US: Activists activists raise concerns over the links between public health & law enforcement surveillance

Questioning the Benefits of Molecular Surveillance

Can this HIV prevention strategy overcome mistrust and fear among marginalized communities?

In Texas, health officials recently used a new surveillance technology to identify a large HIV outbreak among gay and bisexual Latino men. In Massachusetts, officials used the same strategy to respond to an outbreak among injection drug users. And in California, researchers used the method to identify a transmission cluster among transgender women.

Led by initial proof-of-principle research at the Centers for Disease Control and Prevention (CDC), an HIV prevention strategy known as molecular surveillance is quickly expanding across the country. Since December 2015, according to an email from a CDC source who commented on background, the technique, based on sequencing and comparing individuals’ viral genetic blueprints, has identified more than 240 recent and rapidly growing HIV transmission clusters, the vast majority of which had not previously been recognized. Comparing these sequences allows researchers to determine whether individuals’ HIV is closely related, which offers clues about who transmitted the virus to whom.

Traditional public health methods—now being used to trace the spread of COVID-19, the disease caused by the new SARS-CoV-2 coronavirus—largely rely on asking people about their contacts and getting in touch with them by phone or in person. The CDC source said molecular data analysis allows for more rapid and comprehensive cluster and outbreak detection and response. As such, molecular surveillance is seen by the agency as a key part of effective HIV prevention and a means to help hard-hit communities and the nation end the HIV epidemic.

Those idealized goals, however, are clashing with a far messier reality in which decades of mistrust and fear among marginalized communities, heightened in the current political climate, are coming to a head. The tech-aided HIV surveillance strategy, six activists told POZ, could open up new avenues for private data to be breached, exploited, subpoenaed or otherwise released through many of the HIV criminalization laws and statutes still on the books in 34 states.

Activists say the CDC-led molecular surveillance effort was launched with little or no consultation or buy-in from the communities most likely to be impacted. Several meetings ensued, including one convened in 2018 by the O’Neill Institute for National & Global Health Law at Georgetown Law School in Washington, DC, that allowed critics to air some of their concerns. Despite a subsequent round of CDC guidelines on how best to safeguard patient data, however, the controversy has only grown over the potential misuse and unintended consequences of the surveillance scheme.

Patients can’t opt out of providing their viral sequence data for the molecular tracking, critics point out. Nor does the strategy adequately consider the state-by-state patchwork of protections and penalties or the growing health implications of an erosion of immigrant, minority and LGBTQ rights, they say.

Sean Strub, POZ’s founder and the executive director of the nonprofit Sero Project, which focuses on reforming HIV criminalization laws, says he fears the CDC-led strategy will diminish trust and cooperation with public health agencies and drive more vulnerable people further from the health care system out of fear of surveillance. “I think the risk of unintended consequences is very great,” he says.

Strub and other activists see molecular surveillance as part of a broader trend in the “securitization of disease,” which is increasingly blurring the lines between the public health and criminal justice systems.

“We are potentially threatening people’s freedom just to get cleaner data, and I think it’s a clear ethical concern,” says Devin Hursey, a member of the Missouri HIV Justice Coalition and a board member of Blaq Out, a nonprofit advocacy group for Black queer and transgender people in the Kansas City region. “We can’t just look the other way or say we’re doing our best effort when we’re not really addressing that HIV criminalization still exists.”

The CDC source told POZ that the agency understands and has addressed many of the questions and concerns raised by community advocates. The CDC has strong data protections and security measures in place, the source said, and has worked for many years to provide guidance to states on reviewing and revising criminalization laws and ensuring data are well protected.

But Naina Khanna, executive director of Positive Women’s Network–USA, says the CDC hasn’t responded to specific questions about its data-sharing practices with other federal agencies, like the Department of Homeland Security and Immigration and Customs Enforcement (ICE). Khanna points out that the communities most impacted by HIV are also disproportionately affected by surveillance, policing and criminalization. “That’s extremely concerning when we think about how policing intersects with being a Black gay man or being a Latino gay man,” she says. In response, the CDC source told POZ that all HIV surveillance data are reported to the agency without names or any personal identifiers and are encrypted and protected by an Assurance of Confidentiality under Section 308(d) of the federal Public Health Service Act.

A New Surveillance Tool

When someone tests positive for HIV in the United States, a blood draw allows labs to sequence part of the viral genome, or its genetic blueprint, and use that to determine whether the virus contains mutations that might lead to drug resistance. This information can help doctors tailor the best HIV treatment regimen for each individual. But once the genetic sequencing is complete, health departments can access that data for molecular HIV surveillance. Specifically, they compare viral RNA sequences from multiple individuals to identify clusters of transmission. This is possible because HIV mutates over time; as a result, people with similar genetic sequences are more likely to have been infected around the same time as part of the same person-to-person chain of viral transmission.

