HIV criminalisation laws need reforming for all those living with HIV, regardless of U=U

We Need to Talk About the Downside of U=U

I remember when I first heard the statement in 2017: the science-based evidence that stated people living with HIV taking antiretroviral medication who had attained an undetectable viral load no longer transmitted the virus. The slogan “U=U” (undetectable equals untransmittable) from that moment took on a life of its own—and I was all for it. I wrote about it, spoke about it, and even hit the streets to protest to ensure people were given access to this important breakthrough in HIV work. Now I feel differently. Three years later, the fight to reduce stigma using “U=U” as a framework has become nothing more than a gesture to prove that the bodies of people living with HIV are safe to have sex with, and I believe it has added another layer of oppression to Black people’s plight in the HIV epidemic.

Being an activist and advocate in this space for some time now, I’m always going to watch movements founded with white leadership with a critical eye—especially when HIV is an epidemic centered on Black queer folks, cisgender women, and transgender people. Movements seen through a white lens often have a blind eye to the most vulnerable and those who will be most affected. This movement is no different. The same people who are often left out of conversations around barriers to treatment are the same who are most harmed by a movement centering the optimal outcome—viral suppression as a marker of health above and beyond anything else.

It is true that being undetectable is what is recommended by every major medical and public health entity. However, undetectable doesn’t equal healthy, nor is it a status that, once attained, is always manageable—especially for Black queer and fem people. Furthermore, due to religious beliefs, inability to use treatment, barriers to care, or personal choice, we know that not everyone will be undetectable. That should be protected, and not othered. We should always be taking an approach to those living with HIV that centers the totality of their health, not their status.

I was first diagnosed with HIV in 2010. I didn’t start treatment until 2013. Much like seeing the phrase, “infectious disease,” made me cower, I would have been mortified seeing a movement like U=U. I was afraid to go to the doctor, afraid to take a pill for the rest of my life. There was no movement focused on my starting point. U=U doesn’t look like the goal to every person who is first diagnosed, and it puts the cart before the horse.

When I worked as a community health care worker, getting a client to an undetectable status was one of the goals, and not the main one. Shelter, finances, other health conditions, mental health, etc. were all a part of the “care” that we assessed with our clients. U=U is great as science and as a tool in the toolkit of care—not the entire toolbox. And its messaging is not reaching the community it claims to be saving or empowering; it is, rather, emboldening folks to weaponize status while creating a hierarchy within HIV.

I was recently made aware of an Instagram account dedicated to exposing individuals who were HIV positive but not undetectable, called “TheUndetectableList.” Although that account has since been taken down, it is movements like U=U that create an atmosphere for those who may not be undetectable—based on several factors and barriers—to be placed in dangerous positions.

Just like U=U, D can equal D, meaning Disclosure can equal Death. Much like the “It Gets Better” campaign around bullying, there was no system in place for those who, just by virtue of getting older, being queer or trans, things didn’t get better for. It was treating a symptom of the problem rather than the root cause. U=U is the “optimal” goal for medical professionals, while social justice activists and advocates understand that the picture of health for us has to be painted with much broader strokes to encompass all people.

Last year, Tamás Bereczky, with the European Patients Academy (EUPATI), penned an article for The BMJ about what he also perceives as the harm caused by this movement.

“Activists in developed countries have said that advocates in regions lacking access to drugs and testing should use the U=U message to call more strongly for improvements,” he wrote. “But this ignores the political, social, and cultural contexts in which people with HIV live.”

Bereczky also goes on to address the kind of bullying that other activists are experiencing globally if they raise questions about U=U as a framework. “The U=U message has spread readily among communities, but political barriers often make it impossible to be more vocal without advocates risking their liberty and physical integrity. Ideological dogma also acts against people with HIV as well as men who have sex with men, injecting drug users, sex workers, and prisoners—that is, the key affected populations.”

The U=U movement misses the mark on the population it claims to be aiming to prioritize at its center. HIV-positive people cannot be responsible for the burden of the work in ending the epidemic. We are often placed in positions where we carry the responsibility and accountability for the sexual health of others. Our “undetectable” status also shouldn’t be used as a badge of honor to tell people it is “safe to sleep with us” or interact with us without fear of contracting the virus.

Any time I see someone post their negative HIV test results, I push back. The U=U movement has in a sense emboldened the idea that negative status (or as close to it as possible) is perfection. It has created a new kind of class system within the HIV community, and a hierarchy of the bodies that society now deems as acceptable and safe.

Is U=U scientific fact? Yes. Is it important to educate people that when you get to an undetectable viral load, you no longer transmit the virus? Yes. Should a movement be centered on an outcome we scientifically know not everyone can achieve or maintain because of social, economic, and environmental determinants of health? Absolutely not. U=U is just like condoms, harm reduction, pre-exposure prophylaxis (PrEP), TaSP (Treatment as Prevention), and anything in the toolkit. It is one of the many tools that should be used, but it should not be sold as the end-all, be-all. U=U is unfortunately sold as the only marker for good health, which in and of itself is dangerous.

Another major factor is how the U=U movement is creating policy change in HIV criminalization that could be potentially harmful to the overall cause. U=U has been used to create reforms in states like North Carolina to reduce the chance of prosecution for people who can prove they have been undetectable for six months or longer, who do not have to disclose their status nor use a condom during sex. This approach centers our safety from prosecution based on our medical status and still puts many at risk, including those who are undetectable who would be required to prove that they were virally suppressed if someone accused them of nondisclosure or not using a condom—a person is only as undetectable as their last labs. Also, this approach puts no responsibility on lawmakers or health care institutions in states like North Carolina to ensure people with HIV can get into care and remain on treatment as easily as possible—the state still has not expanded Medicaid under the Affordable Care Act, which may exacerbate race and class health disparities in who can achieve viral suppression in the first place.

U=U as science should also be used to fight for Medicaid expansion or Medicare for All and to fight against attempts to not cover people with pre-existing conditions and the barriers to care that exist for so many. It should not be a movement as much as it should be a tool in the various ways we fight against HIV stigma, and for better health care. It also shouldn’t be used to create new laws that only protect those privileged enough to get an undetectable status.

Instead, U=U has become a slogan, a T-shirt, and a notion to people who are HIV negative that our bodies are safe to sleep with. It is classist and elitist. The ability to tell folks that we are undetectable should be a personal one. We can’t in one breath critique HIV-negative folks who post their negative results on social media and reinforce stigma that harms HIV-positive people, but then turn around and loudly boast about our own undetectable status. That too harms those who are detectable and many who are undetectable but discrete.

We should all be empowered by U=U for the science, and for the fact that HIV treatment over the past 25 years has advanced us to a place where people living with HIV no longer transmit the virus, and it can help us sustain a high quality of life. However, we need to be clear that U=U is not a viable option for everyone, and our fight must begin at the barriers as to why more can’t achieve it. Our goal is not a happy ending only some of us have been able to achieve. It should be a tool of encouragement for those afraid to be tested or those lost to care, not another campaign that inadvertently causes more stigma and separation.

Top-down movements have never worked—and this movement is no different. Helping those who start in the best position to get to undetectable or leading with that lens will only harm those most marginalized, who tend to be left out with the promise of, “We’ll come back for you later.” The same way Black Lives Matter can’t work unless All Black Lives Matter is the same way a U=U approach can’t work if all lives can’t get to the “U” of being undetectable—especially when overall health should be our main goal, not status-centered health. Movement work should center those most disenfranchised, not embolden others in a place of privilege to shame those who can’t attain that same status—pun intended.

U may equal U, but it certainly does not equal me and a lot of other people who may struggle to get there. My status is a small part of the total person that I am. As I’ve stated before, “My existence is an HIV campaign,” not my status. We must work to educate the world on U=U as science.

South Africa: Former Constitutional Court Judge Edwin Cameron talks about his life, HIV and the Law

Judge Edwin Cameron on HIV, justice and attacks on the judiciary

Former Constitutional Court Judge Edwin Cameron, whether intentionally or not, has always been an activist. He talks to Manosa Nthunya about his writing life.

