AIDS 2016: Intersectional approaches linking issues across areas of criminalisation have been key themes of AIDS 2016

Susana T. Fried – 22 July 2016

In a moment of global attacks on civil society, an intersectional approach linking issues across HIV, sexuality, adult consensual sex and bodily integrity is critical. Now, more than ever.

Every international AIDS conference seems to have a theme or two that picks up energy as it goes. For me, at the World AIDS Conference 2016 underway in Durban, this was the growing discussion about disastrous impact of criminal law. Of course, this isn’t a new issue – not at an international AIDS conference, nor in advocacy more generally. The 2012 Global Commission on HIV and the Law explored this in depth. However, at this AIDS conference there was a renewed energy behind it. In addition, there were a number of conversations that added a new twist, linking criminalisation of same sex conduct, sex work and HIV criminalisation to criminalisation of abortion.

For someone who stands with one leg in the women’s movement and another in the HIV movement, this was a welcome and long overdue conversation. We know the ways in which abusive laws and practices put sex workers, gay and other men who have sex with men, transgender women (there is still a dearth of data on HIV and transmen or lesbians and other women who have sex with women) and other marginalised groups at increased risk of contracting HIV and create serious and unmanageable barriers to accessing services and justice. We also know the ways in which governments use criminal laws not just to contain and regulate the lives of individuals, but they also use it to circumscribe the work of civil society organisations working on these issues.

Laws that criminalise adult consensual sex, non-heteronormative behavior and gender transgression are used to control (often in the name of “protection”), penalise and, as a result, stigmatise a range of sexual practices and sexual and gender identities that put health and rights at risk. Many of the groups who are on the receiving end of such punitive laws and practices are among those most at risk of contracting HIV. This conversation, despite massive evidence, still doesn’t always inform legislation and public policy. This is, in a sense, “old hat” to social movements across the board.

However, what was new to the conversation at this year’s International AIDS Conference (AIDS2016) in a visible way and in a public conversation was the introduction of criminalisation of abortion to the list of forms of criminalisation that intersect with HIV risk and vulnerability. At one panel, Lucinda O’Hanlon from the UN human rights office drew out some of the parallels between criminalisation of abortion and other forms of criminalisation, stating “Restrictive legal regimes on abortions, including criminalisation, do not reduce abortion rates but rather makes them unsafe. These restrictions are rooted in societal norms that deny women’s agency and capacity to make decisions about their own lives.” In many countries, women who undergo abortions are stigmatised as improper women, much like sex workers who, as Ruth Morgan Thomas noted “Criminalisation of sex work sends the message that sex workers are not seen as fit and worthy to enjoy rights.”

However, the linkages can be more direct. For example, transmen who have sex with other men and become pregnant may find it impossible to find safe and non-judgmental sexual and reproductive health care, let alone abortion services. Sex workers, too, may find their access to abortion services restricted because of the ripple effect of laws criminalising sex work. With abortion, as with other groups whose identities and practices are penalised, other factors of marginalisation matter. In the case of abortion, it is women with fewer resources who are at greatest risk of facing punishment for their choice. The same could be said for those who get penalised for living with HIV. For example, a young woman who has been coerced into having sex and fears that the man she had sex with might be living with HIV, will find it difficult in many countries, to have an abortion. In some countries, if she is under the age of consent for services, she will have to get parental consent just to be able to see a sexual and reproductive health practitioner. A limited number of countries ban abortions under any circumstances, even, in some cases, as a principle of their country’s constitution (Ecuador, for instance). Most countries allow abortion under some circumstances, but access the services requires money, information and the ability to travel. Such resource requirements have a particularly severe impact on young women, poor women, and women in marginalised groups. Failing to learn lessons from HIV, women, adolescents and girls in countries affected by Zika face similar barriers to services and justice.

In a cross-issue conversation, Edwin Bernard from the HIV Justice Network also noted a “shift towards intersectionality in our efforts to end the punitive and abusive laws against various populations,” including women who seek or undergo abortions. In this context, these conversations stand as a clarion call for a new or renewed effort to link forces to challenge the growing reliance on punitive laws and practices, including those about abortion, by governments to control those who step outside of social norms around gender and sexuality.

Originally published in Crosstalk

AIDS 2016: Discriminatory laws and policies hinder access to HIV prevention, treatment, and care for the populations most at risk of HIV

At the 21st International AIDS Conference (AIDS 2016) in Durban, researchers and community representatives discussed the impact of discriminatory laws and policies in many parts of the world that hinder access to HIV prevention, treatment, and care for the populations most at risk of HIV infection — men who have sex with men, transgender people, sex workers, people who inject drugs, and prisoners.

The latest data from UNAIDS show that these vulnerable populations account for more than one-third of all new HIV infections globally. Compared to the general population: transgender people are 49 times more likely to be living with HIV; men who have sex with men and people who inject drugs are each 24 times more likely to become infected with HIV; sex workers are 10 times more likely to become infected; and prisoners are five times more likely to be living with HIV.

“We will not end AIDS without addressing the needs of the most vulnerable individuals and communities, yet far too many are currently being left behind,” said Chris Beyrer, AIDS 2016 International Chair and President of the International AIDS Society. “Protecting human rights is not just a moral issue, it is a scientific issue. Research presented at this conference will demonstrate that exclusion and discrimination help fuel the spread of HIV.”

Beyrer recently served on a special Johns Hopkins University-Lancet Commission on Drug Policy and Health. He was lead author of the Commission’s final report, published in March 2016 in advance of the UN Special Session on the World Drug Problem. The report concluded in part that drug laws intended to protect have instead contributed to disease transmission, discrimination, lethal violence, and forced displacement, and have undermined people’s right to health.

