Intersections of Treatment, Surveillance, and Criminal Law Responses to HIV and COVID-19

• Published in: American journal of public health (1971) 2021-07, Vol.111 (7), p.1252-1254
• Main Authors: Hastings, Colin, McClelland, Alexander, Guta, Adrian, Owino, Maureen, Manning, Eli, Orsini, Michael, Elliott, Richard, Gagnon, Marilou, Molldrem, Stephen
• Format: Article
• Language: English
• Subjects: Access; Antiretroviral agents; Contact tracing; Contact Tracing - legislation & jurisprudence; COVID-19; COVID-19 - prevention & control; COVID-19 - transmission; Crime; Criminal law; Criminal Law - organization & administration; Criminalization; Data; Discrimination; Disease control; Disease transmission; Disease Transmission, Infectious - legislation & jurisprudence; Enforcement; Epidemics; Epidemiology; Everyday life; Genetic analysis; Genetics; Health research; Health services; Health surveillance; HIV; HIV Infections - prevention & control; HIV Infections - transmission; HIV/AIDS and Our World: 1981–2021; Human immunodeficiency virus; Humans; Infections; Intellectuals; Laboratories; Law enforcement; Medical research; Medical treatment; Pandemics; Phylogeny; Police; Public health; Quality of care; Racism; Surveillance; Viral diseases
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2021.306236

Public health institutions are playing an increasingly central role in everyday life as part of the response to the COVID-19 pandemic (e.g., through stay-at-home orders, contact tracing, and the enforcement of disease control measures by law enforcement). In light of this, we consider how COVID-19 disparities and disease control practices intersect with the response to the more longstanding epidemic of HIV infection in Canada and the United States. In a series of developments that predate COVID-19, the HIV response has been shaped by advances in antiretroviral treatment that made HIV infection a manageable condition for people with continuous access to high-quality health care. However, the HIV response has also involved the emergence of novel forms of public health surveillance, sometimes punitive disease control measures, and criminalization measures that have been criticized by people living with HIV and critical public health scholars.1 Developments in this area include the increased use of novel forms of phylogenetic analysis and molecular surveillance without individual consent or community consultation. In 2020, multiple epidemiological research groups published articles noting that they have begun to use phylogenetic analysis of HIV genetic sequence data (also called "molecular" HIV data) to infer the direction of HIV transmission between two individuals (i.e., to discern if "person A" transmitted HIV to "person B") with greater precision than was previously possible.2 This has raised concerns about how analyses of these data may propel prosecution of alleged HIV transmission or nondisclosure. In the context of COVID-19, we have also witnessed enhanced collaboration between police and public health as well as an expansion of policing in response to the pandemic. Critical public health scholarship4 can help make sense of how criminal law, the logics of criminalization, and public health work may be converging in new ways. As critical public health scholars, we argue that critical public health research agendas in this area can have the most impact when they (1) center race and racism, (2) investigate how public health surveillance technologies operate across key HIV disparity groups and across health systems (i.e., on the body, in laboratories, in health departments, and in care settings), and (3) enhance understandings of carceral public health practices.