[Update]US: Washington legislators approve bill reducing the severity of charges in cases of alleged HIV transmission

Washington Legislature Ease Penalties for HIV Exposure

OLYMPIA, Wash. — The Washington Legislature on Tuesday approved a bill that reduces the crime of intentionally exposing a sexual partner to HIV from a felony to a misdemeanor.

Supporters of the change to the rarely used law say the current penalties don’t have an effect on reducing transmissions or improving public health. Opponents argued the move diminishes the significance of the impact on a person who is unknowingly infected.

The House passed the bill on a 57-40 vote last month, and the Senate passed it on a 26-23 vote Tuesday. The measure now heads to Gov. Jay Inslee, who supports the bill and is expected to sign it.

Democratic Sen. Annette Cleveland said that the bill modernizes criminal statutes and recognizes “advancements in medical science that have rendered HIV a treatable disease.”

“I realize that this disease evokes fear and emotion even today,” she said. “I understand that the laws that are currently on the books were originally meant to protect people from HIV, yet three decades later we know that instead these laws have only increased the stigma and led to abuse.”

The legislation, which was requested by the state Department of Health, also calls for more intervention from local and state health officers, allowing them to recommend options ranging from testing to counseling. They could even mandate treatment for an individual determined to be placing others at risk.

The Senate rejected a Republican floor amendment that would have maintained the current criminal felony charge, as well as two others that would have imposed a felony charge for people on their second or third conviction.

Republican Sen. Maureen Walsh said there were several elements of the bill that she agreed with, but she couldn’t support it with the reduction of penalties for intentional transmission.

“There is nothing but malice behind a person who would go out and knowingly infect another individual with, frankly, a life sentence,” she said. “And I realize a lot of people are living longer, but they’re spending a lot of money on drugs.”

Under current law, a person can be charged with a felony for exposing or transmitting HIV to another person and could face as much as life in prison and a $50,000 fine, depending on the circumstances. Under the bill approved by the Legislature, that crime becomes a misdemeanor that could carry a penalty of 90 days in jail and a $1,000 fine if a person is infected. In cases where someone lies about their HIV status, it becomes a gross misdemeanor, with penalties of up to a year in jail and a $5,000 fine. An amendment accepted in the House maintains the felony charge for someone who intentionally transmits HIV to a child or vulnerable adult, and requires them to register as a sex offender.

Between 1986 and 2019, there have been 33 criminal cases filed under the current HIV-related statutes, according to the Department of Health. Three of those cases resulted in a felony conviction.

The Department of Health says there are an estimated 14,744 people in the state living with HIV, with about 81 percent of them virally suppressed, meaning they are unable to transmit the virus.

The Center for HIV Law & Policy says Washington is among 29 states with HIV-specific laws. Once Inslee signs the measure into law, Washington will join seven other states that have reformed or repealed one or more parts of criminal laws specific to HIV.

The proposal is not as expansive as changes made by California, which in 2017 passed a law that reduced penalties for knowingly exposing a sexual partner to HIV from a felony to a misdemeanor. The California law also reduced charges for a person with HIV who knowingly donates blood, tissue, semen or breast milk from a felony to a misdemeanor.

Other states that have introduced bills this year on reforming HIV-specific laws include Ohio, Florida and Virginia.

WA Democrats hope to reduce criminal penalties for intentionally spreading HIV

Published in My North West on 15/02/2020

It’s been a law on the books for decades – anyone busted for intentionally infecting someone with HIV faces felony first degree assault.

Under a controversial bill passed by the House this week, that crime would be lowered to a misdemeanor or gross misdemeanor, depending on the circumstances.

Republicans unanimously rejected the measure in the House, contending, among other things, that lowering the punishment puts the public at risk.

But supporters argue the state’s current law, enacted in the ’80s and only updated with a few minor changes in the ’90s, is outdated and increases stigma surrounding HIV, which in turn damages public health efforts.

