I am Catherine Hanssens, Esq., Founder of The Center for HIV Law and Policy. I have over 30 years of legal experience working with HIV. AMA about HIV law and policy!

So, this doesn't seem like it's exactly in line with what your practice is about, but it's something I've always been curious about: at what point (if ever) is a person criminally liable for infecting another person with HIV? If you've tested positive, for example, are fully aware that you have HIV, and then have unprotected sex with someone without informing them that you're HIV positive, and they found out, can you be prosecuted?

Actually, we do a lot of work on HIV criminal laws. And the answer depends on the state where you live, since each state has its own way of handling this. Unfortunately (in my view), 32 states and 2 US territories have criminal laws that single out HIV for punishment without requiring proof of intent to harm -- which is what the criminal law otherwise requires in any other type of situation. In other words, if you get tested for HIV, and engage in conduct that would be legal if you didn't test positive for HIV, and then can't prove that you disclosed, in many states you can be guilty of a serious felony.

Keep in mind: HIV is not an easy virus to transmit, different types of sex pose little or no risk, and if someone doesn't have a high viral load they probably aren't putting their partner at risk of transmission anyway.

Thanks for a great question!

What fact or statistic seems like obvious exaggeration, but isn't?

One fact that a surprising number of people think is untrue, including medical professionals, is that HIV is not an easy virus to transmit. Multiple studies have suggested that the riskiest type of sex -- being the receptive partner, or the "bottom", in condomless anal sex -- on average causes HIV transmission less than 2 out of every 100 acts. And that is without factoring in the reduction in transmission risk that being on effective HIV treatment, and/or using a condom, provides.

This seems counterintuitive when considering how HIV is so prevalent in places like South Africa. Even considering the lack of education, it seems like that 1/50 is low considering it is such a huge problem in certain countries. Is it just the lack of education that causes the huge prevalence? Thank you for your work and for the AMA!

True, but it makes more sense when you consider that the HIV virus probably crossed over to humans in Cameroon in the early part of the 20th century. The most current research suggests that HIV made it into the U.S. around 1966. I do not work in any African countries, where a different strain of the HIV virus is prevalent, but a variety of factors such as, as you point out, lack of education and the resultant stigma; stigma and discrimination that is either unaddressed or actually reinforced in countries' laws that criminalize not only HIV status but LGBT sexual orientation; inadequate access to highly effective antiretroviral treatment; and an underfunded, crumbling public health structure and communities where other diseases are untreated or under treated, making individuals more susceptible to diseases such as HIV.

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Your stats are certainly on point, but I part company on the genetic factor. Far more likely that The offer of diagnosis and treatment, the quality of the treatment offered, the likelihood that one will have reasonable access to affordable, quality care (including transportation in rural areas with inadequate public transportation), provided by a health care professional who is skilled and has no judgment or prejudices about your identity, is closely related to your identity and associated social/economic capital. It's just a given documented by plenty of research, for e.g., that a white man with private health insurance is going to have access to a very different level of care (and respect) than a Black transgender woman or gay man. That needs to end.

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Yes, sorry and thanks for the clarification!

What's the biggest obstacle you face in your work?

The biggest challenge in this work -- and the common denominator to every case of HIV discrimination I have handled over the last 30 years -- is a profound lack of knowledge about the routes, risks and realities of HIV transmission.

The larger issue is the widespread lack of sexual health literacy. We should be insisting on our children's sexual health literacy as an essential part of their well being as adolescents and adults. Sexual health should be as routine as dental hygiene! Instead, we allow our elected officials to put "ignorance is bliss" policies into place in our schools, detention centers, prisons and jails.

I'm hopeful that our new-ish Surgeon General will take this issue on.

Has the ACA changed things for the better for those with HIV/AIDS?

Two key parts of the ACA have a particular importance for people living with HIV/AIDS: the expansion of Medicaid eligibility and the creation of new Health Insurance Marketplaces where individuals can purchase private coverage. A significant percentage of PLWHA are persons with low incomes, so the ACA means coverage for many more thousands of people living with HIV.

How should our HIV/AIDS laws, particularly with regard to criminal penalties, be modified, in your view? Is there a state with model/somewhat optimal laws?

An appropriate law would: 1) not single out HIV

2) require proof of intent to harm through conduct reasonably likely to transmit HIV

3) impose a sentence that is proportionate to the actual harm caused.

There isn't a model state law yet, in my opinion, although California probably comes the closest in requiring proof of intent to transmit, although California also uses other state laws to prosecute people living with HIV when prosecutors can't establish intent. Illinois was the first state to "modernize" its law, and limits liability to sexual intercourse; Iowa also revised its law last year, but sadly kept the 25 year felony penalty for intentional transmission and also added TB, Hepatitis and meningococcal disease to the law along with HIV.

HIV, while a serious disease, has for a number of years now been a manageable, chronic disease. For most people diagnosed with HIV today, that means one pill a day and a reasonably normal life expectancy. Putting someone in prison for a term of 25 years, even when HIV is intentionally transmitted, means treating HIV disease as the equivalent of homicide. That's just not true, and it's very stigmatizing and harmful to people with or at risk of HIV to perpetuate that notion of HIV.

What's been the biggest advancement in your years of studying hiv?

Another great question! It's hard for me to pick one, so bear with me if I pick a couple, okay?

The first is the adoption in the US of the Americans With Disabilities Act in 1990, which provided for the first time a way to sue private businesses across the country who refused to hire, or fired, or refused to insure, or refused to admit to schools, men, women and children living with HIV.

A second is the National AIDS Strategy, and the very first time our federal government called out HIV discrimination, and in particular HIV criminalization, as a factor in the disparities that people of color and others without social/economic capital experience in access to quality HIV care and prevention.

What ever happened to GRID?

GRID (or Gay Related Immune Disorder) was a term used to describe the cluster of cases of gay men who became ill and died early in the HIV epidemic, before the retrovirus that causes AIDS was identified. As you probably know, since then it has become clear that HIV affects a swath of communities in addition to men who have sex with men (MSM), and so terms like GRID were abandoned. In the U.S., women make up about 20-25% of cases of HIV; the percentage is higher in other countries, such as countries in Africa.

Edit: wording.