Zimbabwe: HIV-specific criminal law criticised for making women with HIV more vulnerable

Women in the country have condemned the law criminalising the willful transmission of HIV claiming that women always feel the brunt of the law. Criminalisation of willful or deliberate transmission has become controversial in a county. Willful transmission is defined in the Zimbabwean law as the failure to disclose one’s status or to take precautions for preventing the transmission of HIV/ AIDS.

Speaking during a TweetT@ble discussion held by the Netherlands Embassy and 263Chat, Martha Tholanah the Director of International Community of Women living with HIV Zimbabwe said the legislation is unlawful.

“HIV/AIDS has always carried the face of a woman and women always carry burden the HIV pandemic. The criminalisation of willful transmission also has a woman face which is unlawful as women always end up being victims of the provision,” said Tholanah.

She also said, “Women are always accused of bringing the HIV virus into marriages and the justice system has not done enough to protect women who end up being imprisoned for 20 years.”

While it is difficult to detect who infected the other in a relationship women have always been labeled as the culprits.

Cases of willful transmission are on the rise mainly based on HIV positive people who have had sex with the primary intent of transmitting the virus to their partner.

Several cases have been brought before the courts where individuals claim to have deliberately infected with HIV by their partners with many occasions pointing the woman as the one who infected the men.

Tamara Jonsson, the Program Officer of UNAIDS Zimbabwe said, “the provisions of the criminal law are problematic especially the criminalisation of non disclosure.

“Criminalisation of non disclosure has negative implications on women as it does not guarantee safety after disclosure.”

She went on to say that stories told always climax with the younger women eventually being summoned to the courts for allegedly infecting the male counterpart.

Tinashe Mudawarara a lawyer with ZLHR, said the law is overbroad and it’s the provision are wide, dangerous, and unlawful and thereby infringing on the right to protection of the law.

Center for Reproductive Rights welcomes Kenya High Court ruling that quashes vague and unconstitutional HIV-specific criminal statute

03.30.15 – (PRESS RELEASE) Key provisions of a law criminalizing the transmission of HIV in an effort to curb spread of the disease in Kenya are unconstitutional and violate fundamental human rights, according to a recent landmark ruling from the High Court of Kenya. The Center for Reproductive Rights filed an amicus brief in support of the case brought by AIDS Law Project in 2010.

While the “HIV and AIDS Prevention and Control Act, No.14 of 2006” (“HIV/AIDS Act”) codifies measures for treatment, counseling, care and support of people living with HIV—it contains troubling provisions that criminalize the transmission of HIV in certain instances and permit partner disclosure of HIV/AIDS status by health care workers. The law also discriminates against women, who are often subject to coercive practices and violations of informed consent and confidentiality when testing for HIV, particularly during pregnancy.

In its decision issued on March 18, the three-judge panel ruled Section 24 of the HIV/AIDS Act which criminalized transmission of HIV was unconstitutional under the Kenyan Constitution, as the provisions are too vague and that disclosing patients’ HIV status violates their rights to privacy and confidentiality. The judges also advised the State Law Office to review the HIV/AIDS Act to “avoid further litigation” surrounding the law.

Said Evelyne Opondo, regional director for Africa at the Center for Reproductive Rights:

“All people are entitled to quality health services—regardless of their HIV status or other health needs.

“This law has inflicted fear, shame, and punishment on countless Kenyans, especially pregnant women who desperately need and deserve quality maternal health care.

“We commend the High Court for finding the criminalization of HIV transmission as unconstitutional and a violation of Kenyans’ fundamental human rights. Now is the time for the Kenya government to immediately amend this legislation and ensure people living with HIV can get the care they need without fear of discrimination or criminalization.”

“We must ensure people living with HIV receive the proper medical care and support that they need,” said Jacinta Nyachae, Executive Director of the AIDS Law Project. “If we want to reduce the spread HIV and AIDS and put an end to the stigma, violence and discrimination surrounding the disease, our public policies must be based on medical evidence and grounded in human rights.”

In 2011, the Center for Reproductive Rights submitted an amicus brief in the AIDS Law Project v. Attorney General & Director of Public Prosecutions (Petition No. 97, 2010), challenging the constitutionality of the law. The Center claimed that the HIV law could be interpreted to criminalize women living with HIV who expose or transmit the virus to a child during pregnancy, delivery, or breastfeeding. The Center argued that criminalizing HIV exposure and transmission does not protect women from transmission, but instead exacerbates existing stigma and discrimination against women, exposing them to risk of prosecution. The Center’s brief also recommended the law’s provisions permitting partner disclosure of HIV status be quashed.

Germany: Aachen Court re-evaluates key ‘mens rea’ requirement in German law, rules HIV transmission without disclosure is negligent injury, not intentional harm

Last week, for the first time a German court ruled that HIV transmission without prior disclosure was negligent injury, rather than intentional harm.

The District Court of Aachen sentenced a 43 year-old man to one year and nine months on probation for having condomless sex with his former female partner without disclosing his HIV-positive status. The woman is now also HIV-positive. The maximum sentence for negligent bodily injury is three years in prison and a fine.

