Canada: People of African, Caribbean and black descent over-represented in the mainstream media coverage of HIV non-disclosure.

Skewed Stories: Race and HIV Criminalization in the Media

By Sané Dube

From Canadian AIDS Treatment Information Exchange

June 12, 2017

In Canada, not disclosing your HIV status to a sex partner can, in some circumstances, be deemed a crime. Media stories of people prosecuted for not disclosing their status show black men on trial in disproportionate numbers. What impact does this have on African, Caribbean and black communities?

“In a word, it’s dehumanizing.” Robert Bardston is talking about media coverage of HIV non-disclosure cases. I’ve spent the past couple of months engaged in a series of poignant, inspiring and sometimes-heartbreaking conversations about the criminalization of HIV non-disclosure. I am trying to understand how mainstream media stories on the issue impact African, Caribbean and black (ACB) people across the country. Robert and I are speaking on the phone — miles stretch between his Medicine Hat and my Toronto. It’s early and the sleep is still working its way out of his voice.

He lets out a weighty sigh and continues: “It’s dehumanizing to see yourself branded as deviant in the public eye, especially through the media.” Robert, an HIV activist and co-chair of the Canadian HIV/AIDS Black, African and Caribbean Network (CHABAC), has lived with the virus since 1988.

In an illuminating conversation, we explore what it feels like to see and hear stories of people criminalized for not disclosing their HIV status before sex. We cycle through the emotional toll the coverage can take and the complicated feelings it evokes. Robert says that people living with HIV are treated as pariahs and that black people living with HIV face both HIV stigma and debilitating racism in how their stories are told.

Throughout our conversation he juxtaposes two key elements of his identity — his status as a person living with HIV and his identity as a black person in Canada. As Robert points out, African, Caribbean and black people living with HIV have pressing and unique concerns regarding the criminalization of HIV non-disclosure. To fully understand how deeply this issue impacts individuals and communities, we must first understand what it means to inhabit both of these spaces. To understand this moment in time, we must look at it in context.

The first cases of people being charged for not disclosing their HIV status to sex partners date back to the late 1980s. Since 1989, more than 180 HIV-positive people have been prosecuted in Canada for not disclosing their status. A sharp rise in the number of cases, which began in 2004, has been accompanied by increasing severity in the type of criminal charges laid at the feet of people living with HIV.

Today, someone facing prosecution typically faces an aggravated sexual assault charge — a serious criminal charge with potentially grave consequences. If convicted, a person can be added to the sex-offenders registry and face a sentence of up to life in prison. In cases where the accused has immigrated to Canada, they may also face deportation.

In all of my conversations, the year 2012 pops up as a recurring focal point. That year the Supreme Court of Canada released decisions on two highly anticipated cases. The Court had been asked to clarify the conditions under which people living with HIV could face criminal prosecution for not disclosing their HIV status to sex partners. Legal obligations to disclose one’s status had already been in effect since the late ’80s, but in 2012 the court was asked to determine how using a condom or having a low viral load could impact criminal liability in cases of HIV non-disclosure.

By 2012 the global HIV epidemic was entering its third decade. Tremendous gains had been made in better understanding the biology of HIV transmission and advocates hoped that the highest court in Canada would seize this opportunity to integrate the latest scientific evidence on HIV transmission risks — showing that condoms and maintaining a low viral load significantly cut the risk — into legal processes. In a 1998 decision the Court had ruled that people living with HIV had a legal duty to disclose their status before having sex that might pose a “significant risk” of transmission. The court’s definition of “significant risk,” however, was vague and unclear, and advocates hoped that the 2012 ruling would bring greater clarity to the law.

Instead, the law became stricter. People living with HIV were now required to disclose their status before sex that posed a “realistic possibility” of HIV transmission. The problem was that sex posing a realistic possibility included situations where there is effectively zero risk. Critics called the decision a step back that diminished the rights of people living with HIV.

While the cases were being deliberated in the highest court in the land, they were also being dissected in the court of public opinion. One case involved a black man accused of failing to disclose his HIV-positive status to several sex partners. Although HIV was never transmitted to any of his partners, he was charged with six counts of aggravated sexual assault.

By the time the Supreme Court issued its landmark ruling, dangerous and harmful ways of talking about HIV and, in particular, African, Caribbean and black men living with HIV had become the norm. Some of the most discussed cases of that period involved black men; the result was a disturbing fusion of blackness and criminal deviance.

Looking back, people living with HIV and advocates describe popular coverage of criminalization cases during that era as uniformly poor, increasing stigma and undermining education and knowledge about the science of HIV. The coverage not only normalized language that framed people living with HIV as inherently deceptive and dangerous to the public, the disproportionate focus on people of African, Caribbean and black descent, particularly straight black men, told a singular, dangerous story.

The fusion of black identity and negative stereotypes is not new. Indeed, it is something black people and communities contend with daily. In another illuminating conversation, Shannon Ryan, the executive director of Black CAP (Black Coalition for AIDS Prevention), who has worked in HIV organizations for two decades, tells me, “Being black in Canada means something. Systemically and institutionally, it means something — whether you stepped off a plane this morning or your family has been here since the 1700s. I try to remind the people I work with that our blackness is something to celebrate and includes strength and solidarity. But in the world outside these doors, being black can also include facing anti-black racism, it means marginalization, it means oppression and vulnerability.” Contemporary narratives about the criminalization of black people who don’t disclose their HIV status draw from and feed into these problematic and stifling conceptions.

Equally stifling is the criminalization that black communities must contend with in the first place. Black people are vastly over-represented in Canada’s prisons. A 2015 report from the Office of the Correctional Investigator found that the federal incarceration rate for African, Caribbean and black people in Canada is three times their representation rate in the general population.

“The criminalization of HIV non-disclosure is another way our communities are being criminalized and torn apart,” says Ciann Wilson, an assistant professor at Wilfred Laurier University who has worked with African, Caribbean, black and Indigenous communities responding to HIV. “HIV follows lines of existing inequity and the criminalization of people living with HIV further disenfranchises communities that are already dealing with structural racism.”

There’s an old adage that we understand the world around us by the stories we tell about it. A team of Ontario researchers analyzed 1,680 Canadian newspaper articles about HIV non-disclosure criminalization cases that were published between 1989 and 2015. They found that 62 percent of the stories focused on cases involving black immigrant defendants, yet only 20 percent of the 181 people charged during the same period were African, Caribbean or black men. The research team concluded that the media disproportionately focuses on cases involving black people facing prosecution for non-disclosure.

“There’s no question about it: Straight black men in particular are over-represented in the media coverage of these cases,” says sociologist Eric Mykhalovskiy, one member of the research team. “If you take a closer look at the coverage, half of the 1,680 articles focused on four black men facing prosecution. The fact that the coverage is so skewed toward those defendants really produces in the public imagination the idea that HIV non-disclosure is a crime of black heterosexual men — when it’s not,” he says. “It’s a profound example of what is clearly a long history of over-representing black people in crime stories in the media.” [To read the full report, Callous, Cold and Deliberately Duplicitous: Racialization, Immigration and the Representation of HIV Criminalization in Canadian Mainstream Newspapers, click here.]

The storytelling pattern Mykhalovskiy references traces back to some of the first HIV non-disclosure cases involving African, Caribbean and black men in Canada. Early media reports drew from racialized stereotypes about black men, masculinity and gender. They conjured images of hyper-sexualized black men maliciously transmitting HIV to unsuspecting partners — usually white and female. News headlines frequently described defendants as “predators” while making reference to “potent” African strains of HIV.

The same patterns emerge in contemporary mainstream coverage of HIV non-disclosure cases involving ACB individuals. “Many people may not personally know someone who is HIV positive. They know about HIV through the media,” Mykhalovskiy says. “When you look at the stories that are told, you see that the kind of knowledge that’s available paints black people living with HIV as a significant threat and danger. It’s really concerning.”

The effects are far reaching. HIV is a pressing concern for many African, Caribbean and black communities across the country and these problematic narratives impact the ways in which communities and individuals experience and respond to HIV.

Take, for example, Linda, who has had HIV since 2003. She currently lives in B.C., where she’s been working with groups supporting black people living with HIV in that province. Linda is a force to reckon with. She is a quiet revolution who resists the oversimplification of the lives of people living with HIV. Yet it’s impossible to miss the fatigue that clouds her voice when she talks about the impact of HIV non-disclosure media stories on the lives of people with HIV.

“The ways they talk about us in the media — it makes you feel worthless. It’s a huge problem for us African people living with HIV. We talk amongst ourselves and we are scared.” She continues after a measured pause: “I think it’s cruel. It’s only expanding the stigma. It’s pushing people away instead of encouraging people with HIV to come forward and talk about stigma.”

Increasing stigma and isolation are top concerns for service providers at HIV organizations, too. These organizations work to disrupt the problematic stories told in the popular press about HIV and the criminalization of non-disclosure. They have been working diligently to shift the conversation and advocate for laws that don’t further marginalize people living with HIV. They argue that stigma is a major barrier in effective responses to HIV.

Two such organizations — Black CAP and the African and Caribbean Council on HIV/AIDS in Ontario (ACCHO) — are located in an inconspicuous office building in downtown Toronto. I’m delivered to the fourth floor of the building by a shaky elevator reminiscent of an earlier time. Stepping into the waiting area I am aware of the unique place in the Canadian conscience and HIV service organization landscape held by agencies like Black CAP and ACCHO.

African, Caribbean and black people make up less than 3 percent of Canada’s population, yet they account for 14 percent of HIV infections. Here again, African, Caribbean and black communities are over-represented and disproportionately impacted. Despite these telling demographics, organizations like Black CAP and ACCHO, which both work specifically with and for ACB communities, are few, far between and often crippled by limited funding.

