of services to an HIV-positive patient in order to use additional precautions beyond the mandated OSHA and CDC infection control procedures. Under certain circumstances, it may even be an ADA violation to use unnecessary additional precautions that tend to stigmatize a patient simply on the basis of HIV status.
• لا يستطيع مقدم الرعاية الصحية تحديد الأوقات المجدولة لعلاج المرضى المصابين بفيروس نقص المناعة البشرية، مثل الإصرار على أن يأتي المريض المصاب بفيروس نقص المناعة البشرية في نهاية اليوم.

What laws prohibit discrimination in credit?

It is illegal under Rhode Island’s HIV-specific antidiscrimination law (RI ST 23-6.3-11) and Rhode Island’s disability antidiscrimination law (RI ST 34-37-4) to discriminate on the basis of HIV status in the granting of any form of credit or loan. Under the National Fair Housing Amendments of 1989 (42 U.S.C. §§ 3601-3619), it is illegal to discriminate on the basis of HIV status in the financing of housing.

For more information about credit and lending discrimination in Rhode Island, see https://www.gladlaw.org/overview/credit-lending-discrimination/rhode-island/

What laws prohibit discrimination in education?

It is illegal under Rhode Island’s HIV-specific antidiscrimination law (RI ST 23-6.3-11) and Section 504 of the federal Rehabilitation Act of 1973 (29 U.S.C. § 794) to discriminate on the basis of HIV status in public school programs or activities.

ما هي بعض الحلول المحتملة للتمييز بموجب القانون الفيدرالي؟

لتقديم دعوى بموجب قانون الأمريكيين ذوي الإعاقة بسبب التمييز في التوظيف، يجب أن يكون لدى صاحب العمل 15 موظفًا على الأقل. يجب على الشخص تقديم دعوى إلى لجنة تكافؤ فرص العمل (EEOC) خلال 180 يومًا من تاريخ الفعل التمييزي. ويجوز للشخص سحب دعوى قانون الأمريكيين ذوي الإعاقة من لجنة تكافؤ فرص العمل ورفع دعوى قضائية في محكمة الولاية أو المحكمة الفيدرالية.

To pursue a claim under the Americans with Disabilities Act for discrimination in a place of public accommodation, a person may, without first going to an administrative agency, file a claim in state or federal court for injunctive relief only (i.e., seeking a court order that the discriminatory conduct cease). Money damages are not available for violation of Title III of the ADA unless they are sought by the United States Department of Justice. However, a person may recover money damages under the Federal Rehabilitation Act in cases against entities that receive federal funding.

لمتابعة المطالبة بموجب قانون إعادة التأهيل، يجوز للشخص تقديم شكوى إدارية إلى المكتب الإقليمي التابع لوزارة الصحة والخدمات الإنسانية الفيدرالية و/أو رفع دعوى قضائية مباشرة في المحكمة.

للمطالبة بتعويض بموجب القانون الوطني للإسكان العادل عن التمييز في مجال الإسكان، يجوز لأي شخص تقديم شكوى إلى مكتب الإسكان والتنمية الحضرية في الولايات المتحدة خلال عام واحد من تاريخ الانتهاك. كما يجوز له رفع دعوى قضائية خلال عامين من تاريخ الانتهاك. ويمكن رفع الدعوى سواءً قدّم الشخص شكوى إلى وزارة الإسكان والتنمية الحضرية أم لا.

HIV/AIDS | Other HIV-Related Laws | Rhode Island

What does it mean that an employer may have to provide a “reasonable accommodation” for an employee with a
disability

Persons with disabilities, such as HIV/AIDS, may experience health-related problems that make it difficult to meet some job requirements or duties. For example, a person may be exhausted or fatigued and find it difficult to work a full-time schedule.

In certain circumstances, the employer has an obligation to modify or adjust job requirements or workplace policies in order to enable a person with a disability, such as HIV or AIDS, to perform the job duties. This is known as a “reasonable accommodation.”

Examples of reasonable accommodations include:

● Modifying or changing job tasks or responsibilities;
● Establishing a part-time or modified work schedule;
● Permitting time off during regular work hours for medical appointments;
● Reassigning an employee to a vacant job; or
● Making modifications to the physical layout of a job site or acquiring devices such
as a telephone amplifier to allow, for example, a person with a hearing
impairment to do the job.