With this judgment the Court has created legal history – the first ruling since 1988 to change the way HIV non-disclosure cases are considered by German courts. Until now, the Federal Court, as well as lower courts, had always considered that HIV non-disclosure prior to sex without a condom meant that the defendant “considered acceptable” that their partner would acquire HIV. This concept, of dolus eventualis, is much closer to the common law definition of ‘recklessness’ than to malicious intent.

Leading HIV and human rights lawyer Jacob Hösl, who attended the hearing in an advisory capacity, told Deutsche AIDS-Hilfe: “The Federal Court has always said that the examination of pre-meditation requires a case-specific overall examination, which can vary greatly depending on the individual circumstances. The lower courts, however, have always assumed intent by default. For the first time this court sees it differently. ”

Hösl praised the fact that the court studied intensively the medical facts and personal circumstances of the accused. “The man did not want his partner infected – for him she was the love of his life,” he noted.

The presiding judge, Hans-Günter Goergen, began his oral verdict, stating: “We have learned a lot about HIV in this trial.” According to press reports, he noted that the defendant had concealed his HIV-positive status because he was afraid his partner would leave him, but that he had no desire for her to become HIV-positive.

The judge also accepted that the defendant had tried to protect his partner (by using condoms most of the time, and withdrawing before ejaculating), but failed due to the circumstances (she started taking contraceptive pills and desired condomless sex) and because of his fear of losing his partner. He noted that the defendant’s former wife had divorced him in 2007 after he had tested HIV-positive. Accordingly, the judge saw no evidence that the defendant acted with intent.

The Court also found the defendant not guilty with respect to three other charges relating to HIV non-disclosure and potential HIV exposure involving two women when the defendant’s viral load was undetectable.

A medical expert told the Court that during the relationship with the complainant that is now HIV-positive, the risk of transmission was low, as he had a low (but not undetectable) viral load. Dr. Heribert Knechten, a witness for the defence, who was also the defendant’s doctor, noted that in 2014, before commencing treatment, his patient’s viral load was stable at 85,000 copies per milliliter, which translated into the risk of HIV transmission during vaginal intercourse to be between 0.05 to 0.15 percent. He also testified that after the defendant’s viral load reached undetectable at the end of 2014 that he was very unlikely to be infectious.

Manuel Izdebski, Deutsche AIDS-Hilfe board member said in a press release:

“This verdict is a step of great value: the first time that a court recognizes that you cannot automatically assume intent in HIV transmission cases; it is almost always due to fear – as it was in this case – that people do not disclose. Accordingly, this must be taken into account. Criminal law is not an appropriate way to measure this. The decision of the District Court in Aachen is a pioneering step towards a legal system that no longer penalises HIV transmission as a criminal offence.”

The written judgement is expected soon. However, today, the prosecution has appealed the ruling, so this judgement may not be final.

Canada: Provocative new resource from anonymous collective of people living with HIV explains how to protect yourself from prosecution

This is not intended as legal advice. Please always consult a lawyer if you are concerned about issues related to HIV non-disclosure or exposure. And do your own research!

Some of the tactics suggested in this document are within a grey area of the law. Make sure you are aware of this, and make onlydecisions that you are comfortable with to protect yourself. We do notpromote non-disclosure of one’s HIV status, nor do we support the stigma that can make it so difficult to do so.

An anonymous collective of people living with HIV and our allies produced this document. We have no leaders, no spokespeople, and no meetings. Copy this, share it, add to it, and adapt it to your own setting. Join us by doing it. Time is running out.

*The photos in this document are from the July 1990 Montreal Sex Garage riots

Download booklet version here!

HOW TO HAVE SEX IN A POLICE STATE: OUR APPROACH

In 1983, Americans Richard Berkowitz and Michael Callen published the book How to Have Sex in an Epidemic: One Approach, which is credited as being the first piece of safer sex literature for gay men. In the early days of the AIDS epidemic and in the absence of state action people with HIV and their friends banded together and took things into their own hands. Through advocating the use of condoms and by sharing available HIV prevention information, safer sex in the late 80s and 90s was conceived as a way to take collective accountability for addressing the epidemic, care for one another, and resist fear-based and abstinence-only responses.

Thirty-years after the publication of How to Have Sex in an Epidemic we face a new type of emergency here in Canada. State neglect in the response supporting people with HIV is now coupled with intensified forms of state control, surveillance and criminalization. Canada is among the most punitive countries in the world for HIV-positive people, where the state is turning towards criminalization instead of public education and support.

