US: ‘Turn It Up!’ an innovative resource for prisoners with HIV needs your help reaching Kickstarter goal

Sero is a national network of people with HIV and allies fighting HIV-related stigma, discrimination and criminalization by engaging and empowering ourselves and others with HIV to speak and advocate, conduct original research, document the experiences of those criminalized, educate communities and work in partnership with others to mobilize for change.

They particularly work to support and strengthen networks of people with HIV, especially those representing key populations, to bring their voice and insight to the discussion and development of policy, delivery of services and the media.

They have received many letters from people with HIV and/or hepatitis who are currently in prison, many on charges arising from their HIV or hepatitis status. Cindy Stine, Sero’s Prisoner’s Network co-ordinator, responds to these inquiries, provides research assistance and sometimes is able to help find legal counsel or other needed resources.

From this informal and growing network, it soon became clear that many people who are incarcerated have unique knowledge about effective strategies to maintain good health and access healthcare while behind bars.

Last September, Sero gathered a group of people who have been incarcerated or work with those who are, as well as HIV and hepatitis experts.

They spent time brainstorming how they could facilitate the sharing of advice, insights and tips from people who are in prisons or jails concerning how they stay as healthy as possible.

That led to the creation of Turn It Up! a new print resource guide for people with HIV and/or hepatitis who are incarcerated, as well as those newly-released from prison or jail and their friends and families.

Written and edited in large part by people who have themselves been incarcerated and/or have HIV and/or hepatitis, Turn It Up! will help those serving time navigate healthcare and stay as healthy as possible.

Laura Whitehorn and Suzy Martin, two longtime and prison reform activists, editors and HIV experts, are co-editing Turn It Up! They are both former editors at POZ magazine and Suzy works closely with Prison Health News.

To produce Turn It Up!, they worked with more than two dozen others, including contributors from prisons and jails in a dozen states, bringing an authentic, passionate and informed voice to the pages of Turn It Up!

The challenge now is to get it distributed to those who need it the most. Sero have launched a modest Kickstarter campaign, that includes this video explaining the project, which they hope will raise at least $5,000 to help with distribution costs.

Support the Kickstarter campaign here.

AFAO Policy Analyst Michael Frommer highlights the many types of anti-HIV criminalisation advocacy undertaken by the Canadian HIV/AIDS Legal Network

The 8th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2015) is on in Vancouver, Canada, this week. AFAO Policy Analyst Michael Frommer reports back on the pre-conference community forum.

Key human rights challenges, such as criminalisation of HIV transmission, were centre stage at the IAS community forum on Saturday 18 July.

Alison Symington, co-director of Research and Policy at the Canadian HIV/AIDS Legal Network (Legal Network), described the challenge of advocacy and policy work in Canada in the face of ongoing criminalisation.

Aside from the significant justice issues when charges are laid for HIV non-disclosure, exposure or transmission, she also identified the serious of issue of people threatening their partners with an allegation, when there is relationship conflict, and how this in particular affects women who may be in abusive relationships.

In Canada, as in Australia, most of the people charged to date have been male heterosexuals, with a strong racialised element – mainly Black men. Since the mid-1990s, there has been an increase in the proportion of gay men charged.

Despite the fact that men make up the majority of those charged, Alison has investigated the pernicious effects of criminalisation on women. She explained how the ‘informal’ criminalisation of HIV positive mothers works, with their sense that their parenting is being under surveillance.

She outlined a huge range of advocacy and policy activities being undertaken by the Legal Network in response.

1) Legal defence strategy and intervention

Tactics include contacting the defence lawyers of individuals who have been charged with criminalisation related offences. The Legal Network also intervenes in the formal court proceedings and provides relevant scientific evidence.

2) Campaigns and advocacy

This has involved the Legal Network’s participation in the ‘Stop the Witch Hunt’ campaign targeting prosecutors, undertaken in collaboration with the AIDS Action Now. Legal Network staff also sit in court during trials, to make clear to judges/prosecutors that the community is monitoring developments.

3) Raising awareness/education

This education work is targeted at raising understanding among judges and among the community.

4) Working with doctors/scientists

A key piece of work was the Canadian Scientist Statement on HIV transmission risk. The Legal Network organised for 70 leading scientists from across Canada to sign this document which explained clearly the actual levels of risk of HIV transmission.

5) Distinguishing between HIV non-disclosure and sexual assault

HIV non-disclosure/exposure/transmission charges in Canada are made under the Canadian criminal law as an aggravated charge using the sexual assault provisions. The Legal Network aims to work with domestic violence/feminist organisations to ensure that HIV-related jurisprudence does not circumvent the appropriate application of sexual assault laws.

6) Prosecutorial guidelines

This has been an ongoing area of work across Ontario, Quebec and British Columbia. Ontario most recently advocated for the adoption of guidelines, but without adequate community input the Government drafted guidelines were dropped. There is still a desire to pursue appropriately formulated guidelines in future.

Marama Pala (in the audience) highlighting Australia’s public

health response to MC Dazon Dixon Diallo.

The comprehensive advocacy and policy response taken by the Canadian Legal Network is extremely impressive.

With one of, if not the highest rates per capita of criminalisation in the world, it is obviously very necessary in the Canadian context.

While some circumstances differ, there are a great many ideas that may be drawn upon for responding to HIV criminalisation in the Australian context.

