Criminalization Of HIV Transmission Research Articles

Criminalizing HIV transmission using model law: troubling best practice standardizations in the global HIV/AIDS response

A growing body of social science research has focused on the negative public health consequences of criminalizing the sexual transmission of HIV. I examine the criminalization of contagion in West and Central Africa and address a significant research gap: How do legislative environments that enable harmful laws to be applied become created in the first place? With stated aims of promoting human rights and public health objectives, HIV/AIDS-related laws have been created transnationally though the use of an omnibus model law. A group of legislative actors have problematized this United States Agency for International Development (USAID) funded model law, known as the USAID/Action for West African Region model law, or N'Djamena model law. This ‘harmonizing’ text led to the rapid spread of HIV/AIDS laws, including the criminalization of HIV transmission, across at least 15 countries in West and Central Africa between 2005 and 2010. The HIV model law was packaged and ‘sold’ to developing countries through the strategic use of best practice discourse. Best practice replications are enabled though a set of social and technological relations of use including the availability of mobile, standardizing texts. Although best practice standardization has been a key feature of global health institutions work activities in the HIV response over the past two decades, recent replications related to the criminalization of HIV transmission illustrate the potential public health dangers of ‘don’t reinvent the wheel’ thinking. I offer a normative critique of the transnational, text-mediated process that has produced highly problematic laws.

Stigmatizing attitudes towards people living with HIV/AIDS: validation of a measurement scale.

BackgroundAlthough stigmatization has long been recognized as a major obstacle to HIV prevention. The lack of a valid and reliable measurement tool for stigmatization is a major gap in the research. This study aimed to: 1) develop a scale of stigmatizing attitudes towards people living with HIV (SAT-PLWHA-S) and 2) demonstrate its reliability and validity.MethodsFrench and English-speaking experts (n = 21) from different professional communities (academics, practitioners) assessed the clarity and relevance of the proposed items. The psychometric properties of the SAT-PLWHA-S were assessed with a random digit dial population based telephone survey (n = 1,500) of respondents in Quebec, Canada. Analyses included exploratory and confirmatory factor analyses, correlations, multiple linear regressions, t-tests, hypothesis testing of factorial structure invariance, and Cronbach’s alpha.ResultsConfirmatory factor analysis (CFA) supported a 27-item structure with seven factors: 1) concerns about occasional encounters; 2) avoidance of personal contact; 3) responsibility and blame, 4) liberalism, 5) non-discrimination, 6) confidentiality of seropositive status, and 7) criminalization of HIV transmission. Cronbach’s alphas indicate satisfactory internal consistency. An assessment of concurrent validity using Pearson’s correlation and multiple linear regression shows that homophobia and HIV transmission knowledge are significant determinants of stigmatizing attitudes toward PLHIV. Discriminant validity (t-test) results suggest that the SAT-PLWHA-S can differentiate attitudes between different groups and indicates invariant factor structure across language.ConclusionsThe results of this study suggest that the SAT-PLWHA-S is a reliable and valid tool for measuring stigmatizing attitudes toward PLHIV and that it can contribute to a deeper understanding of HIV stigma.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-1246) contains supplementary material, which is available to authorized users.

Barriers to legal and human rights in Australia in the era of HIV treatment as prevention.

This paper analyses developments and debates regarding legal and human rights issues relevant to the Australian HIV response in the context of treatment as prevention (TasP). A refocusing of prevention priorities on individual responsibilities to 'test and treat' without regard to the legal and human rights context is, we argue, problematic. The paper maintains that the justification of testing and treating for the greater good risks eroding the foundations of a human rights-based approach to HIV prevention, and that the TasP agenda as presently conceived may divert attention from pressing law reform issues relating to sex work, illicit drug use, and criminalization of HIV transmission.

Criminalization of HIV Transmission and Exposure: Research and Policy Agenda

More than half of US jurisdictions have laws criminalizing knowing exposure to or transmission of HIV, yet little evidence supports these laws' effectiveness in reducing HIV incidence. These laws may undermine prevention efforts outlined in the US National HIV/AIDS Strategy, in which the United States has invested substantial federal funds. Future research should include studies of (1) the impact of US HIV exposure laws on public health systems and practices; (2) enforcement of these laws, including arrests, prosecutions, convictions, and sentencing; (3) alternatives to HIV exposure laws; and (4) direct and opportunity costs of enforcement. Policy efforts to mitigate potential negative impacts of these laws could include developing prosecutorial guidelines, modernized statutes, and model public health policies and protocols.

