HIV criminalisation deters men from testing and can increase HIV transmission rates
愛滋入罪化使人怯於篩檢，無助於降低新感染率
2018.04.09

Findings show that fear of prosecution can drive new infections, as it puts men off knowing their status.

研究發現，恐懼被起訴會驅使新感染人數上升，因為人們會因此怯於篩檢。

A new study published in medical journal PLOS ONE highlights how laws criminalising HIV transmission may deter men who have sex with men from testing. The study found that 7% of respondents would be less likely to test as a result of non-disclosure laws in Canada, with knock-on effects on overall HIV-transmission potential.

發表於醫學期刊 PLOS ONE 的一項新研究強調愛滋入罪化如何使 MSM 族群怯於篩檢。研究發現，加拿大的蓄意傳染法使 7% 的受試者更不傾向於進行篩檢，可能造成擴大整體愛滋疫情的連鎖反應。

Current laws in Canada state that people diagnosed with HIV have a duty to disclose their status before ‘a sex act that holds a realistic possibility of transmission’. Therefore knowing your own HIV status can lead to you being held responsible for non-disclosure and transmission.

現行加拿大法律規範愛滋確診者從事「具實在傳染他人可能性之性行為」前有告知他人的義務。因此，你一但知道自己感染愛滋，就可能引來不告知與傳染他人的法律責任。

The study (conducted between 2010 and 2012, but published last month) recruited 150 HIV-negative men who have sex with men attending a primary care clinic in Toronto. All were asked to complete self-interview questionnaires, including whether non-disclosure laws made them less likely to test for HIV.

這項研究進行於 2010 至 2012 年間，但上個月才發表。研究者找來 150 位愛滋陰性 MSM 前往多倫多一所基礎醫療門診，所有人必須完成一份自我填答問卷，調查內容包括蓄意傳染法是否讓他們更不傾向於進行愛滋篩檢。

Although it was only a relatively small proportion of the respondents who claimed to be put off testing by these laws, the study showed that this can have a big impact on HIV transmission rates at a population level.

After testing positive for HIV in Canada, most people are linked to care and able to access antiretroviral treatment. Effective treatment reduces the viral load of a person living with HIV, often to the point that they are no longer able to transmit the virus.

儘管只有相對少部分的受試者填答法規確實使他們怯於篩檢，研究指出這將在人口層級的愛滋傳染率造成巨大影響。在加拿大，檢驗出感染愛滋後，大多數感染者會被引入醫療體系取得抗病毒藥物。有效的治療能降低感染者的病毒量，達到不具傳播風險的程度。

With this in mind the researchers were able to estimate the probable effect of reduced testing on HIV transmission at a community level.

根據這點，研究者得以推估篩檢率下降對社群內部的愛滋感染率所造成的效應。

They predicted that a 7% decrease in testing could lead to a potential 18.5% increase in HIV infections among the community. Overall people who didn’t test, and therefore were not on antiretroviral treatment, would account for 73% of the total transmission potential within the group, according to their calculations.

他們預測篩檢率下降 7% 將增加社群內部 18.5% 的新愛滋感染率。根據他們的計算，所有因沒接受篩檢而沒接受治療的感染者將直接促成族群內部 73% 的傳播風險。

The predicted effects were thought to be so strong that, even if condom use increased as a result of these laws, transmissions may still go up, as it would not be enough of a change to compensate for these individuals not being enrolled on ART.

這項預測效應如此強而有力，告訴我們即使保險套使用因法律規範而上升，疫情仍可能持續擴大，因其不足以填補未接受抗病毒療法者具備的病毒傳播潛能。

HIV criminalisation laws have further negative implications, as they create stigma around the virus, which can make it harder for people living with HIV to disclose their status, and negotiate condom use.

愛滋入罪的負面效應不僅於此，它還創造了環繞病毒的污名，使感染者更難告知感染事實，協商使用保險套。

Since January 1989, at least 184 people living with HIV have been prosecuted in Canada for not disclosing their HIV status before sex.

The law changed in 2012, shortly after this study was conducted, so as to give a more specific definition of what constitutes a ‘realistic possibility of transmission’. As a result, a person living with HIV is no longer legally obliged to disclose their status if they use a condom and have a ‘low’ viral load. 

加拿大自1989 年 1 月起，至少有 184 名愛滋感染者因未在性愛前告知而被起訴。2012 年，剛好在這項研究進行不久後，修法針對「實在傳染他人可能性」的構成要件給出更明確的定義。從此，感染者只要使用保險套及具「低」病毒量就毋需承擔告知的法律義務。

Yet many claim that this still 'overciminalizes' HIV. In 2017, the federal Justice Minister acknowledged the need to relax the law further, in a report which stated that HIV transmission is first and foremost a public health matter and that criminal law should only be used as a last resort. The report also recognised that those with an undetectable viral load should not face prosecution for non-disclosure as ‘this goes against the science’. However, these statements are not yet reflected in the law. 

仍有許多人認為該次修法依舊「過度入罪化」愛滋。2017 年，加拿大聯邦司法部長在一份報告書中承認有必要將法律更進一步鬆綁，愛滋疫情是公共衛生的首要議題，而刑事法只能被用來當作最後手段。這份報告書同時也承認病毒量測不到的感染者不能因未告知而被起訴，因為「這違反了科學證據」。然而，上述聲明目前尚未反映到再次修法。

出處：https://www.avert.org/news/hiv-criminalisation-deters-men-testing-and-can-increase-hiv-transmission-rates