Abstract
Steven W. Thrasher on the body public.
For almost a decade now, and across three different pandemics, I have been reporting on a criminal case against a young man living with HIV named Michael Johnson. Initially, Johnson was convicted of transmitting HIV to one man and exposing several others to it—and then sentenced to 30 years in prison.
Although his sentence was eventually overturned and he was released 25 years early, a lot of damage was done—and not just to Johnson.
For if there is one thing I have learned in my research, it’s that punishing people for sickness does not protect populations. In fact, it makes containing pandemics even more difficult, facilitates increased pathogenic transmission, and has a deleterious effect on public health.
Among the greatest barriers to getting care for people living with infectious disease in general, and HIV specifically, are stigma, shame, and a fear of punishment. Research has long shown that HIV criminal statutes do not lower transmission, but they do negatively affect populations. Many HIV laws are written so that if someone knows they are living with HIV, yet does not disclose their status while engaging in activities where transmission is possible (and some where it is not possible), they can be arrested and prosecuted.
A promise of care—not the threat of prison or financial ruination—is the only way to help heal the public body in a pandemic.
This further stigmatizes HIV and gives yet another incentive to not know one’s status. Indeed, in the St. Louis metropolitan area where Johnson was arrested, HIV prevention workers had long struggled to get gay Black men, among the most vulnerable to the virus, tested for HIV before his arrest. (The CDC projected in 2016 that one in every two Black gay men would become HIV positive in their lifetime.) After Johnson’s arrest, a prevention worker asked me: Why would someone want to know they had HIV after they saw what happened to him?
Punishment of disease overlaps with prejudices such as homophobia—and not just with HIV; it also happened in the COVID-19 pandemic. In May 2020, South Korea had already navigated one wave relatively well when a second wave began. The epicenter of that outbreak was in the Itaweon gayborhood of Seoul, and contact tracing led to a gay bar and a gay sauna. Both establishments were forthcoming and helpful with public health officials, as was an unnamed man the Los Angeles Times reported answered many questions honestly. But, a freelance tutor, the man was prosecuted for lying when said he had no job. Perhaps he didn’t want the families he tutored to find out that he had been sick or was exposed to Covid; maybe he didn’t want them, or his own family, to think that he was gay. For this, he was sentenced to three years in prison. (Again, when people see others prosecuted for saying the wrong thing—even in one question—they might not come forward during outbreaks to share valuable information.)
In the summer of 2022, economic punishment was common for monkeypox in the United States. A positive MPX diagnosis triggered a mandatory quarantine of two to six weeks, without governmental financial support. Monkeypox moved almost entirely among men who have sex with men. In the United States, the majority of cases were made up of Black and Latino men, unlikely to have a remote “work from home” option or the savings to weather a medical emergency. (White men, in contrast, made up the majority of those getting vaccines.) For them, an unfunded quarantine meant protecting others while risking hunger or eviction from lost wages. That’s a cruel punishment.
Legal, economic, and emotionally stigmatizing punishments do not work to curb infectious diseases. What people need when they are infected by a pathogen is to know that it is safe for them to seek help—and that they will get whatever help they need to recover, including medicine, shelter, and paid time off to quarantine, without encountering homophobia, ableism, or judgment of any kind.
A promise of care—not the threat of prison or financial ruination—is the only way to help heal the public body in a pandemic.