High-risk sexual behavior and failure to disclose HIV infection to sex partners: How do we respond?

AIDS and Public Policy Journal

Volumn 19, Issue 1-2, 2004, Pages 11-36

  Bruner, Daniel ^a,b  

^a Whitman Walker Clinic   (United States)

^b AMERICAN UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

CONDOM; CONFERENCE PAPER; CONFIDENTIALITY; ETHICS; HEALTH PROGRAM; HIGH RISK POPULATION; HUMAN; HUMAN IMMUNODEFICIENCY VIRUS; HUMAN IMMUNODEFICIENCY VIRUS INFECTION; HUMAN IMMUNODEFICIENCY VIRUS PREVALENCE; INFECTION PREVENTION; INTERPERSONAL COMMUNICATION; LAW; MORALITY; SEXUAL BEHAVIOR; SEXUALITY;

EID: 14044270681     PISSN: 08873852     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Conference Paper

References (200)

1. G.M. Herek, J.P. Capitanio, and K.F. Widaman, "HIV-Related Stigma and Knowledge in the United States: Prevalence and Trends, 1991-1999," American Journal of Public Health 92, no. 3 (2002): 371-7; Centers for Disease Control and Prevention, "HIV-Related Knowledge and Stigma-United States, 2000," Morbidity and Mortality Weekly Report 49, no. 47 (2000): 1062-4.
2. G.M. Herek, J.P. Capitanio, and K.F. Widaman, "HIV-Related Stigma and Knowledge in the United States: Prevalence and Trends, 1991-1999," American Journal of Public Health 92, no. 3 (2002): 371-7; Centers for Disease Control and Prevention, "HIV-Related Knowledge and Stigma-United States, 2000," Morbidity and Mortality Weekly Report 49, no. 47 (2000): 1062-4.
3. See, e.g., American Civil Liberties Union AIDS Project, "HIV & Civil Rights: A Report From the Frontlines of the HIV/AIDS Epidemic," November 2003, http://www.aclu.org/HIVAIDS/HIVAIDS.cfm?ID=14363&c=258.
4. R. Klitzman and R. Bayer, Mortal Secrets: Truth and Lies in the Age of AIDS (Baltimore, Md.: Johns Hopkins University Press, 2004); A.A. Alonzo and N.R. Reynolds, "Stigma, HIV and AIDS: An Exploration and Elaboration of a Stigma Trajectory," Social Science & Medicine 41, no. 3 (1995): 303-15.
5. R. Klitzman and R. Bayer, Mortal Secrets: Truth and Lies in the Age of AIDS (Baltimore, Md.: Johns Hopkins University Press, 2004); A.A. Alonzo and N.R. Reynolds, "Stigma, HIV and AIDS: An Exploration and Elaboration of a Stigma Trajectory," Social Science & Medicine 41, no. 3 (1995): 303-15.
6. See, for instance, D.L. Chambers, "Gay Men, AIDS, and the Code of the Condom," Harvard Civil Rights-Civil Liberties Law Review 29 (Spring 1993): 353-85.
7. R. Bayer and A. Fairchild-Carrino, "AIDS and the Limits of Control: Public Health Orders, Quarantine, and Recalcitrant Behavior," American Journal of Public Health 83, no. 10 (1993): 1471-6.
8. See, for instance, Carter v. Mississippi, 803 So.2d 1191 (Miss. Ct. App. 1999).
9. Z. Lazzarini, S. Bray, and S. Burris, "Evaluating the Impact of Criminal Laws on HIV Risk Behavior," Journal of Law, Medicine & Ethics 30, no. 2 (2002): 239-53.
10. CDC, "Advancing HIV Prevention: New Strategies for a Changing Epidemic-United States, 2003," Morbidity and Mortality Weekly Report 52, no. 15 (2003): 329-32; CDC, "Revised Guidelines for HIV Counseling, Testing, and Referral," Morbidity and Mortality Weekly Report 50, no. RR-19 (2001).
11. CDC, "Advancing HIV Prevention: New Strategies for a Changing Epidemic-United States, 2003," Morbidity and Mortality Weekly Report 52, no. 15 (2003): 329-32; CDC, "Revised Guidelines for HIV Counseling, Testing, and Referral," Morbidity and Mortality Weekly Report 50, no. RR-19 (2001).
12. CDC, "Advancing HIV Prevention," see note 8 above; CDC, "Incorporating HIV Prevention into the Medical Care of Persons Living with HIV," Morbidity and Mortality Weekly Report 52, no. RR-12 (2003).
13. CDC, "Advancing HIV Prevention," see note 8 above; CDC, "Incorporating HIV Prevention into the Medical Care of Persons Living with HIV," Morbidity and Mortality Weekly Report 52, no. RR-12 (2003).
14. State v. Gonzalez, 154 Ohio App. 3d 9; 2003 Ohio 4421; 796 N.E.2d 12 (Ct. App.), app. denied, 100 Ohio St. 3d 1532,800 N.E.2d 48 (2003); "Intervention Efforts Retreat as Criminal Laws Advance," AIDS Policy & Law 18, no. 19 (10 October 2003); J.J. Williams, IV, "Two South Dakotans Sentenced For Spreading HIV," Argus Leader (Sioux Falls, South Dakota), 6 March 2003, IB.
15. State v. Gonzalez, 154 Ohio App. 3d 9; 2003 Ohio 4421; 796 N.E.2d 12 (Ct. App.), app. denied, 100 Ohio St. 3d 1532,800 N.E.2d 48 (2003); "Intervention Efforts Retreat as Criminal Laws Advance," AIDS Policy & Law 18, no. 19 (10 October 2003); J.J. Williams, IV, "Two South Dakotans Sentenced For Spreading HIV," Argus Leader (Sioux Falls, South Dakota), 6 March 2003, IB.
16. State v. Gonzalez, 154 Ohio App. 3d 9; 2003 Ohio 4421; 796 N.E.2d 12 (Ct. App.), app. denied, 100 Ohio St. 3d 1532,800 N.E.2d 48 (2003); "Intervention Efforts Retreat as Criminal Laws Advance," AIDS Policy & Law 18, no. 19 (10 October 2003); J.J. Williams, IV, "Two South Dakotans Sentenced For Spreading HIV," Argus Leader (Sioux Falls, South Dakota), 6 March 2003, IB.
17. State v. Gonzalez, 154 Ohio App. 3d 9; 2003 Ohio 4421; 796 N.E.2d 12 (Ct. App.), app. denied, 100 Ohio St. 3d 1532,800 N.E.2d 48 (2003); "Intervention Efforts Retreat as Criminal Laws Advance," AIDS Policy & Law 18, no. 19 (10 October 2003); J.J. Williams, IV, "Two South Dakotans Sentenced For Spreading HIV," Argus Leader (Sioux Falls, South Dakota), 6 March 2003, IB.
18. State v. Gonzalez, 154 Ohio App. 3d 9; 2003 Ohio 4421; 796 N.E.2d 12 (Ct. App.), app. denied, 100 Ohio St. 3d 1532,800 N.E.2d 48 (2003); "Intervention Efforts Retreat as Criminal Laws Advance," AIDS Policy & Law 18, no. 19 (10 October 2003); J.J. Williams, IV, "Two South Dakotans Sentenced For Spreading HIV," Argus Leader (Sioux Falls, South Dakota), 6 March 2003, IB.
19. J. Van Derkeken, "HIV Transmission Case Tossed Out," San Francisco Chronicle, 10 December 2003, A25; see also D. McAree, "The Debate Over HIV Exposure Laws," National Law Journal 4, (29 September 2003); J.M. Glionna, "Law on HIV Infection Little Used," Los Angeles Times, 10 September 2003, B1.
20. J. Van Derkeken, "HIV Transmission Case Tossed Out," San Francisco Chronicle, 10 December 2003, A25; see also D. McAree, "The Debate Over HIV Exposure Laws," National Law Journal 4, (29 September 2003); J.M. Glionna, "Law on HIV Infection Little Used," Los Angeles Times, 10 September 2003, B1.
21. J. Van Derkeken, "HIV Transmission Case Tossed Out," San Francisco Chronicle, 10 December 2003, A25; see also D. McAree, "The Debate Over HIV Exposure Laws," National Law Journal 4, (29 September 2003); J.M. Glionna, "Law on HIV Infection Little Used," Los Angeles Times, 10 September 2003, B1.