WHAT YOU NEED TO KNOW: The “Law” in Canada

The landmark 2012 Mabior and D.C. Supreme Court decisions outline that people are required to tell a partner they have HIV before they engage in sex that poses a ‘realistic possibility’ of transmission. This legal test requires disclosure for vaginal intercourse unless a condom is used and the person with HIV has a “low” viral load. This decision did not address same sex relations, anal sex, or oral sex. Anyone who doesn’t disclose their HIV positive status when having sex with a condom OR low viral load can be arrested and prosecuted. Since this decision at the Supreme Court prosecutions are on the rise. The risk of being labeled a criminal is now biologically marked – we are infected with criminal potential. Acquiring a low viral load requires access to anti-HIV drugs, which are still out of reach for many of us. Condom use is also complex when power and gender-based violence are factors. Charges can range from assault to attempted murder and do not require HIV transmission to occur. A majority of people in these cases are charged with aggravated sexual assault, one of the most serious offences in the Criminal Code reserved for violent sexual assaults. Those prosecuted can face long sentences, are registered as sex offenders and held in segregation units. One accusation from an angry or upset former lover can result in lengthy court battles, incarceration and sensationalized media exposure. Even if the person decides to drop the charges, the state can pursue criminal prosecution in the “public interest”.

Within this context of intensified criminalization we see the reversals of hard-fought protections for our privacy and rights. Under the AIDS Industry’s “treatment as prevention” project, people living with HIV are now understood as carriers of disease who must be neutralized through medical treatment. This treatment imperative plays out regardless of if we have access to the expensive medications, if we can tolerate their many side effects, or even if there is a medical necessity to go on them. The fundamental principles underlying HIV testing (i.e. consent, confidentiality, and counseling) are rapidly disappearing. Voluntary and anonymous HIV testing are being replaced by involuntary and coercive forms of testing, now called “routinized testing”, where people can be systematically tested in health-care settings – many of them without their knowledge. The names and HIV-status of people who test positive can end up on government databases for life. Also, through increased public health oversight, community–based organizations have now become an arm of state surveillance, discipline and control. Many of them now fully endorse and implement new coercive testing approaches in the community.

What follows is a list of suggestions gathered by people living with HIV to help one another steer clear of the law and the state, to protect our communities and ourselves.

TAKE THE TEST & RISK ARREST

People who test HIV-positive will in most cases have this information collected by public health officials. In the early days of the epidemic activists and other people with HIV fought to have their information about their HIV-status be anonymous and out of the hands of state officials. Today things are different.

Today, in order to prevent intervention from the criminal justice system and public health officials it could technically be in your best interest not to know your HIV status. While this is still a grey area within the law, if you do not “officially” know you have HIV, then you could have less of a chance of being charged or prosecuted in relation to non-disclosure. Although, if you have engaged in activities that are commonly understood to put you at risk of HIV infection then you could have a legal obligation to disclose these activities to other partners. In 2003, a case went to the Supreme Court called R. v. Williams, and while the case did not fundamentally alter how the law is applied it did outline that if someone has an awareness of risk, then they have a duty to disclose, even if they are not aware of their HIV status. So we know that willful ignorance about your status is not going to keep you completely out of the courtroom if someone presses charges against you or the police and public health come knocking at your door. But being careful about where you get tested and who knows your HIV test results could prove helpful in some cases. You can order home HIV testing kits online, or buy them while travelling to other countries where they are available.

Avoid all HIV or STI tests at clinics where your real name is recorded. If you do not already know your HIV status, only go for anonymous tests (ensure the clinic you go to does not record your name, or any contact information), or get an at home test from across the border or online. The police and others can use medical records to confirm that someone has HIV, has been counseled about their status, is aware of their viral load etc. and that they are thus criminally liable regarding cases of non-disclosure. To prevent this from happening, try your best to keep your HIV status out of official state, public health, and AIDS service organization record keeping practices.

If you test HIV-positive through anonymous testing and you want to go to a doctor – ask your doctor if they do a confirmatory HIV test. Some doctors are mandated by public health to do a confirmatory HIV test, which will have your name attached to it. However, there are some HIV specialists that do not follow this mandate. Ask your friends and look for a doctor who will not submit your HIV status to public health. Sometimes a doctor needs to make sure you have HIV before they are willing to provide care. You can ask that they do a viral load test, as public health authorities do not as of yet collect this data. Having a record of your viral load can act as an equivalent to a positive HIV-positive test for you, and also for your doctor to provide appropriate care, while keeping you out of the public health database. But this strategy will not help if the medical records your doctor keeps are subpoenaed in the case of arrest.

If you are arrested on a charge in relation an HIV, do not tell the police your HIV status, or anything else without a lawyer. Do not volunteer any information to the police. It is important to try and get a lawyer who is knowledgeable on HIV exposure and non-disclosure cases, so that you can get an adequate defense. Legal HIV organizations have connections to knowledgeable lawyers who understand these sorts of cases.

FUCK SAFELY: HOW TO PROTECT YOURSELF

While we need to protect ourselves from public health and the state, we also need to protect ourselves from potential partners who may call the cops on us out of fear, lack of information or AIDS-phobia.

If disclosing is not possible, maintaining a low viral load and using condoms are the only way to comply with the law. But we know that both acquiring a low viral load and always using condoms is not possible for everyone. Also, there have been cases where people have been charged despite disclosing their HIV status to a sex partner, or have used condoms and had a low viral load. So if you are in position to do so, ask your partners to sign a statement agreeing that they know your HIV-positive status and have agreed to have sex with you. Alternatively, you can keep a record of having disclosed on your phone or computer. Take a screen capture of your disclosure on hook up sites. Remember to record the date and time. Recording your disclosure on a social media app is also a potential strategy. If possible, consider the idea of disclosing your status to person in front of a trusted witness, friend, or at a trusted counselor at a community organization.

