Today we are talking about criminal laws against the intentional transmission of HIV. Previously we've discussed the way in which public health laws allowed government authorities to protect the public from contagious diseases. Using such techniques as isolation and quarantine. Today's subject is quite different. Although legislators may have been motivated by public health considerations, it is quite different to impose criminal penalties for the individual actions of people who are infected with HIV. This is a controversial subject. I generally do not express my personal opinions in these sessions, but today I will. I understand and respect the fact that you may disagree with my judgements, as is natural with controversial topics. I have mentioned that the Ryan White Care Act required states to certify that they could prosecute people who intentionally transmit the virus to others. Although the provision of the Care Act was dropped when it was reauthorized in the year 2000. This aspect of the law reflected a great deal of public thinking in the 1980s and 1990s. In 1988, a presidential commission on HIV appointed by President Reagan recommended that the states consider passing such laws. The report of the commission is available on the web and it makes fascinating reading. In the United States, all the states complied with the requirement of the Ryan White Care Act. Some states said that existing, non HIV specific laws were adequate. But by the year 2014, 32 states had statutes that applied specifically to HIV positive people. Around the world, legislation against various types of transmission exists in many countries. It is beyond my scope to give you a run down of all the different approaches. I believe however, that the main points that I'm making in this session about US laws applies to the laws of many countries. I'd like to reflect on these laws and share my opinion about them with you. And then I'll conclude with some additional facts and the recent recommendations that have been made by authorities in the field. Let's begin our reflection on these laws with a thought experiment concerning other contagious diseases. What would we think of proposals to pass law against it, intentional transmission of Ebola, measles, tuberculosis? I can only imagine our conversations about each of these instances. People would, of course, point out that none of these diseases is transmitted sexually or by contaminated needles. And sexual transmission and contaminated needles are two of the primary modes of transmission of HIV. Yet these other diseases are, in fact, transmitted through contact, though not sexual contract, between individuals. Is sexual behavior or in drug, injection drug use particularly suspect when we think of one person intending to harm another? Isn't it true that a malicious person, with any of these contagious diseases, a person to, who intended to harm another, might infect a victim? The answer might be yes, but. The but would be, but that sort of behavior would be so unlikely and so rare. Why would we take the trouble to pass a law about something that almost never happens? Why wouldn't we say the same thing about the be, behavior of people with HIV? Do we have any reason to believe that they would be more malicious, more attracted to harming other people than other people infected with other viruses? As I have thought about these things, my conclusion has been that there have been two factors that explain the existence of these laws, fear and stigma. A new disease appeared on the scene and it was horrible and fatal. At first the world knew little about what was happening. It was indeed frightening. Before scientific knowledge began to accumulate it was not unreasonable for people to feel scared and vulnerable. Even as scientific knowledge developed it spread slowly to the general public. The knowledge of ordinary people trails far behind the discoveries of science. We are still catching up. The other factor is stigma. In many places AIDS initially struck homosexual males and drug users. Although it would usually, eventually spread to the general population. Gay men and injection drug users were marginalized groups. In many places for a long time homosexual behaviors and drug use were illegal. Law and culture encouraged people to fear and disapprove of members of these groups. Although there have been occasional criminal acts in which disturbed people used their HIV infections as weapons, this has been exceedingly rare. I don't believe these instances truly account for the extensive passage of laws against intentional transmission. Moreover, pre-existing laws dealing with assault and other attempts to harm another person could easily be invoked to prosecute and punish HIV offenders. I think that the assumption that members of a stigma, stigmatized group will do bad things along with the very high level of fear around AIDS, together account for the existence of these laws. To use strong language, panic and bigotry are a powerful combination. Let's leave our thought experiment and the expression of my private opinions and return to some facts about laws against the transmission of HIV. A 2014 review of the HIV-specific laws in the United States was conducted by government scientists from two agencies and by representatives of the Civil Rights Division of the Justice Department. Among their findings are that many state laws criminalized behaviors that have little or no chance of transmitting HIV. Spitting is an example. Most of the laws do not take to, into account measures that substantially reduce the risk of transmission. Such as anti-retroviral therapy, the use of condoms, and pre-exposure prophylaxis. The review concludes by recommending that states review their laws to see if they are consistent with current scientific knowledge about HIV. And also that they reconsider whether criminal laws are the best way to achieve their goals. In July 2010, the US government released its first national HIV/AIDS strategy. When it turns to matters of criminal law, the strategy makes similar recommendations. It says that states should reconsider their legislation. It concludes, quote, in many instances the continued existence and enforcement of these types of law run counter to scientific evidence about the roots of HIV transmission. And may undermine the public health goals of promoting HIV screening and treatment. A UN AIDS document on criminalization concludes by quoting a statement from a meeting of parliamentarians from all over the world. In many instances, it says, the continued existence and enforcement of these types of laws run counter to scientific evidence about roots of HIV transmission. And may undermine, the public health goals of promoting HIV screening and treatment.