“Dealing effectively with HIV will require our communities and societies to break down longstanding prejudice, hatred, and ignorance,” said Justice Edwin Cameron of the Constitutional Court of South Africa. “Only when scientific advances are matched by social and cultural progress can this epidemic truly be contained.”

Originally published in Edge Media Network

AIDS 2016: The criminalization of vulnerable populations fuels the HIV epidemic in many countries

THE criminalization of same-sex relationships and prostitution in most parts of the continent has been cited as the major cause of the recurrence of HIV/AIDS in recent years.

After a period of decline, new HIV infections among adults across the globe are on the rise again, it has emerged at the International AIDS Conference in Durban, South Africa.

South Africa is the only African country legalise same-sex unions.

According to Human Rights Watch (HRW), HIV remains stubbornly high among men who have intercourse with men, sex workers, people who use drugs, and transgender women.

Groups like these, which are criminalized in many places, account for more than one-third of new HIV infections worldwide.

HRW Senior Researcher of Health and Human Rights, Megan McLemore, said criminalization restricted access to health care, forcing those most vulnerable to HIV to the margins of society.

“For the sake of populations most vulnerable to HIV, criminal laws need to be reformed, and fast. There is no time to waste,” said McLemore.

Meanwhile, a special issue of the Lancet medical journal released at the Durban conference described prisoners as the most neglected and vulnerable of all populations in the global HIV/AIDS response.

“Prison health care is abysmal in many parts of the world, and HIV prevention and treatment inside some jails is limited or nonexistent,” said McLemore.

Human Rights Watch has documented government failure to provide HIV prevention and treatment programs to prisoners, most recently in Louisiana parish jails.

Michel Sidibe, executive director at UNAIDS, said nearly 2 million people become HIV-positive every year.

Originally published in Caj News

AIDS 2016: HIV criminalisation is on the rise, report presenters at Beyond Blame preconference

HIV criminalisation on the rise, especially in sub-Saharan Africa

Lesley Odendal

Globally, 72 countries have adopted laws that specifically allow for HIV criminalisation, either because the law is specific to HIV, or because it names HIV as one (or more) of the diseases covered by a broader law. This total increases to 101 jurisdictions when the HIV criminalisation laws in 30 of the states that make up the United States are counted individually.

Prosecutions for HIV non-disclosure, potential or perceived exposure and/or unintentional transmission have now been reported in 61 countries. Of the 61 countries, 26 countries applied HIV criminalisation laws and 32 applied general criminal or public-health related laws, according to HIV Justice Worldwide, an international partnership of organizations, made up of the AIDS and Rights Alliance for Southern Africa (ARASA), the Canadian HIV/AIDS Legal Network, the Global Network of People Living with HIV, the HIV Justice Network, the International Community of Women Living with HIV, the Positive Women’s Network USA and the Sero Project. The findings were presented at the Beyond Blame preconference held at the 21st International AIDS Conference, in Durban, South Africa, this week.

HIV criminalisation refers to the unjust application of criminal law to people living with HIV, based on their HIV status, either through the use of HIV-specific criminal statutes or by applying general criminal laws that allow for the prosecution of unintentional HIV transmission, potential or perceived exposure to HIV – even where HIV is not transmitted – and/or the non-disclosure of known HIV-positive status.

“HIV criminalisation is profoundly bad policy. It is based on fear and outdated understanding of HIV risk and harm and magnifies stigma and discrimination towards people living with HIV,” said Justice Edwin Cameron, judge of the South Africa Constitutional Court.

These laws are not guided by the scientific and medical evidence relating to the transmission mechanisms of HIV, fail to uphold the principles of legal and judicial fairness (such as foreseeability, intent, causality and proof) and directly infringe the human rights of those involved in these cases.

“The evidence that criminalisation as a public health strategy does not work is too plain to contest. It is our responsibility to end it”, said Hon. Patrick Herminie, Speaker of the National Assembly of Seychelles.

To date, thirty countries in sub-Saharan Africa have passed laws criminalising HIV transmission or exposure in some form, including Botswana, Cote d’Ivoire, Nigeria and Uganda, which passed laws in the last year. There has also been a rise in reported prosecutions in sub-Saharan Africa since 2015, in Botswana, South Africa, Uganda and especially Zimbabwe.

An additional workshop at the conference explored the common roots of criminalisation. Panelists identified the key reasons for these misused and often overly-broad interpretations of criminal laws as being due to fear, moral panic, containment of the HIV epidemic and state-sponsored control of bodily autonomy, including sexual conduct and stigma to impose sanctions on those viewed as not being ‘fit and worthy’ of enjoying the protectionist mandate of these laws.

Pervasive gender inequality, power dynamics, and ‘victim-status’ were acknowledged as preventing women from accessing justice to the same extent as men. It was recommended that a feminist framework is used as a strategy to address the criminalisation of HIV as female and transgender sex workers, migrants, indigenous and black women suffer the most from these HIV-specific laws.

Rosemary Namiburu, an ex-nurse from Uganda, who was imprisoned after she was prosecuted for not revealing her HIV status to her partner is an example of this: “My life will not be the same after facing HIV criminalisation. My 30 years of working as a nurse and dedicated to saving lives have been erased. I have spent almost a year in prison and have been branded as a criminal and a killer, even though I have harmed no one.”

Originally published in aidsmap.com

AIDS 2016: Criminal laws need to be reformed for the sake of populations most vulnerable to HIV

Durban – The war on HIV and Aids could be stymied by the unequal application of criminal laws.

This was the consensus of a group of researchers at a session at the International Aids Conference titled “Beyond blame: A feminist dialogue on criminalisation of HIV transmission, exposure and non-disclosure”, which looked at misapplication of the laws of certain countries and their impact on the epidemic.

“The law is a critical tool for creating an enabling environment for effective responses to HIV and to provide access to justice for those affected by HIV. While some have argued in favour of laws criminalising HIV exposure, transmission or non-disclosure as protective of women, they in fact leave them more vulnerable to persecution and increased violence,” said organisers in their introduction.