The situation creates a paradox — one where ACB communities are over-represented among people living with HIV and where the public imagination creates strong links between blackness and HIV — yet interventions that cater specifically to ACB communities are limited. HIV in ACB communities is simultaneously hyper-visible and erased in the same breath.

ACCHO director Valérie Pierre-Pierre begins our conversation by reflecting on the coverage of HIV criminalization cases. “Even though high-profile cases don’t necessarily represent the majority of cases, the media covers those cases in ways that further demonize the accused. They elicit negative reactions toward people living with HIV, especially black men.” She is referring to narratives that frame people living with HIV as maliciously transmitting the virus to unsuspecting partners. She and others in HIV service organizations argue that these portrayals have driven misinformation and stigma — which fuel fear and, in turn, create barriers to addressing HIV in ACB communities.

Black CAP executive director Shannon Ryan, reflecting on the aftermath of the Supreme Court rulings and the media coverage, says, “It does not help us do our work. It does not promote testing. It does not promote diagnosis. It does not promote disclosure. It does not reduce stigma. It diminishes our work.”

While proponents of the current law argue that it helps prevent HIV (that the fear of prosecution will make people living with HIV take precautions with their sex partners), many people living with HIV and many working in the field argue that the criminalization of non-disclosure and the discourses around it become marginalizing forces. In African, Caribbean and black communities, this can have a particularly damaging and splintering effect.

Months after my first call with Robert Bardston and many conversations later, I have talked to people living with HIV, service providers, legal experts and researchers about the impact of HIV non-disclosure criminalization on African, Caribbean and black communities and the stories we tell about it. To be sure, this is a difficult and divisive issue. Yet in the midst of it all, there are extraordinary individuals and groups resisting and challenging harmful narratives about these communities and criminalization.

They are claiming space and demanding this story be told a different way. They want the story to begin with an acknowledgment that structural violence and marginalizing narratives about African, Caribbean and black communities drive increasing rates of HIV and, indeed, criminalization. Many also want to make it clear that the current system does not serve already-vulnerable communities.

Listening to their stories of resistance, I allow myself to start imagining and dreaming about a system that better serves our communities.

For more on the criminalization of HIV non-disclosure, visit the Canadian HIV/AIDS Legal Network‘s website.

Sané Dube is a Zimbabwean transplant to Canada. She lives in Toronto.

US: Plus magazine journalist writes about the latest case of HIV criminalisation in Florida highlighting how the law discriminates against those living with HIV

Alcid Jean was charged with five felonies in the latest HIV criminalization overreach

By Desiree Guerrero
JUNE 07 2017 7:00 AM EDT

An Orlando, Fla. resident, Alcid Jean, was arrested last Thursday on five felony counts of an “unlawful act referencing sexual transmitted disease,” for allegedly not disclosing his HIV-positive status to sexual partners. Jean, 44, was arrested May 25th while working his shift at Walt Disney World’s Old Key West Resort, reports Orlando’s WKMG News 6.

Jean’s arrest highlights the ongoing controversy around laws that criminalize HIV or discriminate those living with HIV. The Florida law (penal code 384.24) that Jean was arrested under states that those with various other sexual transmitted infections—including syphilis—who do not disclose to their sexual partners can only be charged with a misdemeanor. The law singles out people with HIV by allowing them to be charged with a felony for not disclosing their status to partners.

Most of these types of laws were enacted decades ago when HIV was seen as a death sentence. They don’t reflect current medical and scientific realities and thus are discriminatory against people living with HIV. Especially since untreated syphilis can be equally harmful and potentially deadly (once curable, a strain of syphilis has emerged that is resistant to all current antibiotics).

Being able to charge HIV-positive people with a felony versus a misdemeanor under this law, means that much harsher sentencing applies. While first degree misdemeanors are punishable by up to one year in jail under Florida law; just one count of an unlawful act referencing sexual transmitted disease as a felony in the first degree in can result in a 30-year prison sentence. If convicted on all five counts, he would likely remain in jail for the rest of his life.

Racial and sex discrimination are significant factors in HIV criminalization. Research shows that African Americans, sex workers, and women significantly higher rates of conviction and jail sentences. In fact, those who aren’t white men are more likely to see these types of charges proceed to court—and in California, for example, prosecutors have won nearly every case that has gone to trial.

According to a study from University of California Los Angeles School of Law’s Williams Institute, 95 percent of the state’s HIV criminalization arrests involved sex workers. Black and Latinx people make up two-thirds (67 percent) of those who came into contact with the criminal justice system around these statutes. Across all HIV-related arrests, white men were significantly more likely to be released and not charged (60 percent were released).

Florida and California are not the only states that carry these types of HIV criminalization laws. In an analysis by the Centers for Disease Control and Prevention and the Department of Justice, researchers found that, as of 2011, a total of 67 laws explicitly focused on persons living with HIV existed in 33 states.

Another disturbing factor of these laws is that many don’t specify a difference in charge or punishment even if the individual is unaware of their status, or if they have an undetectable viral load (which means one cannot transmit the virus). Partly, that’s because most of these laws were enacted during the 1980s and ‘90s, at the height of the epidemic in this country, when transmission was considered a death sentence.

The ideas that support these laws are grossly outdated in light of the advances in treatment and prevention options, such as antiretroviral therapy and the HIV prevention protocol, PrEP. Today, people living with HIV who are on ART can expect near-normal life expectancy rates, which supports the argument that these laws need serious reform. In February of this year, California has taken the first step in doing so, by introducing a bill to reform the state statutes that criminalize HIV.

Florida, however, has not taken similar steps. Although reports indicate Jean had “unprotected sex” it’s not yet known if he is on ART, or if his viral load is currently undetectable. Though Inside Edition reported that one of Jean’s past partners claims he transmitted HIV to her, but whether she is indeed positive hasn’t been officially confirmed. (It’s also very difficult to prove transmission has occurred between two people, even if both have the same strain of HIV.)

After several media outlets sensationalized the story by using headlines like, “Disney Worker Failed to Tell Women He Was HIV-Positive Before Sex: Cops” (thus connecting children, HIV, sex, and crime in readers’ minds), it should come as no surprise that a representative for Disney announced Jean has been placed on unpaid leave pending the outcome of the case.

Canada: Two staff members of the Canadian HIV/AIDS Legal Network discuss how the 'Undetectable = Untransmittable' campaign might best be understood to impact HIV criminalisation advocacy

U=U and the overly-broad criminalization of HIV nondisclosure

Published on CATIE’s blog on 06/06/2017

By Nicholas Caivano and Sandra Ka Hon Chu

People living with HIV in Canada have been charged with some of the most serious offences in the Criminal Code, even in cases of consensual sex where there was negligible or no risk of HIV transmission, no actual transmission and no intent to transmit.

The Undetectable=Untransmittable (“U=U”) campaign is based on scientific research, including the ground-breaking PARTNER study, establishing that when a person living with HIV on treatment maintains an undetectable viral load for at least six months, the risk of transmitting the virus through sex is effectively non-existent. As advocates for persons living with HIV await action from federal, provincial and territorial governments to address the overly-broad criminalization of HIV non-disclosure, how might the U=U campaign and the results of the PARTNER study impact ongoing prosecutions under the current state of the law?

Canada has the dubious distinction of being a world “leader,” after Russia and the United States, in prosecuting people living with HIV. In 1998, the Supreme Court of Canada (SCC), in R. v. Cuerrier, decided that people living with HIV have a legal duty to disclose their HIV-positive status to sexual partners before having sex that poses a “significant risk” of HIV transmission.

In 2012, in R. v. Mabior, the SCC ruled that people living with HIV have a legal duty to disclose before having sex that poses a “realistic possibility of HIV transmission,” which the Crown must prove. Commenting specifically in the context of a case involving penile-vaginal sex, the Court stated that “as a general matter, a realistic possibility of transmission of HIV is negated if: (i) the accused’s viral load at the time of sexual relations was low and (ii) condom protection was used.”

In Canada, people who face criminal charges related to HIV non-disclosure are typically charged with aggravated sexual assault, a criminal offence usually reserved for the most violent rape, on the theory that the absence of disclosure renders a partner’s consent to sex invalid. Despite the requirement of a “realistic possibility” of transmission, charges are being brought, even when people living with HIV engage in conduct that, based on medical evidence, poses a negligible possibility of transmission.

As U=U makes clear, the available information about HIV transmission has changed dramatically since the SCC’s decision in 1998. The results of the PARTNER study add to the mounting pile of evidence available to assist courts in making sure the law is consistent with science and with human rights.

Advancing U=U as part of broader advocacy efforts to curb unjust prosecutions for HIV non-disclosure, however, warrants further consideration. Individuals who already face discrimination and marginalization may face unique barriers to attaining undetectable status. Research has shown, for example, that people who use drugs have a harder time attaining and maintaining an undetectable viral load. This is also likely to be true for people in prison, many of whom face HIV treatment disruptions because of the temporary unavailability of medications or transfers between institutions. Treatment for Indigenous communities may also be challenging due to the shameful inadequacy of culturally appropriate health care services in rural and remote communities. And women may have a harder time achieving undetectable viral loads for various reasons, including being diagnosed later in life, prioritizing the health of others, and higher rates of poverty, violence, housing instability and food insecurity.

While a growing body of research provides further evidence to consider when determining what constitutes a “realistic possibility of HIV transmission,” advocacy concerning cases of HIV non-disclosure must be informed by the unique challenges that marginalized groups living with HIV face in attaining undetectable status, so that the criminal law does not reproduce further inequities. Advocates must also acknowledge that the criminalization of people living with HIV has a negative impact on public health, regardless of viral load. Without laws and policies to ensure the removal of all barriers to HIV prevention and treatment, new scientific discoveries and their role in the courts may leave disparities between people living with HIV intact — or ultimately, do more to perpetuate them.

Nicholas Caivano is a lawyer and Policy Analyst at the Canadian HIV/AIDS Legal Network, where he works on human rights issues related to access to harm reduction services and access to medicines, and leads the work on law reform possibilities for HIV criminalization in Canada.