The bill, HB 1551, originally sponsored by current Speaker of the House Democrat Laurie Jinkins and now sponsored by Democratic Rep. Eileen Cody, is a wide ranging bill that makes multiple changes to state law regarding mandatory testing for HIV, what the public health departments can and cannot do in investigating, and allowing minors to get treatment for HIV without parental consent, but the provision creating the bulk of the controversy is the reduction of the crime relating to intentionally infecting a person with HIV.

Supporters of the bill say the criminalization of HIV has only led to increased stigma that damages ongoing public efforts, according to the 2016 report from the End AIDS steering committee.

“Criminalizing us with a felony A for having a disease state … that’s not a banner I can get behind anymore, and frankly that doesn’t make people want to rush out and get engaged with public health,” Scott Bertani, an HIV positive man and Lifelong AIDS Alliance member, told lawmakers at a hearing on the bill last session.

“HIV is not the same disease as it was over 30 years ago,” said Lauren Fanning with the Washington HIV Justice Alliance. “The law contributes to stigma so many people with HIV feel by how others treat them like they are dirty and they have a great deal of difficulty overcoming that in their lives.”

Fanning also testified at last year’s committee hearing.

“The law creates fear of being tested, fear of accessing healthcare, and undermines the trust and prevention care and treatment systems impacting our marginalized communities the most,” Fanning added.

Nearly a year later, on the House floor this week, Democratic Rep. Nicole Macri said changing the law was long overdue and would decrease stigma while strengthening public health by finally treating HIV like the disease it is.

“A treatable, a chronic illness, and not a moral failing or criminal justice issue,” Macri said.

But Republicans argued the changed law would put the public at risk by making the crime and penalty for intentionally infecting a person with HIV the same as it is for stealing a candy bar.

Rep. Michelle Caldier said it would have other unintentional consequences by removing a tool for prosecutors who use the HIV felony crime as a method to convict rapists.

“Those rape victims deserve a voice,” Caldier said. “And what’s going to happen to all those rape victims where they were able to prosecute this? And now we’re going to reduce the sentence. We’re going to let those rapists go free. I’m not OK with that! And it breaks my heart that so many people on this floor are.”

Macri painted this bill as a compromise, telling fellow lawmakers that many of her constituents want to completely decriminalize HIV.

Kristin Bergtore Sandvik explores how the criminalisation of infectious diseases can hinder global health interventions

Governing global health emergencies: the role of criminalization

The point of departure for this blog is the apparent frequency of criminalization strategies in early government responses to the Coronavirus. While much attention has been given to the securitization of global health responses – also in the case of Corona – less systematic focus has been given to the partial criminalization of infectious diseases as a strategy of global health governance.

As the scope of the Corona outbreak is broadening, the number of countries deploying criminalization measures is also rapidly increasing. China has introduced harsh regulations to deal with the Coronavirus, including ‘medical-related crimes’ involving harassment and violence against medical personnel, refusal to submit to quarantine and obstructing dead body management. Singapore and Hong Kong have criminalized the breach of travel restrictions and misleading authorities or spreading false rumours.   Taiwan plans sentencing the violation of quarantines. Iran will flog or jail people who spread false rumours. A Russian prankster is facing jail-time for Corona ‘hooliganism’. In the US, prospective quarantine violators from the infamous cruise ship Diamond Princess were facing fines or jail time. Beyond governments’ need to be seen doing something in the face of public panic across the Global East and the Global North, how should we think about this propensity to reach for penal measures?

How we explain disease and whom we blame are highly symptomatic of who we are and how we organize our relations with others, in particular the practices and life forms of marginalized elements of society. This will also likely be the legacy of Corona. Moreover, current global health responses to infectious diseases remain bound up with both colonial-era and historical command-and control trajectories of response and needs to be understood in context.

