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Le Massachusetts dispose-t-il de lois protégeant les personnes vivant avec le VIH contre la discrimination ?

Oui. Le Massachusetts a adopté des lois anti-discrimination protégeant les personnes séropositives contre la discrimination à l'emploi, au logement et dans les lieux publics. De plus, plusieurs lois fédérales protègent les personnes contre la discrimination fondée sur leur statut VIH.

Qui est protégé par ces lois anti-discrimination ?

  • Les personnes atteintes du SIDA ou séropositives, même si elles sont asymptomatiques et ne présentent aucun signe extérieur ou manifeste de maladie.
  • Les personnes qui ont des antécédents de VIH ou qui sont considérées ou perçues comme étant séropositives.
  • Under federal law, but not Massachusetts law, a person who does not have HIV, but who “associates” with a person with HIV– such as a friend, lover, spouse, roommate, business associate, advocate or caregiver.

Quelles lois protègent les personnes vivant avec le VIH contre la discrimination dans l’emploi ?

People with HIV are protected under Massachusetts General Law Chapter 151B and the federal Americans with Disabilities Act (ADA). Both of these statutes prohibit discrimination in employment on the basis of a person’s disability. Massachusetts law covers workplaces with six or more employees. The ADA covers workplaces with 15 or more employees.

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 Massachusetts, see: Discrimination | Employment | Massachusetts

Qu’interdisent ces lois anti-discrimination ?

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, promote, or otherwise discriminate in the terms or conditions of employment, based on an individual’s HIV/AIDS status.

L’accent est mis ici sur la question de savoir si une personne atteinte du sida ou du VIH a été traitée différemment des autres candidats ou employés dans des situations similaires.

Voici des exemples de discrimination illégale :

  • Un employeur ne peut pas refuser d’embaucher une personne atteinte du VIH par crainte que le VIH soit transmis à d’autres employés ou à des clients.
  • Un employeur ne peut pas refuser d’embaucher ou de prendre une décision d’emploi en se basant sur la possibilité, ou même la probabilité, qu’une personne tombe malade et ne soit plus en mesure d’effectuer le travail à l’avenir.
  • Un employeur ne peut pas refuser d’embaucher une personne parce que cela augmenterait les primes d’assurance maladie ou d’assurance contre les accidents du travail.

Un employeur du Massachusetts peut-il exiger d’un candidat ou d’un employé qu’il passe un test de dépistage du VIH ?

No. Massachusetts law (M.G.L. c. 111, § 70F) prohibits an employer from requiring that an employee take an HIV test en toutes circonstances à n’importe quelle étape du processus de candidature ou d’emploi.

Quelles questions un employeur peut-il poser sur la santé d’un employé au cours du processus de candidature et d’entretien ?

Under the ADA and Massachusetts law, 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:

  • Avez-vous déjà été hospitalisé ou sous les soins d’un médecin ?
  • Avez-vous déjà bénéficié d’une indemnisation des accidents du travail ou reçu des prestations d’invalidité ?
  • Avez-vous déjà eu des problèmes médicaux qui vous empêcheraient d’exercer votre travail ?
  • Quels médicaments prenez-vous?

An employer may, however, ask whether an applicant has the knowledge, skill, and ability to perform the job functions.

Après une offre d'emploi, un employeur peut-il exiger un examen médical ? Quelles sont les directives applicables ?

Under the ADA, after a conditional offer of employment, an employer may request a medical examination or any medical information, without limitation.  However, the ADA does require the employer to follow certain practices:

  • L'employeur doit exiger l'examen médical ou l'enquête de tous les candidats de la catégorie d'emploi.
  • Les informations doivent rester strictement confidentielles. Elles doivent figurer sur des formulaires distincts et être conservées dans un dossier distinct, séparé du dossier personnel général.
  • Les informations ne peuvent pas être partagées avec d’autres, à l’exception limitée des superviseurs ou des gestionnaires qui doivent être informés des restrictions ou des aménagements de travail nécessaires, ou du personnel de sécurité qui peut être informé si la personne handicapée a besoin d’un traitement d’urgence.
  • Les résultats de l’examen médical ne peuvent pas être utilisés pour retirer l’offre d’emploi, à moins que les résultats n’indiquent que la personne n’est pas en mesure d’exécuter les fonctions essentielles de l’emploi avec des aménagements raisonnables.