Sandra Ka Hon Chu is the Director of Research and Advocacy at the Canadian HIV/AIDS Legal Network, where she works on HIV-related human rights issues concerning prisons, harm reduction, sex work, women, and immigration.

US: Help stop criminalisation laws in Pennsylvania by signing petition to express your opposition to Bills proposing to expand the current laws criminalising people living with HIV

HIV Is a Medical Condition, Not a Crime. STOP HIV Criminalization Laws in Pennsylvania!

Target: PA Rep. Dom Costa and PA House Judiciary Committee

Dear Pennsylvania Community Members, Colleagues & Supporters:

We, the Positive Women’s Network-USA Pennsylvania Chapter, oppose all forms of criminalization against people living with HIV in our communities, including those who are currently incarcerated.

Two current PA House Bills, HB 305 & 306, if passed, will expand the current laws criminalizing people living with HIV or suspected of having HIV within the Pennsylvania Department of Corrections.

Please sign this petition to express your opposition to PA House Bills 305 & 306.

To: PA Rep. Dom Costa and PA House Judiciary Committee

From: [Your Name]

Pennsylvania House Bills PA-HB 305 and PA-HB 306, if passed, will expand the current laws criminalizing people living with HIV or suspected of having HIV within the Pennsylvania Department of Corrections. HIV is a medical condition, not a crime. Laws criminalizing perceived HIV exposure are extremely damaging to efforts at prevention and treatment, are stigmatizing to people living with HIV, and violate the human rights of people living with HIV.

Our communities stand united as Pennsylvanians in our view that criminalization of people living with HIV is wrong. We, the Positive Women’s Network-USA Pennsylvania Chapter and allies, oppose all forms of criminalization against people living with HIV in our communities, including those who are currently incarcerated.

We urge you to reject HB 305 and HB 306.

US: PJP Update – May 2017

State Advocacy Working Group Updates

California

SB 239, proposed legislation that will modernize California HIV criminalization laws, passed out of the Senate Public Safety Committee in March and is now waiting to be heard in the Senate Appropriations Committee. The bill has the support of nearly 150 organizations, including CHLP.

On May 16, Californians for HIV Criminalization Reform partnered with ACLU, APLA Health, Equality California, GSA Network, Los Angeles LGBT Center, Lambda Legal, Project Inform, National Center for Lesbian Rights, San Francisco AIDS Foundation, and the Transgender Law Center for an HIV/LGBT Advocacy Day at the State Capitol in support of 11 bills, including SB 239. Nearly 300 people participated in the event.

If your organization is interested in supporting modernization of California’s HIV criminal laws, we invite you to join Californians for HIV Criminalization Reform (eqca.org/chcr). Please contact brad@eqca.org or 323-848-9801 for additional information.

Georgia

On March 30, House Resolution 240 passed, which requires the creation of a House Study Committee to examine health care barriers for a range of chronic conditions, including HIV. The resolution also requires the state to “assess the HIV laws’ alignment with current evidence regarding HIV transmission risk and consider whether these laws are the best vehicle to achieve their intended purpose.” The full text of the current resolution can be found here.

Members of the Georgia Coalition to End HIV Criminalization convened in April and May, and conducted an HIV Criminalization 101 Advocacy Training on March 23.  The training included over 30 attendees.

Meetings are held the first Thursday of the month from 4:00-6:00pm (ET)

If you are interested in joining the Georgia Coalition to End HIV Criminalization, please contact Nina Martinez (nina.i.martinez@gmail.com) or Emily Brown (emily@georgiaequality.org) for additional information.

Indiana

On April 12, HIV Modernization Movement-Indiana (HMM) hosted an HIV Advocacy Day at the Indiana Statehouse. The event was very successful in drawing media attention to the issue of HIV criminalization in Indiana and was featured in the NUVO newspaper and on WISHTV.

If you are interested in information about HIV criminalization in Indiana or in participating, supporting or endorsing HMM-Indiana, visit our get involved page or contact us at hmm.indiana@gmail.com.

Louisiana

In April, Louisiana advocates reviewed a draft modernization bill that was ultimately not introduced during the legislative session, but the discussions helped clarify priorities for next year. The group also identified a prospective bill sponsor for 2018. Currently, advocates are developing their longer-term strategic plan and are in the process of selecting a name for their coalition. Louisiana advocates began monthly meetings in Fall 2016 to work on modernizing Louisiana’s HIV criminal law.

Meetings are held on the second Wednesday of the month at 11:00am (CT).

If you are interested in information about HIV criminalization or actively participating in the Louisiana coalition, please contact Chip Eakins at ceakins@philadelphiacenter.org.

Missouri

In May, the Missouri HIV Justice Coalition launched a new website, where members of the public can learn about the group and sign up to get involved.

The coalition is hosting a training later this summer in Springfield with SERO Project. People living with HIV and allies are invited to attend to unify state policy goals for Missouri’s HIV laws, and learn how to educate, engage with the media, and handle Q&A. Those interested in attending are invited to complete this doodle poll to help select the best dates to hold this training.

The coalition is planning some roundtable discussions across the state in June, with a focus on the perspectives and priorities of those who are most severely affected by these laws. If your group or organization is interested in setting up a discussion, please contact Ashley Quinn.

Meetings are held on the fourth Friday of the month at 1:00pm (CT) via conference call.

If you are interested in becoming an advocate with the Missouri HIV Justice Coalition, please contact Ashley Quinn at ashley@empowermissouri.org.

Ohio

On April 13, the Ohio Criminal Justice Recodification Committee voted down a proposed amendment to the state’s HIV-specific felonious assault law which would have expanded the scope of criminalized conditions and retained felony punishment, including in instances where there was no intent to harm. The Committee holds its final meeting and vote on June 15—it will then issue a set of recommendations for the Ohio legislature to consider. Ohio advocates are strategizing about the most effective response to those recommendations and planning outreach to key legislators.

The Working Group held regular meetings in April and May, and is also planning a large community forum event in centrally located Columbus for July 8. The forum will bring advocates together face-to-face to consolidate their energy and planning efforts, but will also offer an opportunity to engage in education, expand the coalition, and build new partnerships.

Next Meeting: Wednesday, June 14 at 5:00pm (ET)

If you would like information on HIV Criminalization or are interested in becoming an advocate with the Ohio HIV Criminalization Working Group, contact Kate Boulton at kboulton@hivlawandpolicy.org

Tennessee

The PJP Working Group convened in April and May and reviewed updates from recent legislative advocacy efforts. A needle exchange bill passed both houses of the legislature and was signed by the governor. AIDS Watch also had high levels of participation, and advocates have identified several new prospective sponsors to support their HIV modernization bill in the next legislative session.

This summer advocates will focus on fine-tuning their legislative strategy, working on a rapid response plan, and creating opportunities for prosecutorial and public defender education.

Meetings are held on the fourth Thursday of the month at 1:00pm (CT).

If you would like information on HIV criminalization or are interested in becoming an advocate with the PJP TN Working Group, please contact Kate Boulton at kboulton@hivlawandpolicy.org.Texas

Advocates convened in April and May and continue to monitor the legislature for the introduction of any harmful legislation. The group is currently finalizing a work plan that reflects the major planks of their strategy moving forward, including advocacy and education, outreach and coalition building, and legal/policy research.

Advocates are also focused on the creation of resources to support their education and advocacy efforts, including a presentation, a palm card, and a one-page fact and advocacy sheet. The group also wants to prioritize the inclusion of other social justice movements in its coalition, such as those focused on racial justice, reproductive rights, and mass incarceration.

Meetings are held on the third Friday of the month at 1:00pm (CT).

If you are interested in information about HIV criminalization or actively participating in the Texas HIV Working Group, please contact Kate Boulton at kboulton@hivlawandpolicy.org

Criminal Case Update

CHLP’s assistance in criminal cases includes counseling defendants and their families, referring defendants to attorneys, providing legal and trial strategy support to criminal defense attorneys, identifying and assisting with preparation of medical and scientific experts, drafting sections of court submissions, and submitting friend-of-the-court briefs.

MIssouri

On April 4, the Missouri Supreme Court denied the State’s application for transfer in Michael Johnson’s case. This upholds the Court of Appeals decision, overturning Johnson’s conviction and remanding for retrial. A preliminary hearing occurred on May 25, at which time Michael, represented by his new trial counsel, entered a plea of not guilty to the charges. The next court date is July 17.

Thanks to many generous donors, the MJ Working Group, coordinated by Charles Stephens of the Counter Narrative Project, has raised more than $25,000 for Michael’s legal defense. Stay up-to-date on developments in this case with our fact sheet and case timeline, which can be found here.

New York

On December 15, 2016, the New York Court of Appeals denied Nushawn Williams’ request that it review the decision to indefinitely civilly commit him to a New York State Psychiatric Center as a dangerous sex offender based on his sexual activity with women while living with HIV. 

On April 27, a petition to the United States Supreme Court seeking review of the case, was filed by Mark Davison, Williams’ attorney. The brief argues that the petition should be granted due to Constitutional violations occurring in a civil commitment hearing when (1) proof of positive HIV status is considered; and (2) a person is deprived the effective assistance of counsel. CHLP, with the support of 7 national and local organizations, and four individuals, filed a brief in support of Williams’ petition, arguing that Williams represents the only case in New York where an individual has been essentially isolated or quarantined in whole or part based on his HIV status, in violation of his Constitutional rights. We also argued that singling out a person living with HIV for this kind of extraordinary treatment under the law violates the Americans with Disabilities Act.

