Transgender Day of Visibility 2023

Honouring the courage of transgender people globally, especially transgender people living with HIV

Today is International Transgender Day of Visibility, held annually on 31st March to celebrate transgender people globally and honour their courage and visibility to live openly and authentically.

This year’s 14th annual celebration is a day to also raise awareness around the stigma, discrimination and criminalisation that transgender people face.

According to the Human Dignity Trust, 14 countries currently criminalise the gender identity and/or expression of transgender people, using so-called ‘cross-dressing’, ‘impersonation’ and ‘disguise’ laws. In many more countries transgender people are targeted by a range of laws that criminalise same-sex activity and vagrancy, hooliganism and public order offences.

Transgender people living with HIV can be further criminalised based on their HIV-positive status, although we know that there are still too many invisibilities around the impact of HIV criminalisation on transgender people.

Cecilia Chung, Senior Director of Strategic Initiatives and Evaluation of the Transgender Law Center, who is also a member of our Global Advisory Panel told our 2020 Beyond Blame webinar that there are not enough data on the impact of HIV criminalisation laws on transgender people. She said such data are not “uniformly collected across the world… The numbers still remain invisible even though we know for sure there are [HIV criminalisation] cases.”

HJN honours the courage of transgender people – especially transgender people living with HIV – to live openly and authentically. We also call for more visibility for transgender people in data collection, as well as reforms of all criminal laws and their enforcement that disproportionately target transgender people.

So many harms, so little benefit: a global review of the history and harms of HIV criminalisation

Last week, The Lancet HIV published an important new advocacy resource – a global review of the history and harms of HIV criminalisation.

So many harms, so little benefit: a global review of the history and harms of HIV criminalisation was co-authored by Joanne Csete (Columbia University Mailman School of Public Health), Richard Elliott (former executive director of the HIV Legal Network and current chair of our Supervisory Board), and Edwin J Bernard (HJN’s executive director and global co-ordinator of HIV JUSTICE WORLDWIDE).

The review summarises key developments in the history of HIV criminalisation and highlights newer research – from the last decade but especially from the last five years – on the public health and human rights impact of HIV criminalisation.

It also summarises expert guidance on the subject, especially as it reflects evolving science, also noting the health and human rights concerns about the application of phylogenetic analysis for molecular surveillance data in the context of HIV criminalisation.

It also explores the impact of HIV criminalisation on different populations – women, sex workers, gay and bisexual men and other men who have sex with men, Indigenous persons, immigrants and racial minorities.

Finally, it reviews recent significant efforts to limit the impact of HIV criminalisation most of which would have been impossible without advocacy organisations of people living with HIV and their allies.

The review concludes that HIV criminalisation…

“is inconsistent with the human rights-based response to HIV espoused in UN strategies for decades. It adds to the legal and societal burden faced by those who experience discrimination based on race, class, gender, sexual orientation and immigration status as well as criminalization of other kinds. It is enabled by laws and a criminal legal system that in many cases have not caught up with the science of HIV, deploying the machinery of the criminal law as a response to conduct posing little or even no risk of transmission. It punishes people harshly even in cases where no bodily harm can be discerned and where there has been no intent to cause harm – indeed, even in some cases where people have actively sought to eliminate or reduce the risk of others acquiring the virus. It reinforces HIV-related stigma and can discourage people from seeking health services. It is a vehicle for the misuse of phylogenetic evidence and the public health apparatus of molecular surveillance.

“Any benefits of HIV criminalization, which are hard to discern from existing research, must be weighed against the enormous costs of deepening stigma and fear among people living with HIV and of incarceration, coercion and blackmail, police investigation, criminal proceedings, media hysteria, and saddling people with criminal records, sex offender status, or deportation. The myth that HIV criminalization protects women from predatory men should give way to investment in proven measures to address gender-based poverty, violence and discrimination. Financial support for the work of networks of people living with HIV in low- and middle-income countries to document HIV criminal laws and their impact would be useful.