There is no fixed set of accommodations that an employee may request. The nature of a requested accommodation will depend on the particular needs of an individual employee’s circumstances.

How may a person obtain a reasonable accommodation?

It is, with rare exception, the employee’s responsibility to initiate the request for an accommodation. In addition, an employer may request that an employee provide some information about the nature of the disability.  Employees with concerns about disclosing HIV/AIDS status to a supervisor should contact the AIDS Law Project’s Legal InfoLine in order to strategize about ways to address any such requests.

Does an employer have to grant a request for a reasonable accommodation?

An employer is not obligated to grant each and every request for an accommodation.  An employer does not have to grant a reasonable accommodation that will create an “undue burden” (i.e., significant difficulty or expense for the employer’s operation).  In addition, the employer does not have to provide a reasonable accommodation if the employee cannot perform the job function even with the reasonable accommodation.

When is a “reasonable accommodation” for an employee an “undue burden” for an employer?

In determining whether a requested accommodation creates an undue burden or hardship for an employer, courts examine a number of factors, which include:

● The employer’s size, budget, and financial constraints;
● The costs of implementing the requested accommodation; and
● How the accommodation affects or disrupts the employer’s business.

Again, each situation is examined on a case-by-case basis.

An employer only has an obligation to grant the reasonable accommodation if, as a result of the accommodation, the employee is then qualified to perform the essential job duties. An employer does not have to hire or retain an employee who cannot perform the essential functions of the job, even with a reasonable accommodation.

Does Rhode Island have a law that criminalizes failure to disclose HIV status?

No, but in 2015 a bill was introduced in the Rhode Island Legislature, H 5245, An Act Related to Criminal Offenses – Criminal Transmission of HIV, that would have criminalized failure to disclose HIV status. GLAD testified against the bill, and it did not pass.

For more information, see: GLAD Testifies in Opposition to Proposed HIV
Criminalization Legislation in Rhode Island

Does Rhode Island law provide for access to clean needles for injection drug users to prevent HIV transmission?

Yes, under Rhode Island law, a pharmacy may sell hypodermic needles and syringes.  Possession of a hypodermic needle is no longer illegal in Rhode Island (RI ST 21-28-4.04).

Rhode Island law also mandates that the Department of Health maintain a program of needle and syringe exchange for persons 18 and older in order to prevent the transmission of HIV among intravenous drug users.  Any site used in the program shall make available educational materials, HIV counseling and testing, and referral services regarding HIV transmission and drug abuse prevention and treatment (RI ST 23-11-19).

HIV/AIDS | Testing & Privacy | Rhode Island

Does Rhode Island have a law governing informed consent for HIV testing?

Yes, while Rhode Island recently eliminated the requirement of written informed consent, Rhode Island prohibits the administration of any HIV test without: (1) providing the person with oral or written information and an opportunity for discussion with a health care provider, (2) informing the person of the right to decline testing, and (3) obtaining the oral consent (prior to the passage of House Bill 5415 Substitute B in November 2009, Rhode Island had required written consent for HIV testing) of the person (RI ST 23-6.3-3(h)(2)). The consent and exchange of information must be documented in the person’s medical record (Id). (Note: A distinction is made between confidential and anonymous testing.  In confidential testing the health care provider may use written consent as an option, but in anonymous testing only oral consent is allowed) (46 RI ST 23-6.3-3 (k)).

What information must the person receive?

Under RI ST 23-6.3-3(h)(4), the information given to the patient must, at a minimum, include the following:

1. An explanation of HIV infection;
2. A description of interventions to reduce HIV transmission;
3. What a positive and negative test result mean
4. The possibility that a recent infection may not be detected;
5. An opportunity to ask questions and to decline being tested.

Physicians and other health care providers are required to offer HIV testing to any person “with a suspected sexually transmitted disease” (RI ST 23-11-17).

Can a physician test a minor for HIV without consent of a parent or guardian?

Yes, in Rhode Island, persons under 18 may give legal consent for testing, examination, and/or treatment for any reportable communicable disease, which under Rhode Island Department of Health guidelines includes HIV and AIDS (RI ST 23-8-1.1).

Are there unique requirements for the administration of HIV tests for pregnant women and newborns?

