Synopsis:

• HIV transmission typically occurs as part of sexual or drug-using activities that are highly personal and often socially sanctioned and/or illegal. Such activities are among the hardest to influence by policy and law.

• The making of policies and laws to control the spread of HIV frequently has pitted two important goals against each another: preserving the civil liberties of people with HIV versus protecting the general public health. Liberals have generally emphasized the need to insulate people with HIV/AIDS from discrimination, while conservatives have often framed the epidemic as a danger to the general population resulting from social decay and personal immorality.

• It has been hypothesized that there are two major and largely incompatible approaches to HIV policy- and lawmaking. The "contain-and-control strategy" focuses on the coercive power of the state to force compliance with laws, while the "cooperation-and-inclusion strategy" relies on the participation of all heavily impacted communities. Different approaches may be appropriate for different policy challenges.

• Another major fault line in policy- and lawmaking has been between the "harm-elimination" approach, which seeks to strengthen people's ability to abstain from all risk behaviors, and the "harm-reduction" approach, which tries to tackle individual risk behaviors.

Coverage in the Encyclopedia

Policy and law issues cannot be separated from one another, because many policies are clarified through the legal system and many laws are implemented by means of administrative policies. Policy can be created by both governmental and non-governmental bodies; laws begin as legislation and are subsequently interpreted by courts. The entries in this section focus largely on the United States, which has in many ways served as the worldwide model for HIV/AIDS policy and law. Specific dimensions of policy and law in other countries are discussed in the entries on the various world regions.

Entries on Policy and Law

Abstinence Confidentiality Conspiracy Theories Contact Tracing and Partner Notification Correctional System Court Cases Disclosure Discrimination Economics Educational Policy Ethics, Personal Ethics, Public Family Policy

Health Care Reform Housing Immigration and Travel Restrictions Informed Consent Insurance Poverty Public Assistance Public Opinion Quarantine Safer-Sex Education Social Work Suicide and Euthanasia Testing Debates Workplace Issues

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Perspectives on the AIDS Epidemic: Policy and Law

Double Discrimination: Women with HIV/AIDS

Throughout the world, women suffer from the stigma and deprivation of second-class citizenship based on their sex. In the case of HIV-positive women, this discrimination is compounded by social responses to their HIV status. Thus, particularly in developing countries, HIV-positive women may be especially subject to violations of their sexual and reproductive rights.

Depending on social factors, a husband may legally force his wife to suspend or significantly alter her sex life. For instance, an HIV-positive woman may be forbidden to have children. Often, HIV-positive married women are abandoned by their husbands, with no legal or economic recourse. In some parts of the world, the widow of a man who dies from AIDS loses her property and may be abandoned by her family. Particularly in Africa and Asia, many such widows must generate income from prostitution or from the prostitution of their children.

In many countries, HIV-positive women have little or no access to family planning centers. Pregnant HIV-positive women living in countries where abortion is criminalized may be forced to seek unsafe and illegal abortions, which can jeopardize their lives. HIV-positive women frequently must submit to sterilization or other family planning methods that they have not freely chosen.

In many societies, women's sexual rights and sexuality remain unrecognized or misunderstood, often owing to cultural and religious values. Practices such as female genital mutilation, early and compulsory marriage of girls, denial of available treatments, and sexual abuse and rape of girls and women create high risks of female HIV infection.

Poverty in developing countries continues to affect more women and children than it does men. Poverty also increases the vulnerability of these women and children to HIV infection. Unemployment and low salaries perpetuate the economic subordination of women and children, and in numerous countries, members of both groups must take up sex work in order to survive. Drug consumption frequently accompanies prostitution, and both increase the risk of HIV infection: sex workers often cannot ensure their clients' practice of safer sex nor their own or their clients' use of sterilized syringes and needles. In addition, the number of street children, many of them girls, increases as poverty levels escalate. These children are exposed to violence, coercion, and abuse and in many instances become infected with HIV, yet they have little or no access to treatment.

At the International Conference on Population and Development held in Cairo, Egypt, in 1995, reproductive rights were recognized globally. When the conference met in 1996 in Beijing, China, the majority of the world's nations extended that recognition to sexual rights (although not sexual orientation).

Mabel Bianco

The Encyclopedia of AIDS: A Social, Political, Cultural, and Scientific Record of the HIV Epidemic, Raymond A. Smith, Editor. Copyright © 1998, Raymond A. Smith. Carried by permission of Fitzroy Dearborn Publishers.

Encyclopedia of AIDS $25 US/832 pp/Illustrated

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