Australia: New campaign launched by state PLHIV organisation to amend HIV disclosure requirement in New South Wales’ Public Health Act

Positive Life’s Communications and Policy Officer, Scott Harlum (pictured), explains why the organisation will advocate for changes to HIV disclosure requirements in the Public Health Act as part of the review.

The Public Health Act is a key piece of NSW legislation which impacts the lived experience of people living with HIV. For many years, Positive Life has advocated for a number of key changes to the Act to reflect the current reality of HIV as a chronic manageable health condition, to better support efforts to end HIV transmission and to acknowledge prevention of HIV transmission is a shared responsibility regardless of sero-status. With charges under the Crimes Act laid against a man relating to the alleged infection of another man in January, now unrelated accusations against a sex worker extradited to Western Australia, Positive Life will again advocate for change to the Public Health Act as part of a required review of the legislation.

Despite an update in 2010, Positive Life argues some sections of the Public Health Act need change, and even removal from the Act to protect the interests of people living with HIV, reduce stigma and discrimination and enhance HIV prevention and testing in the broader community. A key example is the removal of Section 79, known as the ‘disclosure provision’.

Section 79 requires anyone who knows they have a sexually transmissible infection (STI) including HIV to inform a person before they have sex, and for that person to voluntarily accept the risk of acquiring that infection. In NSW, if you are HIV-positive and don’t disclose your status before sex you are guilty of an offence under the Act. The requirement to disclose your HIV status before sex hasn’t changed from the 1991 version of the Act, except for the inclusion of a ‘reasonable precautions’ provision.

This provision provides a defence to prosecution if ‘reasonable precautions’ have been taken during sex to prevent transmission. However, the definition of ‘reasonable precautions’ remains unclear and this amendment falls short of the current reality of HIV. Removing Section 79 will provide a more comprehensive approach to the rights and responsibilities of the community regardless of sero-status.

With today’s HIV treatments, if a HIV-positive person is on treatments and has an ‘undetectable viral load’, the chances of condomless sex resulting in HIV infection are extremely low. However under the current Section 79, without change to the law or a court deciding that an undetectable viral load is a ‘reasonable precaution’, a person with HIV could still be committing an offence under the Act for not disclosing their status before sex.

Under Section 79, criminalising HIV discourages testing and encourages anonymous sex. Put simply, if you don’t know you have HIV you cannot be found guilty of an offence under the Act for not disclosing your status. Equally, anonymous sex reduces your chances of being identified for prosecution. In an era where more than 90% of people with HIV are on treatment and have an undetectable viral load, people who are infected with HIV but unaware of their status are more of a risk for transmission than people on treatment with a suppressed viral load.

Fear of prosecution inhibits honesty with sexual partners and medical providers, so Section 79 may actually increase the transmission of HIV and other STIs, rather than decrease it. An honest and open relationship with our doctor is crucial to maintain good health regardless of our sero-status. For example, contracting an STI such as gonorrhoea is a risk for anyone who is sexually active, and if the symptoms are hidden, we don’t know we’ve picked up an STI. If we can’t speak openly about the sex we have, it’s likely we won’t be tested for STIs and instead transmit any unknown infection to others.

Under Section 79, forced disclosure of our status as a person with HIV can encourage HIV-related stigma and discrimination, both real and perceived. Disclosure of our status as a person with HIV can, in rare circumstances, lead to violence. More often forced disclosure leads to rejection, loss of control over who knows of our status, discrimination on the basis of our status, or the premature ending of relationships.

Section 79 as it stands does not account for PrEP. Today, many HIV-negative people are already importing pre-exposure prophylaxis or ‘PrEP’, and following the announcement on World AIDS Day last year of an expanded trial of the HIV-prevention medication, many more will be taking PrEP as the trial is rolled out in coming months. A benefit of PrEP is it encourages HIV-negative people to take control of their own health and reduce their own risk of acquiring HIV. Reducing HIV transmission is a shared responsibility and Positive Life believes this principle should be reflected in the Public Health Act.

With the coming review of the Public Health Act, Positive Life will share more about other changes we believe should be made to the Act to reflect the modern reality of HIV as an ongoing manageable health condition. In the meantime, if you have questions or comments about our proposed changes to HIV disclosure requirements in the Act, please make contact on 1800 245 677 (freecall) or by email.

Originally published on Gay News Network

US: Powerful new report on impact of criminal justice system on LGBT people highlights unjust HIV-related prosecutions; lawmaker calls for repeal of Michigan's 'outdated' HIV-specific criminal law

A new report from the independent Movement Advancement Project in Washington DC is shining a light on the plight of LGBT people caught up in the nation’s criminal justice system — and it is not pretty.

