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

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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.”

Alone But Together
Women and Criminalisation of HIV

(15 min, Zimbabwe Lawyers For Human Rights, Zimbabwe, 2014)

This video explains why overly broad HIV criminalisation harms women, and highlights the issue with an interview with a woman who is fighting her conviction for allegedly infecting her husband.

Australia: Victoria’s HIV-specific criminal law, Section 19A, finally repealed today

In a joint media release, Living Positive Victoria and the Victorian AIDS Council have welcomed the passage of the Crimes Amendment (Repeal of Section 19A) Act 2015 by the Victorian Parliament. The Act repeals Australia’s only HIV-specific law criminalising the intentional transmission of HIV, section 19A of the Crimes Act 1958, which has been criticised for unfairly targeting and stigmatising people with HIV.

View the story “19A Repeal – Live Tweets from @paulkidd” on Storify

Live Tweets from Victoria’s Parliament today. To find out more about the five year campaign to repeal the law, read this blog post written for the HIV Justice Network by Paul Kidd, Chair of the HIV Legal Working Group.

The two organisations had called for the repeal of section 19A in the lead-up to the 2014 International AIDS Conference, held in Melbourne, as part of an advocacy effort designed to reduce the incidence of HIV-related criminal prosecutions in Victoria.

“Victoria has the unfortunate distinction of having had more HIV-related prosecutions than any other state, and until today had the only HIV-specific criminal law,” said Simon Ruth, Chief Executive Officer, Victorian AIDS Council. “Our organisations strongly believe that HIV should be treated as a health issue, and that criminal prosecutions should only be used in cases where transmission occurs and there is evidence the alleged perpetrator acted with intent.”

The use of the criminal law to control HIV has been roundly criticised by legal theorists, HIV experts and international agencies. The Joint United Nations Program on HIV/AIDS has called for HIV-specific criminal laws, like section 19A, to be repealed.

“Today we can be proud that Victoria has repealed its HIV-specific criminal law, and in doing so, reaffirmed its commitment to treating HIV as a public health issue and not a criminal justice issue. Government, community and industry need to work together if we are to meet our goal of eliminating HIV transmissions by 2020, and the multi-party support for repealing section 19A shows our legislators are listening and prepared to enact evidence-based policies,” said Brent Allan, Chief Executive Officer, Living Positive Victoria.

The repeal of section 19A will not legalise the intentional transmission of HIV, but will ensure that any allegation of intentional transmission is dealt with under general laws, the same as for other forms of injury. The campaign to repeal the laws highlighted the stigmatising effect of HIV criminalisation.

“Criminalising HIV transmission and exposure isn’t just ineffective as a method of prevention, it is actually counterproductive to our efforts because it perpetuates stigma,” said Paul Kidd, Chair of the HIV Legal Working Group. “We know the stigma around HIV is one of the biggest barriers to increasing testing and treatment, and enabling voluntary disclosure of HIV. Section 19A sent a false message that people with HIV are a danger to the community, and todays repeal shows the Parliament accepts that we are not.

“This is a law that was never needed, and should never have been enacted. It has not made Victorians safer, and in fact may have led to an increase in the number of people living with HIV. The whole Victorian community should be happy to see it go.”

The HIV Legal Working Group has been the recipient of GLOBE, VAC and Living Positive Victoria awards for its work on the repeal of section 19A. A community celebration of the repeal of section 19A is being planned and will be announced shortly.

In a blog post written exclusively for the HIV Justice Network, Paul Kidd highlights that although this battle has been won, the work against unjust prosecutions in Victoria is yet not over.

“Now that section 19A is gone, our work continues, he writes. “We still need to address the unacceptably high number of prosecutions for ‘HIV endangerment’ that occur in Victoria. We strongly believe we have a model that will deliver the right public health outcomes while safeguarding the public, without the use of expensive, ineffective and highly stigmatising criminal prosecutions. With the repeal of section 19A, our state government has recommitted itself to a health-based response to HIV, and we believe that gives us the best possible platform to continue our campaign for prosecutorial guidelines.”

