Why Your HIV Status Can Put You On a Sex Offender Registry!

If someone is in [snorts] a state where they are put on the sex offender registry for not disclosing their HIV status, does that transfer to other states even though the laws are different there and they wouldn't have been put on the sex offender registry there? Yeah. Uh it's a good question and the answer is almost always yes. So, usually you have an obligation to register in another state, even if it wasn't a crime in that state. Well, hi Nathan. How are you? >> I'm doing well. It's nice to see you and to talk to you today. >> You as well. So, just jumping right in. Um what this is a question that I ask a lot of folks so you can answer this however you feel is relevant to you but what is your perception of the global or perhaps the um national HIV epidemic at this point? >> Well I I think it's important that you start by mentioning actually two things in there. One is that it is global. Um and and the second is that there is still an epidemic. Transmissions happen every single day. The vast majority of them are preventable. Um and um for every new person who learns of their HIV positive status, we hope that they um are able to enter treatment. we have excellent um uh treatments and therapies available for everyone both people living with HIV and people not living with HIV. Um so the uh the epidemic is still going. Um the good news is that we have a lot of options for care um regardless of your HIV status. Um, and I think the focus really needs to be on uh improving access, improving awareness, and especially above all else reducing uh fear and stigma around HIV. I think that that 40 years on still drives so much of the HIV epidemic both nationally and globally. >> Well said. Thank you. Um, and can you tell me a little bit about the Williams Institute. What, for those that aren't familiar, what does an organization like that do exactly? >> Yeah. Um, Williams Institute is is really kind of unique. We are part of a university. We're part of UCLA's law school. Uh, but we're a research center. Um, we've been going for 23 years now. 23 or 24 years. Um we were for a while the only research center dedicated to studying uh law and policy that affects sexual and gender minorities. So LGBTQ plus individuals. Um and the idea from the start has been to let um the data to let facts inform policy rather than as I just mentioned in fact you know fear, stigma, prejudice. Um uh so if you wind uh rewind all the way back to about the year 2000, that's about when we got going. You know, this was uh don't ask don't tell was still on the books. Uh this was before Lawrence v. Texas. States could still criminalize um people for engaging in same-sex sexual relations. There was no same-sex marriage. Civil unions were still a long way off. um uh let alone all of the tremendous strides we've made um around trans visibility and trans rights. Um that mission uh is just as vital today as it was in the year 2000. um people, sexual and gender minorities across the United States and actually now we're um we have a lot of active research globally, you know, still face um terrible social, legal, economic and political burdens. Um we think that the best way to fight against that um fear, stigma, homophobia, transphobia is to let the data speak, right? um uh same-sex couples uh are are not just beautiful beautiful sort of spiritually beautiful to see on the street, but also for the economy, for society, for the communities that they're embedded in, for the children uh who they um uh raise and love. LGBTQ people make tremendous contributions in the workplace and shouldn't be discriminated against because of their um uh gender identity uh or or sexual orientation. Um, we've also uh looked at HIV and HIV criminalization. Of course, those are not the same thing, right? The people living with HIV are not the same thing as sexual and gender minorities. But one of the communities, two of the communities most affected by the HIV epidemic in the United States um are um uh LGBT people and also TE people. That is um uh lesbian, gay, and bisexual people. although lesbian much much less so, but still are part of this broader um uh community of LGBTQ people. And so we thought it was appropriate um really for almost a decade now to be looking at um the effect of HIV and especially HIV criminalization on people living with HIV. >> So is your organization focused nationally or internationally as well? We used to uh primarily do well we still primarily our research is is focused on the United States. Um at the very beginning it was only uh US related research. Over time we've had the opportunity to grow that portfolio internationally. We have an incredible uh uh set of scholars both within the Williams Institute focused on international issues. um uh Ari colleague and also Miguel our colleague their portfolios are 100% international and we also are able to work with a number of external collaborators to look at um uh issues we recently were uh publishing on uh the Balkans um in southeastern Europe we've had a large portfolio focused on Latin America and Mexico we just released I think last week on attitudes towards LGBTQ people in China So it's really quite exciting for us to be able to take what we know about the