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It should be noted that behavioral interventions are not only the above three, it also includes health education, testing and so on. Generally speaking, behavioral intervention is a kind of HIV prevention and control measure which is distinctly different from legal control. It more focuses on achieving the goal of AIDS prevention and control from the perspective of public health. With the increasing importance of behavioral interventions attached by governments, more and more epidemiological studies have revealed the possibility and necessity of behavioral intervention in HIV prevention and control. Vergidis and Falagas’s (2009) results have showed that there are less than a third of the target population were willing to use condoms before the intervention. After the intervention, the target population's AIDS knowledge rate increased significantly, the number of who used condoms significantly increased.
Mayer, Mimiaga and Safren’s (2017) survey results showed that drug users' needle sharing rate, water and container sharing rate decreased significantly after intervention, and the number of drug users' daily injections was also significantly reduced. Therefore, it is believed that needle exchange combined with propaganda interventions can not only significantly reduce drug users' sharing of needles, washing water and containers, but also reduce the frequency of drug users' needles sharing, while it will not increase the number of drug addicts' drug injections.
Certainly, it should be noted that behavioral interventions of HIV is also facing a dilemma, there is an obvious conflict between legal punishment policy and HIV intervention, some people advocate "legalization of sex", which can not get moral and legal support; part of the public misunderstand commercial sexual interventions, they suggest that interventions carried out towards sex workers are an indulgence of illegal behavior; sex workers are in a weak position in sex trade and they can not decide whether to use condoms (Chidrawi, Greeff, Temane and Doak, 2016). The widespread use of condoms as an important measure of HIV prevention and control, which has been widely understood and supported by the public, but there has been widespread ethical and legal controversy from the outset of implementation of the measure, and many people are worry about that it will encourage juvenile promiscuous sexual activity, Extra-marital sexual activity and even prostitution activities, the controversy has a direct impact on the practical effect of condom promotion (Mayer, Mimiaga and Safren, 2017).
2.3 Discussion
Whether HIV transmission should be punished is a complex issue. Before discussing this issue, it is necessary to clarify the principled views of the government and the public on HIV transmission. According to Mayer, Mimiaga and Safren’s (2017) research, the author believes that at least the following three principles should be definite, first, it should be able to effectively control HIT transmission. Second, whether it is in line with the principle of economic costs, whether it is feasible. Finally, it should protect the rights of AIDS patients.
Considering from the view of effectiveness, the legal means for the deliberate HIV transmission is clear and severe, which can not only deter those who have the intention to transmit HIV, but also prevent them to continue to harm other people, however, for unconscious HIV transmission behavior, the role is not significant (Graham, Treadwell and Braithwaite, 2008). The use of behavioral interventions and other non-punitive means plays an important role in the control of unconscious HIV transmission behavior, because it helps to popularize and enhance public awareness of anti-HIV, for those who have behavior of intentional transmission of HIV, it lacks coercion (Chidrawi, Greeff, Temane and Doak, 2016).
From the feasibility point of view, using legal means to punish HIV transmission behavior will allow some patients with HIV to hide their identity, which increases the cost of controlling HIV transmission, and for those who spread HIV consciously, legal means also increases their crime costs, deterring them. The use of non-punitive means allow HIV carriers to accept control frankly, which can indeed reduce management costs, but for people who consciously spread HIV, behavioral interventions are actually invalid, that is, the costs for behavioral interventions towards them are actually waste.
From the rights point of view, the use of non-punitive means can really guarantee the rights of people with AIDS, and the use of legal means to punish people with behavior of HIV transmission will violate the patients' rights, but this rights damage is not unavoidable, such as infringing privacy, causing discrimination, limiting the access to condoms of AIDS patients in prisons, etc., through a series of measures can effectively reduce damage of their rights. For instance, it should protect personal privacy while investigating and forensics for trials, publicizing in public about the differences between AIDS patients and those who transmit HIV intentionally to reduce public discrimination against AIDS patients, reduce public discrimination, it should strengthen prison management to provide more condoms and other HIV prevention tools and medicines (Weber and Grant, 2015).
