The Public Health Police

As the HIV epidemic wore on in the 2000s, public health authorities became enamored with the idea of “ending AIDS.” That is, if they could just get HIV-positive people to take their pills and stop infecting other people. Health departments began to track HIV-positive clients more closely, aiming to control their behavior and ensure their adherence to treatment regimens. This chapter explores how local health authorities ensure that HIV-positive clients behave in a manner officials deem responsible—and how they catch and punish those who do not. While the state maintains that the work of local health officials is done solely in the interests of promoting public health, their efforts to control HIV-positive clients reveal that they are also engaged in policing and law enforcement.

“HIV Stops with Me”

When the CDC announced its new priorities for HIV prevention in 2003, many public health advocates were alarmed—where were the condoms? This announcement came on the heels of a growing sentiment among public health experts that declining rates of condom use required new strategies for keeping the epidemic in check. This chapter tells the story of how a series of CDC policy shifts over the next decade worked to “repolarize” the very notion of HIV prevention away from targeting HIV-negative people and toward targeting people living with HIV. By framing people living with HIV as individually responsibility for preventing new infections, public health officials contributed to the notion that people with a communicable disease are responsible for their illness and, as such, blameworthy for its continued spread.

Punishment

From the very beginning of the epidemic, AIDS was linked to punishment. Calls to punish people living with HIV—mostly stigmatized minorities—began before doctors could even name the disease. Punitive attitudes toward AIDS prompted lawmakers around the country to introduce legislation aimed at criminalizing the behaviors of people living with HIV. Punishing Disease explains how this happened and with what consequences. Now that the door to criminalizing sickness is open, what other ailments will follow? With lawmakers moving to tack on additional diseases, such as hepatitis and meningitis, the question is more than academic.

HIV on Trial

After the first successful conviction of an HIV-positive person in Michigan, the number of criminal cases quickly grew throughout the 1990s. In this chapter, I go inside the courtroom to show how courts justify their often-harsh sentences by calling HIV-positive defendants murderers and by casting HIV as a deadly weapon. I draw on an original dataset including court transcripts from over one hundred criminal court cases in Michigan and Tennessee that led to convictions. Even in cases in which the defendant could not have plausibly infected their partner, judges scold defendants for being a deadly threat to society. The various intricacies of each case seem to matter little—suggesting that HIV, not the defendant, was on trial.

Making HIV a Crime

When a new deadly disease emerged in urban gay enclaves in the early 1980s, officials originally named it G.R.I.D. (gay-related immune deficiency). The New Right used AIDS as the latest evidence of America’s moral decline, stoking public fears that the disease would spill over into the “general population” and demanding that states implement more invasive control measures. This chapter explores how campaigns to criminalize HIV spread across the country starting in the mid-1980s. Fears of sex work and homosexuality drove early efforts, while one state’s law helped to spread HIV-specific criminal laws across the nation—sparking an epidemic of legislation that would spread to forty-five states.

Punishing Disease

The criminalization fever has arrived, and recent developments suggest it may be contagious. In 2014, Iowa reconsidered its HIV-specific criminal law after a widely reported case involving an HIV-positive gay man accused of having sex with a condom yielded a twenty-five-year prison term and lifetime sex offender registration. After a statewide advocacy campaign, the Iowa legislature moved to reduce the penalties for cases involving low risk—a success that was widely heralded by advocates as a sign of “modernization.” Less discussed was the simultaneous move to add a bevy of other infectious diseases to the criminal law, including tuberculosis and hepatitis. Left-leaning advocacy groups celebrated this shift as a triumph over AIDS stigma. Iowa’s legislative reform comes on the heels of a similar expansion in Tennessee, where the legislature voted to extend their HIV-specific criminal statute to individuals infected with Hepatitis B or C. These troubling developments suggest that the logic of criminalizing diseases is spreading and becoming more deeply entrenched in American society. This chapter reviews how this happened and explains why it is a problem for American society.

Victim Impact

During the summer of 2014, an explosive arrest was splashed across Midwestern newspapers: a young gay black man in a conservative county in Missouri and the accusations against him quickly became a flashpoint for racial and sexual politics—leading some critics to charge that HIV-specific criminal laws target gay black men. This chapter draws on an original dataset of convictions under HIV-specific criminal laws in six states to evaluate whether the enforcement of HIV exposure and disclosure laws has discriminatory effects. Findings show that victim characteristics—rather than defendant demographics—shape uneven patterns in the application of the law. This victim impact flips expected patterns of discrimination on their head, resulting in more convictions among heterosexual and white defendants; at sentencing, black defendants are punished more severely, women are treated more leniently, and men accused of not disclosing their HIV status to women are punished more harshly than those accused by men. This chapter digests these trends using the tools of sociology, epidemiology, and criminology to offer a specific diagnosis for reform.

Controlling Typhoid Mary

While quarantine was a staple of public health efforts for centuries to combat such scourges as the plague and the Spanish flu, with the advent of vaccines, antibiotics, and new treatments in the twentieth century, public health practitioners increasingly viewed quarantine as a regressive and backward approach. These revolutionary technologies effectively put an end to diseases that had once killed or maimed millions, such as polio and smallpox—leading to a new optimism among medical scientists that society might one day be rid of infectious diseases. As chronic illness replaced infectious disease as the leading cause of death in the twentieth century, public health came to view individual health behaviors—such as smoking and diet—as the primary cause of disease. Under this new individualism, smokers and the obese became the new Typhoid Mary. To control these modern health threats, public health devised new strategies, such as health marketing and education. But the volatile politics of AIDS threatened to turn back the clock on public health practice, as conservatives demanded that HIV-positive people be quarantined—or worse.