 Ohio

Orlando Batista was indicted for felonious assault in July 2014 for allegedly engaging in sexual conduct with his girlfriend without first disclosing his HIV status. After the trial court rejected his motion to dismiss, Batista pleaded no contest and the court sentenced him to the maximum term of eight years. CHLP, with support from the Gibbons P.C. law firm and the Ohio Public Defender, along with seven Ohio-based and national organizations, submitted a friend-of-the-court brief in support of Batista to the Supreme Court of Ohio. The ACLU of Ohio Foundation and Center for Constitutional Rights submitted a separate friend-of-the-court brief based on First Amendment grounds.

The Ohio Supreme Court has a background page on its website that provides an overview of Batista’s primary challenges to the HIV-specific felonious assault statute, the arguments put forward by the State of Ohio, and those of the friends-of-the-court. Oral arguments in the case, including that of attorney Avram Frey from Gibbons P.C., representing CHLP and the other organizations, took place on May 17 and can be viewed here.

If you are aware of anyone charged in an HIV exposure or transmission case, please refer them to our website, www.hivlawandpolicy.org and/or have them or their lawyer, contact CHLP for assistance at 212-430-6733 or pjp@hivlawandpolicy.org.

US: Lambda Legal describes California Senate Bill purpose to update HIV criminalisation laws

SB 239: A Long-Overdue Update of CA’s Discriminatory HIV Criminalization Laws

Lambda Legal | Scott Schoettes – California Senate Bill 239 is a long-overdue update of California’s outdated and discriminatory criminal laws targeting people living with HIV. As a co-sponsor of this important legislation, Lambda Legal wants to correct some misperceptions and clarify the purpose of this bill.

SB 239 was introduced to improve public health by creating an environment in which more people are willing to get tested for HIV, to obtain the medical treatment they need to protect their own health and the health of others and to discuss their HIV status with sexual partners.

By singling out people who know they are HIV-positive for severe criminal punishment as a result of sexual activity, regardless whether there was any real risk of transmission or any harm actually occurred, current law inhibits rather than encourages the exact practices that will help combat HIV/AIDS.

Let’s get the biggest misperception about SB 239 out of the way first.

SB 239 does not change California law with respect to disclosure of a person’s HIV status.

Current law does not require disclosure of one’s HIV-positive status prior to sexual activity. While it is true that the current HIV exposure statute applies only if the person did not disclose their HIV-positive status; mere nondisclosure isn’t a violation of the law. Rather, the person must also act with the specific intent to transmit HIV.

SB 239 would not change that.

Instead, SB 239 updates the law to incorporate the current scientific understanding of HIV.

For example, we now know that people living with HIV who are taking HIV medications—and therefore have a suppressed viral load—cannot transmit HIV to their sexual partners. With that in mind, SB 239 clarifies that activities undertaken to reduce the risk of transmission—such as using a condom or being on treatment—demonstrate a lack of intent to transmit HIV (or, for that matter, any other disease).

These refinements of the law help define the limited circumstances under which it is appropriate to penalize disease transmission.

SB 239 also eliminates the injustice in California criminal law for people living with HIV.

Under current law, HIV is the only medical condition that can result in a felony conviction. And individuals with HIV can be subject to a longer potential sentence than for certain types of manslaughter.

Exposure to all other infectious or communicable diseases—several of them also incurable or potentially fatal if untreated—would result in at most a misdemeanor conviction.

Given that HIV is now a manageable condition for people with access to care, it is time to stop putting it in a class all by itself. SB 239 would pull HIV out of its own separate statute and include it in the law that applies to every other serious communicable disease.

Eliminating this type of discrimination against people living with HIV is an important step in achieving the public health goals of SB 239.

Thanks to modern medical science, we now have the tools needed to make AIDS a thing of the past.

People who are diagnosed with HIV in a timely fashion and receive the necessary medical care can expect to lead long, healthy lives. But currently, approximately one in seven people living with HIV in the United States is unaware of their HIV-positive status, and only 40% of people living with HIV are engaged in medical care and have a suppressed viral load.

We must increase the number of people who know their HIV status and are on treatment, and SB 239 will help achieve that.

There is a tremendous amount of work to be done to eliminate public misconceptions about HIV, the routes and relative risks of transmission and the stigma that stems from these misconceptions.

But one thing California can do immediately is remove the discrimination in the law against people with HIV.

That is what SB 239 is designed to do and that’s why over 100 organizations support the bill, including APLA Health, the Black AIDS Institute, Equality California, Positive Women’s Network-USA, ACLU of California, National Alliance of State and Territorial AIDS Directors (NASTAD), HIV Medicine Association, SF AIDS Foundation, Bienestar, Planned Parenthood of California, Transgender Law Center and Human Rights Watch.

Together, we can make California law on this subject a model for the whole country.

Registration for the Legal Network’s 7th Symposium on HIV, Law and Human Rights is open

Rethinking Justice: 7th Symposium on HIV, Law and Human Rights

Symposium on HIV, Law and Human Rights

Chelsea Hotel, 33 Gerrard St. W., Toronto

Thursday, June 15, 2017, 9 a.m. – 5 p.m.

This year’s Symposium is devoted to a critical look at the unjust criminalization of HIV non-disclosure. Themes to be discussed include:

  • Current state of criminalization: Canada and the world
  • Voices rising: speaking out about the experience of HIV criminalization
  • Science of HIV transmission: recent applications, emerging issues
  • Advocacy updates and ways forward

Details for the 7th Symposium are now being finalized. We will update this page with more details as they become available, including a full list of speakers.

Register here for the Symposium. The following registration fees apply:

  • General admission: $75
  • Legal Network members: $50
  • Students, low-income and persons living with HIV or AIDS: $25*

*Please note that, if necessary, you can request a full waiver of this reduced fee by contacting the Legal Network office.

If you have questions about the Symposium, please contact info@aidslaw.ca.

Call for Submissions to shape the Second Africa Regional Dialogue on HIV, TB and the Law

  • Are you protected from discrimination or unfair treatment because of your HIV status or your TB status? Or does discrimination persist? What has changed, if anything, in the last 5 years?
  • As a woman living with HIV, do you still experience violence from partners, stigmatisation, blame, or discrimination from health carers because of your HIV status? Has there been any positive change in laws, practices or the actions of others in the past 5 years?  
  • Are you better protected from violence and harassment, as a person living with HIV, a person who uses drugs, a transgender person, sex worker, or a man who has sex with men? How, if at all? Does this make it easier for you to use HIV health care services? What problems persist?
  • Are you a child or young person affected by HIV? How are you treated, at clinics or at school? Are you able to get health care and social assistance? Has anything changed in the past 5 years to make things easier? What helps and what blocks you from getting the care you need?
  • Has there been any positive change in the past 5 years in the way you’re treated by health care workers [or employers]? Are you treated unfairly because of your HIV status, your TB status, your sexual orientation, gender identity or your work? What, if anything, has changed?
  • Are cultural norms and practices that put you at risk of HIV being changed, challenged or adapted? How? What works? What more is needed?
  • Are you able to access treatment for HIV, AIDS and TB? Is your government doing enough to provide health care? Are intellectual property laws used to increase access to treatment?
  • Do you know your rights? Do health care workers and the police know and respect your rights? What’s been done to improve this? How has this helped?
  • Is there better legal assistance from the state or NGOs to protect you from TB and HIV-related discrimination, in the past 5 years? Can you bring problems to court? Where else can you bring your complaints?
  • Do you provide legal services to people living with HIV and people with TB, women, children, people who use drugs, men who have sex with men, transgender persons, sex workers, prisoners, migrant workers or mobile populations? Have these been strengthened? How has this helped?
  • Do you work to develop protective laws, policies and programmes, challenge laws in court and improve the legal situation of people living with HIV, women, children, people who use drugs, men who have sex with men, transgender persons, sex workers, prisoners, migrant workers and mobile populations? Tell us what you’ve done, what has changed and what you’ve learned.
  • Are you a researcher or activist whose work builds evidence around the impact of human rights, and rights-based responses to HIV, AIDS and TB? Tell us what you’ve done, what has changed and what you have learned’.

 

Share your experience with the Second Africa Regional Dialogue planning team.

Make a submission TODAY!

Your submissions will shape the Second Africa Regional Dialogue on HIV, TB and the Law ’s conclusions and recommendations

Selected submissions will be invited to the Regional Dialogue!

Second Africa Regional Dialogue on HIV, TB and the Law

The AIDS and Rights Alliance for Southern Africa (ARASA) and UNDP Regional Service Centre for Africa, under the Africa Regional Grant on HIV: Removing Legal Barriers, will host the second Africa Regional Dialogue on HIV, TB and the Law on 3-4 August 2017 in Johannesburg,South Africa.

The first Africa Regional Dialogue on HIV and the Law called for evidence on the impact of laws,policies and practices on the lives of key populations and on universal access to HIV-related health care services. The second Africa Regional Dialogue will continue to identify key HIV, as well as TB, issues of critical concern. However, it will include a strong focus on understanding what has been done to follow up the recommendations from the first Africa Regional Dialogue, and what has worked to bring about change. The Dialogue would like to hear how laws and policies have changed, if at all and whether this changes lives; how education and training have helped to empower populations and to change attitudes, if at all and whether populations are better able to access support and mechanisms to enforce their rights.

The second Africa Regional Dialogue will bring together 140 government and civil society participants from across Africa to discuss progress on the implementation of the findings and recommendations of the Commission on HIV and the Law in the region, highlight issues and ongoing challenges and make strategic suggestions and recommendations on the way forward.

Objectives:

1. To provide a platform for a range of stakeholders from different sectors, including people living with HIV/TB, key populations, civil society and government, to engage in evidence informed discussions on priority HIV, TB,  law and human rights issues of regional and national concern;

2. To reflect on the extent to which the findings and recommendations of the Global Commission on HIV and the Law have been implemented and to evaluate the impact of these initiatives on HIV, law and human rights issues;

3. To identify current challenges and obstacles that continue to impede access to justice and to HIV/TB treatment, care and support services; and

4. To share Model Laws, good practices and lessons learned from work undertaken in the region to date on implementing the findings and recommendations of the Global Commission on HIV and the Law and strengthening the legal and policy environments regarding access to HIV/TB, health and social services.

