The Missouri Department of Health and Senior Services requires that all individuals who test positive for HIV sign – and initial every paragraph of – a form in which HIV-positive individuals must acknowledge potential criminal liability, punishable by 10 to 30 years or life imprisonment, if they "create a risk of infecting another person…with the virus through sex, needle sharing, biting or other established means of transmitting the virus." The client's "counseling" and signing of the form, updated as recently as 2008, is administered and witnessed by Missouri DOH medical personnel. This form was provided to CHLP by an individual living with HIV who has been required to sign the form on multiple occasions; identifying information about the individual has been redacted.
The development and use of this form by public health officials is an example of the government-perpetuated stigma that drives the HIV epidemic. The involvement of medical professionals in requiring and witnessing a form that forces people with HIV to sign off on biting as an "established means of transmitting the virus," and to create evidence that can be used against them in criminal proceedings, raises serious ethical questions. This is particularly true if clients' access to services hinges on their signing of these forms.