In South Africa, we are increasingly becoming accustomed to the fact that from time to time a judge, particularly from the Constitutional Court, will, to our delight, pen a book.

Since our transition into democracy, some of the judges who have written books, mostly memoirs, include Albie Sachs, Dikgang Moseneke and Edwin Cameron.

All their books are reflections on the law and its role in our nascent democracy.

Because of our history, these memoirs are reflections of the role the law has played in the individual lives of these judges growing up under apartheid.

It is in this way that for us as readers the law comes alive, as it is presented as not only an abstract entity but something that always has a profound effect on lives.

Judge Cameron, who retired from his position as Constitutional Court justice last year, has written two personal memoirs which have both received acclaim.

His first memoir, Witness to Aids, was published in 2005 and his second, Justice: A Personal Account, in 2014.

Both books chronicle his life, beginning under apartheid and into post-apartheid, and interrogate what the law means in the context of a society where it was used to catastrophic ends.

When I met Cameron to discuss his writing life, I was most interested in what it was that compelled him to write, particularly because there seems to be an expectation in our society that the less it is known about a judges’ life and thinking, the better we can trust in the independence and fairness of their judgments.

When I ask him why it is that he writes, he responds that with his first book his reasons were to “make a point about white privilege, about homosexuality and about HIV”.

With his second book, “my aim was to show the law as an oppressor, as the imprisoner of my father, as something that should be applied to social justice ends”.

Witness to Aids is a book, as the title suggests, that looks at the impact that HIV/Aids has had in South Africa.

It’s a book that tells the story of the disease from a deeply personal perspective.

INFECTED WITH THE VIRUS

Cameron writes in the introduction: “I knew that I had Aids when I could no longer climb the stairs from the judges’ common room in the high court to my chambers, two floors above.”

He goes on to tell his story of being infected with HIV and how that dramatically changed his life.

Having been infected with the virus during the heady days of apartheid, Cameron’s book explores the shame that was – and still is – attached to the virus and how this was exacerbated by his sexuality.

This is an experience, he tells me, that has greatly shaped him.

Even though Cameron’s career as a lawyer and eventually a judge was taking off, he writes that having HIV was a huge blow to how he thought his life would turn out as “the other part of my life was washing away beneath my feet, eroded by microbes and attacked by fungi coursing through my veins and wasting my muscles and bodily reserves, leaving me tired and panicked and isolated in the waiting room”.

Having heard people say that they would kill themselves if they found out they were HIV-positive, he found that he “wanted to keep on living. I wanted my health back, urgently. I wanted to breathe easily, freely, again.”

While Witness to Aids is about Cameron’s battle with the disease, it is also a story about the tragic politics of HIV/Aids in South Africa.

He tells me that this was a very difficult book for him to write: “The first book was agony. Every word was anguish. Writing about stigma, infection, recovering from it.

“Writing about the horror of [former president] Thabo Mbeki’s denialism was very painful. I was under attack by a man named Ronald Suresh Roberts, who should remain nameless.”

And the book does – more so than any popular book I can think of – go into detail about the consequences of Aids denialism in South Africa. What created this, he writes in the book, was “the inauguration of Mbeki’s Aids Advisory Panel in 2000”, which “initiated three years of tragic confusion in South African governmental approaches to Aids”.

This is partly why Cameron became an activist for issues related to HIV/Aids.

Rereading the book now, one realises how far we have come as a country with regard to the disease and the despair that was ever-present at that time.

Some of the most moving words that speak to this despair are when Cameron writes: “We cannot allow our grief and our bereavement to inflict a further loss upon us – the loss of our own full humanity, our capacity to feel and respond and support. We must incorporate our grief into our everyday living by turning it into energy for living, by exerting ourselves as never before.”

What made it possible to challenge government was a ruling by the Constitutional Court that the state was compelled to offer antiretrovirals.

In many ways, the story of HIV/Aids in South Africa is a story which, although tragic, bears witness to the importance and strength of living in a constitutional democracy.

It is testament to what is possible when a country has an independent judiciary and a government that respects the judgments of the courts – as was the case, as Cameron writes, under Mbeki’s presidency.

It is in Cameron’s second book that the importance of a constitutional democracy is interrogated more deeply.

In the context of South Africa this is not an easy examination, as the courts have more often than some would wish come under heavy criticism from politicians and, of late, the public through social media.

Cameron writes that the book is about “our country’s most inspiring and hopeful feature – its big-spirited, visionary Constitution. And it tells the story of my journey from poverty-stricken childhood to becoming a lawyer and eventually a justice in the country’s highest court, which has the duty to interpret and guard that Constitution.”

I put it to him that what struck me while rereading his book was how he seemed to have written a biography of the law.

The ways in which the law, like a human being, is under constant change and how in that consistent metamorphosis it can be perceived as either nefarious or necessary.

Thus, even though the story of apartheid that he tells in the book is one about the tragic uses of the law, there is also a sense that the law is not something stable and fixed, that it depends on who is making use of it.

In the book he writes: “What fascinated me was that the law, apartheid’s oppressive instrument, could also be employed against apartheid. It could be used occasionally to mitigate its effects. Properly employed, it could be used to repair and not to break down or damage.”

What Cameron provides here is a picture of the law that is very much with us in post-apartheid South Africa.

Even though the sense, for most, is that the law should be used to respond adequately to our history, there are also those who are intent on abusing it to further their ambitions.

What this reveals to us as the public is that the law is, in fact, a fragile entity, solely reliant on the motives of those who are in control of it.

In Justice: A Personal Account, we are taken into Cameron’s childhood in an orphanage and how he became interested in law.

Even though he grew up poor in apartheid South Africa, he was nevertheless acutely aware of the fact that being white meant that he had privileges which other racial groups could not have.

“My whiteness bought me the privileges that apartheid was designed to secure for whites. It secured for me access to a first-rate high school and an excellent university. These opened the way for me to get a Rhodes Scholarship to Oxford, and to start my legal career,” Cameron writes.

It is precisely these privileges which he believes South Africa’s democratic Constitution is called on to address, about which he writes: “Our Constitution seeks to offer this generosity and support justly to all. It gives us a framework for a society in which mutual support and generosity are key. And it obliges government, on behalf of all of us, to create a society in which all of us can live in dignity.”

ATTACKS ON THE JUDICIARY

I find it unavoidable to ask him about his reflections on the latest, as we are told, “attacks” the judiciary.

What does he make of them and are they justified?

He responds saying that precisely because South Africa’s transition was legal-centric, it is unavoidable that the judiciary will, from time to time, receive criticism.

At the time he wrote his second book, he says, “the Constitution was under credible and warranted scrutiny”.

What he was saying in the book was that, despite the criticisms the Constitution has received, it has survived, revealing its strength.

Recently, “the particular criticism has come from the EFF, when they got a number of judgments which were adverse to them and [Mbuyiseni] Ndlozi made personal comments about the judge and he referred to the two judges’ genders”, something which Cameron says he found worrying. This was a consequence of a judgment that involved Public Protector Busisiwe Mkhwebane, where the majority of judges found that she had been dishonest and legally incompetent.

Cameron tells me that, despite the fact that the Constitution has shown its resilience, there was a time in our recent history when our democracy was under threat.

He says it was with the help of the Chief Justice Mogoeng Mogoeng and former Public Protector Thuli Madonsela that we survived.

“If I had to nominate two people that have saved our democracy I would nominate Mogoeng and Madonsela. They have played pivotal roles in salvaging democracy from total ruin.”

I ask what advice he would give to young authors, be it in law or otherwise.

“It starts with a message. In Witness to Aids I was trying to talk about how HIV is a manageable but highly stigmatised disease. In Justice: A Personal Account it was [about] a Constitution under threat. For me it starts with a message and the rest flows from that.”

And when I ask what it is that keeps him going, Cameron says: “The young law students are the reason to keep going. Outstanding young South Africans who have a sense of vision about what the law can do and about how the courts should operate. It’s the reason to keep going and not to fall into some kind of pessimism or despair.”

