World AIDs Day: From Ryan White to the Repeal HIV Discrimination Act

Today, December 1, is recognized as World AIDs Day, which has been commemorated since 1988 as the world's first global Health Day. It is an opportunity for people worldwide to unite in the fight against HIV, show their support for people living with HIV, and to commemorate people who have died. An estimated 33.2 million people worldwide live with HIV today, making it one of the most pervasive epidemics in recorded history. Despite improved access to antiretroviral treatment and care in many regions of the world, the AIDS epidemic still claims an estimated 2 million lives each year, about 13% of whom are children.

The HIV epidemic looks very different than when it was first identified in the early 1980s, when it was known variously as “Gay Related Immune Deficiency” and “Gay Bowel Syndrome” (Immunologists have since determined that deaths from AIDs were actually occurring in the 1950s, but were not yet accurately identified). During the 1980s, entire neighborhoods were decimated as the virus spread, with little understanding as to how it was transmitted or how to control it. At the height of the crisis, 50% of Americans believed that patients with HIV should be quarantined. In 1992, while running for the US Senate from Arkansas, Mike Huckabee echoed this sentiment when he declared,

If the federal government is truly serious about doing something with the AIDS virus, we need to take steps that would isolate the carriers of this plague…. It is difficult to understand the public policy towards AIDS. It is the first time in the history of civilization in which the carriers of a genuine plague have not been isolated from the general population, and in which this deadly disease for which there is no cure is being treated as a civil rights issue instead of the true health crisis it represents.

But perhaps no chapter in American history displays the degree of fear and widespread ignorance of HIV transmission than the storm surrounding Ryan White.

Ryan Wayne White (December 6, 1971 – April 8, 1990) was a teenager from Kokomo, Indiana who contracted HIV from tainted blood received in a transfusion (Ryan had hemophilia). After his initial diagnosis, Ryan’s health improved and his mother asked if he could return to school. 117 parents (from a school of 360 total students) and 50 teachers signed a petition asking school leaders to ban Ryan from school, and the school prohibited him from attending. The Indiana State Department of Education insisted that school permit Ryan to attend.

When Ryan tried to return to school, many parents and teachers continued to oppose his attendance, even though medical authorities at the Center for Disease Control assured them that there was no danger. The New England Journal of Medicine published a study on HIV transmission that concluded,
“…the risk of infection was minimal to nonexistent, even when contact included sharing toothbrushes, razors, clothing, combs and drinking glasses; sleeping in the same bed; and hugging and kissing…”

Nonetheless, the school required him to eat with disposable utensils, use separate bathrooms, and waived his requirement to enroll in a gym class. When a bullet was fired through the Whites' living room window, the family decided to leave Kokomo, and Ryan enrolled in a new school in Cicero, Indiana. Ryan would win his court battles, but died in April 1990 – just one month before his graduation.

In his honor, Congress passed the Ryan White Care Act, which remains the largest program providing care for those with HIV in the United States.

Unfortunately, the fear and marginalization of people with HIV continues.

On August 2, 2011, we reported in this blog on the draconian – even medieval – law passed in Iowa in 1998 that criminalized potential HIV transmission as a Class B felony. The sentence designated the ‘carrier’ as a felon, imposed a sentence of up to 25 years in prison, and assigned him or her lifelong sex-offender status, even if the contact was consensual. Under this law, a person aware of his or her positive HIV status does not actually have to transmit the HIV virus, they only have to engage in intimate contact with another person, whether or not that contact is consensual, to be found guilty. The penalty exceeds that for manslaughter. Since the law was enacted, 26 people have been convicted under the law and nine people currently sit behind bars. [Iowa is not alone. 34 states have prosecuted individuals for criminal transmission (or potential transmission) of HIV.]

Seven weeks after we reported on the Iowa convictions, on September 23, 2011, Congresswoman Barbara Lee (D-California) introduced H.R. 3053, the Repeal HIV Discrimination Act. This bill would require a review of all federal and state laws, policies, and regulations regarding the criminal prosecution of individuals for HIV-related offenses. It is the first bill to take on the issue of HIV criminalization, and provides incentives for states to explore repeal or reform of laws and practices that unfairly target people with HIV for consensual sex. Forty different medical and care-giving organizations have signed on to support the bill. This bill recognizes that the earlier criminalization statutes are based, wholly or partially, on prejudice, ignorance, and poor science.

