Advocates alarmed by spike in Missouri prosecutions of people living with HIV

A 20-year-old man was held in St. Charles County, Missouri, awaiting trial on allegations that he knowingly and recklessly exposed another person to HIV. The charge followed an encounter in which authorities alleged that he bit an O’Fallon police officer during an arrest on outstanding warrants.

The prosecution drew scrutiny because Missouri’s HIV-exposure statute expressly listed biting, while public-health guidance said HIV is not ordinarily transmitted that way. Advocates argued that applying an HIV-specific felony charge to the allegation risked reinforcing misunderstanding about how the virus is transmitted.

At the time, the Center for HIV Law and Policy said it had identified five Missouri criminal actions involving HIV since the beginning of 2011, including this case. State health officials said their department tracked relevant filings, although later statements in the report indicated that a comprehensive statewide count was not available.

The Missouri law

Missouri enacted its HIV-specific criminal law in 1988. The statute defined several forms of alleged reckless exposure, including certain contact involving blood or sexual fluids, sharing needles, biting, and conduct that brought specified bodily fluids into contact with mucous membranes or broken skin.

In practical terms, the law treated biting as conduct capable of supporting a felony charge. Advocates objected that this language did not adequately distinguish a theoretical possibility from a realistic transmission risk.

A 1997 amendment also permitted evidence of certain other sexually transmitted infections to be used in an exposure case. Critics said that approach could allow prosecutors to infer conduct without testimony from a person alleged to have been exposed.

Public-health and legal advocates urged lawmakers to ground HIV statutes in established science and proportional assessments of harm. Their concern was broader than a single prosecution: laws that overstate transmission risk can contribute to stigma and may discourage testing or candid conversations with health professionals.

Health-program acknowledgment forms

The report also examined a document presented to some people living with HIV when they enrolled in state-supported medical case management or the AIDS Drug Assistance Program. The form acknowledged both the individual’s status and Missouri law.

Medical case management can help patients coordinate clinical care, nutrition support and other services. The drug-assistance program helps eligible patients obtain antiretroviral medicine and treatment related to opportunistic infections. Advocates questioned whether a newly diagnosed person could reasonably understand the legal consequences of signing such a form while trying to secure essential care.

Critics also argued that official forms should describe transmission accurately and distinguish public-health counseling from the creation of evidence that might later be used in a criminal proceeding. Similar documents used elsewhere had prompted review by health and civil-rights officials.

The number of cases

Although the Missouri law had been in effect since 1988, the report found no complete official count of prosecutions. State health officials said they knew of fewer than ten cases, while the legal-policy center had identified 19 through media reports, including five initiated early in 2011. Those different totals reflected different methods and incomplete records rather than a verified statewide measure.

The article contrasted HIV-specific prosecutions with cases pursued under generally applicable criminal law. That distinction matters because advocates often argue that ordinary statutes can address demonstrable harm without creating a separate legal category based on a medical diagnosis.

The St. Charles County case

According to the county prosecutor’s account, officers learned the defendant’s HIV status from his own statement, information attributed to a caregiver and medication found during the encounter. The report raised questions about whether all subsequent disclosures complied with Missouri’s confidentiality rules for HIV records, which limited who could receive that information and under what circumstances.

The prosecutor emphasized that the statute specifically prohibited a person who knew they had HIV from recklessly exposing someone through biting. Advocates responded that the text of a statute did not resolve whether its scientific premise was sound or whether prosecution was proportionate to the actual risk.

Public-health guidance cited in the original reporting treated transmission through biting as extraordinarily rare and dependent on unusual circumstances involving blood and broken skin. Missouri health officials reported no documented in-state case of transmission by biting.

The central disagreement was therefore not whether an alleged assault could be investigated. It was whether HIV status should transform the allegation into a distinct felony exposure case when the reported transmission risk was exceptionally low. Advocates warned that such prosecutions could deepen stigma, distort public understanding and impose penalties out of proportion to potential harm.