“At a time of reckoning on race in global health, it behooves governments to review, reform and repeal laws that exacerbate the harm that centuries of White colonialism have visited upon racial minorities and Indigenous people. Significantly reducing HIV among sex workers, people who use drugs, criminalized LGBTQI persons, migrants and prisoners remains central to the Global AIDS Strategy and would be helped by eliminating HIV criminalization. And in a time of emerging infectious diseases, HIV criminalization sets a dangerous precedent. The few but dramatic cases of attempted murder charges that have been brought for alleged HIV transmission in the context of rape in South Africa were the closest precedent for attempted murder charges brought against two men who refused quarantine after having tested positive for SARS-CoV-2 in 2020. The demonization of COVID-19 “carriers” in too many countries is at least partly a shameful legacy of HIV criminalization.”

So many harms, so little benefit: a global review of the history and harms of HIV criminalisation is available for free download from The Lancet HIV until November 22 2022 by using this link.

USA: New report from Williams Institute shows HIV-related arrests in Louisiana are disproportionately based on race

Black men account for 91% of HIV-related arrests in Louisiana

A new data interactive looks at the impact of HIV criminal laws on people living with HIV in nine states, including Louisiana

Since 2011, as many as 176 people have had contact with Louisiana’s criminal legal system because of allegations of HIV crimes, according to a new report by the Williams Institute at UCLA School of Law. HIV-related crimes are disproportionately enforced based on race and sex. In Louisiana, Black men represent 15% of the state population and 44% of people living with HIV, but 91% of those arrested for an HIV crime.

Using data obtained from the Louisiana Incident-Based Reporting System and from the state’s most populous parishes, researchers found that enforcement of HIV crimes is concentrated in East Baton Rouge Parish, Orleans Parish, and Calcasieu Parish. Furthermore, the number of HIV incidents—or interactions with law enforcement involving allegations of HIV crimes—is not declining over time.

HIV criminalization is a term used to describe laws that either criminalize otherwise legal conduct or increase the penalties for illegal conduct based upon a person’s HIV-positive status. Nearly two-thirds of U.S. states and territories currently have laws that criminalize people living with HIV.

A new data interactive looks at the impact of HIV criminal laws on people living with HIV in nine states, including Louisiana.

Louisiana has one criminal law related to HIV, which makes it a felony for a person who knows of their HIV-positive status to intentionally expose another person to HIV through sexual contact or other means without consent. The maximum sentence for an intentional exposure conviction is 10 years, and people convicted of an HIV crime are required to register on the state’s sex offender registry for at least 15 years.

Louisiana’s HIV criminal law does not require actual transmission, intent to transmit, or even the possibility of transmission to sustain a conviction. Between 2011 and 2022, incarceration for HIV crimes cost Louisiana at least $6.5 million.

“The cost of Louisiana’s HIV criminal law is likely much higher. Even with only partial access to the state’s criminal enforcement data, the trends were dramatic,” said lead author Nathan Cisneros, HIV Criminalization Analyst at the Williams Institute. “Louisiana’s HIV criminal law may undermine the state’s public health efforts by deterring the communities most impacted by HIV, including people of color and sex workers, from seeking testing and treatment.”

KEY FINDINGS

Most HIV criminal incidents (80%) in Louisiana involved only allegations of an HIV-related crime; no other crimes were alleged in the incidents.
Black people—and especially Black men—were the majority of people identified as suspects and arrested for HIV-related crimes in Louisiana.
- Across the state, 63% of suspects were Black and 45% were Black men. For incidents that resulted in arrest, all of those arrested were Black and 91% were Black men.
- In New Orleans, close to 80% of all suspects were identified as Black and 58% were Black men.
Black people and women were overrepresented among victims of HIV-related incidents.
- Across the state, Black women and white women each represented 28% of all victims.
- In New Orleans, Black men were 58% of all victims.
Since 1998, there have been at least 47 separate HIV-related convictions resulting in sex offender registration, involving 43 people.
Most people (63%) on the sex offender registry because of an HIV-related conviction are on the registry only because of the HIV-related conviction.
Three-quarters of people on the sex offender registry for an HIV-related conviction were Black.
Guilty outcomes resulted in an average sentence of 4.3 years.
Incarcerating people for HIV-related charges has cost Louisiana at least $6.5 million.

