How Did They Do It? Analyzing the Landscape of HIV Criminalization Reform in the USA

Abstract Introduction This study investigates the strategies associated with successful reform or repeal of HIV-specific criminal laws in the USA. These laws penalize people living with HIV (PLWH), often for behavior posing minimal or no risk of transmission, and perpetuate stigma and discrimination. Methods We applied McGarrell and Castellano’s integrative conflict model to analyze seven state-level legislative campaigns. Our dataset included legislative records and 135 media reports coded for thematic content related to stakeholder strategies and resonant framing. Results We identified five key strategies for successful reform: (1) making rhetorical appeals that resonate with issues of broad political import; (2) mobilizing “moral entrepreneurs” to champion legislative change; (3) building coalitions across advocacy groups; (4) leveraging broader legislative movements; and (5) spotlighting egregious legal outcomes to erode the legitimacy of existing laws. These strategies aligned legislative efforts with public concerns and political opportunities, leading to significant reform in diverse political contexts. Conclusions Reform campaigns are iterative and context-specific, requiring sustained advocacy and strategic alignment among stakeholders. Tailored approaches that align with state-specific political, social, and legal conditions enhance the likelihood of success. Policy Implications Policymakers and advocates should cultivate moral entrepreneurs to serve as public representatives, build cohesive coalitions with unified strategies, and deploy resonant frames that link HIV criminalization to issues of broad social import. Flexibility to seize emergent opportunities and focus on legislative strategies can help advance reform efforts. Long-term advocacy is critical to achieving meaningful change while avoiding unintended consequences, such as criminalizing other infectious diseases.