“It used to be a crime to be LGBT in the United States, and while police are no longer raiding gay bars, LGBT people, especially LGBT people of color, are still disproportionately pushed into the criminal justice system. They are treated unfairly within the system and in correctional settings, and face extraordinary challenges in rebuilding their lives,” said Ineke Mushovic, Executive Director of MAP.

The report finds that twice as many people incarcerated identify as LGBT or gender non-conforming than Americans who identify as such. The numbers are even more skewed in relation to juveniles, the report found.

“I’m glad that MAP is bringing to light the critical issue of LGBT people in the criminal justice system,” State Rep. Jon Hoadley, D-Kalamazoo, said in an interview with BTL. Hoadley is one of two openly gay state lawmakers working in Lansing. “This report shows that our work is not done.”

He noted that Michigan continues to have laws which are used to discriminate against members of the LGBT and HIV affected communities. He noted the child welfare system in the state continues to foster discrimination and noted Michigan’s HIV-specific criminal laws. Michigan adopted a new law last year which allows private, religious adoption agencies to refuse to help otherwise qualified adoptive parents based on “sincerely held religious beliefs.”

State Sen. Steve Bieda, D-Warren, said the report was important. He’s been working with the GOP majority to address criminal justice reform in the state as the only Democrat on the Senate Judiciary Committee.

“We need to make sure that justice is blind,” Bieda said in a phone interview. “We need to make sure that justice is actually just.”

He called for a repeal of Michigan’s HIV-specific criminal law, which he called “outdated,” and also said the state needs to remove obsolete laws that are no longer enforceable because they have been declared unconstitutional.

“When we’re talking about reforming a complexing system, like this, you need a yes and strategy,” said Hoadley. He called on lawmakers to repeal obsolete laws as well as laws — such as the gross indecency laws — which criminalize otherwise consensual sexual activity between adults.

Bieda said he would like to have representatives of MAP come to a Senate Judiciary Committee to brief state lawmakers on the findings of the report and possible solutions. Hoadley applauded that idea.

“This would be a great opportunity to have a joint committee meeting,” between House and Senate Judiciary Committees, he said. “We could also have policy meetings on this.”

The chair of the Senate Judiciary Committee, State Sen. Rick Jones, R-Grand Ledge, said the Senate cannot solve all the issues with the criminal justice system but did call for more training by law enforcement related to LGBT related issues. He’s a former county sheriff.

“I also support clean slate legislation,” Jones said. Those laws would allow those convicted of non-violent crimes to wipe their records clean after a set amount of time.

Hoadley said Jones’ idea was certainly on track to addressing reintegration of those convicted of crimes and sentenced to prison into society.

“We have to really think about how we integrate people into society after their rehabilitation,” he said. He discussed working with a person living with HIV who was convicted under Michigan’s HIV-specific law. That person was being forced to disclose their HIV status as a result of having to disclose the felony conviction to potential employers. It significantly limited that person’s job prospects.

MAP officials were pleased to hear Michigan lawmakers were taking the report seriously.

“A goal of this report is to lift up the ways in which LGBT people interact with the criminal justice system to ensure comprehensive reforms,” said Naomi Goldberg, Policy Analyst for the Movement Advancement Project. “Legislative efforts to reduce recidivism rates, such as clean slate legislation combined with vital protections against discrimination, would greatly improve the lives of formerly incarcerated LGBT people. And training, ongoing education and improved procedures for law enforcement, court staff, prison and staff, and probation and parole officers would greatly improve the safety of LGBT people.”

Czech Officials Launch Criminal Investigation Into 30 Gay Men Over HIV Exposure

Canada: Academic article explores problematic police and media practices relating to allegations of HIV non-disclosure, proposes solutions

Kyle Kirkup explores Canadian police and media practices that stigmatize people living with HIV (PLWH) and facilitate the public’s belief that HIV and PLWH are dangerous. In support, Kirkup analyzes the 2010 case of an Ottawa man living with HIV arrested for sexual assault, which involved the public release of the man’s identity, photo, sexual health, and sexual encounters in an article headlined “Have you had sex with this man?”

The ensuing discourse of gay male sexuality using tropes from the HIV epidemic in the 80s illustrates, Kirkup argues, how a lack of police and media regulation and education continue to produce a punitive and isolating environment for PLWH.

Kirkup proposes several strategies for reform, including expanding publication bans and non-disclosure legislation, changing police ethics to keep private information out of the hands of journalists, educating journalists and public officials about the medial realities of HIV transmission risk and medical prognosis, and abandoning the “aggravated sexual assault” charge based on HIV status.