In this blog, I map out three categories of criminalization.  My assumption is that the Corona response will likely involve all three in some form or other. I take the broad conceptualizations of criminalization in circulation in legal, policy and media discourse as the starting point: this includes criminal law sanctions  and administrative and disciplinary sanctions as well as popular perceptions of the uses of penal power and social ‘criminalization-talk’.  The idea is that criminalization can be understood as a strategic tool with multiple constitutive uses in the global health field.  

In the following, I outline three different things that criminalization ‘does’ in the global health field, which may serve as a resource for thinking about how criminalization will shape approaches to the Corona virus.

First, I am interested in the direct and indirect criminalization of health care delivery through the criminalization of individuals infected with or suspected of being infected with specific infectious diseases. The problem with this approach is that it risks aggravating humanitarian suffering because it is either premised on criminalizing the practices and attributes of groups that are already in a marginal position, or that with infection, patients immediately become  socially or economically ‘marginalized’ which allows for criminal interventions. This category of criminalization covers transmission, exposure, interaction with ‘vulnerable groups’ (such as children), failure to disclose or simply physical movement. It relies significantly on the mobilization of othering and of metaphors of fear.  The global health response may also be undermined through the de facto criminalization of individuals by way of the use of compulsory health powers such as surveillance, contact tracing, compulsory examination and treatment, regulation of public meeting places, quarantines and forced isolation of individuals.

These regimes might be so repressive as to have severe humanitarian impact on the populations concerned. Human suffering here does not emanate from the inability to offer health care but from the human rights violations arising from how fear and stigma fuel criminalization of ‘vulnerable/deviant/threat groups (such as drug users, those with precarious migration status, sex workers and the LGBTI population) and how criminalization in turn produces further deviance and marginalization.  A characteristic of early phases of epidemics is that certain groups are singled out as risky and characterized as dangerous, allowing for repressive public health interventions.

At the same time, fear of harassment, arrest and detention may deter people from using health services.  A ‘deviant’ social status combined with health status may lead to discrimination and ill-treatment by health care providers. Criminalization is linked to high levels of harassment and violence, reported by lesbian, gay, transgender people and sex workers around the world (see here and here). Notably, in the context of HIV/AIDS, criminalization, and quarantine and individual responsibility for disclosure have been considered as key tools to halt or limit transmission, despite innovations in treatment that radically transform the nature and lethality of HIV/AIDS. Globally, prosecutions for non‐disclosure, exposure or transmission of HIV frequently relate to sexual activity, biting, or spitting. At least 68 countries have laws that specifically criminalize HIV non‐disclosure, exposure, or transmission. Thirty‐three countries are known to have applied other criminal law provisions in similar cases.

For the fast-moving but relatively low-mortality Corona-virus, these lessons indicate that a marginalized social status can contribute to exacerbating transmission and constitute a barrier to adequate health care, potentially increasing mortality.

Secondly, criminalization and repressive public health measures and discriminatory barriers are also a complicating factor during emergencies caused by other factors. As seen in the context of Ebola, general violence as well as violence against health care workers undermines efforts to end outbreaks. Humanitarian emergencies confront public health systems with often overwhelming challenges. In the midst of this, criminalization of individuals who are infected or perceived as risky or dangerous further compromises the ability to address preexisting epidemics and hamper transmission, thus exacerbating the impact of the overall impact of the crisis. 

Third, in situations when the disease itself is the emergency, criminalization and the attendant practice of quarantines directly hampers efforts. Historically, quarantines have been used for a wide range of diseases including venereal disease, tuberculosis, scarlet fever, leprosy and cholera. Quarantines are co-constructed through the longstanding tradition of framing infectious disease through criminalization, whereby stigma, medicalization and incarceration have worked together to produce colonial bodies construed as racial and sexual threats to national security (see here and here). Quarantine was a widely employed tool against Ebola in Sierra Leone and Liberia.  As noted  by commentators, according to the logic underlying quarantines ‘subjects marked as abnormal, diseased, criminal, or illicit should be isolated for their own betterment and for the collective good’. While resistance becomes a proof of deviance and of the necessity of segregation, in the case of Ebola, quarantines may compel fearful communities to hide suspected cases. In the contemporary context, with an international human rights framework on health suggesting that rights-based approaches to disease prevention and mitigation should be foregrounded,  problematic tradeoffs between criminalization-oriented public health measures and fundamental rights and liberties are likely to proliferate, as illustrated by the US government’s budding ‘war on Corona’.