US: As college student, Michael Johnson, 23, is sentenced to 30 1/2 years for HIV exposure, advocates organise and condemn Missouri’s HIV-specific law as ‘barbaric’

Yesterday, Michael Johnson, 23, was sentenced to 30 1/2 years in prison after being found guilty on May 14th of five counts stemming from the accusations of three people who said he exposed them to the virus without their knowledge.

For the most serious charge, recklessly infecting another with HIV, Johnson will serve 30 years in prison. The remaining four charges, for HIV ‘exposure’, carried sentences of 5.5, 5.5, 5.5 and 14 years. Johnson will serve his sentences concurrently, meaning he will spend a total of 30 1/2 years in prison.

Mr Johnson’s case created considerable attention from HIV, gay and social justice advocates, such as this open letter from black gay men, and the press release from The Center for HIV Law and Policy below.

Tomorrow (Wednesday 15th July), the Counter Narrative Project, HIV Prevention Justice Alliance and Positive Women’s Network – USA will hold a webinar to provide an update on the current on-the-ground efforts to support his appeal and a discussion of advocacy strategy from a legal, media, intersectional and activism perspective.

Click on this link to register for Michael L. Johnson: Strategizing collectively for justice.

Sentencing of Missouri College Student in HIV “Exposure” Case Decried As “Barbaric”

UNAIDS Reference Group on HIV and Human Rights updates statement on HIV testing to include the “key trend” of “prolific unjust criminal laws and prosecutions”

The UNAIDS Reference Group on HIV and Human Rights has updated its statement on HIV testing — which continues to emphasise that human rights, including the right to informed consent and confidentiality, not be sacrifced in the pursuit of 90-90-90 treatment targets — in the light of “three key trends that have emerged since the last statement regarding HIV testing was issued by the UNAIDS Reference Group (in 2007).”

One of these is “prolific unjust criminal laws and prosecutions, including the criminalization of HIV non-disclosure, exposure, and transmission.” The other two involve the recognition that HIV treatment is also prevention, and policies that aim to “end the AIDS epidemic as a public health threat by 2030.”

This statement is an important policy document that can be used to argue that public health goals and human rights goals are not mutually exclusive.

The Reference Group was established in 2002 to advise the Joint United Nations Programme on HIV/AIDS (UNAIDS) on all matters relating to HIV and human rights. It is also fully endorsed by by the Global Fund to Fight AIDS, Tuberculosis and Malaria Human Rights Reference Group.

This statement is issued at a time when UNAIDS and the Global Fund are renewing their strategies for 2016–2021 and 2017–2021, respectively.

To support these processes, the Reference Groups offer the following three key messages:

1. There is an ongoing, urgent need to increase access to HIV testing and counselling, as testing rates remain low in many settings. The Reference Groups support such efforts unequivocally and encourage the provision of multiple HIV testing settings and modalities, in particular those that integrate HIV testing with other services.

2. Simply increasing the number of people tested, and/or the number of times people test, is not enough, for many reasons. Much greater efforts need to be devoted to removing barriers to testing or marginalized and criminalized populations, and to link those tested with prevention and treatment services and successfully keep them in treatment.

3. Public health objectives and human rights principles are not mutually exclusive. HIV testing that violates human rights is not the solution. A “fast-track” response to HIV depends on the articulation of testing and counselling models that drastically increase use of HIV testing, prevention, treatment, and support services, and does so in ways that foster human rights protection, reduce stigma and discrimination, and encourage the sustained and supported engagement of those directly affected by HIV.

The section on HIV criminalisation is quoted below.

The criminalization of HIV non-disclosure, exposure, and transmission is not a new phenomenon, but the vigour with which governments have pursued criminal responses to alleged HIV exposures — at the same time as our understanding of HIV prevention and treatment has greatly advanced, and despite evidence that criminalization is not an effective public health response — causes considerable concern to HIV and human right advocates. In the last decade, many countries have enacted HIV-specifc laws that allow for overly broad criminalization of HIV non-disclosure, exposure, and transmission. This impetus seems to be “driven by the wish to respond to concerns about the ongoing rapid spread of HIV in many countries, coupled by what is perceived to be a failure of existing HIV prevention efforts.” In some instances, particularly in Africa, these laws have come about as a response to women being infected with HIV through sexual violence, or by partners who had not disclosed their HIV status.

Emerging evidence confrms the multiple implications of the criminalization of HIV non-disclosure, exposure, and transmission for HIV testing and counselling. For example, HIV criminalization can have the effect of deterring some people from getting tested and finding out their HIV status. The possibility of prosecution, alongside the intense stigma fuelled by criminalization, is good reason for some to withhold information from service providers or to avoid prevention services, HIV testing, and/or treatment. Indeed, in jurisdictions with HIV-specific criminal laws, HIV testing counsellors are often obliged to caution people that getting an HIV test will expose them to criminal liability if they find out they are HIV-positive and continue having sex. They may also be forced to provide evidence of a person’s HIV status in a criminal trial. This creates distrust in relationships between people living with HIV and their health care providers, interfering with the delivery of quality health care and frustrating efforts to encourage people to come forward for testing.

The full statement, with references, can be downloaded here and is embedded below.

HIV TESTING AND COUNSELLING: New technologies, increased urgency, same human rights

Sweden: HIV activists call for the abolition of the duty to disclose in line with scientific progress

The new knowledge we have today about the transfer risks, should contribute to a change in infectious disease control law design.

