Devin Hursey

HIV Criminalization: Creating an AIDS Predator

I’m continuing a series exploring the relationship between community and public health institutions, with a particular focus on trust. If we have learned nothing else from the COVID-19 pandemic, we have learned that our health is intricately connected with the health of other members of our community. Because of this fact, it is vitally important that communities can trust public health information and interventions enacted by public health institutions.

One common policy believed to cause more harm than benefit to population health, is HIV criminalization. HIV criminalization refers to laws and responses to HIV transmission through means of law enforcement and the criminal justice system. This issue also speaks to the root issue of this series: trust between community and public health institutions.

I want to start out by stating that it is well past time that the public health community takes a decisive stance against the use of the criminal/legal system in response to matters of public health. Instances where public health systems and institutions resort to policing or jail time to enforce their policies constitute a failure of public health. At that point, we have lost the trust of the community and have resorted to measures known to further erode that trust and cause harm to those we are entrusted to serve.

HIV Criminalization

The Story of Nushawn Williams

At the height of the HIV epidemic in 1997, 19-year-old, Nushawn Williams was arrested in Jamestown, New York for allegedly exposing numerous women to HIV. Williams was tested for HIV in 1996 during an arrest for petty larceny, Chautauqua County Health Department officials claim that he was informed of his HIV status immediately. Williams claims that he does not recall being informed of his HIV status at that time. Months later, a number of young women who tested positive for HIV in Jamestown, New York connected their diagnosis back to Williams.

An onslaught of media coverage followed, branding Williams an HIV predator. Stories rehashed Williams’ arrest and warned women who had sex with him to get tested for HIV. Then-Mayor Rudy Guliani called on Williams to be tried for murder, resulting in Williams’ conviction under the New York State’s HIV criminalization law. Williams was sentenced to 12 years for allegedly exposing at least 14 women to HIV, one of whom was just 13 years old.

After serving his 12-year prison sentence, in 2010 Williams was retained behind bars under the state’s 2007 Sex Offender Management and Treatment Act, at the direction of then-New York state attorney general Andrew Cumo. This law, codified after Williams’ initial sentencing, allows for the most dangerous sex offenders to either be retained in state custody or placed on strict and intensive supervision and treatment.

The 2007 Sex Offender Management and Treatment Act year one report states: “Civil Management was never intended to apply to every sex offender. In fact, the legislation was designed to target only those offenders who suffer from a mental abnormality and pose the greatest risk of committing a new crime.” Some reports claim that Williams suffers from antisocial personality disorder.

“The real problem in the public eye is the HIV issue, that he transmitted HIV to individuals. They allege he did it knowingly, but to this day he tells me he wasn’t really sure,” Williams’ lawyer Daniel Grasso told ABC News. Although the state attorney general is allowed discretion in determining the applicability of this law, and there is an option between civil confinement and strict and intensive supervision and treatment, Williams remains in state custody to this day.


Needless to say, HIV criminalization is not a new issue, since 2014 twelve states have successfully modernized their HIV criminal laws to better reflect the current scientific reality of HIV and reduce harm (California, Colorado, Georgia, Illinois, Iowa, Michigan, Missouri, Nevada, New Jersey, North Carolina, Virginia, and Washington). Approximately 35 states have some sort of laws that would criminalize HIV exposure. Yet, people with HIV can still be charged with other violent crimes such as assault or battery, in states that do not have specific HIV laws.

Before we dive into the legal and ethical implications of HIV criminalization, let’s first consider the history and scientific reality of HIV in the modern day. HIV criminalization laws were first drafted around 1990, the year that the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act was signed. Although some laws pre-date this legislation, the act included a mandate for states receiving funding through this policy to enact laws that criminalize the transmission of HIV. HIV, or AIDS as it was commonly known, was considered a terminal illness until 2007. At that time, the advent of HAART changed the classification to a chronic illness, as fewer people with HIV were dying.

How Does HIV Criminalization Impact the Community?

