Critical Book Review – Trevor Hoppe

Trevor Hoppe’s Punishing Disease is a critical evaluation of the way in which society has criminalized HIV/AIDS. By treating “sickness as badness,” society has reacted to a public health crisis with punishment rather than compassion for those affected (Hoppe 2018a:8). He examines under what conditions an desire to punish becomes merged with the social project of controlling disease. This book contains a clear and coherent and style of writing that allows the reader to get an accurate understanding of the chain of events that promoted the criminalization of HIV/AIDS; specifically, the fear, stigma, and ignorance that plagues the general public regarding topics they cannot fathom, how the media capitalized on this, and how our ill-equipped criminal justice system acted on these emotions.

Overall, Hoppe (2018a) presents his material thoroughly to create a coherent critical analysis of the chain of events that promoted the criminalization of this disease. There are six chapters divided into two parts. Part one describes the promotion of coercive strategies to control disease. Chapter one begins with the history of disease control to see how and why the emergence of AIDS led to a return to those tactics. Chapter two details how shifts in preventative measures for HIV lead to the belief that HIV positive people are individually responsible for the disease. Chapter three examines the policing effort of public health officials to stop new infections. Part two specifically looks at HIV disclosure laws and how they are applied in different states. Chapter four examines the debates of legislative bodies to enact criminal laws specific to HIV. Chapter five examines the enforcement of those laws within the courtroom. Finally, chapter six analyzes the communities most vulnerable to conviction under HIV exposure and disclosure laws. Overall, the book is thorough and clearly organized.

The emergence of HIV occurred during the onset of mass incarceration and, with little known about the disease or it’s cause, the public reacted in a way they felt was effective—they isolated and punished those individuals. By first connecting historical examples such as the War on Drugs in the introduction, Hoppe allows the reader to draw comparisons that foster the understanding of how an effort to control certain nonnormative behaviors can ultimately lead to the stigmatization and control of minorities. The book discusses how the criminalization of HIV is a recent example in the history of public health to control disease by coercion and punishment – termed punitive disease control. The reactions by conservatives to AIDS and the War on Drugs are very similar in that they both promoted policies that targeted homosexuals and blacks, respectively. These populations were the ones disproportionately associated with these events. Both responses are just two of the many examples that elucidate the shift from rehabilitation in the 1960s and 1970s to retribution and reveal how “well-intentioned disease control strategies can turn punitive when disproportionately applied to specific marginalized groups” (Hoppe 2018a:24). This was a precise and well-executed comparison that set the stage for the rest of the book.

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The labels created by the public to characterize those affected by HIV described them as a public health threat and tags the sick as hostile aggressors rather than victims—this fear and stigma of contagion have “heightened social exclusion of already stigmatized groups” (Hoppe 2018a:27). From the many examples we have seen, we notice that journalism and media played an important role in spreading information about HIV and other diseases; they try to capitalize on fear and preconceived notions that people already have. If they find that one case to affirm that belief, then it’s broadcasted everywhere.

It is important to note that society’s definition of risky behaviors includes acts that can leave people in compromising health situations, like contracting HIV. The author makes a point that public health professionals are selective with their use of the term risky behaviors (Hoppe 2018a:33). For example, society does not label heterosexual relations as risky but automatically calls homosexual relations risky. This could be attributed to a psychological term known as availability heuristics— mental shortcuts that rely on immediate examples that come to mind when evaluating the probability of an event occurring. These easily reaffirm stereotype for people. In chapter six, Hoppe (2018a) discusses how it is not shocking to people when a homosexual discloses their HIV status as it is a disease the public associates with homosexuality. Thus, the idea of sex in the gay community is considered a risky behavior to the general public. This reaffirms their biases and that boosts up the idea that that person is dangerous or a threat to your health.

From there, Hoppe (2018a) explains how lawmakers frighten people by condemning those behaviors rather than the virus itself as the cause for AIDS, then declaring that only coercion and punishment could curb it. From public outrage to the media’s portrayal of HIV positive people as hostile aggressors to lawmakers demanding justice, judges and prosecutors frequently present HIV as an aggravating factor in a court of law. People in law enforcement label a set of practices as especially egregious and deserving of increased punishment as “organized aggravation” because they are what Hoppe defines as “moral entrepreneurs” —individuals who champion a particular cause (Hoppe 2018a:8). They capitalize on fear from society not knowing the causes and effects of the disease and decide to “help” and satisfy the public by making it look like they are being proactive on the issue by putting them away in jail (Hoppe 2018a:149). Consequently, the arguments legal authorities present in court are not based on facts or the scientific literature available, but on emotion to enrage the public and find the defendant guilty. Had the scientific literature available at the time been used, the argument for AIDS exceptionalism, or treating HIV differently from other infectious diseases, would have been invalidated.

The point of the book is to supply an in-depth analysis of the chain of events that led to the use of punishment as a legitimate disease control measure and stress the fact that our criminal justice system is especially ill-equipped to handle this issue. Handling, treating, and managing disease requires compassion, not sanctioning behaviors that carry no risk of transmitting the disease (e.g., using condoms and antiretroviral therapy to reduce one’s viral load so much so that detection is unlikely and transmission is virtually impossible). His background of being a “sociologist of sexuality, medicine & the law” at the University at Albany and the University of California at Irvine, and currently at the University of North Carolina at Greensboro makes him qualified to speak on the criminalization of disease (Hoppe 2018b). Hoppe’s work is a major contribution to the field as a whole as his research specifically looks at how punishment came to be a legitimate response to managing HIV (Hoppe 2018b).

Hoppe’s book should open your eyes to the dangers of using the criminal justice system to handle problems that the medical field is better equipped to handle (using compassion and not just punishment). Overall, Punishing Disease is so well-written and engaging that, though he uses “tools of sociology, criminology, and epidemiology” to demonstrate the consequences of punishing HIV, it is understandable for audiences who are not knowledgeable of the natural science and social science disciplines (Hoppe 2018a).

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