Marama Pala, a New Zealand activist who was infected 24 years ago, said when the trial against the man who had infected her began, she was painted as the victim. And because she was seen as “criminalising” the spread of HIV, she was ostracised by those living with the virus.

“I was only 22. I didn’t have an education. People would look at me and say: ‘Poor girl’. Everyone called me a victim. But I’m not.”

She said that experience, and many more, had convinced her that this approach did not work and instead became another way to abuse human rights.

“As an indigenous woman (she is Maori) I know how people of colour are always the ones to be disproportionately affected by laws like this one.”

Members of the LGBTI community and prostitutes were also targeted. This point was raised by Jules Kim, a prostitute at Scarlet Alliance, an Australian association, who said that a trans-woman prostitute was now facing charges and was being held in a men’s maximum security prison.

“No white men have been arrested under these laws, unless they are sex workers. Even if a person has been on ARVs for years (meaning that their viral load has been suppressed and they cannot pass on the virus), they are still arrested and face criminal charges.”

She said everyone had a responsibility to protect their sexual health.

Ruth Morgan Thomas, global co-ordinator of the Global Network of Sex Work Projects, said these laws were based on “family values”.

“The custodians of the law – the police – are the ones who are sometimes perpetrators of the violence. If you report a rape, they tell you that that can’t be possible, because you’re a whore.”

Men who had sex with men also bore the brunt of those laws.

Originally published on iol

Uganda: Civil societies challenge HIV criminalisation

KAMPALA – “Whereas the law might have potential to positively contribute to the current HIV/AIDS response efforts in Uganda, there are some contentious clauses that could deter all the benefits realized in the fight against the scourge.”

This is what activists and people living with HIV are saying.

The HIV and AIDS Prevention and Control Act came into effect on July 31, 2014 when President Yoweri Museveni assented to it. But people living with HIV, together with civil society organizations, say it presents a challenge for the human rights of infected people and also undermines several critical issues.

The salient features that are scanned out in the law are: Clauses 41 and 43 of the Act that provide for prosecution on grounds of attempted and intentional transmission of HIV, respectively. Among the provisions of the piece of legislation is criminal penalty for risk and intentional transmission of the virus.

The Act would require mandatory disclosure of one’s HIV status, failure of which would be regarded as “criminal”, and attempting to or, intentionally transmitting the virus.

Failure to use a condom where one knows their HIV status would constitute a criminal offence, making them liable for prosecution.

The Civil Society HIV/AIDS Bill Coalition has been lobbying members of parliament to change the clauses in the Act that are construed to create negative effects in the national response to HIV/AIDS, but lawmakers have been adamant about the issue.

It is against this background that people living with HIV under their umbrella organization the National Forum of People Living with HIV & AIDS Networks in Uganda (NAFOPHANU) together with Uganda Network on Law Ethics and HIV/AIDS (UGANET) and the International Community of Women living with HIV Eastern Africa (ICWEA recently petitioned the constitutional court to review the Act and amend the contentious clauses (41, 43 and 18).

“Honestly, if proven, such behavior cannot go unpunished. The question however is ‘How can it be proven that indeed the HIV of the accuser was got from the accused?’ There is fear that public knowledge of one’s HIV positive status would be used against them due to personal differences,” says Lillian Mworeko (pictured immediately below), regional coordinator for ICWEA.

She argues that this will ultimately discourage people from testing to know their status fearing that if found positive, their status could be used against them in courts of law at any point in time.

It should thus be noted that one who does not know their status cannot be held liable under this law.

“We should avoid creating scenarios where people living with HIV/AIDS are looked at as criminals or potential criminals,” warns Dora Musinguzi, executive director of UGANET.

Eventually, she adds, people will inadvertently live with the virus without accessing treatment and by the time they get to know their status it will be too late.

Stella Kentutsi, the executive director of NAFOPHANU, regrets that these clauses seem to target those already openly living with HIV and as such will affect disclosure, fuel stigma and discrimination thus increasing new infections and affecting access to already available services.

“To this effect, HIV infections and deaths will escalate thus watering down all the achievements so far attained in the fight against HIV. Partner and third party notification in clause 18(2) (e) is likely to breed domestic violence as a health worker is given a right to disclose to a partner without a client’s consent. It also infringes on the right to privacy as per our constitution- Article 27,” Kentutse. –

n their petition, the concerned groups give eight strong points on which they base their ground.

1. The law when enacted will drive people underground

In the face of possible prosecution and forced disclosure, most people will hide away; there would be no reason to take an HIV test in fear of prosecution.

2. It shall be counter-productive

As people shun HIV services and treatment for all possible fears that arise with the provisions of the law, prevention and control cannot be achieved.

3. Taking an HIV test is the beginning point for both control and prevention, however the ACT will deter this effort by empowering medical practitioners to release test results to third parties.

4. It will indiscriminately harass women

Most women get to know their HIV status before their male counterparts as they interface with medical facilities more often. Giving them an extra burden to disclose their status mandatory as a blanket requirement may subject them to violence, abandonment and abuse as they are usually blamed for bringing the virus. In our societies, women cannot easily negotiate sex nor condom use, yet failure to use one while they know their status will warrant such a woman punishment for intentional transmission of the HIV virus.

5. May breakdown families who are already vulnerable

Opening a window for prosecution will encourage family breakdowns where one partner who gets to know their status, blames it on the other and files a case in court. Intentional transmission may never get proved, but the family structure will have been distorted, partners desert each other with the consequent burden born by the poor orphans. HIV status is bad enough for the children but humiliating and sometimes vicious litigation between parents tears their lives apart.