This report is part of a series of reports examining the ongoing impact of state HIV criminalization laws on people living with HIV. Take a look at our new data interactive summarizing the findings of our research.

Read the report

When law and science part ways: the criminalization of breastfeeding by women living with HIV

The HIV Justice Network (HJN) has been monitoring a disturbing phenomenon — at least 12 women living with HIV have faced criminal prosecution in relation to breastfeeding or comfort nursing.

In addition, women living with HIV have been threatened with punitive public health processes and child protection interventions for breastfeeding their children in multiple countries.

To bring this important issue to the attention of women’s health experts and advocates, HJN worked with our HIV JUSTICE WORLDWIDE partners to write a paper for a Special Collection on Women’s Health and HIV for the peer-reviewed, open access journal Therapeutic Advances in Infectious Diseases.

In “When law and science part ways: the criminalization of breastfeeding by women living with HIV,” published last week, Alison Symington (HJN’s Senior Policy Analyst), Nyasha Chingore-Munazvo (Programmes Lead, AIDS and Rights Alliance of Southern Africa) and Svitlana Moroz (Chair of the Eurasian Women’s Network on AIDS) place the criminalisation of women with HIV for breastfeeding within the context of current medical recommendations and cultural views of breastfeeding. They review the criminal cases against women living with HIV for breastfeeding around the globe, examine the injustice of these prosecutions, and provide recommendations for decriminalisation.

This Special Collection includes papers addressing a wide range of health issues impacting women with HIV. According to lead author Alison Symington, “We felt it was important to submit a paper on breastfeeding and HIV criminalisation because so few people are aware of these horrible cases. Healthcare providers have an important role to play in protecting women from punitive actions and providing them with information and support so that they can make the best decisions for themselves and their children.”

To make the paper even more widely accessible, HJN has provided translations into French, Russian and Spanish.

It is HJN’s aim to collaborate with advocates, researchers, service providers, organisations and community members around the world to raise awareness and prevent further unjust prosecutions against women living with HIV who breastfeed or comfort nurse. We are therefore grateful to both the Elizabeth Taylor AIDS Foundation and the Robert Carr Fund for their financial support for this work.

Further resources

Mwayi’s Story is a short film about courage, and about women standing up for their rights. The film is based on a real case in Malawi and the subsequent successful advocacy to prevent an HIV criminalisation statute being passed. The full story of the woman who was prosecuted for briefly breastfeeding another woman’s baby is told in an HJN feature, It Takes More Than A Village to End HIV Criminalisation, by Sally Cameron, based on a report by Peter Gwazayani, Edna Tembo and Charity Mkona.

Why people living with HIV should not be criminalised for donating blood

Preventing the transmission of blood-borne infection by imposing limitations on the donation of blood is an important and legitimate public health objective.

Since the beginning of the HIV epidemic, certain groups – including, but not limited to, gay men and other men who have sex with men – have been subjected to restrictions on their ability to give blood.

Sustained advocacy by gay rights organisations in many high-income countries has focused on the discriminatory nature of these so-called ‘gay blood bans’, highlighting significant advances in blood screening capabilities. This has led to a general softening of restrictions on blood donations for gay men in many of these countries – allowing donations with ‘deferral periods’, or allowing donations based on individual risk assessments.

However, this advocacy has generally not translated into the removal of HIV-specific criminal laws for donating blood, nor has there been a call for a moratorium on singling out people living with HIV for donating blood using non-HIV-specific general criminal laws – even though many of the same public health and human rights arguments apply to both the so-called ‘gay blood bans’ and to HIV criminalisation more generally.

