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hivandhepatitis.com – President's HIV/AIDS Council Responds to Unjust HIV Criminalization Laws | HIV Policy & Advocacy
The Presidential Advisory Council on HIV/AIDS (PACHA) passed a resolution this month stating that punishments imposed for HIV non-disclosure or exposureareout of proportion to actual harm inflicted, and that HIV criminalization is bad public health policy that fuels the epidemic.
Iowa legislators introduce HIV de-criminalization bill – The Daily Iowan
State lawmakers introduced a bill this week that, if passed, would change the human immunodeficiency virus criminalization laws in Iowa. Sen. Steve Sodders, D-State Center, worked extensively on the bill with Sen. Matt McCoy, D-Des Moines. “[Iowa’s criminal HIV law] was put on the books when HIV and AIDS were first coming out and little was known about it,” Sodders said. “We have more information, better drugs, and we know more about the transmission of HIV so we also need to update our law to avoid being overly punitive in cases where they don’t need to be.”
Greek HIV case – Interview with Zoe Mavroudi from Radiobubble
We’re working to support Radiobubble to produce a documentary about the Greek HIV case – the women who were arrested and imprisoned after forced HIV tests. Zoe Mavroudi is directing the documentary. Here Radiobubble interviews her about the progress of the case and the making of the documentary.
US: Interview with Washington State parliamentarian on revising HIV criminal law
A well-meaning law that created stricter penalties for people who knowingly spread HIV to others should be revised to destigmatize those with the illness, says state Rep. Jim Moeller, D-Vancouver. Moeller has introduced a bill to remove references to HIV in the state’s criminal assault laws while also preserving the tough penalties for criminals who intentionally infect another person with a serious disease.
US: Interview with Senator Matt McCoy on modernising Iowa's HIV criminal law
“We have a situation in Iowa where the law did not differentiate between exposure and transmission,” says Sen. Matt McCoy. He’s introducing a bill that he says will modernize the law and recognize that people with HIV can lead healthy lives. “What we wanted to do was de-stigmatize HIV,” says McCoy. ”We have a separate statute for HIV. We don’t have a separate statute for tuberculosis or other contagious diseases.”
News from Ontario Working Group on Criminal Law and HIV Exposure
Thanks to your actions, the office of the Ministry of the Attorney General met with the Ontario Working Group on January 15, 2013, to discuss desperately needed prosecutorial guidelines. Crown counsel does not have to prosecute people who use condoms or have a low viral load, just because they can.
US: President’s AIDS council calls on feds to help states repeal HIV criminalisation laws
Advisory group says these statutes are ‘unjust’ and fuel the epidemic
BY TODD HEYWOOD, AMERICAN INDEPENDENT
The Presidential Advisory Council on HIV/AIDS (PACHA) passed a resolution last week that calls for an end to federal and state HIV-specific criminal laws and prosecutions.
While the resolution is only advisory, it recommends that the departments of Justice and Health and Human Services issue guidance and offer incentives to state attorneys general and state health departments to eliminate HIV-specific laws. The advisory group also asks these federal agencies to develop guidelines for how to approach HIV within criminal and civil justice systems that are “consistent with the treatment of similar health and safety risks.”
As the resolution notes, 32 states and two territories have laws criminalizing people living with HIV.
In explaining the reason to repeal these laws, the resolution reads:
People living with HIV have been charged under aggravated assault, attempted murder, and even bioterrorism statutes, and they face more severe penalties because law enforcement, prosecutors, courts, and legislators continue to view and characterize people living with HIV and their bodily fluids as inherently dangerous, even as ‘deadly weapons. Punishments imposed for non-disclosure of HIV status, exposure, or HIV transmission are grossly out of proportion to the actual harm inflicted and reinforce the fear and stigma associated with HIV. Public health leaders and global policy makers agree that HIV criminalization is unjust, bad public health policy and is fueling the epidemic rather than reducing it.
PACHA is also requesting that state and federal authorities review the cases of persons convicted under such laws and overturn convictions if deemed appropriate. The group is calling on the Centers for Disease Control and Prevention to “issue a clear statement addressing the growing evidence that HIV criminalization and punishments are counterproductive and undermine current HIV testing and prevention priorities.”
