Theory, Analysis, Social Justice, and Criminalizing HIV Transmission: A Commentary on Lehman and Colleagues (2014)

Finitsis, David J.; Stall, Ronald D.; Friedman, Samuel R.

doi:10.1007/s10461-014-0725-z

Cited by 6 publications

(3 citation statements)

References 23 publications

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“…2 For example, the CDC reports that a majority of US states have laws that require people with HIV to disclose their HIV status to sex partners and that all states have assault and reckless endangerment statutes that can and have been used to criminally prosecute people living with HIV for not disclosing their HIV status. 3 While HIV status disclosure laws are criticized and raise issues of social justice, 4 the question remains open as to whether HIV disclosure laws represent sound public health policy. Mathematical modeling shows that increases in HIV status disclosure to sex partners of infected individuals may reduce HIV transmission risks by as much as 40-60%.…”

Section: Introductionmentioning

confidence: 99%

HIV Disclosure and Transmission Risks to Sex Partners Among HIV-Positive Men

Kalichman

Cherry

et al. 2016

AIDS Patient Care and STDs

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Disclosure of HIV-positive status to sex partners is critical to protecting uninfected partners. In addition, people living with HIV often risk criminal prosecution when they do not inform sex partners of their HIV status. The current study examined factors associated with nondisclosure of HIV status by men living with HIV in Atlanta, GA (92% African African, mean age = 43.8), who engage in condomless sex with uninfected sex partners. Sexually active HIV-positive men (N = 538) completed daily electronic sexual behavior assessments over the course of 28 days and completed computerized interviews, drug testing, medication adherence assessments, and HIV viral load retrieved from medical records. Results showed that 166 (30%) men had engaged in condomless vaginal or anal intercourse with an HIV-uninfected or unknown HIV status sex partner to whom they had not disclosed their HIV status. Men who engaged in nondisclosed condomless sex were less adherent to their HIV treatment, more likely to have unsuppressed HIV, demonstrated poorer disclosure self-efficacy, enacted fewer risk reduction communication skills, and held more beliefs that people with HIV are less infectious when treated with antiretroviral therapy. We conclude that undisclosed HIV status is common and related to condomless sex with uninfected partners. Men who engage in nondisclosed condomless sex may also be more infectious given their nonadherence and viral load. Interventions are needed in HIV treatment as prevention contexts that attend to disclosure laws and enhance disclosure self-efficacy, improve risk reduction communication skills, and increase understanding of HIV infectiousness.

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Section: Introductionmentioning

confidence: 99%

HIV Disclosure and Transmission Risks to Sex Partners Among HIV-Positive Men

Kalichman

Cherry

et al. 2016

AIDS Patient Care and STDs

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“… 12 With respect to the analyses of HIV genetic data to infer transmission patterns, the stakes are higher as 33 states in the US have laws that criminalize the transmission of HIV. 13 , 14 Identification of an individual in an HIV transmission network could suggest, although not prove, high risk behaviour such as sharing needles or sex with a large number of partners. Though these data do not exclude the presence of one or more un-sampled infected individuals in the transmission chain, genetic similarities between infections may be misinterpreted as evidence of direct contact with other individuals.…”

Section: Introductionmentioning

confidence: 99%

Perceptions of Molecular Epidemiology Studies of Hiv among Stakeholders

Schairer

Mehta

Vinterbo

et al. 2017

Journal of Public Health Research

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Background: Advances in viral sequence analysis make it possible to track the spread of infectious pathogens, such as HIV, within a population. When used to study HIV, these analyses (i.e., molecular epidemiology) potentially allow inference of the identity of individual research subjects. Current privacy standards are likely insufficient for this type of public health research. To address this challenge, it will be important to understand how stakeholders feel about the benefits and risks of such research.Design and Methods: To better understand perceived benefits and risks of these research methods, in-depth qualitative interviews were conducted with HIV-infected individuals, individuals at high-risk for contracting HIV, and professionals in HIV care and prevention. To gather additional perspectives, attendees to a public lecture on molecular epidemiology were asked to complete an informal questionnaire.Results: Among those interviewed and polled, there was near unanimous support for using molecular epidemiology to study HIV. Questionnaires showed strong agreement about benefits of molecular epidemiology, but diverse attitudes regarding risks. Interviewees acknowledged several risks, including privacy breaches and provocation of anti-gay sentiment. The interviews also demonstrated a possibility that misunderstandings about molecular epidemiology may affect how risks and benefits are evaluated.Conclusions: While nearly all study participants agree that the benefits of HIV molecular epidemiology outweigh the risks, concerns about privacy must be addressed to ensure continued trust in research institutions and willingness to participate in research.Significance for public healthWhen molecular epidemiology is used to study HIV, it can demonstrate how HIV infections are related and how to target prevention efforts. Applying these analyses for maximal benefit in the fight against HIV would almost certainly make individuals whose data are analyzed vulnerable to discovery. However, absolute protection of this sensitive information would require that research into these methods not be done. The success of HIV molecular epidemiology will depend on finding a balance between public health and the interests of individuals living with HIV. The stakeholders interviewed in this study agreed that molecular epidemiology should be used to study HIV epidemics and transmission despite risks to privacy. However, these interviews also highlighted the difficulty of understanding molecular epidemiology and its privacy implications. For HIV molecular epidemiology to continue, privacy protections must go beyond simply masking traditional identifiers and assuming participants are informed enough to consent to the risks.

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“…A particularly promising theoretical inquiry would be to apply theories on the functioning of complex systems in order to better understand the contexts in which U.S. HIV exposure laws are enacted and sustained (56). In a recent commentary, Finitsis et al suggests using multi-level theoretical frameworks such as syndemics theory (57) and cultural-historical activity theory (58) to investigate the impact of criminalization of HIV exposure on HIV risk behaviors by exploring relationships between individual behavioral factors, social and community context, and HIV exposure laws as a structural variable (56). Additionally, the traditional Information-Motivation-Behavior (IMB) model (59) could provide a useful theoretical framework for future studies of the influence of HIV exposure laws on HIV-related behaviors along the steps of the HIV care continuum.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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This review of literature identifies and describes U.S. 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.

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Theory, Analysis, Social Justice, and Criminalizing HIV Transmission: A Commentary on Lehman and Colleagues (2014)

Cited by 6 publications

References 23 publications

HIV Disclosure and Transmission Risks to Sex Partners Among HIV-Positive Men

HIV Disclosure and Transmission Risks to Sex Partners Among HIV-Positive Men

Perceptions of Molecular Epidemiology Studies of Hiv among Stakeholders

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

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