Attitudes Toward HIV-Positive Status Disclosure Among U=U-Aware Sexual and Gender Minority Individuals in the USA: a Consensual Qualitative Research Approach.

Introduction: The U=U (i.e., undetectable equals untransmittable) campaign is founded upon biomedical advancements that have positioned HIV as a manageable condition with effectively zero risk of transmission. In spite of these developments, attitudes of sexual and gender minority populations regarding the necessity of seropositive status disclosure remain unexamined. Methods: The current study analyzed qualitative data regarding the necessity of seropositive status disclosure from 62 sexual minority men as well as transgender and gender non-conforming individuals who have sex with men from 2020 to 2021. Results: The majority of participants believed disclosure to be necessary and invoked several social and structural factors that informed their attitudes. Participants cited HIV criminalization laws, the ethics of non-disclosure, and disclosure as a means of educating sex partners when appraising the necessity of disclosure. Participants also presented concerns regarding U=U efficacy and HIV stigma. Conclusions: Findings indicate that the disclosure of seropositive status to sex partners is still important to U=U-aware sexual and gender minority individuals. The majority of the study sample, irrespective of HIV status, believed seropositive status disclosure was necessary in advance of sex. Policy Implications: Findings suggest opportunities for public health messaging to remediate concerns about U=U efficacy, combat misinformation, and clarify out-of-date information on HIV criminalization.

Beyond criminalization: reconsidering HIV criminalization in an era of reform.

PURPOSE OF REVIEW: This paper reviews recent studies examining the application of human immunodeficiency virus (HIV)-specific criminal laws in North America (particularly the United States and Canada). In the wake of the development of new biomedical prevention strategies, many states in the United States (US) have recently begun to reform or repeal their HIV-specific laws. These findings can help inform efforts to 'modernize' HIV laws (or, to revise in ways that reflect recent scientific advances in HIV treatment and prevention). RECENT FINDINGS: Recent studies suggest that HIV-specific laws disproportionately impact Black men, white women, and Black women. The media sensationally covers criminal trials under these laws, especially when they involve Black defendants who they often describe in racialized terms as predators. Activists contest these laws and raise concerns about new phylogenetic HIV surveillance techniques that have the potential to be harnessed for law enforcement purposes. SUMMARY: These findings collectively raise urgent concerns for the continued use of HIV-specific criminal laws. These policies disproportionately impact marginalized groups - particularly Black men. Media coverage of these cases often helps to spread misinformation and stigmatizing rhetoric about people living with HIV and promulgate racist stereotypes. Although well-intentioned, new phylogenetic HIV surveillance technologies have the potential to exacerbate these issues if law enforcement is able to gain access to these public health tools.

"Spanish Flu": When Infectious Disease Names Blur Origins and Stigmatize Those Infected.

Despite not originating in Spain, the 1918 influenza pandemic is commonly known as the "Spanish flu"-a name that reflects a tendency in public health history to associate new infectious diseases with foreign nationals and foreign countries. Intentional or not, an effect of this naming convention is to communicate a causal relationship between foreign populations and the spread of infectious disease, potentially promoting irrational fear and stigma. I address two relevant issues to help contextualize these naming practices. First is whether, in an age of global hyperinterconnectedness, fear of the other is truly irrational or has a rational basis. The empirical literature assessing whether restricting global airline travel can mitigate the global spread of modern epidemics suggests that the role of travel may be overemphasized. Second is the persistence of xenophobic responses to infectious disease in the face of contrary evidence. To help explain this, I turn to the health communication literature. Scholars argue that promoting an association between foreigners and a particular epidemic can be a rhetorical strategy for either promoting fear or, alternatively, imparting a sense of safety to the public.

Cruel Intentions? HIV Prevalence and Criminalization During an Age of Mass Incarceration, U.S. 1999 to 2012.

A 2014 U.S. Department of Justice Best Practices Report advocates that states eliminate HIV-specific criminal penalties except under 2 conditions: when a human immunodeficiency virus (HIV)-positive person intentionally commits a sex crime or transmits the virus by engaging in behavior that poses a significant risk of transmission, regardless of actual transmission. We assess the premise of these exceptions to understand whether these best practices are based on scientific evidence about the population at risk of infection and the risk of sexual violence by HIV-positive individuals. We employ nationally representative, cross-sectional survey data from the Current Population Survey (CPS), the Survey of Inmates in State, Federal, and Local Jails (SISFLJ), and the National Health and Nutrition Survey (NHANES). Data from the CPS, SISFLJ, and NHANES are weighted and combined to analyze bias in the population at risk of HIV. Linear probability models are employed to estimate the likelihood that HIV-positive inmates are incarcerated for violent or sexual offenses, net of socioeconomic factors. We find significant measurement bias in HIV prevalence rates. The selection of national surveys for population denominators distorts contemporary estimates of HIV prevalence by 7% to 20%. Our findings also illustrate that HIV-positive inmates are 10 percentage-points less likely to be incarcerated for violent offenses than HIV-negative inmates. National best practice guidelines may undermine effective social policy that aims to curtail stigma within HIV-positive communities because scientific evidence neither include inmates into prevalence denominators (as a measure of the population at risk) nor assess the likelihood that HIV-positive inmates commit violent or sexual crimes.

Beyond "getting drugs into bodies": social science perspectives on pre-exposure prophylaxis for HIV.

Social scientists have much to contribute to the analysis of the real and potential contribution of pre-exposure prophylaxis (PrEP) to HIV prevention around the world. Beyond just a matter of clinical efficacy and getting pills into people's mouths, PrEP raises a number of important social-psychological questions that must be attended to in order to translate biomedical and clinical findings into uptake of PrEP among enough people at risk of HIV infection to produce population-level effectiveness. PrEP is a dynamic phenomenon with "dialectical" attributes that invite both optimism and cynicism as a desirable and effective HIV prevention strategy. PrEP disrupts traditional notions of "safe" and "unsafe" sex; it confers on its users a level of agency and control not generally achieved with condoms; and it affects sexual practices and sexual cultures in meaningful ways. As these dynamics play out in different contexts, and as new modes of PrEP administration emerge, it will be important for social scientists to be engaged in assessing their impact on PrEP implementation and effectiveness.

From sickness to badness: the criminalization of HIV in Michigan.

Sociological approaches to the social control of sickness have tended to focus on medicalization or the process through which social phenomena come to be regulated by medicine. Much less is known about how social problems historically understood as medical come to be governed by the criminal law, or what I term the "criminalization of sickness." Thirty three US states have enacted criminal statutes that require all HIV-positive individuals to disclose their infection before engaging in a wide range of sexual practices. Drawing on evidence from 58 felony nondisclosure convictions in Michigan (95% of all convictions between 1992 and 2010), I argue that the enforcement of the state's HIV disclosure law is not driven by medical concerns or public health considerations. Rather, it reflects pervasive moralizing narratives that frame HIV as a moral infection requiring interdiction and punishment.