The following sound reasons have been offered for ending this criminalization of HIV positive people:

1) Criminalizing HIV increases the stigma associated with the illness. Increasing the stigma means that people will be less likely to reveal their status and obtain treatment.

2) HIV is no longer the death sentence it was in the 1980s, nor does it necessarily lead to AIDs. Modern antiretroviral drugs have turned HIV into a lifelong medical condition, not unlike diabetes and high blood pressure. Most state criminal statutes have wrongly assumed that transmitting HIV is akin to murder, and the penalties are excessive.

3) The more cases that come to court, the more people will believe that the responsibility for having safe sex should lie solely with HIV positive people. Safe sex should always be a shared concern.

4) The law has little effect on people's sexual behavior; it does, however enable lovers to use the law as a way of exacting revenge.

5) Prosecuting positive people for reckless transmission provides a disincentive for getting tested: those who know of their positive HIV status are liable under the law, but those who remain ignorant - even purposefully – are not.

6) Most laws do not understand the ways in which HIV is transmitted. Some apply to actions such as spitting (HIV can not be transmitted through saliva), and most apply to anyone who is HIV positive, even though scientific studies have shown that many of those on regular mediation are unable to transmit the virus.

7) Imprisonment does nothing to help people accept their HIV and take a safer attitude towards sex. In addition to imprisonment costs, taxpayers would be forced to cover HIV medical costs of approximately $35,000 per inmate per year. While in prison, the sharing of needles for injecting drugs and the high incidence of male rape and sex between men in prisons makes it likely that an increase in HIV transmission will actually take place behind bars.

8) Criminal cases require the police to investigate the background of anyone they suspect of having transmitted HIV. Accused persons could suggest any number of other possible partners as sources for HIV transmission; this represents a serious invasion of privacy for all actual or potentially named sexual partners – including those who claim to be supportive of such laws.

9) No other illnesses are treated with the same hysteria as HIV, and few people are ever criminalized for transmitting them. No state has ever prosecuted an employee of a nursing home for coming into work with a contagious flu and giving it to the residents, even if several of those residents subsequently died. HIV is only singled out in criminal cases because the stigma associated with it.

10) Statistics show that women often know their status through attending health clinics more frequently than men. As a result, an HIV positive man may accuse his female partner of infecting him, because she was diagnosed first, even if he infected her and was not diagnosed until much later.

Sign the Petition to Pass the Repeal HIV Discrimination Act


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Iowa's Ignorance and HIV

In 1998, Iowa politicians enacted a law that criminalized potential HIV transmission as a Class B felony. The sentence designates the ‘carrier’ as a felon, imposes a sentence of up to 25 years in prison, and assigns him lifelong sex-offender status, even if the contact was consensual. Under the law, a person aware of his or her positive HIV status does not actually have to transmit the HIV virus, they only have to engage in intimate contact with another person.

The penalty exceeds that for manslaughter.

Since the law was enacted, 26 people have been convicted under the law; nine people currently sit behind bars. The cost to taxpayers is an estimated annual cost of $31,500 per inmate, plus medical costs of $24,000 annually per inmate.

The cost to the incarcerated is the destruction of their life for the crime of being human and having an illness.

Last year, the Iowa legislature defeated an effort to repeal the law, considered the most backwards and punitive (I would add ‘medieval’) in the country. Of course, this is Iowa, a state where right-wing fundamentalists are well-organized in the electoral processes and have handed presidential caucus victories to Pat Robertson in 1988 and Mike Huckabee just four years ago. Reason and Science need not apply...

Supporters of the law have a well-honed mantra that follows this general pattern:

“HIV/AIDs is a deadly disease that is a death sentence. When you know you have it and you are intimate with someone, you are infecting them, and committing an assault on them that is as dangerous as any other form of slow murder.”

In reality, much of the support for this law comes from those who look down on all sexual activity in general, and consider homosexuality in particular to be an abomination. Puritanical theology is the root of their desire to punish these people, not health. Nonetheless, in the battle of legislative processes, and insuring under the US Constitution that no excessive punishments be imposed for ‘crimes,’ it is important to address their stated reasoning above…and certainly time to educate the legislators and the public. I have been wanting to post this for a while, and the Iowa law was the tipping point.

