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Criminalization of HIV Exposure: A Review of Empirical Studies in the United States

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Abstract

This review of literature identifies and describes US empirical studies on the criminalization of HIV exposure, examines findings on key questions about these laws, highlights knowledge gaps, and sets a course for future research. Studies published between 1990 and 2014 were identified through key word searches of relevant electronic databases and discussions with experts. Twenty-five empirical studies were identified. Sixteen of these studies used quantitative methods with more than half of these being cross-sectional survey studies. Study samples included male and female HIV-positive persons, HIV-positive and -negative men who have sex with men, public health personnel, and medical providers. Research questions addressed awareness of and attitudes toward HIV exposure laws, potential influences of these laws on seropositive status disclosure for persons living with HIV, HIV testing for HIV-negative persons, safer sex practices for both groups, and associations between HIV exposure laws and HIV-related stigma. Surveys of the laws and studies of enforcement practices were also conducted. Attention should be shifted from examining attitudes about these laws to exploring their potential influence on public health practices and behaviors related to the HIV continuum of care. Studies examining enforcement and prosecution practices are also needed. Adapting a theoretical framework in future research may be useful in better understanding the influence of HIV exposure laws on HIV risk behaviors.

Resumen

Esta revisión de la literatura identifica y describe los estudios empíricos sobre la penalización de la exposición al VIH en los Estados Unidos, analiza los resultados de los estudios sobre cuestiones claves en cuanto a estas leyes, pone de relieve las lagunas del conocimiento sobre el tema y establece un curso para futuras investigaciones. A través de palabras clave en bases de datos electrónicas y de la consulta con expertos, se localizaron los estudios publicados entre 1990 y el 2014. Se identificaron 25 estudios empíricos. Dieciséis de estos estudios utilizaron métodos cuantitativos y más de la mitad encuestas transversales. Las muestras incluyeron hombres y mujeres VIH-positivos y negativos, hombres que tienen sexo con hombres, personal de salud pública y proveedores de servicios médicos. Las investigaciones se centraron en el conocimiento y las actitudes hacia las leyes de exposición al VIH, la posible influencia de las leyes sobre la comunicación del estatus seropositivo por parte de las personas que viven con VIH, el acceso a la prueba de VIH entre las personas VIH-negativas, las prácticas sexuales seguras para ambos grupos y la relación entre las leyes de exposición al VIH y el estigma asociado con el VIH. También se realizaron encuestas sobre las leyes y estudios sobre las prácticas de su aplicación. El énfasis debe cambiar de las actitudes acerca de las leyes, a explorar su posible influencia sobre las prácticas de salud pública y los comportamientos relacionados con el continuo de atención del VIH. También se necesitan estudios que examinen las prácticas en cuanto al cumplimiento de las leyes y enjuiciamiento. En la investigación futura, adaptar un marco teórico puede ser útil para entender mejor la influencia de las leyes de exposición al VIH sobre las conductas de riesgo de VIH.

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Acknowledgments

This study was supported by the National Institute of Mental Health under Award Number P30MH062294 (PI: Cleary). The authors are part of the Criminalization of HIV Exposure Work Group hosted by Center for Interdisciplinary Research on AIDS at Yale University, which includes a broad range of academics, public health and law enforcement experts, and advocates from multiple institutions. The authors wish to thank Stephen Latham and members of the work group for helpful commentary on an earlier draft of this manuscript. The authors would also like to thank Laura Glasman for her assistance with translating the study abstract into Spanish. The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the Center for Interdisciplinary Research on AIDS or the National Institute of Mental Health.

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Authors and Affiliations

  1. Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 200, New Haven, CT, 06510, USA

    Dini Harsono & Elaine O’Keefe

  2. Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 North Summit Avenue, Milwaukee, WI, 53202, USA

    Carol L. Galletly

  3. Department of Community Medicine and Health Care, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030, USA

    Zita Lazzarini

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  1. Dini Harsono
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  2. Carol L. Galletly
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  3. Elaine O’Keefe
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  4. Zita Lazzarini
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Correspondence to Dini Harsono.

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Funding

This study was supported by the National Institute of Mental Health under Award Number P30MH062294 (PI: Cleary).

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The authors declare that they have no conflict of interest.

Ethical approval

The manuscript is a literature review and while it does meet the Code of Federal Regulations’ (CFR) definition of “research”, it does not involve human subjects and 45 CFR part 46 does not apply [62].

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Because the manuscript is a literature review and does not involve human subjects, the requirements related to consent also do not apply (45 CFR part 46.116) [63].

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Harsono, D., Galletly, C.L., O’Keefe, E. et al. Criminalization of HIV Exposure: A Review of Empirical Studies in the United States. AIDS Behav 21, 27–50 (2017). https://doi.org/10.1007/s10461-016-1540-5

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