By Halle Parker, Verite News, KFF Health News

SHREVEPORT, La. — When Robert Smith met his future girlfriend in 2010, he wanted to take things slowly. For Smith, no relationship had been easy in the years since he was diagnosed with the human immunodeficiency virus, or HIV. People often became afraid when they learned his status, even running away when he coughed.

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The couple waited months to have sex until Smith felt he could share his medical status. To prepare her, Smith said, he took his girlfriend to his job in HIV prevention at the Philadelphia Center, a northwestern Louisiana nonprofit that offers resources to people with HIV, which also provided him housing at the time.

Finally, he revealed the news: Smith was diagnosed with HIV in 1994 and started taking daily antiviral pills in 2006. The virus could no longer be detected in his blood, and he couldn’t transmit it to a sexual partner.

Smith said his girlfriend seemed comfortable knowing his status. When it came to sex, there was no hesitation, he said. But a couple of years later, when Smith wanted to break up, he said, her tone shifted.

“She was like, ‘If you try to leave me, I’m gonna put you in jail,’” recalled Smith, now 68. “At the time, I really didn’t know the sincerity of it.”

After they broke up, she reported him to the police, accusing him of violating a little-known law in Louisiana — a felony called “intentional exposure to HIV.” He disputed the allegations, but in 2013 accepted a plea deal to spend six months in prison on the charge. He had a few months left on parole from a past conviction on different charges, and Smith thought this option would let him move past the relationship faster. He didn’t realize the conviction would also land him on the state’s sex offender registry.

For nearly two decades, Smith had dealt with the stigma associated with having HIV; the registry added another layer of exclusion, severely restricting where he could live and work to avoid minors. Not many people want to hire a sex offender, he said. Smith has been told by the local sheriff’s office he’s not allowed to do simple things, like go to a public park or a high school football game, since the conviction.

“I’ve been undetectable for 15 years, but that law still punishes us,” Smith said.

Louisiana is one of 30 states with criminal penalties related to exposing or transmitting HIV. Most of the laws were passed in the 1980s during the emergence of the AIDS epidemic. Since then, several states have amended their laws to make them less punitive or repealed them outright, including Maryland and North Dakota this year.

But Louisiana’s law remains among the harshest. The state is one of five that may require people such as Smith to register as a sex offender if convicted, a label that can follow them for over a decade. And state lawmakers considered a bill to expand the law to apply to other sexually transmitted infections, then failed to pass it before the session ended.

Meanwhile, people with HIV also face the threat that federal funding cuts will affect their access to treatment, along with prevention efforts, supportive services, and outreach. Such strategies have proved to slow the HIV/AIDS epidemic, unlike the laws’ punitive approach.

The tax and domestic policy law previously known as the “One Big Beautiful Bill” will likely affect HIV-positive people enrolled in Medicaid by reducing federal support for Medicaid and restricting eligibility. About 40% of adults under 65 with HIV rely on Medicaid.

The Trump administration proposed in its fiscal 2026 budget request to eliminate HIV prevention programs at the Centers for Disease Control and Prevention and to cancel a grant that helps fund housing for people with HIV. The Ryan White HIV/AIDS program, the largest federal fund dedicated to supporting HIV-positive people, also faces cuts. The program serves more than half of the people in the U.S. diagnosed with HIV, including in Louisiana, according to KFF, a health information nonprofit that includes KFF Health News.

Public health officials maintain that state laws criminalizing HIV exposure hurt efforts to end the HIV epidemic. Epidemiologists and other experts on AIDS agree that the enforcement of such laws is often shaped by fear, not science. For example, in many states that criminalize HIV exposure, people living with HIV can face heightened criminal penalties for actions that can’t transmit the virus, such as spitting on someone. The laws further stigmatize and deter people from getting tested and treatment, undermining response to the epidemic, experts say.

At least 4,400 people in 14 states have been arrested under these laws, though data is limited and the actual number is likely higher, and the arrests aren’t decreasing, according to analyses by UCLA’s Williams Institute.