We know that disclosure can result in violence or other consequences. In this case there are still things that you can do to protect yourself and your partners. If condom use is possible, some people will make sure to keep used condoms from past partners labeled and frozen in the freezer as evidence that the sex they had was protected. These are ridiculous measures, but these are ridiculous times.

If you have questions about safe sex, talk to people you know and learn about different ways to fuck safely. If you talk to a health care provider, ask general questions and don’t detail challenges that you may be having with disclosure and condom use. If you have questions about your legal duties, for example if the condom breaks, don’t ask a health care provider. Ask a person who is familiar with the law (there are organizations what work on HIV and the law in Canada, look them up online). Make sure the person you talk to does not document your concerns in your health records or some other form of record (like records they keep on clients at AIDS Service Organizations).

KEEP YOURSELF OFF THE PUBLIC HEALTH RECORD

The less information the state has on you the harder it will be for them to develop a criminal or public health case against you. This doesn’t mean that you shouldn’t notify people of your own status, but can be a strategy of keeping the state out of your sex life.

Sometimes public health officials do ‘contact tracing’ or ‘partner notification’ where they document who has come into contact with whom (or in this case, who has had sex with whom) to notify other partners of the potential “risk”. If you come into contact with public health officials who are doing ‘contact tracing’ tell them that you do not know the names of anyone you have had sex with. This collection of information by public health could later lead to potential criminal charges, a public health order, or other consequences. One strategy is to tell public health officials that you only have anonymous sex and that you do not know the names of any people you have sex with, or that you don’t have the means of contacting them.

If your HIV status is already recorded by public health, and you test positive for another sexually transmitted infection (STI), you could be asked to meet with a public health nurse. The nurse may ask you to give them the names of whom you have had sexual contact with. Never give names or contact information of other people to public health. Public health could contact them and notify them of your HIV status and that person could press charges if you have not disclosed to them.

Some public health officials can be very aggressive and stigmatizing towards people living with HIV and they may harass you once they have any of your contact information. If this happens, you can make an official complaint against them by contacting the health unit where they work.

Each province has its own public health department and health units. Some public health units are more concerned with regulating people living with HIV than others. Some provinces have public health laws that allow for the issuance of public health orders. Under public health law people can be mandated with legal orders to disclose their HIV-positive status to all sex partners in specific terms, practice sex in specific ways, or even be put under house arrest, as well as being court-ordered to take pharmaceuticals. To better protect yourself, know what public health jurisdiction you are in, and if they issue public health orders to people living with HIV.

If you receive a public health order, or get arrested call a lawyer right away! You often only have 15 days to respond to a public health order, and you will need a lawyer as soon as possible to support you in this process.

ACCESS SUPPORT NOT SURVEILLANCE

When going to a community organization, AIDS Service Organization or healthcare provider always ask any counselor, nurse, doctor, social worker, peer worker, or other support worker how, why, and under what circumstances they are professionally required to document their interactions with you, and if this data can be used to identify you. In many organizations, there is an increasing push to collect more and more information on people who access services, but this information can also be used against you. Anything they write down or collect about you can be subpoenaed and used as evidence in a court of law. Make sure that you trust your healthcare providers and they are transparent about how and why they keep records on you. Do not give out any information about your sex life, sex partners, HIV status or sex practices unless you are absolutely certain that they will respect your confidentiality and not document what you tell them. You can always request a copy of your file or any notes kept on you. Alternately, if you are disclosing to your sexual partners, you can ask your care provider to note this in your file to further protect yourself against accusations.

MAKE THIS AN ISSUE IN YOUR COMMUNITY

We are in a dangerous moment under the watch of a hostile regime and we urgently need to take back control of our lives, our health and our freedom. When possible, talk about HIV and talk about the potential impacts of HIV criminalization with friends, sex partners, colleagues, family and with communities that you are part of. Make it known that you are a person that other people can talk to about these issues. Work in your communities to build consensus at a grass-roots level to end the criminalization of HIV.

Police can pressure people in these cases into pressing charges. Refuse to be a witness and help prosecutions. Respect people’s decisions about disclosing. This complex social issue cannot be understood within – or reduced to – a legal and policing framework of “victim” and “perpetrator”. Work to undermine these practices that support criminalization. Encourage dialogue over calling the cops.

Be proactive and hold community organizations accountable. Call for AIDS Service Organizations, health-care providers, or other community groups to not participate in reporting or record keeping practices that could support HIV criminalization investigations. Ask these organizations to be transparent about what they do and what their policies are around reporting and collection of information. If they do not have policies or practices around this, push them to develop them. Ask community organizations, if their records are subpoenaed, to tell the cops to seal the evidence and instruct them that it can only be opened before a judge. This can buy you time to oppose the use of these records as evidence.