The duty to disclose for people living with HIV should be abolished as soon as possible, writes representatives from RFSL, RFSU and HIV Sweden.

HIV was included in the Swedish Communicable Diseases legislation in 1985. The purpose was to provide support for the measures it considered necessary to slow down the transmissions of HIV, an infection, they were convinced, that could become an epidemic out of control.

Despite the limited knowledge then available on HIV the Government noted in its preparatory work to the Act that: “If a cure is discovered meaning that infected people can become free of infection, the perception of infectiousness willl obviously change. It would also be the same if one could find that the infection, whether a cure is available or not, is not contagious in some periods “(Prop. 1985/86: 13).

In October 2013 the Public Health Agency launched its knowledge base “Infectiousness in treated HIV infection.” The Authority concluded that the risk of transmitting HIV through sexual contact when a condom is used, is almost non-existent.

The risk is also considered as very small if a condom is not used.

In Sweden, over 90 percent of those who received a hiv diagnosis are on effective treatment today. In accordance with the intentions that were in the preparatory work to the country legislation in 1985, the knowledge we now have about transmission risks, should contribute to a change in infectious disease control law design.

One of the positions that RFSL, RFSU and HIV Sweden usually get to explain is precisely why we believe that the so-called disclosure duties should be removed for people living with HIV.

The duty to disclose is one of several precautions that people living with HIV must follow under the current disease control legislation. The duty to disclose requires that people living with HIV must inform their sex partners of their HIV.

he duty to disclose takes the focus away from what is hiv prevention most central message: that all people in sexual encounters should take responsibility to protect themselves and their partners.

So under the legislation this responsibility rests with the party who knows about his/her HIV as the duty to disclose. This despite the fact that over 90 percent of those currently living with HIV are taking effective treatment and are exposing a sexual partner to an almost non-existent risk of HIV transmission.

It stands in stark contrast to the fact that in most cases, it is those who do not know they have HIV who transmit the virus to others. The highest risk of transmission comes from this undiagnosed population.

This group is of course under no obligation to disclose information about which they know nothing, and therefore does not have anything to tell. The duty to disclose is therefore counterproductive and contributes to the stigmatization of people living with HIV who know about their status.

RFSL, RFSU and HIV Sweden are calling for a revision of regulations of the 2004 Infectious Diseases Act and the abolition of the duty to disclose.

We have met with opposition within the authorities, medical officers, their lawyers and policymakers. Often we are subjected to the view that we do not fully understand how the law works and a belief that we want to bring HIV out of the Communicable Diseases Act. That is not the case.

We believe that HIV must be included in the Communicable Diseases Act from a prevention and treatment perspective. But we believe that the law can easily be designed in such a way that HIV, and any other relevant diseases, are excluded from a conduct that is counter-productive, which departs from Prevention key messages, which stigmatizes people living with HIV, and is not in line with the knowledge we have today about transmission risks.

To make it easier for policy makers and officials, we have in collaboration with lawyers developed an example of how Diseases Act may be formulated to overcome the misconceptions there may seem to be about our position. The example can be downloaded here.

It is now our hope that the government ensures that the revision of the Infectious Diseases Act be implemented promptly and that the duty to disclose for people living with HIV can thus be abolished in the near future.

Christian Antoni Möllerop

Vice ‘Union

RFSL

Kristina Ljungros

Chairman of the Federation

RFSU

Christina Franzen

President

HIV Sweden

—————————————–

Den nya kunskap vi i dag har om överföringsrisker, bör bidra till en förändring av smittskyddslagstiftningens utformning.

Informationsplikten för personer som lever med hiv bör avskaffas snarast, skriver representanter från RFSL, RFSU och Hiv-Sverige.

1985 inkluderades hiv i den svenska smittskyddslagstiftningen. Syftet var att ge stöd till de åtgärder man ansåg nödvändiga för att bromsa överföringarna av hiv, en infektion man då var övertygad om att kunde bli en epidemi utom all kontroll.

Trots den begränsade kunskap som då fanns om hiv konstaterade regeringen i förarbetena till lagen att: ”Om något botemedel upptäcks som innebär att den smittade kan bli smittfri, kommer detta självklart att ändra synen på när smittsamhet föreligger. Detsamma blir förhållandet om man skulle finna att infektionen, oavsett om något botemedel finns att tillgå eller ej, inte är smittsam i vissa perioder” (Prop. 1985/86:13).

I oktober 2013 lanserade Folkhälsomyndigheten kunskapsunderlaget “Smittsamhet vid behandlad hivinfektion”. Där slår myndigheten fast att risken för att överföra hiv genom sexuell kontakt vid välfungerande behandling, när kondom används, är närmast obefintlig.

Risken bedöms även som mycket liten om kondom inte används.

I Sverige har över 90 procent av de som fått en hivdiagnos en välfungerande behandling i dag. I enlighet med de intentioner som fanns i förarbetena till smittskyddslagstiftningen från 1985, måste därför den kunskap vi nu har om överföringsrisker, bidra till en förändring av smittskyddslagstiftningens utformning.

Ett av de ställningstaganden som RFSL, RFSU och Hiv-Sverige oftast får förklara är just varför vi anser att den så kallade informationsplikten borde tas bort för personer som lever med hiv.

Informationsplikten är en av flera förhållningsregler som personer som lever med hiv måste följa enligt den gällande smittskyddslagstiftningen. Informationsplikten kräver att den som lever med hiv ska informera sina sexpartners om sin hiv.