HIV criminalization laws differ from state to state, depending on the criminal code, but most of these laws share several components:

  1. Stigmatizing language – bill language, as well as the media narrative
    One of the first problems with HIV criminal laws or HIV-specific laws, is the use of stigmatizing language to refer to people with HIV such as “HIV carrier” or “HIV infected”. Language used to describe HIV and people with HIV. Stigmatizing language informs attitudes toward those living with HIV, and helps to determine which populations should be prioritized.

    People-first language is recommended whenever referring to the HIV population, such as “people with HIV.”


  2. Disclosure
    People with HIV do not benefit from the same level of confidentiality associated with other medical conditions, which is dangerous given the highly stigmatized nature of HIV. Most HIV criminal laws include provisions requiring the person living with HIV to disclose their HIV status prior to sexual contact or participating in an activity that might expose another person to a substance that might transmit HIV.

    There are a few challenges with disclosure laws. First, disclosure is nearly impossible to prove in court. There are also situations where it might not be safe for one to disclose their HIV status due to stigma. Disclosure laws differ from state to state, but resources can be found through the Center for HIV Law and Policy.

    Although confidentiality is a vulnerability for people with HIV, it is important to know that you still have rights when it comes to their HIV status. There are also resources available for those who struggle with disclosure of their HIV status.


  3. Penalty level
    Most HIV criminal laws were introduced in the late 80s and early 90s, before the introduction of effective antiretroviral therapy. At that time people with HIV were not offered much hope of survival. With this in mind, penalties for HIV exposure and transmission were extreme, often akin to murder or manslaughter. Before the law in my state (Missouri) was modernized, the maximum penalty for HIV transmission was 30 and a half years behind bars.

    Today, HIV is a manageable chronic illness thanks to advances in HIV treatment and the accessibility of tools for both HIV treatment and prevention. Unfortunately, most HIV criminal laws do not reflect these scientific advances.


  4. Defense
    Often, these laws rely solely on disclosure and whether or not HIV transmission occurred, making no consideration for attempts at prevention and acts that are known to have no risk of HIV transmission. So, instances where condoms are used or instances where the alleged method of exposure is oral sex (known to carry no risk of transmission), are often tried.

    Again, in my state prior to modernization, one could be charged for acts such as spitting or biting, which carry no risk of HIV transmission. These laws were drafted when there was much less information about HIV available. Even today, some prosecutors might favor penalties for acts that carry no risk of transmission for reasons other than preventing HIV.

  5. Intent Mens rea or criminal intent refers to the state of mind required to prosecute someone for a particular criminal action. Mens rea establishes a standard for purposeful action required to charge someone for a crime. As it pertains to HIV criminal laws, we want to make sure that people are only charged for deliberate attempts to cause harm through the transmission of HIV.

    Using Missouri as an example again, prior to the modernization, law could prosecute “reckless” exposure and transmission of HIV.
    Mens rea was simply knowing that you have HIV and having sex without disclosing. This means that regardless of intention, one could be prosecuted with a crime for simply not being able to prove that they disclosed their HIV status.

  6. Sex offender registry
    Many states require those convicted under HIV criminal laws to register as sex offenders, which further exposes them to prejudice and risks the confidentiality of their HIV status. Every state maintains a sex offender registry, with much of the information pertaining to charges and identification made available to the public. According to the Center for HIV Law and Policy, “They [registrants] must provide their name, address, date of birth, photograph, fingerprints, DNA, driver’s license, travel documents, employment information and professional licenses, criminal history, and school information.”

  7. Civil Confinement
    As detailed by the Nushawn Williams story, Civil Confinement allows for the indefinite detainment of those deemed a substantial risk to society. There is usually some qualifying justification such as mental illness, but determining who should be held under this law is largely at the discretion of prosecutors and judges. According to the Williams Institute at the University of California, Los Angeles, there are 6,300 currently held in civil confinement in 20 states, federal programs, and Washington, D.C.


I come across horrendous stories involving someone accused of “knowingly” transmitting HIV all the time on social media and in all different forums. Even local news outlets share these stories, as if performing some sort of public service, But I find these stories to be especially stigmatizing. Publishing and sharing these stories reflect a simple indication of one’s acceptance of people with HIV.

