How HIV Criminalisation Undermines the HIV Response

Drives people from healthcare, including testing

There have been many anecdotal reports that publicity about HIV criminalisation drives people away from health care services. The studies listed below confirm those reports, showing that HIV-prosecutions increase a sense of state surveillance and undermine the therapeutic relationship healthcare providers depend on to facilitate frank discussion about risk taking behaviours. (For the effects of HIV criminalisation on service provision, see Makes prevention & healthcare more difficult.)

Prosecution of non-disclosure of HIV status: Potential impact on HIV testing and transmission among HIV-negative men who have sex with men

Aims to quantify the potential impact of non-disclosure prosecutions on HIV testing and transmission among MSM. Found that fear of prosecution over HIV non-disclosure was reported to reduce HIV testing willingness by a minority of HIV-negative MSM in Toronto; however, this reduction had the potential to significantly increase HIV transmission at the community level which has important public health implications.

HIV criminal prosecutions and public health: an examination of the empirical research

Concludes that HIV-related criminal laws either fail to influence or increase STI testing avoidance, unprotected anonymous sexual contacts, and avoidance of health care because respondents do not feel safe speaking with health professionals. Suggests HIV-related criminal laws compromise public health and clinicians’ abilities to establish therapeutic relationships and to undertake HIV prevention and treatment work.

Criminal law and HIV testing: empirical analysis of how at-risk individuals respond to the law

Found that people at high risk of HIV living in states with HIV-specific statutes were no more or less likely to report HIV testing. However, HIV testing decreased following media coverage of HIV cases. The application of criminal laws had a negative impact on HIV testing rates among those most at risk of HIV infection, adversely affecting public health.

Nondisclosure Prosecutions and Population Health Outcomes: Examining HIV Testing, HIV Diagnoses, and the Attitudes of Men Who Have Sex with Men Following Nondisclosure

Found that HIV testing and HIV diagnoses among men who have sex with men did not significantly statistically change after media releases about a local nondisclosure prosecution. However, some MSM expressed their belief that the local public health department openly shares information with police. Some HIV-positive participants perceived an association between local public health and police services which caused them to not access public health services.

Nondisclosure prosecutions and HIV prevention: Results from an Ottawa-based gay men’s sex survey

Details the relationships between nondisclosure prosecutions and STI/HIV testing practices. Only a minority of survey participants reported that HIV criminal prosecutions affected their willingness to get tested for HIV, or made them afraid to speak with nurses and physicians about their sexual practices. However, that group may also be at higher risk of HIV infection, reporting higher rates of unprotected penetrative anal intercourse and internal ejaculation with (on average) a higher number of different sexual partners within the previous two months. This same group also reported less STI/HIV testing and a preference for anonymous HIV testing.

The impact of criminalization of HIV non-disclosure on the healthcare engagement of women living with HIV in Canada: A comprehensive review of the evidence

Concludes that HIV-related criminal laws either fail to influence or increase STI testing avoidance, unprotected anonymous sexual contacts, and avoidance of health care because respondents do not feel safe speaking with health professionals. Suggests HIV-related criminal laws compromise public health and clinicians’ abilities to establish therapeutic relationships and to undertake HIV prevention and treatment work.