HIV criminalization laws were introduced and passed early in the epidemic, before effective medication was available. Fear of the virus motivated legislators to try to curb transmission through individualism, blaming the individual for transmission rather than the social root of the spread. The Ryan White CARE Act, although provides much needed support to states to provide HIV treatment and prevention efforts, also requires states to show they criminalize individuals who expose people to HIV. Thirty-four states have laws criminalizing people transmitting or attempting to transmit HIV whether or not actual harm has been demonstrated or caused. In 21 states, laws require persons who are aware they they have HIV to disclose their status to sexual partners and 12 states require disclosure to needle-sharing partners. Several states criminalize one or more behaviors that pose a low or negligible risk for HIV transmission such as spitting, biting, mutual masturbation or oral sex. Some laws require people living with HIV to register as sex offenders. Others allow for the violation of confidentiality and privacy rights for people living with HIV. Still others allow for enhanced sentences for people living with HIV who are convicted of completely unrelated crimes. Despite significant advancements in HIV treatment, including undetectable equals untransmittable (U=U) and PrEP demonstrating 99% effectiveness, criminalization persists. HIV criminalization laws enable stigma and discrimination against people living with HIV and the communities disproportionately affected by it, such as queer, trans, and BIPOC communities, and the continued targeting of these communities for policing and incarceration. It also discourages testing and treatment out of fear of prosecution, which actually undermines management of the disease itself in a public health and epidemiological lens. Because we know that queer, trans, and BIPOC communities are at much higher risk for HIV, especially Black Trans women, and are already disproportionately targeted by the criminal justice system, it is imperative that HIV decriminalization be prioritized within health policy efforts committed to securing the health and wellness of these communities.