Nthunya is a PhD candidate in literature at Wits University. He studied literature, history and philosophy at Rhodes University

France: HIV organisations mobilise to halt sensationalism of news coverage in police violence case

Spit and HIV: the violence of words

Automatic translation via Deepl.com. For original article in French, please scroll down.

Spit and HIV: the violence of words

Following the release of an amateur video in which a police officer stopped and violently beat a demonstrator, a spokesperson for the police union Alliance, in defence of the officer involved, claimed that the person stopped spat blood in the officer’s face and said, “I have AIDS, you’re going to die. Since then, the victim has denied living with HIV and having threatened the police officers with “contamination” by spitting on them.

The case has swelled up in some media outlets, which have taken up the police unionist’s explanations without deflating the sensationalism surrounding the “danger” of spitting on an HIV-positive person.

Faced with this, many of his AIDS activists and associations of people living with HIV intervened to put the facts in their place, regardless of the position of responsibility that existed during the arrest. “The rapidity of news coverage regularly implies approximations or, worse, leaving room for false beliefs. This is particularly true with regard to HIV/AIDS. But to allow false ideas to be conveyed is to feed the serophobia that plays into the hands of the epidemic,” explains AIDES in its press release published in emergency on 20 January.

On Twitter, the president of Act Up-Paris, Marc-Antoine Bartoli, is moved and says that “aggression or “the attack on AIDS does not exist”. A few weeks ago Act Up New York had to deal with a similar case. It is important to remember that people who test positive for HIV have access to treatment that makes their viral load undetectable and cannot transmit HIV. First fact. The second is that, first and foremost, “the modes of contamination are sexual secretions, breast milk, blood. Saliva does not transmit HIV. Moreover, HIV has very low resistance to the open air. After five to ten seconds in the open air, a drop of blood no longer contains the virus,” AIDES recalls.

These simple indications would have deflated a Serophobic line of defence from the outset, continuing to play on irrational fears. “It is everyone’s responsibility to recall this information as soon as necessary. Without this, stigmatization and false beliefs will not be able to stop,” continues AIDES. And the media have their role to play in informing. This is what Fred Colby, a gay activist who is openly HIV-positive and committed to AIDES, is calling for: “People living with HIV are not walking viruses. People living with HIV are not walking viruses. The media needs to think before they publish this kind of thing or qualify it by talking about treatment and undetectable viral load. Without this prerequisite, this spitting case is likely to come back in the news, without any lessons being learned from the previous one. Again to the detriment of HIV-positive people.

Crachat et VIH : la violence des maux

À la suite de la diffusion d’une vidéo amateur, dans laquelle un policier interpelle et frappe violemment un manifestant, le porte-parole du syndicat de policiers Alliance affirmait, pour la défense de l’officier mis en cause, que la personne interpellée aurait craché du sang au visage du policier en disant : « J’ai le sida, tu vas crever ». Depuis, la victime réfute vivre avec le VIH et avoir menacé les policiers de « contamination » en leur crachant dessus. L’affaire a enflé dans certains médias, qui ont repris à leur compte les explications du syndicaliste de la police, sans pour autant dégonfler le sensationnalisme autour du « danger » d’un crachat d’une personne séropositive au VIH. Face à cela, de nombreux-ses militants-es de la lutte contre le sida et des associations de personnes vivant avec sont intervenus pour remettre les faits à leur place, peu importe la position sur les responsabilités en cours durant l’arrestation. « La rapidité de traitement de l’actualité implique régulièrement des approximations ou pire, de laisser la place à de fausses croyances. C’est particulièrement vrai concernant le VIH/sida. Or, laissez véhiculer de fausses idées, c’est nourrir la sérophobie qui fait le jeu de l’épidémie », explique AIDES dans son communiqué publié en urgence, le 20 janvier. Sur Twitter, le président d’Act Up-Paris, Marc-Antoine Bartoli, s’émeut et indique que « l’agression ou « l’attaque au sida n’existe pas ». Il y a quelques semaines Act up New-York a eu à faire à un cas similaire. Il est important de rappeler que les personnes dépistées séropositives ont accès à un traitement qui rend leur charge virale indétectable et ne peuvent pas transmette le VIH. Premier fait. Le second, c’est qu’avant toute chose, « les modes de contamination sont les sécrétions sexuelles, le lait maternel, le sang. La salive ne transmet pas le VIH. De plus, le VIH a une très faible résistance à l’air libre. Après cinq à dix secondes à l’air libre, une goutte de sang ne contient plus de virus », rappelle AIDES. Ces simples indications auraient permis de dégonfler d’emblée une ligne de défense sérophobe, continuant de jouer sur les peurs irrationnelles. « Il est de la responsabilité de toutes et tous de rappeler dès que nécessaires ces informations. Sans cela, les stigmatisations et fausses croyances ne pourront pas cesser », continue AIDES. Et les médias ont leur rôle d’information à jouer. C’est ce que réclame Fred Colby, activiste gay, ouvertement séropositif et engagé à AIDES: « Les personnes vivant avec le VIH ne sont pas des virus ambulants. Il faut que les médias réfléchissent avant de publier ce genre de choses ou nuancent en parlant du traitement et de la charge virale indétectable ». Sans ce préalable, cette affaire du crachat risque de revenir dans l’actualité, sans qu’aucune leçon ne soit tirée de la précédente. Au détriment, encore, des personnes séropositives.

Russia: Mandatory testing proposed for citizens aged 15 to 55 in regions with high HIV prevalence

Ministry of Health intends to introduce mandatory HIV testing for citizens aged 15 to 55

Automatic translation via deepl.com. For Russian article, please scroll down.

Ministry of Health intends to introduce mandatory HIV testing for citizens aged 15 to 55

In January 2019, the Ministry of Health of the Russian Federation published a draft Procedure for the provision of medical care to HIV-infected patients. The document, in case of entry into force, will repeal the relevant recommendations of 2012.

According to the draft document, the agency proposes to conduct rapid testing of citizens aged 15 to 55 years living in regions where more than 1% of pregnant women are HIV-infected. Whereas, according to the current regulations, testing for HIV antibodies is voluntary, HIV tests for representatives of certain specialties are mandatory.The updated document also proposes to conduct rapid screening tests for all persons who have reported contact with people with HIV, are at risk or are undergoing a sexually transmitted disease test.In addition, the draft Procedure provides for the provision of medical care to HIV-positive patients through telemedical technologies.

In 2016, the Ministry of Health of the Russian Federation joined the UNAIDS global strategy, the essence of which was to diagnose 90% of HIV-positive people, 90% of whom should receive therapy and 90% of whom should have an undefined viral load as a result.

In 2019, 714,000 people with a diagnosis of HIV were registered with the Russian dispensary, of whom 60-70% received therapy and no information on its effectiveness is publicly available. The total number of HIV-positive Russians, according to various estimates, can range from 1 to 1.3 million people.

МИНЗДРАВ НАМЕРЕН ВВЕСТИ ОБЯЗАТЕЛЬНОЕ ТЕСТИРОВАНИЕ НА ВИЧ-ИНФЕКЦИЮ ДЛЯ ГРАЖДАН В ВОЗРАСТЕ ОТ 15 ДО 55 ЛЕТ

Минздрав РФ в январе 2019 года опубликовал проект Порядка оказания медицинской помощи ВИЧ-инфицированным пациентам. Документ, в случае вступления в силу, отменит действие профильных рекомендаций от 2012 года.

Согласно проекту документа, ведомство предлагает в обязательном порядке проводить экспресс-тестирование граждан в возрасте от 15 до 55 лет, проживающих в регионах, в которых более 1% беременных женщин ВИЧ-инфицированы. Тогда как, согласно действующему регламенту, исследование на антитела к ВИЧ носит добровольный характер, обязательными же являются тесты на ВИЧ для представителей отдельных специальностей.

Обновленным документом также предлагается проводить скрининговое экспресс-тестирование всем лицам, сообщившим о контакте с ВИЧ-инфицированными, находящимися в группе риска или проходящими исследование на венерические заболевания.

Кроме того, проект Порядка предусматривает оказание медицинской помощи ВИЧ-положительным пациентам с помощью телемедицинских технологий.