That is why today, the HIV Justice Network has published Bad Blood: Criminalisation of Blood Donations by People Living with HIV. The report was written by Elliot Hatt and edited by Edwin J Bernard, based on research undertaken by Sylvie Beaumont, with additional input provided by Sarai Chisala-Tempelhoff and Paul Kidd (HIV Justice Network’s Supervisory Board); Sean Strub (Sero Project) and Robert James (University of Sussex).

We found that 37 jurisdictions in 22 countries maintain laws that criminalise people with HIV for donating blood. Notably, 15 jurisdictions in the United States (US) have laws which specifically criminalise blood donations by people living with HIV, while four US states – California, Illinois, Iowa, and Virginia – have repealed laws which previously criminalised this conduct.

Although prosecutions are relatively rare, we are aware of at least 20 cases relating to blood donation since 1987. Half of these cases have been reported in Singapore, including two as recently as 2021.

We argue that the criminalisation of blood donations by people with HIV is a disproportionate measure – even if the aim of protecting public health through the prevention of transfusion-transmitted infection is legitimate – and is the result of both HIV-related stigma and homophobia. It is not supported by science.

There is no good reason for any country or jurisdiction to have HIV-specific criminal laws – whether they focus on blood donation or on sexual exposure or transmission. HIV-specific criminal laws are discriminatory and stigmatising, especially since people with other serious blood borne infections – including hepatitis B and C and syphilis – are not singled out with specific laws, nor for prosecution under general criminal laws.

Blood donation criminal laws focused on HIV should be repealed, prosecutions based on general laws should end, and instead science-informed measures – such as individual donor risk assessments and universal blood screening – should be relied on to protect the public against transfusion-transmitted infection.

Read the report at: https://www.hivjustice.net/publication/badblood

‘Punishing vulnerability through HIV criminalization’

The HIV Justice Network recently had an editorial published in a special supplement of the American Journal of Public Health. The supplement highlights the importance of moving toward actions to reduce HIV-related intersectional stigma and discrimination.

Our editorial, ‘Punishing vulnerability through HIV criminalization’ explores the links between HIV criminalisation and other punitive laws and policies that regulate bodily autonomy, including reproduction, sexuality and gender.

What we have observed in analysing the research we undertake – when we document all the known cases of HIV criminalisation for our newsletter and then categorise them for further analysis in our Global HIV Criminalisation Database – is this:

“HIV criminalisation is not only a manifestation of state-sponsored HIV stigma but also a proxy for other forms of stigma and discrimination. Exacerbated by heavy-handed policing and vitriolic media coverage enabled by unjust laws that fly in the face of science and human rights, HIV criminalisation thrives at the intersection of social vulnerabilities.”

Although anyone living with HIV could be accused under HIV criminalisation laws or policies, the reality is that HIV criminalisation disproportionately impacts people who are either additionally criminalised, or who are otherwise mistreated by discriminatory legal systems – or both.

These include but are not limited to: sex workers; transgender people; irregular migrants; people who use drugs; gay and bisexual men; people in prison and other closed settings; unsheltered individuals; and people with disabilities, notably with mental health issues.

We also see people discriminated against on the basis of gender, race, religion, ethnicity, and/or country of birth.

That is why we not only cover HIV justice-related issues in our newsletter, but also issues relating to punitive responses to other marginalised populations and identities.

And it’s why we work with a wide range of partners in our work to achieve HIV justice.

Ending HIV criminalisation and truly achieving HIV justice requires much more than reforming or repealing HIV-specific criminal laws – even though that is a pre-requisite and each law reformed or repealed a major step forward.

But, as we conclude in the editorial,

…modernizing or repealing HIV-specific laws alone will be insufficient to address the full complexity of the intersecting stigmas behind both misguided attempts to protect people from HIV infection and intentional criminalization of groups of people (e.g., based on sexual or gender identity, sex work, or drug use). As with other manifestations of discrimination, the ultimate solution lies in equality and empowerment.

