The White House recently released a statement from President Trump voicing his administration’s commitment to ending HIV and urging more Americans to be tested for the disease. “On National HIV Testing Day, I encourage Americans to learn their HIV status. Together, we can protect ourselves and promote the health and safety of all,” the statement concluded.
If actions speak louder than words, it’s important to note that the statement was published following the abrupt resignation of six members of the Presidential Advisory Council on HIV/AIDS, who expressed their dismay over the Trump administration’s apathy toward combating the epidemic and criticized its lack of attention to what has long been a bipartisan priority.
To end the spread of HIV, Trump’s statement is true — we must get people tested, linked to health care, and treated. Thanks to breakthroughs in science and medical research, people infected with HIV can live longer and healthier lives than ever before. The world as a whole has made incredible progress in getting HIV medicines to the people who need them, with 18 million people around the world receiving treatment today. That’s close to half of all people living with the virus worldwide.
However, plenty of work remains if we are to end the AIDS epidemic. Nearly 40,000 people are newly infected with HIV every year in the United States, and only 40 percent of Americans living with the disease are able to access treatment. The statistics are even more troubling in some regions of the country, including the South and Southeast, and among racial and ethnic minorities.
Why aren’t more people getting tested and treated? While our country’s complex health care system is certainly part of the problem, we’re also being held back by harmful laws and policies that discourage people from getting tested, and so from getting the treatment they need.
More than 30 states have laws that can be used to prosecute people living with HIV. Some of these laws criminalize HIV transmission. That means individuals can be thrown into jail if they don’t disclose their status prior to sex, whether or not they transmit HIV. The legislation is aimed at vulnerable populations, such as people who use drugs or sex workers, all of whom have a higher risk of being infected with HIV. But it is counterproductive, because it actually heightens their risk of contracting the disease: Increased stigma leads to people not getting tested. That delays treatment, which reduces the likelihood of transmitting HIV to almost zero.
HIV criminalization isn’t limited to the United States. This month marks the five-year anniversary of a groundbreaking report on HIV criminalization published by the Global Commission on HIV and the Law — a group comprised of former heads of state along with legal, HIV, and human rights experts from the U.S. and around the world. In its report, the commission analyzed how laws and policies are hindering the global AIDS response and urged countries to reform legislation and protect the rights of people living with HIV.
In the last five years, countries ranging from Kenya and Panama to the Seychelles have taken steps to reverse HIV criminalization laws and discriminatory practices. Sadly, not much has changed in the United States, with many states’ criminalization laws still in place from decades ago.
Most HIV criminalization laws in the United States were passed in the 1980s and early 1990s, when fear swept the nation about a deadly disease that we did not understand. Although science has since moved forward dramatically, these archaic laws — which were never helpful in protecting the public — are still being used to prosecute people today.
Take the case of Michael Johnson. The 23-year-old Missouri man was sentenced to spend 30 years in prison for not disclosing his HIV status and allegedly transmitting HIV. His conviction was eventually overturned on appeal and he is now awaiting a new trial.
People with HIV can be prosecuted for having protected, consensual sex with their partners, even when they are taking antiretroviral treatments and are not infectious. HIV-positive sex workers can be charged under HIV criminalization laws, regardless of whether the interaction results in sex. Some people have even faced criminal charges for spitting, despite the fact that HIV is not transmitted through saliva.
While these laws are relics of the past, they continue to perpetuate stigma against people with HIV, singling them out from other infectious diseases. There is no reason to treat people with HIV differently — yet they continue to be condemned in ways that others who have infectious diseases like herpes or gonorrhea are not.
These discriminatory laws discourage individuals from being tested for HIV, in part because only those who know that they are HIV-positive can face criminal charges for being so. But without knowing their status, people can’t be treated for the disease. This is harmful not only to the infected individuals, but it also makes them more likely to infect others.
Some states have made progress. Iowa repealed laws in 2014 and California has reduced the severity of its criminalization laws. However, the process has been slow due to legislative gridlock in many states. Repealing or reforming these antiquated and harmful laws requires the same kind of bipartisan support and collaboration that allowed the Republican and Democratic leadership to create visionary HIV programs like the Ryan White CARE Act and the President’s Emergency Plan for AIDS Relief (PEPFAR). We have come together before to address HIV as a nation and a global community and we need to do so again.
To help end the AIDS epidemic, the Trump administration should pass federal legislation that protects the rights of people with HIV and support states as they do the same. Exhortations for people to get tested need to be accompanied by laws and policies that encourage testing and treatment in safety and dignity.
Chris Beyrer, M.D., is professor of epidemiology; international health; and health, behavior, and society at the Johns Hopkins Bloomberg School of Public Health. He was previously the president of the International AIDS Society and a member of the Technical Advisory Group for the Global Commission on HIV and the Law.
