What effects is The criminal justice system having in hiv prevention?

1. What effects is The criminal justice system having in hiv prevention? Barry D Adam University Professor of Sociology, Senior Scientist & Director of Prevention Research

2. The courts & HIV prevention • Courts (whether they know it or not) becoming actors in the field of HIV prevention • Based on a model of human behaviour that holds that • HIV-positive people can and should assume the responsibility of warning others of the potential for infection, • and that prospective partners, once informed of that potential, will act appropriately to avoid infection • Elevation of disclosure as primary requirement

3. Effectiveness of disclosure • Not associated with higher rates of protected sex among gay and bisexual men • Consistent practice of safer sex usually does not require discussion and proceeds without it. • Benny Henriksson and Sven Axel Månsson, “Sexual Negotiations,” in Culture and Sexual Risk, ed. Han ten Brummelhuis and Gilbert Herdt (1995), 170. • Those who decide from encounter to encounter whether to disclose or not, and who then disclose inconsistently, have higher rates of unprotected sex than either those who disclose consistently or those who do not disclose. • Trevor Hart et al., “Partner Awareness of the Serostatus of HIV-Seropositive Men Who Have Sex with Men,” AIDS and Behavior 9 (2005): 163; Limin Mao et al., “‘Serosorting’ in Casual Anal Sex of HIV-Negative Gay Men Is Noteworthy and Is Increasing in Sydney, Australia,” AIDS 20 (2006): 1204–6.

4. Disclosure in everyday life • Risks stigmatization/rejection • HIV-positive people have reported that “rejection from partners following disclosure took many forms, including refusal to have sex, unwillingness to engage in particular sex practices, emotional distancing, abrupt or longer term relationship dissolution, and even (although rarely) acts of violence.” • Michael Stirratt, “I Have Something to Tell You,” in HIV+ Sex: The Psychosocial and Interpersonal Dynamics of HIV-Seropositive Gay and Bisexual Men’s Relationships, ed. Perry N. Halkitis, Cynthia A. Gómez, and Richard J. Wolitski (Washington, DC: American Psychological Association, 2005), 103.

5. Personal politics of disclosure • Harder to do in a relationship of dependency • Difficulty that many women experience in disclosing to men on whom they are dependent • Karolynn Siegel, Helen-Maria Lekas, and Eric Schrimshaw, “Serostatus Disclosure to Sexual Partners by HIV-Infected Women Before and After the Advent of HAART,” Women and Health 41, 4 (2005), 63. • and among those who feel disadvantaged by their age, attractiveness, or ethno-cultural background

6. Doing disclosure • “I do worry that, you know, I might disclose to someone even before sex and then it becomes his word against mine later—right?—and if I go to court . . . I’d probably lose my job.” • “What if one that’s negative makes a decision to . . . have sex without a condom, and then he gets infected and then it all comes back to me and then I’m charged? I’m in jail . . . so I’m really careful around that.” • Barry D Adam, Richard Elliott, Winston Husbands, James Murray and John Maxwell. 2008. “Effects of the criminalization of HIV transmission in Cuerrier on men reporting unprotected sex with men” Canadian Journal of Law and Society 23 (1–2):137–153.

7. Indirect disclosure • Some “conveyed their serostatus to their partners by mentioning or exhibiting various embodiments of their serostatus: that they received disability payments, worked in HIV/AIDS services, lived in an HIV/AIDS residence, or had visible HIV/AIDS symptoms.” • Stirrat, “I Have Something to Tell You,” 114. Cf. Barry D. Adam, “Constructing the Neoliberal Sexual Actor” Culture, Health and Sexuality 7 (2005), 340; Julianne Serovich, et al., “Methods of HIV Disclosure by Men Who Have Sex with Men to Casual Sexual Partners,” AIDS Patient Care and STDs 19 (2005): 823–32.

8. Disclosure dilemmas • Presumes both partners are certain of their sero-status • Shifts responsibility back towards HIV+ people • . Need to test the presuppositions underlying the obligation to disclose as HIV prevention strategy and public policy by examining their operationalization in everyday life

9. Impacts of criminal prosecutions for HIV exposure and transmission on people living with HIV • To see how PHAs perceive the law and the legal obligation to disclose • How PHAs are affected by changing public climate of increasing prominence of criminal discourses • Follows preliminary research reported in: • Barry D Adam, Richard Elliott, Winston Husbands, James Murray and John Maxwell. 2008. “Effects of the criminalization of HIV transmission in Cuerrier on men reporting unprotected sex with men” Canadian Journal of Law and Society 23 (1–2):137–153.

10. What we want to find out • the sources of legal information available to PHAs, including how they have been advised by ASOs, health providers, and other relevant agencies, • how criminal prosecutions, and media coverage of these legal proceedings, affect understanding of rights and responsibilities of self and others • how public climate is affecting the perceptions, treatment, and possible stigmatization of PHAs • how legal proceedings and associated public discourse affect decisions to test for HIV, • how they affect disclosure practices of self and sexual partners, and • how they affect safer sex practices of self and others.

11. How it came about • Series of meetings of people from academic, community, government, and PHA organizations • Division into a research team and advisory committee • Research team: • Barry D Adam, Sociology, University of Windsor & Senior Scientist & Director of Prevention Research, OHTN • Richard Elliott, ED, Canadian HIV/AIDS Legal Network • Patrice Corriveau, Criminologie, Universitéd’Ottawa • Robb Travers, Psychology, Wilfrid Laurier University • Ken English, AIDS Bureau, Ministry of Health & Long Term Care

12. Advisory committee • Trevor Gray, Youth Outreach Coordinator, Prisoners’ HIV/AIDS Support Action Network, • Murray Jose, Executive Director, Toronto People With AIDS Foundation, • Rick Kennedy, Executive Director, Ontario AIDS Network, • Kara Gillies, Executive Director, Voices of Positive Women, • Frank McGee, AIDS Coordinator, AIDS Bureau , Ontario Ministry of Health and Long-Term Care, • Fanta Ongoiba, Executive Director, Africans in Partnership Against AIDS, • Ryan Peck, Executive Director, HIV & AIDS Legal Clinic (Ontario), • John Plater, lawyer and co-chair of the Ontario Advisory Committee on HIV and AIDS and past president of Hemophilia Ontario, • Michael Smith, Senior Policy Advisor, Public Health Agency of Canada, • Michael Sobota, Executive Director, AIDS Thunder Bay.

13. study participants • Set of questions on AIDS and the law in • OHTN Cohort Study • Positive Spaces, Health Places • Interviews with 100 PHAs, broadly representative of the demographics of HIV in Ontario

14. PHAs who have had difficulties • Interviews with PHAs who have • experienced a threat of legal consequences from a partner, family member, employer, etc in relation to their HIV status (e.g. non-disclosure) • been served with a public health order (e.g. Section 22) • been processed by the criminal justice system related to their HIV status (e.g. police action, charge, prosecution, etc) • complained to criminal justice or public health authorities about having been exposed or infected by HIV