US: Enforcement of HIV crimes in Tennessee disproportionately affects women and Black people

150 people on Tennessee’s sex offender registry for HIV-related conviction

Nearly one-half of HIV registrants on the SOR were women and over three-quarters of HIV registrants were Black.

LOS ANGELES – At least 154 people have been placed on Tennessee’s sex offender registry (SOR) for an HIV-related conviction since 1993, according to a new report by the Williams Institute at UCLA School of Law.

Enforcement of HIV crimes in Tennessee disproportionately affects women and Black people. Nearly one-half of HIV registrants on the SOR were women and over three-quarters of HIV registrants were Black.

Tennessee’s two primary HIV criminalization laws—aggravated prostitution and criminal exposure—make it a felony for people living with HIV to engage in sex work or other activities, such as intimate contact, blood donation, or needle exchange, without disclosing their status. Both are considered a “violent sexual offense” and require a person convicted to register as a sex offender for life.

Examining Tennessee’s sex offender registry, researchers found that Shelby County, home to Memphis, accounts for most of the state’s HIV convictions. Shelby County makes up only 13% of Tennessee’s population and 37% of the population of people living with HIV in the state, but 64% of HIV registrants on the SOR. Moreover, while Black Tennesseans were only 17% of the state’s population and 56% of people living with HIV in the state, 75% of all HIV registrants were Black.

In Shelby County, 91% of aggravated prostitution convictions resulted from police sting operations in which no physical contact ever occurred. In addition, the case files showed that 75% of those convicted were Black women. When it came to criminal exposure case files, all of those convicted except one person were Black men.

“Tennessee’s HIV criminal laws were enacted at a time when little was known about HIV and before modern medical advances were available to treat and prevent HIV,” said lead author Nathan Cisneros, HIV Criminalization Analyst at the Williams Institute. “Tennessee’s outdated laws do not require actual transmission or the intent to transmit HIV. Moreover, the laws ignore whether the person living with HIV is in treatment and virally suppressed and therefore cannot transmit HIV.”

KEY FINDINGS

Incarcerating people for HIV-related offenses has cost Tennessee at least $3.8 million.
Of the 154 people who have been placed on Tennessee’s SOR for an HIV-related conviction, 51% were convicted of aggravated prostitution, 46% were convicted of criminal exposure, and 3% were convicted of both.
Women account for 26% of people living with HIV in Tennessee and 4% of people on the SOR, but 46% of the SOR’s HIV registrants.
Black people account for 17% of people living in Tennessee, 56% of those living with HIV, 27% of people on the SOR, but 75% of the SOR’s HIV registrants.
Black women were the majority of aggravated prostitution registrants (57%), while Black men were the majority of criminal exposure registrants (64%).
People with an HIV-related offense are more economically vulnerable when compared to others on the state’s SOR.
- One in five (19%) HIV registrants were homeless compared to 9% of all SOR registrants.
- 28% of HIV registrants reported an employer address compared to about half (49%) of all SOR registrants.
Shelby County has one aggravated prostitution conviction for every 115 people living with HIV in the county, and Black people were 90% of all people convicted for aggravated prostitution.
- Over 90% of aggravated prostitution convictions in Shelby County were the result of police sting operations.
- Only 3% of aggravated prostitution convictions in Shelby County alleged any intimate contact.
- Nearly all (95%) people arrested in Shelby County for criminal exposure were Black men, compared to 64% of people statewide.

The Williams Institute has conducted research on HIV criminalization in numerous U.S. states.

Mwayi’s Story: a short film about courage,
women’s rights, and HIV justice

Today we are delighted to share with the world a new short film, Mwayi’s Story, produced by the HIV Justice Network on behalf of HIV JUSTICE WORLDWIDE.

Mwayi’s Story is a story about courage, and about women standing up for their rights. The film is based on the story of a woman in Malawi who was prosecuted for briefly breastfeeding another woman’s baby and the subsequent successful advocacy in Malawi to prevent an HIV criminalisation statute being passed.

Ultimately, Mwayi’s Story is about HIV justice!

