A QUARTERLY JOURNAL ON HIV PREVENTION, TREATMENT AND POLITICS SUMMER 2011 acHIeVe INSIDE HIV AND HCV IN U.S. PRISONS: DEBUNKING THE MYTHS 8 Prosecuting There is a wide- spread false belief that most inmates with HIV and HCV were infected while HIV: in prison. But most were infected before entering prison. Take Personal Perspective: KEEP IT TO YOURSELF 10 the Test He kept screaming at her, “Don’t ever touch me, you monster!” and Risk GETTING OUT AND STAYING OUT: MAKING DISCHARGE Arrest? PLANNING WORK 12 Prisoners with HIV have specific needs that must be addressed if they are going to make the transition successfully. by Sean Strub If convicted, you face decades in prison, lifetime registration as a sex offender, and SINCE WHEN ARE CONDOMS magine meeting someone online, hav- other restrictions; if acquitted, your life ILLEGAL? 16 ing a nice chat, and then deciding to is still never the same, because you will Prisoners need hook up. You have HIV, but you’re always be known as the “AIDS Monster”. them, since the adherent to your meds and have had Think about that for a moment: reality of prison life Ian undetectable viral load for years. You Consenting adults. No intent to harm. often includes sex. and your sexual partner use a condom. Undetectable viral load. A condom was Sex workers need Sometime later, the partner learns you used. No HIV transmission. Twenty-five to be able to carry have HIV and presses charges against you years in prison. This isn’t hypothetical; it them without fear for failing to disclose your HIV status is exactly what happened in a recent case of arrest. prior to sex. in Iowa. In fact, as of July 2009 Iowa had Your life is suddenly turned upside Personal Perspective: charged nearly 2% of all Iowans with HIV down, with your name and picture FREED FROM PRISON, BUT NOT with similar crimes. splashed across the media. You are called FREE 20 There have been hundreds of pros- an “AIDS Monster”. You and your family ecutions for HIV crimes in the U.S., all and friends feel humiliated and embar- EDITORIAL 23 over the country. As of today, 34 states rassed. Your employment, housing, and and territories have HIV-specific stat- relationships may be put in jeopardy and utes, but a targeted law isn’t required to Achieve is a joint publication of you need to find tens of thousands of prosecute an HIV crime. These prosecu- ACRIA and GMHC. dollars for legal fees for the impending tions usually have little bearing on the prosecution. actual level of risk of HIV transmission, continued on page 3 acHIeVe ACRIA Trials in Progress BMS-663068 EDITOR IN ChiEF People with HIV who are 18 and protease inhibitor) with peg-interferon Daniel Tietz older and who have become resis- and ribavirin for 12-48 weeks. Janet Weinberg tant to more than one HIV medica- BI 201335 EDITOR tion will take BMS-663068 (an Mark Milano experimental HIV attachment inhibi- People aged 18 to 70 who have tor) or Reyataz for up to 96 weeks. hepatitis C virus and HIV will take ASSOCiaTE EDITORS Everyone will also take Isentress BI 201335 (an experimental HCV Luis Scaccabarrozzi and Viread. protease inhibitor) with peg-interferon Nathan Schaefer and ribavirin for 12-48 weeks. Robert Valadéz Crofelemer Ibalizumab MEDICAL EDITOR People with HIV who are 18 and older and have diarrhea that has not People who are HIV negative will Jerome A. Ernst, MD responded adequately to treatment receive four weekly injections of PUBLICATIONS MaNAGER will take crofelemer for up to a year. ibalizumab (a monoclonal antibody) Mark Milano to study its safety and effect on the Cenicriviroc (TBR-652) immune system. PUBLICATIONS ASSOCiaTE People with HIV who are 18 and Laura Engle Selzentry older and who have not taken HIV meds will take either Cenicriviroc People with HIV who are 18 and older and who have not taken HIV Bulk copies of Achieve are avail- (an experimental CCR5 inhibitor) or Sustiva for a year. Everyone will also meds will take either Selzentry or able free to organizations that take Truvada. Truvada for 22 months. Everyone will provide services to people with also take Prezista with Norvir. HIV. For more information, call BI 201335 For more information on these trials, 212-924-3934, ext. 134, email People aged 18 to 70 who have hep- contact us at 212-924-3934, ext. 130. [email protected], or write to atitis C virus but not HIV, and who Achieve have not taken interferon, will take Compensation is available for some 230 West 38th St., 17th floor BI 201335 (an experimental HCV studies. New York, NY 10018. Copyright © 2011 AIDS Community Research Initiative of LETTERS TO The ediTOR America and Gay Men’s Health Crisis. All rights reserved. Non- To The Editor: to speak. I