Informationsplikten tar bort fokus från det som är hivpreventionens mest centrala budskap: att samtliga personer i det sexuella mötet bär ansvaret för att skydda sig själv och sin partner.

Så som lagstiftningen är utformad vilar ansvaret på den av parterna som vet om sin hiv att informera. Detta trots att över 90 procent av dem som i dag lever med hiv har en välfungerande behandling och därmed utsätter sexpartners för en närmast obefintlig risk för hivöverföring.

Det står i stark kontrast till det faktum att det är de som inte vet om att de bär på hiv som överför viruset i de flesta fall till andra. Det är alltså dessa odiagnostiserade det finns en stor risk att få viruset överfört från.

För denna grupp gäller förstås ingen informationsplikt då de inget vet och därför heller inte har något att berätta. Informationsplikten är därför kontraproduktiv och den bidrar till att stigmatisera personer som lever med hiv och vet om sin status.

RFSL, RFSU och Hiv-Sverige har sedan informationsplikten lagreglerades 2004 jobbat för en översyn av smittskyddslagen och ett avskaffande av informationsplikten.

Vi har stött på patrull inom myndigheter, smittskyddsläkare, deras jurister och bland beslutsfattare. Ofta bemöts vi av en uppfattning om att vi inte helt har förstått hur lagen fungerar eller en övertygelse om att vi vill ta hiv ut ur smittskyddslagen. Så är inte fallet.

Vi anser att hiv måste ingå i smittskyddslagen ur ett preventions- och behandlingsperspektiv. Men vi anser att lagen enkelt kan utformas på så sätt att hiv, och eventuellt andra relevanta sjukdomar, undantas från de förhållningsregler som är kontraproduktiva, som frångår det som är preventionens centrala budskap, som stigmatiserar personer som lever med hiv, och som inte ligger i linje med den kunskap vi numera har om överföringsrisker.

För att underlätta för beslutsfattare och tjänstemän har vi i samarbete med jurister tagit fram ett exempel på hur smittskyddslagen kan formuleras för att råda bot på de missuppfattningar om vårt ställningstagande som kan synas finnas. Exemplet kan laddas ner här.

Det är nu vår förhoppning att regeringen ser till att en översyn av smittskyddslagen sker skyndsamt och att informationsplikten för personer som lever med hiv därmed kan avskaffas inom en nära framtid.

Christian Antoni Möllerop

Vice förbundsordförande

RFSL

Kristina Ljungros

Förbundsordförande

RFSU

Christina Franzén

Ordförande

Hiv-Sverige

World Health Organization publishes analysis of impact of overly broad HIV criminalisation on public health

A new report from the World Health Organization, Sexual Health, Human Rights and the Law, adds futher weight to the body of evidence supporting arguments that overly broad HIV criminalisation does more harm than good to the HIV response.

Drawing from a review of public health evidence and extensive research into human rights law at international, regional and national levels, the report shows how each country’s laws and policies can either support or deter good sexual health, and that those that support the best public health outcomes “are [also] consistent with human rights standards and their own human rights obligations.”

The report covers eight broad areas relating to sexual health, human rights and the law, including: non-discrimination; criminalisation; state regulation of marriage and family; gender identity/expression; sexual and intimate partner violence; quality of sexual health services; sexuality and sexual health information; and sex work.

The authors of the report note that it provides “a unique and innovative piece of research and analysis. Other UN organizations are examining the links between health, human rights and the law: the United Nations Development Programme’s (UNDP’s) Global Commission on HIV and the Law published its report in 2012, and the Office of the High Commissioner for Human Rights (OHCHR) and United Nations Special Rapporteurs regularly report to the Human Rights Council on the impact of laws and policies on various aspects of sexual health. Nevertheless, this is the first report that combines these aspects, specifically with a public health emphasis.”

The points and recommendations made relating to overly broad HIV criminalisation (italicised for ease of reference) are included in full below.

Executive Summary: The use of criminal law (page 3)

All legal systems use criminal law to deter, prosecute and punish harmful behaviour, and to protect individuals from harm. However, criminal law is also applied in many countries to prohibit access to and provision of certain sexual and reproductive health information and services, to punish HIV transmission and a wide range of consensual sexual conduct occurring between competent persons, including sexual relations outside marriage, same-sex sexual behaviour and consensual sex work. The criminalization of these behaviours and actions has many negative consequences for health, including sexual health. Persons whose consensual sexual behaviour is deemed a criminal offence may try to hide it from health workers and others, for fear of being stigmatized, arrested and prosecuted. This may deter people from using health services, resulting in serious health problems such as untreated STIs and unsafe abortions, for fear of negative reactions to their behaviour or health status. In many circumstances, those who do access health services report discrimination and ill treatment by health-care providers.

International human rights bodies have increasingly called for decriminalization of access to and provision of certain sexual and reproductive health information and services, and for removal of punishments for HIV transmission and a wide range of consensual sexual conduct occurring between competent persons. National courts in different parts of the world have played an important role in striking down discriminatory criminal laws, including recognizing the potentially negative health effects.

3.4.5 HIV status (pages 22-23)

Although being HIV-positive is not itself indicative of sexual transmission of the infection, individuals are often discriminated against for their HIV-positive status based on a presumption of sexual activity that is often considered socially unacceptable.