В 2016 году Минздрав РФ присоединился к глобальной стратегии ЮНЭЙДС, суть которой сводилась к охвату диагностикой 90% ВИЧ-инфицированных, из которых 90% должны получать терапию, а 90% из них – иметь в результате неопределяемую вирусную нагрузку.

В 2019 году на диспансерном учете в России состояли 714 тысяч человек с диагнозом ВИЧ, из них терапию получали 60–70%, а сведений о ее эффективности в открытых источниках не содержится. Общее число ВИЧ-положительных россиян, по разным оценкам, может составлять от 1 до 1,3 млн человек.

Canada: Alexander McClelland’s looks at the lives of people who were criminalized due to alleged HIV non-disclosure

How HIV-positive LGBTQ2 people are criminalized in Canada

Three harrowing stories of HIV non-disclosure cases

By Alexander McClellandJan 15, 2020, 1:31 PM EST

From 2016 to 2019, Alexander McClelland, a researcher and Banting Postdoctoral Fellow at the University of Ottawa, spoke to 16 people across the country about their experience with Canada’s legal system and HIV non-disclosure laws. In Canada, those who do not disclose that they are HIV-positive to a sexual partner can face sexual assault charges, and if prosecuted, are mandated to appear on sexual offender registries.

Since 1989, more than 200 Canadians have been criminally prosecuted for HIV non-disclosure; in most of those cases, HIV was not transmitted, and many involve situations in which transmission was not possible—whether because their viral load was undetectable or because they used condoms. Despite reforms over the years, many HIV-positive folks remain vulnerable to criminalization.

The culmination of McClelland’s research is a new booklet, The Criminalization of HIV Non-Disclosure: Experiences of People Living with HIV in Canada. In it, McClelland features interviews with nine Canadians who were criminalized for their HIV status. They are all recent cases, with the earliest stemming back to 2000 and the latest in 2015. Below are three of those stories.

Matteo: “They didn’t know what undetectable meant”

When I met him, Matteo was still under curfew as part of the conditions of his release. His parents were his sureties—he was mandated to live with them in the suburbs. A gay white man in his early 20s, Matteo was still in college, and only allowed out of his parents’ house to attend school for the day. He only recently found out his HIV-positive status. In fact, we met on the one-year anniversary of his diagnosis. He told me about how he had used hook-up applications like Grindr and Scruff. He met a guy that way, and they had sex.

Matteo did not tell the guy his status. He had been told by his doctor that since he was virally undetectable it was impossible for him to transmit HIV. Matteo concluded that he only had to disclose his status if there was a risk of transmission: “I thought if I was taking medication I didn’t have to disclose. Apparently, that is not the case.” A few weeks later, he was at work and the police came to arrest him. Matteo was arrested in front of his staff, coworkers and customers. “I felt really shitty, like I, like I had just robbed a liquor store,” he says. “They [the police] said, ‘You know why we are here. You are being charged and arrested.’

He ended up educating the detectives on the risk factors for transmission. Fundamentally, the police tasked with arresting Matteo did not know the current science behind the actual risks of HIV transmission. The police then released his picture, biometric details including his height, weight, eye and hair colour, any visible identifying marks, the charges filed against him, and his HIV-positive status. They also released a picture of Matteo as part of a public safety warning, asking his past sexual partners to come forward. The warning was widely covered in the media. As a result, it was also shared online, including on Facebook, targeting Matteo’s profile. One such negative post read, “If we still had the lash in Canada for punishment, this would be a case for its proper application.”

While talking at his place, Matteo told me more about what it was like to live under curfew at his parents’ house and the other conditions of his release. He felt constantly surveilled, isolated and depressed. He pulled out a piece of paper and read to me the more than 20 conditions of his release. Among the many conditions, he was barred from socializing in the gay community or going out to participate in social events. The condition that most bothered him was that he was mandated to contact authorities 24 hours before any potential sexual conduct, providing them with the name and contact information of the person. The police would then directly verify that the person knew Matteo’s HIV-positive status and that they consented to sex with him. “Like, who is going to want to do that? How am I going to meet anyone?” He felt extremely isolated and lonely.

Cynthia: “If I had not called the police, I would not have this charge hanging over my head”

I met Cynthia in her neighbourhood on the outskirts of a large Canadian urban centre. She told me about her move to Canada a few years earlier from a South American country. She felt that living as a transsexual woman in her home country was impossible. She feared that had she remained, she would have faced life-threatening violence.

Since moving to Canada, Cynthia had been working as a sex worker. She told me she generally had clients she liked, and she worked out of her home. She was warm and engaged when talking to me. In her late 30s, Cynthia was well-dressed and had a gentle demeanour. As we sat together drinking tea, she began telling me about how she was threatened with a charge of aggravated sexual assault. She was on anti-HIV medications, was undetectable and regularly used condoms with her clients. She knew that she was protecting them and also herself.

One of her regulars came over one night more intoxicated than was typical for him. He pulled a knife on Cynthia and raped her, holding the knife to her neck. He did not use a condom. She was terrified and called the police afterwards. During the police investigation, Cynthia told police about her HIV-positive status. Later, when speaking with the man who raped her, the police told him that he could press charges against Cynthia. She had previously not disclosed her status to the man, thinking that the use of a condom and being undetectable was more than sufficient. A few weeks later, she received a letter from a detective, stating that she was under investigation and they were considering pressing criminal charges of aggravated sexual assault. She was scared and didn’t know what to do. The man knew where she lived and had been violent toward her, and now she was potentially facing criminal charges. She told me that because she was a sex worker, her rape and assault were not being further pursued by the police. But now she was under threat of a charge of aggravated sexual assault for not disclosing her HIV status to her rapist.

After receiving the letter about the investigation from the authorities, Cynthia felt constantly surveilled, scared and worried. Moreover, now that he knew she was HIV-positive, the client who assaulted her began stalking and harassing her. She was terrified in her own neighbourhood, isolating herself and rarely venturing out. She deactivated her social media accounts because he also began posting messages, harassing her and her friends online. She was extremely fearful in her own neighbourhood but also scared to call the police again. “If I had not called them, I would not have this charge hanging over my head,” she says. She felt as though she was under constant watch, but with no means to protect herself. She knew the police were not going to help her and was worried she would face additional violence from her former client.

George: “This rape charge and HIV was worse than being a murderer in their eyes”

I met George in his apartment. He is a warm and gregarious white gay man in his late 50s, with a self-described long history of problematic prescription drug use, gambling and mental health issues. When George began a specific relationship around 10 years earlier, he initially did not tell his boyfriend about his HIV-positive status. At the time, he told me, he was himself uncertain about how HIV was transmitted. He told me that he was often depressed and in denial about aspects of his life. One day, a few months after his own diagnosis, George told me that his boyfriend came home with an HIV-positive test result from the clinic after a routine sexually transmitted infection screen. George then finally told his boyfriend his status in a letter: “There is a possibility that you may have gotten it from me, and I’m very deeply sorry for not disclosing [it to you].” His boyfriend went into a rage and went to police.

A few days later, he received a text message from his boyfriend that he was at the police station giving them his story. George immediately went to the station. “The next thing I knew, they were taking me into custody, and they said, ‘You have the right to call a lawyer,’ and they told me that ‘you are being arrested for sexual assault.’” George told me that a constable initially told him, “You’ve never had a criminal charge before. You will probably just have to stay overnight and tomorrow we’ll get your bail sorted.” But, a few hours later, the same constable came to see him and told him his charges had been elevated to attempted murder: “‘You aren’t going anywhere,’ she says, and she was right.” Due to the severity of the charge, George was denied bail even though he had no previous criminal record.

Due to the fear, shame and anxiety he experienced, George decided to plead guilty. He had never been incarcerated. The Crown Prosecutor asked for 10 years. George’s lawyer told George to plea, that he had no case because he had admitted his crimes. If he pleaded out, he would be sentenced to a lot less time incarcerated. He listened to his lawyer.