sort of data, analyzing the data, letting the data inform policy and share that expertise with colleagues and collaborators across the globe. >> That's amazing. That's exciting. Um I'm curious when you say gathering data, what does that look like? Uh so across the board and I'll talk very generally about the Williams Institute and then I can talk about uh HIV a little bit more uh in detail if you like. Um we look at uh a lot of topics. So for example, health, behavioral health, mental health uh affecting LGBTQ people that might involve you know original surveys that um our collaborators um conduct. You might have heard of the US trans survey. It's the by far the largest survey of trans individuals I think anywhere ever. Um there was one in 2015. There was one that was conducted in 2022. Uh our colleague Jodie Herman was one of the principal investigators on it. And um my understanding is that they had, you know, hundreds of thousands of people who identify as as trans uh who responded um really detailed look at um uh economic, social, uh health um factors. Um things like uh how easy is it? Do you have identity documents that um uh match who you are? How easy has it been to get them? uh you know have you faced discrimination because of lack of identification you know what sort of economic security or insecurity are you facing so you have those sorts of things we also rely on big national surveys of um of health outcomes there's one actually called the California health interview survey um I'm in California that's uh sort of housed at UCLA really really detailed information on um not just uh mental health uh and physical health, but sort of sexual health and well-being. We're able to look in really fine grain detail, for example, on how immigration status or um access to stable housing affects uh outcomes. And of course, the Williams Institute's specific uh gloss on all this is, you know, what is what do these look like for sexual and gender minorities? And sometimes that looks like everybody else, and sometimes there are really distinct patterns. And unless you're able to look at sexual orientation and gender identity like you would race, ethnicity like you would with somebody's um sex assigned at birth like you would with somebody's economic um outcomes, you know, how much money they're making or educational attainment. Unless you're able to specifically focus on that, then um those dynamics can get lost and then you might make, you know, public policies that um uh aren't as wellcrafted as they could be. >> And then as far as HIV, is that through the same surveys or is that separate? Some of some of it is um especially when we're looking at um things like uh access to prep or access to um care continuum for people living with HIV, access to testing. We could look at for example the California Health Interview Survey. There's um Burface and I always forget the acronym that's a very large nationally focused one. Behavioral uh uh health risk factors. I think there's actually a youth version of that as well. The reason we like these sorts of um big comprehensive surveys is that they're some of the few um high quality uh research endeavors that actually ask about sexual orientation and gender identity and expression. You might know the census doesn't ask about that. In fact, it was a monumental fight to get um same-sex couples included in the census. There's something called the American Community Survey. all of these other big sort of demographic data sets that scholars across the United States use to understand Americans and American communities um until very recently just didn't have any information on sexual orientation or gender identity and actually the Williams Institute um has been instrumental in advocating for better data collection around sexual and gender minorities. So we do use that for some of the HIV related research because again um we want to know how um sexual and gender minorities especially are affected by these issues. What I focus on most of my time is HIV criminalization and that's a little bit different. That's not something that you learn about from surveys normally. What we have to do is go state by state and I can talk about what I mean by HIV criminalization in a minute. Um but but really what we're trying to do is go to law enforcement agencies, go to court systems, go to department of corrections, even go to a sex offender registry, something like that, and try to identify among the unfortunately millions and millions of people in the United States who have been criminalized to try to find who are those people who are coming into contact with the criminal legal system because of their HIV status. And then once we're able to identify them, then we get into the documents. It's a much messier um uh more involved process. It's a lot harder to do, but we think it's incredibly important because people are being accused of crimes, being arrested, being prosecuted, being convicted, being incarcerated, uh, and sometimes even put on sex offender registries because of uh, allegations related to their HIV status. So with surveys, I picture I mean you even mentioned a principal investigator. So a more formalized process of creating the survey scientific having people respond. This what you're talking about