In addition, in response to the fact that most HIV infections are due to sexual transmission, a number of countries criminalized transmission of, or exposure to, HIV, fuelling stigma, discrimination and fear, and discouraging people from getting tested for HIV, thus undermining public health interventions to address the epidemic.

Even where persons living with HIV/AIDS may be able, in principle, to access health services and information in the same way as others, fear of discrimination, stigma and violence may prevent them from doing so. Discrimination against people living with HIV is widespread, and is associated with higher levels of stress, depression, suicidal ideation, low self-esteem and poorer quality of life, as well as a lower likelihood of seeking HIV services and a higher likelihood of reporting poor access to care.

HIV transmission has been criminalized in various ways. In some countries criminal laws have been applied through a specific provision in the criminal code and/or a provision that allows for a charge of rape to be escalated to “aggravated rape” if the victim is thought to have been infected with HIV as a result. In some cases, HIV transmission is included under generic crimes related to public health, which punish the propagation of disease or epidemics, and/or the infliction of “personal injury” or “grievous bodily harm”.

Contrary to the HIV-prevention rationale that such laws will act as a deterrent and provide retribution, there is no evidence to show that broad application of the criminal law to HIV transmission achieves either criminal justice or public health goals. On the contrary, such laws fuel stigma, discrimination and fear, discouraging people from being tested to find out their HIV status, and undermining public health interventions to address the epidemic. Thus, such laws may actually increase rather decrease HIV transmission.

Women are particularly affected by these laws since they often learn that they are HIV-positive before their male partners do, since they are more likely to access health services. Furthermore, for many women it is either difficult or impossible to negotiate safer sex or to disclose their status to a partner for fear of violence, abandonment or other negative consequences, and they may therefore face prosecution as a result of their failure to disclose their status. Criminal laws have also been used against women who transmit HIV to their infants if they have not taken the necessary steps to prevent transmission. Such use of criminal law has been strongly condemned by human rights bodies.

Various human rights and political bodies have expressed concern about the harmful effects of broadly criminalizing the transmission of HIV. International policy guidance recommends against specific criminalization of HIV transmission. Human rights bodies as well as United Nations’ specialized agencies, such as UNAIDS, have stated that the criminalization of HIV transmission in the instance of intentional, malicious transmission is the only circumstance in which the use of criminal law may be appropriate in relation to HIV. States are urged to limit criminalization to those rare cases of intentional transmission, where a person knows his or her HIV-positive status, acts with the intent to transmit HIV, and does in fact transmit it.

Human rights bodies have called on states to ensure that a person’s actual or perceived health status, including HIV status, is not a barrier to realizing human rights. When HIV status is used as the basis for differential treatment with regard to access to health care, education, employment, travel, social security, housing and asylum, this amounts to restricting human rights and it constitutes discrimination. International human rights standards affirm that the right to non-discrimination includes protection of children living with HIV and people with presumed same-sex conduct. Human rights standards also disallow the restriction of movement or incarceration of people with transmissible diseases (e.g. HIV/AIDS) on grounds of national security or the preservation of public order, unless such serious measures can be justified.

To protect the human rights of people living with HIV, states have been called on to implement laws that help to ensure that persons living with HIV/AIDS can access health services, including antiretroviral therapy. This might mean, as in the case of the Philippines, for example, explicitly prohibiting hospitals and health institutions from denying a person with HIV/AIDS access to health services or charging them more for those services than a person without HIV/AIDS (167).

International guidance also suggests that such laws should be consistent with states’ international human rights obligations and that instead of applying criminal law to HIV transmission, governments should expand programmes that have been proven to reduce HIV transmission while protecting the human rights both of people living with HIV and those who are HIV-negative.

3.6 Legal and policy implications (pages 29-30)

5. Does the state consider that establishing and applying specific criminal provisions on HIV transmission can be counter-productive for health and the respect, protection and fulfilment of human rights, and that general criminal law should be used strictly for intentional transmission of HIV?

The full report can be downloaded from the WHO’s Sexual and Reproductive Health website.

Sweden: Jan Albert from the Karolinska Institute reports on HIV Criminalisation in Sweden

On a crossroads – Sweden’s view on the criminalization of HIV

BY ANNA-MARIA SÖRBERG REPORTAGE 15-06-22

“We need to disagree with what is humanly reasonable and what is prosecutable. It says infectious prophet Jan Albert hoping for continued decriminalization of people living with HIV. Ottar has looked closely at the advent of one of the world’s toughest guidelines on the criminalization of potential HIV transmission.

“It was counted as the year’s most significant scientific breakthrough, all categories, including the cosmos,” says Jan Albert at the Karolinska Institute.

He talks about the international HIV-drug study, presented in 2011, which has a special significance in Sweden, where what is known as the criminalization of HIV transmission – that people are sentenced for transmission or attempted transmission of the disease – were central to the discussions later year.

Jan Albert has spent a great deal of time as an expert witness in litigation where one or more have reported a cohabitant or temporary partner to have exposed them to the risk of disease. By now, there have been about 30 trials. He points out that these are complex issues.

Jan Albert

The latest case law occurred a little over a year ago in Skåne and led to a free sentence for the man reported by four women for not telling her HIV status. The sentence is referred to as a clear change of course in Swedish HIV history, which is otherwise a country known to have one of the world’s hardest guidelines on the criminalization of potential transmission of HIV. Gone were the earlier offenses as “gross abuse” as well as headlines in the media, as “a new hivman ravaged”.