6. Is not situation-specific or realistic

The conditions for this ACT to operate are not realistic, it is extremely difficult to prove who infected the other and therefore it is to no effect. The judiciary in this country is very much strained and it takes long to pass judgment. How many lives would be destroyed if it takes an average five to seven years to get judgment? Worse, the Police force is ineffective and is known to fail to comprehend and prosecute cases of this nature.

7. Selective prosecution

The ACT targets the 20% of Ugandans that have tested and know their status and presumes that some of those knowingly and intentionally transmit HIV. What about the rest of the population who do not know their status yet transmit and cannot be found in the ambit of this ACT? This is unfair, obnoxious and unreasonable and cannot possibly be regarded as an efficacious law.

8. Increased stigma and discrimination

The moment HIV is construed with criminalization and then people go into hiding, those living with HIV will suffer societal victimization since they would now be regarded as threats to public health. As a nation, we can still do better since on this one, we are all in it together.

Originally published in New Vision

AIDS 2016: Justice Edwin Cameron addresses delegates at Durban AIDS conference

I owe my life to you, says judge

By Edwin Cameron

19 July 2016

“The fact that I am here today at all is a tribute to the activists, researchers, doctors and scientists in the audience,” Judge Edwin Cameron told delegates to the Durban Aids conference, delivering the Jonathan Mann memorial address. He asked sex workers and transgender people to join him on stage. His godson Andy Morobi also addressed the conference.

It is a great privilege and an honour to be here. At the start of a very busy conference, with many stresses and demands and anguishes, I want to start by asking us to pause quietly for just a few moments.

It has been 35 years since the Western world was alerted to Aids. The first cases of a baffling, new, terrifying, unknown syndrome were first reported in the northern summer of 1981. The reports were carried in the morbidity and mortality weekly reports of the CDC on 5 June 1981.¹

These last 35 years, since then, have been long. For many of us, it has been an arduous and often dismaying journey.

Since this first report, 35 million people have died of Aids illnesses² – in 2015 alone, 1.1 million people.^³

We have felt the burden of this terrible disease in our bodies, on our minds, on our friends and colleagues, on our loved ones and our communities.

Aids exposes us in all our terrible human vulnerability. It brings to the fore our fears and prejudices. It takes its toll on our bodily organs and our muscles and our flesh. It has exacted its terrible toll on our young people and parents and brothers and sisters and neighbours.

So let us pause, first, in remembrance of those who have died –

those for whom treatment didn’t come in time
those for whom treatment wasn’t available, or accessible
those denied treatment by our own failings as planners and thinkers and doers and leaders
those whom the internal nightmare of shame and stigma put beyond reach of intervention and help.
These years have demanded of us a long and anguished and grief-stricken journey.
But it has also been a journey of light – a journey of technological, scientific, organisational and activist triumph.

So we must pause, second, to celebrate the triumphs of medicine, science, activism, health care professional dedication and infrastructure that have brought ARVs to so many millions.

Indeed, the fact that I am here today at all is a tribute to the activists, researchers, doctors and scientists in the audience.

Many of you were responsible for the breakthroughs that led to the combination anti-retroviral treatment that I was privileged to start in 1997 – and which has kept me alive for the last 19 years.

I claim no credit and seek no praise for surviving. It felt like an unavoidable task.

All of us here today who are taking ARVs – let us raise our hearts and humble our heads in acknowledgement of our privilege – and often plain luck – in getting treatment on time. That treatment has given us life.

So let us pause, third, to honour the doctors – the scientists – the researchers – the wise physicians and strong counsellors who have saved lives and healed populations in this epidemic.

As important, fourth, let us pause to honour the activists, whose work made treatment available to those who would not otherwise have received it.

We pause to honour the part, in treatment availability and accessibility, of angry, principled and determined activists, in South Africa’s Treatment Action Campaign and elsewhere. For millions of poor people, their anger brought the gift of life.

Without their courage, strategic skill and passion, medication would have remained unimaginably expensive, out of reach to most people with HIV. They led a successful campaign that saved millions of lives.

The fact that many millions of people across the world are, like me, receiving ARV treatment, is a credit to their work.

They taught us an important lesson. Solidarity and support are not enough. Knowledge and insight are not enough. To save lives, we need more. We need action – enraged, committed, principled, strategically ingenious action.

They refused to acquiesce in a howling moral outrage. This was the notion that life-saving treatment – treatment that was available, and that could be cheaply manufactured – would not given to poor people, most of them black, because of laws protecting intellectual property and patent-holders’ profits.

The Treatment Action Campaign and their world-wide allies frontally tackled this. They changed the way we think about healthcare and essential medicines access.

What is more, without the Treatment Action Campaign, President Mbeki’s nightmare flirtation with Aids denialism between 1999 and 2004 would never have been defeated.

Instead, the TAC took to the streets in protest. They demanded treatment for all. And when President Mbeki proved obdurate, they took to the courts.

Because of my country’s beautiful Constitution, they won an important victory. Government was ordered to start making ARV treatment publicly available.

Today my country has the world’s largest publicly provided anti-retroviral treatment program.⁴ More than 3.1 million people, like me, are receiving ARVs from the public sector.⁵

I am particularly proud that when someone with HIV registers for treatment in South Africa, they should not be asked to show an identity document or a passport or citizenship papers. That is as it should be. The imperatives and ethics of public health know no artificial boundaries.

In the sad history of this epidemic, the triumphs of Aids activists, on five continents, are a light-point of joy.

So there is much to celebrate. I celebrate the joy of life every day with the medication – which keeps a deadly virus effectively suppressed in my arteries and veins, enabling me to live a life of vigour and action and joy.

But we must not forget that Aids continues to inflict a staggering cost on this continent and on our world.

What is more important than my survival, and that of many millions of people in Africa and elsewhere on successful ARV treatment, is those who are not yet receiving it.

There still remains so much that should be done. More importantly, there still remains so much that can be done.