saying it's more messy. I almost picture like having an Aaron Brockovich moment and >> papers and things spread around and just trying to like make sense of everything. Is that accurate? [laughter] >> I think that's a good description. Or think about what reporters are doing. We do a lot of document requests. We do a lot of Freedom of Information Act requests. We are an academic institution or academic entity within an academic institution. So, we still have to go through all of those formal processes that everybody else doing research at a university has to do. So, there's something called IRB, institutional board review, instit institutional review board. Um, we submit a proposal. We say we want to study HIV criminalization in Missouri and we think these are going to be the relevant agencies who have the relevant data. We're not sure yet. We're going to try to get it. Um we only are going to collect deidentified information. We never want to personally expose anyone who's had to experience criminalization because of their HIV status. We don't want to be able to identify them individually ourselves. and we certainly don't want any of our reports to be able to identify somebody. So, we have these safeguards in place to make sure that we're not doing any harm as we're conducting our research. But when we're getting down into it, it's it's some Aaron Brockovage stuff. We got lots of, you know, um, uh, governmental agencies, not private sector fortunately, but governmental agencies. They don't want to tell you it. You have to come back and say, "Well, the law says you have to disclose this, and we'd like you to." And then they come back and say, "Well, it's going to cost us money to get us to give you the records. It might take months and months. There might be negotiations." And we have to do that differently in every single state. So, it's fun. It's exciting. Um, it's very challenging. And 90% of what I'm doing is trying to get the records. Um, and you know, it's it's a question I don't have the answer for. Why do why does why do government agencies feel so reluctant sometimes to share information about what they're doing? And I don't have the answer to that question out of my mouth. >> Yeah. [laughter] >> Um you know, we can we can speculate about it. I I will say that >> um you know, these are almost universally very difficult, very unhappy stories. Um and there's a lot of uh often what people would think of as um injustices going on. Um you know, that might be part of it. Also, you know, I have a lot of sympathy for my um my brothers and sisters, my siblings in um in government jobs, local state government. You know, you you don't have a lot of resources. You've got a whole bunch of other things you need to do. Maybe you just don't, you know, you have this annoying person from UCLA saying, "I'd like you to look through all of your records and see, you know, how many people were arrested for criminal exposure." >> Yeah. Okay, that makes sense. Um, and just to touch our toes into the matter, what have your recent findings around HIV criminalization? And I know this is super broad, but what what are some recent findings that aren't top of mind right now? Well, let me back up and and just give a a brief definition. What do I mean by HIV criminalization? We've used the the term a few times. So, it's um uh it's laws that make things conduct that would be legal now illegal because of somebody's HIV status. It's universally somebody's HIV positive status. or else that creative penalty enhancement again because of somebody's HIV positive status. Let me give you a couple of examples. So in Ohio, if I have consensual sex with another adult and I don't disclose my HIV status, that's perfectly legal so long as my HIV status is negative. If it's positive, I'm now liable for a felony conviction, I think 13 years in prison, and sex offender registration. Now between those these two scenarios, the only thing that's different uh is the person's HIV status, right? In one scenario it's negative, in one scenario it's positive. Everything else is the same. And yet now the person living with HIV is liable for these criminal penalties. Another example, we go from Ohio south to Tennessee. Uh prostitution, that is sex work. Prostitution is the term that they use in the law. uh is normally a misdemeanor citation. Uh but until very very recently was um if you're a person living with HIV and you know your status in both cases you need to know your HIV positive status um you're now liable for again felony conviction. So it gets bumped up from a misdemeanor to a felony felony conviction years in prison and mandatory lifetime sex offender registration in Tennessee. a conversation about sex work is enough to sustain that felony conviction. So, we actually went to Memphis with our uh colleague and collaborator there. We got uh dozens and dozens of police arrest affidavit. So, this is what the police say happened when they arrested somebody. And we found that in over 90% of cases, the allegation was an undercover police officer. So, they have a vice squad. The allegation is an undercover police officer from that vice squad approached somebody who they thought was engaged in sex work. They had a conversation about sex work and when a takedown notice was