22. By higher-risk sexual behavior, I mean anal or vaginal intercourse without condoms. For discussion of the relative risk of HIV transmission associated with different types of sexual activity, see CDC, "Incorporating HIV Prevention," see note 9 above, p. 9 and table 5; T. Lane and H. Palacio, "Safer-Sex Methods," December 2003; HIVInsite Knowledge Base, ed. L. Peiperl and P. Volberding http://hivinsite.ucsf.edu/InSite.jsp?page=kb- 07&doc=kb-07-02-02, accessed 16 February 2003.
23. By higher-risk sexual behavior, I mean anal or vaginal intercourse without condoms. For discussion of the relative risk of HIV transmission associated with different types of sexual activity, see CDC, "Incorporating HIV Prevention," see note 9 above, p. 9 and table 5; T. Lane and H. Palacio, "Safer-Sex Methods," December 2003; HIVInsite Knowledge Base, ed. L. Peiperl and P. Volberding http://hivinsite.ucsf.edu/InSite.jsp?page=kb- 07&doc=kb-07-02-02, accessed 16 February 2003.
24. By higher-risk sexual behavior, I mean anal or vaginal intercourse without condoms. For discussion of the relative risk of HIV transmission associated with different types of sexual activity, see CDC, "Incorporating HIV Prevention," see note 9 above, p. 9 and table 5; T. Lane and H. Palacio, "Safer-Sex Methods," December 2003; HIVInsite Knowledge Base, ed. L. Peiperl and P. Volberding http://hivinsite.ucsf.edu/InSite.jsp?page=kb- 07&doc=kb-07-02-02, accessed 16 February 2003.
25. CDC, "Incorporating HIV Prevention," see note 9 above, p. 1.
26. B.A. Koblin et al., "High-Risk Behaviors Among Men Who Have Sex With Men in 6 US Cities: Baseline Data From the EXPLORE Study, American Journal of Public Health 93, no. 6 (2003): 926-32; S.Y. Chen et al., "Continuing Increases in Sexual Risk Behavior and Sexually Transmitted Diseases Among Men who Have Sex With Men: San Francisco, Calif., 1999-2001," American Journal of Public Health 92, no. 9 (2002): 1387-8; M.H. Katz et al., "Impact of Highly Active Antiretroviral Treatment on HIV Seroincidence Among Men Who Have Sex with Men: San Francisco," American Journal of Public Health 92, no. 3 (2002): 388-94; R.J. Wolitski et al., "Are We Headed for a Resurgence of the HIV Epidemic Among Men Who Have Sex With Men?" American Journal of Public Health 91, no. 6 (2001): 883-8; G.M. Crosby and M. Grofe, "Study of HIV Sexual Risk Among Disenfranchised African American MSM," University of California-San Francisco, Center for AIDS Prevention Studies, Science to Community Report, Prevention #8, March 2001, http://www.caps.ucsf.edu/ publications/TESS2C.pdf.
27. B.A. Koblin et al., "High-Risk Behaviors Among Men Who Have Sex With Men in 6 US Cities: Baseline Data From the EXPLORE Study, American Journal of Public Health 93, no. 6 (2003): 926-32; S.Y. Chen et al., "Continuing Increases in Sexual Risk Behavior and Sexually Transmitted Diseases Among Men who Have Sex With Men: San Francisco, Calif., 1999-2001," American Journal of Public Health 92, no. 9 (2002): 1387-8; M.H. Katz et al., "Impact of Highly Active Antiretroviral Treatment on HIV Seroincidence Among Men Who Have Sex with Men: San Francisco," American Journal of Public Health 92, no. 3 (2002): 388-94; R.J. Wolitski et al., "Are We Headed for a Resurgence of the HIV Epidemic Among Men Who Have Sex With Men?" American Journal of Public Health 91, no. 6 (2001): 883-8; G.M. Crosby and M. Grofe, "Study of HIV Sexual Risk Among Disenfranchised African American MSM," University of California-San Francisco, Center for AIDS Prevention Studies, Science to Community Report, Prevention #8, March 2001, http://www.caps.ucsf.edu/ publications/TESS2C.pdf.
28. B.A. Koblin et al., "High-Risk Behaviors Among Men Who Have Sex With Men in 6 US Cities: Baseline Data From the EXPLORE Study, American Journal of Public Health 93, no. 6 (2003): 926-32; S.Y. Chen et al., "Continuing Increases in Sexual Risk Behavior and Sexually Transmitted Diseases Among Men who Have Sex With Men: San Francisco, Calif., 1999-2001," American Journal of Public Health 92, no. 9 (2002): 1387-8; M.H. Katz et al., "Impact of Highly Active Antiretroviral Treatment on HIV Seroincidence Among Men Who Have Sex with Men: San Francisco," American Journal of Public Health 92, no. 3 (2002): 388-94; R.J. Wolitski et al., "Are We Headed for a Resurgence of the HIV Epidemic Among Men Who Have Sex With Men?" American Journal of Public Health 91, no. 6 (2001): 883-8; G.M. Crosby and M. Grofe, "Study of HIV Sexual Risk Among Disenfranchised African American MSM," University of California-San Francisco, Center for AIDS Prevention Studies, Science to Community Report, Prevention #8, March 2001, http://www.caps.ucsf.edu/ publications/TESS2C.pdf.
29. B.A. Koblin et al., "High-Risk Behaviors Among Men Who Have Sex With Men in 6 US Cities: Baseline Data From the EXPLORE Study, American Journal of Public Health 93, no. 6 (2003): 926-32; S.Y. Chen et al., "Continuing Increases in Sexual Risk Behavior and Sexually Transmitted Diseases Among Men who Have Sex With Men: San Francisco, Calif., 1999-2001," American Journal of Public Health 92, no. 9 (2002): 1387-8; M.H. Katz et al., "Impact of Highly Active Antiretroviral Treatment on HIV Seroincidence Among Men Who Have Sex with Men: San Francisco," American Journal of Public Health 92, no. 3 (2002): 388-94; R.J. Wolitski et al., "Are We Headed for a Resurgence of the HIV Epidemic Among Men Who Have Sex With Men?" American Journal of Public Health 91, no. 6 (2001): 883-8; G.M. Crosby and M. Grofe, "Study of HIV Sexual Risk Among Disenfranchised African American MSM," University of California-San Francisco, Center for AIDS Prevention Studies, Science to Community Report, Prevention #8, March 2001, http://www.caps.ucsf.edu/ publications/TESS2C.pdf.
30. B.A. Koblin et al., "High-Risk Behaviors Among Men Who Have Sex With Men in 6 US Cities: Baseline Data From the EXPLORE Study, American Journal of Public Health 93, no. 6 (2003): 926-32; S.Y. Chen et al., "Continuing Increases in Sexual Risk Behavior and Sexually Transmitted Diseases Among Men who Have Sex With Men: San Francisco, Calif., 1999-2001," American Journal of Public Health 92, no. 9 (2002): 1387-8; M.H. Katz et al., "Impact of Highly Active Antiretroviral Treatment on HIV Seroincidence Among Men Who Have Sex with Men: San Francisco," American Journal of Public Health 92, no. 3 (2002): 388-94; R.J. Wolitski et al., "Are We Headed for a Resurgence of the HIV Epidemic Among Men Who Have Sex With Men?" American Journal of Public Health 91, no. 6 (2001): 883-8; G.M. Crosby and M. Grofe, "Study of HIV Sexual Risk Among Disenfranchised African American MSM," University of California-San Francisco, Center for AIDS Prevention Studies, Science to Community Report, Prevention #8, March 2001, http://www.caps.ucsf.edu/ publications/TESS2C.pdf.
31. CDC, "Primary and Secondary Syphilis-United States, 2002," Morbidity and Mortality Weekly Report 52, no. 46 (2003): 1117-20; Whitman-Walker Clinic, "Increase in Syphilis Rates Among Gay and Bisexual Men Seen at Whitman-Walker Clinic" (press release), 20 November 2003 http://www. wwc.org/news/syphilisstats.htm; CDC, "Primary and Secondary Syphilis Among Men Who Have Sex With Men-New York City, 2001," Morbidity and Mortality Weekly Report 51, no. 38 (2001): 853-6; K.K. Fox et al., "Gonorrhea in the HIV Era: A Reversal in Trends Among Men Who Have Sex With Men," American Journal of Public Health 91, no. 6 (2001): 959-64; CDC, "Outbreak of Syphilis Among Men Who Have Sex With Men-Southern California, 2000," Morbidity and Mortality Weekly Report 50, no. 7 (2001): 117-20; CDC, "Resurgent Bacterial Sexually Transmitted Disease Among Men Who Have Sex with Men-King County, Washington, 1997-1999," Morbidity and Mortality Weekly Report 48, no. 35 (1999): 773-7.
