愛滋風險入罪化之公衛與人權省思——國外實證回顧與台灣法院判決分析

Reflections on public health and human rights in HIV criminalization: empirical review and analysis of court judgments in Taiwan

世界各國以刑事手段處罰知悉自己為感染者而暴露或傳播愛滋病毒者，期望讓感染者向其性伴侶揭露感染狀況並放棄風險行為，或促進採行保護措施，最終減少傳播。台灣自1990年制定愛滋防治專法即處罰透過性行為或共用針頭傳播愛滋病毒者，三十多年來除增加處罰未遂行為，更加重刑度至與重傷罪相當，但此類傳播愛滋刑法究為防疫助力或阻力，亟待評估。本研究於PubMed搜尋英文文獻，收集探討傳播愛滋刑法對公衛影響之實證文獻，並利用司法院裁判書查詢系統，收集涉及37名被告之26件傳播愛滋罪地方法院判決，評估現行「人類免疫缺乏病毒傳染防治及感染者權益保障條例」第21條傳播愛滋罪對整體防疫之效益或負面影響。結果顯示，根據國際實證資料，刑罰對改變風險行為之影響不顯著，未能產生預期的嚇阻風險行為防疫效益；雖無充分證據顯示傳播愛滋刑法妨礙檢測意願，但健康照護者擔憂照護可近性、感染者擔憂汙名化可能對愛滋照護產生負面影響；台灣傳播愛滋罪高比例用於訴追及處罰未遂行為，包括幾近零風險行為，主觀上不以傳染故意為要件，而以知悉感染狀況為已足，法院以僅能證明檢體病毒基因相似性的比對分析鑑定結果做為被告致傳染於被害人之證據，量刑上有刑度過高疑慮。政策制定者應思考愛滋風險入罪化之防疫效益，評估採行非刑罰之防治手段。

Countries around the world have enacted HIV-specific statutes that criminalize undisclosed exposure to HIV as a method for preventing and treating the disease. These policies presume that the punishment may encourage people to disclose their infection status to their sexual partners and forgo risky behaviors or increase protective measures, ultimately reducing HIV transmission. When the HIV/AIDS prevention and control law was passed in 1990, Taiwan enacted an HIV-specific statute to criminalize nondisclosure transmission of HIV through sexual intercourse or sharing needles. In the past three decades, the policy scope was extended to attempted acts even if the virus is not transmitted, and longer sentences were adopted, equivalent to sentences for aggravated assault. However, little is known whether such harsh criminal laws are effective HIV prevention methods or have potential negative impacts. This study searched for empirical studies discussing the effects of HIV criminal laws on public health from PubMed and collected twenty-six district court judgments involving 37 defendants charged with criminal HIV transmission from the Judicial Yuan Judgment Court Decisions Inquiry database. Empirical studies show that criminal HIV laws have an insignificant effect on changing risky behavior, failing to produce the expected epidemic prevention benefits of deterring risky behaviors. Although evidence is insufficient to demonstrate that criminal HIV laws hinder the willingness to test, health caregivers are worried about the accessibility of care. Some worry that the care of patients with HIV may still be impeded by stigma. A disturbing proportion of court cases in Taiwan have involved prosecution and punishment of attempted behaviors, including almost zero-risk behaviors. The intention to infect is not considered, while knowledge of the infection status is deemed sufficient. Phylogenetic analysis—the study of the genetic relatedness between HIV strains—has been adopted by courts as evidence to prove that HIV transmission occurred directly between the defendant and the witness. The severity of the sentences is also concerning. Policymakers should consider the benefits of criminalizing public health risks and evaluate the use of noncriminal prevention and control measures. (Taiwan J Public Health.