Discriminação

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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.

A Lei de Reabilitação de 1973 proíbe a discriminação com base na deficiência em programas conduzidos por agências federais, em programas que recebem assistência financeira federal, em empregos federais e nas práticas de emprego de contratados federais.

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

What do these anti-discrimination laws prohibit in employment?

Um empregador não pode tomar medidas adversas contra um candidato ou funcionário simplesmente com base no fato de a pessoa ter uma deficiência, como HIV ou AIDS. Isso significa que um empregador não pode demitir, recusar-se a contratar, recontratar ou promover, ou discriminar de qualquer outra forma nos termos ou condições de emprego, com base no fato de uma pessoa ser HIV positivo ou ter AIDS.

O foco aqui é se uma pessoa com AIDS ou HIV foi tratada de forma diferente de outros candidatos ou funcionários em situações semelhantes.

Seguem alguns exemplos de discriminação ilegal:

• Um empregador não pode se recusar a contratar uma pessoa com HIV com base no medo de que o HIV seja transmitido a outros funcionários ou clientes.
• Um empregador não pode se recusar a contratar ou tomar uma decisão de emprego com base na possibilidade, ou mesmo na probabilidade, de uma pessoa ficar doente e não ser capaz de fazer o trabalho no futuro.
• Um empregador não pode se recusar a contratar uma pessoa porque isso aumentará os prêmios do seguro de saúde ou de indenização trabalhista.

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).

O que um empregador pode perguntar sobre a saúde de um funcionário durante o processo de inscrição e entrevista?

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:

• Você já foi hospitalizado ou esteve sob cuidados médicos?
• Você já recebeu indenização trabalhista ou benefícios por invalidez?
• Que tipo de remédio você está tomando?
• No entanto, um empregador pode perguntar se o candidato tem o conhecimento, a habilidade e a capacidade para desempenhar as funções do cargo.

Após uma oferta de emprego, o empregador pode exigir um exame médico? Quais diretrizes se aplicam?

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.

Como os tribunais abordaram os temores de que os profissionais de saúde que realizam procedimentos invasivos, como cirurgiões, transmitam o HIV aos pacientes?

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:

• A natureza, duração e gravidade do risco;
• A probabilidade do risco; e
• Se o risco pode ser eliminado por acomodação razoável.

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)).

É importante observar que apenas um pequeno número de tribunais abordou os direitos dos profissionais de saúde soropositivos. O AIDS Law Project acredita que esses casos foram decididos incorretamente e são inconsistentes com a intenção do Congresso ao aprovar a ADA. Devido à natureza instável da lei nessa área, um profissional de saúde que se depare com potencial discriminação no emprego deve consultar um advogado ou defensor da saúde pública.

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. Para provar uma alegação de discriminação (ou seja, que você foi demitido, rebaixado, etc. por causa de discriminação e não por algum motivo legítimo), você deve ser capaz de mostrar o seguinte:

• O empregador sabia ou descobriu que você é HIV positivo ou tem AIDS;
• Você estava qualificado para desempenhar as funções essenciais do trabalho com ou sem acomodações razoáveis; e
• Uma ação adversa foi tomada contra você por causa do seu status de HIV ou AIDS e o motivo pretexto dado pelo empregador para a ação adversa é falso.

3. Se o seu empregador sabe que você tem HIV ou AIDS, identifique exatamente quem sabe, como e quando descobriram. Se você não contou ao seu empregador, existe alguma outra maneira de ele saber ou suspeitar do seu status sorológico para o HIV?

4. Considere os motivos pelos quais você acredita que está sendo tratado de forma diferente devido ao seu status sorológico para o HIV, incluindo as seguintes áreas:

• Outros funcionários em situações semelhantes foram tratados de forma diferente ou igual?
• Seu empregador seguiu suas políticas de pessoal?
• O tratamento adverso começou logo depois que o empregador descobriu seu status sorológico para HIV?
• Você ficou afastado do trabalho por algum período de tempo devido a doença e o tratamento adverso começou quando você retornou ao trabalho?
• Qual será a versão dos fatos do seu empregador? Como você provará que a versão do empregador é falsa?

5. Você tem alguma dificuldade em cumprir as obrigações do seu trabalho devido a algum problema de saúde ou médico relacionado ao HIV? Sua condição impede o trabalho em tempo integral ou exige folga para consultas médicas, tarefas mais leves ou um cargo menos estressante? Você pode tentar fazer um brainstorming para criar uma acomodação razoável que possa propor ao seu empregador. Aqui estão alguns pontos a serem considerados:

• Como a empresa opera e como a acomodação funcionaria na prática?
• Coloque-se no lugar do seu supervisor. Que objeções poderiam ser levantadas à acomodação razoável solicitada? Por exemplo, se você precisasse sair em um determinado horário para consultas médicas, quem assumiria suas funções?

Quais leis proíbem a discriminação na habitação?

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.

Portanto, pessoas com HIV são protegidas contra discriminação em praticamente todos os locais ou estabelecimentos públicos, incluindo bares, restaurantes, hotéis, lojas, escolas, programas vocacionais ou outros programas educacionais, táxis, ônibus, aviões e outros meios de transporte, academias, hospitais e consultórios médicos e odontológicos, desde que essas instalações sejam geralmente abertas ao público.

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

A discriminação por parte dos profissionais de saúde contra pessoas com HIV ainda é um problema?

Acredite ou não, pessoas com HIV ainda enfrentam discriminação por parte de hospitais, médicos, dentistas e outros profissionais de saúde. Essa discriminação pode se manifestar na forma de uma recusa total em prestar serviços médicos ou de um encaminhamento ilegal devido ao status sorológico do paciente.