want my voice heard. Once this incarceration is over, I commercial reproduction is I have been a peer educator at a encouraged provided appropriate plan to advocate on different issues correctional facility for a while. I credit is given. Subscription lists – I want to be the person I was put love educating and advocating. are kept confidential. on this earth to be. Your publication is so informative Photos used in Achieve imply I am organizing a World AIDS nothing about the health status, – this is where I get my up-to- Day ceremony. Participants will sexual orientation, or life history date statistics. I plead with the dedicate a patch to someone and of the models. public to help teach the basics of I will read the new statistics and healthy behaviors. Achieve would love to hear from you! tell my story. Please send your comments to: I face all types of young adults and I’d love to be on your mailing list and Letters to the Editor even older people who still label get info on volunteering because I’ll Achieve you. It’s sad because no one here be out in March. 230 W. 38th St., 17th floor in the prison system wants to be New York, NY 10018 labeled, so they remain in denial. Thank you, Or email them to: [email protected] I, for one, am very open. I’m liv- Caridad ing with HIV and HCV and choose 2 SUMMER 2011 acHIeVe Prosecuting HIV continued from first page ignoring factors like whether a condom was used or the viral load of the person with HIV. It’s important that people with HIV and their advocates understand the issues at stake, the risk they present for people with HIV, and how they may undermine public health strategies to reduce HIV transmission. The issue is complicated, especially since the public is generally sup- portive of criminal prosecution of people with HIV who do not disclose their HIV status to a partner before sex. One study, from the University of Minnesota, showed that about 2/3 of gay men supported such prosecutions; among very young gay men, it approached 80%. Even among gay men with HIV, it was nearly 40%. Outside of gay men, it is likely that support for these statutes is even higher. Criminalization supporters often believe these statutes are effective in reducing HIV transmission, but there are no data to support this; in fact, These laws not only require people to there is a growing body of research disclose their HIV status to partners, but demonstrating that they do not reduce HIV transmission and may even con- also to be able to prove it in a court of law. tribute to its further spread. Imagine this line at a bar: “Let’s go home A Viral Underclass and get it on. Since I have HIV, could you Since the earliest days of the AIDS epi- demic, stigma has been a major obstacle sign this affidavit stating that I told you to effective HIV prevention and care. Even as fear of contagion from casual that? We can stop by a notary public on the contact has lessened over the years, pro- way home and get it notarized.” found stigma persists. People with HIV face judgment, marginalization, discrim- ination, and misunderstanding about the Nothing drives stigma more than who have not tested positive for HIV, actual risks of transmission. when government sanctions it by unremarkable. Many people with HIV internalize enshrining discriminatory practices This is reflected perhaps most dra- and accept this judgment, perpetuat- in the law. That is what has hap- matically in the criminal prosecution of ing the perception of those with HIV as pened with HIV, resulting in the cre- people who know they have HIV but are toxic, highly infectious, or dangerous ation of a “viral underclass” of people unable to prove they disclosed their sta- to be around. This has serious adverse with rights inferior to other citizens. tus prior to sexual contact. The osten- effects on them personally, as well as for Stigma driven by HIV criminaliza- sible purpose of these statutes is to deter the broader effort to combat the epidemic tion promotes illegal discrimination HIV-positive people from putting others while protecting sexual freedoms. against people with HIV, including at risk. The inherent problem with these Stigma discourages people at risk prohibitions on certain occupations laws is that they focus primarily on the from accessing care – including testing and licensing. existence of proof of disclosure, not on for HIV – and it discourages people who After three decades of the epidemic, the nature of the exposure, the actual know they are HIV positive from dis- people with HIV continue to experience level of risk present, or whether HIV was closing to potential sexual partners and punishment, exclusion from services, and transmitted.