HIV Clusters Spread, as Republicans Seek Deep Cuts to HIV Funding

By: Ranier Simons, ADAP Blog Guest Contributor

In the current political climate, given the government’s health policy landscape, many stakeholders are concerned about the stability of public health. This is undeniably true in the HIV space. Republicans seek deep cuts to HIV prevention and treatment funding, which would destabilize the already tenuous nature of care for people living with HIV/AIDS (PLWHA), especially those in vulnerable populations. Hindering effective HIV response is disconcerting, with trends such as HIV clusters appearing. In recent times, HIV cluster outbreaks have been identified. Fruitful public health support of PLWHA requires an increase in resources, not a reduction.

Photo Source: Maine.gov

One such cluster of increased HIV transmission is in Penobscot County, Maine, where Bangor is located. A cluster outbreak was first identified there in late 2023 (Budlon, 2025). A cluster is a group of people with related HIV infections. As of September 2025, the number of cases in this cluster has reached 29 (main DHHS). This area of Maine typically sees only two instances of transmission per year (Budlon, 2025). The majority of those involved in this cluster have been experiencing homelessness, injection drug use, or both in the 12 months before their diagnosis (Tusinksi, 2025). These conditions do not cause HIV; however, they do increase the risk of transmission. Housing instability hinders treatment adherence and consistent access to HIV care. Injection drug use can lead to behavior with increased risk, including sharing needles (Arum et al., 2021). Public health officials infer that the number of transmissions is likely higher than 29, given that many have not been tested.

Another cluster seeing a notable increase is in New York. The increase in infections in a reported cluster in Broome County, New York, in early August is higher than the number seen annually over the past four years. Most of those in the cluster are unhoused, have used intravenous drugs, are Caucasian, and between the ages of 30 and 45 (McCarthy, 2025). In addition to those identified in the clusters, the Broome County Health Department estimates there are a couple of dozen more people who have been exposed to HIV that they are not aware of (McCarthy, 2025). Additionally, as of 2023, Broome County has the third-highest rate of new Hepatitis C mortality in New York state (McCarthy, 2025). Hepatitis C, tuberculosis, Hepatitis B, and syphilis are often comorbid with HIV (McCarthy, 2025). HIV transmission has historically been overrepresented in the South; thus, this Northeastern trend is concerning.

Actions by the current administration are in direct opposition to supporting the reversal of these transmission trends. Reductions in HIV-related funding are harmful on many levels. In a July 2025 Executive Order (EO), the President implies defunding harm reduction. Harm reduction includes syringe service programs (SSP) in which evidence-based data shows that they are one of the best ways to prevent HIV and Hepatitis spread among those who inject drugs. Unlike the EO states, SSPs or safe consumption sites do not facilitate or worsen drug use. Two prominent SSPs in Maine have already shut down. The Maine Center for Disease Control and Prevention revoked the Health Equity Alliance’s (HEAL) syringe exchange certification in January 2025 (Bush, 2025). Additionally, due to a zoning issue, SSP Needlepoint Sanctuary was forced to close in July 2025 (Rupertus, 2025).

The language of the EO also paints the unhoused as a criminal group riddled with drug addiction and mental health disease, deserving of involuntary commitment to facilities to restore public safety. The President’s prescription of rounding up people experiencing homelessness and destroying encampments is the same sentiment that resulted in Camp Hope being closed in February of this year. It was the largest homeless encampment in Bangor, Maine (Peters, 2025). Many of those pushed out of the encampment have not been connected to residential situations and remain unhoused. The encampment served as a means for public health providers to reach unhoused PLWHA for treatment and tracing. However, with the residents of the encampments now scattered, any linkage to care that had occurred is destroyed. That is detrimental to PLWHA and the public since HIV prevention is a public issue.

Photo Source: CNN

The House Republican budget proposal slashes federal HIV prevention and treatment funding, seeking almost $2 billion in HIV-related cuts (Ryan, 2025). This is coupled with the large number of HIV related NIH grants that have already been defunded. In a speech, NIH Director Dr. Jay Bhattacharya stated, “We have now in our capacity the ability to actually end the HIV epidemic by 2030, to reduce HIV transmission to very, very low levels. And we just need to figure out how to do it” (Ryan, 2025). It is unclear how this goal can be achieved, given the massive amount of HIV treatment and prevention defunding that the Trump Administration and House Republicans wish to achieve. 