Outcomes

1. Increased understanding of ongoing, key HIV/TB, law and human rights issues of regional and national concern, the impact of rights-based responses, as well as current and ongoing gaps, challenges and barriers to universal access to HIV-related health care.

2. The prioritisation of regional and national recommendations for action in the short, medium and long term to strengthen HIV/TB, law and human rights in Africa; and

3. A strengthened network of CSOs, academia, activists, government, legislators, members of the judiciary and other stakeholders to provide continued engagement on HIV/TB and the law in Africa

Thematic areas of the Dialogue

• Stigma and discrimination, legal aid responses, legal frameworks and access to justice

• Laws and practices that mitigate or sustain violence and discrimination lived by women

• Laws and practices that facilitate or impede treatment access

• Law and HIV pertaining to children and young people

• Laws and practices that effectively criminalise people living with HIV and key populations at higher risk of HIV and those at risk of TB

How can the law play a central role in the HIV and TB response?

Imagine living in a world where the law fully protects the human rights and dignity of all. In that world women, young people and key populations– sex workers, people who use drugs, gay men and men who have sex with men, transgender people, prisoners and migrants – could safely and freely take steps to protect themselves against HIV infection and to stay healthy if they are living with HIV. They would be able to access services that benefit not only them but also for the benefit of their partners.

The law can protect those vulnerable to and living with HIV and those with TB, against abuse and harassment by the police and against discrimination by healthcare workers and employers. The law can make it possible for people at risk of HIV to access the tools they need to prevent infection. Likewise, the law can make it possible for people living with HIV and those with TB to access life-sustaining treatment.

Knowledge of and respect for the law and how to enforce it can help to create an safe, protective environment for all affected populations. A world in which laws support human rights for all can be a world without HIV and TB!

Why is your submission important?

To have the greatest impact, the Second Africa Regional Dialogue’s planning team is seeking inputs from diverse civil society groups and individuals, including those advocating for human rights, women’s issues, key populations, etc. We are looking to learn from the experiences and knowledge of those most affected, to find out about empowering laws and practices and how they’ve led to change, and disempowering laws and practices that remain. The Dialogue wants to hear what’s been done to create change, what works and why, or why not. By speaking out now, your experience and knowledge will help to shape the Regional Dialogue’s thinking and recommendations, and influence advocacy efforts in the region.

WHAT TO SUBMIT

We want to learn from your experience or knowledge.

The first Africa Regional Dialogue found that in many parts of Africa, as in other parts of the world, the law treats people vulnerable to HIV as criminals. Many African countries criminalise a wide range of behaviors that may expose a person to HIV, making potential criminals of people living with HIV. In some countries, people with TB are detainedunnecessarily and forced to take treatment. In other countries, it is illegal to be a sex worker, a homosexual, a transgender person, a drug user or a migrant. Even in places where these behaviours are not crimes, law enforcement agencies, including police officers, harass or abuse members of these groups. The Global Commission recommended repealing punitive criminal laws and working to reduce stigma, discrimination and violence by law enforcers and others.  Are you a member of one these groups who has been cast as a criminal or mistreated by police because of who you are? Do you work with marginalised people whose lives are criminalised?  Share your experience of any changes in laws and practices that have impacted on your life or the lives of those you work with, and what still needs to be done.

Similarly, the Africa Regional Dialogue found that women and young people often experience violence, discrimination and inequality, and are unable to access basic rights for survival, increasing their vulnerability to HIV. They recommended law review to promote equal access to their rights, prevent discrimination and violence and access to justice and enforcement to help those who have suffered. Have you lived this experience or worked with people who have? What, if anything, has changed? Share your experiences.

In many places, intellectual property laws create barriers to treatment access, resulting in inflated prices and reduced supplies of life-saving medicines. Are you an academic, researcher or human rights advocate who works to increase access to HIV and TB treatment through intellectual property rights in your country?  Share your work and your perspective with us.

HOW TO SUBMIT

1) Countries covered by this call

You are invited to make a submission if your experience has been in a country within the African Union.

Submissions will be reviewed by a selection committee composed of the Africa Regional Grant on HIV: Removing Legal Barriers’ Sub recipients (ARASA, KELIN, SALC and Enda Santé), the Principal recipient (UNDP) and a number of regional key populations groups. A number of authors of submissions will be invited to Johannesburg to participate in the Second Regional dialogue, which will be conducted with simultaneous translation between English, French and Portuguese.

2) Languages

Submissions are welcome in English, French and Portuguese.

3) Confidentiality of Submissions

Submissions can be made at two levels: Public or Confidential. You should clearly state if you would like it to remain confidential. All submissions will be collected by ARASA for an objective review by the Regional Review Panel, based on a range of criteria. ARASA will then submit the relevant submissions to a Regional Selection Committee which will select the submissions to be shared at the Regional Dialogue.

If you would like your submission to be treated as confidential, then please provide two versions of the submission: (1) a confidential version, which will be viewed only by ARASA, (2) a public version with all confidential information removed, which will be submitted to the Regional Selection Committee for review.

Please note that while only some submissions will be selected for the Regional Dialogue, all submissions sent to the Regional Selection Committee are important and will in form and shape the Dialogue’s agenda, conclusions and recommendations.

4) Format of Submissions

All submissions must follow the template for submissions prescribed below.

• Letter format: Submissions should be no more than 3 pages long (maximum 1500 words in the main body of the submission), on A4 size paper. If sent by email, submissions should be in PDF (.pdf), RTF (.rtf) or Word Doc (.doc; docx) format. (Please note if your submission is confidential, only the public version will be shared with the Regional Selection Committee for review).

• Audio/Video format: Submissions in audio or video format should be no more than 10 minutes long. (If your audio or video submission is confidential, please do not mention your name and contact details in the submission. Instead, please include this information in the submission template accompanying your submission.)

• Online Audio/Video submissions: Submissions that cannot be sent via mail or email can be submitted online. They may be uploaded on “youtube.com” or “vimeo.com” using a personal account. Please make sure to secure your video as “private” and send us the link and password to your video

5) Deadline

12 June 2017

Please note that only 1 submission per individual or organisation will be accepted.

Send your entries to:

• Via Email to: submissions@arasa.info

Subject line should be: “Submission Second Africa Regional Dialogue-level of Confidentiality-Key issue(s)”. (e.g. Submission Africa Regional Dialogue-Public- Criminalisation of drug use).

• Via Mail to: ARASA, Unit 203 Saltcircle, 374 Albert Road, Woodstock. Cape Town, South Africa, 7915

US: Rolling Stone magazine covers HIV criminalisation and life as a person living with HIV in the US armed forces

What It’s Like to Be HIV Positive in the Military

Soldiers can be prosecuted for having sex, latest medications aren’t widely available – are the armed forces living in the 1980s when it comes to AIDS?

There’s not much to see in Otisville, New York. The town, with a population of just over 1,000 people, looks like an old mining village with white-painted ranch homes tucked behind the terrain’s rolling hills. The town is on the tip of Orange County, about 60 miles northwest of New York City; turn left down I-209 and you’ll pull into New Jersey, turn right and you’re in Pennsylvania.

For Kenneth Pinkela, Otisville dates back four generations with his family. The old Railroad Hotel and Bar off Main Street – one of the town’s three major roads – is the one his grandfather owned.

“Not a lot to look at, but it’s where I was raised. It’s home,” says Pinkela, driving his Ford pickup through the winding streets.

For Pinkela, Otisville is bittersweet. At 50 years old, the former Army lieutenant colonel, who still holds the shape of a weightlifter, is stuck there. He was forced to move back into his parent’s home three years ago after a military court martial had found him guilty of aggravated assault and battery back in 2012.

But Pinkela never bruised up anyone. Instead, he was tried and charged for exposing a younger lieutenant to HIV, though there was no proof of transmission. Pinkela has been HIV positive since 2007 when he was diagnosed right before deployment to Iraq during the surge.

President Jimmy Carter denounced Pinkela’s trial, and advocates argue it was one of the last Don’t Ask Don’t Tell cases the military tried and won. (Pinkela is also openly gay.) He served eight months in prison, lost his home and was dishonorably discharged from the Army.

Otisville was the only place for Pinkela to retreat to – specifically, back to his mother’s house.

Since being home, things have only gotten worse for Pinkela. His relationship with his mother is strained, he hasn’t had sex for years and doesn’t feel safe in public places.

“The post-traumatic stress I suffer now is worse than what I actually experienced in battle,” he says, pointing out a gunshot wound to his face.

Now, with a felony assault charge, Pinkela is having a hard time finding work even at a hardware store. “I was good at what I did. I loved my job. Now I can’t even get a job.”

Pinkela’s case is not unique. Other HIV positive service members interviewed say that serving their country while fighting for access to HIV care or preventative treatments is an uphill battle rife with bureaucracy, old science and misnomers within the Department of Defense on how HIV is transmitted. Much of the problem has to do with education, but both LGBTQ and HIV advocates say the issue is framed within the military’s staunch conservatism around sexual activity – particularly when it comes to gay sex.

The military isn’t alone in their policies; state laws also give prosecutors authority to charge those who have HIV with felony assault, battery and in some cases rape for having unprotected sex. As a result, gay men are facing what they say is an ethos of discrimination by the military against those who have HIV, including barring people from entering the services and hampering deployment to combat zones.

“It’s not a death disease anymore.”

Nationally, HIV transmission rates have gone down as access to medication and education have increased. But since tracking HIV within the armed forces, positive tests have “trended upwards since 2011,” according to the Defense Health Agency’s Medical Surveillance Monthly Report published in 2015. The highest prevalence of HIV is among Army and Navy men, according to the report.