given, the person was arrested. They found out the person's HIV status got bumped up to a felony. A conversation about sex work is not an HIV transmission route. We also found out that in half of those cases, the riskiest sex act alleged was receptive oral sex from the person who wasn't living with HIV. And the average dollar amount was about $15. And of course, all of these people again convicted lifetime sex offender registration. If you're on the sex offender registry and you have a kid, you can't take your kid to the playground. You can't walk them to school. If your kid wants to have a friend over, that's not going to happen because you're not allowed to have other children in the house. If you want to go to a house of worship, but that house of worship has a daycare center attached, you're not allowed to go there. If you want to go to a treatment facility that has a pediatric ward, you're not allowed to go to that impatient treatment facility. You have to carry around an ID with you at all times that says, "I am a sex offender." There's a little on your state ID, a little um tag that you have to have on there. every time you move, you have to update this state um within I think two weeks of moving. And it's not the worst part, but what really drove it home to me was every year on your birthday, within two weeks of your birthday, but basically on your birthday, you had to go to the Tennessee Bureau of Investigation and pay them money because you are on the sex offender registry. So there's an annual registration fee that you had to pay every single year. So imagine trying to have stable housing, stable income. Imagine trying to um uh have a a stable home life, be embedded in a community when you have these constraints on you. And again, for the vast majority of these people who wound up on the sex offender registry because of aggravated prostitution, that's the name of the offense, what they did, what what they were alleged to have done was have a conversation about sex work. So, you know, these are two examples. One is non-disclosure. The other one is sex work while positive essentially. Um, those are two examples of HIV criminalization. Let me give you a couple of other ones to really drive home the po point. So, in Indiana, they have what's called battery by bodily fluid. It's essentially spitting or biting. Um, spitting and biting are not HIV transmission routes. Throwing fluids at other people. So, in prisons, they have um what's called gassing. You throw urine on somebody. Again, this is not an HIV transmission route. And yet in Indiana, if you do that and you're a person living with HIV, then you're liable for years in prison. And we actually got the probable cause of arrest, similar sort of narratives from police for dozens and dozens of these people who were arrested and prosecuted for this battery by bodily fluid. And what did we find? And this this hasn't been published yet, but we're hoping to release these findings in the fall. We have a report and I I'm happy to share a link uh to that Tennessee reports to a report recently from uh Ohio. So you can look at some of the description and an analysis of the laws. Um in Indiana what um our report will show is that overwhelmingly people were uh arrested in the context of an acute mental health crisis. either it was um uh something like a psychotic break, you know, they were in acute um distress um because of some behavioral health challenge or else they were extremely intoxicated which again could be a mental health problem, right? And so the allegation is um they were uh arrested handcuffed in a police car and they spit at or toward a police officer. probably they weren't um they didn't have all of their faculties there when they did it anyway. But even if you did, you know, you're very frustrated, right? You're trapped. It's sort of uh I can imagine it an expression of frustration regardless. U you know, I don't want to get spit at, right? Like I don't want somebody to th urine at me. I get it. It's gross. We already have laws for that. But because of the person's HIV status, now there now there's a penalty enhancement. Now you're exposed to even harsher penalties. So that's what I mean by HIV criminalization. I know that was a lot. [laughter] Maybe you have questions. Sorry. I talk about this all day long every day. So I packed a lot. >> I mean, I have to say just my immediate reaction is how shocked I was. I got chills a number of times when you were talking about it. Like way beyond what I would just imagine cursor like thinking about it. Um, and and with the spitting the bodily fluids, it just makes me think of act up and and protests and how often protesters can be seen spitting at police or other people and how that could be interpreted by the law in this way is really scary. >> Yeah. And um we see um unfortunately sometimes public health collaborating with law enforcement as well. All of these laws require that the person knew of their HIV positive status. And so sometimes the police will go to the county or the state public health department and as as as you may know right there's a confidential case report form that gets sent to the CDC every time there's a positive diagnosis. Um also the state collects information on people living with HIV. Um, and so