“ Some people think it’s an issue that’s gone away, and that simply isn’t the case,” said Nathan Cisneros, a researcher at the Williams Institute.

In Louisiana, a 2022 Williams Institute analysis found at least 147 allegations reported to law enforcement under the state’s HIV law from 2011 to mid-2022. Black people made up nearly three-quarters of the people convicted and placed on the sex offender registry. Most were Black men, like Smith. At the time of the analysis, Black people made up about two-thirds of HIV diagnoses in the state.

“ We see over and over that Black people are disproportionately affected by the HIV epidemic and disproportionately affected by policing and incarceration in the United States,” Cisneros said.

Nationally, other marginalized groups such as women, sex workers, the queer community, or people who overlap across more than one group are also disproportionately arrested and prosecuted under similar criminalization laws, Cisneros said.

Ensnared in the System

Louisiana’s law hinges on the requirement that if a person knows they have HIV, they must disclose their HIV status and receive consent before exposing someone to the virus.

Louisiana District Attorneys Association Executive Director Zach Daniels said these cases don’t come up often and can be difficult to prosecute. Daniels said the intimate nature of the cases can lead to little evidence in support of either side, especially if the accuser doesn’t contract HIV.

When it comes to talking about one’s sex life, Daniels said, “there are often no other witnesses, besides the two participants.”

Louisiana’s law is written so that “intentional exposure” can occur through “any means or contact.” That includes sex and needle-sharing, practices known to transmit the virus. But the language of the law is so broad that actions known not to transmit the virus — like biting or scratching — could be included, said Dietz, the statewide coordinator for the Louisiana Coalition on Criminalization and Health, an advocacy network founded by people living with HIV that has opposed the law.

The broad nature of the law creates opportunities for abuse, as the threat of being reported under the law can be used as a coercive tool in relationships, said Dietz, who goes by one name and uses they/them pronouns. Such threats, Dietz said, have kept people in abusive relationships and loomed over child custody battles. Dietz said they’ ve supported people accused of exposing their children to HIV in ways that are not medically possible.

“ ‘Any means or contact’ could be just merely being around your kids,” they said.

The prosecutors’ organization still supports the law as a recourse for emergency responders who, in rare instances, come into contact with blood or syringes containing the virus. In one recent high-profile case in New Orleans, the law was used against a local DJ accused of knowingly transmitting HIV to several women without informing them of his status or using a condom.

The person accused of violating the law, not the accuser, must prove their case — that they disclosed their HIV status beforehand. Without a signed affidavit or tape recording, courts can end up basing their decisions on conflicting testimonies with little supporting evidence.

That’s what Smith alleged happened to him.

After his relationship ended, he said, he remembered being called into a meeting with his parole officer where a detective waited for him, asking about his former relationship and whether his girlfriend had known about his HIV status.

Smith said yes. But that’s not what she had told police.

Verite News could not find a working phone number for Smith’s former girlfriend but corroborated the story with the incident’s police report. His attorney at the time, a public defender named Carlos Prudhomme, said he didn’t remember much about the case, and court documents are sealed because it was a sex offense.

In court, it was her word against his. So when he was offered six months in prison instead of the 10-year maximum, he switched his plea from not guilty to guilty. But he said he didn’t know his new conviction would require him to register as a sex offender once he got out — worsening the stigma.

“When people see ‘sex offender,’ the first thing that comes to their mind is rape, child molester, predator,” Smith said. “This law puts me in a category that I don’t care to be in.”

He has tried to make the most of it, despite the expense of paying fees each year to reregister. After being rejected from jobs, he started a catering business and built a loyal clientele. But he said he’s still stuck living in a poorly maintained apartment complex primarily inhabited by sex offenders.

“I understand their strategy for creating this law to prevent the spread, but it’s not helping. It’s hurting; it’s hindering. It’s destroying people’s lives instead of helping people’s lives, especially the HIV community,” he said. “They don’t care about us.”