Too many people are still denied access to ARVs. In South Africa, despite our many successes, well over six million people are living with HIV. And, though about half of South Africans with HIV are still not on ARVs,⁶ from September this year ARVs will be provided to all with HIV, regardless of CD4 count.

Globally, of the 36.7 million people living with HIV at the end of 2015, fewer than half had access to ARVs.⁷

Worse, the pattern of ARV availability is one that reflects our own weaknesses and vices as humans – our prejudices and hatreds and fears, our selfish claiming for ourselves what we do not grant to others.

Most of those still in need of ARVs are poor, marginalised and stigmatised – stigmatised by poverty, sexual orientation, gender identity, by the work they do, by their drug-taking and by being in prison.

Dr Jonathan Mann, to whom this lecture is dedicated, did pioneer work in recognising the links between health and human rights. He stressed that to address Aids, “we must confront those particular forms of inequity and injustice – unfairness, discrimination – not in the abstract, but in its specific and concrete manifestations which fuel the spread of Aids.”⁸

He recognised that the perils of HIV are enormously increased by laws that specifically criminalise transmission of HIV and exposure of another to it. This was also confirmed by the wonderful and authoritative work the Global Commission on HIV and the Law has recently done.

These laws are vicious, ill-considered, often over-broad and intolerably vague. By criminalising undefined “exposure”,⁹ they ignore the science of Aids, which shows how difficult HIV is to transmit.¹⁰ Apart from driving those at risk of HIV away from testing and treatment, they enormously increase the stigma that surrounds HIV and Aids.

Across this beautiful continent of Africa, men who have sex with men (MSMs) remain chronically under-served. They lack programs in awareness, education, outreach, condom provision and access to ARVs. As a recent study by Professor Chris Beyrer and others has shown, we have the means to end HIV infections and Aids deaths amongst men having sex with men. Yet “the world is still failing”.¹¹

For this, there is one reason only – ignorance, prejudice, hatred and fear. Theworld has not yet accepted diversity in gender identity and sexual orientation asa natural and joyful fact of being human.

Seventy eight countries in the world continue to criminalise same-sex sexual conduct. Thirty four of them are on this wide and wonderful continent of Africa.

It is a shameful state of affairs. As a proudly gay man I have experienced the sting of ostracism, of ignorance and hatred. But I have also experienced the power of redeeming love and acceptance and inclusiveness.

We do not ask for tolerance, or even acceptance. We claim what is rightfully ours. That is our right to be ourselves, in dignity and equality with other humans.

Discrimination on the ground of sexual orientation or gender identity is a colossal and grievous waste of time and social energy.

As our beautiful Archbishop Desmond Tutu has said, when we face so many devastating problems – poverty, drought, disease, corruption, malgovernance, war and conflict – it is absurd that we waste so much time and energy on sexual orientation (“what I do in bed with whom”.)¹²

The sooner we accept the natural fact that gender and orientation diversity exists naturally between us, the quicker we can join together our powers of humanity to create better societies together.

The same applies to sex workers. Sex workers are perhaps the most reviled group in human history – indispensable to a portion of mostly heterosexual males in any society, but despised, marginalised, persecuted, beaten up and imprisoned.

Sex workers work.¹³ Their work is work with dignity.

Why do people do sex work? Well, ask a sex worker –

To buy groceries, and pay their rent, to study, to send their children to school, and to send money to their parents and extended family.
It is hard work. Perilous work. Sex workers have a tough, dangerous job. They deserve our love and respect and support – not our contempt and condemnation.

They deserve police protection, not exploitation and assault and humiliation.

More importantly, they deserve access to every bit of HIV knowledge and power that can protect them from infection and can help them to protect others from infection.^¹⁴

Pre-exposure prophylaxis (PrEP) works for sex workers.¹⁵ It should be made available to them, as a matter of urgent priority, as part of all national Aids treatment programs.

In September 2015, the World Health Organization, recognizing PrEP’s efficacy, recommended that PreP be provided to all “people at a substantial risk of HIV,” including sex workers.^¹⁶

When we in South Africa launched our three-year National Sex Worker HIV Plan in March 2016, we proposed providing PrEP to sex workers. WHO recognized South Africa as the “first country in Africa to translate this recommendation into national policy.”¹⁷

Beginning last month (June 2016), the first programs began providing daily PrEP to sex workers in South Africa.¹⁸

Criminalising sex workers is a profound evil and a distraction from the important work of building a humane society.¹⁹

Especially vulnerable too are injecting drug users. Upon them are visited the vicious consequences of perhaps the most colossal public policy mistake of the last 80 years – the war on drugs.

The vulnerability of injecting drug users is evident in the high percentage of injecting drug users with HIV. Throughout the world, of about 13 million injecting drug users, 1.7 million (13%) are living with HIV.^²⁰

They are denied elementary life-saving services. This is not on the supposedly “dark” continent of Africa – but in the United States of America. If you want an example of evidence-ignoring public policy, that causes loss of life and injury, and spread of HIV, do not look complacently to President Mbeki’s South Africa twelve years ago – look to the United States of America, now, and the federal government’s refusal to make needle substitution available to IDUs . While the US government’s decision to partially lift this ban on federal funding for needle exchange programs earlier this year is a welcome development, this decision was only spurred by an outbreak of new HIV cases among drug users in the United States,^²¹ and the delay has undoubtedly resulted in preventable HIV infections.^²²

Injecting drug users living with HIV are further denied access to treatment. And the United States and Canada, healthcare providers are less likely to prescribe ARVs for injecting drug users, because they assume that IDUs are less likely to adhere to treatment and/or will not respond to it. This is in spite of research showing similar responses and survival rates for those who do have access to ARVs.^²³

We know exactly what we have to do to tame this epidemic.

We have to empower young people and especially young girls, to make health seeking choices when thinking about sex and when engaging in it.^²⁴

We have to redouble our prevention and education efforts.