We wanted to produce a film that was authentic to the lived experience of an HIV criminalisation survivor but without making her go through the trauma of having to relive the experience by telling her story again.

HJN’s video, visuals and webshows consultant, Nicholas Feustel, who produced and directed the film, said: “Since this story is primarily about mothers and children, we decided to produce the film in the style of an illustrated children’s storybook. We searched for a female illustrator working in sub-Saharan Africa and found the wonderful Phathu Nembilwi of Phathu Designs.

“For our narrator, we found Upile Chisala, a storyteller from Malawi known for her short and powerful poems.”

The script by HJN’s Senior Policy Analyst, Alison Symington, was written in consultation with our Supervisory Board member, Sarai Chisala-Tempelhoff, a Malawian human rights lawyer and legal researcher with over 15 years of experience in women’s access to justice.

We also worked with our HIV JUSTICE WORLDWIDE partners, Southern Africa Litigation Centre (SALC) and AIDS and Rights Alliance for Southern Africa (ARASA), to ensure that the film was relevant to their ongoing advocacy in the region. In fact, Mwayi’s Story had its world premiere last week on Zambia’s Diamond TV, in anticipation of a verdict in a similar breastfeeding case.

The film will be shown in a number of forums over the next few months, including at AIDS 2022. It will soon be subtitled in French, Russian and Spanish, and we are also looking for partners to translate additional subtitles if they think the film can be useful in their own advocacy. If you’re interested you can get in touch with us at breastfeeding@hivjustice.net. We will send you the English subtitle file for translation. After you return the file to us, we will upload it to YouTube.

Mwayi’s Story is part of our ongoing work to end the criminalisation of women living with HIV for breastfeeding and comfort nursing, including our Breastfeeding Defence Toolkit. It is our goal to collaborate with advocates, researchers, service providers, organisations and community members around the world to raise awareness and prevent further unjust prosecutions against women living with HIV who breastfeed or comfort nurse. We are grateful to both the Elizabeth Taylor AIDS Foundation and the Robert Carr Fund for their financial support for this work, and this film.

New report shows how women living with HIV are leading the response against HIV criminalisation in the EECA region

A new report produced by the Eurasian Women’s Network on AIDS with the Global Network of People Living with HIV on behalf of HIV JUSTICE WORLDWIDE, illustrates how women living with HIV, who are disproportionally impacted by HIV criminalisation across the Eastern Europe and Central Asia (EECA) region, have also been the leaders in research, advocacy and activism against it. The report is now available in English after being originally published in Russian in January.

The report illustrates how HIV criminalisation and gender inequality are intimately and inextricably linked. By highlighting prosecution data from Belarus, Kazakhstan, Russia and Ukraine disaggregated by sex, the report shows how the burden of HIV criminalisation is falling upon women.

The report also includes some heart-breaking personal stories including that of a woman in Russia who was prosecuted for breastfeeding her baby, as well as several women in Russia blackmailed by former partners who threatened to report them for alleged HIV exposure as a way to control, coerce, or abuse them.

The evidence provided in the report clearly demonstrates that HIV criminalisation not only fails to protect women from HIV, but worsens their status in society, making them even more susceptible to violence and structural inequalities due to the way their HIV-positive status is framed by the criminal law.

The report goes on to explore how women living with HIV in the region are vulnerable to a range of economic consequences including loss of property, as well as ostracism and discrimination in their communities, including being separated from their children, because:

Women living with HIV’s reproductive and maternal choices are controlled by, and can be abused by, the state.
Women living with HIV in partnerships with HIV-negative men can be threatened with prosecution, or be prosecuted, even if there has been prior disclosure and consent to the ‘risk’ and even when condoms were used or the woman had an undetectable viral load.
Confidential medical information can be illegally shared with law enforcement agencies.

The report also shows a direct connection between HIV criminalisation and other forms of criminalisation – notably the use and possession of drugs, and of sex work – that exacerbate the burden of discrimination, the violation of rights, and violence experienced by women living with HIV in the region.

Despite the difficult picture painted, the report provides hope, however.

