Op-ed: This World AIDS Day, Let's Talk About Decriminalizing HIV

Annually on December 1, we commemorate World AIDS Day and reflect on our global response to the HIV/AIDS epidemic and the challenges that still face us as an international community. This year we recognize the disparate effect social policy and compounding public health crises like COVID-19 have on communities most affected by HIV. In this global context, it is more important than ever that governments take seriously how criminal law and human rights protections inform pandemics. Overcriminalization, in particular, poses unique public health challenges to key populations around the world today.

COVID-19’s effect on the epidemic is far-reaching. The virus has undoubtedly placed enormous strain on health systems and had a devastating impact on HIV/AIDS, tuberculous, and malaria programming globally.  For many of us, COVID-19 also illuminated the intersecting structural drivers that shape global health emergencies.  Though efficacious vaccines were created with incredible speed, for example, the vast majority of vaccines has been distributed in high and middle-income countries. This is due largely to failed global cooperation and manufacturers’ refusal to share technology and public-health oriented licensing. As a result, more than 50 countries have vaccinated less than 25 percent of their populations and the virus continues to spread faster than the global distribution of vaccines.

Similarly, political and legal barriers continue to thwart access to HIV treatment and prevention around the globe. Today, there are more prevention and treatment options in the research pipeline than ever. These technologies range from long-acting, injectable HIV medication to multipurpose technologies like the vaginal ring.  International adoption of U=U messaging has also strengthened advocacy efforts for universal access to effective treatment and care and reduced stigma and discrimination against people living with HIV (PLHIV).   Despite these exciting developments, however, there is much work to be done as social policy has failed to keep pace with medical advancements. 

The criminalization of key populations has especially devastating effects on epidemic control and response. Norm-setting institutions like UNAIDS, Human Rights Watch and WHO have long called for the repeal of laws that criminalize the transmission of HIV, sex work, drug use and same-sex sexual relationships. Indeed, there is ample evidence to suggest a strong correlation between punitive laws and higher rates of HIV transmission and incidence. In countries where same-sex sexual acts are criminalized, for example, the number of PLHIV who know their HIV status is 11 percent lower and viral suppression levels 8 percent lower.  Similarly, The Lancet Series on HIV and sex work demonstrated that the decriminalization of sex work could avert 33-46 percent of HIV infections in the next decade.  Research has also consistently shown that repressive drug law enforcement practices prevent people who use drugs (PWUD) from accessing public health services and markedly increase rates of HIV transmission among PWUD populations.

Without a strong, global effort towards decriminalization, key populations will continue to bear the burden of high HIV incidence and codified discrimination. Unfortunately, however, the majority of the world’s governments continue to over-incarcerate and ignore best-practice research.  During the United Nations General Assembly High-Level Meeting on AIDS in June, United Nations Member States failed to include a call for decriminalization in a new political declaration to end the global AIDS epidemic by 2030. Instead, world leaders adopted ambitious targets without committing to tangible policy changes in their own countries. Presently, only six countries in the world do not criminalize sex work and only seven countries have national laws that refrain from criminalizing personal drug use and possession. The majority of governments also criminalize non-intentional HIV exposure and transmission, which has been shown to increase stigma and discourage HIV testing.

Decriminalization is essential in the fight against HIV/AIDS. If governments are serious about addressing HIV, they must acknowledge that punitive attempts to control the behaviors of key populations perpetuate stigmatization and, ultimately, undermine global health equity. Without access to an enabling social and political environment, those most impacted by HIV/AIDS cannot and will not benefit from ever-expanding prevention and treatment options.    

Hannah Yore (she/her) is a New York based writer and advocate with expertise in the intersections of international human rights, sexuality, and gender.  All views expressed in this piece are her own.  Find her on Twitter at @HannahYore.