愛滋病防治減害基礎初探－－以人權保障為皈依

Harm Reduction for HIV Control and Prevention - A Call for a Humanitarian Approach

各國推動愛滋病防治計畫時，時常捉襟見肘。其中執行障礙有三：愛滋污名、社會道德觀對性之質疑，及風險過度補償疑慮。本文首先將國際上毒品與墮胎減害政策類型化為三類，藉此定位我國愛滋防治計畫現行走向與不足。第二部分則檢視美國性管制相關違憲審查判決，說明國家或社會看待個人私密行為時，潛藏有一貫的祭罰思維，導致國家推廣「安全性行為」政策上多所猶豫，並在求助刑罰「威嚇效應」提升傳染病防治成效時，侵害人民建立連結關係之私密與發展空間。第三部分則透過「風險恆定理論」釋明風險補償現象本質，並參考現行藥品安全評估與風險管理機制，提出風險過度補償之因應方法，並於文末呼籲以人權化減害模式取代刑罰作結。

It is never easy to implement the plan of HIV control and prevention, and there are three obstacles: the imputation on unpopular minorities, moral panic and concerns for risk overcompensation. First, this article classifies the harm reduction plans in international drug and abortion policies into three patterns, and finds the pros and cons in each pattern, to illustrate a harm reduction pathway for HIV policy in Taiwan. Second, to cope with the moral panic, I review the judicial cases involving sex issues in U.S., and reiterate the entitlement of intimacy to balance against the retributivist principle which leads to blanket prohibition against sex and obstructs the policy of safe sex. Third, I explain the essence of risk compensation effects and take reference of premarket approval and post-market surveillance of drugs policy as risk management, to find a win-win rule for the avoidance of risk overcompensation. Instead of criminalization of sex related activities, this article proposes a humanitarian approach to support the patients as a comprehensive strategy to fight against HIV epidemic.