HIV: confidentiality, employment, housing and your medication

This is a bill of rights written for the situations where the diagnosis is used against someone: work, renting, the emergency room, the conversation you are not present for. There is nothing to apply for and nowhere to register; the rights exist by the law’s text. What makes it different from other bills of rights is that it carries teeth of two kinds: a criminal sanction for whoever violates it, and two named forums — the Patient’s Advocate and the Insurance Commissioner — depending on who denied you what.

Every person with a positive HIV diagnosis at any of its stages. The law defines a person with a positive HIV diagnosis as one who has received a positive result on a confirmatory test for the virus. And it defines the stages: HIV is a retrovirus that can cause Acquired Immunodeficiency Syndrome (AIDS), the most advanced phase of the infection; an AIDS diagnosis occurs when people with HIV have a severely compromised immune system and contract opportunistic infections and/or their defense cell (CD4) count falls below 200 cells. Those definitions were added by Act 42-2025 to Article 2A, and the law itself says they are based on the definitions of the National Institute of Health and the United States Department of Health and Human Services. The phrase "at any of its stages" repeats in nearly every item on purpose: the rights do not depend on how advanced the infection is.

• Having received a positive result on a confirmatory HIV test. The rights apply at any stage of the infection.Verified against the official source
• To claim: no prior procedure, registration or health plan is needed. The law expressly says the complaint before the Patient’s Advocate proceeds regardless of whether the person has a health plan.Verified against the official source

• The law requires no documents to exercise these rights. For reasonable accommodation at work it does mention one: when the employer is presented with the corresponding medical certifications, they must offer, within their possibilities, the accommodation so the employee can continue their treatment and medical follow-up.

1. 1

   Step 1: Nobody may speak of your diagnosis without your consent

   Item 9 says it plainly: no person may refer to another person’s positive HIV diagnosis, or to their HIV test results, without that person’s consent, except as contained in Act 81-1983 — the Sexually Transmitted Disease Prevention and Treatment Act. And it adds that all medical and assistance services must ensure these persons’ privacy. Item 11 says it from your side: you have the right to communicate your health status or your test result only to the people you wish. And item 3 closes a front people do not expect: neither the State nor any natural or legal person shall request information that infringes your privacy, nor establish registries of persons who have been your sexual contacts, except for Department of Health epidemiological investigations under that same Act 81-1983. All of this sits under Article 6’s criminal sanction, which is why it is worth citing by number.

2. 2

   Step 2: They cannot test you by force

   Item 10 is categorical: no person may be compulsorily subjected to HIV testing in any case, except as provided in Act 81-1983. And it limits the use of the result: the HIV test must be used exclusively for diagnosis, treatment, transfusion and transplant control, and epidemiological studies, but never for any kind of control of persons or populations. The same item adds what is yours if you choose to be tested: persons interested in taking the test must be counseled and informed of the results by a competent professional. That is, counseling is not an extra, it is part of the right.

3. 3

   Step 3: Housing: they cannot require the test to rent to you

   Item 4 recognizes the right to decent housing and adds a concrete prohibition: housing and/or rental credit may not be granted on the condition that the person provide proof of an HIV diagnosis. The law writes one exception and it is worth knowing because it is not a trap but the opposite: except for federal programs that establish the diagnosis as an indispensable requirement, such as HOPWA and Ryan White. Those programs exist precisely to serve this population, so asking for the diagnosis there is part of how they work. Outside that case, conditioning a rental or housing credit on showing your result is what this item prohibits.

4. 4

   Step 4: Employment: stability, accommodation and not having to say it

   Item 7 is the longest in the bill of rights and is worth reading whole. It recognizes the right to job stability, subject to the federal Americans with Disabilities Act and its state counterpart, Act 44-1985. And it sets the rule: a reduction in the working capacity of a person with a positive HIV diagnosis cannot be the reason for terminating an employment relationship, provided the person can, with or without reasonable accommodation, perform the essential functions of the position. On accommodation: when the employer is presented with the corresponding medical certifications, they must offer, within their possibilities, the reasonable accommodation so the employee can continue their treatment and medical follow-up. And it closes with two sentences that settle the most common doubt: the person with a positive HIV diagnosis is not obliged to disclose their diagnosis; however, having disclosed it, the employer must safeguard the person’s privacy and not divulge that information. Disclosing is not permission to discuss it.

5. 5

   Step 5: At the hospital: your medication from day one

   Item 15 is the most useful in the whole bill of rights when an admission is involved. From the first day of admission to a hospital, the person has the right to have it provide all medications necessary for their treatment, including antiretrovirals, per the current Treatment Guidelines established by the federal Department of Health, even if they have them at home. That last phrase — "even if they have them at home" — is there because treatment interruption during hospitalization is a real problem. The same item adds a linkage duty: should a person be diagnosed with HIV in a hospital, or be identified as having a prior diagnosis and be off treatment, it shall be the institution’s duty to coordinate their referral to a clinic specializing in HIV treatment so they are promptly linked to treatment and their health does not deteriorate. And item 5 protects another flank of admission: no one shall be subjected to isolation, quarantine or any other type of segregation, except in clinically warranted situations, duly documented, for the protection of their health and with their knowledge; and in those cases it shall be done without identifying their condition or diagnosis.