Prevention remains a key necessity in all our strategies about Aids.

Second, we have to test, test, test, test, test, test and test. We cannot promote consensual testing enough. Testing is the gateway to knowledge, power, understanding and action.

Without testing there can be no access to treatment. The more we test, the more we know and the more we can do.

Testing must always be with the consent of the person tested. But we have to be careful that we do not impose unnecessarily burdensome requirements for HIV testing.

HIV is now a fully medically manageable disease. Consent to testing should be capable of being implied and inferred. We must remove barriers to self-testing.

I speak of this with passion – because, by making it more difficult for health care workers to test, we increase the stigma and the fear surrounding HIV.

We must make it easier to test, not harder. Gone are the terrible days when testing was a gateway only to discrimination, loss of benefits and ostracism.

In all this, we must be attentive to the big understated, underexplored, under-researched issue in the epidemic. That is the effect of the internalisation of stigma within the minds of those who have HIV and who are at risk of it.

Internalised stigma has its source in outside ignorance, hatred, prejudice and fear.

But these very qualities are imported into the mind of many of us with HIV and at risk of it.

Located deeply within the self, self-blame, self-stigma and self-paralysing fear are all too often deadly.^²⁵

We must recognise internalised stigma. I experienced its frightening, deadening effects in my own life. Millions still experience it. We must talk about it. And we must find practical ways to reduce its colossally harmful effects.

And, most of all, we must fix our societies. As my friend and comrade, Mark Heywood, has recently written, we have medically tamed Aids. But we have not tamed the social and political determinants of HIV, particularly the overlapping inequalities on which it thrives – gender, education, access to health care, access to justice. That is why prevention strategies are not succeeding.

A better response to HIV, Mark rightly says, needs a better world. Governments must deliver on their human rights obligations. Activists and scientists must join struggles for meaningful democracy, gender equality and social justice. Activists must insist on equal quality education, health and social services; investment in girls and plans backed by money to stem chronic hunger and malnutrition.²⁶

But, to end, I want to return to the light points in our struggle against the effects of this disease over the last 30 years.

I want to end with a thrilling fact – this is that, unexpectedly, joyously, beyond our wildest dreams, perinatal and paediatric ARVs have proved spectacularly and brilliantly successful.

First, let us rejoice that perinatal transmission of HIV can be completely eliminated. It was about this that the Treatment Action Campaign fought President Mbeki’s government all the way to the Constitutional Court, the Court in which I am now privileged to sit.

Now we know how effectively we can protect babies at birth and before birth from infection with HIV.

In South Africa, the rate of mother-to-child transmission of HIV is now reduced to 4%.²⁷ Worldwide, in 2015, 77% of all pregnant women received treatment to prevent perinatal transmission of HIV.²⁸

Last year, Cuba became the first country to eliminate mother to child transmission of HIV entirely.^²⁹ In 2016, Thailand, Belarus, and Armenia have also reached this milestone.^³⁰

More even, fifteen years ago we didn’t know how well babies and toddlers would tolerate ARVs.

We didn’t know just a decade ago how young children born with HIV would thrive on ARVs.

And would they take their ARVS? Would they grow to normalcy?

Instead of this uncertainty, we now know, triumphantly, that ARVs work wonderfully for children born with HIV.

I want to rejoice in the beauty and vigour of my godson Andy Morobi. Andy and I became family twelve years ago, at the end of 2004.

He is young, energetic, ambitious and enormously talented. He was born with HIV. He has been on ARVs for the last eight years. Like me, he owes his life to the medical and social miracle of anti-retroviral treatment.

I want to end on another light point. I want to honour the treatment activists from Africa, Europe, North America, South America, Australasia and Asia, who fought for justice in this epidemic.

I want to honour them, like Dr Jonathan Mann, to whom this lecture is dedicated. Like my mentor, Justice Michael Kirby of Australia, for their energy and courage and determination and sheer resourceful and resilience in fighting for justice in this epidemic.³¹

And I want to end by celebrating the fact that we have sex workers here this morning. They are wearing the T-shirts in the slide a few minutes ago. The T-shirts say: “THIS IS WHAT A SEX WORKER LOOKS LIKE”.

And, most of all, as a gay white man who has lived a life privileged by my race and my profession and my maleness, I ask that we celebrate the astonishing courage of transgender activists, of lesbians and gay men across the continent of Africa and in the Caribbean.

They are claiming their true selves. They do so often at the daily risk of violence, attack, arrest and imprisonment.

They have the right to be their beautiful selves. They are claiming a right to be full citizens of Africa, the Islands and the world. They have done so at extraordinary risk.

They know that they cannot live otherwise.

It is to these brave people that this conference should be dedicated: to the sex workers, injecting drug users, migrants, lesbian, gays and transgendered people, the children, the activists, those in prison, the poor and the vulnerable.

It lies within our means to do everything that will ensure whole lives and whole bodies for everyone with HIV and at risk of it.

All it requires is a passion and a commitment and a courage starting within ourselves. Starting within each of ourselves. Starting now.

Thank you very much.

For footnotes please see original articles in GroundUp

Beyond Blame @ AIDS 2016 Communique

DURBAN, SOUTH AFRICA, 17 JULY 2016

We cannot end the HIV pandemic without ending the epidemic of criminalisation of people living with HIV.

As activists, advocates, lawyers, and researchers engaged in the fight against HIV criminalisation, we are acutely aware of the harms it causes – to people who are criminalised, to those living with the threat of criminalisation, and to the HIV response in our countries. We stand in solidarity with survivors of unjust criminalisation, whose powerful stories we have heard and whose courage we honour.

