Policy Papers


Criminalising Disease Transmission: Lessons from Soviet Approaches to Sexual Health

Dr Siobhán Hearne |

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Executive Summary

  • The transmission of STIs was criminalised in the Soviet Union. Sex education materials classified STIs as antisocial illnesses that were contracted by people engaged in deviant or immoral behaviour.
  • In the USSR, state approaches to STIs significantly influenced official responses to the HIV epidemic in the late 1980s.
  • Current approaches to tackling STIs and HIV in Russia are rooted in the Soviet past, namely the use of criminal law to prevent the spread of infection and moral judgement of people infected with STIs and individuals who are HIV-positive.
  • In both the Soviet period and in the present-day Russian Federation, the criminalisation of STI/HIV transmission was and is not effective in achieving the intended objective of preventing the spread of infection.
  • Both the stigmatisation of patients and the criminalisation of disease transmission disincentivise seeking treatment, impose barriers to accessing healthcare services, and contribute to rising rates of infection.

 

 

 

Introduction

The use of criminal sanctions to achieve specific public health outcomes has become an issue of intense public interest and debate in the context of the COVID-19 pandemic. Governments across the world have introduced emergency laws with the stated goal of curbing the spread of coronavirus. In Russia, the State Duma (Parliament) approved a package of anti-COVID laws on 31 March 2020. One of these laws introduced a prison sentence of up to seven years for infected individuals who violate quarantine, with someone dying as a result. CCTV cameras in Moscow were fitted with facial recognition software in order to instantly alert the police of people deemed to be breaking self-isolation measures and lockdown rules. New measures were introduced criminalising those who spread information about COVID-19 that was deemed to be false, with penalties ranging from fines to a three-year prison sentence. Medical workers in Russia who have spoken out against unsafe working conditions and shortages in personal protective equipment during the pandemic have faced charges for spreading false information.

While the introduction of Russia’s anti-COVID laws can be regarded as emergency measures introduced in the context of a global pandemic, they are also part of a longer trend of using criminal sanctions and police surveillance to prevent disease transmission, rooted in the Soviet past. In the Soviet Union, infecting another person with a sexually transmitted infection (STI) or evading STI treatment were criminal offences punishable either by steep fines or a prison sentence. In 1987, a new clause was added to the anti-STI law, which criminalised HIV exposure and transmission. These laws were introduced by the Soviet government to prevent the spread of STIs and HIV, but they did not achieve their intended outcome. Rather than preventing the circulation of diseases, criminalisation acted as a significant deterrent for individuals seeking treatment, served to stigmatise individuals with STIs or HIV, and contributed to extremely high rates of infection.

The Soviet case offers important perspectives on the detrimental impact of the criminalisation of STI and HIV transmission upon public health; perspectives which are vital because the criminalisation of HIV transmission continues in the present day across the world. At least 92 countries currently have laws that criminalise HIV non-disclosure, exposure, or transmission. Fifteen of these countries were part of the USSR before its collapse in 1991. The region of the former Soviet Union also has the fastest growing number of HIV infections in the world, and within this area, Russia has the largest HIV epidemic. The ineffective, discriminatory, and counterproductive nature of criminal laws punishing the transmission, exposure, and non-disclosure of HIV has long been acknowledged by public health experts and civil society organisations. The UN-adopted Global AIDS Strategy for the period 2022–2027 has the removal of laws criminalising HIV exposure, non-disclosure, and transmission as one of its goals.

 

Soviet approaches to preventing the spread of STIs

Approaches to combatting STIs in the Soviet context combined therapeutic, educational, and punitive measures. From their seizure of power in October 1917, the Bolshevik Party (who would later rename themselves the Communist Party) sought to completely break with the pre-revolutionary past and establish a new political, social, economic, and cultural order. From 1918 onwards, hospitals, clinics, and other treatment facilities were subject to compulsory nationalisation and Soviet citizens who engaged in state-approved labour were granted the right to demand free healthcare from the state.

In 1918, the new Soviet government launched an interdepartmental campaign known as the ‘struggle with venereal diseases’: a collaborative effort on the part of central and regional authorities to provide citizens with health education, ensure free and accessible treatment, and discourage apparently unhygienic or risky behaviours that were believed to cause the widespread circulation of infection. Thousands of anti-STI posters were printed throughout the 1920s to popularise information about symptoms, promote good sexual hygiene, and encourage citizens to take advantage of the free treatment provided by the government. Extramarital sex and prostitution were also condemned as health risks and ideologically incompatible with the new socialist society.

