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Awareness and Understanding of HIV Non-disclosure Case Law and the Role of Healthcare Providers in Discussions About the Criminalization of HIV Non-disclosure Among Women Living with HIV in Canada

Abstract

In 2012, the Supreme Court of Canada ruled that people with HIV are legally obligated to disclose their serostatus before sex with a “realistic possibility” of HIV transmission, suggesting a legal obligation to disclose unless they use condoms and have a low HIV viral load (< 1500 copies/mL). We measured prevalence and correlates of ruling awareness among 1230 women with HIV enrolled in a community-based cohort study (2015–2017). While 899 (73%) participants had ruling awareness, only 37% were both aware of and understood ruling components. Among 899 aware participants, 34% had never discussed disclosure and the law with healthcare providers, despite only 5% being unwilling to do this. Detectable/unknown HIV viral load, lack of awareness of prevention benefits of antiretroviral therapy, education ≤ high-school and high HIV-related stigma were negatively associated with ruling awareness. Discussions around disclosure and the law in community and healthcare settings are warranted to support women with HIV.

Resumen

En 2012, la Corte Suprema de Canadá dictaminó que las personas con VIH están legalmente obligadas a revelar su estado serológico antes de tener relaciones sexuales con una “posibilidad realista” de transmisión del VIH, lo que sugiere una obligación legal de divulgar a menos que usen condones y tengan una carga viral baja (< 1500 copias/mL). Medimos la prevalencia y los correlatos de la conciencia dominante entre 1230 mujeres con VIH inscritas en un estudio de cohorte basado en la comunidad (2015–2017). Si bien 899 (73%) de los participantes tenían conciencia sobre el gobierno, solo el 37% conocía y entendía los componentes dominantes. Entre los 899 participantes conscientes, el 34% nunca había discutido la divulgación y la ley con los proveedores de atención médica, a pesar de que solo el 5% no estaba dispuesto a hacerlo. La carga viral del VIH detectable/desconocida, la falta de conciencia de los beneficios de prevención de la terapia antirretrovírica, la educación en la escuela secundaria y el alto estigma relacionado con el VIH se asociaron negativamente con la conciencia dominante. Las discusiones sobre la divulgación y la ley en entornos comunitarios y de atención médica están justificadas para apoyar a las mujeres con VIH.

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Acknowledgements

The authors would like to thank all CHIWOS participants for giving their time and voices to this study. CHIWOS is funded by the Canadian Institutes of Health Research (CIHR), the CIHR Canadian HIV Trials Network (CTN 262), the Ontario HIV Treatment Network (OHTN), and the Academic Health Science Centres (AHSC) Alternative Funding Plans (AFP) Innovation Fund. SP received support in the form of a Study Abroad Studentship from the Leverhulme Trust, AC received support from a CIHR Doctoral Award, AdP received salary support through the Fonds de Recherche du Quebéc—Santé (FRQS) (Chercheur-boursier clinicien), and AK received salary support through a Tier 2 Canada Research Chair in Global HIV and Sexual and Reproductive Health. M-JM is supported by the United States National Institutes of Health (U01-DA0251525), a New Investigator award from CIHR and a Scholar award from the Michael Smith Foundation for Health Research. His institution has received an unstructured gift from NG Biomed Ltd., a private firm seeking to produce medical cannabis, to support him. He is the Canopy Growth professor of cannabis science, a position created by arms’ length gifts to the University of British Columbia by Canopy Growth, a licensed producer of cannabis, and the Government of British Columbia’s Ministry of Mental Health and Addictions.

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Correspondence to Angela Kaida.

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Appendix A

Appendix A

Brief definition of 2012 SCC ruling discussed with all participants answering CHIWOS survey questions on the criminalization of HIV non-disclosure.

In Canada, people living with HIV can face criminal charges for not telling their sexual partners what their HIV status is, even if they do not intend to transmit HIV, and even if no HIV transmission actually occurs. In 2012, the Supreme Court of Canada ruled that people living with HIV must disclose their HIV status to a sexual partner before having sex unless they use condoms AND have a viral load of 1500 copies/mL or less. People who do not meet these criteria can face a criminal charge of aggravated sexual assault if they do not tell their sexual partners they have HIV. To summarize, people living with HIV are legally required to disclose their HIV status to sex partners UNLESS they use a condom AND have a viral load less than 1500 copies/mL.”

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Patterson, S., Nicholson, V., Milloy, M. et al. Awareness and Understanding of HIV Non-disclosure Case Law and the Role of Healthcare Providers in Discussions About the Criminalization of HIV Non-disclosure Among Women Living with HIV in Canada. AIDS Behav 24, 95–113 (2020) doi:10.1007/s10461-019-02463-2

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Keywords

  • HIV
  • Women
  • Criminalization of HIV non-disclosure
  • Canada
  • CHIWOS
  • Community based research