I am not an expert on HIV/AIDS. But there are related stories that come across my desktop. This diary is a sad attempt at pasting some of those stories together. I apologize in advance for the disconnectedness.
So what starts out as a discussion of the results of a survey will morph into the criminalization of of people who are HIV+ and then emerge in the need to reauthorize the Ryan White CARE Act.
In May findings of the National HIV Criminalization Survey, a product of the Sero Project, were presented at the National Transgender Health Summit.
The survey discovered that 58% of transgender or gender nonconforming people feel it is reasonable to avoid HIV testing, 61% thought it was reasonable to avoid disclosing one's status to sex partners, and 48% thought it was reasonable to avoid accessing HIV treatment, all because of fear of HIV criminalization and/or distrust of the US criminal justice system.
These findings don’t surprise us. The data speaks to the long-standing history of stigmatization and discrimination of trans people, especially trans people of color, by the criminal justice system, because of either their race or their gender identity.
Criminalization of a disease may not be something most Americans think about, choosing to believe that it is something we find only in Africa. You can read more about that at HIV and the Law. But the truth of the matter is that criminal laws against HIV transmission that exist across the US are selectively enforced. Such laws allow for prosecution of people who do not disclose their HIV status, even if they did not know what it was at the time of sexual intercourse and transmission risk is minimal or non-existent.
More than 3000 people living with HIV participated in the survey, which was conducted online by Eastern Michigan University from June to August 2012. The senior researcher was Laurel Sprague, who was also a PhD candidate at Wayne State University.
Laws that criminalize non-disclosure of HIV status raise key issues about community norms, expectations of fair treatment by authorities, privacy and the increased vulnerability of certain communities.
Nearly 25% of HIV-positive respondents said they knew one or more people who did not get tested because they feared criminal prosecution.
While the results revealing that HIV criminalization discourages HIV testing were not surprising, the analysis of transgender/gender nonconforming respondents revealed that those respondents "faced increased levels of vulnerability in relation to the U.S. justice system."
The majority (57%) of HIV+ gender-variant respondennts feared false accusations of nondisclosure, whereas only 14% of them felt an American HIV+ person could get a fair hearing if accused of non-disclosure.
When transgender and third sex respondents were asked their opinions about HIV criminalization, two out of three respondents (67%) said that non-disclosure of HIV status should not be criminalized. When asked if a sex worker living with HIV should disclose to clients, most transgender and third sex respondents (41%) said it depends on the circumstances. In fact, transgender and third sex respondents were the most likely to focus on the context (“it depends on the circumstances”) when determining whether there should be criminal charges for non-disclosure related to sex, drug use or sex work.
Sprague shared some quotes:
In order to file charges, I [would have] had to disclose my rape, my [HIV] status and I would have to give up my privacy and be subjected to public scrutiny.
--a transwoman, explaining why she didn't press charges for nondisclosure
I think in cases of rape, incest and other power- or force-related situations, prosecutions should go forward. Otherwise, NO!
--a genderqueer respondent
Another trans woman said that she didn’t press charges for non-disclosure because of the “difficulty in proving in court that he had infected me—and also accepting that we took equal risk in being intimate without protection.”
The responses highlight a critical need for access to legal education and legal services, safe and confidential locations for accessing health care, and support for spaces where transgender people living with HIV can share their experiences, provide mutual support, and work together to identify resilience strategies and advocacy priorities.
Transgender communities are at the highest risk of HIV prevalence in the United States. The HIV epidemic among transpeople is contributed to by the high incidences of homelessness, unemployment, attempted suicide, violence, stigma, and limited access to health care. The infection rate for transwomen was 2.6% in 2009, as compared to 0.6% of the general population. A more current figure is that transgender women are 49 times more likely to be HIV compared to other populations.
Transgender women are the fastest-growing population of HIV-positive people in the country.
Transgender women have been contracting HIV since the beginning of the epidemic, but the data collection has not always allowed for capturing gender identity and more often than not transgender women were lumped in with MSM or men who have sex with men. Additionally, there has been very little specific outreach, prevention strategies, or public education specifically for transgender women or gay and bisexual transgender men. What may be occurring is more accurate data collection and a growing awareness of the need for services and prevention efforts targeted for transgender women and also for transgender men.
--Gunner Scott, director of programing at Pride Foundation
The Ryan White program, enacted in 1990, has been amended and reauthorized by Congress in 1996, 2000, 2006, and 2009. The current authorization is set to expire on September 30, 2013. There is speculation that it may not be reauthorized in lieu of the Affordable Care Act. That could be devastating to people living with HIV/AIDS. The argument in favor of reauthorization is made here.