The Case for Reform

Since 2014, there has been a nationwide effort to update or repeal state laws that criminalize HIV nondisclosure, exposure, or transmission. A dozen states have changed their laws to align more closely with modern science, and four have gotten rid of them completely in hopes of reducing stigma and improving public health outcomes, according to the Center for HIV Law and Policy.

Sean McCormick, an attorney with the center, said these changes are influenced partly by a growing body of evidence showing the laws’ negative consequences.

McCormick said the laws offer a “clear disincentive” for people to get tested for HIV. If they don’t know their status, there’s no criminal liability for transmission or exposure.

A 2024 survey by Centers for Disease Control and Prevention and DLH Corp. researchers found that after California updated its HIV criminalization law in 2018, respondents were more likely to get tested. Meanwhile, survey respondents in Nevada, which still had a more punitive law on the books, were less likely to get tested.

There’s no one-size-fits-all solution, McCormick said. His center works with HIV-positive people across the country to determine what legislative changes would work best in their states.

Texas was the first to repeal its HIV law in 1994.

“As a person living with HIV in Texas, I’m deeply appreciative that we don’t have an HIV-specific statute that puts a target on my back,” said Michael Elizabeth, the public health policy director for the Equality Federation.

But Elizabeth points out that Texans living with HIV still face steeper penalties under general felony laws for charges such as aggravated assault or aggravated sexual assault after state courts in Texas equated the bodily fluids of a person with HIV with a “deadly weapon.”

Louisiana activists have pushed lawmakers in the state to amend the law in three ways: removing the sex offender registration requirement, requiring transmission to have occurred, and requiring clear intent to transmit the virus.

“Our strategy, as opposed to repeal, is to create a law that actually addresses the kind of boogeyman that they ostensibly created the law for: the person who successfully, maliciously, intentionally transmits HIV,” said Dietz with the Louisiana Coalition on Criminalization and Health.

In 2018, a bill to narrow the statute was amended in ways that expanded the law. For example, the updated law no longer had any definition of which actions “expose” someone to HIV.

In 2023, state lawmakers created a task force that recommended updating Louisiana’s law to align with the latest public health guidelines, limit the potential for unintended consequences, and give previously convicted people a way to clear their record.

Lawmakers in the state House pushed forward a bill this year to criminalize other sexually transmitted infections, including hepatitis B and the herpes simplex virus. That bill died in the Senate, but it spurred the creation of another legislative task force with a nearly identical mission to that of the first.

“ This state has no idea how closely we just dodged a bullet,” Dietz said.

In the meantime, the Louisiana coalition is helping Smith petition the state to take his name off the sex offender registry. Louisiana law allows people to petition to have their names removed from the registry after 10 years without any new sex crime convictions. Smith expects his case to be approved by the end of the year.

Despite the difficulty of the past 12 years, he said, he’s grateful for the chance to be free from the registry’s restrictions.

“It’s like a breath of fresh air,” Smith said. “I can do stuff that I wanted to do that I couldn’t. Like, go to a football game. Simple stuff like that, I’m going to be ready to do.”

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

By Renuka Rayasam, Sam Whitehead, KFF Health News

Every time Ashton Alexander sees an ad for Georgia Pathways to Coverage, it feels like a “kick in the face.”

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Alexander tried signing up for Pathways, the state’s limited Medicaid expansion, multiple times and got denied each time, he said, even though he met the qualifying terms because he’s a full-time student.

Georgia is one of 10 states that haven’t expanded Medicaid health coverage to a broader pool of low-income adults. Instead, it offers coverage to those who can prove they’re working or completing 80 hours a month of other qualifying activities, like going to school or volunteering. And it is the only state currently doing so.

“Why is this marketing out here?” said the 20-year-old, who lives in Conyers, east of Atlanta. “It’s truly not accessible.”

Each denial used the same boilerplate language, Alexander said, and his calls to caseworkers were not returned. State offices couldn’t connect him with caseworkers assigned to him from the same state agency. And when he requested contact information for a supervisor to appeal his denial, he said, the number rang to a fax machine.

“It’s impenetrable,” Alexander said. “I’ve literally tried everything, and there’s no way.”