Regardless of the current destabilization in the HIV-related public health space, monitoring for transmission trends and cluster outbreaks is imperative. A challenging aspect of monitoring is HIV molecular surveillance. HIV molecular surveillance involves the collection and tracking of virus sequences from specific genetic strains of HIV. HIV transmission reporting is required by law for public health purposes. When a person tests positive for HIV, additional genetic bloodwork is done to determine the specific strain of HIV for epidemiological and cluster tracking purposes. 

In theory, meaningful data analysis is achieved by collecting this information. However, there are no proper safeguards in place to ensure the privacy of the PLWHA from whom this data is collected. Privacy breaches could result in harm, including economic and physical safety concerns. There are safer means of acquiring tracking data, such as tracking HIV through comprehensive case surveillance, behavioral and clinical monitoring, and analysis of pharmaceutical data (CDC, 2025). ADAP Advocacy is strongly opposed to HIV molecular surveillance being used to combat HIV clusters and has routinely supported the Center for HIV Law and Policy in its advocacy in this space.

Photo Source: Center for HIV Law & Policy

Data shows that some HIV transmission statistics are trending in the wrong direction. Now is not the time to destabilize the fragile infrastructure that is the status quo. If massive defunding ultimately becomes a permanent reality, HIV clusters will increase, and many preventable transmissions will occur. That outcome will result in a significantly higher level of societal and governmental spending compared to the savings the administration professes to achieve from its proposed fiscal cuts.

[1] Arum, C., Fraser, H., Artenie, A. A., Bivegete, S., Trickey, A., Alary, M., Astemborski, J., Iversen, J., Lim, A. G., MacGregor, L., Morris, M., Ong, J. J., Platt, L., Sack-Davis, R., van Santen, D. K., Solomon, S. S., Sypsa, V., Valencia, J., Van Den Boom, W., Walker, J. G., … Homelessness, HIV, and HCV Review Collaborative Group (2021). Homelessness, unstable housing, and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis. The Lancet. Public health, 6(5), e309–e323. https://doi.org/10.1016/S2468-2667(21)00013-X. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC8097637

[2] Budlon, K. (2025, July 11). Penobscot County HIV outbreak continues to grow; providers say the rest of Maine is at risk. Retrieved from https://www.mainepublic.org/health/2025-07-11/penobscot-county-hiv-outbreak-continues-to-grow-providers-say-the-rest-of-maine-is-at-risk

[3] Bush, B. (2025, January). Maine CDC change to syringe-exchange program in Bangor displaces need for services. Retrieved from https://www.newscentermaine.com/article/news/health/health-equity-alliance-syringe-needle-exchange-program-revoked-maine-cdc/97-f5132e6d-2c9f-405c-b034-cae05cd6de1c

[4] Centers for Disease Control and Prevention. (2025, February 7).About HIV Surveillance and Monitoring. Retrieved from https://www.cdc.gov/hiv-data/about/index.html#:~:text=Medical%20Monitoring%20Project%20(MMP):,outlets%20in%20the%20United%20States. 

[5] McCarthy, J. (2025, September 17). HIV cases have increased in Broome County cluster. Why there is still a 'big unknown'? Retrieved from https://www.pressconnects.com/story/news/public-safety/2025/09/17/hiv-cases-rise-in-ny-cluster-while-health-leaders-grapple-with-containment/86181140007/

[6] Peters, D. (2025, February 28). 'It's family here': Bangor officially closes city's largest homeless encampment. Retrieved from https://www.newscentermaine.com/article/news/local/bangor/bangor-closes-homeless-encampment-camp-hope-maine/97-00f3028d-4739-4ce9-b5fc-9287ab30e6ff#:~:text=Boyd%20Kronholm%2C%20executive%20director%20of%20the%20Bangor,approach%2D%2Drather%20than%20an%20immediate%20sweep%2D%2Dis%20more%20effective.

[7] Rupertus, A. (2025, July 28). Bangor syringe exchange service shuts down shortly after opening. Retrieved from https://www.bangordailynews.com/2025/07/28/bangor/bangor-health/needlepoint-sanctuary-shut-down-shortly-after-opening-n6hjn1me0n/

[8] Ryan, B. (2025, September 29). Republicans seek deep cuts to HIV prevention and treatment funding. Retrieved from https://www.msn.com/en-us/news/other/republicans-seek-deep-cuts-to-hiv-prevention-and-treatment-funding/ar-AA1NGD63?ocid=socialshare

[9] Tusinski, D. (2025, July 23). How a ‘cluster’ of HIV cases in Penobscot County became one of Maine’s largest outbreaks. Retrieved from https://www.pressherald.com/2025/07/23/how-a-cluster-of-hiv-cases-in-penobscot-county-became-one-of-maines-largest-outbreaks/

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.    

