愛滋蓄意傳染之處罰與危險性行為之認定

人類免疫缺乏病毒(Human Immunodeficiency virus, HIV)又稱愛滋病毒，係主要透過體液、血液作為傳染途徑之病毒，若感染者之病毒量累積至發病程度則轉換為後天免疫缺乏症候群（Acquired Immune Deficiency Syndrome），即俗稱之愛滋病。按目前醫學技術已可以透過藥物控制，使患者之生活與一般人無異，如同高血壓、糖尿病等慢性疾病，已不如疾病發見之初致命。然而，以目前醫學技術而言，仍無法達到完全治癒之程度。故各國設定各式防疫流程加以因應，亦對於感染者傳播疾病之行為透過刑罰加以規制，盼能達成遏止疾病擴散與惡化目的，我國當然也不例外。按《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「明知自己為感染者，隱瞞而與他人進行危險性行為或共用針具、稀釋液或容器等施打行為，致傳染於人者，處五年以上十二年以下有期徒刑。」我國對於感染者明知自身染病而蓄意傳染他人之行為，以等同於重傷害之刑度加以處罰，且同條第3項亦有處罰未遂犯之特別規定。由於醫學上目前仍難以證明愛滋病毒之傳染途徑，使「致傳染於人」之構成要件難以實現。故實務案件皆以未遂犯之規定加以處罰，僅需主觀上明知自身染病並對接觸者加以隱瞞，而實施危險性行為即該當本罪。不論該行為是否造成感染結果，似於抽象危險犯之立法模式。入罪的案件主要以共用針頭注射藥物、危險性行為為傳染途徑。其中有關危險性行為之定義按《危險性行為之範圍標準》第2條，係指未經隔絕器官黏膜或體液而直接接觸且經醫學上評估可能造成人類免疫缺乏病毒感染之性行為。其中在危險性的判斷上，實務往往僅以是否配戴保險套作為唯一的衡量準則。不論患者體內病毒量多寡、性行為本身的感染風險等，只要為隔絕體液接觸，即具有危險性。然而，在高效能抗愛滋病毒治療（Highly active antiretroviral therapy ; HAART）於1997年正式於台灣地區開始普及後，透過降低愛滋病毒感染者之血漿病毒量(plasma viral load)、提高CD4淋巴球數，已能大幅降低病患發生愛滋病毒感染相關的伺機性感染、腫瘤與死亡風險，也同時阻絕患者感染他人之可能性。按聯合國愛滋病規劃署、國際愛滋學會等國際組織之聲明，若患者體內病毒量低至一定成度，則患者並不具備傳染性(undetectable = untransmittable, U=U )。既患者透過穩定治療與服藥已無法造成他人感染之風險，自無理由僅因爲配戴保險套處罰行為人，始符罪刑相當原則與刑法之謙抑性。故本文欲以醫學實證研究作為基礎，探討我國現行法制的缺漏與最新修法結果可能面臨之問題。盼能真正保障愛滋病患權益與減少疾病擴散傳染，兼顧公衛防疫與感染者權益，達成完全阻絕愛滋病毒傳播之最終目標。

關鍵字

愛滋蓄意傳染；人類免疫缺乏病毒；後天免疫缺乏症候群；人類免疫缺乏病毒傳染防治及感染者權益保障條例；危險性行為之範圍標準

並列摘要

Human Immunodeficiency virus is a type of virus can be transmitted by sexual contact, by sharing needles or syringes for drug injection, or through blood transfusions with a HIV infected person. When HIV attacks the immune system so serious that the patients can’t fight off infections and disease, HIV infection leads to acquired immunodeficiency syndrome stage, or AIDS. Although there is no safe and effective cure for HIV, there exist some effective combination therapies combination therapies, which conduct impressive efficiency on prolonging life expectancy of HIV-infected people, and even lowering their chance of infecting others. To prevent the spread of the infections of HIV, many countries legislating for the intentional transmission of HIV, including Taiwan. According to the HIV Infection Control and Patient Rights Protection Act article 21, Individuals who are fully aware that they are the infected have, by concealing the fact, unsafe sex with others or injections by sharing needles and syringes, diluted fluids or containers, and thus infect others, shall be sentenced for five years up to twelve years. In addition, the unaccomplished offenders of the preceding Paragraph shall be punished. The law punished the individuals having unsafe sec with others without awareness and sentenced to five years up to twelve years, which is the same as causing serious injury to others. Because of the difficulty of defining the infection procedure of the HIV, most of the cases punished individuals with the regulation of the unaccomplished offenders. It means that the individuals need to be punished because they cause the danger of infection instead of infect someone indeed. The critical issue of the regulation is the definition of the danger to infect someone else. Due to the adjudgment of several instances of the court, the only factor influencing whether the sexual activity between individuals is dangerous is wearing a condom during sex or not. However, since the Highly active antiretroviral therapy is invented, patient can remarkably decrease the viral load of HIV in their own body. Additionally, there are many researched proved that if the viral load of HIV is lower than 200 copies/ml or undetectable, the HIV cannot be transmitted to others. As a result, we should not imprison the individual who cannot transmit the HIV to others just because of not using the condom during sex. In order to protect the patient infected HIV, the regulation of the punishment of intentional transmission need to be refined. The unsafe sex cannot be judged only due to the usage of the condom, or it might imprison lots of HIV patient who cannot really cause the danger of spreading disease. Fortunately, As a result of many researchers’ effort, the Criteria of Unsafe Sexual Behavior ,which defines the unsafe sexual behavior, Amended Articles 2 and announced by the Ministry of Health and Welfare on July 2, 2021. The risk of infection of HIV cannot only define with the usage of the condom during sex, but need to cause critical danger of the infection. This article may analyze the medical research, and the adjudgment of the instances of court. To announce that the definition of risky behavior cannot only rely on the usage of the condom, but need to consider the viral load of HIV in the body of individuals and how they have sex. Accordingly, the regulation can protect the innocent patient from imprisoning and control the spread of the disease as well.