“Today’s announcement is an important advancement in our collective effort to modernize unjust and discriminatory HIV criminalization laws,” said Rep. Barbara Lee (D-Calif.), co-chair of the Congressional HIV/AIDS Caucus in a statement last week. Lee introduced the REPEAL HIV Discrimination Act in 2011, which never passed, and served on the United Nations’ Global Commission on HIV and the Law.
“I join the President’s Advisory Council on AIDS in calling on the Department of Justice and the Centers of Disease Control and Prevention to issue clear guidance to states and public health departments on the counterproductive effects of HIV criminalization policies; we must end this clear discrimination against people living with HIV,” Lee continued. “Criminalization laws breed fear, discrimination, distrust and hatred, and we must end them.”
The White House declined to comment on the resolution, but the National HIV/AIDS Strategy adopted by the Obama administration in July 2010 does call for state legislatures to “consider reviewing HIV-specific criminal statutes to ensure that they are consistent with current knowledge of HIV transmission and support public health approaches to preventing and treating HIV.”
Policymakers at the state level also welcomed the resolution. Randy Mayer, chief of the Bureau of HIV, STD, and Hepatitis for the Iowa Department of Public Health, said the resolution was a new tool in advocates’ fight to repeal Iowa’s HIV-specific law.
“This resolution came at an excellent time for Iowa,” Mayer said in an email to The American Independent.
State activists and public health officials, including Mayer, have laid out a strategy to repeal the state’s law.
“The advocates in Iowa have also aligned their efforts with a public health perspective, so the resolution was a reinforcement of their justification,” Mayer said. “I think the more public health entities that weigh in on this discussion the better.”
But while policymakers praise the resolution, activists urge cautious optimism.
Sean Strub, executive director of the anti-HIV-criminalization organization Sero Project, said the resolution was appreciated, but the “real test will be in whether federal agencies and the administration responds with the necessary urgency.”
Catherine Hanssens, executive director of the Center for HIV Law and Policy, which runs the Positive Justice Project, echoed Strub’s sentiment, noting that while the resolution is important, PACHA “has no power to order anyone to do anything.”
“[HHS] Secretary [Kathleen] Sebelius and President Obama both have the discretion to ignore the resolution’s recommendations.”
Regardless, Hanssens said the resolution is an important milestone in the battle to repeal HIV criminal laws in the U.S.
“The work of advocates who pushed for passage of the resolution is not over,” she said. “But we have passed a major marker on the road to reform, and justice, for many people and communities affected by HIV.”
Nigeria: Advocates successfully argue for removal of HIV criminalisation clause from draft HIV and AIDS Anti-Discrimination Act
Advocates in Nigeria have successfullly argued to remove a clause criminalising the ‘willful or deliberate spead of HIV’ from the latest draft of the long-awaited HIV and AIDS Anti-Discrimination Act.
Last week, the National Agency for the Control of AIDS (NACA) held a two-day stakeholders forum on the much delayed national anti-discrimination law. The meeting aimed to re-energize the passing of the bill into law, and to ensure that it incorporated international human rights conventions and standards as they relate to people living with HIV.
The national law also aims to harmonise state anti-discrimination laws. Currently, three states – Lagos, Enugu and Cross River State – include HIV criminalisation statutes in their their laws.
The vaguely-worded proposed HIV criminalisation statute of the draft national anti-discrimination bill read as follows:
Section 31 Willfull or Deliberate Spread of HIV Virus
Any person, having known his/her seropositive status, deliberately transmits the HIV directly or indirectly shall be guilty of an offence and, upon conviction be sentenced up to twelve months imprisonment or fine of up to N500,000 or both.
At the meeting, many stakeholders proposed to keep the HIV criminalisation statute in the bill, but civil society organisations, led by the Network of People Living with HIV and AIDS in Nigeria (NEPWHAN), successfully advocated against the statute.
Instead, the provisions of the anti-discrimination bill were expanded from covering workplace discrimination to be broadly applicable at the workplace, school, correctional institutions, religious institutions, and in society at large.
The draft harmonized bill as proposed with input from NEPWHAN and other civil society organisations is below. Note the absence of Section 31. Although this is unlikely to be the final wording of the law, it certaily shows how successful advocacy can remove problematic provisions in otherwise supportive and enabling HIV-related laws.