they will go and say, you know, do you have a case report for this person? In Indiana, and not just in Indiana, in many states, they would often make u you sign a a document when you receive your your positive diagnosis, you know, prising you of your obligations, and then that gets held with the county or the state public health department, and then the public health department gave that information to police. Fortunately, that's changing in Indiana. Um, they know there's not a document that has to be signed like that anymore. Um, public health departments are increasingly coming around to the idea that HIV criminalization runs counter to public health objectives. It can discourage testing and treatment um for exactly the reason that I just described. Uh there used to be a phrase uh fortunately it's fallen out of um uh out of use and that was take the test risk arrest. Um that sends that sends chills down my spine. Um the idea that um these laws which certainly are not increasing testing and treatment could actually be discouraging people from getting tested or treated. Um uh I hope the people listening here today um will use this as an opportunity to do exactly the opposite. Go out if you don't know your status right now. Go out and get tested. Bring a friend with you. Get two for the price of one. Um uh we don't end the epidemic with HIV criminalization. But um we can end the epidemic through increased testing and treatment. And fortunately, the National Association of State and Territorial AIDS Directors has come out against HIV criminalization. The American Medical Association has come out against HIV criminalization. The the Association of Prosecuting Attorneys even has come out against HIV criminalization. So, the professional groups know that this is hurting their, you know, their professional goals, the thing that they want to achieve with their job. you know, if you're in public health, you do it because you care about the health of the public. Um, and all of the evidence that we have, at least is showing that HIV criminal laws aren't achieving that. >> Yeah, I can't I can't say that that's surprises me. um kind of like the war on drugs or you know just any kind of law that's so restrictive like that against sex work uh against LGBTQ all of it is just so counterproductive when it comes to public health anyway. >> Yeah. And um we've seen uh actually you know tremendous um advocacy um led by people living with HIV around um molecular HIV surveillance lately as well. Um it can potentially be a powerful public health tool but it can be also a powerful tool for surveillance. Um the CDC has endorsed the practice. Um I don't know how many people living with HIV they consulted before they endorsed molecular surveillance but um >> can you define what that is? >> Uh yeah so um it's also known as um for example cluster detection. So the idea is to sequence um HIV um in people living with HIV to see if you can detect um clusters of cases. Um the science is not very good and it what it absolutely cannot do is detect directionality. Right? So this case resulted from this person. What it can do at best is say um these two strains of HIV look similar to each other. So they're probably um somehow more related to each other than say you know the this one over here or this one over here. Um you know the the idea is if you can detect a cluster then maybe you can do some behavioral interventions. It's like contact tracing that we all remember from CO except this is using some more sophisticated science behind it. Um uh if your listeners um uh or viewers um are living with HIV um find out what your state is doing about molecular surveillance and um if you need help getting in contact with and most of the states that we um interact with have an active coalition led by people living with HIV who are trying to affect policy both on HIV criminalization and other issues. um uh see see what the the state public health department's policy on this. See if um advocates in your state are making sure the public health department is incorporating the views of people living with HIV. And if they're not, then show up, knock on their door. [laughter] uh you know policy you know um uh policy needs to be um made by the people who are most affected by the policy. >> Yeah. Um I'm just backtracking a little bit. I had a question about the sex offender registry. Um, if someone is in a state where they are put on the sex [clears throat] offender registry for not disclosing their HIV status, does that transfer to other states even though the laws are different there and they wouldn't have been put on the sex offender registry there? >> Yeah. Uh, it's a good question and the answer is almost always yes. So, usually you have an obligation to register in another state even if it wasn't a crime in that state. Uh, and there's a very tragic recent case of a man by the name of Robert Suttle. Um, he's an incredible person. He's an incredible spokesperson as well. You can hear him tell his story in his own voice on YouTube and other outlets. Um, Pause Magazine has profiled him. several places have profiled him. Um, uh, he was convicted in Louisiana and placed on the sex offender registry. Um, Louisiana has a an exposure statute. So, um, the allegation was that he