While incarcerated, George was placed in the general population with men facing all types of charges. He started facing verbal and physical harassment. Prisoners began calling him a rapist and asked why he took medication. After days of harassment, he was brutally assaulted by other prisoners. Those assaulting him said they knew he was trying to spread HIV. George said the guards watched and did nothing. (Under an institutional directive, prisoners’ charges and health status should remain confidential, and the only people with access to the information are guards.)

While in protective custody, George remained unsafe and was beaten again and again: “I went into the protective custody wing, and there are all kinds of sex offenders there and murderers and everything else like that. And when I got there, they found out my charge. So, they beat the shit out of me as well. I never fought a day in my life. I have never lifted a hand to anybody… I was on an isolated range for violent murderers and would still get harassed. You know, this rape charge and HIV was worse than being a murderer in their eyes.”

He told me that other sex offenders and murderers were left alone. But he was continually attacked for having HIV combined with a “dirty charge”—that is, aggravated sexual assault. One day, George was being harassed by another prisoner when a guard intervened. George told me he felt the guard had it out for him, and he was scared of the guard who had said demeaning things to him in the past. After the altercation with the other prisoner, George started to have a panic attack. While hyperventilating, that same guard forced George to strip naked and made him lay down on the cold concrete floor, holding him down on the floor with his boot. The guard pushed his boot into George’s chest hard and said, “I don’t touch anyone with AIDS,” as a nurse arrived to sedate George, sticking a syringe in his arm.

Ultimately, he served the rest of his sentence in administrative segregation, where he only had a concrete floor with no bed until night time. He was given just one sheet of paper and a pencil to occupy his time while locked down alone in a cell. He served approximately one year in those conditions.

 

Uganda: Reporter looks at the role of the media in driving stigma surrounding HIV criminalisation

Is the media fanning stigmatisation in the HIV/AIDS fight?

KAMPALA – In the third and last part of the series to shine a light on the impact of stigimatisation in the fight against HIV/Aids, PML Daily’s Senior Staff Writer David Mafabi looks at how the media has unknowingly fanned the vice of stigimatisation.

Ms Rosemary Namubiru a nurse is today paranoid about her safety and has stopped taking anything for granted.

She enters her house at 7.00pm and never opens for strangers ever since she was convicted and sent to jail allegedly for infecting a child with HIV/ Aids.

This has been so since 2014, when a Ugandan court sentenced her to three years in jail for negligence over the potential infection of a two-year-old boy with HIV.

Ms Namubiru, who is HIV-positive, was reportedly criminally negligent by using an intravenous needle, that she had accidentally pricked her finger with, on the child, the court ruled.

Many journalists were awash with condemnation to the level that many newspapers dubbed her as a “killer nurse”, something that stigmatises her up to now.

Ms Namubiru is not alone in this condemnation and criminalization, there are many people living around the World who have gone through this kind of criminalization especially when the laws don’t add up.

In 2018, Ms Sylvia Komuhangi was also charged with committing a “negligent act” likely to spread disease contrary to Section 171 of the Penal Code Act of the Republic of Uganda for reportedly infecting a baby with HIV/Aids.

The Magistrates Court sentenced her to two years in prison; six months after her ordeal started even when the baby was tested and found to be HIV negative, Ms Komuhangi was kept in jail.

One newspaper article labeled Komuhangi as a “monster” at the time of her arrest. Another newspaper ran a story under the headline; “Woman gets two year jail term for infecting baby with HIV blood” which was so stigmatising.

Ms Komuhangi would possibly still be languishing in jail if her case had not caught the attention of lawyers from the NGO, Uganda Network on Law, Ethics and HIV/AIDS (UGANET) who appealed and the case was later overturned.

Members of UGANET, UNASO and other NGOs engaged in the national response to HIV and AIDS were unhappy with the way journalists covered Ms Namubiru’s arrest.

The general feeling was that the media led the public trial and conviction of Namubiru and Ms Komuhangi.

Actually many NGOs working to prevent new HIV infections and scale up access to treatment and related health services for people with HIV described the media as suffering from attention-deficit syndrome.

The media has the potential to influence public opinion and attitudes about HIV/AIDS, including attitudes towards people living with HIV/AIDS.

According to Mr Ben Bella Illakut, a veteran journalist, an effective media can raise the awareness level and can also bring about sustainable behavior change thereby reducing vulnerability to the virus.

He explained that the media should work as a facilitator for removing stigma and discrimination attached with the disease: HIV/AIDS afflicted individuals besides the anatomical discomforts undergo the mental suffering of stigma and discrimination at the hands of the society.

“A number of media campaigns should focus on the need to overcome prejudice and encourage solidarity with people infected/affected by virus,” said Mr Ben Bella.

Reports from veteran journalists also indicate that the media too have the capability to bring about transformation in the thinking pattern of the society in respect of PLWAHA and thus sowing the seeds of attitudinal changes.

They add that the media besides creating awareness and providing knowledge base about HIV/AIDS is also to remove the misconceptions about the transmission of the virus and the social ostracism of affected persons.

Mr Charles Odoi, the TASO manager, Mbale says that when writing about PLWHA, you ought to mind so much about how you address an issue as complex as HIV stigma and that there are many small things you can do that will make a big difference

He revealed that the media should also know how talk about HIV to avoid stigma, the words they use and avoid use of words like ‘Monster nurse’

“When talking about HIV, certain words and language may have a negative meaning for people at high risk for HIV or those who have HIV. The media can do their part to stop HIV stigma by being intentional and thoughtful when choosing our words, and choosing to use supportive—rather than stigmatizing— language when talking about HIV,” said Mr Odoi.

The stories written about these two PLWHA reflect a common pattern of how the media cover HIV; the story is highly unusual with a strong element of condemnation, stigmatisation and criminalisation.

Although it is clear that Ms Namubiru was not charged under the HIV and AIDS Prevention and Control Act 2014, some provisions of the law are vague and likely to cause further arrests, stigmatisation and criminalisation of people living with HIV/Aids.

Reports from WHO indicate that laws criminalizing HIV transmission and exposure exist in many developed and developing countries.

It is clear that by 2005, at least 36 European countries had either HIV-specific criminal laws or had used existing laws on bodily harm to prosecute people living with HIV and that by 2009, 15 African countries had enacted HIV-specific criminal laws, and this number increased to at least 25 countries by 2011.

While the HIV/AIDS pandemic has been inflicting a devastating impact on various sectors of life, one of the major obstacles to its prevention is social stigma.

Stigma is defined as an attribute that is deeply discrediting which links a person to undesirable characteristics, thus reducing that individual’s status in the eyes of society.

The stigma and discrimination associated with HIV/AIDS has been conceptualized at two levels: societal and individual. At the societal or cultural level, it manifests in discriminatory laws, policies, popular discourse and social conditions of people living with HIV/AIDS.

At the individual level, it takes the form of behaviours, thoughts and feelings that express the prejudice against persons infected with HIV. The primary targets of HIV/AIDS stigma are individuals with HIV and those perceived to be infected.

Ms Dora Musinguzi, the executive director at Uganda Network on Law, Ethics and HIV/AIDS (UGANET) said even when the media condemned and criminalized Ms Namubiru, if used effectively, the media can play an important role in lessening fear and stigma about HIV – the biggest obstacles to seeking information and treatment about the disease.

“It is unfortunate that the  of this important health issue remained patchy and sensationalist and there is need to discuss better ways for which the media can report about stigma, the law and ethics in HIV/Aids,” said Ms Musinguzi.

She says in keeping with this exhortation, journalists’ reports need to go beyond simplistic views of the global HIV epidemic as merely a crisis in public health and reflections on the complex social, cultural and economic determinants and consequences of the epidemic and the required complexity.

She explained that on a positive note, analysis of HIV reporting in Uganda and world over reveal that the language and tone of HIV stories from the mid-1990s onwards show greater sensitivity to people living with HIV.

Although Namubiru, a paediatric nurse with 30 years’ experience, had maintained her innocence during the trial, handing down the sentence in a packed courtroom, chief magistrate Olive Kazaarwe said Namubiru lacked remorse for her actions.