It is the mobilisation of the women’s community and the meaningful participation of HIV-positive women and their allies in advocacy for law reform, rights protections – and in the preparation of alternative reports to UN Committees such as the Committee on the Elimination of Discrimination against Women (CEDAW) – that are making a real difference in the fight against HIV criminalisation in the region.

Read the report in English or Russian.

US: Disability Rights Education & Defense Fund (DREDF) publishes statement opposing HIV criminalisation

DREDF HIV Criminalization Statement

Disability Rights Education & Defense Fund (DREDF) opposes the criminalization of people based on their HIV-positive status. In addition to being harmful to public health, laws and prosecution targeting HIV-positive people constitute discrimination on the basis of disability. The Americans with Disabilities Act (ADA)[1] prohibits disability discrimination by state and local governments.[2] State laws and prosecutions that criminalize people living with HIV without a basis in current objective medical and scientific knowledge violate the ADA and other antidiscrimination mandates. We urge lawmakers across the country to modernize their HIV laws and policies, and to discard outdated and harmful punitive approaches.

Background

During the outset of the HIV epidemic, many states enacted laws that criminalized or enhanced the criminal penalties for certain acts by people living with HIV that were thought to create the risk of exposure to HIV.[3] These laws were passed at a time when fear and misinformation about HIV was widespread, particularly about how HIV is transmitted. Today, with the benefit of more than 30 years of research and considerable advances in medical treatments, the scientific and medical communities have learned much more about how HIV is transmitted and how to prevent transmission. We now know that HIV is not spread through saliva, tears, or sweat.[4] We also know that the use of condoms, PrEP (pre-exposure prophylaxis), and antiviral medication, by themselves or in combination, can dramatically reduce the risk of HIV transmission, in some cases to zero.[5] HIV has also become a medical condition that is managed with medications and other treatments, with people with HIV now having a life expectancy that matches that of the general public.[6] Yet most HIV criminal laws do not reflect current scientific and medical knowledge.[7] In addition, HIV criminalization laws undermine public health by discouraging people from seeking testing and treatment options, such as antiviral medication, that can protect their health and reduce transmission.[8]

Outdated HIV criminalization laws constitute disability discrimination because they treat people living with HIV more harshly without an objective scientific basis. Several states, such as California, Missouri, and North Carolina, have taken steps in recent years to modernize their state HIV laws.[9] Unfortunately, many state laws have still not been updated to reflect current scientific and medical knowledge. Laws in several states criminalize acts that cannot transmit HIV, such as spitting,[10] or that pose no material risk of transmission.[11] These laws do not account for actions that reduce risk, such as condom usage or PrEP or whether transmission has actually occurred.[12]
People with disabilities, including people living with HIV, deserve to live lives free from discrimination and irrational prejudice. DREDF opposes outdated laws that single out people for criminal penalties or enhanced criminal penalties based on their HIV-positive status. These laws violate the ADA and undermine public health. They should be repealed.

[1] 42 U.S.C. § 12131 et seq.

[2] 42 U.S.C. § 12132.

[3] See J. Kelly Strader, Criminalization as a Policy Response to a Public Health Crisis, 27 J. Marshall L. Rev. 435 (1994); Wendy E. Permet, AIDS and Quarantine: The Revival of an Archaic Doctrine, 14 Hofstra L. Rev. 53 (1985-1986).

[4] Centers for Disease Control and Prevention, Ways HIV is Not Transmitted, (April 21, 2021) available at https://www.cdc.gov/hiv/basics/hiv-transmission/not-transmitted.html (“[HIV] is not transmitted […] Through saliva, tears, or sweat”).