HIV/AIDS Fireside Chat Retreat in New Jersey / New York Tackles Pressing Issues

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

The ADAP Advocacy Association hosted an HIV/AIDS "Fireside Chat" retreat in Weehawken, New Jersey among key stakeholder groups to discuss pertinent issues facing people living with HIV/AIDS. The Fireside Chat took place on Thursday, December 5th, and Friday, December 6th. U = U, Molecular HIV Surveillance, and Mental Health were evaluated by 20 diverse leaders in the fight against the HIV/AIDS epidemic.

Photo Source: Getty Images

The Fireside Chat included moderated white-board style discussion sessions on the following issues:

• U = U: A Foundation for Ending the HIV Epidemic — moderated by Murray Penner, Executive Director, North America, Prevention Access Campaign
• Ryan White Program: Is Molecular HIV Surveillance a Public Health Tool or Weapon to Fuel Stigma  — moderated by Brandon M. Macsata, CEO, ADAP Advocacy Association (planned facilitator was sick)
• Mental Health: Implications of Co-Occurring Diagnosis of a Mental Condition and HIV/AIDS  — moderated by Brandon M. Macsata, CEO, ADAP Advocacy Association (planned facilitator was sick)

The discussion sessions were designed to capture key observations, suggestions, and thoughts about how best to address the challenges being discussed at the Fireside Chat. The following represents the attendees:

• Tez Anderson, Founder, Let's Kick ASS (AIDS Survivor Syndrome)
• Guy Anthony, Founder, Black, Gifted & Whole
• William E. Arnold, President & CEO, Community Access National Network (CANN)
• Robert Breining, spokesperson, Positively Fearless
• Patricia Charleston, Program Supervisor, Gaudenzia, Inc.
• Jeffrey S. Crowley, Distinguished Scholar & Program Director at the Infectious Disease Initiatives, O'Neill Institute for National and Global Health Law, Georgetown Law
• Hilary Hansen, Executive Director, US Patient Advocacy & Strategic Alliances, Merck
• Catherine Hanssens, Founding Executive Director, The Center for HIV Law and Policy
• Ben Kelly, VP Operations, Maxor National Pharmacy Services
• Scott Kramer, President & Psychotherapist, Affirming Psychotherapy LCSW PC
• Jen Laws, policy consultant
• Vickie Lynn, Visiting Instructor, USF
• Brandon M. Macsata, CEO, ADAP Advocacy Association
• Julie Marston, Executive Director, Community Research Initiative of New England, Inc.
• Ann-Margaret Navarra, Faculty - Assistant Professor, NYU Rory Meyers College of Nursing
• Stephen Novis, Director, Government Relations, ViiV Healthcare
• Murray Penner, Executive Director, North America, Prevention Access Campaign
• Alan Richardson, Executive Vice President of Strategic Patient Solutions, Patient Advocate Foundation
• Lee Storrow, Executive Director, North Carolina AIDS Action Network (NCAAN)
• Marcus Wilson, National Policy & Advocacy Director, Johnson & Johnson

The ADAP Advocacy Association is pleased to share the following brief recap of the Fireside Chat.

Undetectable = Untransmittable:

Murray Penner provided a basic overview on the science behind "undetectable equals untransmittable" ("U=U"), which is clear and indisputable. Treatment as prevention dates back to the 1990s, including preventing mother-to-child transmission. According to Penner, there have been four large international studies that have demonstrated U=U is sound public health policy.

According to Penner: "Four major scientific studies have proven that HIV-positive individuals who have an undetectable viral load and stay on their medications do not transmit the virus to sexual partners. The findings were initially announced in 2008 with the Swiss Statement, and they were confirmed again in 2016. For many people diagnosed with the virus, the news is nothing short of life-changing. Diagnosis doesn’t mean no more satisfying relationships. And that lifts people out of depression. They feel like they can be intimate and free in their sexual relations, and that’s at the heart of it.”