On the revised charge of criminal negligence — the nurse attracted sympathy and emerged as the apparent victim of rampant stigma in a country that until recently was being praised as a global leader in fighting AIDS and promoting an open attitude toward the disease.

The International activists claim Ms Namubiru and Ms Komuhangi were victims of discrimination because she is HIV positive, and said that their trial was unwarranted.

Several HIV/Aids activists in Uganda said the nurse had not acted maliciously, and her life had been ruined and that the public anger towards her showed the stigma people with HIV/Aids still face.

Ms Namubiru was released after one year of her sentence after the child was found HIV/Aids negative but reportedly got threats to harm her from her neighbours and had to travel to the countryside and stay away from her home in Kampala for safety.

The AIDS-Free World, in a statement said both of these cases illustrate “the failure of both the media and the prosecutor’s office to act responsibly” and could set “a dangerous precedent and could have grave consequences for the fundamental rights of people living with HIV and AIDS in Uganda and beyond,” said AIDS-Free World, in a statement.

The Global Commission on HIV and the Law said the nurse’s “life has been ruined. No matter the outcome of the trial, the panorama of ferociously intemperate accusation will haunt her and her family forever.”

Maj. Rubaramira Ruranga, the director of Health and Community Outreach Campaign at Operation Wealth Creation, one of few people who have publicly revealed they have HIV in a bid to discourage stigma, said the case against the nurse proves that “stigma still rages on” in Uganda.

“I am sure she felt isolated and dejected because of the way the media reported about her, calling her all types of names,” he said. “She was hurt and injured beyond repair.”

Mr Joshua Wamboga, a long-standing HIV/AIDS and Health-care advocate and former executive director at Uganda Network of Aids Service Organisations [UNASO] says some of the contentious provisions of the law include Article 18 (2) (d) where the results of an HIV test may be disclosed or released to “a medical practitioner or other qualified officer who is directly involved in the treatment or counseling of that person, where the HIV status is clinically relevant.”

He adds that this is “too wide a window” for the medical officer to operate in and that the other provisions of the law are those that criminalise “attempted transmission of HIV” and “intentional transmission of HIV”.

“The argument against this provision is that it interferes with medical ethics and the doctor patient relationship and criminalisation of HIV positive persons fuels discrimination as it happened in the case of Namubiru, Komuhangi,” said Mr Wamboga.

The executive director of National Community of Women living with HIV/Aids [NACWOLA], Ms Florence Buluba said People living with HIV infection and AIDS should have the same basic rights and responsibilities as those which apply to all citizens of the country.

She revealed that they are not allowed to be separated, isolated or quarantined in prisons, schools, hospitals or anywhere else because of their HIV-positive status.

She added that PLWHA are entitled to make their own decisions about matters that affect their marriage and having children and counseling about the consequences of their decisions should be provided.

“And no person may be tested for HIV infection without his or her consent beforehand and PLWHA have rights; a right of access to healthcare including reproductive health, a right to sufficient food and water; and a right to social security, including, if they are unable to support themselves and their dependants, appropriate social assistance,” said Ms Buluba.

Although Uganda is one of the 60 countries that criminalise the intentional transmission of HIV [The HIV and AIDS Prevention and Control Act 2014], many a NGO says they are worrying not because of the deadly virus but due to the HIV and AIDS Prevention and Control law.

Human Rights Watch, HEALTH, Global advocacy project and UGANET say that The HIV Prevention and Control Act passed by the Ugandan parliament on May 13, 2014, is discriminatory and will impede the fight against AIDS.

They add that the new law in Uganda criminalizes HIV/AIDS Transmission, requires Pregnant Women to Undergo HIV Testing, the “willful and intentional” transmission of HIV to another person is an offense that is punishable on conviction with up to a ten-year prison term and a fine of up to UGX4. 8 million (about US$1,846).

Activists want the Constitutional Court to speed up Petition Number 24 of 2016 where the community of HIV activists challenged the HIV and AIDS Prevention and Control Act 2014.

Activists say the current HIV law is regressive and should be struck down and argue that it criminalises transmission which intensifies Stigmatisation and discrimination adding that the mandatory testing, provided in the law, is also discriminative.

Dominican Republic: National Council for HIV asks for a review of HIV laws & drug laws, including HIV criminalisation provisions

Conavihsida asks to modify the HIV-AIDS law in the country

Source: Diario Libre, December 12, 2019 – Google translation, scroll down for article in Spanish

Conavihsida asks to modify the HIV-AIDS law in the country

In the country there are 12,000 people who have VHI and do not know it

The director of the National Council for HIV (Conavihsida), Víctor Terrero, asked the authorities to review and adapt laws and policies that affect drug users in HIV prevention and care programs.

It proposed the modification of Laws as 135-11 in its articles 50.78 and 79, as well as the Drug Law 50-88. He argued that sometimes a mother is sentenced to eight and ten years in prison for occupying a small portion of prohibited drugs and forgets that this woman has three and four small children to care for and maintain and that this type of case should be considered In the law.

“We are raising our voice in favor of injecting drug users living with HIV status and who are 22% more likely to get the virus,” he said.

He said that according to UNAIDS data these users often share needles, syringes and other supplies for injection, with which they contract the disease. He said that type of restrictive policy has failed elsewhere. He called to change the restrictive policy that is currently applied by a water utility so that drug use is not criminalized and is seen as a public health problem.

Third, the policies should focus on working with the person to avoid consumption, but also the spread of HIV through the use of syringes and other instruments. He recalled that there are about 12,000 people in the country who have HIV and do not know it.

By participating in the conference on “Drug, HIV and Human Rights Policies,” Terrero said that the most vulnerable population to contract HIV are the LGBTI population, Haitian migrants, low-school children in the bateyes who are the ones They provide the most new cases.

The director of Conavihsida reported that more than 79,750 people live with HIV in the country, of which they work with almost 69,000 for a missing 10,000. Retrovirals are supplied to all those identified, for which the State invested 17 million dollars this year.

On his side, Mauricio Ramírez Villegas, coordinator of the United Nations System in the Dominican Republic also advocated comprehensive policies on the issue of drugs and HIV.

He said that public policies must be more humanized to respond effectively to the fight against drugs and said there is scientific evidence from the United Nations, specialized agencies that demonstrate that a more humanized public policy is more effective than restrictive and criminal They deepen drug problems.

The items in dispute

Article 50.- Mandatory evidence . The tests for the detection of HIV or its antibodies are mandatory when:

1) It is required for the purpose of evidence in a criminal proceeding, upon order of the competent judicial authority; However, the accused refuses to carry out the test for detection

of HIV or its antibodies.

2) It involves donating blood, blood products, breast milk, semen, organs and tissues.

3) It is a pregnant woman, as part of the examinations prescribed by the attending physician, in order to ensure the best interest of the unborn child.

Article 78.- Obligation to inform the sexual partner. Any person who, knowing his HIV seropositivity, does not communicate his serological condition to the person with whom he is going to

Having sex will be punishable by imprisonment for two (2) to five (5) years.

Article 79.- Transmission of HIV intentionally. Any person who, by any means, transmits HIV intentionally to another, will be punished with imprisonment for twenty (20) years.

Conavihsida pide modificar ley de VIH-SIDA en el país

  • En el país hay 12,000 personas que tienen VHI y no lo saben

El director del Consejo Nacional para el VIH(Conavihsida), Víctor Terrero, solicitó a las autoridades revisar y adaptar legislaciones y políticas que afectan a los usuarios de drogas en los programas de prevención y atención del VIH.

Planteó la modificación de Leyes como 135-11 en sus artículos 50,78 y 79, así como la Ley de Drogas 50-88. Sostuvo que en ocasiones se condena a una madre a ocho y diez años de prisión por ocuparle una pequeña porción de droga prohibida y se olvida de que esa mujer tiene tres y cuatro hijos pequeños que cuidar y mantener y que ese tipo de caso se debe contemplar en la ley.

“Estamos levantando nuestra voz en favor de los usuarios de drogas inyectables que viven con la condición de VIH y quienes tienen un 22% más de posibilidades de contraer el virus”, sostuvo.