Millions of Americans trying to access Medicaid benefits could soon find themselves navigating similar byzantine state systems and work rules. Legislation signed into law by President Donald Trump on July 4 allocates $200 million to help states that expanded Medicaid create systems by the end of next year to verify whether some enrollees are meeting the requirements.

Conservative lawmakers have long argued that public benefits should go only to those actively working to get off of government assistance. But the nation’s only Medicaid work requirement program shows they can be costly for states to run, frustrating for enrollees to navigate, and disruptive to other public benefit systems. Georgia’s budget for marketing is nearly as much as it has spent on health benefits. Meanwhile, most enrollees under age 65 are already working or have a barrier that prevents them from doing so.

What Georgia shows is “just how costly setting up these administrative systems of red tape can be,” said Joan Alker, executive director of Georgetown University’s Center for Children and Families.

Over the past two years, KFF Health News has documented the issues riddling Georgia’s Pathways program, launched in July 2023. More than 100,000 Georgians have applied to the program through March. Just over 8,000 were enrolled at the end of June, though about 300,000 would be eligible if the state fully expanded Medicaid under the terms of the Affordable Care Act.

The program has cost more than $100 million, with only $26 million spent on health benefits and more than $20 million allocated to marketing contracts, according to a KFF Health News analysis of state reports.

“That was truly a pretty shocking waste of taxpayer dollars,” Alker said.

The Government Accountability Office is investigating the costs of the program after a group of Democratic senators — including both members of the Georgia delegation — asked the government watchdog to look into the program. Findings are expected this fall.

A state report to the federal government from March said Georgia couldn’t effectively determine if applicants meet the qualifying activities criteria. The report also said the state hadn’t suspended anyone for failing to work, a key philosophical pillar of the program. Meanwhile, as of March, more than 5,000 people were waiting to have their eligibility verified for Pathways.

The Pathways program has strained Georgia’s eligibility system for other public benefits, such as food stamps and cash assistance.

In April, the state applied to the federal government to renew Pathways. In its application, officials scaled back key elements, such as the requirement that enrollees document work every month. Critics of the program also say the red tape doesn’t help enrollees find jobs.

“Georgia’s experience shows that administrative complexity is the primary outcome, not job readiness,” said Natalie Crawford, executive director of Georgia First, which advocates for fiscal responsibility and access to affordable health care.

Despite the struggles, Garrison Douglas, a spokesperson for Georgia’s Republican governor, Brian Kemp, defended the program. “Georgia Pathways is doing what it was designed to do: provide free healthcare coverage to low-income, able-bodied Georgians who are willing to engage in one of our many qualifying activities,” he said in an emailed statement.

New federal requirements in the tax and spending legislation mean that the 40 states (plus Washington, D.C.) that expanded Medicaid will need to prepare technology to process the documentation some Medicaid recipients will now have to regularly file.

The federal law includes exemptions for people with disabilities, in addiction treatment, or caring for kids under 14, among others.

The Trump administration said other states won’t face a bumpy rollout like Georgia’s.

“We are fully confident that technology already exists that could enable all parties involved to implement work and community engagement requirements,” said Mehmet Oz, head of the Centers for Medicare & Medicaid Services, in an emailed statement.

In a written public comment on Georgia’s application to extend the program, Yvonne Taylor of Austell detailed the difficulties she faced trying to enroll.

She said she tried to sign up several times but that her application was not accepted. “Not once, not twice, but 3 times. With no response from customer service,” she wrote in February. “So now I am without coverage.”

Victoria Helmly of Marietta wrote in a January comment that she and her family members take care of their dad, but the state law doesn’t exempt caregivers of older adults.

“Georgia should recognize their sacrifices by supporting them with health insurance,” she wrote. “Let’s simplify this system and in the end, save money and lives.”

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

The combination of a recently approved blood test for detection of Alzheimer’s disease combined with two medications that slow progression of the disease is drastically improving outcomes for patients and their families, according to a neurologist and surgeon at Yale New Haven Health.

