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The starting point for any question about HIV-related information is that, in Michigan, it is confidential and cannot be disclosed unless the circumstances fit clearly within one of a few exceptions. The basic rule, then, is "shush." There are criminal penalties for unlawful disclosure (misdemeanor: one year in jail and a fine) plus there are civil penalties (the blabber can be sued by the HIV-positive person for $1000 per disclosure or their actual damages, AND attorney fees, AND court costs).

Generally speaking, homeowners insurance does not usually cover this sort of unlawful act, so the blabber will have to pay out of pocket. And if the blabber is a professional who learns someone's HIV status in the course of their employment, and they disclose it, then the employer can be held liable to the same extent as the blabber. This means that a clever lawyer will sue the blabber and everybody they work for, right up the chain of command to the governor or the Chair of the Board of Directors if necessary.

A basic guideline to remember in responding to legal or ethical questions about related to HIV, AIDS, STD and substance abuse information is this: the legislature's goals were, are and continue to be to get people into treatment. Evidence of that can be seen in the ways the law works to encourage people to disclose their diagnosis and get help, with their confidentiality and privacy rights protected in a variety of ways. More evidence is that these laws do often apply to minors: by extending confidentiality laws to kids, the legislature took a strong stance that says that the person who gets to control what happens to their medical information is the patient. Therefore, "ties" (like uncertainty about the requirements of the law) should always be broken in favor of being respectful of the patient's wishes to the fullest extent possible. This usually means keeping quiet.

That said, the counterbalance is the responsibility of the state, and by proxy the public health department, to protect the public health and welfare. This means that a professional faced with a knotty little dilemma like whether it is okay to tell a kid's parent or guardian about something should objectively analyze the risk to the public health that might come from NOT telling. (The presumption should be that the kid gets to control the info, so the analysis should always start from the premise of "I am NOT going to spill the beans unless I find a clear and compelling reason to do so." This is quite different from the opposite mind set, wherein someone has to be talked out of telling.)

In this context, employees and decision-makers of other branches of state government besides the Michigan Department of Community Health (MDCH) have the same sort of responsibility for protecting the public health and welfare. While MDCH is the state's main guardian of public health, it sure isn't the only one. But MDCH administrative rules trump the administrative rules of other branches, at least on issues that MDCH is directly responsible for. Administrative rules promulgated by a state government department have the force of law, so when MDCH says in its administrative rules, for example, that local health departments can only keep HIV partner notification files open for 90 days, and that those files have to be encoded while they are open to protect the confidentiality of the HIV-infected person, those rules are law. And the same sort of protections are supposed to be implemented even when the newly diagnosed person is a guest of the state someplace in corrections: partner notification is supposed to be confidential.

This presumption of keeping quiet, and the legislative attention to allowing the patient to control their own information, gels nicely with the need for professionals who are involved in counseling anybody about anything to have an open and trusting sort of relationship. Nobody is going to confide in someone who they think is going to blab. So for probate workers and juvenile counselors to make progress in their work, there has to be some expectation of confidentiality and trust between them and their patients. I know, this is obvious, but when these dilemmas come up folks need to make snap decisions and feel good about them. Nobody can remember all the law, but most everyone can remember a few basic tenets to guide them.