For this assignment, provide a synopsis of the review of the research literature. Using the "Literature Evaluation Table," determine the level and strength of the evidence for each of the eight research articles you have selected. The articles should be c

20200709000331hiv___criminalization.pdf

Home >Business & Finance homework help >Management homework help >For this assignment, provide a synopsis of the review of the research literature. Using the "Literature Evaluation Table," determine the level and strength of the evidence for each of the eight research articles you have selected. The articles should be c

P E R S P E C T I V E

1174

Polluting Developing Brains

n engl j med 378;13 nejm.org March 29, 2018

Disclosure forms provided by the author are available at NEJM.org.

From the Heilbrunn Department of Popula- tion and Family Health and the Columbia Center for Children’s Environmental Health, Mailman School of Public Health, Columbia University, New York.

1. Slotkin TA, Seidler FJ. Comparative de- velopmental neurotoxicity of organophos- phates in vivo: transcriptional responses of pathways for brain cell development, cell

signaling, cytotoxicity and neurotransmitter systems. Brain Res Bull 2007; 72: 232-74. 2. Rauh V, Arunajadai S, Horton M, et al. Seven-year neurodevelopmental scores and prenatal exposure to chlorpyrifos, a com- mon agricultural pesticide. Environ Health Perspect 2011; 119: 1196-201. 3. Rauh VA, Perera FP, Horton MK, et al. Brain anomalies in children exposed prena- tally to a common organophosphate pesticide. Proc Natl Acad Sci U S A 2012; 109: 7871-6. 4. Bellinger DC. A strategy for comparing

the contributions of environmental chemi- cals and other risk factors to neurodevelop- ment of children. Environ Health Perspect 2012; 120: 501-7. 5. Silver MK, Shao J, Zhu B, et al. Prenatal naled and chlorpyrifos exposure is associ- ated with deficits in infant motor function in a cohort of Chinese infants. Environ Int 2017; 106: 248-56.

DOI: 10.1056/NEJMp1716809

Rethinking Criminalization of HIV Exposure — Lessons from California’s New Legislation Y. Tony Yang, Sc.D., LL.M., M.P.H., and Kristen Underhill, J.D., D.Phil.

Laws that criminalize certain behaviors on the basis of the person’s HIV status have long been challenged as ineffective preven- tion measures that harm public health. They are nevertheless wide- spread: according to the Center for HIV Law and Policy, 34 states have HIV-specific criminal statutes, and 23 have applied more general laws (e.g., against assault with a deadly weapon) in order to criminalize HIV exposure. Most of these laws don’t reflect current evidence re- garding protective factors such as antiretroviral treatment (ART), and many encompass behaviors that carry negligible risk.

California is now breaking from these precedents. In October 2017, Governor Jerry Brown signed SB 239, which reduces the criminal charges associated with exposing a sexual partner to HIV without dis- closing one’s HIV status. In place of former felony charges, Califor- nia will impose misdemeanor charges that carry a maximum of 6 months of jail time and will reserve penalties for intentional disease transmission. The law also repeals felony charges for solici- tation (prostitution) by people who have tested positive for HIV, and it decriminalizes their donation of blood or tissue.

The strongest arguments for criminalizing HIV exposure em- phasize two functions of criminal law: retribution and deterrence. But emerging evidence casts doubt on both those justifications. The justification for criminalizing HIV exposure for the purpose of retri- bution is that such behavior is morally blameworthy. If we follow this rationale, the defendant’s state of mind is important. Most HIV- specific statutes, however, omit intent to infect as a condition of the offense — simply being aware of one’s HIV status is enough to warrant a penalty. Such laws also do little to differentiate among reasons for nondisclosure (e.g., fears of partner violence, or eco- nomic necessity for sex workers), and they often impose heavy penalties for conduct that poses slim risks of infection or about which there is substantial moral ambiguity.1 Retribution is partic- ularly inappropriate for behaviors that have virtually no capacity to transmit infection, and prevention tools for HIV-positive people (e.g., ART) have reclassified many ac- tivities as lower risk.

Evidence also indicates that penalties associated with HIV- specific statutes are unevenly im- posed on the basis of race and

sex. In California, for example, black and Latino people compose half the population of people with HIV but two thirds of defendants in HIV-criminalization cases; black women, in particular, account for only 4% of the state’s HIV- positive population but 21% of these cases.2 Moreover, among people arrested for HIV-related crimes, white men were released and not charged in 61% of inci- dents, as compared with 44% of incidents for black women, 39% for white women, and 38% for black men. Discriminatory en- forcement of HIV-criminalization statutes compounds injustices based on race, sex, and socioeco- nomic status, and it undermines the retributivist rationale for HIV criminalization.