The Court’s reasoning was that , despite being unprotected sex with four different women , the man remained undergoing treatment, did not infect any of the women and had so low levels of virus that they were not considered to be a danger of transmission. A reasoning that is a direct result of the international study that states that the risk of contagiousness is extremely small, perhaps not existing at all, in the case of effective treatment.

“Today, HIV is, by medical means, a relatively manageable disease. The medications mean that the one who lives with HIV is likely to die from something else and then I think it becomes more important to look at social stigma, “says Jan Albert.

Putting people into prison because they have not informed about their HIV status reinforces that stigmatism, says the infectious professor.

The National Board of Health and Welfare recently updated the guidelines for the obligation to provide information. Nowadays, it does not apply to everyone, but the assessment is done on a case-by-case basis.

“We are now starting to approach the UN agency UNAIDS minimum requirement not to be convicted of HIV infection if no one has been infected, and especially if the risk is virtually non-existent as it is during effective treatment.

This can be seen as a first step towards not having criminalization at all, as is the case in, for example, Holland. And as regards the duty of information, today there is a majority in the Swedish Parliament to completely remove it.

In most cases , HIV is transmitted from people who do not themselves know that they are suffering from the disease. For those who work with HIV issues, the convicting judges make the effort to make people more informed about themselves and others about the disease.

“It is important that we disagree with what is socially reasonable, what the laws say and what should be prosecutable,” says Jan Albert, and continues: If I’m infected and my wife is not, I personally think that the recommendation should be that I should tell her, but it is a completely different matter what the laws should contain, and above all, whether it should be punishable in court.

In the 1980s, Jan Albert worked as an infection physician at Roslagstull Hospital and saw the first difficult aids. The suffering he experienced as a young doctor has characterized him and many others for the rest of his life. After Jonas Gardell’s novel and television series Never wipe tears without gloves , few people in Sweden can claim that they never heard of the HIV / AIDS epidemic.

The hysterical campaigns in the 80’s that sometimes threatened people from having sex is unthinkable today, Jan Albert believes. At the same time there is a view from the 80’s that we have not done in other ways.

“Then you did not know how the spread of infection looked or how big the epidemic would be. Through that, a view was made of HIV and AIDS as a very special disease. It is an approach we have never really managed to change, I think.

The ignorance and prejudice remain alive.

– They are only very rarely up to the surface because the subject is not as current.

Mattew Weait is a professor of law at Birkbeck College in London. He has examined Scandinavia and the common path chosen by the countries in terms of HIV policy and the consequences it has had for the sight of the disease. He believes that one of the explanations for the relatively extensive criminalization, such as Sweden, Norway and Finland, has been found in the relentless confidence in the state, as well as interpersonal relations.

– The regular World Value surveys investigating countries’ attitudes in the world show that what separates Nordic countries from many others is the ability to consider a person’s failure to tell the truth as a crime, and something that could be a criminal offense.

Swedish HIV policy has not been subjected to any major review over the years . Compared to drug issues, there are now several different lines raised in public, while the HIV issue is rarely presented as an issue with several different inputs.

The one who attempts to challenge the current policy must, as Matthew Weait is in, often argue in the first place that: the reason for questioning the criminalization of so-called HIV cases is based on a desire to facilitate people to escape liability – or at least to be a consequence of the expiry of the case.

For Jan Albert, a course change in the HIV issue is about seeing how preventive work can be improved, how we reach out to more people with knowledge that is updated, nuanced and reality-based.

“We can not have a right of justice for HIV, which differs so much from how we handle other serious infectious diseases in this country, as is the case today. It counteracts the overall goal of limiting the damage without reinforcing them, “says Albert.

Anna-Maria Sörberg is a freelance journalist and has previously written the book “Det Sjuka” (2009)

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Vid ett vägskäl – Sveriges syn på kriminalisering av hiv

AV ANNA-MARIA SÖRBERG REPORTAGE 15-06-22

– Vi behöver hålla isär vad som är medmänskligt rimligt och vad som är åtalbart. Det säger smittskyddsprofessorn Jan Albert som hoppas på fortsatt avkriminalisering av människor som lever med hiv. Ottar har tittat närmare på uppluckringen av en av världens hårdaste riktlinjer kring kriminalisering av potentiell överföring av hiv.

– Den räknades som det årets mest betydelsefulla vetenskapliga genombrott, alla kategorier, kosmos inräknat, säger smittskyddsprofessorn Jan Albert vid Karolinska Institutet.

Han pratar om den internationella studie om medicinering av hiv som presenterades 2011 och som fått en särskild betydelse i Sverige, där det som kallas kriminalisering av hiv-överföring – att människor döms för överföring eller försök till överföring av sjukdomen – varit central i diskussionerna under senare år.

Jan Albert har tillbringat en hel del tid som expertvittne i rättegångar där någon eller flera har anmält en sambo eller tillfällig partner för att ha utsatt dem för risk för sjukdom. Vid det här laget har det blivit ett 30-tal rättegångar. Han påpekar att det här rör sig om komplexa saker.