Draft Harmonized Nigerian HIV and AIDS Anti-Discriminational Act 2013
UK: Updated guidance on HIV transmission, the law and the work of the clinical team now published
The British HIV Association (BHIVA) and the British Association for Sexual Health and HIV (BASHH) have produced updated guidance on HIV Transmission, the Law and the Work of the Clinical Team.
This guidance is aimed at those working in the field of HIV medicine, especially clinicians, but will also be of use to general practitioners and people living with HIV who want to understand the legal and medical basis for some of their care decisions.
The guidance begins with a clear statement against HIV criminalisation:
BHIVA and BASHH believe that this use of the law is unhelpful and potentially harmful to public health and support UNAIDS recommendations to limit the use of criminal law and the Oslo declaration view that a “non-punitive, non-criminal HIV prevention approach” is preferable.
Covering the law in England & Wales as well as Scotland, the document aims to provide information and guidance on managing issues related to sexual transmission of HIV based on current scientific evidence. It applies generic ethical and professional principles but with a greater emphasis on providing a confidential environment in which extremely sensitive matters can be frankly and fully discussed. This enables appropriate care of people with HIV and benefits public health by encouraging individuals to access testing and treatment. Within this framework this document sets out the roles and responsibilities of health care professionals when caring for individuals living with HIV.
Consistent with the recent BHIVA and the Expert Advisory Group on AIDS (EAGA) position statement on the use of antiretroviral therapy to reduce HIV transmission, the guidance notes:
In most situations the appropriate use of antiretroviral treatment is at least as effective as condoms in preventing sexual transmission of HIV. This is accepted by the [Crown Prosecution Service of England and Wales] and [Scottish Crown Office and Procurator Fiscal Service] so it is likely that evidence showing that the defendant was taking effective antiretroviral treatment at the time of the alleged transmission may be used to demonstrate that they were not reckless.
The guidance also clearly states that healthcare professionals “must be mindful of their duty not to work beyond their expertise in legal matters. For people with HIV, advice must include the routes of HIV transmission and how to prevent transmission, with information about safer sexual practices, the use of condoms and suppression of viral load. Advice must be given in a non-judgmental way.”
It also discusses issues of confidentiality, noting that “it is important when considering breaching confidentiality to weigh up all potential harms as there may be situations where disclosure of HIV status to protect a sexual partner results in considerable harm to an individual e.g. domestic violence. In situations where a health care professional believes that an HIV positive individual continues to put sexual contacts at risk their duties and subsequent action depend upon the type of contact.” See Figure 1 below.
The guidance also clearly states that “no information should be released to the police unless patient consent has been verified or there is a court order in place, except in very limited circumstances defined by the [General Medical Council].”
Importantly, it also notes that only individuals can make complainants to the police “and health care workers should remain impartial during discussions with patients.”
Finally, it provides clear advice to both help prevent transmission of HIV to sexual partners and to avoid prosecution for ‘reckless’ HIV transmission. Accordingly, people with HIV should do at least one of the following:
- Use a male or female condom fitted correctly along with water-based lubricant. Individuals doing this are unlikely to be seen as reckless for legal purposes. In the event of a condom split, it is advisable to disclose HIV status in order to support the partner’s decision whether or not to obtain post-exposure prophylaxis (PEPSE), which should be taken within 72 hours. The need for PEPSE will depend upon the type of sexual activity and the HIV viral load. An assessment of the risk should be undertaken by a clinician according to the BASHH PEPSE guidelines. Disclosure in these situations would suggest that the person with HIV was not reckless.
- Adhere to effective (suppressed viral load) antiretroviral medication. There is growing evidence of extremely low/minimal risk of transmission when plasma HIV is fully suppressed with the use of antiretroviral medication. In some situations an undetectable viral load can afford protection equivalent to or greater than that of condoms. A person with HIV is unlikely to be seen as reckless when relying on a suppressed viral load instead of condom use if they have been counselled accordingly by an HIV clinician or similar medical authority. It is recommended that this discussion is documented in the patient’s medical records.
In addition people with HIV should be advised that disclosure of HIV positive status to a partner before sex is important to support informed agreement around risk and safer sex behaviours. To avoid successful prosecution an individual who is not taking effective antiretroviral medication and does not use a condom must disclose their HIV status to sexual partners before sex takes place.
The entire guidance is reproduced below.