title: Prevalence and predictors of facing a legal obligation to disclose HIV serostatus to sexual partners among people living with HIV who inject drugs in a Canadian setting:a cross-sectional analysis.
abstract: BACKGROUND
  In October 2012, the Canadian Supreme Court ruled that people living with HIV must disclose their HIV status before sex that poses a "realistic possibility" of HIV transmission, clarifying that in circumstances where condom-protected penile-vaginal intercourse occurred with a low viral load (< 1500 copies/mL), the realistic possibility of transmission would be negated. We estimated the proportion of people living with HIV who use injection drugs who would face a legal obligation to disclose under these circumstances.
  
  
  METHODS
  : We used cross-sectional survey data from a cohort of people living with HIV who inject drugs. Participants interviewed since October 2012 who self-reported recent penile-vaginal intercourse were included. Participants self-reporting 100% condom use with a viral load consistently < 1500 copies/mL were assumed to have no legal obligation to disclose. Logistic regression identified factors associated with facing a legal obligation to disclose.
  
  
  RESULTS
  We included 176 participants, 44% of whom were women: 94% had a low viral load, and 60% self-reported 100% condom use. If condom use and low viral load were required to negate the realistic possibility of transmission, 44% would face a legal obligation to disclose. Factors associated with facing a legal obligation to disclose were female sex (adjusted odds ratio [OR] 2.19, 95% confidence interval [CI] 1.13-4.24), having 1 recent sexual partner (v. > 1) (adjusted OR 2.68, 95% CI 1.24-5.78) and self-reporting a stable relationship (adjusted OR 2.00, 95% CI 1.03-3.91).
  
  
  CONCLUSIONS
  Almost half the participants in our analytic sample would face a legal obligation to disclose to sexual partners under these circumstances (with an increased burden among women), adding further risk of criminalization within this marginalized and vulnerable community.
authors.affiliation: Faculty of Health Sciences (Patterson, Kaida, Hogg), Simon Fraser University, Burnaby; British Columbia Centre for Excellence in HIV/AIDS (Patterson, Nguyen, Dobrer, Hogg, Kerr, Montaner, Wood, Milloy), St. Paul's Hospital; BC Women's Hospital and Health Centre (Ogilvie); Faculty of Medicine, University of British Columbia, Vancouver, BC.
authors.forename: Sophie
authors.initials: S
authors.lastname: Patterson
authors.affiliation: Faculty of Health Sciences (Patterson, Kaida, Hogg), Simon Fraser University, Burnaby; British Columbia Centre for Excellence in HIV/AIDS (Patterson, Nguyen, Dobrer, Hogg, Kerr, Montaner, Wood, Milloy), St. Paul's Hospital; BC Women's Hospital and Health Centre (Ogilvie); Faculty of Medicine, University of British Columbia, Vancouver, BC.
authors.forename: Angela
authors.initials: A
authors.lastname: Kaida
authors.affiliation: Faculty of Health Sciences (Patterson, Kaida, Hogg), Simon Fraser University, Burnaby; British Columbia Centre for Excellence in HIV/AIDS (Patterson, Nguyen, Dobrer, Hogg, Kerr, Montaner, Wood, Milloy), St. Paul's Hospital; BC Women's Hospital and Health Centre (Ogilvie); Faculty of Medicine, University of British Columbia, Vancouver, BC.
authors.forename: Paul
authors.initials: P
authors.lastname: Nguyen
authors.affiliation: Faculty of Health Sciences (Patterson, Kaida, Hogg), Simon Fraser University, Burnaby; British Columbia Centre for Excellence in HIV/AIDS (Patterson, Nguyen, Dobrer, Hogg, Kerr, Montaner, Wood, Milloy), St. Paul's Hospital; BC Women's Hospital and Health Centre (Ogilvie); Faculty of Medicine, University of British Columbia, Vancouver, BC.
authors.forename: Sabina
authors.initials: S
authors.lastname: Dobrer
authors.affiliation: Faculty of Health Sciences (Patterson, Kaida, Hogg), Simon Fraser University, Burnaby; British Columbia Centre for Excellence in HIV/AIDS (Patterson, Nguyen, Dobrer, Hogg, Kerr, Montaner, Wood, Milloy), St. Paul's Hospital; BC Women's Hospital and Health Centre (Ogilvie); Faculty of Medicine, University of British Columbia, Vancouver, BC.
authors.forename: Gina
authors.initials: G
authors.lastname: Ogilvie
authors.affiliation: Faculty of Health Sciences (Patterson, Kaida, Hogg), Simon Fraser University, Burnaby; British Columbia Centre for Excellence in HIV/AIDS (Patterson, Nguyen, Dobrer, Hogg, Kerr, Montaner, Wood, Milloy), St. Paul's Hospital; BC Women's Hospital and Health Centre (Ogilvie); Faculty of Medicine, University of British Columbia, Vancouver, BC.
authors.forename: Robert
authors.initials: R
authors.lastname: Hogg
authors.affiliation: Faculty of Health Sciences (Patterson, Kaida, Hogg), Simon Fraser University, Burnaby; British Columbia Centre for Excellence in HIV/AIDS (Patterson, Nguyen, Dobrer, Hogg, Kerr, Montaner, Wood, Milloy), St. Paul's Hospital; BC Women's Hospital and Health Centre (Ogilvie); Faculty of Medicine, University of British Columbia, Vancouver, BC.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.affiliation: Faculty of Health Sciences (Patterson, Kaida, Hogg), Simon Fraser University, Burnaby; British Columbia Centre for Excellence in HIV/AIDS (Patterson, Nguyen, Dobrer, Hogg, Kerr, Montaner, Wood, Milloy), St. Paul's Hospital; BC Women's Hospital and Health Centre (Ogilvie); Faculty of Medicine, University of British Columbia, Vancouver, BC.
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
authors.affiliation: Faculty of Health Sciences (Patterson, Kaida, Hogg), Simon Fraser University, Burnaby; British Columbia Centre for Excellence in HIV/AIDS (Patterson, Nguyen, Dobrer, Hogg, Kerr, Montaner, Wood, Milloy), St. Paul's Hospital; BC Women's Hospital and Health Centre (Ogilvie); Faculty of Medicine, University of British Columbia, Vancouver, BC.
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
authors.affiliation: Faculty of Health Sciences (Patterson, Kaida, Hogg), Simon Fraser University, Burnaby; British Columbia Centre for Excellence in HIV/AIDS (Patterson, Nguyen, Dobrer, Hogg, Kerr, Montaner, Wood, Milloy), St. Paul's Hospital; BC Women's Hospital and Health Centre (Ogilvie); Faculty of Medicine, University of British Columbia, Vancouver, BC.
authors.forename: M-J
authors.initials: MJ
authors.lastname: Milloy