Alongside therapeutic and coercive measures, the Soviet government also turned to criminal law in their efforts to prevent the spread of STIs. In 1922, knowingly and ‘maliciously’ infecting another person with an STI became a criminal offence. In the 1926 Criminal Code, the anti-STI criminal article was expanded to include ‘knowingly putting another person in danger of contracting an STI by sexual relations or other actions’, essentially criminalising both STI exposure or non-disclosure. The 1926 Family Code stipulated that couples intending to marry were obliged to inform each other about any STIs and present written documentation confirming this exchange of information when registering their marriage. From 1927, health authorities gained the right to forcefully examine and treat people suspected of having a venereal infection. This legal framework was modified over time, but it largely remained in place until the collapse of the Soviet Union in 1991.

 

The push for criminalisation and its impact

The transmission of STIs had been criminalised from the early years of Soviet power, but the Brezhnev era (1964–1982) brought a renewed push for the prosecution of so-called ‘malicious transmitters’, alongside the expansion of the anti-STI law to include a wider range of activities. By the time Leonid Brezhnev began his premiership, STIs had become a matter of grave concern for the Soviet government. In the late 1940s, the Soviet leadership  drafted plans to expand and improve venereological treatment facilities, but this program had stalled by the end of the next decade due to lack of funding. By the early 1960s, STIs were on the rise again. In 1963, the USSR’s Ministry of Health issued an order chastising regional and republican health authorities for the sharp increase in incidence of STIs. The order emphasised the need for health education programmes, new specialists, and improved facilities, but also it instructed health authorities to closely collaborate with the police and prosecutors to prosecute transmitters under the anti-STI law.

Moscow’s call for the criminalisation of those who transmitted STIs was part of the broader official response to the social consequences of the Second World War and immediate post-war years. The Second World War caused a demographic catastrophe in the Soviet Union, as an estimated 27 million Soviet citizens lost their lives, approximately three quarters of whom were men. To address the severe destabilisation of the sex ratio and increase the birth rate, the Soviet government pursued pronatalist policies, including providing financial incentives for women to bear more children and taxing individuals and couples who either chose, or were not able, to have children of their own. Despite this package of pronatalist measures, birth rates fell under replacement rates in the decades that followed. The impact of STIs on the reproductive capabilities of Soviet citizens (especially women) was especially concerning to policymakers in this climate.

This push for criminalisation was also likely part of broader effort to tackle criminal and ‘immoral’ behaviour that began after the death of Stalin in 1953. From the mid-1950s onwards, Soviet leadership oversaw the significant scaling back of the Gulag system of forced labour camps. Millions of camp prisoners were amnestied with the hope of their rehabilitation and reintegration within society. The mass return of former prisoners into civilian society evoked moral panic across the Soviet Union and the crime waves that followed were a matter of grave concern for the Soviet government. In the late 1950s and early 1960s, the Soviet regime implemented a new ‘zero-tolerance’ approach to any manifestations of anti-social behaviour. In 1956, a petty hooligan decree was implemented across the USSR which transformed minor everyday infractions committed either in public or in private into imprisonable offences. In the late 1950s and early 1960s, anti-parasite laws were enacted across the Soviet republics, which targeted individuals who made a living from informal economies, refused to work, or socialised with foreigners.

Despite this concern, the Ministry of Health’s call for the prosecution of so-called ‘malicious’ transmitters of STIs in 1963 had little effect. STIs continued to rise across the Soviet Union throughout the 1960s and early 1970s. In the Latvian Soviet Socialist Republic, incidence of gonorrhoea doubled, and syphilis increased 36 times between 1967 and 1973. Between 1964 and 1968, the number of syphilis cases registered in Leningrad increased seven times over, and between 1971 and 1972 incidence of syphilis doubled again. Registered cases of gonorrhoea increased by over 42 per cent in Khabarovsk region (in the Far East) between 1967 and 1968.

Alarmed by rising rates of STIs, Soviet leadership initiated a series of legislative changes to expand the activities for which an individual could be punished under the anti-STI law. In October 1971, the Presidium of the Supreme Soviet of the USSR changed the wording of the law to criminalise individuals who evaded treatment for STIs. Evasion included a wide range of activities, from non-attendance at the hospital to any violation of hospital rules, such as the consumption of alcohol or narcotics on hospital premises. The police were given the power to forcefully deliver those who evaded treatment to VD clinics and hospitals. In 1973, the USSR’s Supreme Court issued new instructions regarding judicial practice in the case of STI transmission. The Supreme Court confirmed that in order to prosecute somebody, the court had to prove that the person had deliberately transmitted their infection, but mere awareness of infection was enough proof of motive. Individuals could also be prosecuted for exposing others to STIs through any violation of the ‘hygienic rules of behaviour in the family, at home, and at work’.

