[Update]US: Missouri Governor signs bill that modernises HIV criminalisation laws

Missouri Updates HIV Laws Criminalizing Transmission For The First Time In Over 30 Years

For the first time since enacting HIV laws in the 1980s, Missouri will update its laws that make it a crime to expose a person to the virus. Gov. Mike Parson on Wednesday signed a bill that reduces the charges a person faces for transmitting the virus.

Missouri joins a number of states that have passed such legislation this year. Legislatures around the country are moving to correct HIV laws that were based on false assumptions about how the virus is transmitted.

Advocacy groups and politicians in Missouri successfully lobbied for SB 53, a sweeping measure affecting police and prosecutors, to include changes to the state’s HIV laws after years of attempts to pass similar legislation. Public health professionals say laws criminalizing HIV have not reduced transmission of the virus.

Under the new law, prosecutors must prove someone “knowingly” exposed a person to the virus to obtain a felony conviction. The measure also reduces the minimum sentence from 10 years to 3 years, if the person contracts HIV. A previous law made it a felony crime in Missouri to “recklessly” expose another person to HIV, which is harder to defend in court.

Missouri’s updated law goes into effect on Aug. 28.

While the Missouri HIV Justice Coalition wants state lawmakers to eliminate laws against transmitting the virus, some advocates say the law lessening penalties is still a victory for the more than 13,000 people in Missouri who live with HIV.

“We still feel like it’s a really strong step in the right direction, to make sure that the laws are medically accurate and are charging people at an appropriate level,” said Mallory Rusch, executive director for Empower Missouri, an advocacy group within the HIV Justice Coalition that lobbied for the bill’s passage.

Advocates argued the old law was outdated, since modern medication can reduce people’s viral load to undetectable levels. People who are consistently on HIV treatment for at least six months cannot transmit HIV to others.

The former law treated all HIV-positive people as if they were a public health risk, Rusch said. The new law updates language to correct misconceptions about how HIV is transmitted. HIV transmission doesn’t occur through saliva or touching. It’s very rarely transmitted through biting or oral sex.

“[The old laws] were based on faulty assumptions about science, and it’s no fault of the legislature at the time, it’s just all they knew,” said Rep. Phil Christofanelli, R-St. Peters, who filed the bill in the House. “Back in the ‘70s and ‘80s, when HIV entered the public consciousness, the legislators at the time first thought it was a death sentence.”

Public health professionals say they still feel the consequences of faulty science and outdated laws.

“It put people living with HIV in a position to where, number one, they’re criminalized unfairly, but two propagated the stigma and the shame that still persists around people living with HIV,” said Dr. Matifadza Hlatshwayo Davis, an infectious disease specialist at Washington University School of Medicine.

Davis, who has treated people with HIV for more than a decade, said laws that penalized HIV transmission discouraged people from getting tested because if people didn’t know their HIV status, they couldn’t be charged.

But that also led to people forgoing necessary treatment.

“If people don’t see this big fear about being criminalized, they may be more willing to take a test to find out what their status is,” said Erise Williams Jr., CEO of Williams and Associates, a public health agency in St. Louis that has a robust HIV program.

Since 1990, more than 100 people in Missouri have been convicted of an HIV crime, according to the Williams Institute, a think tank at UCLA Law.

The institute found Black men account for half of HIV crime arrests and convictions in the state, despite being only 5.5% of the state’s population.

In St. Charles County, a Black student at Lindenwood University made national headlines in 2015 when a judge sentenced him to 30 years in prison after a jury found him guilty of infecting one partner with HIV and endangering four others. An appeals court later ruled that Michael L. Johnson’s trial was “fundamentally unfair” and granted him parole after he had served five years.

Public health professionals say Johnson’s and other high-profile cases of alleged intentional HIV transmission have distorted the public’s view that this is a common occurrence and have instead undermined efforts to prevent infections.

That’s led lawmakers in Nevada, Illinois and Oregon to change their HIV laws this year, either adjusting punishments for transmission or expanding access to HIV medication.

Illinois’ legislature recently passed a bill to completely decriminalize HIV, which would make it only the second state to do so, after Texas. Illinois Gov. J.B. Pritzker has yet to sign the bill into law.

Missouri expands access to HIV preventive medication

Missouri’s Republican-controlled legislature also passed a bill during the 2021 session to allow pharmacists to dispense HIV medication. Parson signed the bill into law last month, making Missouri the fourth state to do so.

Pharmacists must be trained by a doctor before they can give someone post-exposure prophylaxis.

If the medication is started within 72 hours of an HIV exposure, it can greatly decrease chances of contracting the virus. But getting the pill during that crucial window can be difficult in rural areas with few health care providers.

The Centers for Disease Control and Prevention found that 13 mostly rural counties in Missouri are at risk for an HIV outbreak.

Rep. Christofanelli co-sponsored the bill to make the drug more accessible. Medicaid and Medicare both cover PEP.

“I think public health issues cross party boundaries,” he said. “HIV is something that’s affecting this entire state whether you live in a rural area community or an urban or suburban community, like mine. And Missouri has continued to come up on national news stories for the prevalence of spread of HIV across our state.”

Published in December in Empower Missouri

Lawmakers Pass Legislation To Update Missouri’s Outdated HIV Criminalization Laws

After decades on the books, Missouri lawmakers have finally passed legislation to update the criminal codes dealing with the prosecution of people living with HIV.

The legislation, introduced by Senator Holly Rehder (R-27) and Representative Phil Christofanelli (R-105), rewrites Missouri’s HIV-specific criminal laws. The bill would lower the penalties under the HIV exposure statute and raise the level of intent a prosecutor would need to prove in order to convict someone of a felony. The legislation also updates the law to be consistent with medical science by limiting the law to only cover activities that have been scientifically shown to create a substantial risk of transmission. Further, the measure would combat the stigma associated with HIV by ending the singling out of HIV and instead  making the law apply to all “serious non-airborne infectious or communicable diseases.”