In 1986, roughly five years after the HIV and AIDS epidemic began, the military began testing for HIV during enlistment, and barred anyone who tested positive. By the time the AIDS crisis began to lessen in the mid-1990s, the Army and Navy started testing more regularly. Now, service members are tested every two years, or before deployment.

Medical advocates say that the current two-year testing policy is partially to blame for the increase by creating a false sense of security against sexually transmitted diseases. The Centers for Disease Control suggest testing for HIV every three months for people who are most at risk of getting the virus, such as gay men or black men who have sex with men.

“The military, depending on how you look at it, could be seen as high risk for contracting HIV,” says Matt Rose, policy and advocacy manager with the National Minority AIDS Council in Washington D.C. “The military likes to treat every service member the same, but it makes testing for HIV inefficient.”

Former Cpt. Josh Seefried, the founder of the LGBTQ military group OutServe, said the group identified HIV as a problem within the armed forces nearly a decade ago after anonymously polling members.

“People have this mindset that since you’re tested and you’re in the military, it must be OK to have unprotected sex,” he says. “That obviously leads to more infection rates.”

Such was the case for Brian Ledford, a former Marine who tested positive right before his deployment out of San Diego. He told Rolling Stone he never got tested consistently because of the routine tests offered by the Navy. “I was dumb and should’ve known better, but I just thought, you know, I’m already getting tested so it’ll be fine.”

But a larger problem for the military is the number of civilians who try to enlist and test positive. The Defense Health Agency last year said there was a 26 percent increase of HIV positive civilians trying to sign up for the service.

All of those people, per military policy, were denied enlistment.

A Department of Defense spokesperson told Rolling Stone that the military denies HIV positive enlistees because the need to complete training and serve in the forces “without aggravation of existing medical conditions.”

But gay military groups say the policy is simply thinly-veiled discrimination.

“This policy, just like every other policy that was put in place preventing LGBTQ people from serving, is discriminatory and segments out a finite group of people,” says Matt Thorn, the current executive director of OutServe-SLDN. “Gen. Mattis during his confirmation said he wanted the best of the best to serve. If someone wants to serve their country they should be allowed to serve their country.”

The U.S. is one of the few Western nations left that have a ban on HIV positive enlistees. In Israel, where service is compulsory, their ban was lifted in 2015. In a press conference, Col. Moshe Pinkert of the Israeli Defense Forces said that “medical advancement in the past few years has made it possible for [those tested positive] to serve in the army without risking themselves or their surroundings.”

And as more countries begin to change their attitudes toward HIV and embrace a more inclusive military policy, there is hope that the U.S. might follow suit.

“Lifting the ban on transgender service members and Don’t Ask Don’t Tell was because a lot of other countries had lifted those bans, as well,” says Thorn. “In general, we don’t have a lot of good education awareness within the military on being HIV positive. People are looking back and they’re reflecting back on those initial horrors. But the truth of the matter is that it’s not a death disease anymore.”

Stuck in the 1980s

In July 2007, Pinkela was just about to be deployed out of Fort Hood when he was brought into an office; he was then told the news about his HIV status.

After the shock set in, he returned back to the D.C. area where he was required to sign what is known in the military as a “Safe Sex Order.” The order requires service members to follow strict guidelines on how they approach contact with others due to their diagnosis. If violated, soldiers can face prosecution or discharge.

“That piece of paper was a threat,” says Pinkela. “I couldn’t believe it was something that we did. Even to this day I look back on it and can’t believe that someone thought the order was okay.”

The Safe Sex Orders differ slightly between the military branches, but some of the details are troubling to medical professionals who say it appears as though the military is stuck in the 1980s.

For example, guidelines in the Air Force and Army tell soldiers to keep from sharing toothbrushes or razors. But the science and medical communities have known for decades that HIV can’t survive outside of the human body and needs a direct route to the bloodstream – something razors and toothbrushes can’t provide.

The Navy and Marine guidelines also tell service members to prevent pregnancy, as transmission of HIV between the mother and child may occur. But transmission between mother and child has become exceedingly rare.

“It’s your right to procreate,” says Catherine Hanssens, executive director of the HIV Law and Policy Center. “To effectively say to someone that because you’re HIV positive, even if you inform your partner, you shouldn’t conceive a child raises constitutional issues.”

Since 2012, HIV transmission has had a dramatic turnaround – partially due to preventative treatments that make the virus so hard to contract.

When someone is on HIV medication, they can reach an “undetectable” level of virus in their blood. At that point, transmission of HIV without a condom is nearly impossible, according to studies conducted in 2014 and released last year.

Rolling Stone reached out to the Department of Defense to specify why, given the medical advancement and low transmission rate, Safe Sex Orders were still being issued in their current format. The department defended the orders, saying “It is true that the risk is negligible if… the HIV-infected partner has an undetectable HIV viral load. However, it cannot be said that the risk is truly zero percent.”

If a service member breaks any of these rules, the military can charge them under the Uniform Code of Military Justice with assault, battery, rape or conduct unbecoming of an officer or gentleman.

Though department officials told Rolling Stone that “the Army does not use the [policy] to support adverse action punishable under UCMJ,” Hanssens’ organization currently represents service members who are facing charges as a result of not following their Safe Sex Order.

But military advocates – and even their staunch opponents – have said the U.S. military is just falling in line with other states throughout the country that criminalize HIV transmission and exposure. There are currently 32 states that have laws on the books related to HIV.

“Safe Sex Orders are unfortunately consistent with some laws enacted within certain states,” says Jonathon Rendina, an Assistant Professor at Hunter College at The City University of New York’s Center for HIV and Education Studies and Training. “What the military is doing is no different that what many civilian lawmakers are doing.”

In 2011, California Rep. Barbara Lee introduced a bill that would end HIV criminalization nationwide, though it failed to pass. In 2013, she helped push a line in the National Defense Authorization Act that forced the Department of Defense to review its HIV policies; though, only the Navy made changes to their Safe Sex Order.

“Too often, our brave service members are dismissed – or even prosecuted – because of their status,” Lee tells Rolling Stone in an email. “These shameful policies are based in fear and discrimination, not science or public health.”

Such was the case for Pinkela, who feels that the military has been using HIV as a reason to prosecute and kick out gay men since the legislative repeal of Don’t Ask Don’t Tell in 2010.

“I could not have sex. And even if I had sex and I told somebody, someone in the military could still prosecute me. They have this little piece of paper that lets some bigot and someone who doesn’t understand us, slam us and put us in jail,” he says.

And he’s not alone. Seefried, the retired Air Force captain, says he advises his gay friends – he calls them “brothers” – not to join the military.

“Right after Don’t Ask Don’t Tell was repealed, I came out and I said that gays should join to help change the culture,” Seefried says. “Now, I tell them not to not sign up… I just think that policies are very, very bad and unsafe for gays in the military right now.”

Quality care, for some

Travis Hernandez, a former sergeant in the Army, has been on the drug Truvada for just under two years now. He started using the the once-a-day blue pill while stationed at Ft. Bragg after he learned from a hook up that the drug could prevent HIV transmission by nearly 100 percent.

“A guy I was in the Army with and having sex with told me about it, and I was sexually active so it made sense for me to try it,” Hernandez says, adding how his experience getting the drug through the Army was very positive. “The doctors were really open talking about safe sex and everyone was very nice. I didn’t have any issues getting the drug.”

Hernandez finished his Army service last year and continues to receive Truvada through his veteran health benefits. But his story is not similar to everyone else’s.

The military provides access to Truvada through it’s healthcare provider TriCare, but only for certain individuals. Each military branch makes their own rules for who can get access.

Emails obtained by Rolling Stone between the National Minority AIDS Council and military health officials confirm that there are different protocols for prescribing Truvada between the service branches and its members without any specific reason.

“The military likes to set their own rules, even if it doesn’t always make sense,” says Rose, with the council. “The Army thinks they know what’s best for the Army, and Marines think they know what’s best for the Marines. But they all have different medical requirements that shouldn’t have any dissimilarities.”

In a statement, Military Health officials within the Department of Defense say they are conducting studies on the effectiveness of Truvada in certain situations, such as while on flight status or sea duty, and are also looking into barriers service members faced with access to care across the military branches. Among those barriers, Military Health noted that not every military hospital has infectious disease specialists who would prescribe the drug.

Truvada does not require a prescription from an infectious disease doctor, though. And the different policies, Seefried says, shows the lack of scientific competence within the Department of Defense and the policies they create.

“Navy Pilots, for example, can take Truvada while on the flight line, but Air Force pilots cannot while they are on the flight line,” says Seefried. “These military branches have different chains of command, so they have different policies that all agree on nothing. It’s just disjointed, and not grounded in science.”

Once a prison, now a home

The charges brought against Pinkela are confusing – even to lawyers who have reviewed his case. Hanssens, with the HIV Law and Policy Center, was one of them.

“What happened to him makes no sense,” she said.

Typically, when a prosecutor files charges, certain requirements have to be met. For assault and battery, according to the UCMJ, one of the primary actions has to be an unwanted physical and violent encounter or an action that is likely to cause death. There are no statutes that label the virus as a determinant for the charge.

Despite there not being an authorization on the books, scores of HIV positive service members like Pinkela have been brought before a court martial with felony assault and battery charges.

Pinkela’s case had gone through six prosecutors who thought the case was too weak before one finally picked it up, according to Pinkela.

And Pinkela’s court martial testimonies are even more bizarre: the soldier never said Pinkela and he had sex, nor did he ever say that Pinkela was the one who transmitted the virus to him. Instead, the evidence came down to an anal douche that may have been used and could’ve exposed the young soldier to HIV.

Not possible, says Rendina, the investigator from the City University of New York.

“Like most viruses, HIV is destroyed almost immediately upon contact with the open air,” he said. “The routes of transmission [listed in Pinkela’s case] have an extremely low probability of spreading infection due to the multiple defenses along the route from one body to the next – this is made even more true if the HIV-positive individual is also undetectable.”