Considering from the perspective of social and public health, the use of non-punitive means has lot of benefits, but for those who have intention to transmit HIV, the control is not enough. Based on the above analysis, the means of punishment for behavior of conscious spread of HIV has more control, and the costs will not be increased a lot, the ethical issues brought can also be under control, while non-punitive means can control behavior of unconscious HIV transmission better. Then from this point of view, whether punishment means should be adopted towards HIV transmission depends on what kind of control objects it faces. The author comments that people who have behavior of spreading HIV intentionally should be punished by laws. The reasons are listed as follows. First, according to data in the United States, in 2011 there were about 1.2 million people carrying HIV. Among this group of people, 14% of them did not know that they were infected with the deadly virus (Chidrawi, Greeff, Temane and Doak, 2016), which means that only 14% of people can be completely ruled out from the possibility of intentionally spreading HIV, the vast majority of people who spread HIV are aware of their infection with the virus. Second, the behavior of transmitting HIV intentionally is very bad, because they deliberately take no protective measure, resulting in more possibility of spreading HIV, at the same time, events of deliberately spreading HIV are also likely to cause public panic after disclosure, it will also cause the public’s negative stereotypes for AIDS patients. Finally, if those who spread HIV consciously are not punished by laws, it will go against the spirit of existing law, because in essence, intentionally spreading HIV and other intentional assault have a lot in common (Gable, Gostin, Hodge. 2009).
Actually, the use of legal punishment for intentional HIV transmission behavior is not appropriate in the following circumstances, such as there is no obvious risk in the HIV transmission behavior; it is not clear that whether HIV can be transmitted; disclosure of his / her HIV-positive status will bring serious negative consequences and risks; reasonable measures have been taken to reduce the risk of HIV transmission, or the two sides in advance accept the possible risks to reach a consensus (Chidrawi et al., 2009).
3.0 Conclusion
Judging from the perspective of social and public health, the use of non-punitive means has a lot of benefits, but for those who transmit HIV intentionally, the control is not enough. The punishment means for behavior of spreading HIV consciously has more control, and the costs will not be increased a lot, the ethical problems brought can also be under control, and non-punitive means can control the behavior of unconscious spread of HIV better. The author suggests that those who spread HIV intentionally should be punished by law. The reasons are shown as follows: first, only 14% of people can completely rule out the possibility of intentionally spreading HIV, the vast majority of people who know that they have been infected with HIV before they transmit the virus to other people. Second, the behavior of spreading HIV intentionally is very bad. Thirdly, setting free those who have intention to spread HIV goes against the spirit of existing laws. Of course, the use of legal punishment for intentional HIV transmission behavior is not appropriate in some special circumstances.
References
Balisanga, H. et al. (2016). HIV surveillance in Rwanda: readiness assessment to transition from antenatal care-based to prevention of mother-to-child transmission program-based HIV surveillance. International Journal of Infectious Diseases, 52(11), 62-67.
Brown, W., Hanefeld, J. and Welsh, J. (2009). Criminalising HIV transmission: punishment without protection. Reproductive Health Matters, 17(34),119-126.
Chidrawi, H. C., Greeff, M., Temane, Q. M. and. Doak, C. M. (2016). HIV stigma experiences and stigmatisation before and after an intervention. Health SA Gesondheid, 21(12), 196-205.
Dodds, C., Bourne, A. and Weait, M. (2009). Responses to criminal prosecutions for HIV transmission among gay men with HIV in England and Wales. Reproductive Health Matters, 17(34), 135-145.
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Graham, L. F., Treadwell, H. M. and Braithwaite, K. (2008). Social policy, imperiled communities and HIV/AIDS transmission in prisons: a call for zero tolerance. Journal of Men's Health, 5(4), 267-273. |