Judged against the goal of deterrence, HIV-specific statutes haven’t been successful, and they may detract from more effective prevention efforts such as advanc- es in treatment and blood-supply screening. Past analyses have found that neither the presence of an HIV-criminalization statute nor people’s awareness of it affects their views regarding responsi- bility for HIV transmission.1 These statutes therefore may not affect moral calculations for people mak-

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Rethinking Criminalization of HIV Exposure

n engl j med 378;13 nejm.org March 29, 2018

ing disclosure decisions. And al- though awareness of the law and fear of prosecution have been as- sociated with earlier disclosure of serostatus, analyses have found no effect of these statutes on rates of sex without using con- doms or on HIV or AIDS inci- dence,1,3 perhaps in part because 40% of new infections can be traced to people who don’t know their HIV status.4

The deterrence rationale is par- ticularly weak for statutes that neglect scientific evidence on HIV transmission and prevention. A majority of Americans with HIV have achieved viral suppression, which is proven to reduce, if not eliminate, transmission risk. Sim- ilarly, criminalization of blood donation neglects the fact that donated blood is now screened for HIV before use, resulting in residual risks that are lower than 1 per 1 million donations, and Food and Drug Administration guidelines exclude donors who may be at risk. Criminalizing blood donation by people with HIV doesn’t add to these protec- tions and may discourage donors from disclosing information on risk behaviors.

Research increasingly suggests that HIV-criminalization statutes can also cause harm. Such laws may increase HIV-related stigma, which is linked to poor engage- ment in care. The possibility of criminal penalties for known ex- posure may also encourage peo- ple to remain unaware of their HIV status and to withhold infor- mation that is central to partner- notification efforts. One analysis, for example, found that HIV test- ing decreased after there was media coverage of HIV-specific prosecutions.5 Providers have also reported that criminalization in- hibits trusting relationships with their patients with HIV, potential-

ly leading to deferred ART treat- ment (and reducing its potential for preventing transmission).

Unlike most state legislation pe- nalizing HIV exposure, California’s new misdemeanor statute reflects up-to-date science. The law applies only to people who know they have an infectious disease, who act with specific intent to transmit the dis- ease to another person, who en- gage in conduct posing a substan- tial risk of transmission without attempting to prevent transmis- sion, and who transmit the disease to someone who doesn’t know that the person is infected. Behaviors such as spitting and biting aren’t considered to pose substantial risk, and acquiring an infection while pregnant and refusing treat- ment while pregnant are specifi- cally exempted. The statute en- compasses all infectious diseases, not just HIV — which may miti- gate HIV-related stigma.

We believe that California’s new legislation is a meaningful im- provement over its former law, although the remaining misde- meanor charge may still permit discriminatory enforcement based on race and sex. HIV status may also still be used as a sentence enhancement for some noncon- sensual sex offenses.

California is not alone in tak- ing a more evidence-based and less stigmatizing approach to HIV prevention. In 2016, for example, Colorado repealed two HIV-crim- inalization laws and modernized its statutory language regarding sexually transmitted infections. But additional developments coun- sel against optimism; the Ohio Supreme Court recently upheld a charge of felonious assault for peo- ple with HIV who have sex with- out disclosing their HIV status.

Laws criminalizing HIV expo- sure and transmission can dis- tract from the real challenges in-

volved in preventing the spread of HIV, and they fail to account for the structural factors that under- lie risk. We believe existing HIV- criminalization statutes should continue to be restructured, amended, or repealed. A broad- based harm-reduction approach could involve modernizing statu- tory language on infectious dis- ease, updating prosecutorial guide- lines, developing guidance to support HIV treatment and test- ing efforts that may be affected by laws, and supporting research into how criminal statutes affect HIV prevention and treatment. By providing draft language for amended legislation and crafting model policies for public health authorities, researchers and advo- cates can help states move to- ward more evidence-based and effective responses to HIV.

Disclosure forms provided by the authors are available at NEJM.org.

From the Department of Health Adminis- tration and Policy, George Mason University, Fairfax, VA (Y.T.Y.); and the Columbia Law School and the Mailman School of Public Health, Columbia University, New York, NY (K.U.).

1. Burris S, Beletsky L, Burleson JA, Case P, Lazzarini Z. Do criminal laws inf luence HIV risk behavior? An empirical trial. Ariz State Law J 2007; 39: 467-519 (http://ssrn .com/ abstract=977274). 2. Hasenbush A, Miyashita A, Wilson BDM. HIV criminalization in California: penal implications for people living with HIV/ AIDS. Los Angeles: The Williams Institute, December 2015 (https:/ / williamsinstitute .law .ucla .edu/ research/ health-and-hiv-aids/ hiv-criminalization-in-california-penal -implications-for-people-living-with-hivaids/ ). 3. Sweeney P, Gray SC, Purcell DW, et al. Association of HIV diagnosis rates and laws criminalizing HIV exposure in the United States. AIDS 2017; 31: 1483-8. 4. Dailey AF, Hoots BE, Hall HI, et al. Hu- man immunodeficiency virus testing and diagnosis delays — United States. MMWR Morb Mortal Wkly Rep 2017; 66: 1300-6. 5. Lee SG. Criminal law and HIV testing: empirical analysis of how at-risk individuals respond to the law. Yale J Health Policy Law Ethics 2014; 14: 194-238.

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