This issue is not over. There are opportunities for change if people start taking action now! As people living with HIV, we know this: We are responsible and we already practice care for the health of our sex partners. Now we must take action to protect ourselves from the violence of the state, the violence of the AIDS Industry, the violence of AIDS-phobia, and the violence of the criminal injustice system. As the carceral system becomes the watermark of our everyday life it is becoming clear that we are not the “public” that public health is interested in protecting. But we can protect ourselves if we work together, support each other, share strategies and push for change.

Infectious Disease Society of America (IDSA) and HIV Medicine Association (HIVMA) Position on the Criminalization of HIV, Sexually Transmitted Infections and Other Communicable Diseases (2015)

This statement was issued by the Infectious Diseases Society of America (IDSA) and the HIV Medicine Association (HIVMA) on the urgent need to repeal or modernize HIV-specific criminalization statutes and laws criminalizing transmission or exposure to sexually transmitted infections and other communicable diseases.

US: Positive Justice Project releases a set of principles to guide modernisation of state criminal laws

Today, in the wake of recent court decisions rejecting several applications of the criminal law to people with HIV, the Positive Justice Project (PJP) , a national coalition challenging HIV criminal law policies in the United States, released a set of principles to guide the modernization of state HIV criminal laws across the country.

“Ending criminal prosecutions based on HIV or other health conditions is a vitally important part of a sound, public health approach to ending the epidemic,” said Kim Miller of the HIV Medicine Association (HIVMA). “Treating a medical condition as evidence of a crime is at direct odds with public health campaigns to get as many people as possible tested and, if HIV positive, into treatment,” added Ms. Miller. “That is the best way to protect everyone, since treatment keeps people healthy while reducing already low transmission risks to near-zero.”

Currently, 32 states have criminal laws that punish people living with HIV for conduct that would be legal if they did not get tested and did not know their HIV status. Conviction under these laws can result in decades-long prison sentences despite very low transmission risks and dramatic improvements in treatment that have transformed what it means to live with HIV.

Carole Treston of the Association of Nurses in AIDS Care (ANAC) confirmed, “On treatment people living with HIV can expect to live long and healthy lives. It’s time for the law to catch up with the science on the real risks and realities of HIV in the twenty-first century.”

The Guiding Principles for Eliminating Disease-Specific Criminal Laws call for modernization of existing laws that exclude HIV and other infectious diseases from long-established interpretations of criminal felony laws requiring proof of intent to harm accompanied by conduct likely to cause death or severe injury for a conviction. At present, most states require only evidence that a person has been diagnosed with HIV and has engaged in some form of contact with a third party for a felony conviction and, in some cases, life-long sex offender registration.

In 2014, the U.S. Department of Justice issued the Best Practices Guide to Reform HIV-Specific Criminal Laws to Align with Scientifically-Supported Factors; and in 2013 the Presidential Advisory Council on HIV/AIDS (PACHA) issued a Resolution on Ending Federal and State HIV-Specific Criminal Laws, Prosecutions, and Civil Commitments. A growing number of political, legal, public health and advocacy organizations also have called for the modernization of HIV laws.

“Both HIV and the prison system have a disproportionate reach into communities of color,” stated C. Virginia Fields, Director of the National Black Leadership Commission on AIDS. “Laws that make an HIV test the basis for a felony prosecution are a double burden for those at greatest risk of both HIV and entanglement in the criminal justice system. We need to end this yesterday, and we need to do it right. These principles are a great step in the right direction.

Criminalizing HIV: Recent Experience in the United States and Africa to Update Laws and Policies to Promote the Public Health

Conference Dates and Location:

February 23-26, 2015 | Seattle, Washington

Abstract Number:

129

Criminalizing HIV: Recent Experience in the United States and Africa to Update Laws and Policies to Promote the Public Health

Primary Author:

Jeffrey Crowley¹

¹ O’Neill Institute for National and Global Health Law, Georgetown University, Washington, District of Columbia, United States

Abstract Body:

Laws and policies have been used to protect people living with HIV and affected communities from stigma and discrimination. Indeed, the Americans with Disabilities Act (ADA) and the UN Convention on the Rights of Persons with Disabilities are just two legal instruments that help to create environments where people feel safe enough to come forward for HIV testing and to engage in care. Laws and policies also are used in ways that are highly stigmatizing and that hinder public health approaches to responding to HIV. In the United States, thirty-four states and territories have laws that criminalize the conduct of people living with HIV based on perceived exposure to HIV and without any evidence of intent to do harm. Far from representing a legacy of the past, people with HIV continue to be prosecuted and jailed for failure to disclose their HIV status prior to engaging in sex and for spitting and biting offenses, often in the context of arrest by law enforcement. Moreover, this is a challenge in countries across the globe. As of 2013, twenty-six African countries had overly broad and/ or vague HIV-specific criminal laws, most enacted over the past decade, with a further three countries considering new HIV-specific criminal laws. As governments, clinicians, researchers, and advocates seek to maximize population-level HIV viral suppression both to protect the health of people with HIV and also to reduce HIV transmission, these laws and policies could hinder our collective efforts. This talk will examine the current landscape of HIV criminal laws and policies in the US and selected African countries, will examine available data on the effectiveness of such laws at deterring behaviors such as failure to disclose HIV status prior to sexual encounters, and will look for common lessons from both Africa and the US to suggest a path forward for promoting effective evidence-based approaches to reducing HIV transmission.