This blog has provided an initial map of how criminalization may shape the Corona response. In sum, when criminalization is pegged directly onto suffering human bodies, criminalization hinders global health interventions in three ways. Criminalization might be so repressive that it has severe health-related impacts on the populations concerned. Criminalization also undermines and exacerbates challenges already faced by the public health infrastructure during an emergency. Finally, the repercussions of criminalization are most impactful in situations when the disease itself is the humanitarian crisis and where criminalization directly hampers efforts to contain and mitigate epidemics.

US: Georgia Republican lawmaker co-sponsors bill that would revise HIV criminalisation law in the State

Republican lawmaker pushes to decriminalize HIV in Georgia

An influential Republican lawmaker in the Georgia House wants to modernize the state’s HIV laws, which activists have criticized as outdated and said stigmatize people living with HIV.

Current Georgia law makes it a crime for people living with HIV to have sex or donate blood without disclosing their status. It’s a felony punishable by up to 10 years in prison. State law also criminalizes spitting at or using bodily fluids on a law enforcement officer by a person living with HIV, an offense that can carry up to 20 years in prison. 

But Rep. Sharon Cooper (photo), a Republican from Marietta, wants to change that. The chair of the Health & Human Services Committee in the Georgia House is a co-sponsor of a bill that would revise state law so it’s only illegal to intentionally transmit HIV during sex. The legislation would also downgrade the punishment from a felony to a misdemeanor, which is punishable by up to a year in prison. The revisions to the law would also decriminalize spitting at and using bodily fluids on a law enforcement officer by a person living with HIV.

“[Current Georgia HIV laws] make people so biased and afraid,” she told Project Q Atlanta. “And when you’re afraid of something and don’t understand it, it makes people act in very negative ways.”

“Misinformation is not only harmful to the person who has HIV, it’s harmful to the perceptions of everyone around and how they handle or treat the person. Having that correct information is extremely important,” she added.

Rep. Deborah Silcox, a Republican from Sandy Springs, introduced House Bill 719 on the final day of the 2019 legislative session. It was assigned to Cooper’s HHS committee.

Cooper said she will meet with Kathleen Toomey, commissioner of the Georgia Department of Public Health, to discuss the bill on Feb. 19. Cathalene Teahan, a registered nurse and a board member for the Georgia AIDS Coalition, is also expected at the meeting.

“Is there a more comprehensive bill? Should we have more than one bill? Where are our holes in the system? This is a big issue and I think we have a chance to really look at it,” Cooper said.

Georgia is one of some three-dozen states that criminalize a lack of HIV disclosure, whether or not the specific act actually exposed the sex partner to HIV. Activists and lawmakers have tried for years to modernize state law by decriminalizing non-disclosure of the disease to sex partners.

It’s way past time to update Georgia’s HIV laws, according to Jeff Graham, executive director of Georgia Equality.

“As they are currently written, there is no basis in science,” he said. ”If Georgia is going to get serious about making changes to end the epidemic in the next decade, we have to start by ending policies like this that are so harmful and have gone unchallenged for far too long.”

Rep. Mark Newton, a Republican from Augusta, is a co-sponsor of the legislation with Silcox and Cooper as a sponsor of the bill. The Democratic sponsors include Reps. Michele Henson of Stone Mountain, Karla Drenner of Avondale Estates and Sam Park of Lawrenceville. Drenner and Park are two of the five openly LGBTQ members of the legislature.

Cooper sponsored a measure that created a study committee to examine the state’s HIV criminalization laws in 2017.

