Does criminalization increase stigma related to HIV?

Stig.ma  (plural stig.ma.ta)
Noun: A mark of disgrace associated with a particular circumstance, quality, or person. (Oxford English Dictionary)

• What is HIV related stigma?
• What impact does criminalization have on stigma?

What is HIV related stigma?

Even though experiences of stigma relating to HIV have changed since the 1980s and 1990s, stigma remains a concern today.  HIV is stigmatized because it is associated with social taboos and intimate behaviours like sex and drug use. Some people still lack basic information about HIV and how it is transmitted, some have misunderstandings about HIV, and some have prejudices towards people most often affected by HIV. All three fuel stigma.  

Stigma can also re-enforce power inequalities and socially exclude some people. HIV-related stigma can be made worse because HIV disproportionately affects groups of people that are often already marginalized - and stigmatized - by society because of other aspects of their identity or behaviour. For example, men who have sex with men (MSM), Lesbian, Gay, Bisexual or Transgender people (LGBT), people who sell sex, people who use drugs, women and girls, immigrants, and people living in poverty may be stigmatized because of their race, gender, ethnicity, behaviour and/or sexual orientation. If they are also HIV positive, they may experience stigma more intensely.

Stigma plays into society’s view of HIV as something that happens to ‘other’ people that shouldn’t be openly discussed. It can discourage some people from testing for HIV or seeking treatment, care, support and other services. Overall stigma can damage people’s ability to manage and live well with HIV. It can also be or become internalised.

In simple terms, the more stigma around HIV there is, the more difficult it is to prevent and treat HIV, and care for the people whose lives it directly touches.

What impact does criminalization have on HIV-related stigma?

Criminalization of HIV transmission and exposure adds another layer to HIV related stigma by associating the idea of ‘being a criminal’ with HIV-status, implicating all people living with HIV as ‘potential criminals’ in the process. The stigma fuelled by criminalization can:

• Affect the self-esteem and well-being of people living with HIV

Stigma can be or become internalised, perhaps as feelings of shame or embarrassment or low self-esteem that may cause some people to exclude themselves from social events, community spaces, the workplace and perhaps from intimacy with friends, family and relationships.

• Limit access to treatment and support 

HIV stigma is one of the biggest barriers to testing, treatment and support. Criminalization reinforces that barrier by creating another layer of difficulty for people living with HIV to openly access health and other services.  

• Entrench myths and misunderstanding about HIV

Coverage of HIV-related prosecutions often generates unnecessary fear about the risk of HIV transmission. In some cases reports exaggerate risk where none exists, such as in cases where people are prosecuted for spitting or biting. The coverage is often sensationalized, and can disproportionately fuel fear and/or the threat of ‘deliberate transmissions’. Such 'Intentional' cases are extremely rare, however coverage of criminalization often confuses the idea of ‘reckless’ and ‘intentional’ transmission, giving the false impression that many people are setting out to transmit HIV to others. 

• Disrupt the lives of those directly involved in a police investigation

Invasion of privacy can affect everyone involved in these cases - those bringing the charge as well as those facing them. The police investigation can have just as damaging an effect on people’s lives as a prosecution itself. Community advocates in the UK estimate that there have been over 200 arrests and investigations relating to HIV criminalization since 2001, resulting in 20 prosecutions. This means that for every known case, there could be as many 10 people living with HIV subjected to arrest or investigation.  

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