Despite the fact that HIV is now a treatable medical condition, the majority of U.S. states still have laws on the books that criminalize exposing other people to HIV. Whether or not the virus is transmitted does not matter. Neither does a person’s intention to cause harm. A person simply must be aware of being HIV-positive to be found guilty.
In 1981, the U.S. Centers for Disease Control and Prevention reported the first cases of what later would be called acquired immune deficiency syndrome, or AIDS. By 1982, researchers had strong evidence the disease could be transmitted through blood and sexual activity. At the time, the death rate for AIDS patients was estimated to be 65%.
Operators at the National AIDS Hotline run by the American Social Health Association in 1991.AP Photo/Karen Tam
In 1994, AIDS was the leading cause of death for all Americans ages 25 to 44. Medical treatment for the disease was in its infancy. Both factors fueled the public’s fear of being exposed to AIDS. A diagnosis seemed like a death sentence.
Criminal laws
The 1988, Ronald Reagan’s Presidential Commission on the HIV Epidemic recommended that states establish criminal penalties as a way of deterring people with HIV from engaging in behavior likely to transmit the virus. The 1990 Ryan White CARE Act, which provided major funding for HIV services, required states to certify they had adequate laws in place to prosecute individuals who knowingly exposed another person to HIV.
Indeed, HIV criminal laws have backfired from a public health perspective. A 2017 study found people living in states with HIV criminal laws are less likely to get tested and know their HIV status than those in states without HIV laws. Stigma and fear of prosecution discourage people from seeking information or help.
Minnesota AIDS Project banner at the Twin Cities Pride Parade in Minneapolis in 2013.Tony Webster/flickr, CC BY
This lack of knowledge is significant because pharmaceutical treatments, beginning in 1996 with highly active antiretroviral therapy, or HAART, have steadily transformed HIV into a chronic manageable condition.
Being arrested for an HIV-related crime is often devastating for individuals – beginning with the permanent exposure of personal health information to the public. For indigent defendants, felony charges pursued by a county’s district attorney will result in the appointment of a public defender, who will most likely counsel a guilty plea – regardless of whether the individuals believe they are guilty or even understand the consequences of such a plea.
Scientists can identify solutions to public health challenges, but it takes action by politicians to turn solutions into policy. HIV criminal laws are largely ignored because the people they directly affect are not connected to political power.
Bipartisan support is needed to replace existing laws with proven public health interventions.
