Prosecution of non-disclosure of HIV status: Potential impact on HIV testing and transmission among HIV-negative men who have sex with men.

Maya A Kesler,Jason Brunetta,Ted Myers,Mona Loutfy,Rupert Kaul,Dionne Gesink,Robert S Remis,Garrett Prestage

doi:10.1371/journal.pone.0193269

Abstract

BackgroundNon-disclosure criminal prosecutions among gay, bisexual and other men who have sex with men (MSM) are increasing, even though transmission risk is low when effective antiretroviral treatment (ART) is used. Reduced HIV testing may reduce the impact of HIV “test and treat” strategies. We aimed to quantify the potential impact of non-disclosure prosecutions on HIV testing and transmission among MSM.MethodsMSM attending an HIV and primary care clinic in Toronto completed an audio computer-assisted self-interview questionnaire. HIV-negative participants were asked concern over non-disclosure prosecution altered their likelihood of HIV testing. Responses were characterized using cross-tabulations and bivariate logistic regressions. Flow charts modelled how changes in HIV testing behaviour impacted HIV transmission rates controlling for ART use, condom use and HIV status disclosure.Results150 HIV-negative MSM were recruited September 2010 to June 2012. 7% (9/124) were less or much less likely to be tested for HIV due to concern over future prosecution. Bivariate regression showed no obvious socio/sexual demographic characteristics associated with decreased willingness of HIV testing to due concern about prosecution. Subsequent models estimated that this 7% reduction in testing could cause an 18.5% increase in community HIV transmission, 73% of which was driven by the failure of HIV-positive but undiagnosed MSM to access care and reduce HIV transmission risk by using ART.ConclusionsFear of prosecution over HIV non-disclosure was reported to reduce HIV testing willingness by a minority of HIV-negative MSM in Toronto; however, this reduction has the potential to significantly increase HIV transmission at the community level which has important public health implications.

Highlights

In Canada, between January 1989 and December 2015, 181 HIV-positive persons were criminally charged for failing to disclose their HIV status prior to sex [1]
Subsequent models estimated that this 7% reduction in testing could cause an 18.5% increase in community HIV transmission, 73% of which was driven by the failure of HIV-positive but undiagnosed men who have sex with men (MSM) to access care and reduce HIV transmission risk by using antiretroviral treatment (ART)
Participants were asked: “How much would a concern about being prosecuted affect your decision to get tested for HIV?” Participants answered on a 5-point Likert scale that ranged from much less likely to much more likely to be tested for HIV

Summary

Introduction

In Canada, between January 1989 and December 2015, 181 HIV-positive persons were criminally charged for failing to disclose their HIV status prior to sex [1]. In 2012, the SCC revisited the matter and established that people living with HIV must disclose prior to sex acts that pose a “realistic probability” of HIV transmission [7, 8]. When defining this new standard, the SCC found that there is a duty to disclose before vaginal sex unless a condom is used and the accused’s viral load at the time of sexual relations is “low” (e.g. less than 1,500 copies per milliliter) [7, 8].

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