The committee published its findings in December 2017, and some of those recommendations became part of HB 719. The committee found that “criminal exposure laws had no effect on detectable HIV prevention” and that these laws should be eliminated unless there was a clear intent to transmit the virus, according to the report.

HIV exposure arrests in Georgia

An Augusta man was arrested in January after allegedly having sex with a relative without informing him he had HIV. He was later released on bond.

A Rome, Ga., man was charged in August with exposing police officers to HIV after allegedly spitting on them, which HIV activists said highlights why the state needs to fix its laws. He is being held without bond in the Floyd County Jail.

An Athens man was arrested in July after allegedly having sex with a woman without informing her he had HIV. He was charged with reckless conduct by a person with HIV. He remains in Athens-Clarke County Jail without bond six months later, according to the Clarke County Sheriff’s Office.

A gay Atlanta man was arrested for HIV exposure in South Carolina in 2015. He claimed he disclosed his status before having sex with the alleged victim. The charges were later dropped.

US: Slow progress for Nevada Advisory Task Force on HIV Exposure Modernization

Task force on HIV decriminalization off to slow start

By Michael Lyle

Six months after Gov. Steve Sisolak authorized the creation of an Advisory Task Force on HIV Exposure Modernization to examine Nevada’s antiquated laws, the committee hasn’t been filled. 

The law establishing the task force authorizes up to 15 appointments. The only three appointments made thus far were made in January. The task force has until Sept. 1 to present its finding to the Legislative Counsel Bureau along with any recommendations on potential legislation. 

“As is the case with any other board or commission, the Governor can only make appointments when the application process is complete,” said Ryan McInerney, a spokesman for the governor. “There are multiple steps in the application process, and applicants will only be reviewed when all of their paperwork is completed and submitted.” 

The governor’s office said it is working with the Department of Health and Human Services to encourage applicants to apply and has a goal of seven total members by mid-February. 

“We are not concerned about meeting the deadline and will be prepared to immediately start work with the task force when appointments are announced,” added Shannon Litz, a spokeswoman with Nevada’s Department of Health and Human Services. 

HIV criminalization laws developed in the late 1980s following the height of the HIV/AIDS epidemic. 

Despite three decades of advancements in medicine that have decreased mortality rates and lowered transmission rates, the laws overwhelmingly remain in place across the United States.

Various movements have worked to change those existing laws. 

California passed legislation in 2017 that reduces the penalty for those who expose others to HIV without their knowledge.  

In a previous interview, state. Sen. David Parks, who sponsored Senate Bill 284, said he had tried for three sessions to bring forth legislation to address HIV criminalization. 

The task force, once formed, is expected to review existing HIV exposure laws, research the impact of those laws, review corresponding court decisions and identify disparities of arrest based on indicators such as gender identity or expression, sexual orientation, race or sex. 

In its 2017 report HIV Criminalization in the United States, the Center for HIV Law and Policy identified several existing Nevada laws that criminalizes HIV: 

  • People living with HIV are prohibited from engaging in conduct known to transmit HIV, which is a Class B felony that can come with a two to 10 year prison sentence or up to a $10,000 fine.
  • People living with HIV can’t engage in sex work, which also comes with six months in prion and up to a $1,000 fine. 
  • Health authorities have “broad powers to prevent transmission of communicable and infectious diseases, including HIV”

As the report points out, “conduct ‘likely to transmit’ HIV is not defined.” 

Like most laws, Nevada’s statutes also don’t reflect the science advancements behind transmission. 

For example, the Centers for Disease Control and Prevention along with other health organizations and scientific studies found that those on medications who achieve an undetectable viral load — when the copies of HIV per milliliter of blood are so low, it can’t be detected on a test — have no risk of transmitting the virus.

While speaking in support of SB 284, the Nevada Attorneys for Criminal Justice also noted other Nevada laws targeting people living with HIV. 

