Published March, 2018
Prosecution of non-disclosure of HIV status: Potential impact on HIV testing and transmission among HIV-negative men who have sex with men, Maya Kesler et al, PloS One (2018)
Advocacy for HIV criminal law reform often emphasizes that such laws may deter HIV testing and weaken the public health response to HIV. However, there has been limited evidence to support the relationship between HIV criminal laws and decreased HIV testing. Research in this study on men who have sex with men (MSM) in Toronto, Canada showed that about 7% of HIV-negative participants were less likely to get tested due to fear of prosecution. Participants were provided brief background information on the existence of HIV criminal prosecutions in Ontario, Canada, and then asked whether fear of prosecution would make them more or less likely to get an HIV test.
While it may seem like a small proportion, the study demonstrated that a 7% decrease in HIV testing could increase overall HIV transmission potential by 18.5%. The findings suggest that even a minor decrease in testing due to fear of prosecution can have potentially significant population-level effects on transmission.
The researchers note the importance of individuals who are HIV-positive but not yet aware of their status as a significant driver of transmission, particularly in light of the role of ART as a preventative tool. The study has various limitations, including a geographically limited sample (Toronto, Canada) and reliance on mathematical modeling that may not identify all the possible variables that affect willingness to disclose serostatus and testing behaviors. Moreover, other research has suggested that relatively few people are aware of HIV criminal laws, meaning fear of prosecution would not be something that influences the decision to get tested one way or the other.
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