Criminalization of HIV Transmission and Exposure: In Search of Rights-Based Public Health Alternatives to Criminal Law

The use of criminal law to address HIV transmission and exposure has been misguided and ineffective. Criminalization of HIV transmission and exposure raises difficult legal questions: what is the appropriate degree of mental culpability to trigger criminal prosecution? Is it appropriate for the law to equate nondisclosure of (known) HIV-positive status to a sexual partner with rape (as the law does in some jurisdictions)? Can it be justified to treat mere nondisclosure of HIV status as equivalent to the intent to cause harm? To what extent will the law recognize circumstances that mitigate harm, risk of harm and mental culpability, such as safer sex practices and low viral load, in mitigating the application of criminal sanctions? Sound guidance on avoiding the misuse of the criminal law in this area has been developed, but unfortunately many criminal laws in this area allow for prosecution even in cases where there is little justification. It is reasonable to expect that the use of these laws contributes to HIV-related stigma and discrimination, particularly when cases are portrayed sensationally in mass media. The harm caused by unjustified prosecutions and convictions and stigma is not counterbalanced by any evidence of public health benefits of this use of criminal law. These laws should urgently be repealed or reformed as part of a shift to strategies centered on human rights.

International consultation on the criminalization of HIV transmission: 31 October – 2 November 2007, Geneva, Switzerland

RésuméDepuis le début de l’épidémie de VIH, certaines juridictions ont appliqué le droit pénal à la transmission du virus. En 2002, l’ONUSIDA a publié une étude des politiques possibles en la matière. Devant les demandes accrues d’application du droit pénal à la transmission du VIH et les préoccupations émises à cet égard par le Groupe de référence de l’ONUSIDA sur le VIH et les droits de l’homme et d’autres organes, le PNUD et le Secrétariat de l’ONUSIDA ont décidé de réunir des juristes et d’autres parties prenantes pour débattre de la question dans le contexte d’une riposte efficace au VIH fondée sur les droits de l’homme et la santé publique. La discussion définira une politique générale ONUSIDA/PNUD sur ce thème. Il a été précisé que la consultation portera principalement sur la transmission sexuelle du VIH, même si l’application du droit pénal à la transmission du VIH dans d’autres contextes suscite aussi des inquiétudes. Cet article est formé d’extraits du rapport de la réunion.ResumenDesde el principio de la epidemia del VIH, algunas jurisdicciones han aplicado el derecho penal a la transmisión del VIH. En el año 2002, ONUSIDA publicó un artículo sobre opciones de políticas al respecto. En vista de nuevos llamados a la aplicación del derecho penal a la transmisión del VIH y de las inquietudes expresadas al respecto por el Grupo de Referencia de ONUSIDA sobre el VIH y los Derechos Humanos y otros, UNDP y la Secretaría de ONUSIDA decidieron reunir a varios peritos jurídicos y otras partes interesadas para tratar el asunto en el contexto de una respuesta eficaz de derechos humanos y salud pública al VIH. La discusión informaría a un compendio de políticas de ONUSIDA/UNDP al respecto. Se aclaró que la consulta se centraría principalmente en la transmisión del VIH por contacto sexual, aunque se señaló que existen inquietudes con relación a la aplicación del derecho penal a la transmisión del VIH en otros contextos. Este artículo consiste en pasajes del informe de la reunión.

The Case Against Criminalization of HIV Transmission

younger than 14 years (at which time the AAP recommends full disclosure for all patients, with a preference for earlier disclosure as appropriate), full disclosure of the diagnosis may not be necessary for meaningful assent. Rather, it may be necessary only that the child and family be engaged in an established disclosure process. Such a process requires that the clinician or researcher obtaining assent be familiar with the child’s development and progress through the disclosure algorithm. In addition, the language to be used in the assent process should be discussed and agreed on in advance with the family. At age 14 years, most children ordinarily are able to understand the implications of an HIV diagnosis and are ready for full disclosure. Wider debate and consensus building about assent and disclosure are needed among agencies that sponsor pediatric HIV research in the United States and internationally. Financial Disclosures: None reported. Funding/Support: This Commentary was supported in part by Cancer Center Support Core Grant P30 CA21765 from the US Public Health Service and by the American Lebanese Syrian Associated Charities (ALSAC). Role of the Sponsors: The Cancer Center Support Grant and ALSAC fund St Jude’s infrastructure but had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; or the preparation, review, or approval of the manuscript. Additional Contributions: We thank Patricia Flynn, MD (Department of Infectious Diseases, St Jude Children’s Research Hospital), for information about the staged disclosure process at St Jude and for her critique of the manuscript. We also thank Sharon Naron, MPA, ELS (Department of Scientific Editing, St Jude Children’s Research Hospital), for editing and review of the manuscript. No compensation was received by those named herein. REFERENCES

Intimacy and Responsibility: The Criminalization of HIV Transmission by Author: Dr Matthew Weait