exposed somebody else to HIV and it's a very very very broad statute. Um, he moved to New York. It was not a crime in New York. Um uh the state of New York said you have to register because you um uh were convicted in Louisiana. Um this was litigated in New York state courts. The Center for HIV Law and Policy has done a lot of advocacy on behalf of Robert Suttle. The New York uh appeals courts um decided in the end against Robert Suttle. So he was required to register in New York. I don't know what the latest status of that case is, but that um is I think where it stands today. It truly is um a heartbreaking story. And somebody who's um uh so thoughtful and kind and willing to share his pain to and to also go through the challenge of of a court battle um because he thought it was unjust. Um it uh it breaks my heart the outcome. >> Yeah. I can't imagine that most people watching, listening, would ever consider that someone on a sex offender registry would have gotten there in a way that I or someone else would think is not not valid or that they would have that they would land on the registry based on the laws in another state that don't apply in this state. And >> yeah, >> yeah, tragic is is is a good start for that. >> And I think you know what we often imagine when we think of HIV criminalization are these worstcase scenarios. You know, somebody intentionally trying to cause harm to someone else. Um, for which we already have criminal laws. So we don't need something that singles out people living with HIV. But what we find over and over in state after state, first of all, is that these laws are continuing to be enforced today. This is not HIV criminalization is not something that went away in the 1990s or early 2000s. People are still being arrested and convicted today. Um, but we also find that it's overwhelmingly for things that can't transmit HIV like spitting and biting or that there's no allegation of any um malicious intent that um act allegations of actual transmission are really really rare. Um and yet people again are being exposed to overwhelmingly felony uh prosecution. Um and if convicted then years uh in uh in an incarceration facility, usually a prison, >> [clears throat] >> um that that worst case scenario that we have in our minds um is what gets reported on in the media, but when you look at the data, that's overwhelmingly not what's happening. It's um uh it's for, you know, again, things like non-disclosure, but you're undetectable. But there's not an exception for that in the law. >> And um just to remind everybody, if you're uh engaged in intimate contact with somebody and you're the person who's not living with HIV, you can also take medication to prevent to completely eliminate the possibility of HIV transmission. So whether you're the person living with HIV or not living with HIV, there are affirmative steps you can do to completely eliminate HIV transmission risk. And most of the laws don't take that into account uh at all. Um and what we read in the media again are these really really you know terrible heartbreaking stories. But that's not what we see over and over. You know for example um uh you know two people are together they break up um or there's a hookup um and you find out the person's HIV status by finding that medication. Well, if they're in medication treatment um and they're virally suppressed anyway, then um then they were doing what they should have been doing to take care of themselves and to take care of you. But we see that sometimes in the arrest affidavit used as evidence that the person knew of their HIV status and then they become vulnerable to prosecution. Uh fortunately, things like that aren't possible in in many states, but you know, that can happen in some states. So, I don't want to give the impression that the um that things like that are happening in every state. Um but it can happen in some states. Um in Louisiana, for example, that could happen. Um in uh Arkansas, I think that that could happen. In Florida, I think that could happen. Uh California, where uh where I am today, um uh I think after the 2017 law revision, that's no longer a possibility. I'll recommend again Center for HIV Law and Policy. They have um an excellent resource uh if you're curious about the HIV criminal laws in your state. They have a 50 state um uh blowby-blow of the ways in which people can and cannot be criminalized uh everywhere. >> Wow. Okay, that's fantastic. I'll be sure to include that in the description below once this goes live. Um, >> and sorry and I'll give you um two other organizations, national organizations if you're interested in getting involved. Um, one is the SIRO project um led by people living with HIV working on HIV decriminalization. um a fantastic organization if you want to know uh how to get organized um how to bother public health officials and politicians to change laws. uh they are um leading that charge in a lot of states and the other is positive women's network again um led by people living with HIV um specifically for um people who identify as women or or fem oriented um a and you know if you think that you are alone um positive women's network will hug you and hold you tight and tell you that you're not alone. >> Thank you. Yeah. and they also [clears