Dr. Ausim Azizi is among those seeing the overall early results, as Yale New Haven Hospital is in the forefront of research and clinical care, he said, calling it “tops in the country,” and home to a federally-funded Alzheimer’s Disease Research Center.

“We have started 350 people on these drugs,” he said. “Everybody I see feels better,” and feels, along with their families that they have “more control” of their lives.

With easy early detection and treatment patients may never reach the end stage of the disease, he said. The medication slows the disease progression and maintains what patients have, longer, he said.

In terms of quality of life, someone 75 years old, retired with significant memory problems, can still have friends and, “a good life,” with early detection and treatment, Azizi said.

The debilitating, progressive condition robs sufferers of their memory and cognitive abilities.

Azizi said there is no cure for Alzheimer’s, but the disease can be “modified” with medications from two different companies.

The medications approved about two years ago are Lecanemab, also known as Leqembi and Kisunla, also known as Donanemab. The drugs are administered through an IV infusion that targets amyloid plaque in the brain.

Azizi said confirmation of Alzheimer’s, as opposed to other forms of dementia, is needed to treat with those medications and, until the blood test diagnosis, was complicated, stressful, and expensive, Azizi said.

The blood test, Lumipulse G, for Alzheimer’s Disease, approved in late May, can confirm the disease with 98 percent accuracy, he said.

Prior to the blood test, doctors confirmed the disease by drawing spinal fluid to test for chemicals or through a pet scan, Azizi said.

The blood test is not predictive and the test is for people 55 and older suffering cognitive issues, he said. Confirmation of Alzheimer’s is needed for the medication to be prescribed.

That early detection is key, he said, because while the medications don’t cure Alzheimer’s, they slow progression.

According to the Alzheimer’s Association, it is a progressive disease, “where dementia symptoms gradually worsen over a number of years. In its early stages, memory loss is mild, but with late-stage Alzheimer’s, individuals lose the ability to carry on a conversation and respond to their environment.

“On average, a person with Alzheimer’s lives four to eight years after diagnosis but can live as long as 20 years, depending on other factors,” according to the association.

The association notes that its “2025 Alzheimer’s Disease Facts and Figures” report found that “nearly 4 in 5 Americans would want to know if they had Alzheimer’s disease before it impacted their lives,” which means “91% of Americans say they would want to take a simple test — such as a blood biomarker test — if it were available,” because that would then open access to early treatment.

Azizi said that, in Alzheimer’s, sticky proteins or plaques are found on the brain that he likened to rust on an engine.

“The wheels don’t turn, things are squeaky,” he said.

People with the plaques have trouble with cognition, sequencing events and their memory noticeably going, he said.

The new medications “clear the rust,” and slow progression, but the damage already done remains, he said.

Cognitive problems can develop with other forms of dementia, but the same medications don’t work for those. He said 70 percent of the time when there are cognitive problems, it’s Alzheimer’s.

“Before we treat we ask, do you have biologic evidence?,” Azizi said.

He said of early treatment, “It’s huge for the family.”

Simple lifestyle changes can also improve outcomes, he said.

He said 10 factors that boost the brain and help prevent dementia include:

Control blood pressure, low number should be below 80
Control blood sugar to around 100
Control cholesterol, total fasting less than 200
Adequate and restful sleep
Diet, eat mostly unprocessed plants
Maintain a healthy body weight
If you are smoking, stop
Reduce alcohol intake – maximum of 3 to 4 drinks per week
Increase physical activity, including daily aerobic exercise
Engage in enjoyable and healthy social and mental activities

Summer evening skies are the home of some classic constellations. One of them is Scorpius the Scorpion, the 10th-brightest constellation in the night sky and one of those few constellations that actually looks like what it’s supposed to be. Personally, I see Scorpius as a “giant fishhook” that trolls our low summer skies. You certainly won’t have to crane your neck to see it because it’s a low rider. Begin looking for Scorpius in the very low southern sky at the end of evening twilight.