1. HIV is not AIDs. Say that out loud. Again. HIV (Human Immunodeficiency Virus) is a virus that attacks the immune system, as do thousands of viruses. The HIV virus may lead to AIDs as a long-term complication of the viral attack, but HIV is not AIDs any more than blindness or neuropathy is the same thing as diabetes. One may cause the other, but they are not the same thing.

2. HIV is not a death sentence. Gay activists often (appropriately) refer to the 1980s as a health holocaust, as entire neighborhoods were decimated. But times have changed significantly, and thousands of men and women live normal healthy lives for decades with the HIV virus under control. In other words, HIV is now a manageable medical condition, not the end of life.

3. As viruses go, transmission of the HIV virus is very, very difficult. It is not transmitted by close contact, or sharing food or drinking glasses, or by breathing on each other, or by kissing (unlike many other viruses). It is not transmitted through saliva, sweat, or urine. Unlike many prevalent STDs such as syphilis, gonorrhea, herpes, HPV, and genital warts (none of which carry the penalties imposed in Iowa), it is not transmitted through oral sex.

Repeat: in the 30+ year history of HIV, there is not one single scientific case study that has documented transmission via fellatio. Period. In order to be on the ‘safe side,’ many doctors and government-funded clinics will publicly state that this is a ‘hypothetical’ route of transmission. But as for documenting a single case – it doesn’t exist…and privately, the medical community knows this. In July 2002 a study was concluded in Spain of serodiscordant couples (one HIV positive, One HIV Negative), where they evaluated for risks of HIV transmission through unprotected oral sex. In over 19,000 unprotected oral-genital contacts with HIV-infected partners, there was not a single case of seroconversion to HIV. (http://hivinsite.ucsf.edu/insite?page=pr-rr-05)

Even vaginal and anal transmission of the virus is unlikely. According to the Guidelines for the Management and Post Exposure Prophylaxis of Individuals who Sustain Nonoccupational Exposure to HIV, ANCAHRD/CTARC Bulletin, February 2001, the risk of transmission as a result of receptive anal sex is approximately three per cent. Other experts place the risk as low as 1 in 1300. (http://aids.about.com/od/hivaidsstats/f/infectionrisk.htm)

4. HIV positive individuals who have their virus controlled with medication can not transmit the HIV virus. (http://www.aidsmap.com/page/1429357/)

“…Swiss HIV experts have produced the first-ever consensus statement to say that HIV-positive individuals on effective antiretroviral therapy…are sexually non-infectious… After review of the medical literature and extensive discussion [the] Swiss Federal Commission for HIV / AIDS resolves that, “An HIV-infected person on antiretroviral therapy with completely suppressed viraemia (“effective ART”) is not sexually infectious, i.e. cannot transmit HIV through sexual contact.”

The statement officially defines a ‘suppressed viraemia’ (or “Undetectable Viral Load,” the common US parlance) as a viral load that has been suppressed to less than < 40 copies/ml for at least six months. (For comparison, someone not controlled on medication may have a viral load of 500,000 to over 1 million copies/ml). At the time this statement was made, that was the most sensitive that HIV tests could detect; today, these tests can detect viral loads of only 20 copies/ml, which means someone declared to have an Undetectable Viral Load has even fewer copies of the virus in their system than the limit established by the original Swiss statement. Finally, the Commission specifically stated that “courts will have to take into account the fact that HIV-positive people on antiretroviral treatment…cannot transmit HIV sexually in criminal HIV exposure and transmission cases….Unprotected sex between a positive person on antiretroviral treatment…and an HIV-negative person, does not comply with the criteria for an “attempt at propagation of a dangerous disease” according to section 231 of the Swiss penal code nor for “an attempt to engender grievous bodily harm” according to section122, 123 or 125.”

Iowa politicians, take note.

The current law in Iowa, then, locks someone up in a cage for up to 25 years and brands them a sex offender for engaging in normal human activity that has no chance of endangering someone else…simply because of their ‘status’ as a branded individual. The law is not based in science or humanity or health, but expresses a punitive, uneducated, and fearful attitude towards what they do not wish to understand.