The science of HIV is settled. HIV treatment works: it prevents disease, prevents death, and prevents transmission. Yet the scientific advances of recent years, which have saved countless lives, have all too often been misunderstood, misrepresented or ignored in the criminal justice system. The number of countries – 72 – with laws targeting people with HIV is increasing, not falling, and unjust prosecutions continue unabated. To protect both public health and human rights, these unjust laws must be repealed, police and prosecutorial policies must be reformed, and legal practitioners must be educated about the reality of HIV today.

There has been insufficient attention paid to the issue of HIV criminalisation within the scientific and medical community. While many researchers and clinicians are powerful and valued allies in our fight against unjust laws, we believe the medical and scientific communities can do more – indeed they must do more if the promise of ending HIV is to be achieved.

There has also been insufficient attention paid to these issues by the International AIDS Conference. As the leading global event in the HIV/AIDS arena, the IAC should provide greater prominence to the ways in which law and health intersect, especially in the area of HIV criminalisation. We call on the IAS to make a clear commitment to greater visibility of and access to HIV criminalisation-related research and policy.

We call on the scientific and medical community to join us as advocates in the fight to end HIV criminalisation. We are united by a common desire to see an end to new HIV infections, to AIDS deaths, to HIV-related discrimination, and to stigma against communities living with and affected by HIV. There can be no ‘end to AIDS’ while people with HIV face police action, prosecution, and imprisonment. We cannot reach the 90-90-90 target while criminal laws actively discourage testing, treatment, and prevention.

Public health policy, treatment, and support programmes are all impeded if they are not coupled with creating an enabling environment free of HIV criminalisation. The time is right for a new, holistic approach that incorporates all these issues under a single umbrella of action to end HIV.

ABOUT HIV JUSTICE WORLDWIDE

HIV JUSTICE WORLDWIDE is an initiative made up of global, regional, and national civil society organisations – most of them led by people living with HIV – who are working together to build a worldwide movement to end HIV criminalisation. All of the founding partners have worked individually and collectively on HIV criminalisation for a number of years.

The founding partners are: AIDS and Rights Alliance for Southern Africa (ARASA); Canadian HIV/AIDS Legal Network; Global Network of People Living with HIV (GNP+); HIV Justice Network; International Community of Women Living with HIV (ICW); Positive Women’s Network – USA (PWN-USA); and Sero Project (SERO).

ABOUT BEYOND BLAME @ AIDS 2016

On 17 July 2016, 150 advocates, activists, researchers, and community leaders met in Durban for a full-day pre-conference meeting for AIDS 2016, to discuss progress on the global effort to combat the unjust use of the criminal law against people with HIV. The Durban meeting followed similar successful meetings held at the International AIDS Conferences in Melbourne (2014) and Vienna (2010). The purpose of the meeting was to provide practical opportunities for advocates working in different jurisdictions to share knowledge, collaborate, and energise the fight against HIV criminalisation. Detailed summaries and outcomes of the meeting, including a video summary, will be available in due course from www.hivjusticeworldwide.org

BEYOND BLAME
Challenging HIV Criminalisation @ AIDS 2016, Durban

(29 min, HJN, South Africa, 2016)

On 17 July 2016, approximately 150 advocates, activists, researchers, and community leaders met in Durban, South Africa, for Beyond Blame: Challenging HIV Criminalisation – a full-day pre-conference meeting preceding the 21st International AIDS Conference (AIDS 2016) to discuss progress on the global effort to combat the unjust use of the criminal law against people living with HIV.

Attendees at the convening hailed from at least 36 countries on six continents (Africa, Asia, Europe, North America, Oceania, and South America).

Beyond Blame was convened by HIV Justice Worldwide, an initiative made up of global, regional, and national civil society organisations – most of them led by people living with HIV – who are working together to build a worldwide movement to end HIV criminalisation.

The meeting was opened by the Honourable Dr Patrick Herminie, Speaker of Parliament of the Seychelles, and closed by Justice Edwin Cameron, both of whom gave powerful, inspiring speeches. In between the two addresses, moderated panels and more intimate, focused breakout sessions catalysed passionate and illuminating conversations amongst dedicated, knowledgeable advocates

USA: People living with HIV shared their determination to lead the fight for HIV decriminalization at the second HIV is Not a Crime conference

“Thirty-three years ago, a group of activists, tired of how they were being treated, drafted the Denver Principles,” Barb Cardell said to the sleepy but energized audience at an early morning session of the second HIV is Not a Crime conference. Cardell, a long-time HIV activist, is co-chair of the Colorado chapter of Positive Women’s Network, an advocacy network of women living with HIV.

In essence, recalled Cardell, activists were declaring, “Nothing is determined about us without us. … In 1983, we refused to let other people set the agenda. These are the shoes we walk in today.”

The Denver Principles opened with these words: “We condemn attempts to label us as ‘victims,’ a term which implies defeat, and we are only occasionally ‘patients,’ a term which implies passivity, helplessness and dependence upon the care of others. We are ‘People with AIDS.'”

This spring, nearly 300 activists from 34 different states and four countries (Canada, Germany, Mexico and the United States) gathered on the campus of Huntsville, Alabama, to continue that work. Many have been involved in advocacy for years, if not decades, and are determined that the fight for HIV decriminalization be led by those who are living with HIV. They are committed to fostering the meaningful involvement of people living with HIV and AIDS (commonly known as MIPA) in the discussions about policies that affect them.

Khafre K. Abif was diagnosed with HIV 27 years ago. Now, Abif is a community organizer with the Southern AIDS Coalition. “This is my first time working — and by working, I mean getting a salary — in HIV,” he said. Though this is his first paid job in the field, Abif has been advocating around HIV for nearly three decades, always as a volunteer determined to make sure that the voices of those with HIV were not left out of the discussions. “I always brought my table to the table,” he said. “I wasn’t waiting to be invited to the table.”

