Testing & Privacy | HIV/AIDS | Massachusetts

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 escrito consentimento informado:

• Revelar a terceiros que uma pessoa fez um teste de HIV; ou
• Divulgar a terceiros os resultados do teste de HIV de uma pessoa.

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

A competent adult has the right to decide whether they wish 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.

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.

Consentimento informado por escrito significa que uma pessoa deve assinar uma autorização específica autorizando o profissional de saúde a fazer o teste de HIV e/ou divulgar os resultados de um teste de HIV.

A general release to a health care 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.

A health care 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.

De acordo com a lei de Massachusetts, menores (pessoas com menos de 18 anos) são geralmente considerados incapazes de consentir em receber tratamento médico. No entanto, dada a importância de disponibilizar o teste de HIV para adolescentes, existem duas fontes de direito que autorizam um menor a consentir em receber tratamento ou teste médico, como um teste de HIV, sem o consentimento de um dos pais ou responsável legal.

Tanto os legisladores quanto os tribunais reconheceram a importância de menores poderem tomar decisões independentes sobre seus cuidados de saúde em determinadas circunstâncias.

Massachusetts law (M.G.L. c. 112, § 12F) provides that a minor may give consent to medical or dental care if they are:

• Married, widowed or divorced;
• Um pai de uma criança;
• Um membro das forças armadas;
• Pregnant or believes herself to be pregnant;
• Living separate and apart from his parents or legal guardian and is managing his own financial affairs; or
• “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.  The minor may only consent to care relating to the diagnosis or treatment of that disease.

A physician or dentist is not liable for performing a procedure without informed consent if the physician relied in good faith on the patient’s statement that they are over 18 years of age.

Medical or dental records and other information about a minor who consents to treatment are confidential and may not be released except with the consent of the minor or upon a 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.

Além das disposições do Capítulo 112, Seção 12F, os tribunais têm decidido que menores podem fornecer consentimento informado para tratamento médico se forem suficientemente inteligentes e maduros para compreender os riscos e benefícios do tratamento, independentemente de sua independência financeira ou situação de moradia. Isso é conhecido como a regra do "menor maduro".

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

Os tribunais darão especial importância à proximidade da pessoa em relação à maioridade (18 anos de idade), aos benefícios do tratamento ou teste (que são significativos no caso de um teste de anticorpos contra o HIV) e à complexidade do tratamento ou teste.

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 health care providers and health care 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 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, visit HIV Reporting in Massachusetts for Consumers available aqui, na seção Doenças e Condições em Saúde Física e Tratamento).

As noted above, the HIV testing statute prohibits a health care 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.

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:

• O HIV é informação médica pessoal; e
• O VIH está associado a um estigma social significativo e

Contudo, simplesmente ter um “direito de privacidade” sobre determinadas informações pessoais não significa que toda divulgação seja uma violação da lei.

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 a disclosure was necessary in spite of the infringement upon privacy.

For example, if an employee reveals their 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 day care 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.

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, 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.

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 their 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.

A posição do Projeto de Lei da AIDS é que essas disposições não devem ser interpretadas como aplicáveis ao 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;
• O cliente tem um histórico de violência física que é conhecido pelo assistente social e o assistente social tem uma base razoável para acreditar que um cliente matará ou infligirá ferimentos corporais graves a uma vítima razoavelmente identificável.

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 health care 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.

No entanto, como esta é uma área do direito em evolução, é fundamental consultar um advogado para tirar dúvidas sobre situações específicas.

Sim. Se você tem menos de 18 anos e é sexualmente ativo, a lei de Massachusetts permite que você tenha acesso à medicação preventiva do HIV (PrEP) de um profissional de saúde ou clínica de saúde sem a necessidade do consentimento dos pais ou responsáveis legais. A lei estadual garante a privacidade dos jovens para receber a PrEP ou qualquer outra terapia de prevenção do HIV, e os profissionais de saúde não podem compartilhar isso com ninguém, incluindo seus pais, sem o seu consentimento por escrito. Para mais informações, visite PrEP para menores.

• Paternidade planejada – Testes de HIV/IST e saúde sexual
• Fenway Health – especializada em assistência médica para comunidades LGBTQ e pessoas vivendo com HIV/AIDS
• BOLSO – Aliança de Jovens LGBTQ de Boston
• Boston GLASS – uma variedade de serviços para jovens LGBTQ, incluindo testes de HIV

Existem leis em outros estados que exigem a divulgação ou criminalizam a transmissão do HIV. Essas leis foram aprovadas décadas atrás com base no estigma e na ignorância sobre o vírus. Felizmente, não há leis específicas em Massachusetts que criminalizem a transmissão do HIV.

Respostas GLAD can help you:

• Entenda como registrar uma reclamação se você for discriminado no trabalho, em uma acomodação pública, moradia, obtenção de crédito ou na escola.
• Entenda o que significa pedir uma “acomodação razoável” no seu trabalho.
• Entenda seus direitos quando se trata de fazer o teste de HIV e manter os resultados do teste em sigilo.