The Role of Law in the HIV/AIDS Epidemic
World AIDS Day, Dec. 1, is a time to reflect on how far the United States and world populations have come since the disease was first identified in 1981, as well as what we still need to do to respond to the epidemic.
Others can talk about the scientific achievements that have helped stem the devastation wrought by the disease such as the introduction of the HIV test in 1985, the 076 protocol that dramatically reduced the risk of mother-to-child transmission, and the introduction of highly active antiretroviral therapy in 1996 that substantially improved the lives of those living with HIV. Instead, I wish to reflect on the role law in the epidemic.
In the early days, my former colleagues in San Francisco watched estranged families take control over their sons’ medical decision-making, often in violation of the patients’ and their partners’ wishes. The law came to the rescue with advance directives and health care proxies. These tools allowed dying patients to specify what care they would accept and who they wanted to make decisions when they could not and gave authority to physicians to honor those wishes.
The adoption of strict confidentiality laws at the time the HIV test became available provided reassurance in a time when disclosure of an HIV infection could result in loss of employment, housing, even medical care. While some question whether such special protections are needed today, there is little doubt that they were instrumental in encouraging people to discover their HIV status.
The Ryan White Comprehensive AIDS Resources Emergency Act of 1990 ensured essential services were provided to those in need. The Supreme Court extended the protection of the Americans with Disabilities Act to those living with HIV in the 1998 decision of Bragdon v. Abbott. The President’s Emergency Plan for AIDS Relief has played a significant role in addressing the global AIDS burden.
Unfortunately, while the law often has had a positive impact on the epidemic, sometimes it runs counter to public health efforts at combatting the disease. Possession of syringes remains illegal in most states, despite evidence that access to clean syringes reduces HIV infection, without increasing drug use. And many states have laws that criminalize exposure to HIV through sexual activity, without taking into account current science regarding prevention measures that reduce the likelihood of transmission to practically zero. Globally, a number of countries have adopted criminal exposure laws in the last decade, just as federal support for them has waned.
So on World AIDS Day 2015, we rejoice in the various ways that law has helped in the response to the HIV/AIDS epidemic during the last 34 years. But we must also recognize where the law needs to change to support public health efforts and make an AIDS-free generation possible.
Leslie E. Wolf, professor of law and the director for the Center for Law, Health & Society, conducts research in a variety of areas in health and public health law and ethics, with a particular focus on research ethics. From 1998-2007, she was on faculty at University of California San Francisco in the Program in Medical Ethics and the Center for AIDS Prevention Studies. Her research has been funded by the National Institute of Mental Health, the National Cancer Institute, the National Human Genome Research Institute, the Agency for Healthcare Research and Quality and the Greenwall Foundation. This work includes empirical research on conflicts of interest, research with stored biological materials, Certificates of Confidentiality, IRB web guidance, and HIV-related laws and policies.