He doesn’t feel that his outspokenness is exceptional. “There’s a willingness [for people to speak up],” he pointed out. “But people need the support to do it. Once they know that someone will be standing beside and behind them when they speak out, they’ll do it.”

Such support has even reached behind bars to empower those traditionally silenced by prison walls. Kerry Thomas is on the board of the Sero Project. When he speaks at conferences across the country about the effects of HIV criminalization, he does so from the Idaho State Correctional Center, where he is serving a 30-year sentence under a state law criminalizing non-disclosure. Inside prison, he’s been active in combatting fear and ignorance about HIV and has been working to develop a network of imprisoned people living with HIV and other illnesses. He also reaches outside to educate people about the very real effects of criminalization laws. At 7:15 on Tuesday night, he called into the opening plenary to share his thoughts and experiences.

“A few months ago, I was sent a photo of the first HIV is Not a Crime conference,” he told the audience, his voice crackling through the cell phone set beside a microphone. He carries that photo with him at all times to remind himself that he is part of a larger movement. It’s a reminder that gets him through some of the isolation of being in prison. “There are times I may feel lonely, and that’s when the support from you guys means a lot.” At the same time, he acknowledges that the support and opportunities he has are exceptional. “I’m one of the lucky ones that has this community and has the opportunity to speak at these conferences,” he said. “But across the country, there are people who don’t.”

Naina Khanna, the executive director of the Positive Women’s Network USA, points to Thomas as an example of meaningful involvement by those most impacted by criminalization. “If you can figure out a way to have an incarcerated person regularly participate in these board meetings, then we should be able to eliminate barriers to meaningful participation,” she stated. But, she said, doing so involves creating spaces that are trauma-informed and healing as well as understanding — and that address the multiple barriers to participation. For some, physically attending a conference presents numerous challenges, including paying for travel and being targeted at airports for invasive and demeaning search procedures.

For some, having HIV is one of many identities to navigate. Ashton P. Woods refuses to compartmentalize his multiple identities as a black person, a person living with HIV, a gay man and a formerly homeless youth. “To people who say, ‘Pick an issue,’ I say, ‘That’s bullshit,'” he declared. Standing at the podium during a morning plenary, he reminded the audience of the need for solidarity and support for those even more in the crosshairs of intersecting oppressions. “We have to step up as people living with HIV because our trans sisters are at risk.”

Tommy Luckett is a black trans woman. She is also living with HIV in Arkansas, where it is a felony for people who know that they have HIV to engage in any form of sexual intercourse without disclosing their status. Spitting, biting and receiving medical and dental care are also criminalized for people who do not disclose their status.

The fear of prosecution looms over Tommy’s daily life, compounded by the fact that she is both black and trans. “All of these [identities] paint me as a target in my own home state,” she told TheBody.com. The threat of violence is ever present whenever she leaves her house. Across the country, trans women aredisproportionately targeted in hate-motivated attacks and murders. In 2015, it was reported that at least22 trans and gender non-conforming people were murdered in the U.S. This number reflects only the murders that were reported and investigated and whose victims were recognized as trans or gender non-conforming.

But despite the constant risks, Luckett is also an outspoken advocate for HIV and trans issues. She knows the importance of bringing the experiences of trans women of color living with HIV to the table so that their issues are not left out of the conversation. She often finds herself to be the only trans person around, which means having to be both cautious about her behavior and wary of her surroundings. That vigilance can be exhausting and discouraging. (There were at least eight people who identified as trans among the 300 attendees at the HIV is Not a Crime conference.)

“You want to know how to help trans women? Put them in your organization.” Luckett points to Positive Women’s Network USA and the Well Project as models. “They brought me to the table and listen to what I have to say,” she said. She also noted that, as one person, she cannot be everywhere at once — nor should she be expected to be. “When I can’t get to places, that’s where I need my allies to be and to carry my message,” she said.

Andy Spieldenner is an assistant professor at Hofstra University (where he was recently awarded the 2016 Distinguished Teacher of the Year award) and an officer of the U.S. People Living With AIDS Caucus. “Part of MIPA is making sure you’re not the only person in the room,” he noted. To expand meaningful participation — and to avoid burnout — he encouraged attendees to bring their peers along and help develop their leadership. “Ask if you can bring someone. Or just bring someone,” he recommended. Tell that person about the history of the organization, what happened at the last meeting or gathering, and anything else you know.

People living with HIV, particularly those most marginalized, are not waiting to be invited to the table. Some, like Abif, are bringing their own table to the table. Others are creating their own table, conducting research on the issues that impact them most. In 2015, sex workers and trans people published Nothing About Us Without Us: Sex Work, HIV Policy Organizing, Transgender Empowerment. The report is the first of a series and explores the ways in which HIV policies impact trans people who are sex workers or are profiled as sex workers.

That same year, the Transgender Law Center launched Positively Trans, a project to develop self-empowerment and advocacy by and for trans people living with HIV. The project conducted its own research about the experiences and challenges facing trans women living with HIV. Researchers were the trans people directly impacted; they reached out to hundreds of people, gathering partial responses from more than 400 trans people and complete responses from 157. In March 2016, Positively Trans published its first report, finding economic and systemic disparities for trans people, including the fact that the majority of trans women who are U.S. citizens earned less than $23,000 a year, more than 40% had been incarcerated in their lives and 69% had experienced HIV-related discrimination. The Center is also offeringdigital storytelling sessions, allowing people with HIV to tell their own stories instead of having them mediated by a third party.

“We need to prioritize the most impacted people,” declared Maxx Boykin, an organizer at AIDS Chicago and an organizing co-chair of the Chicago chapter of Black Youth Project 100, a national organization of young black activists. “Don’t tell them what they need. Listen — so they can tell you.”

Victoria Law is a freelance writer and editor. Her work focuses on the intersections of incarceration, gender and resistance. She is the author of Resistance Behind Bars: The Struggles of Incarcerated Women.