Après le début de l'emploi, un employeur ne peut exiger un examen médical d'un employé actuel que si celui-ci est « lié à l'emploi et conforme aux nécessités de l'entreprise ». L'employeur doit démontrer que l'examen médical est nécessaire pour évaluer l'exécution réelle des fonctions de l'employé.

Bien entendu, comme indiqué ci-dessus, il est interdit aux employeurs du Massachusetts de demander un test de dépistage du VIH à tout moment.

En général, la loi du Massachusetts limite les demandes de renseignements médicaux des employeurs de manière plus stricte que la loi fédérale. Selon cette loi, après une offre d'emploi conditionnelle, un employeur ne peut exiger un examen médical que pour déterminer si l'employé est capable d'exercer les fonctions essentielles du poste moyennant des aménagements raisonnables.

How have the courts addressed fears that healthcare employees who perform invasive procedures, such as surgeons, will transmit HIV to patients?

The risk of HIV transmission from a healthcare 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 healthcare 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.

Les dispositions relatives à l'emploi de l'ADA prévoient qu'un employé n'est pas qualifié pour exercer son emploi s'il représente une « menace directe pour la santé ou la sécurité d'autrui ». Pour déterminer si un employé représente une « menace directe », un tribunal analyse :

  • The nature, duration, and severity of the risk;
  • La probabilité du risque ; et
  • Whether the risk can be eliminated by reasonable accommodation

In the case of HIV-positive healthcare workers, courts have ignored the extremely remote probability of the risk and instead have focused on the nature, duration, and severity of the risk. The following excerpt from a recent case is typical of the 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 System Corporation, 50 F. 3d 1261 (4th Cir. Md) (1995)).

It is important to note that only a small number of courts have addressed the rights of HIV-positive healthcare 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 healthcare worker who is confronted with potential employment discrimination should consult a lawyer or public health advocate.

Évaluation de la discrimination par un employeur

Bien qu’il puisse être utile de consulter un avocat, les étapes suivantes peuvent être utiles pour commencer à considérer et à évaluer un problème potentiel de discrimination à l’emploi.

  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, a 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. In order to prove a discrimination claim (i.e., that you were fired, demoted, etc. because of discrimination and not because of some legitimate reason), you must be able to show the following:
  • L’employeur savait ou a découvert que vous étiez séropositif ou atteint du sida ;
  • Vous étiez qualifié pour exécuter les fonctions essentielles du poste avec ou sans aménagement raisonnable ; et
  • Des mesures défavorables ont été prises à votre encontre en raison de votre statut VIH ou SIDA et la raison invoquée par l’employeur pour justifier ces mesures défavorables est fausse.
  1. If your employer knows that you have HIV or AIDS, identify exactly who knows, how they know, and when they found out. If you have not told your employer, is there any other way the employer would know or suspect your HIV status?
  2. Consider the reasons why you believe that you are being treated differently because of HIV status, including the following areas:
  • D’autres employés dans des situations similaires ont-ils été traités différemment ou de la même manière ?
  • Votre employeur a-t-il respecté ses politiques en matière de personnel ?
  • Le traitement défavorable a-t-il commencé peu de temps après que l’employeur a appris votre statut VIH ?
  • Avez-vous été absent du travail en raison d’une maladie pendant une période donnée et le traitement défavorable a-t-il commencé dès votre retour au travail ?
  • Quelle sera la version des faits de votre employeur ? Comment prouverez-vous que sa version est fausse ?
  1. Do you have any difficulty fulfilling the duties of your job because of any HIV-related health or medical issue? Does your condition prevent full-time work, or require time off for medical appointments, lighter duties or a less stressful position? You might want to try brainstorming to create a reasonable accommodation that you can propose to your employer. Here are some points to consider:
  • Comment fonctionne l'entreprise et comment fonctionnerait l'hébergement en pratique ?
  • Mettez-vous à la place de votre supérieur. Quelles objections pourraient être soulevées face à l'aménagement raisonnable demandé ? Par exemple, si vous devez partir à une heure précise pour des rendez-vous médicaux, qui assurera votre remplacement ?