Session Number:

S-5

Session Title:

Advancing HIV Prevention: Lessons from Biology, Medicine, and Public Health Law

Presenting Author:

Crowley, Jeffrey

Presenter Institution:

Georgetown University

US: Rhode Island politician wants the state to consider new unscientific, stigmatising HIV non-disclosure law

State Lawmaker Targets People With HIV With Bill To Criminalize Exposure” by Zack Ford

Rhode Island state Rep. Robert Nardolillo (R) has introduced a new bill ( H 5245) that would criminalize exposing individuals to HIV without disclosing a positive status. Rhode Island is one of only 13 statesthat does not have such a law, but efforts are underway to roll back many of those other laws, which were passed when the virus was not as well understood as it is today.

Currently, Rhode Island does have a law that makes it a misdemeanor to expose another person to any sexually transmitted disease (STD), punishable by up to three months in jail and a fine of up to $100. Nardolillo told ThinkProgress that he doesn’t think this is appropriate for exposure HIV. “HIV is different. I put it alone,” he explained. “If this act happened, the penalty would be what?” According to his bill, it should be imprisonment up to 15 years and a fine up to $5,000.

A freshman legislator, Nardolillo openly discussed in his campaign that he was a victim of sexual assault as a minor and that he thus has “very strong views on sex offenders and the weak legislation that continually fails to protect those who are, have been, and will be victimized.” He noted that Rhode Island’s current laws offer “no penalty or enhancement” when STD transmission takes place during a sexual assault, though individuals can be punished for both. His new bill does criminalize when someone with HIV “forcibly engages in sexual intercourse,” but it also criminalizes when someone “knowingly engages in sexual intercourse with another person without first informing that person of his/her HIV infection.”

ThinkProgress confronted Nardolillo with studies that show that criminalizing HIV actually disincentivizes individuals from getting tested for HIV because they fear prosecution if they know their status is positive. As a result, the stigma against people with HIV increases and fewer people seek care for their HIV, which could increase their potential for transmitting the virus. “Have I read the research? I did,” Nardolillo confirmed, saying that he still felt that HIV was too serious not to prosecute in a distinct way.

ThinkProgress also asked Nardolillo about recent research showing that for HIV-positive people who have sought care and reduced their viral load to undetectable levels, it’s virtually impossible for them to transmit the virus to others. Should those individuals similarly be prosecuted for not disclosing their status? “I have no comment on that,” Nardolillo responded.

It was research about the risk of transmission that actually led the Iowa Supreme Court to overturn the conviction of a man who had been charged under that state’s HIV criminalization law last year. In fact, the Court said that, regardless of viral load, protected anal sex or unprotected oral sex are now known to carry such a minimal risk of transmission that they could not hold someone accountable for “risking” exposure when engaging in those activities. Nardolillo’s bill implicates any and all vaginal, anal, or oral sex with no qualifications as to whether protection is used.

Last year, Iowa became one of the first states to rescind its HIV criminalization laws, leaving penalties only for those who insidiously intend to transmit the virus. Though other states have not yet followed Iowa’s example, there is consensus among HIV/AIDS experts and advocates that they should. Both the Presidential Advisory Council on HIV/AIDS and the U.S. Department of Justice Civil Rights Division have recommended the repeal of state HIV criminalization laws. These laws, they argue, are not based on the medical evidence currently available and counter-intuitively increase stigma and interfere with prevention efforts, making it harder to fight the HIV epidemic, not easier.

The House Committee on the Judiciary will consider Nardolillo’s bill Tuesday afternoon. It currently has four other co-sponsors, but its prospects for passage are unclear.

Criminal Law Not Effective Against HIV

THE CONFESSIONS of the 40-year-old man who went on a “deliberate spree to infect as many other people as possible” in 2002 (The Namibian, 14 January 2015) sparked a series of media reports in the past few weeks, which featured calls from the public for the enactment of an HIV-specific crime of intentional transmission of HIV.

The push to apply criminal law to HIV exposure and transmission is often driven by the wish to respond to serious concerns about the ongoing spread of HIV, coupled by what is perceived to be a failure of existing HIV prevention efforts.

No one suggests that a person who, knowing he has HIV, sets out intending to infect another, and achieves his aim, ought to escape prosecution. In these cases, as infrequent as they may be, the victims and their society seek justice because harm was caused with clear intention.

There is, however, no need to enact a new HIV-specific law to address this situation. We have existing common law crimes that can be applied. Where we seek to apply these, we must ensure that the use of criminal law in relation to HIV should be guided by the current best available scientific and medical evidence.

Two key scientific and medical developments in the past five years call for a reconsideration of the application of criminal law in the context of HIV. The first is that we know that effective HIV treatment has significantly reduced AIDS-related deaths and has transformed HIV infection from a condition that inevitably resulted in early death to a chronic manageable condition.