32. CDC, "Primary and Secondary Syphilis-United States, 2002," Morbidity and Mortality Weekly Report 52, no. 46 (2003): 1117-20; Whitman-Walker Clinic, "Increase in Syphilis Rates Among Gay and Bisexual Men Seen at Whitman-Walker Clinic" (press release), 20 November 2003 http://www. wwc.org/news/syphilisstats.htm; CDC, "Primary and Secondary Syphilis Among Men Who Have Sex With Men-New York City, 2001," Morbidity and Mortality Weekly Report 51, no. 38 (2001): 853-6; K.K. Fox et al., "Gonorrhea in the HIV Era: A Reversal in Trends Among Men Who Have Sex With Men," American Journal of Public Health 91, no. 6 (2001): 959-64; CDC, "Outbreak of Syphilis Among Men Who Have Sex With Men-Southern California, 2000," Morbidity and Mortality Weekly Report 50, no. 7 (2001): 117-20; CDC, "Resurgent Bacterial Sexually Transmitted Disease Among Men Who Have Sex with Men-King County, Washington, 1997-1999," Morbidity and Mortality Weekly Report 48, no. 35 (1999): 773-7.
33. CDC, "Primary and Secondary Syphilis-United States, 2002," Morbidity and Mortality Weekly Report 52, no. 46 (2003): 1117-20; Whitman-Walker Clinic, "Increase in Syphilis Rates Among Gay and Bisexual Men Seen at Whitman-Walker Clinic" (press release), 20 November 2003 http://www. wwc.org/news/syphilisstats.htm; CDC, "Primary and Secondary Syphilis Among Men Who Have Sex With Men-New York City, 2001," Morbidity and Mortality Weekly Report 51, no. 38 (2001): 853-6; K.K. Fox et al., "Gonorrhea in the HIV Era: A Reversal in Trends Among Men Who Have Sex With Men," American Journal of Public Health 91, no. 6 (2001): 959-64; CDC, "Outbreak of Syphilis Among Men Who Have Sex With Men-Southern California, 2000," Morbidity and Mortality Weekly Report 50, no. 7 (2001): 117-20; CDC, "Resurgent Bacterial Sexually Transmitted Disease Among Men Who Have Sex with Men-King County, Washington, 1997-1999," Morbidity and Mortality Weekly Report 48, no. 35 (1999): 773-7.
34. CDC, "Primary and Secondary Syphilis-United States, 2002," Morbidity and Mortality Weekly Report 52, no. 46 (2003): 1117-20; Whitman-Walker Clinic, "Increase in Syphilis Rates Among Gay and Bisexual Men Seen at Whitman-Walker Clinic" (press release), 20 November 2003 http://www. wwc.org/news/syphilisstats.htm; CDC, "Primary and Secondary Syphilis Among Men Who Have Sex With Men-New York City, 2001," Morbidity and Mortality Weekly Report 51, no. 38 (2001): 853-6; K.K. Fox et al., "Gonorrhea in the HIV Era: A Reversal in Trends Among Men Who Have Sex With Men," American Journal of Public Health 91, no. 6 (2001): 959-64; CDC, "Outbreak of Syphilis Among Men Who Have Sex With Men-Southern California, 2000," Morbidity and Mortality Weekly Report 50, no. 7 (2001): 117-20; CDC, "Resurgent Bacterial Sexually Transmitted Disease Among Men Who Have Sex with Men-King County, Washington, 1997-1999," Morbidity and Mortality Weekly Report 48, no. 35 (1999): 773-7.
35. CDC, "Primary and Secondary Syphilis-United States, 2002," Morbidity and Mortality Weekly Report 52, no. 46 (2003): 1117-20; Whitman-Walker Clinic, "Increase in Syphilis Rates Among Gay and Bisexual Men Seen at Whitman-Walker Clinic" (press release), 20 November 2003 http://www. wwc.org/news/syphilisstats.htm; CDC, "Primary and Secondary Syphilis Among Men Who Have Sex With Men-New York City, 2001," Morbidity and Mortality Weekly Report 51, no. 38 (2001): 853-6; K.K. Fox et al., "Gonorrhea in the HIV Era: A Reversal in Trends Among Men Who Have Sex With Men," American Journal of Public Health 91, no. 6 (2001): 959-64; CDC, "Outbreak of Syphilis Among Men Who Have Sex With Men-Southern California, 2000," Morbidity and Mortality Weekly Report 50, no. 7 (2001): 117-20; CDC, "Resurgent Bacterial Sexually Transmitted Disease Among Men Who Have Sex with Men-King County, Washington, 1997-1999," Morbidity and Mortality Weekly Report 48, no. 35 (1999): 773-7.
36. CDC, "Primary and Secondary Syphilis-United States, 2002," Morbidity and Mortality Weekly Report 52, no. 46 (2003): 1117-20; Whitman-Walker Clinic, "Increase in Syphilis Rates Among Gay and Bisexual Men Seen at Whitman-Walker Clinic" (press release), 20 November 2003 http://www. wwc.org/news/syphilisstats.htm; CDC, "Primary and Secondary Syphilis Among Men Who Have Sex With Men-New York City, 2001," Morbidity and Mortality Weekly Report 51, no. 38 (2001): 853-6; K.K. Fox et al., "Gonorrhea in the HIV Era: A Reversal in Trends Among Men Who Have Sex With Men," American Journal of Public Health 91, no. 6 (2001): 959-64; CDC, "Outbreak of Syphilis Among Men Who Have Sex With Men-Southern California, 2000," Morbidity and Mortality Weekly Report 50, no. 7 (2001): 117-20; CDC, "Resurgent Bacterial Sexually Transmitted Disease Among Men Who Have Sex with Men-King County, Washington, 1997-1999," Morbidity and Mortality Weekly Report 48, no. 35 (1999): 773-7.
37. CDC, "Incorporating HIV Prevention," see note 9 above, p. 2; M.H. Katz et al., "Impact of Highly Active Antiretroviral Treatment," see note 14 above, p. 392; R.J. Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 884; G. Marks, S. Burris, and T.A. Peterman, "Reducing Sexual Transmission of HIV From Those Who Know They Are Infected: The Need for Personal and Collective Responsibility," AIDS 13, no. 3 (1999): 300.
38. CDC, "Incorporating HIV Prevention," see note 9 above, p. 2; M.H. Katz et al., "Impact of Highly Active Antiretroviral Treatment," see note 14 above, p. 392; R.J. Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 884; G. Marks, S. Burris, and T.A. Peterman, "Reducing Sexual Transmission of HIV From Those Who Know They Are Infected: The Need for Personal and Collective Responsibility," AIDS 13, no. 3 (1999): 300.
39. CDC, "Incorporating HIV Prevention," see note 9 above, p. 2; M.H. Katz et al., "Impact of Highly Active Antiretroviral Treatment," see note 14 above, p. 392; R.J. Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 884; G. Marks, S. Burris, and T.A. Peterman, "Reducing Sexual Transmission of HIV From Those Who Know They Are Infected: The Need for Personal and Collective Responsibility," AIDS 13, no. 3 (1999): 300.
40. CDC, "Incorporating HIV Prevention," see note 9 above, p. 2; M.H. Katz et al., "Impact of Highly Active Antiretroviral Treatment," see note 14 above, p. 392; R.J. Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 884; G. Marks, S. Burris, and T.A. Peterman, "Reducing Sexual Transmission of HIV From Those Who Know They Are Infected: The Need for Personal and Collective Responsibility," AIDS 13, no. 3 (1999): 300.
41. M.E. O'Brien et al., "Prevalence and Correlates of HIV Serostatus Disclosure," Sexually Transmitted Diseases 30, no. 9 (2003): 731-5.
42. D.H. Ciccarone et al., "Sex Without Disclosure of Positive HIV Serostatus in a US Probability Sample of Persons Receiving Medical Care for HIV Infection," American Journal of Public Health 93, no. 6 (2003): 949-54.
43. CDC, "Advancing HIV Prevention," see note 8 above, p. 330.
44. Chen et al., "Continuing Increases in Sexual Risk Behavior," see note 14 above.
45. Crosby and Grofe, "Study of HIV Sexual Risk," see note 14 above, p. 3; see also Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, pp. 298-99 and table 1 (1999) (reviewing studies conducted between the late 1980s and mid-1990s).
46. Crosby and Grofe, "Study of HIV Sexual Risk," see note 14 above, p. 3; see also Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, pp. 298-99 and table 1 (1999) (reviewing studies conducted between the late 1980s and mid-1990s).
