Two-thirds of US gay
men believe that it should be illegal for an HIV-positive man to have
unprotected anal sex without disclosure, investigators report in the October
edition of AIDS Care.
“Believing that it
should be illegal was associated with HIV-negative or unknown status, less
education, having a non-gay sexual orientation, living in a state that was
perceived as hostile towards GLBT persons, reporting fewer UAI [unprotected
anal intercourse] partners…and feeling greater responsibility”, write the authors.
Since 2008, at least
30 individuals in the US have been prosecuted for exposing others to HIV.
Penalties vary between states and range from a small fine to a lengthy prison
sentence. The impact of such laws on HIV prevention efforts are hotly debated.
Moreover, there is uncertainty about the attitudes of the communities most
affected by HIV about the criminalisation of HIV exposure.
Gay and other men who
have sex with men remain the group most affected by HIV in the US. In 2008 investigators
therefore used gay social websites to recruit 1725 to a study designed to:
Overall, 65% of men
believed that it should be illegal for HIV-positive individuals to have
unprotected sex without disclosure, 23% thought it should not be illegal and
12% did not know.
criminalisation was highest (79%)
among men aged between 18 and 20, and lowest (56%) among those aged 41 to 70.
The investigators note that younger gay men were significantly less likely to
have been tested for HIV. Separate research has shown that untested men are
more likely to adopt a disclosure-based HIV prevention strategy “that gains
credibility by transmission laws.”
majority (70%) of HIV-negative and untested men (69%) supported legal
sanctions, but only 38% of HIV-positive men endorsed criminalisation. “These differences
most likely reflect a shift in orientation toward criminal statues on HIV
transmission following seroconversion”, comment the investigators.
Men with the lowest
educational achievements were most likely to support criminalisation (75%), and
those with a degree least likely (58%).
Over three-quarters of
men who did not identify as gay or bisexual supported criminalisation compared
to 63% of those who had some form of gay identity.
In addition, those who
were least comfortable with their sexual orientation were most likely to
Living in a state
which was perceived to be hostile to gay, bisexual, lesbian and transgender
people was also associated with support for criminalisation.
Sexual behaviour was
also significant. Men who reported two or more episodes of unprotected anal sex
within the previous three months were least likely to support criminalisation
(52%), and those who reported no unprotected sex the most likely (69%).
investigators found that a sense of responsibility was associated with support
showed that men who were HIV-positive were less likely to support
criminalisation (OR, 0.33; 95% CI, 0.24-0.44), as were those with a higher
degree (OR, 0.42; 95% CI, 0.27-0.64). Living in a state that was perceived to
be more accepting of homosexuality was also associated with less support for
criminalisation (OR, 0.75; 95% CI, 0.59-0.96), as was having had a greater
number of episodes of unprotected anal sex (OR, 0.72; 95% CI, 0.56-0.93) and a
lower feeling of responsibility towards the sexual health of sex partners (OR,
0.75; 95% CI, 0.69-0.81).
Conversely, men who
did not identify as gay or bisexual were 54% more likely to support
criminalisation (OR, 1.54; 95% CI, 1.08-2.02).
found no evidence that laws deterred high-risk sexual behaviour. However they
conclude “further research is needed to examine whether they act as a barrier
for MSM [men who have sex with men] at highest risk for acquiring or
Research carried out among MSM in England and Wales in 2006 found a strong relationship between the expectation that a man should disclose his HIV status to prospective sexual partners and support for criminal prosecution of HIV transmission. The authors of that study, conducted by SIGMA Research at the University of Portsmouth, concluded that the practice of prosecuting transmission worked to reinforce the expectation that men would disclose, thereby impeding any HIV prevention efforts that seek to educate men against making assumptions about HIV status on the basis of a lack of disclosure.