6. 6

   Step 6: Two different forums depending on who denied what

   Item 14 names them and the distinction matters because filing in the wrong place costs time. If you are denied medical services, you have the right to file a complaint with the Office of the Patient’s Advocate, and the law clarifies something that often stops people: regardless of whether you have a health plan. If the actor is a private health plan insurer — because it denies a covered service or cancels a policy or contract on account of your health condition — you also have the right to file a complaint with the Office of the Insurance Commissioner. And there is a third path, in Article 5, to claim any right under this law or to ask that an action contravening it be suspended: going before the Civil Rights Violations Investigation and Prosecution Unit of the Department of Justice, or before any courtroom of the Court of First Instance in the judicial region where you reside. You may do so yourself, through your guardian or through a public official. And the law adds something that removes a real barrier: the courts shall have the power to appoint you legal representation or a judicial defender when you lack the economic means to hire an attorney.

7. 7

   Step 7: The ninety days for new medications

   Article 4 puts a clock on access. The Department of Health shall guarantee access to and availability of treatment for HIV infection at any of its stages. And together with the Health Insurance Administration (ASES) of the Government Health Plan, they shall take the pertinent steps for access to and availability of new FDA-approved antiretroviral medications within a period of no more than ninety (90) calendar days after approval and their integration into the Clinical Guidelines for HIV treatment in Adolescents and Adults approved by the Federal Government (DHHS). The law names who is responsible for the last step: it shall be ASES’s responsibility to include those medications in the corresponding formularies for medication coverage under the Government Health Plan, within the same term. The same article gives the Auxiliary Secretariat for Health Facility Regulation and Accreditation (SARAFS) the responsibility of overseeing and monitoring the operation of hospital facilities and other entities, and the sanitary conditions in providing appropriate services and treatment.

8. 8

   Step 8: The criminal sanction, and why it changes the conversation

   Article 6 says that anyone who violates any of this law’s provisions shall be guilty of a misdemeanor and, if convicted, punished with imprisonment of up to six (6) months, a fine not exceeding five thousand (5,000) dollars, or both at the court’s discretion. It does not say "any entity" or "any employer": it says any person, and it applies to any of the provisions. Two more articles complete the picture. Article 7 clarifies that exercising the action this law authorizes is independent of any other civil or criminal action, right or remedy the law in force provides, and that nothing here limits or prevents exercising those. And Article 8 says nothing in this law shall be understood to exclude, restrict, limit, impair or affect in any way the rights recognized by legislation to any other natural or legal person. That is: this bill of rights adds, it does not replace.

It depends on who acted. Denied medical services: Office of the Patient’s Advocate, whether or not you have a health plan. A private insurer that denies a covered service or cancels a policy or contract on account of your condition: Office of the Insurance Commissioner. Any right under this law, or to ask that an action contravening it be suspended: the Civil Rights Violations Investigation and Prosecution Unit of the Department of Justice, or any courtroom of the Court of First Instance in the judicial region where you reside; you may go yourself, through your guardian or through a public official, and the court may appoint you legal representation if you cannot afford an attorney. The Department of Health guarantees access to treatment, ASES answers for the Government Health Plan formularies, and SARAFS monitors health facilities. Article 9 charges the Department of Health and the Office of the Patient’s Advocate with publicizing this bill of rights, informing and educating health professionals, patients and the community, keeping the informational material available at both agencies, and annually filing a report on its implementation with the Secretariat of both legislative bodies.

• Believing you must disclose the diagnosis to your employer: the law expressly says you are not obliged.
• Accepting that, having disclosed it, the employer may discuss it: they must safeguard your privacy and not divulge it.
• Handing over your result to be rented to: conditioning housing or rental credit on that proof is prohibited, except in HOPWA, Ryan White and similar federal programs.
• Accepting compulsory testing: no person may be subjected to it in any case, except as provided in Act 81-1983.
• Taking your own antiretrovirals to the hospital and accepting not being given them: the law obliges the institution from day one, even if you have them at home.
• Filing a policy cancellation with the Patient’s Advocate: that goes to the Office of the Insurance Commissioner.
• Not filing because you have no health plan: item 14 says the complaint proceeds regardless of that.
• Not asking the court for legal representation for lack of means: the law empowers the court to appoint it.

These are the government pages this guide is based on.

• Departamento de Salud de Puerto Rico

  Salud

  bvirtualogp.pr.gov

• Puerto Rico Department of Health

  Salud

  www.salud.pr.gov