In Namibia the treatment programme has been a flagship of the response, achieving 2010 Universal Access target 2009, and has since continued to register remarkable achievements. By March 2014, an estimated coverage of over 81% of eligible adults and 54% of eligible children were on anti-retroviral therapy (ART).

Secondly we now know that effective HIV treatment significantly reduces the risk of HIV transmission from people living with HIV to their sexual partners.

Since HIV is now a chronic treatable health condition, it is thus no longer appropriate for criminal prosecution for HIV transmission to involve charges of murder, attempted murder or assault with intent to cause grievous bodily harm.

Based on current evidence, the harm of HIV infection should not be treated differently from that of other serious sexually transmitted infections like hepatitis B or C. Transmission of these infections is, however, seldom if ever subject to criminal prosecution.

In addition, the effectiveness of criminal law as a tool for reducing the spread of HIV is questionable. Criminal law is traditionally used to incapacitate, rehabilitate or deter offenders.

Why then should we treat HIV differently?

In order to slow the spread of the HIV epidemic, vast numbers of people would have to be prevented from having unsafe sex or engaging in other risk behaviours, which no criminal law could possibly do.

Indeed, imprisoning a person with HIV does not prevent the transmission of HIV. HIV risk behaviours are prevalent in prisons, yet correctional services authorities continue to reject the introduction of evidence-informed prevention measures such as condoms and fail to address sexual violence in prisons.

There is little evidence to suggest that criminal penalties for conduct that transmits HIV will “rehabilitate” a person such that they avoid future conduct that carries the risk of HIV transmission. Most cases of HIV transmission are related to sexual activity – human behaviour that is complex and very difficult to change through the blunt tool of criminal penalties.

There is no scientific data to support the claim that criminal prosecution, or the threat thereof, has any appreciable effect in encouraging disclosure to sexual partners by people living with HIV or deterring conduct that poses a risk of transmission.

What nearly 30 years of addressing AIDS has taught us is that key to preventing the spread of HIV is the reduction of stigma and discrimination on the basis of HIV status, real or perceived, the fear of which deters many people from seeking HIV testing and knowing their status as an entry point to accessing HIV treatment and other related services.

Applying criminal law to HIV exposure or transmission, except in very limited circumstances, does the opposite. It reinforces the stereotype that people living with HIV are immoral and dangerous criminals, rather than, like everyone else, people endowed with responsibility, dignity and human rights.

Instead of focusing our attention on passing more criminal laws that provide for an HIV-specific crime, we should rather be putting our energies into creating an enabling legal environment in which the social and legal constructs that place some people more at risk of HIV infection than others are addressed. In particular we should ensure that the laws in place protect women’s equal rights and that their right to be free from violence are enforced.

We should promote access to comprehensive, age-appropriate sex education and sexual and reproductive health services and other evidence-based strategies designed to reduce HIV risks. We should adopt a comprehensive anti-discrimination law that protects people against discrimination on the basis of real or perceived HIV status or on the basis of sexual orientation and gender identity and we should repeal laws that criminalise or further marginalise vulnerable groups such as sex workers, people who use drugs, and men who have sex with men, which create barriers to access to effective HIV prevention and treatment services by these groups.

Our response must be based on the best scientific and medical evidence rather than misguided fears and stigma.

• Michaela Clayton is a human rights lawyer who has worked on HIV and human rights in Namibia and internationally since 1989. She is Director of the AIDS and Rights Alliance for Southern Africa, based in Windhoek and serves as the co-chair of the UNAIDS Reference Group on HIV and Human Rights as well as co-chair of the Human Rights Reference Group of the Global Fund to Fight AIDS, Tuberculosis and Malaria. – See more at: http://www.namibian.com.na/indexx.php?id=23584&page_type=story_detail#sthash.kMTUAWlM.dpuf

Zimbabwe: HIV-specific criminal law on trial; ZLHR launches campaign highlighting impact of overly broad HIV criminalisation on women

Tomorrow, Zimbabwe’s HIV-specific criminal statute, Section 79 of the Zimbabwe Criminal Law (Codification and Reform) Act 23 of 2004 will be on trial itself, facing its first-ever challenge in the Constitutional Court.

The Court will hear arguments on behalf of two applicants – Pitty Mpofu and Samukelisiwe Mlilo – both of whom were unfairly convicted of “deliberate transmission of HIV” in 2012, and who are now represented by Zimbabwe Lawyers for Human Rights (ZHLR).

“The provision is too wide, arbitrary and therefore violative of the protection of the law guarantee. It is submitted that the legislature has created an offence which is as scary as the evil that it seeks to redress.” Applicants head of arguments (1.1)

Law on trial

Although the ‘crime’ in Section 79 is called “deliberate transmission of HIV”, a wide range of variables are possible that involve neither being deliberate nor actually transmitting HIV.

It is a crime for anyone who realises “that there is a real risk or possibility” that he or she might have HIV to do “anything” that the person knows will involve “a real risk or possibility of infecting another person with HIV.”

This, argues the applicants, is overly broad and unconstitutionally vague.

(Scroll to the bottom of the page, or click the link, to read the entire Applicants heads of arguments.)

