Introduction
There have been conflicting ethical imperatives that health professionals face when treating contacts of patients suffering from sexually transmitted infections (STI). Can a person be blamed if another gets infected with a sexually transmissible infection? More than half of the US jurisdictions, Australia and Canada have laws that criminalize knowing exposure to or transmission of STIs such as HIV. However, very little evidence supports the effectiveness of these laws in reducing the incidence of these infections (Lazzarini et al., 2013).
Article Summary and Analysis
Denton Callander (2017) in his article “Punishing one person for STI transmission weakens public health efforts” explains the recent Australian Public Health Act amendment which increased the associated penalties of knowingly transmitting STIs such as doubling maximum fines and adding potential jail time. Just in the USA, most Australian states require that if you have certain STIs such as HIV, you have a legal responsibility or obligation to notify your potential sexual partners. The newly amended Section 79 (1) states that a person who knows that they have a notifiable disease that is sexually transmitted is required to take reasonable actions or precautions against spreading the disease. The maximum penalty includes 100 penalty units or a six months’ imprisonment.
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Despite this being a positive change for the law pushing for the best available research STIs and transmission, there have been ethical dilemmas and mixed messages about sexual health in Australia. The idea that the punishing of STI exposure or transmission will lead to a decrease in infection rates is yet to be supported by research evidence, especially on HIV. Also, the moral responsibility for an individual to disclose his or her HIV status to partners is also not so clear-cut.
The author’s concern is particularly in New South Wales’ law fixation on STIs being punishable. In Australia, health law is pretty complex but an individual risks punishment for knowingly infecting another person with notifiable diseases. These diseases cover a range of infections alongside STIs such as chlamydia, HIV, gonorrhea, and hepatitis a, b and c. The Public Health Act in NSW state has been used to single out STIs and describe particular punishments above and beyond other notifiable diseases. However, even though disclosure seems to be a sensible step towards preventing transmission, it may not be the most ethical or effective method. One of the reasons is because it requires an individual to be aware that he or she is infected. Most people infected with STIs do not realize they are infected and therefore the reliance on disclosure may give people a false sense of security (Callander, 2017).
Callander outlines that there are more effective strategies other than disclosure of protecting people from STI infections. For instance with HIV, successful treatment translates to minimizing the risk of transmitting the virus to other people. There are more than 100,000 STI diagnoses in Australia per year, majority of which are curable via antibiotics (Callander, 2017). Public health initiatives such as the new amendment aim to reduce the occurrence of new cases and lower the overall rates of infections.
Ethical Issues
The ethical issue of criminalizing the transmission of STIs is that it can undermine public health efforts by reinforcing stigma and hence leading to people delaying testing, treatment, and care. In a recent literature review by Weait (2012), research has shown that there is no correlation between criminalizing HIV transmission and lower infection rates. This review also indicates that such laws tend to disproportionately impact individuals experiencing marginalization such as women and the youth (Weait, 2012). The reality is that situations whereby an individual recklessly or wilfully transmits an STI are rare, and health officials have numerous options other than punishment.
Lazarrini et al. (2013) state that the ethical concerns of policies such as the criminalization of STI infections in a bid to reduce HIV incidences may in most cases override concerns with the self-determination and the privacy rights of people living with HIV as well as people who have been exposed to HIV infection. PLHIV who are aware and conscious of their status share with others the duty not to harm others in addition to abiding by laws. This legal obligation can conflict with their rights to self-determination and privacy (Lazzarini et al., 2013). In most Australian and USA states, the only reliable way for PLHIV to have sex without any risk of prosecution is to have incontrovertible proof that they disclosed their HIV status to their sexual partner. The production of such evidence in most cases is nearly impossible. On the other hand, individuals at risk of HIV infection seem to have been absolved the responsibility of avoiding engaging in activities that may expose them to HIV infection. Another ethical dilemma is that who is responsible for ensuring that sex is well informed and the risk of infection minimized? Is the informed consent the ideal model to follow?
Conclusion
John Rawls reminds us that ethics is essentially about the relationship between what is right and good. The good is defined in the human well-being spectrum and how one should ideally live. The right is defined regarding justice and fairness as well as the allocation of rewards and ensuring no harm is done to others. In classical philosophy, the good has to take precedence over the right, establishing a just social condition. In the modern era the right is more preeminent (Rawls, 2000). The right and the good are seemingly in a conflict in the quest to reduce the rate of HIV and STIs infections.
References
Callander, D. (2017, September 21). Punishing one person for STI transmission weakens public health efforts . Retrieved from The Conversation: https://theconversation.com/punishing-one-person-for-sti-transmission-weakens-public-health-efforts-84210
Lazzarini, Z., Galletly, C. L., Mykhalovskiy, E., Harsono, D., O’Keefe, E., Singer, M., & Levine, R. J. (2013). Criminalization of HIV Transmission and Exposure: Research and Policy Agenda. American Journal of Public Health , 1350-1353.
Rawls, J. (2000). Lectures on the History of Moral Philosophy. Cambridge,MA: Harvard University Press.
Weait, M. (2012). The Criminalisation of HIV Transmission and Exposure: A Global Review. Third Meeting of the Technical Advisory Group, Global Commission on HIV and the Law (p. 36). London: University of London.