It was noted that U=U has been endorsed by the World Health Organization ("WHO"), as well as the U.S. Centers for Disease Control & Prevention ("CDC"). The foundation of U=U includes treatment, labs, and connection to care (or "TLC"), and it provides the public health argument for the U=U campaign.

The discussion also focused on the role of providers in educating patients and the general community, as well as how best to communicate the U=U message. There was also some conversation about how the messaging needs to adapt to address diverse communities. The group agreed more needed to be done to use U=U to change the outdated HIV Criminalization laws.

The following materials were shared with retreat attendees:

• Providers Should Discuss U=U with all Patients Living with HIV
• HIVMA Pocket Guide for Providers 
• CDC Letter Approving U=U 
• U=U Basic Fact Sheet – October 2019
• Basic Fact sheet from FHI 360 
• Video: Chloe Orkin is past-chair of the British HIV Association and Gareth Thomas is a rugby player in the U.K. (from Wales) 
• Resources from Prevention Access Campaign (U=U)

The ADAP Advocacy Association would like to publicly acknowledge and thank Murray for facilitating this important discussion.

Molecular HIV Surveillance:

Molecular HIV surveillance involves data collection and sharing between healthcare practitioners and public health departments to track individual treatment resistance, as well as trends in HIV infections. It also leverages cluster detection to identify new infections.

The discussion included an overview on healthcare & privacy rights, which fuel many of the concerns expressed by patients, advocacy groups, and some leading civil rights organizations. Background context included HIV-related stigma, dating back to early 1980s to current times; it also touched on HIV-related criminalization.

Weighing the pros and cons of this took was at the center of the debate on the issue. Whereas it is favored by Health Departments and some public health advocates, there remains considerable push-back from the community. There is no informed consent by patients for data collected using individuals’ blood samples. State and local health departments report de-identified data to the CDC, but there are obvious patient privacy concerns.

HIV Criminalization occupied a lot of the group's time during the discussion. Draconian HIV-specific criminalization laws still exist in 34 states; another 24 states have used general criminal statutes against people living with HIV for “HIV exposure” or non-disclosure of HIV status (CHLP, 2019). These laws relegate people living with HIV to second-class citizenship for numerous reasons. According to the Center for HIV Law and Policy, state HIV criminalization laws “criminalize non-disclosure of HIV status or exposure of a third party to HIV; make exceptions to confidentiality and privacy rights of people living with HIV; provide for sentence enhancements for people living with HIV convicted of underlying crimes such as prostitution and solicitation; and require sex offender registration for people living with HIV” (CHLP, 2019).

The following materials were shared with retreat attendees:

• Molecular HIV surveillance: public health tool or weapon?

Jeffrey R. Lewis, President & CEO of the Legacy Health Endowment, was suppose to facilitate this discussion on Molecular HIV Surveillance but he was unable to attend due to illness. The ADAP Advocacy Association thanks him, nonetheless.

Mental Health:

Mental health and its intersection with HIV/AIDS included important statistics about both health issues in the United States. Research has found considerable overlap between many mental health disorders and HIV infection. Individuals who are receiving care for a mental health condition are four times as likely to be living with HIV compared to the general population, according to a multisite study of the prevalence of HIV with rapid testing in mental health settings.

Increasingly, it is an emerging issue among an aging population living with HIV/AIDS as it has become a chronic disease. As of 2015, over half of the 1.6 million individuals with HIV/AIDS are  50 years, or older. The discussion presented an excellent opportunity to discuss AIDS Survivor Syndrome, which is the term coined by Tea Anderson to describe the “spectrum of sustained trauma survivorship resulting from living through the AIDS pandemic.”

An important tool to address the unmet needs is targeted case management under Medicaid, although not widely utilized for individuals living with HIV/AIDS. Assertive community treatment is an intensive and highly integrated approach for community mental health service delivery. Four states have taken this approach to address the needs of the HIV community.

Once again, HIV Criminalization was discussed because it is linked to numerous mental health conditions among individuals living with HIV/AIDS. According to the CDC's Medical Monitoring Project, four in five HIV-positive patients report feeling internalized HIV-related stigma; two in three say that it is difficult to tell others about their HIV infection; one in three report feeling guilty or ashamed of their HIV status; and one in four say that being HIV-positive makes them feel dirty or worthless (CDC, 2018).