Quelles lois du Massachusetts interdisent la discrimination en matière de logement ?

It is illegal under both Massachusetts law (M.G.L. c. 151B) and the federal National Fair Housing Amendments of 1989 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 status, or because he or she is regarded as having HIV or AIDS.

De plus, une personne ne peut être discriminée en matière de logement en raison de son « association » avec une personne séropositive. Cela signifie qu'une personne ne peut être discriminée parce que son colocataire, son amant, son ami, son parent ou son partenaire professionnel est séropositif.

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

Existe-t-il des exceptions à ces lois ?

Oui. La loi du Massachusetts exempte les logements de deux logements occupés par leur propriétaire. De plus, la loi sur le logement équitable (Fair Housing Act) exempte, dans certaines circonstances, les immeubles occupés par leur propriétaire ne dépassant pas quatre logements, les maisons individuelles vendues ou louées sans l'aide d'un courtier, ainsi que les logements gérés par des organisations et des clubs privés dont l'occupation est réservée à leurs membres.

Les lois du Massachusetts protègent-elles contre la discrimination de la part des prestataires de soins de santé, des entreprises et d’autres lieux publics ?

Yes. Under both Massachusetts law (M.G.L. c. 272, § 98) and the ADA, 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. In addition, the Federal Rehabilitation Act of 1973 (29 U.S.C.A. § 794) prohibits discrimination on the basis of disability in any agency or program that receives federal funding, including hospitals, medical or dental offices, and educational institutions.

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 Massachusetts, see: Discrimination | Public Accommodations | Massachusetts

Is discrimination by healthcare professionals against people with HIV still a problem?

Believe it or not, persons with HIV are still faced with discrimination by hospitals, doctors, dentists, and other healthcare 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.

Quels types d’arguments sont avancés par les médecins qui discriminent les personnes vivant avec le VIH et sont-ils légitimes ?

Les médecins tentent généralement de justifier la discrimination à l’encontre des personnes vivant avec le VIH avec l’un des deux arguments suivants :

  • « Traiter les personnes atteintes du VIH est dangereux » (Certains médecins refusent de traiter les personnes atteintes du VIH en raison d'une peur irrationnelle de la transmission du VIH) ; et
  • « Traiter les personnes atteintes du VIH nécessite une expertise particulière » (Certains médecins orientent leurs patients vers d’autres prestataires de soins médicaux en se basant sur la croyance erronée selon laquelle les médecins généralistes ne sont pas qualifiés pour fournir des soins aux patients atteints du VIH).

Le refus catégorique de fournir un traitement médical ainsi que les orientations inutiles fondées sur le handicap d'une personne sont illégaux en vertu de l'ADA et de la loi du Massachusetts.

Comment les tribunaux et les experts médicaux ont-ils répondu à ces arguments ?

Les tribunaux et les experts médicaux ont répondu à ces arguments de la manière suivante :

  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 needle sticks or other exposures to blood. However, studies of healthcare workers have concluded that the 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, that healthcare providers cannot refuse to treat people with HIV based on concerns or fears about HIV transmission (524 U.S. 624 (1998)).

In addition to the legal perspective, both the American Medical Association and the American Dental Association, and many other professional healthcare organizations, have issued policies that it is unethical to refuse treatment to a person with HIV.

  1. “Treating People with HIV Requires Special Expertise”

Dans ces cas, le bien-fondé d’une plainte pour discrimination dépend de la question de savoir si, sur la base de preuves médicales objectives, les services ou le traitement dont le patient a besoin nécessitent une orientation vers un spécialiste ou relèvent du champ de services et de la compétence du prestataire.

In United States v. Morvant, a federal trial court rejected a dentist’s claim that patients with HIV require a specialist for routine dental care (898 F. Supp. 1157 (E.D. La 1995)). 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.

What are the specific provisions of the ADA that prohibit discrimination by healthcare providers?