47. See, for instance, Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, pp. 883-8.
48. E.g., Katz et al., "Impact of Highly Active Antiretroviral Treatment," see note 14 above, pp. 388-94 (between 1997 and 1999, annual HIV incidence rate among MSM who sought anonymous HIV testing doubled, from 2.1 percent to 4.2 percent); Koblin et al., "High-Risk Behaviors Among MSM," see note 14 above, p. 926 (discussing other evidence of increases in HIV prevalence rates among MSM over the levels observed in the late 1980s and early 1990s).
49. E.g., Katz et al., "Impact of Highly Active Antiretroviral Treatment," see note 14 above, pp. 388-94 (between 1997 and 1999, annual HIV incidence rate among MSM who sought anonymous HIV testing doubled, from 2.1 percent to 4.2 percent); Koblin et al., "High-Risk Behaviors Among MSM," see note 14 above, p. 926 (discussing other evidence of increases in HIV prevalence rates among MSM over the levels observed in the late 1980s and early 1990s).
50. CDC, "Increases in HIV Diagnosis-29 States, 1999-2002," Morbidity and Mortality Weekly Report 52, no. 47 (2003): 1145-8.
51. K. Buchacz et al., "Trends in Primary and Secondary Syphilis and HIV Seroincidence Among Men Who Have Sex With Men in San Francisco, 1998-2002," (abstract presented at the 11th Conference on Retroviruses and Opportunistic Infections, 10 February 2004), http://www.retroconference.org/ 2004/cd/Abstract/88.htm; M. Ackers et al, "High HIV Incidence Among Men Who Have Sex With Men Participating in an HIV Vaccine Efficacy Trial, United States, 1998-2002," abstract presented at the 11th Conference on Retroviruses and Opportunistic Infections, 9 February 2004), http://www.retroconference. org/2004/cd/Abstract/857.htm.
52. K. Buchacz et al., "Trends in Primary and Secondary Syphilis and HIV Seroincidence Among Men Who Have Sex With Men in San Francisco, 1998-2002," (abstract presented at the 11th Conference on Retroviruses and Opportunistic Infections, 10 February 2004), http://www.retroconference.org/ 2004/cd/Abstract/88.htm; M. Ackers et al, "High HIV Incidence Among Men Who Have Sex With Men Participating in an HIV Vaccine Efficacy Trial, United States, 1998-2002," abstract presented at the 11th Conference on Retroviruses and Opportunistic Infections, 9 February 2004), http://www.retroconference. org/2004/cd/Abstract/857.htm.
53. R. Stall et al., "Association of Co-Occurring Psychosocial Health Problems and Increased Vulnerability to HIV/AIDS Among Urban Men Who Have Sex With Men," American Journal of Public Health 93, no. 6 (2003): 939-42; Kobliri et al., "High-Risk Behaviors Among MSM," see note 14 above, pp. 930-1; CDC, "Primary and Secondary Syphilis-New York City," see note 15 above, p. 855; Crosby and Grofe, "Study of HIV Sexual Risk," see note 14 above, p. 3.
54. R. Stall et al., "Association of Co-Occurring Psychosocial Health Problems and Increased Vulnerability to HIV/AIDS Among Urban Men Who Have Sex With Men," American Journal of Public Health 93, no. 6 (2003): 939-42; Kobliri et al., "High-Risk Behaviors Among MSM," see note 14 above, pp. 930-1; CDC, "Primary and Secondary Syphilis-New York City," see note 15 above, p. 855; Crosby and Grofe, "Study of HIV Sexual Risk," see note 14 above, p. 3.
55. R. Stall et al., "Association of Co-Occurring Psychosocial Health Problems and Increased Vulnerability to HIV/AIDS Among Urban Men Who Have Sex With Men," American Journal of Public Health 93, no. 6 (2003): 939-42; Kobliri et al., "High-Risk Behaviors Among MSM," see note 14 above, pp. 930-1; CDC, "Primary and Secondary Syphilis-New York City," see note 15 above, p. 855; Crosby and Grofe, "Study of HIV Sexual Risk," see note 14 above, p. 3.
56. R. Stall et al., "Association of Co-Occurring Psychosocial Health Problems and Increased Vulnerability to HIV/AIDS Among Urban Men Who Have Sex With Men," American Journal of Public Health 93, no. 6 (2003): 939-42; Kobliri et al., "High-Risk Behaviors Among MSM," see note 14 above, pp. 930-1; CDC, "Primary and Secondary Syphilis-New York City," see note 15 above, p. 855; Crosby and Grofe, "Study of HIV Sexual Risk," see note 14 above, p. 3.
57. Koblin et al., "High-Risk Behaviors Among MSM," see note 14 above, pp. 930-1; CDC, "Primary and Secondary Syphilis-New York City," see note 15 above, p. 855.
58. Koblin et al., "High-Risk Behaviors Among MSM," see note 14 above, pp. 930-1; CDC, "Primary and Secondary Syphilis-New York City," see note 15 above, p. 855.
59. Stall et al., "Association of Co-Occurring Psychosocial Health Problems," see note 27 above, pp. 939-42; J. Bancroft et al., "Sexual Risk-Taking in Gay Men: The Relevance of Sexual Arousability, Mood, and Sensation Seeking," Archives of Sexual Behavior 32, no. 6 (2003): 555-72; Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, pp. 299-300.
60. Stall et al., "Association of Co-Occurring Psychosocial Health Problems," see note 27 above, pp. 939-42; J. Bancroft et al., "Sexual Risk-Taking in Gay Men: The Relevance of Sexual Arousability, Mood, and Sensation Seeking," Archives of Sexual Behavior 32, no. 6 (2003): 555-72; Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, pp. 299-300.
61. Stall et al., "Association of Co-Occurring Psychosocial Health Problems," see note 27 above, pp. 939-42; J. Bancroft et al., "Sexual Risk-Taking in Gay Men: The Relevance of Sexual Arousability, Mood, and Sensation Seeking," Archives of Sexual Behavior 32, no. 6 (2003): 555-72; Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, pp. 299-300.
62. Stall et al., "Association of Co-Occurring Psychosocial Health Problems," see note 27 above, pp. 939-42; G. Wyatt et al., "How Does Childhood Sexual Abuse Affect HIV Prevention?" U.C.S.F. Center for AIDS Prevention Studies, Fact Sheet #52E, September 2003 http://www.caps.ucsf.edu/ CSA.html. A history of sexual abuse can be associated with a tendency to submit to unsafe sex initiated by a dominating partner; it might also be associated with increased aggression and a tendency to subject one's partner(s) to unsafe sex, particularly in men. (Wyatt et al., "How Does Childhood Sexual Abuse Affect HIV Prevention?" see above in this note, pp. 1-2).
63. Stall et al., "Association of Co-Occurring Psychosocial Health Problems," see note 27 above, pp. 939-42; G. Wyatt et al., "How Does Childhood Sexual Abuse Affect HIV Prevention?" U.C.S.F. Center for AIDS Prevention Studies, Fact Sheet #52E, September 2003 http://www.caps.ucsf.edu/ CSA.html. A history of sexual abuse can be associated with a tendency to submit to unsafe sex initiated by a dominating partner; it might also be associated with increased aggression and a tendency to subject one's partner(s) to unsafe sex, particularly in men. (Wyatt et al., "How Does Childhood Sexual Abuse Affect HIV Prevention?" see above in this note, pp. 1-2).
64. Stall et al., "Association of Co-Occurring Psychosocial Health Problems," see note 27 above, pp. 939-42; G. Wyatt et al., "How Does Childhood Sexual Abuse Affect HIV Prevention?" U.C.S.F. Center for AIDS Prevention Studies, Fact Sheet #52E, September 2003 http://www.caps.ucsf.edu/ CSA.html. A history of sexual abuse can be associated with a tendency to submit to unsafe sex initiated by a dominating partner; it might also be associated with increased aggression and a tendency to subject one's partner(s) to unsafe sex, particularly in men. (Wyatt et al., "How Does Childhood Sexual Abuse Affect HIV Prevention?" see above in this note, pp. 1-2).
65. Stall et al., "Association of Co-Occurring Psychosocial Health Problems," see note 26 above, pp. 939-42; Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 885.
66. Stall et al., "Association of Co-Occurring Psychosocial Health Problems," see note 26 above, pp. 939-42; Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 885.
67. Bancroft et al., "Sexual Risk-Taking in Gay Men," see note 28 above, pp. 555-72.
68. J.I. Martin, J.G. Pryce, and J.D. Leeper, "Avoidance Coping and HIV Risk Behavior Among Gay Men," Health & Social Work (in press).