The following materials were shared with retreat attendees:

• Implications of Co-Occurring Diagnosis of a Mental Condition and HIV/AIDS
• MENTAL HEALTH INFOGRAPHIC #1: Implications of Co-Occurring Diagnosis of a Mental Condition and HIV/AIDS (August 2019)
• AIDS Survivor Syndrome & Understanding the Linkages between Mental Health and HIV/AIDS
• MENTAL HEALTH INFOGRAPHIC #2: Implications of Co-Occurring Diagnosis of Depression and HIV/AIDS
• Implications of Health Stigma, Mental Health and HIV/AIDS
• MENTAL HEALTH INFOGRAPHIC #3: Implications of Health Stigma, Mental Health & HIV/AIDS

John Williamson, candidate for Masters in Social Work at Fordham University, was suppose to facilitate this discussion on Mental Health but he was unable to attend due to illness. The ADAP Advocacy Association thanks him, nonetheless.

Additional Fireside Chats are planned in 2020.

References:

• Centers for Disease Control and Prevention. (2018). Medical Monitoring Project. Retrieved from: https://www.cdc.gov/hiv/statistics/systems/mmp/resources.html#Fact%20Sheets,%20
• Center for HIV Law and Policy (March 2019). HIV Criminalization in the United States: A Sourcebook on State and Federal HIV Criminal Law and Practice (Third Edition). Retrieved online at http://www.hivlawandpolicy.org/sourcebook. 

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.

Molecular HIV surveillance: public health tool or weapon?

By: Jeffrey R. Lewis

There is a longstanding, inherent value in the assurance of privacy in our healthcare system. Among other things, it is the keystone of the physician-patient relationship (Holman, 2017); it improves treatment adherence (Heath, 2017); and it has been proven to promote better health outcomes (2013). An ambitious new initiative to combat HIV/AIDS in the United States, however, employs technology that places patients’ privacy protections at risk.

President Trump’s “End the Epidemic by 2030” (EtE) initiative focuses on the 46 (out of 3,000) counties in the United States that account for more than half of new HIV infections. The Administration's plan also provides the opportunity to evaluate the ongoing rise in sexually transmitted diseases, which include worrying trends reported by the U.S. Centers for Disease Control and Prevention (CDC). Examples of the rise of STDs include  a 19% increase in Chlamydia, 63% increase in Gonorrhea, and 71% increase in Syphilis (CDC, 2019).

It is through this initiative that HIV stakeholders are getting an important glimpse into a potentially useful, but troubling, new tool being used by our public health infrastructure – namely, molecular HIV surveillance.

Photo Source: CDC

Molecular HIV surveillance involves data collection and sharing between healthcare practitioners and public health departments to track individual treatment resistance, as well as trends in HIV infections. It also leverages cluster detection to identify new infections of “people normally out of reach to public health” (McClelland, 2019). This information is shared with the CDC, which in turn uses the data to determine funding allocations for state and local health departments combating HIV (CDC, 2017). But at what cost to patients already living with HIV?

What’s troubling is that there is no informed consent by patients for data collected using individuals’ blood samples. State and local health departments report de-identified data to the CDC, but there are obvious patient privacy concerns.

Major health data breaches have become a problem in recent years. In 2016, patients enrolled in California’s AIDS Drug Assistance Program (“ADAP”) (Gorman, 2018); in 2017, patients served by CVS Pharmacy under Ohio’s ADAP  (Hassan, 2018), and Aetna patients in Pennsylvania  (Gordan, 2018), all had their privacy violated. It is not outside the realm of possibility that a data breach could also happen on a larger scale, exposing people living with HIV to further stigma.

Photo Source: Insurance Journal

Although the CDC’s data collection is governed by federal guidelines which intend to protect the privacy of individuals, for those living in the shadows of the nation’s long, dark history of HIV-related stigma, these provide little comfort. The fact remains that negative attitudes toward HIV/AIDS persist.

According to the Kaiser Family Foundation, nearly one in five Americans are somewhat or very uncomfortable working with someone who is living with HIV. One in five Americans is also somewhat or very uncomfortable having a close friendship with someone who is living with HIV. And a staggering two out of five Americans report being somewhat or very uncomfortable sharing a living space with someone who is living with HIV (Kirzinger, 2019). These attitudes are from current data -  not from the early 1980s!

Because molecular HIV surveillance identifies where clusters of people living with HIV reside, there are concerns that it will further fuel HIV-related stigma, which is already high and continues to grow. Worse, patient advocacy groups and legal scholars fear the potential exists for more unfair criminal prosecutions under outdated state HIV criminalization laws that allow prosecution of those who fail to disclose their HIV status.