“NACJ would particularly like to highlight one such law, NRS 212.189, which imposes a life sentence on a person with HIV in lawful custody who exposes another person to their bodily fluids,” the group wrote.  “This is dramatically overbroad – a person with HIV who spits on a police officer as they are being arrested faces a life sentence, because HIV is sometimes present in saliva even though there is no actual risk of transmission.”

There hasn’t been any indication when the task force will begin meeting. 

The three appointments in January include Stephan Page, Steve Amend and Ruben Murillo. 

Digital technologies could threaten the safety of vulnerable groups, especially in juridictions that criminalise HIV non-disclosure

OPINION: The promises and perils of digital health

 Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.

by Mandeep Dhaliwal 

The potential for technology to transform health services is tremendous, but advances in digital health can bring privacy and data security challenges.

Mandeep Dhaliwal is the director of the UN Development Programme’s HIV, Health and Development team.

From health apps that record blood sugar or air quality to drones that deliver vaccines, technology is increasingly shaping nearly every aspect of our lives. The potential for technology to transform health services is tremendous, especially for poor, hard-to-reach and marginalized communities. But advances in digital health can bring privacy and data security challenges that threaten human rights and exacerbate inequalities.

When developing countries have access to technology, it can be deployed to address longstanding challenges in access to health services. In Guinea-Bissau, health workers record data on malaria by hand and then send it by public transport for analysis, a process which can take up to three weeks. This makes it difficult to track where outbreaks are occurring or make informed, timely decisions about where to direct resources. UNDP, the Global Fund and the World Bank are working with the government to disseminate mobile tablets to health facilities across the country, allowing health professionals to monitor malaria data electronically. This streamlined system has contributed to a 16 percent decrease in the number of malaria-related deaths in the country since 2017.

However, technological advances aren’t necessarily reaching those with the greatest need. Well over half the world’s population still lack access to the internet, and those who lack access are overwhelmingly from marginalized groups such as women, elderly people, people with disabilities and those who live in poor, remote or rural areas.

Where digital technologies are reaching these communities, security and privacy issues can exacerbate stigma and discrimination. Between 2016 and 2017, there were over 1300 recorded incidents of protected health information data breaches across 27 countries. Leaking this type of information can threaten the safety and wellbeing of vulnerable groups, such as people living with HIV, especially in the 75 countries around the world that criminalize HIV non-disclosure.

Even if data is collected for altruistic purposes, it can be misused or shared with others who may use it for purposes other than what was intended. For example, data-sharing agreements can give governments access to personal information that could be used to target or monitor marginalized groups. This can lead to a breach of trust in the confidential doctor-patient relationship and discourage vulnerable populations from seeking care.

In some places, civil society is pushing back against these potential breaches of patient privacy. Kenyan civil society opposed the health authorities’ plan to use biometric data, such as fingerprints or eye scans, in a study on HIV. They argued that this data could be used by police to target groups – such as sex workers, men who have sex with men, transgender persons and people who inject drugs – for arrest and prosecution. Other countries are following suit – the Supreme Courts of  India, Jamaica and Mauritius all affirmed the need for strong safeguards when collecting biometric data to ensure privacy rights are protected.

Countries must take action to enable vulnerable communities to benefit from advances in digital health while respecting their privacy. First, all people – not just a select, privileged few – should be able to enjoy the benefits of innovation and technology. The goal of digital health must be to drive universal health coverage (UHC) while reducing inequalities, rather than deepening them.

Second, strong rights-based legal and ethical frameworks for digital health are critical. Digital health tools must be accompanied by laws and policies that protect the privacy and dignity of patients, particularly those who risk further stigmatization and discrimination.

Finally, greater efforts are needed to ensure advances in technology are distributed equally, so that communities most in need can benefit. Partnerships across sectors can help accelerate the introduction of new technologies in poor, marginalized or remote communities.

Technology offers new opportunities to tackle some of the world’s most challenging diseases, drive UHC and ultimately, save lives. The digital health revolution has happened – it’s time to close the digital divide and for global and national governance, laws and safeguards to catch up.

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.