Intimacy and Responsibility: The Criminalization of HIV Transmission by Author: Dr Matthew Weait

The criminalization of HIV transmission in England and Wales: a brief review of the issues arising

The HIV virus has been present in our society for more than two decades. Although there was originally much academic interest in the possibility of prosecuting for the reckless transmission of HIV in England and Wales, it was thought impossible by many (including the government) under existing legislation. The first prosecution in England in 2003 (following the first UK prosecution in 2001, in Scotland) provoked a great deal of surprise not least in the HIV voluntary sector, which has since been campaigning for the cessation of such prosecutions. This review examines the law in this area and provides an understanding of the development of the ethical and other issues involved. Since 2003 there have been seven further convictions for the reckless transmission of HIV in England and Wales. These prosecutions have led to several responses that are discussed here and the current developments in this area outlined. Whether it is right to prosecute the reckless transmission of HIV remains a controversial, pressing question. This brief article aims to dissect and question the relevant issues and help inform this debate.

Criminalization of HIV transmission: can doctors be liable for the onward transmission of HIV?

The English Court of Appeal has recently confirmed that the reckless transmission of HIV can amount to a criminal offence, following on from a similar development in Scotland in 2001. This development has led to some concern as to whether doctors could, in certain circumstances, themselves be liable for the onward transmission of HIV by a patient. This article reviews the current scope of the criminal law, before considering the law on liability for onward transmission in the UK. It concludes that civil liability (liability in damages) for onward transmission will be imposed only in unusual cases, and probably only where a doctor has failed to discharge his or her duty of care towards one of his or her own patients. Criminal liability is perhaps theoretically possible but exceptionally unlikely.

Prevention with people with HIV/AIDS: a perspective from a person living with HIV/AIDS in Latin America.

Data from the United States suggest that approximately 60% of people living with HIV/AIDS (PLWHA) are aware of their HIV status. These data contrast with Brazil, where a report from 2001 estimates that 600,000 men and women are living with HIV (age range: 15–49 years), of whom 149,000 (in 2003) receive treatment. 1 The estimate for persons living with HIV (PWHIV) who are aware of their status is 215,000 (approximately 35%; D. Barreira, MD, PNSTD-AIDS, private communication). This trend toward low proportions of persons who know their serostatus has been observed in many countries in the world. So, although prevention with PLWHA who know their serostatus is certainly worthy of the attention devoted by this issue as well as by resources allocated in the United States, this strategy may not always act on the “core” of the epidemic, at least in countries where prevention efforts then miss the majority of persons who do not know they have HIV. In this commentary, I highlight some important aspects of the focus of prevention on HIV-positive persons, especially in international settings. First, we must remember that many PLWHA were most likely aware of the threat of HIV and exposed to preventive messages before they became infected; in a sense, this means that these approaches failed for them. Moreover, it is also likely that the individual and social characteristics of their vulnerability still persist in their lives. Some people do not easily overcome the news of an HIV diagnosis, even in places where there is access to antiretroviral (ARV) therapies. Certainly, some people reshape many aspects of their lives after learning their HIV diagnosis and make positive changes such as risk reduction and being adherent to therapy. The question remains, however, as to whether HIV infection is such an important additional circumstance that it would be a logical strategy to rely on delivering the same kinds of prevention messages that had already failed for this person. It has been argued that too much focus on prevention with positive persons is blaming these individuals for new infections; I argue that this is an insufficient framework for prevention because it continues to ignore the social contexts that favor infections. Did they have easy and affordable access to preventive means such as condoms or syringes? Did they live in neighborhoods where disadvantages, discrimination, and a lack of social capital provide them with few healthy alternatives? In my opinion, criminalization of HIV transmission should also be interpreted within this frame; what kind of a barrier does this issue present for eliminating stigmatization from the prevention and treatment process? Second, it now seems clearer than ever that it is important to listen carefully to persons who have become HIV-positive and try to see where preventive activities failed for them so as to provide new approaches tailored for others like them. I note a positive trend in that several of the studies in this issue seem to have drawn on the expertise of the consumer community for new directions. For example, in an article in this issue on an integrated behavioral intervention with HIV-positive injection drug users to address medical care,

Public Health Strategies for Confronting AIDS

Legislation and regulation can make an important contribution to efforts to confront AIDS by promoting professional standards through reasoned guidelines; by mandating appropriate health care services and public education, particularly in sex education in schools, condom advertising, and outreach programs for drug-dependent people; by funding research; and by safeguarding confidentiality and protecting against discrimination. AIDS-related legislative and regulatory policy across the United States is reported and categorized, and an assessment is made of the likely impact of laws covering treatment and education, protection of the blood supply, screening, reporting, isolation, criminalization of HIV transmission, confidentiality, and discrimination.