Under Title III of the ADA (42 U.S.C. §§ 12181-12188), and similar provisions of Massachusetts law, it is illegal for a healthcare provider to:

  • Deny an HIV-positive patient the “full and equal enjoyment” of medical services or deny an HIV-positive patient the “opportunity to benefit” from medical services in the same manner as other patients.
  • Établir des « critères d’éligibilité » pour le privilège de recevoir des services médicaux, qui tendent à exclure les patients dont le test de dépistage du VIH est positif.
  • Fournir des services « différents ou séparés » aux patients séropositifs ou ne pas fournir de services aux patients dans le « cadre le plus intégré ».
  • Refuser l’égalité des services médicaux à une personne connue pour avoir une « relation » ou une « association » avec une personne vivant avec le VIH, comme un conjoint, un partenaire, un enfant ou un ami.

What specific healthcare practices constitute illegal discrimination against people with HIV?

En appliquant les dispositions spécifiques de l’ADA ci-dessus à la pratique des soins de santé, les pratiques suivantes sont illégales :

  • A healthcare provider cannot decline to treat a person with HIV based on a perceived risk of HIV transmission or because the physician simply does not feel comfortable treating a person with HIV.
  • A healthcare provider cannot agree to treat a patient only in a treatment setting outside the physician’s regular office, such as a special hospital clinic, simply because the person is HIV-positive.
  • A healthcare 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 healthcare 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 be an ADA violation to even use unnecessary additional precautions which tend to stigmatize a patient simply on the basis of HIV status.

A healthcare provider cannot limit the scheduled times for treating HIV-positive patients, such as insisting that an HIV-positive patient come in at the end of the day.

Quels sont les recours potentiels en cas de discrimination en vertu de la loi fédérale ?

Pour déposer une plainte pour discrimination à l'emploi en vertu de l'Americans with Disabilities Act, l'employeur doit compter au moins 15 salariés. Une personne doit déposer une plainte auprès de la Commission pour l'égalité des chances en matière d'emploi (EEOC) dans les 180 jours suivant la date de l'acte discriminatoire. Une personne peut retirer sa plainte ADA de l'EEOC et intenter une action en justice devant un tribunal d'État ou fédéral.

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.

Pour faire valoir une réclamation en vertu de la Loi sur la réadaptation, une personne peut déposer une plainte administrative auprès du bureau régional du ministère fédéral de la Santé et des Services sociaux et/ou intenter une action en justice directement devant le tribunal.

Pour déposer une plainte en vertu de la loi nationale sur le logement équitable pour discrimination en matière de logement, une personne peut déposer une plainte auprès du Bureau du logement et du développement urbain des États-Unis dans un délai d'un an à compter de l'infraction. Une personne peut également intenter une action en justice dans un délai de deux ans à compter de l'infraction. Une action en justice peut être intentée, que la personne ait ou non déposé une plainte auprès du HUD.

Ressources

For more information about the MCAD complaint process see:

For information about filing a discrimination complaint under the ADA, see:

Cases & Advocacy

To see HIV/AIDS cases or advocacy in which GLAD has been directly involved with in Massachusetts, go to: Cases and Advocacy – GLAD and under “By Issue” click on “HIV/AIDS” and under “By Location” click on “Massachusetts.”

Actualités et communiqués de presse

To see news and press releases about HIV/AIDS in Massachusetts, go to: News & Press Releases – GLAD and under “By Issue” click on “HIV/AIDS” and under “By Location” click on “Massachusetts.”

What laws in Massachusetts govern informed consent for HIV testing?

In 2012, Massachusetts changed the HIV testing part of the law (M.G.L. c. 111, § 70F) to require only “verbal informed consent.” However, a physician, health care provider, or health care facility may not do any of the following without first obtaining a person’s written informed consent:

  • Reveal to third parties that a person took an HIV test; or
  • Disclose to third parties the results of a person’s HIV test.

It is important to keep in mind that this law only prohibits the disclosure of HIV status by healthcare providers.

A competent adult has the right to decide whether he or she wishes to undergo any medical treatment or testing. Without informed consent, the provision of medical treatment is considered to be a “battery,” a legal claim based upon nonconsensual physical contact with or intrusion upon a person’s body.

What type of consent is considered sufficient?

