Prevalence and predictors of facing a legal obligation to disclose HIV serostatus to sexual partners among people living with HIV who inject drugs in a Canadian setting:a cross-sectional analysis

Patterson, Sophie; Kaida, Angela; Nguyen, Paul; Dobrer, Sabina; Hogg, Robert S.; Montaner, Julio S. G.; Wood, Evan; Milloy, M‐J

doi:10.9778/cmajo.20150106

Cited by 11 publications

(10 citation statements)

References 38 publications

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“…WLWH are not only subjected to the gendered sexual violence of male condom refusal but, at the more upstream level, also to the structural violence of legislation that does not account for the gendered power imbalance shaping condom negotiation. Our findings indicate that WLWH carry an amplified gendered burden in negotiating condom use in order to be exempt from the legal obligation to disclose their HIV status, and resonates with previous work that highlighted that, among people living with HIV with a history of illicit substance use, women faced a disproportionate legal burden to disclose their HIV status [ 38 ].…”

Section: Discussionsupporting

confidence: 85%

“…In Canada, and other environments where HIV non-disclosure to sexual partners is criminalized, the fears and apprehensions that shape disclosure among WLWH are augmented by the threat of criminal charges, public exposure and incarceration [ 32 – 34 ]. Existing social science and epidemiological research on the criminalization of HIV non-disclosure has focused primarily on the experiences and understandings of people living with HIV/AIDS regarding the criminal laws related to HIV and the relationship between such laws and sexual risk behaviours [ 35 – 38 ]. Indeed, the application of the criminal law disproportionately impacts marginalized people living with HIV/AIDS [ 38 ], and criminalization of HIV non-disclosure can exacerbate HIV-related stigma [ 39 ], interfere with access to HIV testing [ 40 ], and complicate relationships between health care providers and people living with HIV/AIDS [ 41 ].…”

Section: Introductionmentioning

confidence: 99%

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Positive sexuality: HIV disclosure, gender, violence and the law—A qualitative study

Krüsi

Ranville²,

Gurney³

et al. 2018

PLoS ONE

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While a growing body of research points to the shortcomings of the criminal law in governing HIV transmission, there is limited understanding of how cis and trans women living with HIV (WLWH) negotiate their sexuality and HIV disclosure in a criminalized environment. Given the ongoing criminalization of HIV non-disclosure and prevalence of gender-based violence, there is a critical need to better understand the dynamics of negotiating sexual relationships and HIV disclosure among WLWH. We conducted 64 qualitative interviews with cis and trans WLWH in Vancouver, Canada between 2015 and 2017. The interviews were conducted by three experienced researchers, including a cis and a trans WLWH using a semi-structured interview guide. Drawing on a feminist analytical framework and concepts of structural violence, the analysis sought to characterize the negotiation of sexual relationships and HIV disclosure among WLWH in a criminalized setting. For many participants their HIV diagnosis initially symbolized the end of their sexuality due to fear of rejection and potential legal consequences. WLWH recounted that disclosing their HIV status shifted the power dynamics in sexual relationships and many feared rejection, violence, and being outed as living with HIV. Participants’ narratives also highlighted that male condom refusal was common and WLWH were not only subjected to the gendered interpersonal violence of male condom refusal but also to the structural violence of legislation that requires condom use but fails to account for the gendered power imbalance that shapes condom negotiation. Despite frequently being represented as a law that ‘protects’ women, our findings indicate that the criminalization of HIV non-disclosure constitutes a form of gendered structural violence that exacerbates risk for interpersonal violence among WLWH. In line with recommendations by, the WHO and UNAIDS these findings demonstrate the negative impacts of regulating HIV prevention through the use of criminal law for WLWH.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Positive sexuality: HIV disclosure, gender, violence and the law—A qualitative study

Krüsi

Ranville²,

Gurney³

et al. 2018

PLoS ONE

View full text Add to dashboard Cite

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“…Given that women are less likely than men to meet the legal criteria that remove the obligation to disclose before intercourse (i.e. condom use and having a low viral load) (Patterson et al 2016), the current legal test may be putting an increasing number of women at risk for prosecution and conviction. Furthermore, Canadian data from 2015 to 2017 reveal that although 73% of women enrolled in the national CHIWOS cohort study (chiwos.ca) were aware of the law, only 27% had a reasonably complete understanding of the legal requirements to disclose Patterson, Kaida, Ogilvie, et al 2017).…”

Section: Gendering the Criminalisation Of Hiv Non-disclosure Lawmentioning

confidence: 99%

How women living with HIV react and respond to learning about Canadian law that criminalises HIV non-disclosure: ‘how do you prove that you told?’