HIV criminalization remains a controversial component of the public health landscape in the ongoing response to HIV. I think public health leaders fail to acknowledge that the very same systems urging historically marginalized communities to test for HIV include avenues for prosecution. Although we would like to think of these systems as separate, we need to have a more honest conversation about the ways that public health is complicit in the criminal prosecution of people with HIV.


  1. Barré‐Sinoussi F, Abdool Karim SS, Albert J. Expert consensus statement on the science of HIV in the context of criminal law. Journal of the International AIDS Society. 2018;21(7). doi: 
  2. Besecker A. New York State can keep Nushawn Williams locked up, appeals court rules. Buffalo News. Published May 2, 2023. Accessed June 21, 2023. 
  3. Confidentiality and Disclosure | The Center for HIV Law and Policy. Published 2019. Accessed June 22, 2023. 
  4. Congressional Research Service. Mens Rea: An Overview of State-of-Mind Requirements for Federal Criminal Offenses. Congressional Research Service; 2021. Accessed June 23, 2023. 
  5. Disclosure and HIV. The Well Project. Published August 20, 2019. 
  6. Douglass Dowty. HIV-infected man who had sex with 42 women can be confined. Published May 10, 2016. Accessed June 21, 2023.
  7. Dowd R. More than 6,300 people are detained in civil commitment programs in the US. Williams Institute. Published October 22, 2020. Accessed June 23, 2023. 
  8. Frey J. Style Live: Jamestown and the Story of “Nushawn’s Girls.” Published June 1, 1999. Accessed June 21, 2023.
  9. Gross J. Trail of Arrests, H.I.V. Fears And a Woman’s Tale of Love. The New York Times. Published October 29, 1997. Accessed June 22, 2023. 
  10. Hakim D. Man Who Spread H.I.V. May Be Held. The New York Times. Published April 13, 2010. Accessed June 22, 2023. 
  11. Limits on Confidentiality and HIV Disclosure Laws. Published 2017. Accessed June 22, 2023. 
  12. Hursey D. Missouri’s Redo of Its HIV Criminalization Law Is a Good Start—but It’s Not Enough. Published July 23, 2021. Accessed June 22, 2023. 
  13. Lehman JS, Carr MH, Nichol AJ, et al. Prevalence and public health implications of state laws that criminalize potential HIV exposure in the United States. AIDS Behav. 2014;18(6):997-1006. doi:10.1007/s10461-014-0724-0 
  14. Lopez G. Spitting landed an HIV-positive man in prison for 35 years. Spitting doesn’t transmit HIV. Vox. Published December 1, 2016. Accessed June 23, 2023. 
  15. McNiff E. “HIV Predator” Served Time For Crime But May be Confined for Life. ABC News. Published July 20, 2010. Accessed June 22, 2023.
  16. NIAID HIV Language Guide.; 2020. Accessed June 22, 2023. 
  17. Saigal P, Weait M, Poulton M. Criminalisation of HIV transmission: an overview for clinicians. Sexually Transmitted Infections. 2018;94(6):399-400. doi: 
  18. Sex Offender Registration | The Center for HIV Law and Policy. Published March 29, 2016. Accessed June 23, 2023. 
  19. THE SEX OFFENDER MANAGEMENT and TREATMENT ACT: THE FIRST YEAR.; 2007. Accessed June 22, 2023. 
  20. Strub S, Haught T, Henne J, McKay DrTara. The National HIV Criminalization Survey.; 2021. Accessed June 23, 2023. 
  21. Topousis T. Cuomo: Man intentionally infecting women with HIV should stay in prison. New York Post. Published April 14, 2010. Accessed June 22, 2023.
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The mission of the Boston Congress of Public Health Thought Leadership for Public Health Fellowship (BCPH Fellowship) seeks to: 

  • Incubate the next generation of thought leaders in public health;
  • Advance collective impact for health equity through public health advocacy; and
  • Diversify, democratize, and broaden evidence-based public health dialogue and expression.

It is guided by an overall vision to provide a platform, training, and support network for the next generation of public health thought leaders and public scholars to explore and grow their voice.