NC AIDS Action Network

History of HIV Criminalization in North Carolina

August 5, 2026 · 4 min read · ncaan.orgHealth

As HIV advocates in North Carolina, we are a key part of the decades-long fight for science-based public health policy.

More than 40 years after the beginning of the HIV epidemic, our understanding of HIV has changed dramatically. Today, people living with HIV can manage it with medication, and people who reach and maintain an undetectable viral load cannot sexually transmit HIV. Prevention tools like PrEP have also changed what is possible in preventing new HIV transmissions.¹

But many of the laws and policies created during the early years of the epidemic remain part of North Carolina’s public health approach today. So when we understand that history, it helps us understand the work we must do today!

The Early Years of HIV Policy in North Carolina

When HIV first emerged in the 1980s, North Carolina was one of many states that created policies in response to widespread fear. As time went on, states passed even more laws criminalizing people living with HIV in order to be eligible for Ryan White funding.²

In 1988, North Carolina adopted HIV-specific public health rules through the state’s Commission for Public Health. Instead of creating a separate HIV criminal law, North Carolina used public health regulations to establish requirements for people living with HIV.³

These rules required people diagnosed with HIV to take certain steps to prevent transmission. At the time, they included requirements to:

Tell sexual partners about their HIV status before vaginal or anal sex.
Use condoms during sex.
Avoid sharing needles or injection equipment.
Not donate blood, organs, tissues, or semen.³

These rules were created at a time when much less was known about HIV. Treatment options were limited, and public health officials were working to respond to a rapidly growing epidemic and moral panic.

Over the next 30 years, HIV science changed significantly.

The development of antiretroviral therapy transformed HIV from a life-threatening illness into a manageable chronic condition for many people. Researchers also learned more about how HIV is transmitted and how treatment can prevent transmission.

In 2016, the scientific community confirmed the principle that people living with HIV who maintain an undetectable viral load do not sexually transmit HIV. This message became known as **Undetectable = Untransmittable (U=U).**¹

During the same period, PrEP became available as an effective HIV prevention option for people who do not have HIV.

As medical knowledge advanced, advocates, healthcare providers, and public health experts began calling for North Carolina’s HIV policies to reflect current science.

North Carolina Updates Its HIV Rules

After years of discussion and advocacy, North Carolina revised its HIV control measures in 2018. The updated rules took effect on January 1, 2018.⁴

The changes brought the state’s policies closer to current HIV science by recognizing the role of viral suppression and HIV prevention tools like PrEP. The updated rules also removed some requirements that were no longer supported by current evidence.⁴

The changes marked an important moment in North Carolina’s HIV policy history. They reflected a broader shift happening across the country as states reviewed HIV-related laws and policies created during the early years of the epidemic.

HIV Policy Today

North Carolina’s HIV regulations continue to be part of the state’s public health framework.

While North Carolina’s HIV regulations have changed significantly since their 1988 creation, HIV remains one of the few health conditions with specific legal requirements tied to a person’s diagnosis.

The history of HIV criminalization in North Carolina reflects the larger history of the epidemic itself: a traumatic period of misinformation and fear continues to impact laws, and thus our communities’ lives, despite decades of scientific progress and advocacy.

If you want to be part of the work to change this, join NCAAN’s action team!

North Carolina Administrative Code. “10A NCAC 41A .0202: Control Measures for HIV.” Cornell Law School Legal Information Institute, originally effective 1 Mar. 1988, amended 1 Jan. 2018, https://www.law.cornell.edu/regulations/north-carolina/10A-N-C-Admin-Code-41A-0202. Accessed 5 Aug. 2026.
Galletly, Carol L et al. “HIV-positive persons’ awareness and understanding of their state’s criminal HIV disclosure law.” AIDS and behavior vol. 13,6 (2009): 1262-9. doi:10.1007/s10461-008-9477-y
Center for HIV Law and Policy. HIV Criminal Law Reform, Before and After: North Carolina. 2020, https://www.hivlawandpolicy.org/resources/hiv-criminal-law-reform-and-after-north-carolina-2020. Accessed 5 Aug. 2026.
North Carolina Department of Health and Human Services. 10A NCAC 41A .0202: Control Measure – HIV Rule Revision. North Carolina Division of Public Health, https://cph.dph.ncdhhs.gov/ArchivedRules/EpiHealth/10A_NCAC_41A.0202_Control_Measure_HIV.htm. Accessed 5 Aug. 2026.