Manifestó que de acuerdo con datos ONUSIDA esos usuarios muchas veces comparten agujas, jeringas y otros suministros para inyección, con los cuales contraen la enfermedad. Aseguró que ese tipo de política restrictiva ha fracasado en otros lugares. Llamó a cambiar la política restrictiva que se aplica actualmente por una sanitaria para que no se siga criminalizando el uso de drogas y se vea como un problema de salud pública.

Terrero que las políticas deben enfocarse en trabajar con la persona para evitar el consumo, pero además, el contagio de VIH a través de uso de jeringas y otros instrumentos. Recordó que en el país hay unas 12,000 personas que tienen VIH y no lo saben.

Al participar en la conferencia sobre “Políticas de Drogas, el VIH y los Derechos Humanos”, Terrero señaló que la población más vulnerable para contraer VIH son la población LGBTI, los migrantes haitianos, los niños de baja escolaridad en los bateyes que son los que aportan la mayor cantidad de los nuevos casos.

El director de Conavihsida informó que más de 79,750 personas viven con VIH en el país, de los cuales trabajan con casi 69,000 para un faltante de 10,000. A todos los identificados se les suministran los retrovirales, para lo cual el Estado invirtió este año 17 millones de dólares.

De su lado, Mauricio Ramírez Villegas, coordinador del Sistema de Naciones Unidas en República Dominicana también abogó por política integrales en el tema de las drogas y el VIH.

Dijo que las políticas públicas deben ser más humanizadas para responder con efectividad a la lucha contra las drogas y aseguró que hay evidencias científicas por parte de Naciones Unidas, organismos especializados que demuestran que una política pública más humanizada es más efectiva que las restrictiva y criminales que profundizan los problemas de las drogas.

Los artículos en disputa

Artículo 50.- Pruebas obligatorias. La realización de las pruebas para la detección del VIH o de sus anticuerpos, son obligatorias cuando:

1) Se requiera para fines de prueba en un proceso penal, previa orden de la autoridad judicial competente; no obstante el imputado se rehúse a la realización de la prueba para la detección del VIH o de sus anticuerpos.

2) Se trate de donación de sangre, hemoderivados, leche materna, semen, órganos y tejidos.

3) Se trate de una mujer embarazada, como parte de los exámenes prescritos por el médico tratante, con la finalidad de asegurar el interés superior de la criatura por nacer.

Artículo 78.- Obligación de informar a la pareja sexual. Toda persona que, conociendo su seropositividad al VIH, no comunique su condición serológica a la persona con la que vaya asostener relaciones sexuales, será castigada con la pena de reclusión de dos (2) a cinco (5) años.

Artículo 79.- Transmisión del VIH de manera intencional. Toda persona que, por cualquier medio, transmita el VIH de manera intencional a otra, será castigada con pena de reclusión de veinte (20) años.

US: Bipartisan group of Missouri Lawmakers working to change HIV Laws that date from the 1980s

Missouri Lawmakers Want To Bring HIV Laws To The 21st Century

A bipartisan group of lawmakers is working to change current Missouri law on HIV that they say hasn’t been updated since the 1980s. 

Rep. Holly Rehder, R-Sikeston, said current laws now actually discourage people from being tested. She said if someone knowingly exposes their partner to HIV and they contract the disease, it’s a class A felony. This is the most serious of felony crimes which include murder, rape and forcible kidnapping. 

“If you don’t know your status, there’s no way in Missouri you can be charged with that class A felony,” Rehder said Wednesday in announcing the proposed legislative change. “Not knowing your status in Missouri, unfortunately, keeps people from having that concern, which, in turn, keeps people from getting tested.” 

In comparison, driving intoxicated and causing someone’s death is a class C felony. 

Rehder’s legislation would reduce knowingly exposing someone to HIV who then contracts it to a class C felony. Her bill also reduces the penalty of knowingly exposing someone to the disease who does not contract it from a class B felony to a class D felony. 

Rep. Tracy McCreery, D-St. Louis, filed separate legislation that completely eliminates felony charges and reduces all transmission offenses to misdemeanors. 

“That’s based on input that we received from experts around the country,” she said. “It puts it more in line with other kinds of disease transmission, as well.” 

Jeanette Mott Oxford, executive director with Empower Missouri, said it gets it out of the area of disclosure altogether. Both of these laws focus on intent. 

“Were you intending to transmit HIV? Because right now our law says condom use is no defense,” she said. “So you could be trying not to transmit HIV and still be charged with a crime in Missouri.”

There were roughly 13,000 people living with HIV in Missouri in 2018, according to the Department of Health and Human Services. Missouri has also been categorized as one of seven states in the U.S. with a rural HIV epidemic. However, with adequate treatment, those who are HIV-positive can avoid getting AIDS. Medication can also suppress the virus and reduce the risk of transmitting it to another person. 

“HIV is no longer a death sentence if you’re being treated,” said Rehder. 

Rehder’s bill and McCreery’s bill have been pre-filed, but full language has not been made available yet. Sen. Shalonn “Kiki” Curls, D-Kansas City, plans to file similar legislation in the Senate next week. 

On another health issue, Rehder will again attempt to pass a statewide prescription drug monitoring program. 

Many states across the nation experienced a decrease in drug overdose deaths in 2018, according to the Centers for Disease Control and Prevention. But Missouri saw a 12% increase. 

Data from the Missouri Department of Health and Senior Services shows that one out of every 65 deaths in Missouri in 2017 was caused by opioid overdose. Also, Missouri is also the only state without a PDMP.

Rehder said she believes she has the support to get it done this year. Approaching her final year in the House, she said it’s incredibly important to get it done this legislative session. 

“I was raised on welfare, single mom, multiple stepdads, multiple mom’s boyfriends in the home; one of my stepdads was a dealer,” she said. “I had quite a bit of a different lifestyle than many of my colleagues. You know, I had to quit school at 15 to help take care of my family and had my first baby at 16. I’ve seen some things that maybe some others haven’t.”

Rehder said she feels a personal responsibility to explain how policies affect the people that grew up in “her part of the community.”

US: It’s time Ohio’s laws reflected our new understanding of the science of HIV

Ohio’s HIV laws should be based on science, not hysteria

Even if you weren’t a fan of the National Basketball Association in 1991, you probably remember the day in November that Earvin “Magic” Johnson, the dazzling point-guard of the Los Angeles Lakers announced he was retiring from the game after testing HIV-positive. How many more years did you give Magic? Three, four, maybe five?

Over the last 28 years, we’ve watched Magic briefly return to the NBA, coach the Lakers, announce NBA games, host a talk show, open movie theaters and coffee shops, buy a stake in the L.A. Dodgers and serve as Lakers president.

It would have been impossible in 1991 to conceive of Magic cycling through all those career choices because we couldn’t have imagined him having the time. But now, it’s fairly common to hear of people who’ve lived for decades after a positive diagnosis.

Their longevity shouldn’t be used to minimize the seriousness of the virus. If left untreated, HIV will cause AIDS, and AIDS will kill. But the advancements in treatment and prevention are reason enough to reconsider some of the decades-old laws that were drafted to punish people who sleep with others without informing them that they’re HIV-positive. Those laws were largely based on the belief that there was nothing on the other side of an HIV diagnosis but sickness and death.

In Ohio, a person who is HIV-positive can be sentenced up to eight years in prison and made to register as a sex offender for engaging in sexual conduct without disclosing their status.

What if that person uses a condom?

It doesn’t matter.

What if the person is faithfully taking pre-exposure prophylaxis, or PReP, which, according to the Centers for Disease Control and Prevention, “reduces the risk of getting HIV from sex by about 99%”

That doesn’t matter, either.

What if long after the fact, the partner tests negative for the virus?

Not even that matters. The offense, according to the law, is not telling. The crime isn’t the transmission. The crime isn’t even the likelihood of transmission. Just the not telling. Even if the person is reasonably trusting the science that says transmitting the virus is virtually impossible.

