Zille's views out on lunatic fringe

Gregg Gonsalves says there's no evidence criminalising knowing HIV transmission prevents new infections

Dear Editors:

Helen Zille seems to want to position herself as a straight-talking, law-and-order politician. It's a classic strategy that links her to many others politicians around the world, from many of the Republican presidential candidates in the USA to Vladimir Putin in Russia. Appealing to people's fears and telling them you're going to protect them from the threats around them reaches deep down into the brain stem, to our basest instincts.

Sadly, Mrs. Zille has decided to take this law-and-order approach to HIV/AIDS, proclaiming her support for criminalizing HIV transmission as well as non-disclosure of HIV status, going as far to say that "no-one can be assumed to have had consensual sex in a situation of non-disclosure."

Mrs. Zille's views may be politically useful, but in terms of public health put her way out on the lunatic fringe.  There is no evidence to support the idea that criminalization of HIV transmission or non-disclosure will be effective in preventing new HIV infections. In fact, studies have shown that is no difference in behavior between jurisdictions where criminalization is in place and those in which it is not.

Furthermore, many new infections happen when someone with HIV has just been infected and the amount of virus in their blood is at its peak-most people don't know their status at this point and standard diagnostic tests might easily show someone is HIV-negative in this window period.  Perhaps, Mrs. Zille is playing politics with public health, which is shameful.  Perhaps, she truly believes what she says: then she is unfit for office in a country where the AIDS epidemic still rages on.

We need to invest in real HIV prevention based on scientific evidence.  We need to scale-up what we know works and which would include: condom promotion and sex education starting as early as possible and definitely in schools (and which would include information about delaying sexual activity and partner reduction as well); male circumcision and; provision of early antiretroviral therapy (which reduces transmissibility by >90%).  It would also mean targeting factors that exacerbate risk in communities and among individuals such as: sexual violence, depression and other mental illness and substance use.

Gregg Gonsalves 
Yale University 
New Haven,
CT 06511 USA

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