Greene

Odhiambo

Muchenje

et al. 2019

Culture, Health & Sexuality

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The Women, ART and the Criminalization of HIV Study is a qualitative, arts-based research study focusing on the impact of the HIV non-disclosure law on women living with HIV in Canada. The federal law requires people living with HIV to disclose their HIVpositive status to sexual partners before engaging in sexual activities that pose what the Supreme Court of Canada called a 'realistic possibility of transmission'. Drawing on findings from seven education and discussion sessions with 48 women living with HIV regarding HIV non-disclosure laws in Canada, this paper highlights the ways in which women living with HIV respond to learning about the criminalisation of HIV non-disclosure. The most common emergent themes included: the way the law reproduces social and legal injustices; gendered experiences of intimate injustice; and the relationship between disclosure and violence against women living with HIV. These discussions illuminate the troubling consequences inherent in a law that is antithetical to the science of HIV transmission risk, and that fails to acknowledge the multiple barriers to HIV disclosure that women living with HIV experience. Women's experiences also highlight the various ways the law contributes to their experiences of sexism, racism and other forms of marginalisation in society.

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“…At least 181 people have faced charges for HIV non-disclosure since the late 1980s (Patterson et al, 2016), with socio-economically marginalized individuals overrepresented (Canadian HIV/Aids Legal Network, 2014). In the absence of HIV-specific laws, Canadian prosecutors apply existing criminal laws (predominantly sexual assault laws) to cases of HIV non-disclosure, guided nationally by precedents set by the Supreme Court of Canada (SCC).…”

Section: Introductionmentioning

confidence: 99%

“…This means HIV positive people who do not use condoms or who have a viral load of 1500 copies/mL or more may face a criminal charge of aggravated sexual assault for not telling their sexual partners they have HIV. To clarify, the revised ruling suggests that people living with HIV are legally required to disclose their HIV status to sex partners UNLESS they use a condom AND have a viral load less than 1500 copies/mL.” *current estimates suggest that 181 PLWH have faced charges (Patterson et al, 2016). …”

mentioning

confidence: 99%

Awareness and understanding of HIV non-disclosure case law among people living with HIV who use illicit drugs in a Canadian setting

Patterson

Kaida

Hogg

et al. 2017

International Journal of Drug Policy

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Background In 2012, the Supreme Court of Canada (SCC) ruled that people living with HIV (PLWH) could face criminal charges if they did not disclose their serostatus before sex posing a “realistic possibility” of HIV transmission. Condom-protected vaginal sex with a low (i.e., <1500 copies/mL) HIV viral load (VL) incurs no duty to disclose. Awareness and understanding of this ruling remain uncharacterized, particularly among marginalized PLWH. Methods We used data from ACCESS, a community-recruited cohort of PLWH who use illicit drugs in Vancouver. The primary outcome was self-reported awareness of the 2012 SCC ruling, drawn from cross-sectional survey data. Participants aware of the ruling were asked how similar their understanding was to a provided definition. Sources of information from which participants learned about the ruling were determined. Multivariable logistic regression identified factors independently associated with ruling awareness. Results Among 249 participants (39% female), median age was 50 (IQR: 44–55) and 80% had a suppressed HIV VL (<50 copies/mL). A minority (112, 45%) of participants reported ruling awareness, and 44 (18%) had a complete understanding of the legal obligation to disclose. Among those aware (n = 112), newspapers/media (46%) was the most frequent source from which participants learned about the ruling, with 51% of participants reporting that no healthcare providers had talked to them about the ruling. Ruling awareness was negatively associated with VL suppression (AOR:0.51, 95% CI:0.27,0.97) and positively associated with recent condomless sex vs. no sex (AOR:2.00, 95% CI:1.03,3.92). Conclusion Most participants were not aware of the 2012 SCC ruling, which may place them at risk of prosecution. Discussions about disclosure and the law were lacking in healthcare settings. Advancing education about HIV disclosure and the law is a key priority. The role of healthcare providers in delivering information and support to PLWH in this legal climate should be further explored.

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Prevalence and predictors of facing a legal obligation to disclose HIV serostatus to sexual partners among people living with HIV who inject drugs in a Canadian setting:a cross-sectional analysis

Cited by 11 publications

References 38 publications

Positive sexuality: HIV disclosure, gender, violence and the law—A qualitative study

Positive sexuality: HIV disclosure, gender, violence and the law—A qualitative study

How women living with HIV react and respond to learning about Canadian law that criminalises HIV non-disclosure: ‘how do you prove that you told?’

Awareness and understanding of HIV non-disclosure case law among people living with HIV who use illicit drugs in a Canadian setting

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