People living with HIV frequently worry about the legal ramifications of disclosing their HIV status not only to sexual partners, but also to health service providers, which may have consequences for their health, an Australian study published in AIDS Care found.
While HIV status disclosure before sex is no longer mandated in Australia, PLWH are still sometimes prosecuted under general laws for exposure and transmission. Such cases often receive sensationalist and stigmatizing media coverage.
For their study, researchers utilized a periodic HIV survey, whose latest iteration was conducted in 2015-2016, and added six items on perceptions of and responses to the country’s legal situation regarding HIV. The questionnaire was distributed widely through HIV-related and LGBTQ community channels. The 895 participants were mostly male (91%), tended to live in inner urban/suburban areas (61%), and usually reported English as their first language (89%, used as a proxy for ethnicity).
A third of respondents said they worried about disclosing their HIV status to sexual partners and a quarter worried about disclosure to service providers due to HIV criminalization laws. Beyond not disclosing their HIV status to health care providers, PLWH may also not be open about their sexual practices—or may not access health care at all—because of anxiety about laws criminalizing their sexual conduct, the authors wrote.
Anxiety about HIV-related laws was highest among younger respondents (≤ 29 years old), possibly because of lack of experience with disclosure. Anxiety was also particularly high among those with multiple partners, possibly because of awareness of higher exposure risk, the authors hypothesized. Additionally, anxiety levels were higher among participants who spoke English as a second language, experienced financial stress, or did not identify as heterosexual.
The study authors noted that believing someone understands the laws governing HIV disclosure in their jurisdiction (reported by 79% of participants) does not mean that person actually does so; they recommended research into PLWH’s actual knowledge of their legal situation. More detailed research into anxiety related to HIV criminalization among specific ethnicities who are already stigmatized is also needed.
“These findings demonstrate a clear association between HIV criminalization and poorer mental wellbeing and further challenge the credibility of continuing, disproportionate efforts to apply the law for management of sexual conduct in ways that exacerbate stigma and place an undue burden of responsibility on people living with HIV,” the study authors concluded.