The CDC has defended the use of this strategy, claiming it is “important to identify growing clusters of recent and rapid transmission to intervene to interrupt transmission” (Oster, 2017). According to their data through December 2015, such clusters have surfaced in each region of the United States, with 1,923 clusters identified, ranging in size from 2-22 cases (Oster, 2017).

Some of these clusters have gained national attention, namely ones in Scott County, Indiana, and San Antonio, Texas. The former resulted in more than 200 diagnoses of new HIV infections, whereas the latter helped to identify a cluster of 24 Latino gay and bisexual men (O’Neill Institute, 2019). What is often overlooked in the discussion over both of these clusters is whether and how syringe exchange programs could have effectively prevented many new infections.

To fully understand why public identification of these clusters is problematic, one must view the current situation in the context of its potential legal implications. Draconian HIV-specific criminalization laws still exist in 34 states; another 24 states have used general criminal statutes against people living with HIV for “HIV exposure” or non-disclosure of HIV status (CHLP, 2019). These laws relegate people living with HIV to second-class citizenship for numerous reasons. According to the Center for HIV Law and Policy, state HIV criminalization laws “criminalize non-disclosure of HIV status or exposure of a third party to HIV; make exceptions to confidentiality and privacy rights of people living with HIV; provide for sentence enhancements for people living with HIV convicted of underlying crimes such as prostitution and solicitation; and require sex offender registration for people living with HIV” (CHLP, 2019).

Lambda Legal,  considered the leading advocacy organization for the LGBTQ community, takes it a step further in characterizing the harm done by state HIV criminalization laws, speculating that these laws harm public health by creating disincentives for people to get tested for HIV and  prevent others who are HIV-positive from seeking care and treatment. Lambda argues that “information from healthcare providers is often used to prosecute,” which undermines the keystone of the physician-patient relationship (Lambda Legal, 2013).

Photo Source: SERO

It isn’t hard to imagine a worst-case scenario in which molecular HIV surveillance data makes its way into a courtroom and contributes to the “unjust prosecutions” (Lambda Legal, 2013), or into the court of public opinion to “stigmatize and oppress” people living with HIV (Lambda Legal, 2013). While molecular HIV surveillance alone cannot be used in court to establish HIV transmission (Schneider, 2019), it can be used as evidence, and that alone should cause considerable concern.

People living with HIV see very little difference between molecular HIV surveillance as an effective “tool” fighting the epidemic and HIV criminalization. They see it more as  a weapon aimed at further isolating, stigmatizing, and punishing people living with HIV. We should be listening to them rather than trying to reassure them.

In our quest to eradicate HIV/AIDS in the United States (and across the globe), it is important to keep the ongoing struggle in perspective. As we pursue new approaches toward ending the epidemic – including leveraging new technologies that can pinpoint HIV clusters and link more people to care – we must not become over-zealous and ignore the very real concerns expressed over molecular HIV surveillance by our family, friends, colleagues, neighbors, and even strangers living with HIV.

HIV-positive people should be afforded the very same privacy protections as their HIV-negative counterparts. That is what this community expect, deserves, and should be guaranteed.

Editor's Note: Mr. Lewis has worked on issues impacting the HIV/AIDS community for many years. The views expressed our his own. He can be reached at jeffreyrobertlewis@gmail.com.

References:

• Centers for Disease Control & Prevention (2017). Surveillance Overview. U.S. Department of Health & Human Services. Retrieved online at https://www.cdc.gov/hiv/statistics/surveillance/index.html. 
• Centers for Disease Control & Prevention (2019). Sexually Transmitted Disease Surveillance 2018. U.S. Department of Health & Human Services. Retrieved online at https://www.cdc.gov/std/stats18/default.htm. 
• Center for HIV Law and Policy (March 2019). HIV Criminalization in the United States: A Sourcebook on State and Federal HIV Criminal Law and Practice (Third Edition). Retrieved online at http://www.hivlawandpolicy.org/sourcebook. 
• Eustace-McMillan, Loni (1999, December 17). Protecting Private Medical Information: Liability for Unauthorized Disclosure. University of Houston Law Center. Retrieved online at https://www.law.uh.edu/healthlaw/perspectives/Privacy/991217Protecting.html. 
• Gorman, Anna (2018, April 6). Former California State Contractor Sued Over Breach Of HIV Patient Privacy. California Healthline. Retrieved online at https://californiahealthline.org/news/former-california-state-contractor-sued-over-breach-of-hiv-patient-privacy/. 
• Gordon, Elena (2018, January 17). Aetna Agrees To Pay $17 Million In HIV Privacy Breach. NPR. Retrieved online at https://www.npr.org/sections/health-shots/2018/01/17/572312972/aetna-agrees-to-pay-17-million-in-hiv-privacy-breach. 
• Hassan, Carma (2018, April 1). Lawsuit claims CVS unintentionally revealed HIV status of 6,000 customers. CNN. Retrieved online at https://www.cnn.com/2018/04/01/health/cvs-lawsuit-hiv-status-customers/index.html. 
• Heath, Sara (2017, August 22). 5 Ways to Improve Medication Adherence in Chronic Care Patients; Providers need to uncover the patient barriers to help improve medication adherence in chronically sick patients. Patient Engagement Hit. Retrieved online at https://patientengagementhit.com/news/5-ways-to-improve-medication-adherence-in-chronic-care-patients. 
• Holman, Tayla (2017, June 27). How to Build Patient Trust to Improve the Doctor-Patient Relationship. Dignity Health. Retrieved online at https://www.dignityhealth.org/articles/how-to-build-patient-trust-to-improve-the-doctor-patient-relationship. 
• Kempner, Martha (2019, March 4). New Study Triggers Concerns Over Use of Molecular HIV Surveillance. TheBodyPro. Retrieved online at https://www.thebodypro.com/article/concerns-over-use-of-molecular-hiv-surveillance. 
• Kirzinger, Ashley, Lunna Lopes, Bryan Wu, and Mollyann Brodie (2019, March 26). KFF Health Tracking Poll – March 2019: Public Opinion on the Domestic HIV Epidemic, Affordable Care Act, and Medicare-for-all. Kaiser Family Foundation. Retrieved online at https://www.kff.org/health-reform/poll-finding/kff-health-tracking-poll-march-2019/. 
• Lambda Legal (2013, December 13). 15 Ways HIV Criminalization Laws Harm Us All. Retrieved online at https://www.lambdalegal.org/publications/15-ways-hiv-criminalization-laws-harm-us-all. 
• Macsata, Brandon M. (2019, May 2) The ADAP Blog. When State & Local Public Health "Policies" Fuel HIV Stigma. ADAP Advocacy Association. Retrieved online at https://adapadvocacyassociation.blogspot.com/2019/05/when-state-local-public-health-policies.html. 
• McClelland, Alexander, Adrian Gula, and Marilou Gagnon (2019, February 10). The rise of molecular HIV surveillance: implications on consent and criminalization. Critical Public Health. Retrieved online at https://www.tandfonline.com/doi/citedby/10.1080/09581596.2019.1582755?scroll=top&needAccess=true. 
• Mesika, Robert (2012, July). The Ethics of HIV Criminalization. ETHICAL INQUIRY: JULY 2012. International Center for Ethics, Justice and Public Life. Retrieved online at https://www.brandeis.edu/ethics/ethicalinquiry/2012/July.html. 
• O’Neill Institute for National & Global Health Law (2019, Augsut). Quick Take: Using Cluster Detection to End the HIV Epidemic. Georgetown Law. Retrieved online at https://oneill.law.georgetown.edu/wp-content/uploads/Quick-Take_HIV-Cluster-Detection_August-2019.pdf. 
• Oster, M.D., Alexa, et. al. (2017, March 24). National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Use of molecular surveillance data to identify clusters of recent and rapid HIV transmission. U.S. Centers for Disease Control & Prevention. Retrieved online at https://www.seaetc.com/wp-content/uploads/2017/01/Use-of-Molecular-Surveillance-Data-to-Identify-Alexandra-Oster.pdf. 
• Schneider, Jacon (2019, September 12). Is HIV Molecular Surveillance Worth The Risk? The Center for HIV Law & Policy. Retrieved online at http://www.hivlawandpolicy.org/fine-print-blog/hiv-molecular-surveillance-worth-risk. 
• Serenko*, Natalia, and Lida Fan (2013). Patients’ perceptions of privacy and their outcomes in healthcare. Int. J. Behavioural and Healthcare Research, Vol. 4, No. 2. Retrieved online at http://aserenko.com/IJBHR_Serenko_Fan.pdf. 

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.