Rhode Island law provides that a physician or health care provider shall include HIV testing among the routine prenatal tests for all pregnant women unless testing is declined (RI ST 23-6.3-3 (i) (1)). In order to be tested for HIV, pregnant women must provide oral consent which must be documented in the medical record.  If a pregnant woman has not been tested for HIV, she will be offered testing again at the time of labor
and/or delivery (RI ST 23-6.3-3 (i) (2)). If the mother refuses all these offers for testing and if the mother also refuses to consent to the testing of the newborn, then the newborn can be tested without the mother’s consent (RI ST 23-6.3-3 (i) (3)). If the child’s HIV test is positive, then the mother will be told that she is also infected with HIV.

Are there HIV testing laws regarding life insurance?

A person applying for a life insurance policy can be required to undergo HIV testing provided written consent is obtained, and the results of the test can be used by the insurance company for making decisions about whether to issue a life insurance policy. However, once someone has a life insurance policy, HIV status cannot be used to
cancel or refuse to renew the policy (RI ST 23-6.3-16).

Are there circumstances under which Rhode Island law permits HIV testing, even against a person’s wishes?

Yes, under certain circumstances, enumerated in RI ST 23-6.3-4, Rhode Island law permits, but does not require, a physician or other health care provider to perform an HIV test without the consent of the subject.

A) Youth

Rhode Island law permits the involuntary HIV testing of:

• Any person under one year of age;
• Any person between one and thirteen years of age who “appears to be symptomatic for HIV”;
• Any person under the age of eighteen who is “under the care and authority of the department of children, youth, and families, and the director of that department certifies that an HIV test is necessary to secure health or human services for that individual.”

B) Occupational Exposure in a Healthcare Facility

Rhode Island law permits involuntary testing in the event of an exposure to a health care provider in a licensed health care facility or private physician’s office, if:

1. a sample of the patient’s blood is available and an occupational health
representative or physician, nurse practitioner, physician assistant, or nurse-
midwife not directly involved in the exposure determines that a healthcare worker
had a significant exposure to the blood or bodily fluids of a patient; and
2. the patient refuses to grant consent for an HIV test. The health care worker must
have a baseline HIV test within seventy-two hours of exposure before the
patient’s blood can be tested.
If a sample of the patient’s blood is not available and the patient refuses to consent to
an HIV test, the health care worker may petition the Superior Court for an order
mandating an HIV test.

C) Emergency

An involuntary HIV test is permitted “in an emergency, where due to a grave medical or psychiatric condition, it is impossible to obtain consent from either the patient, or the patient’s parent, guardian, or agent.”  This exception appears by its language to be limited to circumstances in which an HIV test is deemed necessary for the patient’s health.

Does Rhode Island law require mandatory testing under any circumstances?

Yes, Rhode Island law requires mandatory HIV testing under certain circumstances.

A) Rhode Island law requires an HIV test for any person convicted of:

1. Possession of any controlled substance that has been administered with a
hypodermic needle or syringe (RI ST 21-28-4.20);
2. “Violation of any provisions” of the commercial sex activity statute (RI ST 11-34.1-12); and
3. Committing “any sexual offense involving sexual penetration,” where “the victim,
immediate family members of the victim, or legal guardian of the victim” has
petitioned the court to order testing (RI ST 11-37-17).

B) Rhode Island law requires mandatory testing of “[e]very person who is committed to the adult correctional institutions to answer for any criminal offense, after conviction,” as well as “periodic testing for HIV, including testing at the time of release and when deemed appropriate by a physician” (RI ST 42-56-37 & RI ST 23-6.3-4(a)(11)).

C) Rhode Island law requires HIV testing of donated or collected sperm (RI ST 23-1-38).

What laws in Rhode Island protect the privacy of medical information, such as HIV?

In Rhode Island, there are multiple laws that protect the privacy of medical information such as HIV.  For example, under the HIV-Specific Privacy Law, it is “unlawful for any person to disclose to a third party the results of an individual’s HIV test without the prior written consent of that individual” (RI ST 23-6.3-4 (b) (emphasis added)), except for certain exemptions that are listed below. Other laws that protect privacy of medical information in various circumstances are discussed below.

What law protects the confidentiality of HIV test results that are recorded in patient files?

Rhode Island law also has a specific provision for protecting records of HIV test results, which states that: “Providers of healthcare, public health officials, and any other person who maintains records containing information on HIV test results of individuals are responsible for maintaining full confidentiality of this data and shall take appropriate steps for their protection” (RI ST 23-6.3-8(a)).