Greg Cote told Columbus radio station WOSU last month that he has made himself into a walking billboard proclaiming that he’s HIV-positive. As a policy, everybody should be as honest as he is. Even so, Cote hasn’t been intimate with anybody, he said, because if a bitter lover claims they weren’t informed, it can be difficult for people with HIV to prove to the satisfaction of jurors that they were, indeed, honest and forthcoming about their status.

A 2004 episode of The Chappelle Show included a sketch about “The Love Contract,” which was described as a way that people engaged in casual sex could prove in court that their partners consented. As absurd as the idea of a pre-coital contract sounds, advocates for Ohio’s HIV-positive residents say that or something close to that is required for them to prove that they haven’t been dishonest with their partners.

The Ohio Health Modernization Movement advises sexually active HIV-positive people to do one of the following things: save email or text messages that indicate that a potential partner has been informed of the person’s status; take that potential partner to a doctor’s visit or a caseworker’s visit so a third-party can confirm a disclosure was made; discuss one’s status in front of a third-party who can attest that a disclosure was made; video a conversation of a disclosure or, lastly, do what Chappelle did in that comedy sketch and have a potential partner sign a document. This document would acknowledge the partner’s awareness of the positive person’s status.

The best way for a HIV-positive people to protect themselves from criminal prosecution for consensual sex is to not getting tested. After all, Ohio law doesn’t allow people who don’t know that they’re HIV-positive to be charged with not telling their partners that they are. And this, advocates say, provides a regrettable incentive for people to avoid finding out if they’re carrying the virus.

The advocates’ position lines up with the federal government’s. In a 2014 report, the Civil Rights Division of the U.S. Department of Justice cited a CDC finding that the stigma associated with an HIV diagnosis discourages many from learning their status. That DOJ report notes that “intentional HIV transmission is atypical and uncommon” and suggests that states rewrite their laws to focus on two types of offenders: HIV-positive rapists whose crimes put their victims at risk of contracting the virus and people who intend to transmit HIV through behavior that carries a “significant risk of transmission.”

Such a focus is warranted. Prosecutors shouldn’t be pursuing those who aren’t trying to infect their partners, especially those who’ve been made to believe that they can’t. The American Medical Association has called for a complete repeal of HIV criminalization laws, but the Ohio Health Modernization Movement favors changing a failure to disclose one’s status from a felony to a misdemeanor.

After retiring in 1991, Magic tried to return to the court in 1992, but many players expressed a fear of playing against him. But in 1996, Magic did return with hardly anybody objecting. Players had a better understanding, then, about how the virus is transmitted. And we have an even better understanding of things in 2019. It’s time our laws reflected that new understanding.

Jarvis DeBerry is a columnist at Cleveland.com and a member of the editorial board. Reach him at jdeberry@cleveland.com or on Twitter at @jarvisdeberry.

Kenya: Advocates argue that HIV criminalisation law is impeding progress in Kenya’s response to the epidemic

Group criticises sexual offences law in war against HIV

In Summary

  • Despite the opposition from the State, persons living with HIV and Aids want the courts to declare section 26 of the Sexual Offences Act unlawful.
  • But the state argues that the challenged provisions are clear, precise, unambiguous, and do not disclose any infringement of their constitutional rights

The government could be shooting itself in the foot in the ongoing efforts to contain the spread of HIV and Aids by allowing the Director of Public Prosecutions (DPP) to arrest and commence criminal trial against those suspected of spreading the virus.

The state has been calling on the public to come out openly and seek testing and treatment.

However, recent events where the DPP wants a 42-year-old woman in Nakuru jailed for breastfeeding and infecting her neighbour’s nine-month-old baby with HIV last year, could undo the gains already made in containing the spread of the virus.

It is feared that such prosecution may discourage others from going public about their status and seeking treatment among other state interventions aimed at curbing the virus.

The law under which the woman was charged, Section 26 of the Sexual Offences Act, is also the subject of litigation at the High Court by HIV positive persons (PLWHA) who want it repealed.

The woman’s lawyer, Ms Jenifer Mugweru, is appealing the orders issued by a magistrate on October 18, requiring her to provide her blood samples to be tested for HIV.

INFORMED CONSENT

The woman who is out on a Sh50,000 bond is said to have committed the offence on September 18, 2018 at Gichobo area in Njoro Sub-County.

The HIV and Aids Prevention and Control Act (Hapca), which has been in force since 2009, provides at Section 14 that, “No person shall undertake an HIV test in respect of another person except: (a) with the informed consent of that other person.”

Informed consent refers to consent given with the full knowledge of the risks involved, probable consequences and the range of alternatives available.

“Informed consent for HIV testing means that the person being tested for HIV agrees to undergo the test on the basis of understanding the testing procedures, the reasons for the testing, and is able to assess the personal implications of having or not having the test performed,” the HIV and Aids Tribunal ruled in one of its decisions.

In their application challenging Section 26 of the Sexual Offences Act, and its subsections, people living with HIV and Aids argue that it could undermine government efforts to eradicate or contain HIV and Aids spread.

They have interpreted section 26 of the Sexual Offences Act to imply that a person living with the disease is a potential criminal, who needs to be prosecuted and jailed, should it be established that he or she is “spreading” HIV/Aids.

POTENTIAL CRIMINAL

Section 26(1) of the Sexual Offences Act provides that “any person who, having actual knowledge that he or she is infected with HIV or any other ‘life threatening’ sexually transmitted disease, intentionally, knowingly and wilfully does anything or permits the doing of anything which he or she knows ….

“ … (a) Will infect another with HIV or any other ‘life threatening’ sexually transmitted disease … Shall be guilty of an offence, whether or not he or she is married to that other person, and shall be liable upon conviction to imprisonment for a term of not less than fifteen years but which may be for life.”

The effect of this section and its subsidiary sections is that it perpetuates discrimination, stigma and fear against persons with HIV/Aids.

Living with the disease makes a person a criminal waiting to be arrested, prosecuted and visited with a lengthy jail term.

“It therefore discourages people from testing for HIV, seeking treatment and disclosing their status,” the litigants said in court papers.

According to people living with HIV and Aids, knowledge of one’s HIV status is important because it allows one to seek treatment and greatly reduces if not eliminates the risk of further transmission.

It also makes it possible to employ a range of other transmission prevention strategies and can improve expansion of HIV diagnosis and treatment, therefore a necessary condition for a successful HIV response.

“Section 26 of the Act thereby threatens progress gained and severely constrains further progress in Kenya’s response to the HIV epidemic,” the PLWHA argue.

PRIVACY

The section, according to the group, also intrudes on the privacy of marriage between consenting parties, it creates stigma and discrimination against couples in which one partner has HIV and the other does not (discordant couples).

It criminalises consensual physical intimacy between partners, threatens to separate families by removing a parent or partner from the family to be incarcerated (it criminalises procreation between discordant couples).

The group says the section creates stigma and discrimination against breastfeeding whereas this is the means by which most people in Kenya nourish their infants, and the only practical means by which to do so for many as well as the medically suggested means including people with HIV.

“And in that it threatens to separate children from their parents by removing the parent from the child to be incarcerated for lengthy periods on the basis of their HIV status, whereas it is in the presumptive interest of the child to be raised by both parents,” said PLWHA in court papers.

The group also takes issue with the meaning of the term “life-threatening sexually transmitted disease” or what constitutes it, saying it has not been explained in the Act, and the law is therefore vague in that respect.

VICTIM’S INTENTION

The state in defending the law disagrees with the arguments being advanced by the group, saying the challenged provisions are clear, precise, unambiguous, and do not disclose any infringement of their constitutional rights.

The group wants the court to declare Section 26 of the Sexual Offences Act unlawful. The case is still pending in the high court.

Further, that it is important to appreciate why section 26 of the Sexual Offences Act was enacted.

“While examining whether a particular law is unconstitutional, the court must have regard not only to its purpose but also its effect. The purpose of section 26 of the Sexual Offences Act was to address the intentional spread of HIV and Aids,” state counsel Anne Wanjiku Mwangi in court papers.

Despite the opposition from the State, persons living with HIV and Aids want the courts to declare section 26 of the Sexual Offences Act unlawful.