This study examines HIV counseling practices in Alabama and North Carolina – states with different HIV control laws but similar HIV epidemiology. Both states require mandatory disclosure, but North Carolina’s public health code features an additional seven requirements related to HIV control, as well as two vehicles for prosecution in its criminal code. The authors conducted open-ended interviews with 40 HIV care providers to answer three questions: how clients were counseled about mandatory disclosure; what are the levels of support for HIV disclosure law; and whether providers felt that HIV counseling was effective in altering patient behavior.
The authors found that providers in both states were skeptical that counseling resulted in disclosure or safer sex with all or most partners. The majority of participants reported that counseling about HIV laws was inferred to invoke fear rather than honesty in patients. Support for HIV laws related to locality: “[Alabama] had an ethos of legal leniency, informal counseling practices, and less support for enforcement. North Carolina’s ethos was toward stricter law, formal counseling practices, and greater support for enforcement . . . .”
The authors suggest that it may be time to reconsider the law enforcement model of HIV counseling so that the possible legal consequences of violating mandatory disclosure laws do not constitute barriers to patient care.