Consent to an HIV test only needs to be done orally, but disclosure that a person took an HIV test or the results of an HIV test requires written informed consent and must be HIV-specific, not general.

Written informed consent means that a person must sign a specific release authorizing the health care provider to test for HIV and/or disclose the results of an HIV test.

A general release to a healthcare provider authorizing the disclosure of medical records and information is insufficient. The release must specifically authorize the disclosure of HIV test results and must state the purpose for which the information is being requested.

What are the possible penalties for health care providers that do not obtain written informed consent?

A healthcare provider or facility that tests for HIV or discloses an HIV test result without written informed consent violates a Massachusetts law (M.G.L. c.  93A) that protects consumers from unfair and deceptive trade practices. Under this law, a person may receive compensatory damages for harm such as emotional distress, attorneys’ fees, and, under certain circumstances, multiple damages— damages up to three times the amount of a person’s actual damages.  A physician may also be liable for medical malpractice or battery.

Can minors give informed consent?

Under Massachusetts law, minors (persons under the age of 18) are generally considered to lack the legal capacity to consent to medical treatment. However, given the importance of making HIV testing available to adolescents, there are two sources of law that authorize a minor to consent to medical treatment or testing, such as an HIV test, without the consent of a parent or legal guardian.

Both lawmakers and the courts have acknowledged the importance of minors being able to make independent decisions about their health care in certain circumstances.

What laws govern minors and informed consent?

Massachusetts law (M.G.L. c. 112, § 12F) provides that a minor may give consent to medical or dental treatment and prevention of HIV under certain circumstances.

Minors may consent to testing and treatment  if they are:

  1. Married, widowed, or divorced;
  2. A parent of a child;
  3. A member of the armed forces;
  4. Pregnant or believes themself to be pregnant;
  5. Living separate and apart from their parents or legal guardian and is managing their own financial affairs; or
  6. “Reasonably believes himself to be suffering from or to have come in contact with any disease defined as dangerous to the public health [by the Department of Public Health] pursuant to Chapter 111.” The list of such diseases includes HIV.
  7. Minors may consent to therapies for the prevention of HIV, such as Pre-exposure prophylaxis if they are sexually active.

A physician or dentist is not liable for performing a treatment or procedure, or for prescribing an HIV preventative therapy, without informed consentof the parent or guardian if the physician relied in good faith on the patient’s representation of eligibility for consent under this law.

Medical or dental records and other information about a minor who consents to treatment or prevention of HIV are confidential. They may not be released except with the minor’s consent or judicial order. The statute, however, creates an exception to the confidentiality of a minor’s medical information when the physician or dentist “reasonably believes” that the minor’s condition is “so serious that his life or limb is endangered.” In this case, the physician or dentist must notify the parents or legal guardian of the minor’s condition.

What do the courts say about minors and informed consent?

In addition to the provisions of Chapter 112, Section 12F, courts have held that minors can provide informed consent for medical treatment if they are sufficiently intelligent and mature to understand the risks and benefits of treatment, regardless of financial independence or living situation. This is known as the “mature minor” rule.

Courts will typically assess the minor’s age, experience, education, training, judgment, conduct, and demeanor to assess whether, under a particular circumstance, the minor can appreciate the nature and consequences of treatment.

Courts will give particular weight to how close the person is to majority (18 years of age), the benefits of the treatment or test (which are significant in the case of an HIV antibody test), and the complexity of the treatment or test.

Can people under 18 access PrEP for HIV prevention without informing their parents?

Yes. If you are under 18 and sexually active, Massachusetts law enables you to access HIV-preventative medication (PrEP) from a healthcare provider or health clinic without needing the consent of a parent or legal guardian. State law ensures the privacy of young people to receive PrEP, or any other HIV prevention therapy, and medical providers can’t share that with anyone, including your parents, without your written consent. For more information, visit PrEP for Minors.

Does Massachusetts have reporting laws that require HIV or AIDS diagnoses to be reported to the Department of Public Health?