Most of Scorpius is easy to find. The brightest star is Antares, a brick-red star, marking the heart of the beast. It’s the brightest star in that part of the sky. To the right of Antares, you’ll see three dimmer stars in a nearly vertical row that make up the Scorpion’s head. To the lower left of Antares, look for the long, curved tail of the beast. Unfortunately, here in Minnesota and Western Wisconsin, the lowest section of the tail never gets above our horizon. At the end of the tail, barely above our horizon, is the celestial scorpion’s stinger, made of two moderately bright stars very close together.

(Mike Lynch)

The stinger stars, also known as the “cat’s eyes,” can be a bit of a challenge to see. You have to have a low, flat, treeless southern horizon to see them. Part of the difficulty of seeing the stinger stars is that visibility is greatly hampered close to the horizon because you’re forced to look through a lot more of Earth’s blurring atmosphere. Moderate to heavy light pollution and high humidity in the air can also add to the challenge. If you’re ever in the southern U.S., Scorpius will be a lot higher above the horizon, and you can get a much better look at it.

Antares (Mike Lynch)

Getting back to Antares, its reddish hue, demonstrates that stars come in different colors. They are not just little white lights in the sky. A star’s color tells a lot about its nature. Bluish-white stars are the hottest, with some having surface temperatures exceeding 30,000 degrees Fahrenheit. Reddish stars like Antares are cooler. In fact, Antares is cooler than our own sun, with a surface temperature of approximately 6,000 degrees. A thermometer plopped on the sun’s photosphere would show close to 10,000 degrees. Antares’ reddish hue is also reflected in its name. Antares is derived from the Greek language and means “rival of Mars,” as it shares a similar reddish tone with the planet Mars. You can easily confuse Mars and Antares with each other if you’re new to stargazing.

There’s no confusion between Mars and Antares when it comes to size. Mars is only about 4,000 miles across, a far celestial cry from the over-600-million-mile diameter of Antares. That’s over 700 times the diameter of our sun. If Antares were at the center of our solar system instead of our sun, the planets Mercury, Venus, Earth and Mars would all be living inside Antares.

There are many stories about how Scorpius came to be a constellation. The one I like is the Greek mythology story about how Zeus, the king of the gods, sent a giant Scorpion to kill the mighty hunter Orion, to end an affair he was having with Zeus’ daughter Artemis, the goddess of the hunt. Orion hunted by night and slept by day, and while he was on his nocturnal hunting adventures, Orion was a hunk and caught the eye of Artemis. After watching Orion for a few weeks, she started to call down to the very manly hunter and have long-distance conversations with him every night. As time went on, Artemis eventually joined Orion in his hunting jaunts, ignoring her other duties.

Zeus learned of his daughter’s negligence and put a contract out on Orion. He had his staff send a giant scorpion to sting and kill Orion during his daytime slumber. When the fateful day arrived and the giant scorpion approached Orion, the ever-alert hunter awoke as the beast stirred the nearby brush with its approach. Orion shot up and valiantly fought the scorpion with all his might, but eventually he was stung by the steroid-enhanced scorpion and died instantly.

That night, Artemus discovered the body of her boyfriend and was filled with tremendous grief. She managed to compose herself and lift Orion’s body to the sky and transform it into the famous constellation we see during the winter evenings. As she looked back down to Earth, she saw the giant scorpion not far from where she had found Orion. She put two and two together and decided to get revenge. She dive-bombed the scorpion, picked it up, and flung it up into the opposite end of the sky from her dead boyfriend, where it transformed into a constellation. That’s why the constellations Orion and Scorpius are never seen in the sky at the same time. Orion prowls the winter skies and Scorpius trolls the summer heavens. Orion won’t get stung again.

Celestial happening this week

(Mike Lynch)

On Sunday and Monday, toward the end of evening twilight in the very low western sky, look for the new crescent moon hanging close by the faint planet Mars.

Mike Lynch is an amateur astronomer and retired broadcast meteorologist for WCCO Radio in Minneapolis/St. Paul. He is the author of “Stars: a Month by Month Tour of the Constellations,” published by Adventure Publications and available at bookstores and adventurepublications.net. Mike is available for private star parties. You can contact him at mikewlynch@comcast.net.

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