Australia: Academic article explores the prevention impact of treatment on criminal 'exposure' laws and prosecutions

Evidence that treating people with HIV early in infection prevents transmission to sexual partners has reframed HIV prevention paradigms. The resulting emphasis on HIV testing as part of prevention strategies has rekindled the debate as to whether laws that criminalise HIV transmission are counterproductive to the human rights-based public health response. It also raises normative questions about what constitutes ‘safe(r) sex’ if a person with HIV has undetectable viral load, which has significant implications for sexual practice and health promotion. This paper discusses a recent high-profile Australian case where HIV transmission or exposure has been prosecuted, and considers how the interpretation of law in these instances impacts on HIV prevention paradigms. In addition, we consider the implications of an evolving medical understanding of HIV transmission, and particularly the ability to determine infectiousness through viral load tests, for laws that relate to HIV exposure (as distinct from transmission) offences. We conclude that defensible laws must relate to appreciable risk. Given the evidence that the transmissibility of HIV is reduced to negligible level where viral load is suppressed, this needs to be recognised in the framing, implementation and enforcement of the law. In addition, normative concepts of ‘safe(r) sex’ need to be expanded to include sex that is ‘protected’ by means of the positive person being virally suppressed. In jurisdictions where use of a condom has previously mitigated the duty of the person with HIV to disclose to a partner, this might logically also apply to sex that is ‘protected’ by undetectable viral load.

Is Louisiana's 'AIDS exposure' statute outdated? Advocates say it needs an update

Richard Covington of Baton Rouge was accused earlier this year of breaking into the house of someone who apparently owed him money and then fighting the resident. During the scuffle, Covington allegedly bit the man’s arm.

Coalition Pushes To Soften HIV Laws In California

A coalition including the American Civil Liberties Union and Equality California have joined together in an effort to change certain state laws they say criminalize people living with HIV. At a forum held in Fresno last week, a dozen activist and medical professionals talked about a number of goals including reducing the penalty for intentionally spreading HIV from a felony to a misdemeanor.

“We believe the punishment is not proportionate to the crime,” says Craig Pulsipher, with the AIDS Project Los Angeles.

“I would just point to similar offenses that are felony in California statutes. This puts intentional transmission of HIV on par with voluntary manslaughter and so we really believe a misdemeanor is sufficient consequence,” he says.

The group also wants to repeal a handful of laws including being charged with a felony for soliciting sex while knowingly having HIV. In this case, the law doesn’t require any sexual contact or transmission of HIV just the act of soliciting while being positive. Other laws make it a felony for HIV positive people to donate blood or breast milk. In many cases, people convicted under these laws could face jail time.

Dr. Simon Paul with Community Regional Medical Center specializes treating those with HIV and AIDS in the Central Valley. He says these laws aren’t up to date with modern science.

“A lot of these things are crime even if no harm was done,” Paul says. “The fact that if you have HIV, and if you sleep with someone you’re practically at zero risk if you’re on treatment. The way the laws are written now it’s just as bad as if the person had HIV in the 80’s and had no treatment. That’s the part to me seems the craziest.”

Today people living with HIV can take a pill on a daily basis to reduce the amount of the virus in their body to minimal levels. Paul says this makes the patient highly unlikely to pass the virus to someone else.

With the current state laws dealing with HIV, a person can only be convicted of charges if they are aware of their status. Paul says this creates unintended consequences.

“These laws make people less likely to get tested and into care which is the way you’ll actually get HIV to decrease. I think the laws are passed out of fear and not helpful at this point,” he says.

In Fresno County alone, only around half of those living with HIV are linked intro treatment. And there many that don’t know their status.

Many advocates like Pulsipher say these laws actually discourage people from getting tested.

“Some of these sites that specifically talk about HIV criminalization laws, one of the pieces of advice they give is: the best way to not be prosecuted under these statutes is to not know their HIV status. So that’s the exact opposite of what we would like to do. We want to encourage people to know their status.”

The coalition is hosting forums throughout the state and they’re working on a bill they plan to introduce next year in Sacramento.

Uganda: Community Health Alliance Uganda (CHAU) board chairman, Dr Stephen Watiti calls for repeal of clauses on disclosure, mandatory testing and transmission in HIV and AIDS Prevention and Control Act

Community Health Alliance Uganda (CHAU) board chairman, Dr Stephen Watiti, has called for an amendment of the 2014 HIV and AIDS Prevention and Control Act.

Watiti, who was speaking at the launch of CHAU’s 2016-2020 Strategic Plan last week in Kampala, wants clauses on disclosure, mandatory testing and intentional transmission repealed.

CHAU is one of the local non-governmental organizations (NGOs) involved in anti-HIV/Aids campaigns in the country. Enacted last year amidst protests from civil society and activists, the HIV and AIDS Prevention and Control Act criminalizes intentional transmission of HIV, enforces mandatory testing and requires spouses to disclose results to their partners, among others.