throat] do fantastic fierce advocacy of course as well. >> Yeah. Um I'm curious just as a kind of a side note, do you think that as far as disclosure goes and and the fight in in um the decrim decriminalizing these these law these laws against HIV? [clears throat] Excuse me. Do you think that long acting injectable treatments might offer an off-ramp at some point being that? Because often the the argument that I hear um as far as being undetectable and disclosure is people will say, "Well, how do I know that you're adequately taking your treatment um every day?" Um and then I'm seeing up to six month long acting injectable treatments. It's like once you have that injection, well then you're good for 6 months. No, there's no argument. >> Yeah. Some states um have revised their laws now so that um you're only subject to criminalization if uh transmission is possible or there's a substantial risk of transmission. So um uh if you're undetectable then obviously you can't transmit HIV and any um intervention that gets you there whether it's an injectable whether it's a daily pill regimen um can be helpful in um inoculating you from preventing you from prosecution. The challenge is that many states don't have these carveouts. And also that um some people can't get to undetectable. Um and if that's the only affirmative defense, the only way that you can prevent prosecution, then that sort of leaves some people out. Um you know, I think that's a difficult negotiation that stakeholders have sometimes with lawmakers is how to if you can't do a full repeal, is there a way to do a modernization that still includes some people? Um, and if you're only including some people, that means you're leaving some people behind. And again, that's a very, very difficult conversation and negotiation. The only way that it can happen is if everybody is at the table talking about it, uh, openly and honestly. Um, uh, injectables though are are a fantastic way though to make sure that you're again taking care of yourself and helping to take care of other people. Um, whatever the law is, right? It's just it's a good practice um if you can tolerate the medications to to and have access to them to use them. Um I also think that you know um HIV treatment has made such tremendous strides and I think the general public and lawmakers are really still stuck in the 1980s in a lot of ways. They don't know that undetectable equals untransmittable. They don't know what prep is, let alone an injectable that you can take that will last for three months or six months. Um, you know, there are really novel interventions now with postexposure prophylaxis as well or um prep that UT there's a 211 sequence that uh is being experimented with now for people who only uh occasionally have encounters. Um, so there are all these new and interesting things and lawmakers uh and policy makers just have no idea. So often when advocates, you know, people from serial projects, state coalitions for example, are meeting with lawmakers, um you know, there's just basic education that um that still needs to happen. Um and who better to deliver that that um education than of course you know have a doctor in the room have a tr trusted expert as well but how about the people who are living it every single day of their lives. Um you know this is why I keep on coming back to it. The people most affected need to be are also the best spokespeople for what the best policy should be. >> Yeah. I mean, you want to talk about lack of information, nurses and doctors who still are are not caught up, let alone politicians who don't even work in the medical field >> and ter, you know, and there's still this terrible moral judgment as well, right? That um if you're a person living with HIV, then you must have done something wrong, that it must be your fault. Um uh and you know I think you know you encounter that certainly with policy makers but also with medical people who should be medical professionals right um uh yeah sometimes you think that people who ought to be good spokespersons for the cause um are not so much uh and I know it's I know it's exhausting to have to be an advocate to have to educate people every single day right you just want to live your life. Um uh but sometimes we're called on to do more than what we want to do. [laughter] Sometimes we just want to stay in bed and binge watch some TV or catch up on my Bridgetton and we can't do it. [laughter] >> I hear you. Well, I do appreciate your insistence on including people in the community and people living with HIV. that's been a huge focus for HIV cure research, HIV treatment research in general. Um and we see how not doing that especially when it comes to treatment um and vaccine excuse me and vaccine approach. We saw that during COVID and the pandemic how um kind of just imposing policy and treatment on a populace without engaging and being transparent and educating first or simultaneously led to so much resistance and conspiracy theories and what have you. And this is why um I keep on coming back to for example serial project and positive women's network. Um you know they are um led by people who live this day in uh and day out. Um, so, uh, if you're listening to this or watching this, um, and you think, well, like I don't know anybody living