Repealing Section 19A: How we got there, by Paul Kidd, Chair of the HIV Legal Working Group

Australia’s only HIV-specific criminal law, section 19A of the Crimes Act in the state of Victoria, has now been repealed. This is an exciting step forward for those of us working to turn around Victoria’s poor record on criminalisation of HIV. This blog entry outlines the process we used to achieve this historic reform.

This story starts just before the 2010 International AIDS Conference in Vienna, at the first-ever HIV criminalisation pre-conference meeting, co-organised by the Canadian HIV/AIDS Legal Network, the Global Network of People Living with HIV (GNP+) and NAM (who host the HIV Justice Network). Attending this meeting and hearing about the incredible work being done in this area was the inspiration for starting a joint advocacy project to address the issue here in Victoria. The partners in that project are the two largest HIV organisations in our state, Living Positive Victoria and the Victorian AIDS Council.

Our objectives were to achieve a set of prosecutorial guidelines, on a similar model to those adopted by the Crown Prosecution Service for England and Wales, and the repeal of s 19A. Although our initial focus was on the guidelines, with the announcement that Melbourne would host the 2014 International AIDS Conference, we decided to shift our focus to the repeal of s 19A. We felt that by focusing on a law that was manifestly out of step with best practice, we could use the conference to embarrass our legislators into action. With a state election due three months after AIDS 2014, we felt confident we could make political headway with the issue.

Section 19A makes it a criminal offence to intentionally transmit a ‘very serious disease’, which is defined to mean only HIV. It carries a maximum 25-year prison sentence, making it one of the most serious crimes on the Victorian statute book. It was enacted in 1993, following a high-profile case in which a prison officer in NSW was stabbed with a hypodermic syringe, and a number of cases in which blood-filled syringes were used in armed robberies.

Although the law was passed, supposedly, to deal with this kind of ‘syringe bandit’ assault, in practice it has been applied exclusively against people accused of sexual transmission of HIV. Although only a handful of cases have ever been prosecuted (and none successfully), s 19A has often been charged, or used as a threat against people accused of reckless transmission or endangerment. Its presence on the statute book has sent an unwelcome and false signal that people with HIV are a danger to public safety.

Additionally, we were armed with a solid evidence base – particularly the reports of UNAIDS and the Global Commission on HIV and the Law, which specifically criticise HIV-specific laws like s 19A.

We made a point of telegraphing our intentions to the government and opposition political parties well ahead of the conference. We developed a policy brief setting out the case for repeal of the section, and sought dialogue with both parties in the months before the conference. We wanted to give them every opportunity, at a time when the eyes of the world would be on us, to take action that would generate international attention and goodwill.

Our approach to the government was initially rebuffed, with a curt reply that they had no intention of changing the law. The Labor opposition, which had opposed the law in 1993, was more welcoming and we were able to explain our position at a number of meetings leading up to the conference. We were unable to get a commitment for action, but we were confident that both sides knew what we were asking for.

We gathered together a strong coalition of supporting organisations who agreed to back our call. As well as the HIV sector, we had support from the broader civil sector (organisations focused on human rights, mental health, gay and lesbian rights) and from the legal sector, particularly the criminal bar. We had the backing of the AIDS 2014 chairs. We spent a good deal of time before the conference drafting talking points that enabled us to get our media messaging clear, and thinking about ways to get our message out to conference delegates already being showered with slogans, messages and leaflets.

As the conference approached, however, we had no commitment from either party. We were taken by surprise when the health minister used a speech opening the ‘Beyond Blame’ HIV criminalisation pre-conference to make a commitment to ‘amend section 19A to make it non-discriminatory.’ Given the blunt ‘not interested’ we had received a couple of months earlier, this was a stunning turnaround, but still fell short of what we wanted – full repeal of section 19A. Worse, the way the announcement was phrased suggested the scope of the law could in fact be widened to include other diseases like hepatitis C – the last thing we wanted.