The anti-STI law also inscribed the right of medical professionals to forcefully examine individuals thought to have STIs, as well as suspected sources of infection. Medical staff were under enormous pressure to identify and eliminate sources of infection, and faced verbal abuse by representatives of the Ministry for Health if they failed to do so. The police and medical workers collaborated to conduct compulsory examinations of individuals found at sobering-up stations (vytrezviteli, medical facilities controlled by the police where people found to be drunk in public would be sent), receiver-distribution centres (temporary places of detention for juvenile offenders), and during brothel raids. The decision to conduct medical examinations in sobering-up stations, correctional facilities, and suspected brothels reveals prejudices regarding the kind of people who contracted STIs, largely presumed by the authorities to be alcoholics, criminals, sex workers, and juvenile delinquents.

As well as rooting out suspected sources of STIs, staff at STI clinics were also instructed to perform contact tracing. Medical workers were given targets for the number of contacts to be identified per patient, and the republics’ ministries of health were required to relay information about the annual average number of contacts identified within their particular republic back to Moscow. Contact tracing hindered patient confidentiality as it made an individual’s infection known to their sexual partners, as well as friends, colleagues, and relatives if they were living or working in close proximity. Providing the names of contacts also subject these individuals to compulsory examination, and if they refused, their forced transportation to a VD clinic by the police, or even criminal prosecution for evading VD treatment.

 

The consequences of criminalisation

The criminalisation of STI transmission reinforced Soviet officialdom’s perception that STIs were antisocial illnesses contracted by people engaged in deviant or immoral behaviour. This message was forcefully pushed in sex education. Throughout the 1970s, anti-STI radio lectures, films, and newspaper articles insisted that STIs were primarily spread by ‘people leading immoral lifestyles’, defined as parasites, vagrants, alcoholics, and sex workers. According to these materials, so-called ‘ordinary’ Soviet citizens could only contract an STI through engaging in ‘immoral’ sexual behaviour, like casual sex, extramarital sex, and commercial sex. Sex education materials were also littered with constant reminders about the criminalisation of STI transmission, the authorities’ right to conducted forced examinations of suspected sources of infection, and medical workers’ legal obligation to perform contact tracing.

The criminalisation of STI exposure/infection, the stigmatising messages pushed in Soviet sex education materials, and the forced examination of the contacts of an infected person significantly disincentivised seeking STI treatment, especially through the state healthcare system. Health authorities across the Soviet Union reported low rates of contact tracing and STIs remained an extremely concerning public health problem throughout the 1970s and 1980s.

Classifying STI transmission as antisocial and criminal behaviour allowed the Soviet government to ignore crucial structural factors that led to the widespread circulation of infection. Venereological facilities across the Soviet Union did not meet the needs of patients. There were chronic shortages in the number of hospital beds available for STI patients across the USSR, and in some republics, patients were even sent away from STI clinics due to lack of space. If a patient did make it into an STI clinic, treatment was slow and invasive. The length of hospital stays decreased for STI patients in various international contexts after the end of the Second World War due to the introduction of penicillin and the development of new treatment procedures. In contrast, prolonged hospitalization appears to have been the preferred treatment in the USSR, arguably driven by the desire to ensure patient compliance with the treatment regime and the more general fetishization of hospital stays within the Soviet healthcare system.

There were also chronic shortages in contraceptives that prevented the transmission of STIs in the Soviet Union. The most commonly used contraceptive methods (induced abortion, the withdrawal method, the use of a menstrual calendar, and vaginal douching) may have terminated or prevented pregnancy in some cases, but they did not offer any protection against STIs. The quality of barrier methods such as condoms was also poor, and usage remained low throughout the entire Soviet period.

 

Legacies of Soviet approaches to preventing STIs

The classification of STI transmission as criminal and antisocial behaviour and the use of punitive measures to prevent the spread of STIs significantly influenced state approaches to HIV/AIDS in the USSR. The first case of HIV was officially reported in the Soviet Union in 1987, although there is evidence that physicians recorded earlier cases. Upon its appearance, HIV was immediately classified as a disease spread primarily through ‘deviant’ behaviour and ‘immoral’ sexual practices. In 1987, 16 young physicians penned a letter to the Soviet AIDS Research Group claiming that AIDS was a useful tool for cleansing society of ‘unsavoury’ individuals (such as drug users and sex workers) and insisting that AIDS patients ought to be refused treatment. In August 1987, a clause criminalising HIV transmission and exposure was inserted into the Soviet Union’s anti-STI law. Alongside this, HIV patients who refused to follow strict regulations or who were deemed to pose a danger to public health could be quarantined within medical institutions for an unspecified period of time. HIV-positive individuals were required to provide the authorities with full lists of all their sexual partners so that contact tracing could be performed. Just like with state approaches to STIs, all these factors significantly disincentivised getting tested and seeking treatment for HIV.