Yes. All states require that certain health conditions be reported to public health authorities in order to track epidemiological trends and develop effective prevention strategies. Massachusetts requires that licensed healthcare providers and healthcare facilities licensed by the Department of Public Health report HIV and AIDS cases by name to the Massachusetts HIV/AIDS Surveillance Program. AIDS cases have been reportable by name since 1983.  In 1999 HIV cases became reportable using a unique identifier code. Due to funding conditions by the federal government, however, Massachusetts was forced to require HIV reporting by name beginning January 1, 2007.

The Department of Public Health has strong security measures in place to prevent the dissemination of HIV/AIDS reporting data. In addition, state regulations prohibit names from being shared with anyone else, including state or federal government entities (for more information, see HIV Reporting in Massachusetts for Consumers available at Mass.gov, in the Diseases & Conditions section under Physical Health and Treatment).

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

As noted above, the HIV testing statute prohibits a healthcare provider from disclosing to a third party the results of an HIV test without written informed consent. A more general Massachusetts privacy law applies in other contexts.

Massachusetts law (M.G.L. c. 214, § 1B) provides:

A person shall have a right against unreasonable, substantial, or serious interference with his privacy.

How do courts determine whether there has been a violation of this general privacy law?

As an initial matter, in order to be protected by this law, a person must have a “privacy right” in particular information. Courts have ruled that a person has a privacy right in HIV infection status because:

  • HIV is personal medical information; and
  • HIV is associated with significant social stigma and

Simply having a “privacy right” in certain personal information, however, does not mean that every disclosure is a violation of the law.

In analyzing whether there has been a violation of the statute, courts will determine whether there is any legitimate countervailing reason for the disclosure. In other words, a court will balance privacy rights versus other reasons that a defendant articulates as to why the disclosure was necessary in spite of the infringement upon privacy.

For example, if an employee reveals his or her HIV status to a supervisor, the supervisor may only reveal that information to others for a necessary business reason.  It may be considered a legitimate business reason to discuss the employee’s HIV status with other management personnel in connection with making adjustments to a person’s job duties as a reasonable accommodation. It would not, however, be a legitimate business reason to tell the employee’s co-workers or non-essential management personnel.

If a daycare center or school revealed the identity of a child or student with AIDS to parents or other students, there is a good argument that such conduct violates Massachusetts law. There is no legitimate interest in disclosing the child’s HIV status, especially since the risk of transmission to others is minuscule.

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, intimate 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, or doctors at a state hospital.

Similar to the Massachusetts privacy statute (M.G.L. c. 214, § 1B), courts balance the nature of the intrusion into a person’s privacy against the weight to be given to the government’s legitimate reason for a policy or practice that results in disclosure.

Do healthcare professionals ever have an obligation to warn a third party about a client’s HIV status?

It is the AIDS Law Project’s view that there is no clear justification for such a breach of confidentiality under Massachusetts law, even if a counselor or physician learns that a client is engaging in unsafe sex or other risky behavior without having disclosed his or her HIV-positive status to a partner. Providers and consumers alike, however, should be aware that the case law in this area is still developing and remains unresolved. For a legal opinion on how to handle a specific situation, consult with a supervisor or lawyer.

Do provisions under Massachusetts law that permit health care providers, under certain limited circumstances, to warn third parties of potential harm apply to HIV status?

It is the AIDS Law Project’s position that these provisions should not be understood to apply to HIV.

Take, for example, the Massachusetts statute that permits licensed social workers and licensed mental health professionals to warn third-parties under certain limited circumstances (M.G.L. c. 112, § 135A). Under certain circumstances, Massachusetts law provides that a social worker may, but is not legally mandated to, disclose confidential communications, including situations when:

  • The client has communicated an explicit threat to kill or inflict serious bodily injury upon a reasonably identified victim or victims with the apparent intent and ability to carry out the threat;
  • The client has a history of physical violence that is known to the social worker and the social worker has a reasonable basis to believe a client will kill or inflict serious bodily injury on a reasonably identifiable victim.

There are virtually identical statutes for licensed psychologists (M.G.L. c. 112, § 129A) and licensed mental health professionals (M.G.L. c. 123, § 36B).

And, with respect to physicians, the Massachusetts Supreme Judicial Court stated in Alberts v. Devine in 1985, that physicians owe patients a legal duty not to disclose confidential patient medical information without the patient’s consent, “except to meet a serious danger to the patient or others.” The Court did not, and has not since then, articulated the meaning and scope of the words “serious danger.”

