A comparative assessment of different legal systems and its impact on HIV/AIDS responses: a learning point for HongKong in the unabated fight against HIV/AIDS

Abstract

Aim. This paper reveals key considerations required to reform and enact public health legislation to reduce and maintain the low prevalence of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) in Hong Kong Special Administrative Region (HKSAR), in light of the growing global transmission of the epidemic.

Background. There are a total of 33.3 million people living with HIV/AIDS globally, with 2.7 million becoming newly infected in 2010. Despite an overall global decline in HIV incidence of 19%, the number of newly infected people still exceeds the amount of people placed on antiretroviral drugs. HKSAR experienced a 0.5% increase in incidence in 2011, with 438 new cases reported to the Department of Health. There are currently no protective or punitive laws either for or against people living with HIV/AIDS, Men who have sex with men (MSM), sex workers or injecting drug users in HKSAR. Additionally, HIV/AIDS is not reportable under the notifiable disease act.

Methods. The data used was collected between 1983 and 2012 and researched using electronic databases: MEDLINE, Google Scholar and Web of Science.

Results. Ten studies met the inclusion criteria. The themes identified from the literature are: (1) True prevalence not reflected due to unawareness of serostatus, (2) Low uptake of screening due to the fear of stigmatisation, discrimination and/or prosecution and (3) Protective laws encourage responsibility. The statistics of HIV/AIDS in HKSAR may not be reflective of the true prevalence given the current methods of data collection. Additionally, the legal system in HKSAR fails to protect against discrimination based on an individual’s sexual orientation, which can potentially exacerbate existing stigma and consequently fuel the HIV/AIDS epidemic in Hong Kong.

Conclusion. The inclusion of HIV/AIDS under the notifiable disease act can provide a more accurate prevalence and incidence rate. It can also be used as a tool to evaluate ongoing prevention efforts. HIV/AIDS specific laws, with regard to transmission and exposure, are detrimental to public health efforts in managing the epidemic. Instead, protective laws, such as anti-discrimination laws and the furthering of women’s rights, would yield greater benefits.