As with STIs, the top rungs of the Soviet government prioritised punitive measures over investing in HIV prevention, treatment, and sex education. Throughout the late 1980s, health authorities at the level of the republics and regions across the USSR complained that there were chronic shortages of syringes, needles, capillary tubes, and pipettes within their hospitals and clinics, which meant that equipment was often reused multiple times without sterilisation, causing infection rates to soar. Much to the frustration of medical professionals, there were no serious attempts to disseminate accurate information about HIV/AIDS to the wider population, and the availability of barrier contraceptives remained extremely limited.  

 

Conclusion

In the Soviet Union, individuals with STIs or HIV were subject to stigmatisation, marginalisation, and criminalisation. Criminalisation in particular created barriers to accessing healthcare services and complicated the relationship between healthcare professionals and their patients. There is no evidence to suggest that the criminalisation of STI and HIV transmission achieved the desired public health goal of preventing the spread of infection. In fact, criminalising infection worked to disincentivise treatment and allowing the Soviet government to deflect attention away from more pressing structural issues, such as underinvestment in healthcare services, inadequate supplies of necessary equipment and medication, outdated treatment methods, and chronic shortages in barrier contraceptives.

The Soviet Union collapsed in 1991, but Soviet-era policies have cast a long shadow in the Russian Federation. The Soviet Criminal Code was replaced by the Criminal Code of the Russian Federation in 1996. The 1996 Criminal Code included articles criminalising the transmission of STIs and HIV and both remain criminal offences in the present day. Only a handful of people have been prosecuted under the anti-STI law in recent years, but there have been hundreds of convictions under the anti-HIV law. As well as criminalisation, there are other barriers to accessing treatment for HIV in Russia. HIV-positive migrants are denied treatment within the Russian healthcare system and are routinely deported if their status becomes known. The Russian federal government guarantees free antiretroviral treatment to HIV-positive Russian citizens, but the federal healthcare budget only covers treatment for fewer than half the number of registered patients. Rather than addressing this deficit in funding, the Russian government’s strategy for combatting the HIV epidemic is couched in moralising rhetoric regarding the need to ‘strengthen traditional family and moral values’ in order to reduce rates of infection.

Just like in the Soviet period, condom use remains low in Russia, despite condoms being widely available for purchase. Funding for sex education in schools is minimal and the 2012 law ‘On Protecting Children from Information Harmful to their Health and Development’ forbids any discussion of sexual intercourse or acts of a sexual nature to children under the age of 16. Both these factors mean that information about safe sex practices is not embedded within the Russian school curriculum, despite widespread support for its introduction.

The Russian government urgently needs to decriminalise STI and HIV transmission, adequately fund HIV treatment, introduce comprehensive sex education, provide free barrier contraceptives, and develop harm reduction programs for drug users. By taking these steps, the Russian government can take steps towards stemming the growing HIV epidemic and break with the legacies of the Soviet past.

They key lessons of the Soviet experience for governments around the world is that the criminal justice system is simply not the place to solve issues related to public health. Punitive approaches to disease control exacerbate existing public health problems and place undue pressure on the criminal justice system. Criminalisation does not achieve the intended objectives of preventing the spread of HIV and STIs, and instead, serves to stigmatise patients and discourage them from seeking testing and treatment. The only way to end the HIV epidemic is to introduce evidence-based policies that both address health existing inequalities and protect the human rights of patients. Decriminalising HIV transmission and implementing a robust package of harm reduction measures will not only help reduce rates of infection, but will also allow governments to make significant savings on law enforcement and incarceration.


Further Reading


Françoise Barré-Sinoussi et al. ‘Expert Consensus Statement on the Science of HIV in the Context of Criminal Law’, Journal of International AIDS Society, vol. 21, no. 7 (2018): 1-12.

Frances Bernstein, The Dictatorship of Sex: Lifestyle Advice for the Soviet Masses (DeKalb: Northern Illinois University Press, 2011).

Yuri Dud’, HIV in Russia, YouTube film, 2020 https://www.youtube.com/watch?v=GTRAEpllGZo&t=2453s

Murray Feshbach, ‘The Early Days of the AIDS Epidemic in the Former Soviet Union’ in Judyth L. Twigg (ed) HIV/AIDS in Russia and Eurasia, vol. 1 (New York: Palgrave Macmillan, 2007).

Siobhán Hearne, ‘Sanitising Sex in the USSR: State Approaches to Sexual Health in the Brezhnev Era’, Europe-Asia Studies (forthcoming 2021).

Ulla Pape, The Politics of HIV/AIDS in Russia (London: Routledge, 2014).

Jessica Whitbread and Svitlana Moroz, ‘HIV Criminalisation Scan: Regional Report on Eastern Europe and Central Asia’ https://www.hivjusticeworldwide.org/wp-content/uploads/2018/11/HJWW-EECA-Regional-HIV-Criminalisation-Report.pdf

 

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