with HIV and I'd love to get involved, um, but I don't want to, you know, I don't want to take up space where um, where other people have lived experience. I'm I'm happy to put you in touch with Positive Women's Network, Sierra [clears throat] Project. They will um, they will let you know how you can be helpful to them. Yeah, I'll have links to those as well in the description below. Um, and again, go ahead. Center for HIV Law and Policy as well are just they are the definitive resource for knowing what the laws are in your state. >> Perfect. And so I'm curious kind of going back to all the data gathering that you do uh compiling aggregating sorting h how does this what's the next step for all of this all these findings how does that interface with politicians and policy? >> Yes. So um we we produced the research and then advocates and policy makers um hopefully use that to to make better laws. Um you know for example what we saw over and over was well first of all you know thousands and thousands of people have come into contact with the criminal legal system because of these laws. um it's not it's not um a rare occurrence you know it does happen um uh pretty often and it's continuing to happen so that itself I think is sort of a wakeup call to policy makers to say oh maybe we should pay attention to this um and we also point out over and over we see this wherever we look that some communities some individuals are much more likely to be criminalized because of their HIV status that's especially black Americans women sexually uh and also sex workers. We suspect sexual and gender minorities as well are overcriminalized, but we don't have data on that because um police are not and courts are not regularly collecting this information. Um >> when you say women, are you referring to cisgender women, trans women, both? >> Yeah, I I wish I could give you a clearer um answer to that. We suspect it's um cisgender women. Um this is again in sort of like police reports uh and in court records when they have to fill out the demographic information. That's how we know for example the age of somebody or um what's reported as their race ethnicity. Um we often see for example that um uh police can only see in black and white literally. If you're not black you're white. So people who would identify as for example Hispanic or Latino often don't get written down as Hispanic or Latino. They're sometimes put in put in unknown or white or something else. It really does come down to just black and white. Um >> why is that? >> It's a great question. I would love to know. >> Oh my gosh. Oh >> yeah. It's um it's shocking how um the the beautiful diversity in the United States sort of um race, ethnicity, but also um gender identity and expression are just flattened and forced into binaries by you know um law enforcement by the courts. So when I say women, um certainly cisgender women um and we know from qualitative research as well that trans women especially are really vulnerable to criminalization. Okay. Wow. Um >> and and you know what do we what do we hope will happen with it? We hope that the lawmakers um and the advocates will look at the findings and say you know I think there are things that we can do here. You know if our goal for example is to end the epidemic is this doing what our own you know public health departments are saying we need to do in order to end the epidemic. I there are so many rabbit holes that I would love to go down with you. We're the time has lit literally flown by. Um this is been a really fascinating conversation. I would love to have you back on at some point in the future to maybe really deep dive on something um with you and >> Okay, that's >> I'll try to get better lighting. You know, you look fantastic here. >> Get out of here. [laughter] You're focused on much much bigger and better things. Aaron Brachovich does not have time for lighting. [laughter] >> I bet Aaron Brachovich has a great line >> now these days. Um, [laughter] and you also mentioned that you would love to have someone with lived experience um as a follow-up to come on and talk to me. I'd love to um connect with that person too. >> Yeah, I would be happy to organize something. Um, you know, I think that is the the most important really is to have people with lived experience who can say, you know, this is this is what these laws did to me and to my community. >> Fantastic. Thank you, Nathan, um, for this truly enlightening um, scary, slightly empowering um, conversation, especially in an election year. Uh >> yeah, >> speaking of policy and law that has so much impact on all of our lives in here in the US and globally, um you have your work cut out for you and I am cheering you on. Um I would love for folks, please weigh in with your questions, comments. I'm sure you'll have plenty for Nathan and I'm I'm happy to follow up and follow up with him as well. So thank you very much. >> Yeah, I'd love to hear from everybody. Everybody at home, please don't forget to like, subscribe, hit that notification bell so you get a notification every time a new video like this comes out. And please share this with anyone who might find value in this type of content. Those are the best ways that you can help support me and my channel. Until next time, cheers.