The problem of ‘significant risk’: Exploring the public health impact of criminalizing HIV non-disclosure

Emphasizes that the concept of significant risk undermines communication about transmission risk during HIV counselling and contributes to contradictory advice about disclosure obligations. Criminalization discourages openness about HIV non-disclosure in counselling relationships. The recontextualization of public health interpretations of significant risk in criminal proceedings can intensify criminalization.

Keeping Confidence: HIV and the criminal law from service provider perspectives

Based on discussions with 75 service providers, this study found that criminalisation has influenced, and sometimes disrupted provision of HIV services, creating ambivalence and concern among many providers about their new role as providers of legal information. Service providers’ approach were influenced by their personal views on shared responsibility for health, concerns about professional liability and their degree of trust in non-coercive approaches to managing public health.

Controlling Sex in the Name of “Public Health”: Social Control and Michigan HIV Law

Found that local health officials’ interpretation of ‘health threat’ and understanding of the law varied. Indicates how public health institutions themselves may contribute to and facilitate enforcement of Michigan’s problematic HIV disclosure law. Shows that stigma and fear often drive community members to police HIV-positive neighbours’ disclosure practices.

Counselling anomie: Clashing governmentalities of HIV criminalisation and prevention

Found that HIV criminalisation is rendering disclosure counselling difficult and potentially compromising trust between healthcare workers and patients. Counsellors’ understanding of the up-to-date science of HIV transmission risk also conflicts with the need to inform clients to disclose before any kind of sex to avoid prosecution – even when condoms are used or they have a low viral load. The study concludes that it is not only difficult for counsellors to determine when to discuss legal obligations during the counselling process, but exactly how to discuss them without undermining therapeutic relationships.

Discussing the Limits of Confidentiality: The Impact of Criminalizing HIV Nondisclosure on Public Health Nurses’ Counselling

Found HIV criminalisation negatively impacts nursing practice as public health nurses endeavour to control information about the limits of confidentiality at the outset of HIV post-test counselling. Individual practice varies as nurses pragmatically balance ethical and professional concerns. Some intentionally withhold information about the risk of subpoena, while others talk to clients about confidentiality in ways that focus on the risk of harm associated with criminalisation.

Examining public health nurses’ documentary practices: the impact of criminalizing HIV non-disclosure on inscription styles

Found that public health nurses’ anticipation that medical and public health records could be used as evidence in court is affecting public health nurses’ reasoning and documentary practices during HIV post-test counselling. Nurses have real concerns that notes will be misinterpreted and given a legal significance contrary to their original purpose, and fear their professional competence could be attacked. Traditional counselling practices prioritising client care and risk reduction are in conflict with HIV criminalisation.

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.

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.

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.