Det senaste rättsfallet inträffade för ett drygt år sedan i Skåne och ledde till en friande dom för mannen som anmälts av fyra kvinnor för att inte ha berättat om sin hiv-status. Domen betecknas som en tydlig kursändring i svensk hiv-historia, som annars är ett land känt för att ha en av världens hårdaste riktlinjer kring kriminalisering av potentiell överföring av hiv. Borta var de tidigare brottsrubriceringarna som »grov misshandel« liksom rubriker i media i stil med att »en ny hivman härjat«.

Domstolens motivering var att mannen – trots att han haft oskyddat sex med fyra olika kvinnor – stått under fungerande behandling, inte smittat någon av kvinnorna och haft så låga virusnivåer att de inte ansågs utgöra någon fara för överföring. Ett resonemang som är ett direkt resultat av den internationella studien som fastslår att risken för smittsamhet är ytterst liten, kanske inte existerande alls, vid fungerande behandling.

– Numera är ju hiv medicinskt sett en relativt hanterbar sjukdom. Medicinerna gör att den som lever med hiv förmodligen kommer dö av något annat och då anser jag att det blir viktigare att titta på socialt stigma, säger Jan Albert.

Att sätta människor med hiv i fängelse för att de inte informerat om sin hiv-status förstärker det stigmat, konstaterar smittskyddsprofessorn.

Socialstyrelsen uppdaterade för några år sedan riktlinjerna för informationsplikten. Numera gäller den inte alla, utan bedömningen sker från fall till fall.

– Vi börjar nu närma oss FN-organet UNAIDS minimikrav att man inte ska dömas för att ha spridit hiv om ingen har blivit smittad, och framförallt inte om risken är så gott som obefintlig som den är vid fungerande behandling.

Det kan ses som ett första steg mot att inte ha kriminalisering överhuvudtaget, vilket är fallet i till exempel Holland. Och när det gäller just informationsplikten finns det i dag en majoritet i Sveriges riksdag för att helt ta bort den.

I de flesta fall överförs hiv från personer som inte själva vet om att de bär på sjukdomen. För de som arbetar med frågor om hiv försvårar de fällande domarna arbetet med att få människor att i högre grad informera sig själva och andra om sjukdomen.

– Det är viktigt att vi håller isär vad som är medmänskligt rimligt, vad lagarna säger och vad som ska vara åtalbart, säger Jan Albert och fortsätter: Om jag är smittad och min fru inte är det tycker jag personligen att rekommendationen ska vara att jag ska berätta för henne, men det är en helt annan sak vad lagarna ska innehålla och framförallt huruvida det ska vara straffbart i domstol.

På 1980-talet arbetade Jan Albert som infektionsläkare på Roslagstulls sjukhus och såg de första svåra aidsfallen. Det lidande han upplevde på plats som ung läkare har präglat honom och många andra för resten av livet. Efter Jonas Gardells roman och tv-serie Torka aldrig tårar utan handskar kan få människor i Sverige hävda att de aldrig hört talas om hiv/aids-epidemin.

De hysteriska kampanjerna under 80-talet som ibland nästan hotade folk från att ha sex är otänkbara idag, tror Jan Albert. Samtidigt finns ett synsätt kvar från 80-talet som vi på andra sätt inte har gjort upp med.

– Då visste man ju inte hur smittspridningen såg ut eller hur stor epidemin skulle bli. Genom det formades en syn på hiv och aids som en väldigt speciell sjukdom. Det är ett synsätt som vi aldrig riktigt har lyckats förändra, anser jag.

Okunskapen och fördomarna lever fortfarande kvar.

– De är bara väldigt sällan uppe vid ytan eftersom ämnet inte är lika aktuellt.

Mattew Weait är professor i juridik vid Birkbeck College i London. Han har granskat Skandinavien och den gemensamma väg länderna valt vad gäller hiv-politik och vilka konsekvenser det har fått för synen på sjukdomen. Han tror att en av förklaringarna till den relativt omfattande kriminalisering som framförallt Sverige, Norge och Finland haft går att finna i den obevekliga tilltron till staten, liksom till mellanmänskliga relationer.

– De regelbundna World Value-undersökningar som undersöker länders attityder i världen visar att det som skiljer nordiska länder från många andra är möjligheten att betrakta en persons misslyckande att berätta sanningen som ett brott, och något som ska kunna vara en straffbar handling.

Den svenska hiv-politiken har inte utsatts för någon större granskning genom åren. Om man jämför med narkotikafrågan så finns där numera flera olika linjer som lyfts fram i offentligheten medan hiv-frågan sällan presenteras som en fråga med flera olika ingångar.

Den som försöker sig på ett ifrågasättande av den rådande politiken måste, som Matthew Weait är inne på, ofta först argumentera sig ur fällan som uppstår: att anledningen till att man ifrågasätter kriminalisering av så kallade hiv-fall sker utifrån en önskan att underlätta för människor att undkomma ansvar – eller att det åtminstone kommer bli en konsekvens om rättsfallen upphör.

För Jan Albert handlar en kursändring i hiv-frågan snarare om att se hur det förebyggande arbetet kan förbättras, hur vi når ut till fler människor med kunskap som är uppdaterad, nyanserad och verklighetsförankrad.

– Vi inte kan ha en rättskipningspraxis för hiv som skiljer sig så mycket från hur vi hanterar andra allvarliga infektionssjukdomar i det här landet, så som är fallet idag. Det motverkar det övergripande målet att begränsa skadorna utan att förstärka dem, säger Albert.

