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Science Policy Around the Web – June 29, 2018

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By: Patrick Wright, Ph.D

 

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source: pixabay

Exposure Laws

Laws That Criminalize Spread of Infectious Diseases Can Increase Their Stigma

In most states, it is a crime to knowingly expose others to HIV and other infectious diseases. Many of these laws were passed in the 1980s and 1990s during the onset of the HIV era, when no effective treatments were available and fear and stigma surrounding the disease were at their highest. According to the CDC, there were 67 HIV-specific criminal laws in 33 states as of 2011. Many of these laws even turn biting or spitting, despite saliva not being a means of HIV transmission, into felony aggravated assault or attempted murder. Early in 2018, an Ohio man living with hepatitis C (HCV) reportedly spit saliva (mixed with blood) repeatedly at police and emergency medical technicians on scene to transport him to a hospital; he was sentenced to 18 months in prison last week. While it is crucial that there be laws in place to protect the public from malicious attempts at harm, it is possible these laws are contributing to stigmas already faced by individuals living with these diseases. These laws may not even by effective at stopping spread of disease. Regarding the sentenced man in Ohio, Kate Boulton, a staff attorney at the Center for HIV Law and Policy, noted “This person is now facing a year and a half of incarceration for something that didn’t harm anyone and didn’t pose a risk of harm to anyone”, emphasizing that HCV is not transmitted through saliva and requires substantial volumes of blood for there to be a transmission risk when exposed to the eye.

These exposure laws have been in a constant state of flux and revision, with some states reducing penalty and others outlining stricter and harsher approaches. In 1998, Iowa passed a law that stated individuals found guilty of knowingly exposing others to HIV faced up to 25 years in prison and had to register as sex offenders; this even applied even if safe sex practices were used and no one became infected. As a means to reduce HIV-associated stigma and reduce these punishments, advocates successfully pushed for that law to be replaced with a new one that both reduced penalties and also added hepatitis, meningococcal disease, and tuberculosis to the list of prosecutable exposure offenses so HIV was not singled out. However, this has the potentially negative effect of criminalizing exposures by people with diseases in addition to HIV. South Dakota Senate Bill No. 93 passed this year states that any person with a venereal disease (syphilis, gonorrhea, chancroid) who intentionally exposes another person to infection of that venereal disease is guilty of a Class 1 misdemeanor. It also states that any person who deliberately exposes another person to HCV infection (e.g. through blood or tissue donation, exchanging nonsterile intravenous/intramuscular drug paraphernalia) is guilty of a Class 3 felony. Just last year, California lawmakers voted to reform several criminal statues (S.B No. 239) that targeted people living with HIV. It reduced the penalty for HIV status non-disclosure from a felony charge punishable by up to eight years of imprisonment down to a misdemeanor with only six months of incarceration. Moreover, the new provisions now require an actual transmission to occur or for prosecutors to demonstrate that a defendant had intent to transmit HIV. It also recognizes that certain risk reduction measures (e.g. being on an HIV treatment regimen, safe sex practices) negate intent.

However, the negative consequences of these laws can be profound and far-reaching. Dr. Anne Spaulding, M.D., MPH is an Associate Professor in the Department of Epidemiology in the Rollins School of Public Health at Emory University noted “If you have to let people know that you are infected with HIV or hepatitis C before you have sex with them, why would anyone in their right mind get themselves tested and begin treatment?” commenting on the disclosure of disease status and possible criminal charges potentially discouraging individuals from getting tested in the first place. According to the Center for HIV Law and Policy, “HIV-related testing…can be the basis of criminal prosecution for those who are sexually active. The potential negative consequences of HIV testing at a particular time or location might inform an individual’s decision of whether or when to get tested for HIV; or whether to test anonymously or through a “confidential” testing process that reports their test results and identifying information to the state but maintains the confidentiality of those results.”. Kesler and colleagues recently estimated that 7% of their 124-person HIV at-risk cohort were less likely to get test for HIV due to concern over future prosecution, and this 7% reduction in testing could lead to an 18.5% increase in community in HIV transmission, 73% of which would be driven by the failure of undiagnosed HIV+ individuals to access treatment that would substantially reduce transmission risk. States have been unable to converge on an ideal solution to both address the criminal actions of infected individuals with malevolent intent while protecting those with no malice who are burdened with living with these diseases.

(Michelle Andrews, NPR)

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Written by sciencepolicyforall

June 29, 2018 at 10:42 pm

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