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Opinion: To Better Missouri’s Health, We Must Decriminalize HIV

Almost 30 years after HIV/AIDS was declared an epidemic, discrimination against people living with HIV/AIDS still persists in our society and in Missouri’s laws. 

HIV criminalization is bad for public health. The Missouri Legislature has an opportunity this year to update our laws and save lives. It should seize the opportunity to decriminalize HIV. 

Basic misinformation about HIV/AIDS, how it is transmitted, and what it means to live with it, is at the root of much of the discrimination embedded in our current laws.  Advances in science have turned a once-fatal disease into one where those who are HIV Positive often live long healthy lives.

One pill, taken daily, can suppress the virus in a person’s body so they cannot pass on the virus to others. This concept, defined by a strong body of literature over several years and endorsed by the federal government, is called “undetectable equals untransmittable,” or “U=U.” 

This is a remarkable turning point in our ability to stop the spread of HIV. When coupled with other prevention tools which can keep uninfected persons HIV free, it is now possible for us to envision the elimination of HIV in the United States during our lifetime.

That’s why we must change the laws in Missouri to decriminalize HIV. Missouri’s current laws discourage people living with HIV from getting treatment and fail to meet modern medical standards. 

Missouri’s laws on HIV, prevent me from doing my job. As the director of the HIV Pre-Exposure Prophylaxis (PrEP) Program at Washington University in St. Louis, I know that when people are aware of having or not having the virus, they can obtain the next step of treatment or prevention. 

Not only does our law fail to encourage people to get treatment, it gets in the way of prevention.  The first step to coming closer to ending the HIV epidemic in the Show-Me State is making HIV testing accessible to people of all socioeconomic backgrounds and ages. Today in Missouri, seeking treatment for HIV and getting healthy can further your own prosecution and incarceration. Our laws treat no other disease in this way. 

If I can get a person to seek out medical care, I know they can reduce their risk of getting HIV by 95 percent, if they are HIV negative and take pre-exposure prophylaxis, a single daily pill. If they have the virus already, they can get on treatment and live a long, healthy life without significant risk of transmitting the virus to anyone else. 

Stigma surrounding HIV testing is fueling Missouri’s non-declining new HIV infections. President Trump and several federal health agencies have classified Missouri as one of eight states in the nation facing a “rural epidemic” of HIV. We know that laws specifically targeting people living with HIV do not reduce the number of new cases of HIV.

To stop new transmission of HIV, the No. 1 priority must be to create an environment in which all people want and have access to HIV testing, treatment, and other prevention options.

Missouri will not be able to turn its course from a worsening epidemic if state HIV-related criminal laws remain stuck in the 1980s, when our knowledge of the virus was very limited. 

HB 167 and HB 166, sponsored by Rep. Holly Rehder and Rep. Tracy McCreey, are important milestones in our efforts to reform HIV law in Missouri. They will reduce stigma against HIV by removing a requirement that the Missouri Department of Health has to provide defendants’ health records to prosecutors in criminal cases. They will also require the law applies to behaviors that actually carry a risk of HIV transmission — based on current medical evidence.

Our understanding of HIV has evolved and so too must the law. We must decriminalize HIV in Missouri.