Client Acknowledgment Form, Kalamazoo County Health and Community Services

Client/Agency Forms

This form is presented to individuals who test positive for HIV in Kalamazoo, Michigan.  After testing positive, clients are asked to sign and date the form, in the presence of a witness, attesting to the fact that they have been informed of behaviors that "could transmit the virus to others," and acknowledging that the individual "must inform my partner that I am infected" before engaging "in any activity where there is a risk of exchanging body fluids (semen, vaginal secretions or blood)."  The form also mentions unspecified actions the Kalamazoo County Health Department "may have to take" if the individual does not comply with the notification.

The form effectively asks the client to acknowledge in writing his/her potential liability for failure to disclose under Michigan's HIV-specific criminal law (Mich. Comp. Laws Ann. § 333.5210), which makes it a felony for a person who knows that she/he has tested HIV positive to engage in sexual penetration – defined as "sexual intercourse, cunnilingus, fellatio, anal intercourse, or any other intrusion, however slight, of any part of a person's body or of any object into the genital or anal openings of another person's body" –  without first having informed the sexual partner that she/he has HIV.

 

Signing the form can create real risk for the client; this type of form has been used in court proceedings as evidence of criminal intent in prosecutions of individuals charged with nondisclosure of their HIV status.  Consequently, individuals who test HIV positive should avoid signing such forms, and test counselors should avoid pressuring clients to sign them.