69. Katz et al., "Impact of Highly Active Antiretroviral Treatment," see note 14 above, pp. 388, 392; CDC, "Primary and Secondary Syphilis-New York City," see note 15 above, pp. 855; Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, p. 300.
70. Katz et al., "Impact of Highly Active Antiretroviral Treatment," see note 14 above, pp. 388, 392; CDC, "Primary and Secondary Syphilis-New York City," see note 15 above, pp. 855; Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, p. 300.
71. Katz et al., "Impact of Highly Active Antiretroviral Treatment," see note 14 above, pp. 388, 392; CDC, "Primary and Secondary Syphilis-New York City," see note 15 above, pp. 855; Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, p. 300.
72. CDC, "Primary and Secondary Syphilis-New York City," see note 15 above, p. 855; Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 884; Fox et al., "Gonorrhea in the HIV Era," see note 15 above, p. 963.
73. CDC, "Primary and Secondary Syphilis-New York City," see note 15 above, p. 855; Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 884; Fox et al., "Gonorrhea in the HIV Era," see note 15 above, p. 963.
74. CDC, "Primary and Secondary Syphilis-New York City," see note 15 above, p. 855; Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 884; Fox et al., "Gonorrhea in the HIV Era," see note 15 above, p. 963.
75. M.A. Chesney et al., "An Individually Tailored Intervention for HIV Prevention: Baseline Data From the EXPLORE Study," American Journal of Public Health 93, no. 6 (2003): 936.
76. J.I. Martin, "Gay Men and Intimacy: Missing Link in HIV Prevention," Focus 14, no. 8 (1999): 5-6; J.I. Martin and J.K. Pryce, "The Role of Intimacy in HIV Prevention Among Gay Men," National Social Science Journal 13, no. 1 (1999): 64-9; G. Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, p. 298.
77. J.I. Martin, "Gay Men and Intimacy: Missing Link in HIV Prevention," Focus 14, no. 8 (1999): 5-6; J.I. Martin and J.K. Pryce, "The Role of Intimacy in HIV Prevention Among Gay Men," National Social Science Journal 13, no. 1 (1999): 64-9; G. Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, p. 298.
78. J.I. Martin, "Gay Men and Intimacy: Missing Link in HIV Prevention," Focus 14, no. 8 (1999): 5-6; J.I. Martin and J.K. Pryce, "The Role of Intimacy in HIV Prevention Among Gay Men," National Social Science Journal 13, no. 1 (1999): 64-9; G. Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, p. 298.
79. Martin, Pryce, and Leeper, "Avoidance Coping and HIV Risk Behavior," see note 32 above (in press); Martin, "Gay Men and Intimacy," see note 36 above, pp. 5-6; Martin and Pryce, "The Role of Intimacy," see note 36 above, pp. 64-9.
80. Martin, Pryce, and Leeper, "Avoidance Coping and HIV Risk Behavior," see note 32 above (in press); Martin, "Gay Men and Intimacy," see note 36 above, pp. 5-6; Martin and Pryce, "The Role of Intimacy," see note 36 above, pp. 64-9.
81. Martin, Pryce, and Leeper, "Avoidance Coping and HIV Risk Behavior," see note 32 above (in press); Martin, "Gay Men and Intimacy," see note 36 above, pp. 5-6; Martin and Pryce, "The Role of Intimacy," see note 36 above, pp. 64-9.
82. J.I. Martin, "Transcendent Experience Among Gay Men: Implications for HIV Prevention," (unpublished manuscript-readers may contact the author to obtain a copy).
83. W. McFarland and P. DeCarlo, "What Is the Effect of HIV Treatment on HIV Prevention?" U.C.S.F. Center for AIDS Prevention Studies, Fact Sheet #27ER, revised September 2003 http://www.caps.ucsf.edu/treatment. html; CDC, "Incorporating HIV Prevention," see note 9 above, p. 2; Katz et al., "Impact of Highly Active Antiretroviral Treatment," see note 14 above, pp. 388, 392; Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 884; Fox et al., "Gonorrhea in the HIV Era," see note 15 above, p.963; Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, p. 300.
84. W. McFarland and P. DeCarlo, "What Is the Effect of HIV Treatment on HIV Prevention?" U.C.S.F. Center for AIDS Prevention Studies, Fact Sheet #27ER, revised September 2003 http://www.caps.ucsf.edu/treatment. html; CDC, "Incorporating HIV Prevention," see note 9 above, p. 2; Katz et al., "Impact of Highly Active Antiretroviral Treatment," see note 14 above, pp. 388, 392; Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 884; Fox et al., "Gonorrhea in the HIV Era," see note 15 above, p.963; Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, p. 300.
85. W. McFarland and P. DeCarlo, "What Is the Effect of HIV Treatment on HIV Prevention?" U.C.S.F. Center for AIDS Prevention Studies, Fact Sheet #27ER, revised September 2003 http://www.caps.ucsf.edu/treatment. html; CDC, "Incorporating HIV Prevention," see note 9 above, p. 2; Katz et al., "Impact of Highly Active Antiretroviral Treatment," see note 14 above, pp. 388, 392; Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 884; Fox et al., "Gonorrhea in the HIV Era," see note 15 above, p.963; Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, p. 300.
86. W. McFarland and P. DeCarlo, "What Is the Effect of HIV Treatment on HIV Prevention?" U.C.S.F. Center for AIDS Prevention Studies, Fact Sheet #27ER, revised September 2003 http://www.caps.ucsf.edu/treatment. html; CDC, "Incorporating HIV Prevention," see note 9 above, p. 2; Katz et al., "Impact of Highly Active Antiretroviral Treatment," see note 14 above, pp. 388, 392; Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 884; Fox et al., "Gonorrhea in the HIV Era," see note 15 above, p.963; Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, p. 300.
87. W. McFarland and P. DeCarlo, "What Is the Effect of HIV Treatment on HIV Prevention?" U.C.S.F. Center for AIDS Prevention Studies, Fact Sheet #27ER, revised September 2003 http://www.caps.ucsf.edu/treatment. html; CDC, "Incorporating HIV Prevention," see note 9 above, p. 2; Katz et al., "Impact of Highly Active Antiretroviral Treatment," see note 14 above, pp. 388, 392; Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 884; Fox et al., "Gonorrhea in the HIV Era," see note 15 above, p.963; Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, p. 300.
88. W. McFarland and P. DeCarlo, "What Is the Effect of HIV Treatment on HIV Prevention?" U.C.S.F. Center for AIDS Prevention Studies, Fact Sheet #27ER, revised September 2003 http://www.caps.ucsf.edu/treatment. html; CDC, "Incorporating HIV Prevention," see note 9 above, p. 2; Katz et al., "Impact of Highly Active Antiretroviral Treatment," see note 14 above, pp. 388, 392; Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 884; Fox et al., "Gonorrhea in the HIV Era," see note 15 above, p.963; Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, p. 300.
89. HAART may reduce the degree of infectiousness by reducing viral load, but there is no indication that persons on antiretroviral therapy become non infectious. McFarland and DeCarlo, "What is the Effect of HIV Treatment on HIV Prevention?" see note 39 above, p. 2. CDC, "Incorporating HIV Prevention," see note 9 above, pp. 9-10. Moreover, transmission of drug-resistant strains of HIV from individuals who have developed resistance in response to HAART is a concern. CDC, "Incorporating HIV Prevention," see note 9 above, p. 10; Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 883.
90. HAART may reduce the degree of infectiousness by reducing viral load, but there is no indication that persons on antiretroviral therapy become non infectious. McFarland and DeCarlo, "What is the Effect of HIV Treatment on HIV Prevention?" see note 39 above, p. 2. CDC, "Incorporating HIV Prevention," see note 9 above, pp. 9-10. Moreover, transmission of drug-resistant strains of HIV from individuals who have developed resistance in response to HAART is a concern. CDC, "Incorporating HIV Prevention," see note 9 above, p. 10; Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 883.
91. HAART may reduce the degree of infectiousness by reducing viral load, but there is no indication that persons on antiretroviral therapy become non infectious. McFarland and DeCarlo, "What is the Effect of HIV Treatment on HIV Prevention?" see note 39 above, p. 2. CDC, "Incorporating HIV Prevention," see note 9 above, pp. 9-10. Moreover, transmission of drug-resistant strains of HIV from individuals who have developed resistance in response to HAART is a concern. CDC, "Incorporating HIV Prevention," see note 9 above, p. 10; Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 883.
