Do Criminal Laws Effect HIV Risk Behavior? An Empirical Trial

Abstract

BACKGROUND: All states have criminal laws that can punish sexual behaviors that pose some risk of HIV transmission and most have HIV-specific laws criminalizing sexual contact by people with HIV unless they abstain from unsafe sex, or disclose their HIV status and obtain consent from their partners. Whether these laws influence behavior is not known. Illinois and New York exhibit contrasting legal conditions. Illinois has an HIV-specific law explicitly requiring disclosure by HIV+ persons. New York has no HIV-specific law. This study tests the null hypothesis that differences in law and beliefs about the law do not influence condom use in anal or vaginal sex.

METHODS: 490 participants were interviewed in 2002 (248 in Chicago; 242 in New York City). Approximately half in each state were MSM and half were IDUs (men and women). Respondents were classified as MSM if they reported ever having had sex with a man, and as IDUs if they reported having injected drugs at least twice in the last three months. 162 subjects reported known HIV infection (Chicago 58; New York City 104). 328 reported being HIV negative or not knowing their HIV status. Indicators of the law were 1) residence in the state, and 2) belief that it is a crime for a person with HIV to have sex with another person without disclosing his or her serostatus. Using stepwise logistic regression, we examined independent predictors of unprotected sex adjusting for factors including age, race/ethnicity, disclosure, biological sex at birth, sexual orientation and numbers of partners.

RESULTS: People who lived in a state with a criminal law explicitly regulating sexual behavior of the HIV-infected were little different in their sexual behavior from people in a state without such a law. People who believed the law required the infected to practice safer sex or disclose their status were just as risky in their sexual behavior as those who did not. Our data do not support the proposition that passing a law prohibiting unsafe sex or requiring disclosure of infection has a normative effect, for the simple reason that the overwhelming majority of people in our study already believed that it was wrong to expose others, and right to disclose infection, regardless of their beliefs about the law or whether they lived in a state with such a law or not. Because law was not significantly influencing sexual behavior, our results undermine the claim that such laws "drive the epidemic underground."

CONCLUSIONS: We failed to refute the null hypothesis that criminal law has no influence on sexual risk behavior. We did not find that law is a clearly useful intervention for promoting disclosure by HIV+ people to their sex partners. Given concerns about possible negative effects of criminal law, such as stigmatization or reluctance to cooperate with health authorities, our findings suggest caution in deploying criminal law as a behavior change intervention for seropositives pending further evaluation.

Keywords: Criminal Justice, Health Care