HIV INTERVIEW FORM No. 917, Mississippi State Department of Health (2009)

Client/Agency Forms

The six "requirements" which all HIV-positive individuals are directed to acknowledge in writing on this Mississippi State Department of Health form include the "necessity of not causing pregnancy or becoming pregnant," and the necessity of informing future contact s of HIV status before sex even if condoms are used.  (The use of this form was suspended in Fall 2010)

This form consists of three pages of instructions for Disease Intervention Specialists or Health Projection Nurses responsible for ensuring the forms' completion; a two-page client interview form that staff complete with the client who tests positive; and a one-page form that requires the individual who has tested positive to acknowledge six "requirements" by initialing each one and signing the form in the presence of a Mississippi State Department of Health (MSDH) witness, who also signs the form. 

It seems unlikely that the MSDH attempted prohibition against pregnancy for those who are HIV positive would withstand a federal constitutional legal challenge as a violation of a fundamental right to reproductive choice.  In any event, individuals who test positive should not agree to sign the form, and case managers and counselors should support clients in their refusal to do so.

In Mississippi, (Miss. Code Ann. § 97-27-14(1) )it is a felony punishable by up to ten years in prison and/or a $10,000 fine if an HIV-positive person knowingly exposes another to HIV.  Proof of a partner's consent is a defense under the law, although neither the intent to transmit HIV nor actual transmission is required for conviction.