Joyce Hunter, D.S.W. HIV Center for Clinical and Behavioral Studies,

1. HIV POSITIVE YOUTH IN THE JUVENILE JUSTICE SYSTEMXIX International AIDS Conference, Washington, DCJuly 26, 2012 Joyce Hunter, D.S.W. HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York jh547@columbia.edu

2. INCARCERATED YOUTH AT RISK There is a public health crisis among youth incarcerated in state custody. These youth are particularly at-risk for acquiring sexual transmitted infections (STIs)/HIV. (The Center for HIV Law and Policy, 2010) For youth who are incarcerated in foster care or detention facilities: • Health care providers typically do not raise sexual health care issues with youth (i.e., STIs, HIV, unwanted pregnancy); • Youth were not aware if they had been tested for HIV or, if they had, had not been given their test results.

3. INCARCERATED YOUTH AT RISK, cont. • Female youth were not responded to when they requested appointments about sexual health care with agencies such as Planned Parenthood, or their appointments were delayed for months. • Lack of information, conflicting information, and lack of confidentiality, were reported by youth. (Child Welfare League of America, 2006)

4. INCARCERATED YOUTH AT RISK, cont. Before coming into custody, many of these youth: • were living on the streets, • engaging in high-risk sexual behaviors for shelter, food, money, • risk becoming victims of assault, increasing their chances of contracting STIs or HIV.

5. YOUTH OF COLOR The CDC and the National Institute of Justice find that incarcerated youth are disproportionately youth of color and disproportionately at risk for STIs and HIV. Among youth aged 13-19 diagnosed with HIV/AIDS: • 72% were African-American (AA), non-Hispanic; • 13% were Hispanic, • 13% were white (in contrast to general population of 17% AA, 15% Hispanic, and 62% white) (CDC, 2009).

6. YOUTH AT RISK • Young MSM and transgender youth who use alcohol and illegal drugs are at risk for incarceration. • African American/Black MSMs are more likely than other MSMs to be incarcerated, increasing the likelihood of exposure to HIV. (SAMSHA, 2009) • An estimated 15% of youth in detention are LGBT youth, who are more likely to be convicted in Juvenile Court for longer times. (Juvenile Justice, Louisiana, 2010)

7. CRIMINALIZATION OF HIV IN THE U.S. In the U.S., 35 states have prosecuted HIV positive individuals for exposing another person to HIV: • A person diagnosed with HIV who infects their partner while engaging in sexual intercourse is committing a crime; • A person donating HIV infected organs, tissues, and blood can be prosecuted for transmission of the virus; • Spitting or transmitting HIV infected bodily fluids is considered a criminal offense in some states, particularly where the target is a prison guard.

8. CRIMINALIZATION OF HIV--WORLDWIDE Some countries, particularly in parts of Africa, Asia, Latin America, the Caribbean, have enacted new HIV-specific laws that criminalize HIV transmission and exposure, • Others, primarily in Europe and North America, charge under the existing laws, • In many countries, the intentional or reckless infection of a person with HIV is considered to be a crime, • This often includes “criminal exposure to HIV,” does not require the transmission of the virus and often, as in the cases of spitting and biting, does not even include a realistic means of transmission (CDC, 2005, 2009), • People who do so can be charged with criminal transmission of HIV, murder, manslaughter, attempted murder, or assault, or, in some cases, a misdemeanor.

9. CRIMINALIZATION OF YOUTH WITH HIV DOESN’T WORK Criminalizing HIV: • will not slow down the epidemic, • undermines prevention efforts, • promotes fear and stigma, • is carried out unfairly, • should only be applied where someone has infected another with criminal intent, using existing laws, • diverts attention from enacting laws that promote prevention and treatment. (Open Society Institute, 2008)

10. INTERVENING WITH HIV-POSITIVE INCARCERATED YOUTH Criminalization of HIV interferes with prevention efforts and medical intervention: • Youth must have access to information and education regarding sexual health; • Youth must be protected from sexual violence; • Youth must have access to medical diagnosis and treatment.

11. CONCLUSION Teenagers and young adults in the U.S. are deserving of sexual health care, including: • disease prevention, • treatment, and • an understanding of human sexuality. Sexual health care is essential to reaching and maintaining a healthy adulthood.

12. REFERENCES • CDC, HIV/AIDS Surveillance Report, 2004 32 (2005). • CDC, Sexual and reproductive health of persons aged 10-24 years—United States, 2002-2007 (2009). • Child Welfare League of America, CWLA best practice guidelines: Serving LGBT youth in out-of-home care, 7,54-55 (2006). • Juvenile Justice, Louisiana (2010). • Open Society Institute, Ten reasons to oppose the criminalization of HIV exposure or transmission (2008). lawandhealth@sorosny.org • SAMSHA (2009). • The Center for HIV Law and Policy, Teen Sense Initiative, Juvenile Injustice (2010).