On World AIDS Day, we are asked to remember those before us and those amongst living with HIV/AIDS. The LGBT community in particular has a connection to this disease through the long and tenuous history of our community and its liberation movement. So many amongst us live with HIV and with its stigma; many others live in fear that one day they might. The HIV/AIDS crisis of the 80s and 90s scarred our community and many of our community leaders, activists and role models died in its wake.
From pill cocktails that required a burdensome regimen of 10 or more pills a day to sustain a few years of life living with the disease to a world w here a pill a day can prevent its transmission, the world has come a long way in our fight to end HIV/AIDS, but many of our laws surrounding it have not. In our modern world, with HIV preventatives like PrEP and the un-transmissible status of people who are undetectable, it’s hard to imagine how we coexist in a world that criminalizes HIV; an act that promotes stigma and may be a detriment to public health.
Recently, in the UK, hairdresser Daryll Howe was sentenced to years in jail for deliberately infecting several men with HIV. A disgusting act that sparked controversial conversations and whispers in many of my gay circles about what this means for the community as a whole and what happens now.
Cases like Daryll’s are egregious acts of violence filled with malicious intent that should be qualified as such, but they are the exception and not the rule. However, the public stigma and perception that represent gay men as wildly deviant predatory beings allow people see Daryll’s case as the norm and wish to address it as such. In the US, many states have HIV criminalization laws on the books that make it a criminal offense, not just for cases of intentional transmission, but also for not disclosing your positive status even if the person who raises the claim did not contract the virus from an encounter you had with them. These laws make it dangerously ambiguous about what it is it about HIV that we are punishing. Is it the weaponizing of HIV intentionally, failure to disclose, or simply being HIV positive? It seems the answer is all of the above.
No one is debating the benefit of and responsibility one should have in maintaining their own personal health, but criminalizing non-disclosure of HIV status creates a larger public health risk. By criminalizing the failure to disclose HIV status, these laws incentivize not knowing one’s status. This loophole operates on a troubling notion that “ignorance is bliss”. By exonerating those who are unaware of their status, these laws put the very same people they are purporting to protect at risk. If anything, we should be doing everything possible to incentivize people to know their HIV status, as almost all new infections occur when people do not know their status. People who know their HIV-positive status are more likely to be actively receiving treatment and, as such, remain dramatically less likely to transmit their infection than someone who is unaware of their status.
Putting the onus on people living with HIV to disclose to their status puts those living with the infection and its stigma in the precarious position of being solely responsible for preventing future transmission. It’s a practice that perpetuates stigma by codifying the notion that people who are living with HIV bear the sole responsibility for preventing transmission to their HIV-negative sex partners, which only increases stigma. It forces those living with HIV to entrust private information to their partners who, quite honestly, have done very little to earn that trust. Meanwhile, it raises the stakes for disclosure.
If there is a conversation about criminality and HIV that demands engagement with, it’s not about the disclosure or lack thereof of those living with the virus: it’s the ways we’ve failed to protect the lives and dignity of people living with it and the education of those who are not.
Public HIV knowledge and education is lacking – and that’s being kind. Real, science-based information about HIV is so underrepresented in our sexual health discussions that it could be considered criminal. The regressive policies and the stripping of funding from programs that make it easier for those living with HIV to get access to treatment are criminal. Martin Shkreli raising the price of an HIV medication by 750% is criminal. Mike Pence CREATING AN AIDS EPIDEMIC IN HIS HOME STATE OF INDIANA is criminal.
Living with HIV is not.
What’s also criminal about HIV criminalization laws is that these laws, like many others, disproportionately affect socio-demographic groups that are already discriminated against. Black gay men are the most at risk for HIV and are disproportionately more likely to be living with HIV, and these laws will unduly and unjustly impact them. As we, as a nation, begin to finally reckon with the reality that communities of color are over-policed, HIV criminalization should be a part of that conversation.
As a black gay man, I represent one of the groups most at risk for contracting HIV. It is appalling to me how little access and education about things like PrEP have been afforded to my community. I know gay men who said they have had to educate their own healthcare providers about the existence of Truvada, the pill approved by the FDA in 2012 for PrEP. I was fortunate to have friends who worked in the HIV field who informed me about the effectiveness of PrEP and how I could get it at reduced cost through the drug manufacturer. I had to find out through similar networks about the Center for Disease Control’s endorsement of the U=U consensus: that someone with HIV who is undetectable on medication (meaning that HIV is so suppressed by medication that it cannot be detected by blood tests) cannot transmit HIV to their HIV-negative sex partners.
HIV is a real issue. HIV can be scary. But don’t criminalize the infection and DEFINITELY don’t stigmatize the people living with it. Stigmatize its ignorance and shame the people who seek to perpetuate that ignorance.