92. HAART may reduce the degree of infectiousness by reducing viral load, but there is no indication that persons on antiretroviral therapy become non infectious. McFarland and DeCarlo, "What is the Effect of HIV Treatment on HIV Prevention?" see note 39 above, p. 2. CDC, "Incorporating HIV Prevention," see note 9 above, pp. 9-10. Moreover, transmission of drug-resistant strains of HIV from individuals who have developed resistance in response to HAART is a concern. CDC, "Incorporating HIV Prevention," see note 9 above, p. 10; Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 883.
93. Klitzman and Bayer, Mortal Secrets, see note 3 above, pp. 30-72.
94. Ibid., 43-44, 45, 49; Ciccarone et al., "Sex Without Disclosure," see note 18 above, p. 953; Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, p. 298.
95. Ibid., 43-44, 45, 49; Ciccarone et al., "Sex Without Disclosure," see note 18 above, p. 953; Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, p. 298.
96. Ibid., 43-44, 45, 49; Ciccarone et al., "Sex Without Disclosure," see note 18 above, p. 953; Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, p. 298.
97. Klitzman and Bayer, Mortal Secrets, see note 3 above, pp. 56-60.
98. A significant percentage of women with HIV are living with or at risk of domestic violence. M. Cohen et al., "Domestic Violence and Childhood Sexual Abuse in HIV-Infected Women and Women at Risk for HIV," American Journal of Public Health 90, no. 4 (2000): 560-5. The problem is by no means limited to women. Domestic violence in male couples may be as prevalent as among heterosexual couples, and HIV-positive MSM appear to have higher rates of battering victimization than other MSM. G.L. Greenwood et al., "Battering Victimization Among a Probability Sample of Men Who Have Sex With Men," American Journal of Public Health 92, no. 12 (2002): 1964-9.
99. A significant percentage of women with HIV are living with or at risk of domestic violence. M. Cohen et al., "Domestic Violence and Childhood Sexual Abuse in HIV-Infected Women and Women at Risk for HIV," American Journal of Public Health 90, no. 4 (2000): 560-5. The problem is by no means limited to women. Domestic violence in male couples may be as prevalent as among heterosexual couples, and HIV-positive MSM appear to have higher rates of battering victimization than other MSM. G.L. Greenwood et al., "Battering Victimization Among a Probability Sample of Men Who Have Sex With Men," American Journal of Public Health 92, no. 12 (2002): 1964-9.
100. Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, p. 297.
101. See, e.g., Martin, Pryce, and Leeper, "Avoidance Coping and HIV Risk Behavior," see note 32 above; J.I. Martin and J. Knox, "Self-Esteem Instability and Its Implications for HIV Prevention Among Gay Men," Health & Social Work 22, no. 4 (1997): 264-73.
102. See, e.g., Martin, Pryce, and Leeper, "Avoidance Coping and HIV Risk Behavior," see note 32 above; J.I. Martin and J. Knox, "Self-Esteem Instability and Its Implications for HIV Prevention Among Gay Men," Health & Social Work 22, no. 4 (1997): 264-73.
103. See also Ciccarone et al., "Sex Without Disclosure," see note 18 above, p. 953; Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 885; Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 885; Martin, Pryce, and Leeper, "Avoidance Coping and HIV Risk Behavior," see note 32 above; Martin, "Gay Men and Intimacy," see note 36 above, pp. 5-6.
104. See also Ciccarone et al., "Sex Without Disclosure," see note 18 above, p. 953; Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 885; Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 885; Martin, Pryce, and Leeper, "Avoidance Coping and HIV Risk Behavior," see note 32 above; Martin, "Gay Men and Intimacy," see note 36 above, pp. 5-6.
105. See also Ciccarone et al., "Sex Without Disclosure," see note 18 above, p. 953; Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 885; Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 885; Martin, Pryce, and Leeper, "Avoidance Coping and HIV Risk Behavior," see note 32 above; Martin, "Gay Men and Intimacy," see note 36 above, pp. 5-6.
106. See also Ciccarone et al., "Sex Without Disclosure," see note 18 above, p. 953; Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 885; Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 885; Martin, Pryce, and Leeper, "Avoidance Coping and HIV Risk Behavior," see note 32 above; Martin, "Gay Men and Intimacy," see note 36 above, pp. 5-6.
107. D.R. Buchanan, An Ethic for Health Promotion: Rethinking the Sources of Human Well-Being (New York: Oxford University Press, 2000), 65-6, 102-8.
108. For a detailed, penetrating critique of reductionistic, "behaviorist" trends in public health literature and interventions and the importance of incorporating values and moral reasoning into health promotion, see ibid., 49-84.
109. See, e.g., C. Taylor, "Philosophical Reflections on Caring Practices," in The Crisis of Care, ed. S.S. Phillips and P. Brenner (Washington, D.C.: Georgetown University Press, 1994), 182-3. For a much more detailed exposition, see C. Taylor, Sources of the Self: The Making of the Modern Identity (Cambridge, Mass.: Harvard University Press, 1989), 3-107; and "What is Human Agency?" and "The Concept of a Person," in Philosophical Papers 1: Human Agency and Language (Cambridge, England: Cambridge University Press, 1985): 15-44, 97-114.
110. See, e.g., C. Taylor, "Philosophical Reflections on Caring Practices," in The Crisis of Care, ed. S.S. Phillips and P. Brenner (Washington, D.C.: Georgetown University Press, 1994), 182-3. For a much more detailed exposition, see C. Taylor, Sources of the Self: The Making of the Modern Identity (Cambridge, Mass.: Harvard University Press, 1989), 3-107; and "What is Human Agency?" and "The Concept of a Person," in Philosophical Papers 1: Human Agency and Language (Cambridge, England: Cambridge University Press, 1985): 15-44, 97-114.
111. See, e.g., C. Taylor, "Philosophical Reflections on Caring Practices," in The Crisis of Care, ed. S.S. Phillips and P. Brenner (Washington, D.C.: Georgetown University Press, 1994), 182-3. For a much more detailed exposition, see C. Taylor, Sources of the Self: The Making of the Modern Identity (Cambridge, Mass.: Harvard University Press, 1989), 3-107; and "What is Human Agency?" and "The Concept of a Person," in Philosophical Papers 1: Human Agency and Language (Cambridge, England: Cambridge University Press, 1985): 15-44, 97-114.
112. C. Feldblum, "Sexual Orientation, Morality, and the Law: Devlin Revisited," University of Pittsburgh Law Review 57 (Winter 1996): 331-5.
113. Buchanan, An Ethic for Health Promotion, see note 49 above, pp. 108-13.
114. I b i d.
115. R.N. Bellah, "Understanding Caring in Contemporary America," in The Crisis of Care, ed. S.S. Phillips and P. Benner (Washington, D.C.: Georgetown University Press, 1994), 28-9.
116. Ibid., 33-5; Buchanan, An Ethic for Health Promotion, see note 48 above, pp. 163, 166-7.
117. Ibid., 33-5; Buchanan, An Ethic for Health Promotion, see note 48 above, pp. 163, 166-7.
118. See Klitzman and Bayer, Mortal Secrets, see note 3 above, pp. 46-50; Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, p. 298.
119. See Klitzman and Bayer, Mortal Secrets, see note 3 above, pp. 46-50; Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, p. 298.
120. See Klitzman and Bayer, Mortal Secrets, see note 3 above, pp. 66-68; Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, pp. 298-9.
121. See Klitzman and Bayer, Mortal Secrets, see note 3 above, pp. 66-68; Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, pp. 298-9.
122. For a discussion of how caring transcends ethical thinking based on a dichotomy between what is in my interest and what I think I ought to do because it is in the interest of others, see Taylor, "Philosophical Reflections on Caring Practices," see note 50 above, pp. 174-87.
123. See above at notes 41, 42, and 43.
124. Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, pp. 298-300.
125. Ibid., 300.
126. G.M. Herek, "Thinking About AIDS and Stigma: A Psychologist's Perspective," Journal of Law, Medicine & Ethics 30, no. 2 (2002): 594-607; S. Burris, "Disease Stigma in U.S. Public Health Law," Journal of Law, Medicine & Ethics 30, no. 2 (2002): 179-90.
127. G.M. Herek, "Thinking About AIDS and Stigma: A Psychologist's Perspective," Journal of Law, Medicine & Ethics 30, no. 2 (2002): 594-607; S. Burris, "Disease Stigma in U.S. Public Health Law," Journal of Law, Medicine & Ethics 30, no. 2 (2002): 179-90.
