Is De-Criminalizing HIV The Key To Ending Epidemic? – WebMD

June 16, 2021 — For many people, being told that they are HIV positive is no longer a death sentence. But for Robert Suttle, a Black gay male and social justice educator, it is a life sentence.

Unexpectedly caught up in the HIV criminalization web at the age of 30, Suttle spent 6 months in a Louisiana state prison for a consensual sexual relationship with an adult partner. The crime? Not disclosing his HIV-positive status, a charge that Suttle says is untrue.

“I did disclose my status to my partner; however, I can’t really answer how they might have received it,” he says.

Today, at the age of 42, Suttle still carries the indelible stain of a conviction and of a registered sex offender. “After their diagnosis, criminal charge, and/or conviction, many people think they’re done — either ‘I’ve gotten out of prison’ or ‘I’m still on probation’ — whatever the case may be,” he explains. “But we’re still living out these collateral consequences, be it with housing, moving to another state, or finding a job.”

The same remains true for HIV-positive people who are charged and tried but manage to dodge prison. . Monique Howell, a straight, 40-year-old former Army soldier and single mother of five, says that she was afraid to disclose her HIV status to a sexual partner but did advise him to wear a condom. She points to her Army discharge papers , which were issued when her military duty was ended after her court case was dismissed.

“I was going to re-enlist but I got in trouble,” she says, explaining that while a military separation helps to ensure that she can receive benefits and care, the papers were issued with a caveat reading, “serious offense,” an indelible stain that like Suttle’s, will follow her for the rest of her life.

Laws Criminalize Myths and Misconceptions

HIV criminalization laws made it illegal to expose another person to HIV without warning. Depending on the state, it can be considered a felony or misdemeanor and carry prison terms anywhere from less than 10 years to life, according to the CDC.

Originally enacted in 1986 at a time when fear was rampant and hundreds were dying at the height of the AIDS epidemic the laws were intended to reduce HIV transmission. But they’re responsible for a series of unintended consequences: amplifying stigmatization and discrimination and perpetuating HIV myths and misconceptions, including how HIV is transmitted.

Decades of scientific advances challenge the laws’ most basic reasoning. For example, studies have shown that the risk of transmission from biting or spitting, or even a single sexual act, is as low as 0% to 1.4%). In addition, few laws reflect one of the most important HIV research findings of the past decade: undetectable equals untransmittable, meaning that people who are taking antiretroviral therapy (ART) and whose viral loads are undetectable cannot sexually transmit the virus to others.

In most of these cases, HIV-positive individuals are charged and punished for unintentional exposure and not deliberate intent to harm. Moreover, a sexual partner doesn’t need to have acquired the virus for the charge to stick or prove how they became infected if they do become HIV positive.

Howell notes that it was the Army that brought the charges against her, not her sexual partner at that time (who, incidentally, tested negative). He even testified on her behalf at the trial. “I’ll never forget it,” she says. “He said, ‘I don’t want anything to happen to Monique; even if you put her behind bars, she’s still HIV-positive and she’s still got those children. She told me to get a condom and I chose not to.’”

Criminal vs Clinical Fallout

In 2018, 20 scientists from across the world issued a statement saying HIV criminalization laws are based on bad information and faulty science. The statement — which remains one of the most viewed in the Journal of the International AIDS Society — also points out that 33 countries, including the U.S.,use general criminal statutes such as attempted murder or reckless endangerment to lengthen sentences when people with HIV commit crimes.

When the laws were created, “many were the equivalent [to general criminal laws] because HIV was seen as a death sentence,” explains Chris Beyrer MD, a professor in public health and human rights at Johns Hopkins Bloomberg School of Public Health in Baltimore. “So, failure to disclose your status, to wear a condom, was seen as risking someone else’s life, which is no longer the case.”

In fact, “from the perspective of the kinds of impact that these laws have had on transmission, or risk, or behavior, what you find is that they really have no public health benefit and they have real public harms,” says Beyrer.

Claire Farel MD, assistant professor and medical director of the Infectious Diseases Clinic at the University of North Carolina in Chapel Hill, agrees.

“Because of the criminalization undercurrent, there are people who don’t get tested, meaning that they are at risk for worse health outcomes such as cancer, vascular disease, and of course, HIV-related poor outcomes including progression to AIDS.”

Farel also points to the residual stigma around HIV. “Much of this is inextricable from that surrounding homophobia, especially among young men of color who have sex with men. It opens up a larger conversation that a lot of people don’t want to engage in,” she says.

Laws Broaden Existing Disparities Even Further

This month, the CDC released a study showing substantial declines in the overall incidence of HIV in the U.S., with an important caveat: there’s been a worsening disparity in cases, implying that access to care and continuing care remain low among certain populations. For example, Black individuals accounted for 41% of new HIV infections in 2019, while representing only 12% of the U.S. population. Meanwhile, Hispanics/Latinos accounted for 29% of new infections but only represent 17% of the entire population.

The same is true for HIV criminalization.: In 2020, more than 50% of defendants were people of color, according to U.S. case data collated by the HIV Justice Network.

But the momentum to change these antiquated laws is gaining speed. In May, the Illinois Senate passed a bill repealing HIV criminalization, while this past March, Virginia Gov. Ralph Northam signed a bill lowering HIV-related criminalization charges from a felony to a misdemeanor and changing the wording of its law to include both intent and transmission. Both states now join California, Colorado, Iowa, Michigan, Nevada, and North Carolina, all of which have modernized or repealed their laws.

Ending the U.S. HIV Epidemic: Patients First

Without true HIV criminalization reform, efforts to change the public and clinical mindset around HIV from a highly stigmatized disease to a preventable, treatable infection are likely to fall short. Beyrer emphasizes that the onus lies with the scientific and activist communities working together. “I don’t know how you can end the epidemic if you are still stigmatizing the people who are actually acquiring these infections,” he says. 

But there are also steps that patients can take while these forces push for change.

“As people first process their diagnosis, they need to learn as much about HIV and the science behind it as possible,” advises Suttle. He also says that it’s essential to learn about HIV criminalization and the laws in their states to protect themselves.

“Find someone you can trust, starting with your medical provider if possible, and if you have a significant other, bring that person to your appointments so they can see that you are in care and doing all that you can do to lower viral loads and protect others,” he adds.

Although people should be in treatment and care, attitudes also need to change on the provider side, Howell says. “We’re just given these meds, told to take them, and are sent on our merry ways, but they don’t tell us how to live our lives properly; nobody grabs us and says, hey, these are the laws and you need to know this or that.”

When an HIV-positive person does get caught up in the system, whenever possible they should consult an attorney who understands these laws. But Suttle says that they should also reach out to organizations in the HIV Criminalization Movement (for example, the Sero Project, the Center for HIV Law and Policy, or the Positive Women’s Network) for further support, help with the cases, including providing experts to testify, social services, and other resources. Suttle also encourages people who need help and direction to reach out to him directly ([email protected]).

Forty years ago this month, the CDC published its first report of an illness in  five  healthy gay men living in Los Angeles. The first cases in women were reported shortly thereafter. Theyears that have passed have seen many exciting scientific advances in prevention and treatment. But as Beyrer aptly notes in an editorial published this past January in Lancet HIV journal, “time has not lessened the sting of the early decades of AIDS.”

“We should not have to be afraid of who we are because we are HIV positive,” says Howell.