These steps include:

• Keeping records secure at all times and establishing adequate confidentiality safeguards for any such records electronically stored;
• Establishing and enforcing reasonable rules limiting access to these records; and
• Training persons who handle records in security objectives and techniques (RI ST 23-6.3-8).

Are there additional statutes that can protect the confidentiality of a person’s HIV positive test result?

Yes, Rhode Island law expressly prohibits the nonconsensual disclosure of confidential health care information, which is described as “all information relating to a patient’s health care history, diagnosis, condition, treatment, or evaluation obtained from a health care provider who has treated the patient.”  This law is referred to as the Confidentiality of Health Care Communications and Information Act (RI ST 5-37.3-3 (3) (i); RI ST 5-37.3-4 (a)).

Under this act, “confidential health care information” cannot be released or transferred without a written consent form containing clear information regarding the proposed uses of the information and the extent of information to be released (RI ST 5-37.3-4 (d)).

Are there circumstances under which Rhode Island law permits the disclosure of HIV status without written informed consent?

Yes, Rhode Island law provides for disclosure of HIV status under specifically prescribed circumstances (RI ST 23-6.3-7).

(A) A physician may without the consent of the patient:

• “[E]nter HIV test results in the patient’s medical record.”
• Release confidential medical information, including a patient’s HIV status,
  pursuant to the exceptions listed in the Confidentiality of Health Care
  Communications and Information Act (RI ST 5-37.3-4 (b)) and the Mental Health
  Law (RI ST 40.1-5-26 (b)).
• Notify the director of the department of children, youth, and families (DCYF) the
  results of an involuntary test (RI ST 23-6.3-7 (a) (3)).
• “Inform third parties with whom an HIV-infected patient is in close and continuous
  exposure-related contact, including but not limited to a spouse and/or partner, if
  the nature of the contact, in the physician’s opinion, poses a clear and present
  danger of HIV transmission to the third party; and if the physician has reason to
  believe that the patient, despite the physician’s strong encouragement, has not
  and will not inform the third party that they may have been exposed to HIV” (RI
  ST 23-6.3-10 (b)).

(B) Under RI ST 23-5-9, when a person dies with certain enumerated health conditions,
including AIDS, a physician or family member (if the person did not die in a healthcare
facility) must notify the person picking up the body that the person died of AIDS. The
person picking up the dead body must convey that notification to any embalmer or
funeral director (RI ST 23-5-9).

(C) If a first responder (e.g., firefighter, police officer, EMT) treating or transporting a
person to a licensed facility is exposed to the blood of a person subsequently
diagnosed with an infectious disease, and the exposure is sufficient to create a risk of
transmission, the facility shall issue notification of exposure (RI ST 23-28.36-3).

How can violations of the HIV privacy statutes be addressed?

Under Rhode Island law, a civil suit can be filed for damages (RI ST 5-37.3-9; (RI ST 23-6.3-8 (e)). An intentional and knowing violation of these statutes may also result in criminal prosecution (RI ST 5-37.3-9).

Does a person with HIV have a Constitutional right to privacy?

Many courts have found that a person has a constitutional privacy right to the nondisclosure of HIV status.  Courts have based this right on the Due Process Clause of the U.S. Constitution, which creates a privacy interest in avoiding disclosure of certain types of personal information.

The constitutional right to privacy can only be asserted when the person disclosing the information is a state or government actor — e.g. police, prison officials, doctors at a state hospital.

To determine whether there has been a violation of this right to privacy, courts balance the nature of the intrusion into a person’s privacy against the weight to be given to the government’s legitimate reasons for a policy or practice that results in disclosure.

Does Rhode Island have reporting laws that require positive HIV test results or AIDS to be reported to the Rhode Island Department of Health?

All states require that numerous health conditions be reported to state health officials in order to assess trends in the epidemiology of diseases and develop effective prevention strategies. Rhode Island law requires that physicians, health care providers, health care facilities and prisons report the names of persons diagnosed with HIV or AIDS (except in the case of anonymous testing) to the Department of Health (RI ST 23-6.3- 14), including those perinatally exposed to HIV as indicated by two positive PCR tests (RI ST 23-6.3-14 (4)).
All information in connection with HIV or AIDS cases is subject to strong confidentiality
provisions under Rhode Island law.