When asked about the case, the Army only confirmed Pinkela’s charges but wouldn’t comment on the nature of the case or how HIV is prosecuted, generally, within the armed forces.

Pinkela has run out of appeals and is forced to now move forward with what little means he has. But in true spirit of service, he has found a new way to give back to the small town that he’s been forced to live in. In May, Pinkela plans to announce his plans to run for office in Otisville.

“I still believe in this country. And I still believe in the service, no matter that it’s the same system that allowed for this to happen to me,” he said.

In an effort to move past the experience, Pinkela and a friend went to last year’s Burning Man – the art and music festival held in Death Valley, California. There, when the fires began burning on the last day, he wrapped up his Army uniform, tied it off and threw it in a fire. He said it was one of the most cathartic moments he’s felt since being back in the Army.

Published in Rolling Stones on May 20, 2017

US: Rural Health Quarterly investigates the impact of HIV criminalisation and stigma in rural America

The little brown church in Nashua, Iowa, has a certain notoriety. In the mid-1800s, a music teacher passing through the town wrote a song about a church that he envisioned there. It was a perfectly prophetic gesture.

A few years later, a church was erected on that very spot—even though its parishioners had never heard the teacher’s song. Ever since, the church has been a special place—and a popular destination for weddings. As of August 2014, over 74,000 had taken place there.

One of those was Tami Haught’s. On November 27th, 1993, just two days after Thanksgiving, she married Roger in a joyful ceremony. But unbeknownst to the guests, the newlyweds harbored a dark secret: Roger had AIDS, and Tami had HIV.

“The doctor said to cancel [the wedding] because [Roger] wouldn’t live,” Haught said.

Roger had been diagnosed with AIDS a few months before, on August 4th. Tami was diagnosed with HIV on August 23rd, the day before her 25th birthday.

Roger lived for almost three years after his diagnosis. He died about two months before the birth of their son Adrian.

In those three years, Roger and Tami chose to love each other. But in the outside world, they suffered a lot—especially from the stigma.

“Back in the 90s, if you had cancer, people cared. If you had AIDS, people judged,” Haught said.

Roger was diagnosed with HIV in 1984, but shortly thereafter, following a car accident, his bloodwork came back with a false negative for HIV. Wanting to believe that he didn’t really have HIV, Roger didn’t question those results, and never mentioned his previous HIV diagnosis to anyone—not even his fiancé.

“I didn’t have time to blame him,” Tami said. “I had slept with him without having the conversation. I had put myself at risk.”

“It was a heterosexual foolery that we didn’t have to worry about it, because we were straight, or didn’t do drugs,” Tami continued. “It was a rude awakening, and proof that HIV doesn’t discriminate.”

Like much of the American public during the late 80s and 90s, Roger’s own family struggled to understand HIV/AIDS and accept that he had it. What made Roger’s situation worse is that he himself never really accepted it, Haught added.

“He was a redneck, homophobic cowboy, and he absolutely hated living with AIDS,” Haught said.

Tami and Roger moved back to Roger’s native rural Texas briefly after their wedding because that’s where he wanted to live, but they didn’t find adequate support there, and Roger didn’t want to go to the doctor and risk being seen.

So they moved back to Iowa where he could be somewhat anonymous. He was treated two hours away from Haught’s hometown, at the University of Iowa Hospitals and Clinics in Iowa City, a university town. They told everyone except their families that he had cancer.

Three or four months before Roger died, he told Haught that he couldn’t keep fighting.

“Finally, it was emotionally as well as physically that he was tired. And passed away.”

The death certificate says he died of kidney failure.

“But what the death certificate doesn’t show are all the mental issues,” Haught said.

THE SEEDS OF STIGMA

Haught will always remember the day she disclosed her HIV status to her family: February 10th, 1993. A couple of months after her wedding.

“It’s a day that my sister will never forget,” Tami said. “I disclosed it in probably one of the absolute worst ways. I came home. I had gotten some flyers and brochures [on HIV/AIDS]. I threw them on the coffee table. [I said] ‘Roger has AIDS. I am living with HIV. I don’t know how long I will live. I’m tired, and I’m going to bed.’

“They sat there in shock,” Tami continued. “My brother stood up and gave me a hug and said: ‘No matter what you need, we love you. We’re here for you.’ Some people are disowned. I was very lucky that I’ve always had their support.”

That was especially true because they were living in a punitive social environment. Several states, including Iowa, had criminalization laws against people for not disclosing their HIV status to partners.

“In order to get Ryan White funding, states had to prove that if somebody was intentionally propagating HIV, they could be prosecuted,” Tami said. The Ryan White Care Act, also known as the AIDS Prevention Act of 1990, was designed to improve the care of people with HIV/AIDS, especially those without insurance.

To receive funding, states had to enact disclosure laws, which thirty-three states did.

“Iowa’s was the most punitive,” Tami said. “In Iowa, if you could not prove you had disclosed your status, you were sentenced to 25 years in jail and put on a sex offenders’ registry.”

But proof of disclosure was difficult, not least because the burden of proof was always on the person with HIV, Haught said. As a result, the law sometimes became a weapon against people with HIV.

“People stayed in abusive relationships,” Haught said. “[Partners would say things like], ‘If you break up with me, I will tell police that you did not disclose your status.’”

The laws were also enacted at a time when there was limited medical knowledge about the disease and how it is transmitted.

“In Texas, someone got thirty years for spitting at a corrections officer,” Haught recalled. “You cannot get HIV from spitting.”

Haught dealt with discrimination head-on in Iowa while she was raising her son. She first ran into it when she went to introduce herself at his preschool.

“The first time I went to meet [the teachers], they didn’t want to shake my hand,” she said.

Haught had a case manager who guided her through those early years of disclosing her HIV status in school environments. For example, she agreed not to make homemade treats at preschool—and to be fair, all the other parents agreed they also wouldn’t make treats.

“Luckily, Adrian didn’t have any issues until eighth grade,” Haught said. “A friend of his came over and made fun of Adrian. He said his mom had AIDS and was going to die.”

Haught called the boy’s father, who made him stop. But still, the seeds of that stigma—along with Haught’s fear of her own death—stayed with her.

“I never imagined that I would live long enough to see [Adrian] graduate in 2015,” Haught said. “I was a blubbering mess. On December 27th of this year, he made me a grandma.”

Haught said that she began living to live—instead of die—about twelve years ago. She was at the dentist, and the hygienist cleaning Haught’s teeth scolded her lightly for not flossing her teeth every day.

“She said, ‘In ten years, when you start losing your teeth, you will regret it,’” Haught said. “I knew the diagnosis was that we were living longer, healthier lives, but I just never believed it having lived through the loss of my husband.”

“But it was the trigger for me to think about what I was going to do if I didn’t die,” Haught said.

What she did was throw herself into activism.

THE EVOLUTION OF A CAUSE

Haught started an advocacy group in 2006 called PITCH, which stands for Positive Iowans Taking Charge. They now have about 125 members, with various support groups throughout the state and an annual wellness summit.

“Some people say they look forward to it every year,” Haught said. “It’s the only time they can be themselves and ultimately admit they have HIV. The rest of the year, they live in silence.”

Haught also became involved with a national group called SERO, which is focused on ending inappropriate criminal persecutions of people with HIV. They are helping to repeal, state by state, criminalization laws that are rooted in a poor understanding of HIV transmission. Most laws do not consider that correct and consistent condom use as well as the use of antiretroviral therapy reduces the risk of transmission to a negligible level.

The National HIV/AIDS Strategy, released by the White House in 2010, also called attention to the problem of HIV criminalization, and the CDC has encouraged states to revisit these laws. The American Psychological Association has spoken out against HIV criminalization, recommending the repeal or reform of these laws so that they only punish HIV positive people who intentionally engage in behavior that is risky for transmission.

On its website, SERO lists several recommended actions for HIV positive people to protect themselves, including having sexual partners sign disclosure forms and saving all written communication should it be questioned.

So far, two states have reformed their laws: Iowa and Colorado. In 2014, Iowa replaced the 25-year flat prison sentence with a tiered sentencing system, depending on the circumstances of HIV transmission.

“I was actually speechless,” said Haught, who between 2012 and 2014 served as community organizer for CHAIN (Community HIV/Hepatitis Advocates of Iowa Network). Five days later, 200 activists came to Iowa to celebrate—and to ceremoniously cut off the ankle monitors on two HIV positive Iowans who had been forced to wear them under the old law.

Last May, Colorado became the second state to reform its laws.

“We’re working in other states to make progress,” Haught said, who as SERO’s organizing and training coordinator travels around to different states lobbying legislators.

“It’s really tough in the South,” she added.

THE LAW THAT ALMOST TOOK DOWN AN OLYMPIAN

In March, Haught was lobbying in Florida, the state with the highest number of HIV diagnoses. It is fourth in the nation for people living with HIV/AIDS.

Darren Chiacchia, an equestrian who won the Bronze medal in the 2004 Olympics, is one of those people. Chiacchia, who lives for part of the year on a horse farm in North Central Florida (and the other part in upstate New York) also knows first-hand the challenges of Florida’s HIV criminalization law and the stigma surrounding it.

In 2009, Chiacchia’s former lover Chandler decided to take revenge on Chiacchia for ending their four-month relationship: Chandler filed a report to the Marion County Sheriff’s Department claiming that he had found out about Chiacchia’s HIV status only one month before. Had that been true, Chiacchia would have violated Florida law by having had sex more than once without revealing his HIV status to his partner.

Chiacchia says he told Chandler about his status on their first date. “His [Chandler’s] reaction was, ‘True love will prevail,’” Chiacchia said.

But the relationship was rocky from the start, and every time Chiacchia tried to end it, Chandler threatened him with: ‘Don’t do this. Your life will be over as you know it.’

The twist in the story is that there were times that Chiacchia questioned his own truth. “He [Chandler] almost had me convinced that I hadn’t told him,” Chiacchia said.