Que tipos de argumentos os médicos que discriminam pessoas com HIV usam e eles são legítimos?

Os médicos geralmente tentam justificar a discriminação contra pessoas com HIV com um de dois argumentos:

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.

Como os tribunais e os especialistas médicos responderam a esses argumentos?

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.

Além da perspectiva legal, tanto a Associação Médica Americana quanto a Associação Odontológica Americana, e muitas outras organizações profissionais de saúde, emitiram políticas que afirmam que é antiético recusar tratamento a uma pessoa com HIV.

2. “O tratamento de pessoas com VIH requer conhecimentos especializados”

Nesses casos, o mérito de uma alegação de discriminação depende se, com base em evidências médicas objetivas, os serviços ou tratamentos necessários ao paciente exigem encaminhamento a um especialista ou estão dentro do escopo de serviços e competência do provedor.

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.

Quais são as disposições específicas da ADA que proíbem a discriminação por parte de prestadores de serviços de saúde?

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

1. Negar a um paciente seropositivo o “gozo pleno e igualitário” dos serviços médicos ou negar a um paciente seropositivo a “oportunidade de beneficiar” dos serviços médicos da mesma forma que os outros pacientes.
2. Estabelecer “critérios de elegibilidade” para o privilégio de receber serviços médicos, que tendem a excluir pacientes que testaram positivo para o VIH.
3. Fornecer serviços “diferentes ou separados” a pacientes que são HIV-positivos ou não fornecer serviços a pacientes no “ambiente mais integrado”.
4. Negar serviços médicos iguais a uma pessoa que se sabe ter um “relacionamento” ou “associação” com uma pessoa com HIV, como um cônjuge, parceiro, filho ou amigo.

Quais práticas específicas de assistência médica constituem discriminação ilegal contra pessoas com HIV?

Aplicando as disposições específicas da ADA acima à prática de cuidados de saúde, as seguintes práticas são ilegais:

• Um profissional de saúde não pode se recusar a tratar uma pessoa com HIV com base no risco percebido de transmissão do HIV ou porque o médico simplesmente não se sente confortável em tratar uma pessoa com HIV.
• Um profissional de saúde não pode concordar em tratar um paciente apenas em um ambiente de tratamento fora do consultório regular do médico, como uma clínica hospitalar especial, simplesmente porque a pessoa é HIV positiva.
• Um profissional de saúde não pode encaminhar um paciente HIV positivo para outra clínica ou especialista, a menos que o tratamento necessário esteja fora do escopo de sua prática habitual ou especialidade. A ADA exige que os encaminhamentos de pacientes HIV positivos sejam feitos da mesma forma que os encaminhamentos de outros pacientes. No entanto, é permitido encaminhar um paciente para atendimento especializado se ele apresentar condições médicas relacionadas ao HIV que estejam fora da competência ou do escopo de serviços do profissional.
• 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.
• Um profissional de saúde não pode limitar os horários agendados para tratar pacientes HIV positivo, como insistir que um paciente HIV positivo compareça no final do dia.

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.

Quais são algumas possíveis soluções para discriminação segundo a lei federal?

Para entrar com uma ação judicial por discriminação no emprego sob a Lei dos Americanos com Deficiências, o empregador deve ter pelo menos 15 funcionários. A pessoa deve apresentar uma ação à Comissão de Igualdade de Oportunidades de Emprego (EEOC) no prazo de 180 dias a partir da data do ato discriminatório. A pessoa pode retirar uma ação da ADA da EEOC e entrar com uma ação judicial em um tribunal estadual ou federal.

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.

Para prosseguir com uma reclamação sob a Lei de Reabilitação, uma pessoa pode registrar uma queixa administrativa no escritório regional do Departamento Federal de Saúde e Serviços Humanos e/ou entrar com uma ação judicial diretamente no tribunal.

Para apresentar uma queixa ao abrigo da Lei Nacional de Moradia Justa por discriminação na habitação, uma pessoa pode apresentar uma queixa ao Departamento de Habitação e Desenvolvimento Urbano dos Estados Unidos no prazo de um ano a contar da violação. Uma pessoa também pode intentar uma ação judicial no prazo de dois anos a contar da violação. Uma ação judicial pode ser movida independentemente de a pessoa ter ou não apresentado queixa ao Departamento de Habitação e Desenvolvimento Urbano (HUD).

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

Pessoas com deficiência, como HIV/AIDS, podem apresentar problemas de saúde que dificultam o cumprimento de alguns requisitos ou tarefas do trabalho. Por exemplo, uma pessoa pode sentir-se exausta ou fatigada e ter dificuldade em cumprir um horário de trabalho em tempo integral.

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.”

Exemplos de acomodações razoáveis incluem:

● 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.

Não há um conjunto fixo de adaptações que um funcionário possa solicitar. A natureza da adaptação solicitada dependerá das necessidades específicas de cada funcionário.

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.

Um empregador é obrigado a atender a uma solicitação de acomodação razoável?

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.

Quando uma “acomodação razoável” para um funcionário é um “ônus indevido” para um empregador?

Ao determinar se uma acomodação solicitada cria um ônus ou dificuldade indevida para um empregador, os tribunais examinam uma série de fatores, que incluem:

● 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.

Novamente, cada situação é examinada caso a caso.

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.

Para mais informações, consulte: 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).

Uma pessoa com HIV tem direito constitucional à privacidade?

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.

Para determinar se houve uma violação desse direito à privacidade, os tribunais avaliam a natureza da intrusão na privacidade de uma pessoa em relação ao peso a ser dado às razões legítimas do governo para uma política ou prática que resulta em divulgação.

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.