Published August, 1998

Patient's Acknowledgment of Counseling of Positive HIV Status, Arkansas Department of Health, Bureau of Public Health Programs, AIDS/STD Division (1998)

This form was created and used by the Arkansas Department of Health, Bureau of Public Health Programs to document the warning of persons after they have tested positive for HIV that their HIV status can be the basis of felony and misdemeanor charges if they engage in certain conduct. By signing the form, the individual with HIV states that they understand it is a felony to fail to inform a partner of his/her HIV status before engaging "in any type of sexual activity." The one-page acknowledgment form is accompanied by a two-page list of state laws that govern, and potentially criminalize, their conduct.

This form was provided to CHLP by an individual living with HIV who was required to sign the form in 1999, following a positive HIV antibody test.  Identifying information about the individual has been redacted.


The involvement of public health professionals in requiring and witnessing a form that forces people with HIV to create evidence that can be used against them in criminal proceedings raises serious ethical questions, particularly if clients are informed that they do not have the option to refuse to sign. Forms such as these have in fact been used as evidence of criminal intent in prosecutions of people with HIV for consensual sexual activity, even when condoms are used and transmission does not occur.