As the conference week progressed, we continued to press our case and to highlight the need for repeal. We garnered positive press coverage following a media conference held on the opening day (even the tabloid press gave us a sympathetic hearing). The sight of thousands of protesters marching through the streets of Melbourne with signs reading ‘#REPEAL19A’ made the evening news. We publicly called on the government to clarify why they were saying ‘amend’ rather than ‘repeal’. Behind the scenes, we used every social event and reception to buttonhole politicians and push our case, highlighting the goodwill that an announcement would generate for them on the international stage. It was an exhausting week, but with each passing day we knew our opportunities were diminishing.

Finally, on the last full day of the conference, the opposition Labor Party committed to full repeal of section 19A, within one year, if they won the election in November. The word came though via text message while I was sitting in a conference session on criminalisation advocacy, and I felt close to tears as I told the room what had happened. We now had commitments from both major parties, meaning reform of the law was almost assured.

Following the conference, we continued to push the government to explain how they intended to ‘amend’ section 19A and pressed our case for full repeal further. We never got an answer to our question, because the government didn’t bring the legislation forward before the expiry of the parliamentary term, then at the election there was a change of government.

The Labor Party, which had unambiguously promised to repeal s 19A, was now in government, and one of the most pleasing things about the last five months has been seeing them stick to their guns around 19A. Seeing government ministers on gay pride day carrying a banner saying ‘repeal section 19A’ was amazing.

I think the key message from our experience is that if you have an opportunity and you plan well, you can make tremendous use of it. I realise most activists won’t have the luxury of having the international AIDS conference come to their city, but hopefully other opportunities exist where local and global attention can be used to highlight inequities in the law. Building collaborations and learning from what has worked elsewhere is vital, but develop a strategy that suits your local needs and capacities.

Don’t be deterred if others disagree with your strategy – I’ve lost count of the number of times I’ve been told that criminalisation isn’t a first-order issue, or that by advocating for change we risk ‘making things worse’, or that by advocating too hard we risk getting nothing in return and pushing the issue off the agenda.

Now that s 19A is gone, our work continues. We still need to address the unacceptably high number of prosecutions for ‘HIV endangerment’ that occur in Victoria. We strongly believe we have a model that will deliver the right public health outcomes while safeguarding the public, without the use of expensive, ineffective and highly stigmatising criminal prosecutions. With the repeal of section 19A, our state government has recommitted itself to a health-based response to HIV, and we believe that gives us the best possible platform to continue our campaign for prosecutorial guidelines.

Paul Kidd (@paulkidd) chairs the Victorian HIV Legal Working Group.

US: [Update] Texas HIV criminalisation bill defeated (link does not reflect this updated news)

The Texas State House is considering SB 779, a bill that would allow any HIV test results to be used in any criminal proceedings against a person with HIV in Texas. This bill is unnecessary – 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 these tests confidential. This bill goes much further – HIV tests could be subpoenaed and used in any criminal proceeding.

HRC opposes this legislation because stigma against people with HIV may bias criminal proceedings, this may unfairly result in enhanced penalties, and of course, because it undermines medical privacy.

From a public health perspective, it is inadvisable and dangerous to create obstacles that might prevent people from seeking or receiving HIV tests. If this bill passes, having a positive HIV test result may be used to enhance penalties or foster bias in criminal proceedings, which creates an incentive for the public to avoid testing. Everyone deserves medical privacy.

SB 779 has already passed the Texas Senate, so this is our last chance to stop this bill from becoming law. Please, if you live in Texas, reach out to your state representative and urge them to oppose SB 779. HRC is also coordinating with state and local advocates to oppose this measure, which compromises the privacy of people living with HIV and public confidence in HIV testing.