Neither of these provisions provides clear legal justification to breach the confidentiality of a client’s HIV status, in light of the specific Massachusetts statute prohibiting the involuntary disclosure of HIV status by a healthcare provider.

No court has ever interpreted the relationship between the HIV confidentiality statute and other general provisions permitting disclosure of patient information under limited circumstances by doctors or mental health providers. Therefore, providers who involuntarily disclose a client’s HIV status risk liability for invasion of privacy.

However, because this is an evolving area of law, it is crucial to consult an attorney with questions about specific situations.

 

HIV/STI Testing and Counseling Resources

  • Planification familiale – HIV/STI Testing and sexual healthcare
  • Fenway Health – specializing in healthcare for LGBTQ communities and people living with HIV/AIDS
  • BAGLY – Boston Alliance of LGBTQ Youth
  • Verre de Boston – a variety of services for LGBTQ Youth, including HIV testing

 

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

People 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 “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.

How can 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 GLAD Answers at Réponses GLAD in order to strategize about ways to respond to such requests.

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.

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, including:

  • 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.

Am I able to purchase syringes at a pharmacy without a prescription?

Yes. In 2006, Massachusetts passed a law allowing pharmacies to sell syringes over the counter to anyone who is 18 years of age or older and decriminalizing possession of needles (M. G. L. c. 94c §§27-27A).

Does Massachusetts have needle exchange programs?

Yes. Massachusetts law permits the Department of Public Health to establish needle exchange programs, but unfortunately requires “local approval” for the siting of a program (M. G. L. c.111 §215). To date, only Boston, Cambridge, Northampton, and Provincetown have needle exchange programs.

Does Massachusetts have a law that requires health insurance plans to cover lipodystrophy surgery?

Yes, on August 10, 2016, Massachusetts Governor Charlie Baker signed into law An Act Relative to HIV-Associated Lipodystrophy Syndrome Treatment. This first-of-its-kind legislation requires public and private insurers to cover treatment of a debilitating side effect of early HIV medications. This historic victory means that some of the longest-term survivors of the HIV epidemic will finally have access to the critical health care they need and deserve.

For more information, see: Governor Baker Signs Historic Law Requiring Treatment for HIV-Associated Lipodystrophy – GLAD.

Are insurance companies required to provide long-term care or life insurance to people who are taking PrEP?

As a general matter, no. However, in a GLAD case, Doe v Mutual of Omaha Insurance Company, Mutual of Omaha agreed to revise its underwriting guidelines to no longer decline long-term care insurance applicants solely on the basis that an applicant takes PrEP for HIV prevention.

For more information, see: Doe v. Mutual of Omaha Insurance Company – GLAD.

Ressources

For support and more information, contact AIDS Action.

For information about Post-Exposure Prophylaxis (PEP), see: Post-Exposure Prophylaxis (nPEP) | Mass.gov.

For information about Pre-Exposure Prophylaxis, see: HIV Pre-Exposure Prophylaxis (PrEP) information for the public | Mass.gov

 

If you are unable to work and are on SSDI or private disability insurance, it is important to work closely with your medical providers to make sure that the medical documentation supports your continuing need for disability insurance.

MA private health plans and MassHealth must provide coverage for the treatment of lipodystrophy. You can learn more at www.GLAD.org/TLC

   

There are laws in other states requiring disclosure or criminalizing the transmission of HIV. These laws were passed decades ago based on stigma and ignorance about the virus. Fortunately, there are no specific statutes in Massachusetts criminalizing the transmission of HIV.

GLAD Answers can help you:

  • Understand how to file a complaint if you are discriminated against in your job, a public accommodation, housing, obtaining credit, or at school.
  • Understand what it means to ask for a “reasonable accommodation” in your job.
  • Understand your rights when it comes to being tested for HIV and having those test results kept private.

 

  

Pour plus d'informations sur vos droits et protections, et pour des références, vous pouvez contacter Réponses GLADLigne d'information juridique gratuite et confidentielle de GLAD. Votre ressource sur les droits juridiques LGBTQ et VIH !

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August 2022