128. Taylor, see note 50 above, pp. 97-114.
129. Ibid.; see also Buchanan, An Ethic for Health Promotion, see note 49 above, pp. 102-18.
130. Ibid.; see also Buchanan, An Ethic for Health Promotion, see note 49 above, pp. 102-18.
131. Bellah, "Understanding Caring in Contemporary America," see note 54 above, pp. 28-9.
132. Buchanan, An Ethic for Health Promotion, see note 48 above, pp. 105-6.
133. See Martin, Pryce, and Leeper, "Avoidance Coping and HIV Risk Behavior," see note 32 above.
134. See Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, pp. 301-4 (discussing the need for all of us to assume collective responsibility for addressing the social injustices that facilitate HIV transmission). See also R.G. Parker, "Empowerment, Community Mobilization and Social Change in the Face of HIV/AIDS," AIDS 10, supp. 3 (1996): S27-31.
135. See Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, pp. 301-4 (discussing the need for all of us to assume collective responsibility for addressing the social injustices that facilitate HIV transmission). See also R.G. Parker, "Empowerment, Community Mobilization and Social Change in the Face of HIV/AIDS," AIDS 10, supp. 3 (1996): S27-31.
136. For a critique of HIV prevention policies based primarily on the privacy and civil rights of persons with HIV/AIDS and persons at high risk of HIV, see N. Scheper-Hughes, "AIDS and the Social Body," Social Science & Medicine 39, no. 7 (1994): 991-1003. She argues that in Brazil, such policies have led to HIV infection of substantial numbers of women, homeless children, and transgender people, who lack the sexual power of men in Brazilian society.
137. Klitzman and Bayer, Mortal Secrets, see note 3 above.
138. D.C. Ainslie, "AIDS and Sex: Is Warning a Moral Obligation?" Health Care Analysis 10 (2002): 51-4. See also Ciccarone et al., "Sex Without Disclosure," see note 18 above, p. 953; Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, p. 298.
139. D.C. Ainslie, "AIDS and Sex: Is Warning a Moral Obligation?" Health Care Analysis 10 (2002): 51-4. See also Ciccarone et al., "Sex Without Disclosure," see note 18 above, p. 953; Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, p. 298.
140. D.C. Ainslie, "AIDS and Sex: Is Warning a Moral Obligation?" Health Care Analysis 10 (2002): 51-4. See also Ciccarone et al., "Sex Without Disclosure," see note 18 above, p. 953; Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, p. 298.
141. Chambers raises the question of whether gay men in certain sexual situations really want honesty about HIV status. Chambers, "Gay Men, AIDS, and the Code of the Condom," see note 4 above, p. 379. In a similar vein, some of the men that Klitzman and Bayer interviewed stated that discussion of HIV status was a "turn-off" in anonymous or casual sex. Klitzman and Bayer, Mortal Secrets, see note 3 above, pp. 56-60. In view of the risks of HIV transmission in such settings, particularly given the danger of misunderstandings when men in sexual situations rely on coded or indirect communication, this desire for silence about HIV in such settings should be re-thought.
142. Chambers raises the question of whether gay men in certain sexual situations really want honesty about HIV status. Chambers, "Gay Men, AIDS, and the Code of the Condom," see note 4 above, p. 379. In a similar vein, some of the men that Klitzman and Bayer interviewed stated that discussion of HIV status was a "turn-off" in anonymous or casual sex. Klitzman and Bayer, Mortal Secrets, see note 3 above, pp. 56-60. In view of the risks of HIV transmission in such settings, particularly given the danger of misunderstandings when men in sexual situations rely on coded or indirect communication, this desire for silence about HIV in such settings should be re-thought.
143. D.C. Ainslie, "AIDS and Sex: Is Warning a Moral Obligation?" see note 71 above, p. 60; Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, pp. 298-9. See Klitzman and Bayer, Mortal Secrets, see note 3 above, pp. 46-50, 55-6, 58, 64.
144. D.C. Ainslie, "AIDS and Sex: Is Warning a Moral Obligation?" see note 71 above, p. 60; Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, pp. 298-9. See Klitzman and Bayer, Mortal Secrets, see note 3 above, pp. 46-50, 55-6, 58, 64.
145. D.C. Ainslie, "AIDS and Sex: Is Warning a Moral Obligation?" see note 71 above, p. 60; Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, pp. 298-9. See Klitzman and Bayer, Mortal Secrets, see note 3 above, pp. 46-50, 55-6, 58, 64.
146. Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, p. 298.
147. MSM HIV/STD Prevention Taskforce, "Community Manifesto: A New Response to HIV and STDs," http://www.metrokc.gov/health/apu/taskforce/ manifesto.htm (accessed 14 February 2004).
148. Cohen et al., "Domestic Violence and Childhood Sexual Abuse in HIV-Infected Women," see note 44 above, pp. 560-5.
149. Greenwood et al., "Battering Victimization," see note 44 above, pp. 1964-69.
150. Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, pp. 299-300, 301; Parker, "Empowerment, Community Mobilization and Social Change," see note 68 above, pp. S27-31; Ciccarone et al., "Sex Without Disclosure," see note 18 above, p. 953; Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 885.
151. Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, pp. 299-300, 301; Parker, "Empowerment, Community Mobilization and Social Change," see note 68 above, pp. S27-31; Ciccarone et al., "Sex Without Disclosure," see note 18 above, p. 953; Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 885.
152. Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, pp. 299-300, 301; Parker, "Empowerment, Community Mobilization and Social Change," see note 68 above, pp. S27-31; Ciccarone et al., "Sex Without Disclosure," see note 18 above, p. 953; Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 885.
153. Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, pp. 299-300, 301; Parker, "Empowerment, Community Mobilization and Social Change," see note 68 above, pp. S27-31; Ciccarone et al., "Sex Without Disclosure," see note 18 above, p. 953; Wolitski et al., "Are We Headed for a Resurgence?" see note 14 above, p. 885.
154. Marks, Burris, and Peterman, "Reducing Sexual Transmission of HIV," see note 16 above, p. 301.
155. E.g., K. Clements-Nolle et al., "HIV Prevalence, Risk Behaviors, Health Care Use, and Mental Health Status of Transgender Persons: Implications For Public Health Intervention," American Journal of Public Health 91, no. 6 (2001): 915-21.
156. Sadly, a number of such programs, including programs that have received federal funding, teach children information about the risks of sex that is simply false. See, for instance, "Ignorance Only: HIV/AIDS, Human Rights and Federally Funded Abstinence-Only Programs in the United States: Texas, A Case Study," Human Rights Watch Reports 14, no. 5(G): 23-6 (September 2002) http://hrw.org/reports/2002/usa0902/USA0902.pdf.
157. 42 U.S.C. § 300ff-78. See also § 300ff-67(1).
158. M. Smith, "Federal Investigators Clear AIDS Prevention Programs of Wrongdoing-and Then Reinvestigate Them," San Francisco Weekly, 7 May 2003 http://www.sfweekly.com/issues/2003-05-07/smith.html/l/index.html; M.A.J. McKenna, "Political Shift Felt as CDC Endures Change," Atlanta Journal-Constitution, 23 November 2002, A1.
159. M. Smith, "Federal Investigators Clear AIDS Prevention Programs of Wrongdoing-and Then Reinvestigate Them," San Francisco Weekly, 7 May 2003 http://www.sfweekly.com/issues/2003-05-07/smith.html/l/index.html; M.A.J. McKenna, "Political Shift Felt as CDC Endures Change," Atlanta Journal-Constitution, 23 November 2002, A1.
160. R. Weiss, "Critics of NIH Studies Prompt Senate Hearing," The Washington Post, 19 January 2004, A19; "Attacks on Prevention Work Have Increased: One Researcher Experienced In-Depth Federal Audit," AIDS Alert 19, no. 1 (1 January 2004): 5.
161. R. Weiss, "Critics of NIH Studies Prompt Senate Hearing," The Washington Post, 19 January 2004, A19; "Attacks on Prevention Work Have Increased: One Researcher Experienced In-Depth Federal Audit," AIDS Alert 19, no. 1 (1 January 2004): 5.
162. See, e.g., S. Satel, "Opiates for the Masses," Wall Street Journal, 8 June 1998, http://www.junkscience.com/news2/satel.htm (accessed 16 February 2004) ("harm reduction is the public-policy manifestation of the addict's dearest wish: to use free drugs without out consequence").
163. Lazzarini, Bray, and Burris., "Evaluating the Impact," see note 7 above, pp. 239-53.
164. Ibid., 241.
165. Ibid., 244.
166. Ibid., 244.
167. Ibid., 247.
168. Ibid., 245.
169. Ibid., 247-52.
170. D.L. McColgin and E.T. Hey, "Criminal Law," in AIDS and the Law, 3rd ed., D.W. Webber (New York: John Wiley & Sons, 1997), 261-2.