A near-fatal horse accident in 2008 had left Chiacchia with Traumatic Brain Injury, which often comes with deep memory lapses. Incidentally, it was while hospitalized for the accident that Chiacchia found out he had HIV.

“It didn’t really freak me out,” he said. “It was just something that had to be taken care of.”

While recovering from the accident, Chiacchia fell into his relationship with Chandler. He was vulnerable, and his brain, he said, was “very malleable.”

It was only when Chiacchia, who’d made millions as a professional athlete, was sliding into bankruptcy to defend his case, that he began to recover his memory. To make sure his tax returns were up to date, he did his own forensic accounting, collecting the restaurant and country club receipts. That unlocked his memory about the night he told Chandler that he had HIV.

He reconstructed that night, and went back to the restaurant where he’d taken Chandler.

“I sat at the same stool at the end of the bar. I ordered my same favorite cocktail. I ordered my same favorite meal, and then afterwards I pulled into the same vacant parking lot where it all happened,” he said.

At that point, the case might have just ended up being a case of conflicting reports, but Chiacchia had a few other factors in his favor:

“Florida statute reads that the person must be informed,” Chiacchia said. “So what about the three other people who told him [my HIV status] instead?”

They all testified in favor of Chiacchia.

Also, to sue someone for HIV-related crimes, Chiacchia explained, HIV transmission must take place. “He [Chandler] gleefully reported himself negative,” Chiacchia said.

In February, after eight years of legal battles and debt, the Florida assistant state attorney dropped all charges against Chiacchia. It was the start of the biggest horse show of the year in Marion County, known as the horse capital of the world. It is Florida’s fifth largest county, as well as one of its most rural.

Chandler had suffered stigma living there during the eight years of his legal battles. He was in earshot of comments like, ‘They’re a couple of queers. They belong in jail anyway,’ Chiacchia said. His livelihood training equestrians and buying and selling prize horses suffered.

“People were quick to judge. My life as I knew it was over,” Chiacchia said. “That’s the stigma we’re talking about.”

That all changed when his case was cleared.

“The week the news hit was the first day of the horse show, and I think I got twenty-five hugs from people,” he said. “That was amazing.”

Chiacchia still has his horse farm in the thicket of Florida’s horse country. He’s grooming ten future champion horses and training young equestrians from all over the world, who in exchange help him out on the farm where he keeps an array of sheep, donkeys, chickens and dogs.

He’s always been a hustler, he said. Starting from the moment, when as a twelve-year-old delivering newspapers, he was first mesmerized by horses at the race track in Buffalo, New York, where he grew up. Since then, he’s tenaciously pursued his dreams—even in the face of the accusations.

His main concern with the HIV criminalization laws is that they empower accusations, he said.

“They also give people a false sense of security that someone wouldn’t do that,” meaning not reveal their HIV status. “Imagine a father telling his daughter not to worry whether she’s pregnant because it’s a guy’s responsibility.”

“The law suggests one’s sexuality is someone else’s responsibility,” he said. “People who don’t know their own status are the worst risk group.”

According to the CDC, 13 percent of HIV positive people in the U.S. over age 13 don’t know their status. Chiacchia said he wants to get more involved with education efforts now that the burden of his trial is over.

He’s acutely aware that most people with HIV similarly accused might not have had the resources to fight such a battle. HIV, especially in rural areas, disproportionately affects the poor.

“I’m an upper-middle class, white male, an Olympic athlete, living the American Dream, and this law almost took me down,” he said. “Think about all the other people out there.”

THE DEEP SOUTH: THE PERFECT STORM FOR HIV

AIDS activist Kathie Hiers remembers when the scope of the HIV/AIDS crisis in her home state of Alabama hit her. She was doing a home visit in Choctaw County, a deeply rural county with just under 14,000 inhabitants. Hiers was visiting a mother and her two daughters—all of whom were HIV positive. The older daughter was pregnant, and the younger one had pneumonia. The younger one sat facing the open oven door. She had a towel over her head to capture the heat, since they couldn’t afford to heat their home. A few weeks later, she died.

“Unfortunately, we just didn’t get her into care in time,” Hiers said, adding that all three women, who developed full-blown AIDS, had not been in regular care.

“They were sharing their medications with their boyfriends, thinking that would keep them from getting it. They weren’t getting the proper dosages,” Hiers added.

Poverty, lack of access to health care, pervasive stigma, racial inequalities and a high rate of STIs (sexually-transmitted infections)—which make it easier to transmit HIV—have made the rural South “the perfect storm for HIV,” Hiers said.

“Alabama is 50 percent plus rural, and it is exceedingly difficult to serve these people adequately,” Hiers added.

According to a recent report by the Center for Health Policy and Inequalities Research at Duke University, the South has had the highest number of HIV diagnoses for over a decade.

Of the 17 states comprising the South, the nine that make up the Deep South are particularly afflicted. In 2013, 40 percent of the country’s HIV diagnoses occurred in the Deep South, which accounts for only 28 percent of the U.S. population. The states in this region include Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Texas.

African-Americans in the South are also disproportionately affected by HIV. In 2013, 53 percent of the diagnoses in the Deep South were in African-Americans, compared to 44 percent in the U.S.

The Deep South has also traditionally had the highest death rates for people with HIV. Between 2008 and 2013, 43 percent of deaths in the U.S. attributed to HIV were in the Deep South, according to the report.

“You should not be dying from HIV in this day and age,” said Carolyn McAllaster, the Director of the Duke HIV/AIDS Policy Clinic. “If you’re on treatment, it’s a chronic illness with normal life expectancies. The folks who are dying are dying from inadequate care—late diagnosis, or not accessing care once they’ve been diagnosed.”

“The higher death rates are telling the story better than any number that we have,” she added.

Also, people with HIV in the rural Southeast were more likely to have an AIDS diagnosis within a year of being diagnosed with HIV, according to the report.

One of the problems is that rural areas in the South lack physicians. According to the report, 40 percent of HIV-specific providers are in the South, where 44 percent of the country’s HIV positive people are. Transportation issues also disproportionately affect people in rural areas. Some patients don’t have cars and can’t get to clinics—and they don’t want to ask for help lest people find out about their status.

“If they don’t have a car, stigma can kick in,” McAllaster said.

Stigma persists amongst providers as well, McAllaster added.

“Primary care providers do not want to prescribe PrEP because they think it will encourage risky sex,” she said. PrEP, or pre-exposure prophylaxis, is a preventive medication for people who are at substantial risk of HIV.

McAllaster likens likens the resistance to PrEP to the resistance to birth control pills because “they think she’ll sleep around.”

For similar reasons, sex education is not taught in schools in much of the South, which ultimately leads to unsafe practices, Hiers said. In Alabama, the number of young people with HIV has increased from one in four to one in three.

To overcome some of these hurdles, Hiers, the CEO of the nonprofit AIDS Alabama, has been working to get help and resources for HIV positive people in all of the state’s 67 counties. She started a telemedicine initiative so that people can be seen remotely—and privately.

“We’re learning that people would rather [our offices] not be located at health departments. A lot of peoples’ relatives work at the health department, and people are afraid of losing confidentiality,” Hiers said.

Local initiatives like this also help offset a disparity in funding at the national level for the rural South.

“A lot of the resources go to the big, urban areas,” McAllaster said. “A lot of our advocacy is around getting resources to the rural areas and smaller cities.”

Hiers added that certain urban areas like New York and San Francisco have almost ended the epidemic. “I tell my colleagues in bi-coastal areas that they will never end the epidemic in the U.S. without dealing with the South,” she said.

The updated National HIV/AIDS Strategy (NHAS) targets the South, with the goal of reducing HIV diagnoses by 25 percent within five years.

THE FUTURE OF HEALTH COVERAGE

Hiers breathed a sigh of relief when Trumpcare failed to pass in late March.

“Nothing about it was good for people with HIV,” she said, adding that the Affordable Care Act gave many HIV positive people a window of opportunity to access affordable healthcare and medications.

“Definitely the ACA helped people with HIV, even if they weren’t in states that expanded Medicaid,” she added. As an example, in Alabama—a non-expansion state—five percent of people with HIV signed up for the exchanges, she said.

In expansion states, Medicaid coverage for people with HIV increased six percent between 2012 and 2014 nationwide. In those same states, the uninsured rate of people with HIV dropped six percent, according to the Kaiser Family Foundation.

Haught said that the ACA also gave her access to more physicians.

“For the first time in twenty years, I was able to go to doctor five minutes from home, and I get all my medications from one source,” Haught said, adding that before the ACA, she would drive five hours round-trip just to see one doctor.

She is worried that any changes to the ACA will negatively affect people living with HIV.

“[Losing coverage] impacts adherence. If affects our lives. If we don’t get our medications, we will die.”

“I’ve seen that death,” she continued. “I wouldn’t wish it on anyone.”

While no one can predict the changes coming around the corner, one thing is certain for HIV activists:

“It’s not the right time to pull back in resources,” McAllaster said. “We’ve made some real advances in fighting this epidemic.”

Just a few days after the AHCA was sent back to the drawing board, activists were celebrating some of those advances—and advocating for more—at AIDS Watch. On March 28th over 650 people from 34 states gathered in Washington D.C. to educate members of Congress about their needs.

“I went to something that really choked me up,” Hiers said. “It’s a new wave of what’s coming.”

The presentation was called “Undetectable Equals: untransmittable,” and featured discussion of three major studies that have shown that HIV-positive people who are virally suppressed cannot transmit HIV. That knowledge should help revamp states’ criminalization laws, she said.

But the more profound impact might be an internal one to people living with HIV, she added.

“It was so moving to see HIV positive people change their perception of themselves. They don’t have to think of having sex as a loaded gun anymore. It’s really an encouragement for people to stay on theirs meds.”

Published in Rural Health Quarterly on May 12, 2017