Since 1996, International Guidelines on HIV and Human Rights have recommended that:

 ”Criminal and/or public health should not include specific offences against the deliberate and intentional transmission of HIV but rather should apply general criminal offences to these exceptional cases. Such application should ensure that the elements of foreseeability, intent, causality and consent are clearly and legally established to support a guilty verdict and/or harsher penalties.”

It is eminently clear that Section 79 does not ensure that “elements of foreseeability, intent [or] causality” are adequately provided for, although there is a defence of informed consent via disclosure. (It is not clear, however, exactly what needs to be disclosed, given that it is possible to be prosecuted for anything that might be a risk even if you haven’t been tested).

Although the Zimbabwe law predates other African laws based on the flawed N’Djamena model law, funded and disseminated with US international aid money, it contains many of the same problems. (Zimbabwe passed the first version of Section 79 in 2001 and updated it in 2004 to include people who suspected they were HIV-positive, but were not yet diagnosed.)

‘UNAIDS recommendations for alternative language to some problematic articles in the N’Djamena legislation on HIV (2004)’, specifies the kind of language that could be used, should Zimbabwe still deem to find an HIV-specific criminal statute necessary.

Notably, it recommends defining ‘deliberate transmission of HIV’ as “transmission of HIV that occurs through an act done with the deliberate purpose of transmitting HIV”.

It further recommends that no criminal liability should be imposed upon:

an act that poses no significant risk of HIV infection.**
a person living with HIV who was unaware of his or her HIV infection at the time of the alleged offence.
a person living with HIV who lacked understanding of how HIV is transmitted at the time of the alleged offence.
a person living with HIV who practised safer sex, including using a condom.**
a person living with HIV who disclosed his or her HIV-positive status to the sexual partner or other person before any act posing a significant risk of transmission.
a situation in which the sexual partner or other person was in some other way aware of the person’s HIV-positive status.
a person living with HIV who did not disclose his or her HIV status because of a well-founded fear of serious harm by the other person.
the possibility of transmission of HIV from a woman to her child before or during the birth of the child, or through breastfeeding of an infant or child.

**The issues of significant risk and safer sex (along with the difficulties of proving timing and direction of transmission) are further expounded upon in UNAIDS expanded and updated 2013 guidance.

However, Zimbabwe could also decide to do away with Section 79 altogether, and implement a new law based on a model law developed for the Southern African Development Community (SADC; www.sadc.int), which comprises Angola, Botswana, Democratic Republic of the Congo, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Seychelles, South Africa, Swaziland, Tanzania, Zambia and Zimbabwe.

This model law, which was unanimously adopted by the SADC Parliamentary Forum in 2008, integrates the protection of human rights as a key element of an effective response to HIV and has no specific provisions allowing for the criminalisation of potential or actual HIV exposure or transmission.

Alone But Together

Zimbabwe Lawyers for Human Rights are using the Constitutional Court hearing as a springboard for a campaign against overly broad HIV criminalisation, highlighting the case of Samukelisiwe Mlilo who features in a powerful 15 minute documentary produced by ZLHR, ‘Alone But Together – Women and Criminalisation of HIV Transmission: The story of Samukelisiwe Mlilo’.

Today, they will launch the documentary in Harare under the banner; ‘HIV on Trial – a threat to women’s health’.

Ms Mlilo was found guilty of ‘deliberately’ infecting her husband with HIV and faces up to 20 years in jail despite there being no proof that she had infected her husband. She claims she had disclosed her status to him following her diagnosis during pregnancy, and that her husband only made the complaint in revenge for her own complaint of gender-based violence following the breakdown of their marriage.

“At this point we do not know who infected who,” ZLHR’s Tinashe Mundawarara told Voice of America News in August 2012. “This is an example of the violation of women’s rights. Women are likely to know of their status first. Mlilo might have been infected by her husband, no one knows, and got charged and convicted.”

The other applicant, Pitty Mpofu, was also found guilty of ‘deliberate’ transmission of HIV a month after Ms Mlilo.

It was alleged that he infected his wife sometime between October 2009 and June 2011 , although he wasn’t diagnosed until “sometime in 2010.” No proof regarding timing nor direction of transmission was provided during the trial.

Highest number of reported criminal prosecutions in Africa

The first known successful prosecution in Zimbabwe took place in 2008, although it is believed that more than 20 prosecutions had previously been attempted.

In this case, a 26-year-old woman who had mutually consensual sex with a male partner pleaded guilty to non-disclosure prior to unprotected sex. She was given a five-year suspended sentence, primarily because the partner – who had tried to withdraw the charges – did not test HIV-positive.

A further five men and three women have since been prosecuted, along with a 2010 case where a man was fined for falsely accusing his girlfriend, who subsequently tested HIV-negative, of infecting him with HIV.

The most recent court case, from November 2014, involved a man who was found guilty “based on a single witness” and sentenced to 15 years in prison.

Mpofu/Mlilo vs State, Constitutional Court of Zimbabwe, Harare (Case SC96/12 and 340/12 by HIV Justice Network