[5] Robert W. Eisinger, Carl W. Dieffenbach, Anthony S. Fauci, HIV Viral Load and Transmissibility of HIV Infection: Undetectable Equals Untransmittable, Journal of the American Medical Association (2019), available at https://jamanetwork.com/journals/jama/article-abstract/2720997; National Institute of Allergy and Infectious Disease, The Science Is Clear—With HIV, Undetectable Equals Untransmittable: NIH Officials Discuss Scientific Evidence and Principles Underlying the U=U Concept, (Jan. 10 2019), available at https://www.niaid.nih.gov/news-events/science-clear-hiv-undetectable-equals-untransmittable (“In recent years, an overwhelming body of clinical evidence has firmly established the HIV Undetectable = Untransmittable (U=U) concept as scientifically sound, say officials from the National Institutes of Health. U=U means that people living with HIV who achieve and maintain an undetectable viral load—the amount of HIV in the blood—by taking and adhering to antiretroviral therapy (ART) as prescribed cannot sexually transmit the virus to others.”); Alison J. Rodger, Valentina Cambiano, Tina Bruun, et al., Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy, JAMA. 2016;316(2):171-181. doi:10.1001/jama.2016.5148 (2016), available at https://jamanetwork.com/journals/jama/fullarticle/2533066; Roger Chou, Christopher Evans, Adam Hoverman, et al., Preexposure Prophylaxis for the Prevention of HIV Infection: Evidence Report and Systematic Review for the US Preventive Services Task Force, JAMA (2019), available at https://jamanetwork.com/journals/jama/fullarticle/2735508; Centers for Disease Control and Prevention, PrEP Effectiveness (May 13, 2021), available at https://www.cdc.gov/hiv/basics/prep/prep-effectiveness.html (“PrEP reduces the risk of getting HIV from sex by about 99% when taken as prescribed.”).

[6] Hasina Samji, et al., Closing the Gap: Increases in Life Expectancy among Treated HIV-Positive Individuals in the United States and Canada (December 18, 2013), PLOS ONE, available at https://doi.org/10.1371/journal.pone.0081355.

[7] Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention – Centers for Disease Control and Prevention, HIV Criminalization and Ending the HIV Epidemic in the U.S., available at https://www.cdc.gov/hiv/policies/law/criminalization-ehe.html (“After more than 30 years of HIV research and significant biomedical advancements to treat and prevent HIV, most HIV criminalization laws do not reflect current scientific and medical evidence.”).

[8] Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention – Centers for Disease Control and Prevention, HIV Criminalization and Ending the HIV Epidemic in the U.S., available at https://www.cdc.gov/hiv/policies/law/criminalization-ehe.html (“[HIV criminalization] laws have not increased disclosure and may discourage HIV testing, increase stigma against people with HIV, and exacerbate disparities.”); J. Stan Lehman et al., Prevalence and Public Health Implications of State Laws that Criminalize Potential HIV Exposure in the United States, AIDS Behav. 2014; 18(6): 997–1006., available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4019819/.

[9] Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention – Centers for Disease Control and Prevention, HIV and STD Criminalization Laws, available at https://www.cdc.gov/hiv/policies/law/states/exposure.html.

[10] See, e.g., MISS. CODE ANN. § 97-27-14(2); Ind. Code §§ 35-42-2-1, 35-45-16-2(c), 35-50-3-3; OHIO REV. CODE ANN. §§ 2921.38, 2929.14.; 18 PA. CONS. STAT. ANN. § 2703.

[11] See ALA. CODE § 22-11A-21; ARK. CODE ANN. § 5-14-123; Centers for Disease Control and Prevention, Ways HIV Can Be Transmitted, (April 21, 2021) available at https://www.cdc.gov/hiv/basics/hiv-transmission/ways-people-get-hiv.html (“[t]here is little to no risk of getting HIV” from oral sex); Julie Fox, Peter J. White, Jonathan Weber, et al., Quantifying Sexual Exposure to HIV Within an HIV-Serodiscordant Relationship: Development of an Algorithm, AIDS 2011, 25:1065–1082 at 1077 (2011).

[12] J. Stan Lehman et al., Prevalence and Public Health Implications of State Laws that Criminalize Potential HIV Exposure in the United States, AIDS Behav. 2014; 18(6): 997–1006., available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4019819/.