“In most of our communities if a woman tested positive and told her husband as stipulated in this law, it sparks domestic violence and stigmatization. So, my appeal is to review and scrap such clauses,” said Watiti, also plans to join elective politics in his bid to push for the aforesaid changes in parliament next year.

He also noted that it would be difficult to prove whether someone set out to intentionally infect their partners in a love affair.

“Preventing new infections should be a responsibility of both HIV positive and negative people,” Watiti argued, adding that testing should be voluntarily because making it mandatory is a violation of human rights.

His comments were directed to chief guest at the function, Dr Chris Baryomunsi, the state minister for health in charge of general duties and also MP for Kinkiizi East.

In response, Baryomunsi assured guests the parliamentary health committee would consider such appeals upon reviewing the HIV/Aids Act and also address concerns about the NGO Bill, which many civil society activists claim is intended to curtail their work.

Noting that some NGOs such as CHAU have done a good job as government partners in the battle against HIV/Aids, Baryomunsi said they would consider progressive provisions to ensure work is not stifled.

Baryomunsi explained that the law is intended to clamp down on NGOs that registered to health-related work but deviate from their mandate along the way.

Baryomunsi lauded the organization for its work of supporting people living with HIV in 20 districts including Kayunga, Luweero, Nakasongola, Mukono, Wakiso, Kamuli, Mayuge, Mityana, Gulu and Mbarara.

CHAU also provides family planning and sexual reproductive health education services.

US: Should we criminalize HIV? [Op-ed, St Louis American]

By Opal Jones and Theodore (Ted) Kerr | Posted: Wednesday, August 19, 2015 8:47 pm

Opal M. Jones

In the last month we saw Michael Johnson, a 23-year-old black college student, sentenced to 30-plus years in prison on HIV criminalization-related charges. David Magnum was also sentenced to 30-plus years in prison, and Robert Smith has been held on $50,000 bail for attempting to expose a person to HIV.

This is part of a disturbing trend: an ongoing criminalization of people living with HIV, at the same time as more people are living with HIV in Missouri. This prompts us to ask: Is criminalization how to deal with HIV?

As the president and CEO of Doorways, an interfaith organization providing housing and supportive services for people living with HIV/AIDS, and a Doorways volunteer, we say no.

Every day we see how support for people living with HIV is what is needed to end the epidemic, not criminalization, something echoed in a 1987 op-ed printed in this paper, “AIDS is a public health problem, not one that should be criminalized.” Written before MO. REV. STAT. § 191.677 was passed, the op-ed illustrates that even when less was known about the virus, it was understood that isolation and penalization were not answers to the crisis.

Yet, since 2008, we have seen more than 15 prosecutions and arrests for HIV exposure in Missouri. Meanwhile, the number of people living with HIV in the state is increasing. In 2008, 9,877 people in Missouri were living with HIV; by 2013, the number rose to 11,704. While this reflects the good work Doorways and other care providers are doing – people with HIV are living longer – it also indicates there has not been a significant drop in new cases.

Anecdotally, we see the majority of those charged for failure to disclose are black men, and an article in the Journal of AIDS Behavior reports “sentences of black individuals arrested for HIV exposure were significantly more severe than the sentences of their white counterparts.” Black people already bear a heavier burden of HIV. According to the Center of Disease Control, “the estimated rate of new HIV infections among blacks/African Americans (68.9) was 7.9 times as high as the rate in whites (8.7).”

Missouri’s HIV criminalization law – and similar ones existing in 33 other states – fly in the face of what has been learned about HIV in the last three decades. This exceptional dehumanization of people makes it harder for people with HIV to receive and maintain care, making criminalization a leading driver in the ongoing epidemic.

When entering into an intimate relationship, we believe that people should clearly communicate and disclose their status. However, people are being imprisoned based on a law that dictates it is 100 percent up to the person living with HIV to disclose their status and prove the disclosure, releasing other willing partners of responsibility. This may be unrealistic to prove and is not applicable for any other medical condition.

Medical advances have made it possible for people living with HIV to have an undetectable viral load, making it nearly impossible to transmit the virus. But to be undetectable, you need what for 27 years Doorways has been providing to people who need assistance: stable housing, access to care and hope.

But we can’t do our job if people living with HIV do not know their status. Reasons we hear for not getting tested: fear of a positive status being confirmed; not knowing where to go for care; not wanting to have to disclose “risky” behaviors and partners to authorities; and people often do not get tested because of the burden of knowing. The earlier someone knows their status, the sooner they are able to make treatment decisions and adapt to being someone with a communicable condition.

If we are worried about HIV, we need to come up with something better than criminalization.

Opal Jones is president and CEO of Doorways. Theodore (Ted) Kerr, a Masters student at Union Theological Seminary, is a Doorways volunteer.