171. E.g., Chambers, "Gay Men, AIDS, and the Code of the Condom," see note 4 above, pp. 382-3.
172. E.g., Ohio Rev. Code § 2950.01 et seq.; Va. Code Ann. § 9.1-900 et seq.
173. E.g., Ohio Rev. Code § 2950.01 et seq.; Va. Code Ann. § 9.1-900 et seq.
174. Actually, we appear to know relatively little about why people decide to be tested for HIV or to avoid HIV testing. See, e.g., S. Burris, "Law and the Social Risk of Health Care: Lessons from HIV Testing," Albany Law Review 61 (1998): 831-95.
175. Ohio Rev. Code Ann. § 2903.11(B)(1).
176. Ohio Rev. Code Ann. § 2903.11(B)(3).
177. Ohio Rev. Code Ann. §§ 2907.01(A) & 2903.11(B)(3).
178. Va. Stat Ann. § 18.2-67.4:1(A).
179. Va. Stat. Ann. § 18.2-67.4:1(B).
180. Md. Code Ann., Health-Gen. § 18-601.1.
181. E.g., Commonwealth v. Smith, 58 Mass. App. Ct. 381, 790 N.E.2d 708 (App. Ct. 2003); Hall v. Commonwealth, No. 2572-96-2, 1997 Va. App. LEXIS 782 (Ct. App. Dec. 30, 1997); Weeks v. Scott, 55 F.3d 1059 (5th Cir. 1995).
182. E.g., Commonwealth v. Smith, 58 Mass. App. Ct. 381, 790 N.E.2d 708 (App. Ct. 2003); Hall v. Commonwealth, No. 2572-96-2, 1997 Va. App. LEXIS 782 (Ct. App. Dec. 30, 1997); Weeks v. Scott, 55 F.3d 1059 (5th Cir. 1995).
183. E.g., Commonwealth v. Smith, 58 Mass. App. Ct. 381, 790 N.E.2d 708 (App. Ct. 2003); Hall v. Commonwealth, No. 2572-96-2, 1997 Va. App. LEXIS 782 (Ct. App. Dec. 30, 1997); Weeks v. Scott, 55 F.3d 1059 (5th Cir. 1995).
184. Van Derkeken, "HIV Transmission Case Tossed Out," see note 11 above; see also McAree, "The Debate Over HIV Exposure Laws," see note 11 above; Glionna, "Law on HIV Infection Little Used," see note 11 above.
185. Van Derkeken, "HIV Transmission Case Tossed Out," see note 11 above; see also McAree, "The Debate Over HIV Exposure Laws," see note 11 above; Glionna, "Law on HIV Infection Little Used," see note 11 above.
186. Van Derkeken, "HIV Transmission Case Tossed Out," see note 11 above; see also McAree, "The Debate Over HIV Exposure Laws," see note 11 above; Glionna, "Law on HIV Infection Little Used," see note 11 above.
187. See D. Webber's article, "Self-Incrimination, Partner Notification, and the Criminal Law. Negatives for the CDC's 'Prevention for Positives' Initiative," in this issue of APPJ; see also Lazzarini, Bray, and Burris, "Evaluating the Impact," see note 7 above, pp. 250-1.
188. See D. Webber's article, "Self-Incrimination, Partner Notification, and the Criminal Law. Negatives for the CDC's 'Prevention for Positives' Initiative," in this issue of APPJ; see also Lazzarini, Bray, and Burris, "Evaluating the Impact," see note 7 above, pp. 250-1.
189. CDC, "Advancing HIV Prevention," see note 8 above, p. 331; CDC, "Incorporating HIV Prevention," see note 9 above, pp. 13, 15-7.
190. CDC, "Advancing HIV Prevention," see note 8 above, p. 331; CDC, "Incorporating HIV Prevention," see note 9 above, pp. 13, 15-7.
191. See, e.g., M.R. Golden et al., "Support Among Persons Infected With HIV for Routine Health Department Contact for HIV Partner Notification," Journal of Acquired Immune Deficiency Syndromes 32, no. 2 (2003): 196-202; see also Klitzman and Bayer, Mortal Secrets, see note 3 above, pp. 70-2, 177, 188.
192. See, e.g., M.R. Golden et al., "Support Among Persons Infected With HIV for Routine Health Department Contact for HIV Partner Notification," Journal of Acquired Immune Deficiency Syndromes 32, no. 2 (2003): 196-202; see also Klitzman and Bayer, Mortal Secrets, see note 3 above, pp. 70-2, 177, 188.
193. See Webber, "Self-Incrimination, Partner Notification," in this issue of APPJ.
194. See, e.g., Doe v. Medlantic Health Care Group, Inc., 814 A.2d 939 (D.C. 2003), where a coworker of the plaintiff at his night job was also a daytime receptionist at the hospital where the plaintiff obtained HIV care. When she saw him at the hospital, the coworker/hospital receptionist accessed his confidential medical records, learned that he was HIV positive, and disclosed this information to their night-job coworkers.
195. I am not suggesting that once a lawsuit is brought that the plaintiffs attorney should fail to pursue the case vigorously or try to balance his or her client's interests against those of the defendant or any third party. Of course, a lawyer owes to any client he or she agrees to represent a duty of vigorous representation. I am suggesting that we think carefully, before taking a case, about the broader ramifications.
196. I have had experiences in which physicians have sought my advice regarding patients who were exposing their spouses or partners to HIV and who refused to notify them or to use condoms. When I suggested that the appropriate action might be to notify the public health department rather than the patient's spouse or partner, I have on occasion been told that, in the physician's experience, the public health authorities take no action or are ineffectual in such situations.
197. Klitzman and Bayer report that their interviewees expressed no opposition to, and some support for, partner notification when carried out by public health workers, but that many of their interviewees were adamantly opposed to breaches of confidentiality by doctors, therapists, and other healthcare professionals, whatever the motivation. Klitzman and Bayer, Mortal Secrets, see note 3 above, pp.188-9.
198. Many state laws provide that physicians, and sometimes other licensed healthcare professionals, have the right, but not the obligation, to notify the sex partners of a patient diagnosed with HIV when the patient refuses to do so. Typically, such laws also provide that the healthcare professional has no legal obligation to provide such third-party notice, and is immune from liability for any decision to disclose or not to disclose that is made in good faith. See, e.g., Md. Code Ann., Health-Gen. §§ 4-305(b), 4-308, 18-337(b) & (e)-(g); Va. Code Ann. §§ 32.1-36(C), 32.1-36.1(A)(11) & (D).
199. Many state laws provide that physicians, and sometimes other licensed healthcare professionals, have the right, but not the obligation, to notify the sex partners of a patient diagnosed with HIV when the patient refuses to do so. Typically, such laws also provide that the healthcare professional has no legal obligation to provide such third-party notice, and is immune from liability for any decision to disclose or not to disclose that is made in good faith. See, e.g., Md. Code Ann., Health-Gen. §§ 4-305(b), 4-308, 18-337(b) & (e)-(g); Va. Code Ann. §§ 32.1-36(C), 32.1-36.1(A)(11) & (D).
200. In most states, legal ethics rules provide at most that a lawyer has the option, but not the duty, to disclose a client's confidences to the extent reasonably necessary to prevent the client from committing a crime or another act likely to result in death or substantial injury to another person. See, for instance, District of Columbia Rules of Professional Conduct 1.6; Maryland Rules of Professional Conduct 1.6. Several states, however, have adopted an ethical rule that requires lawyers to disclose client confidences in limited circumstances. For instance, in Virginia a "lawyer shall promptly reveal the intention of a client, as stated by the client, to commit a crime and the information necessary to prevent the crime, but before revealing the information, the attorney shall, where feasible, advise the client of the possible legal consequence of the action, urge the client not to commit the crime, and advise the client that the attorney must reveal the client's criminal intention unless thereupon abandoned." Virginia Supreme Court Rule 1.6. The Virginia rule refers only to a client's stated intention to commit a crime in the future, not to past conduct that might have been criminal. Virginia law criminalizes not only certain sex acts by an HIV positive person committed with the intent to transmit the infection to another person," Va. Code Ann. § 18.2-67.4:1, but also the commission of any of those sex acts "without disclosing the existence of his infection to the other person," § 18.2-67.4:1(B). Thus, a Virginia lawyer faced with a client's statement of intent to have anal, vaginal, or oral sex without disclosing his HIV infection would face an ethical dilemma. Virginia ethics rules and criminal law, therefore, create a strong incentive for a lawyer not to discuss his clients' sex lives with them.