Missouri’s current law allows prosecutors to charge an HIV-positive person with a felony based on whether she or he can prove they disclosed their HIV status to their sexual partner. If someone knows they are living with HIV but does not disclose their status before engaging in certain activities considered to be “exposure”— some of which don’t carry any risk of transmission — they can be charged with a class A felony (punishable by 15-30 years in prison) if transmission occurs and with a class B felony (punishable by five to fifteen years in prison), even if no HIV transmission actually occurs. And several Missouri laws punish people living with HIV at a higher level simply because of their HIV status.

Between 1990 and 2019, at least 593 people have been arrested in Missouri for an HIV/hepatitis crime, including 318 who were convicted for those crimes. Missouri has had one arrest for an HIV crime for every 60 people living with HIV in Missouri.

The Missouri HIV Justice Coalition, Empower Missouri, not-for-profits focusing on health care and better public policy, and long-term HIV survivors have supported rewriting the HIV criminalization laws for the last five years.

Empower Missouri’s Executive Director Mallory Rusch said, “We are thankful that Missouri lawmakers have finally taken a step in the right direction and have updated the state’s outdated and medically inaccurate HIV criminalization laws. Empower Missouri believes the updated law will reduce stigma associated with HIV and, in turn, encourage more people to get proper testing and treatment..”

Empower Missouri is pleased with the passage of the legislation, but will also continue to advocate for additional changes to the criminal code in future sessions, including removing the sentencing enhancement for people living with HIV who are charged with prostitution.

“Many people do not know that there have been significant strides in the prevention, testing, and treatment of HIV,” said Rusch. “HIV is often treatable with one pill a day, and people living with HIV have the same life expectancy as the average person with proper treatment. Updating these laws to reflect medical advances is critical to basic justice and fairness to all Missourians.”

In 2019, Missouri had roughly 13,000 people living with HIV, according to the Missouri Department of Health and Senior Services. Many are in the south central part of the state, includingBates, Cedar, St. Francois, Hickory, Wayne, Ozark, Wright, Iron, Madison, Reynolds, Ripley, Crawford and Washington counties.

Empower Missouri staffs the Missouri HIV Justice Coalition and welcomes participation by people living with HIV. Details may be found at: https://empowermissouri.org/hiv-justice-coalition/.

Published on Dec 3, 2020 in the Missouri Times

Lawmakers promote legislation to ‘decriminalize HIV’ on World AIDS Day

Rep. Phil Christofanelli and incoming Sens. Holly Rehder and Greg Razer pre-filed legislation to change Missouri’s laws regarding people with HIV on World AIDS Day Tuesday.

“It’s special that we get to file our bills on this day,” Rehder told The Missouri Times. “We’ve had so many advancements in HIV treatment since the 80s when our statutes were put in place, and medical professionals, researchers, and scientists know so much more about it now than they did. Living with HIV is not a death sentence any longer, and it’s incredibly important to remove the stigma.”

The legislators joined a virtual press conference with multiple advocacy groups Tuesday, where Rehder outlined her planned legislation. She said she will sponsor a “harm reduction package” which includes establishing a statewide Prescription Drug Monitoring Program (PDMP), ensures safe syringe access, and modernizes the state’s HIV regulations. The provisions were staples of her tenure in the House.

Current Missouri statute mandates an individual who is knowingly infected with HIV not act in a “reckless” way that could expose another person to the disease without his or her knowledge or consent. Violating the statute could result in a Class A or B felony, depending on if another individual contracted HIV.

The way the statute is written deters people from finding out his or her status and seeking appropriate treatment, advocates say. The statute also suggests an HIV diagnosis is equivalent to a death sentence, but Rehder said modern medicine tells a different story.

The bill would update the language to reflect more recent research on the disease since the law was enacted in the 1980s, including removing spitting from the list of “reckless” actions.

Christofanelli said he would sponsor two HIV-related bills in the lower chamber next year, including a similar modernization provision.

“I think that we need to let people know that while science has not yet found a way to cure HIV, we certainly have the tools at our disposal to end HIV if we take the correct actions,” Christofanelli said. “To that end, I intend to file two pieces of legislation in the upcoming session in order to put Missouri at the forefront of preventing the spread of HIV in our communities and helping those afflicted with the disease.”

The other piece would concern Pre-Exposure Prophylaxis (PEP) and Post-Exposure Prophylaxis (PREP), relatively new treatments for the disease. The bill would allow pharmacists to screen patients and prescribe the treatment over-the-counter. Now, patients must make a doctor’s appointment to receive a prescription for PREP which could cause them to receive it past the critical three-day exposure period. The bill would also allow patients to receive a 30-day prescription of PEP after receiving a negative test for HIV. He said the use of the treatments greatly reduced the risk of contracting HIV.

Razer said he would be handling the bill on the Senate side.

“Our state’s HIV-specific law was originally passed in the late ’80s, when our cultural understanding of HIV was informed by fear and stigma,” Missouri HIV Justice Organizer Molly Pearson said. “Thanks to advances in modern medicine, people living with HIV can live long, healthy lives without transmitting the virus. Using criminalization as a public health intervention simply does not work, and it upholds the stigma and fear of HIV that got us here in the first place.”

World AIDS Day has been observed on Dec. 1 every year since 1988. The day was set aside to educate the public about the disease and examine the future of the fight against it.

Tuesday was also the first day of pre-filing for the Missouri legislature.