Anna-Maria Sörberg är frilansjournalist och har tidigare skrivit boken ”Det sjuka” (2009)

Zambia: Network of people living with HIV react to last week’s prosecution of a Zambian man in Wales for reckless HIV transmission, say HIV criminalisation is unworkable and unjust

THE Network of Zambian People Living with HIV and AIDS says criminalizing HIV transmission cannot work in a country like Zambia which has a high prevalence rate of the disease. Commenting on a story in Swansea, Great Britain where a Zambian man has been jailed for seven years after infecting two women with HIV, NZP+ programme manager Kunyima Banda in an interview described the situation as unfortunate.

According to the South Wales Evening Post, Mweetwa Muleya, 28, had unprotected sex with two women knowing he had HIV and he failed to tell them about his HIV condition before having sex with them. A court heard the women were “devastated” to find out they had caught the life changing illness after going for blood tests.

Asked if Zambia could also introduce a law to criminalize HIV infection, Banda said criminalizing HIV infection would becomes a barrier for people to access HIV/AIDS services.

“It is not right to willfully infect another person but it would be difficult for Zambia because you have to establish whether willful infection did take place, whether the person at a time that they had intercourse, the other person never knew that the partner was infected, that has to be determined as well. You also have to determine that the person actually did want to infect on purpose,” Banda said.

She said Zambia’s current system could not allow the criminalization of HIV because the country was putting interventions where more people could go for be testing.

“If we have a law which criminalizes HIV infection, it means that a lot of people will not go for HIV testing. What it will mean is that if people do not want to know their status, chances of them infecting other people then becomes higher because then they do not know that they are infected with HIV,” Banda said.

“Just imagine if a pregnant woman who has no access to medical facilities then gives birth and the baby gets infected, what do you call that? So all those are issues that we need to consider to make that law in Zambia which will not work for us because we are looking at getting to the 90- 90 target where 90 per cent of the people knowing their status, 90 per cent of people getting their treatment,” she said.

Banda said her organization could not support the criminalization of HIV infection.

She however said NZP+ did not encourage people to go out and infect other people willfully.

International Community of Women Living with HIV (ICW) publish updated position statement on overly broad HIV criminalisation

The International Community of Women Living with HIV (ICW) have published an updated position statement on the criminalisation of women living with HIV for non-disclosure, potential or perceived exposure, and transmission.

The statement highlights many problems with overly broad HIV criminalisation, but is notable for singling out issues that specifically relate to women living with HIV:

Critically, rather than reducing transmission of HIV, fear of prosecution may deter women from accessing needed treatment care and support, discourage disclosure, and increase vulnerability of women to violence…

Criminalization is often framed as a mechanism to protect women who are experiencing intimate partner violence or sexual assault. However, in practice there same laws intended to protect women often place them in increased risk for violence and increasing stigma surrounding HIV…

The criminalization of mothers for HIV transmission and/or exposure serves to further increase stigma for positive women who want to have children or who are pregnant, by blaming women for transmission.

ICW recommends the following:

Repeal laws that criminalize non-intentional HIV exposure or transmission, particularly those that single out women living with HIV or people living with HIV for prosecution or increased punishment solely based on their HIV status.
Empower women to know about the criminal context of HIV transmission and exposure.
Enact legislation that promotes gender equality in the criminal justice system.
Remove all laws that disproportionately target women living with HIV and marginalized groups.
Promote community based awareness campaigns to address criminalization as a human rights violation.
Train health care providers, and other support workers to ensure that confidentiality for women living with HIV is protected.
Increase legal support for women living with HIV facing prosecution under these harmful laws.

Read the full position statement below.

ICW Position Statement 2015 CRIMINALIZATION OF WOMEN LIVING WITH HIV: NON-DISCLOSURE, EXPOSURE, AND TRANSMI…

US: Texas 'HIV criminalization bill' defeated

Despite some last-minute legal wrangling, the Texas legislature failed to pass several anti-gay measures as of the May 27 final deadline for passing any bills that lawmakers wish to see enacted into law. This year’s legislative session ends on June 1….

The legislature also failed to approve an HIV criminalization bill, which would have allowed prosecutors to subpoena the medical records and HIV test results of defendants living with HIV if prosecutors believe that they intended to intentionally infect people. The measure would have protected anybody who releases or discloses a test result in response to a subpoena from any liability, either civil or criminal, or any professionally disciplinary action.

According to LGBT and HIV/AIDS advocates, the bill was unnecessary, as Texas law already allows law enforcement and public safety officials to conduct HIV testing on individuals when appropriate, but there are privacy measures to keep the tests confidential. The advocates claimed the bill would have allowed an HIV-positive test result to be subpoenaed and used in any criminal proceeding against a person who happens to live with HIV, and was subjective, based on the personal whims and discretion of individual prosecutors.

The Human Rights Campaign (HRC), the nation’s top LGBT rights organization, worked with Legacy Community Health of Houston to oppose the HIV criminalization measure, saying revealing the results of an HIV test could potentially bias criminal proceedings, lead to enhanced privacy, and could discourage other people from getting tested for HIV for fear that a positive result would not be kept private and could be used against them.

“The defeat of SB 779 ensures that Texans living with HIV are not further stigmatized and penalized for their positive status,” Januari Leo, the director of public affairs with Legacy Community Health, said in a statement. “HIV is a public health issue that must be addressed through testing, treatment and prevention methods, not criminal prosecutions. HIV is neither a crime nor a death sentence.”