Randy Mayer, MS, MPH, chief of the Bureau of HIV, STD and Hepatitis at the Iowa Department of Public Health, says the HIV resistance tests sent in by doctors around the state essentially provide his department with free surveillance data. “It’s something that we can use to try to improve our response that doesn’t really cost us anything,” Mayer says. “So from that point of view, it is cost effective.”

If a state-run computer program finds two or more individuals who share closely related viral sequences, it suggests that HIV might have passed between them or through a close intermediary. Spotting such clusters of transmission could help public health officials identify HIV-positive individuals and their close sexual or needle-sharing partners.

The surveillance approach has multiple potential benefits, researchers say. “This is just one more strategy in the toolbox of surveillance tools used to guide public practice,” says Nanette Benbow, MAS, research assistant professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine in Chicago. HIV transmission clusters identified through this method, she says, may represent only the “tip of the iceberg” of at-risk individuals, since the genetic information is available only for HIV-positive people who’ve been to a doctor and received drug resistance testing. Through contact tracing, though, public health officials can find other people associated with the cluster, contact them and offer them a range of care or prevention services, like pre-exposure prophylaxis (PrEP), if they’re not already receiving them.

Benbow says evidence suggests that the rate of HIV transmission within such clusters is much higher than that of transmissions overall, bolstering the case that public health agencies should focus on these clusters as significant sources of active viral transmission.

Some public health experts say the growth of surveillance is inevitable. “You’re not going to stop technology. All you can do is try to get it implemented in an ethical manner,” says Eve Mokotoff, MPH, managing director of HIV Counts, a consulting business based in Ann Arbor, Michigan, that assists with HIV surveillance.

Andrew Spieldenner, PhD, vice chair of the U.S. People Living with HIV Caucus and an assistant professor of communications at California State University San Marcos, rejects that argument. “Just because technology exists doesn’t mean we have to use it,” Spieldenner says. “We have to balance it with the harms it does to individuals.”

Newer technology that could extend molecular HIV surveillance is giving activists more pause. One method, called ultra-deep whole-genome next-generation sequencing, isn’t yet part of the CDC strategy. But emerging study data suggest that it could predict the directionality of linked HIV transmissions, potentially adding new evidence to suggest who infected whom. Researchers at Johns Hopkins University School of Medicine, in fact, recently described how they correctly predicted HIV transmission from an index case to a sexual partner in more than 90% of 105 sample pairs. The direction couldn’t be established in the remaining cases, but the method didn’t incorrectly predict any transmissions.

Other research the CDC is pursuing may help estimate the recency of an infection, meaning whether one person acquired HIV more recently than another. Together, the data could enable additional predictions about when and how HIV infections occurred within transmission clusters. Benbow says the data on their own don’t prove direct transmission, since another individual could have been an intermediary in the chain, but Khanna points out that judges and juries wouldn’t necessarily take these scientific caveats into account. “We see a lot of potential for opening the door to criminalization,” she says.

Despite privacy assurances, Strub maintains that data collected for one purpose is being unethically used for another without patient consent. “It’s not being used evenly across the society. Molecular surveillance focuses on the communities that are already highly marginalized, communities where there is the greatest risk of serious, harmful consequences,” he says. “People of privilege don’t see this.”

In a 2019 letter in the journal Lancet, researchers at the University of California, San Diego responded to criticism of their molecular surveillance study of an HIV transmission cluster involving transgender women by questioning whether informed consent is “imperative” for such analyses. “Surveillance for numerous infectious agents, including HIV, is done ethically and without consent. The public good of HIV surveillance justifies this approach,” they wrote. “Requiring consent for surveillance reporting would preclude a robust understanding of disease distribution and spread and the ensuing benefit to the health of individuals and communities.”

Alexander McClelland, PhD, a postdoctoral researcher in the Department of Criminology at the University of Ottawa, says such arguments reflect the logic that people living with HIV are an “object of risk” to be managed by public health. “We’re not considered to be people who have autonomy or rights to privacy or security of our own lives and our own bodies and our own data,” he says.

Many defenses of molecular surveillance, McClelland adds, also overlook other implications beyond the “broader public good” of repurposing patient data for public health surveillance. Among them, he says, are the criminalization, uncertainty and fear of people who are living with HIV and subject to continual privacy breaches. “People love to say, ‘We’re looking at molecules not people.’ But those molecules are connected to people, and those people are in the social world,” McClelland says, “and you can’t evacuate a virus from the social context that it’s in.”

A Climate of Fear

According to the Center for HIV Law & Policy in New York City, 34 states have enacted some form of HIV criminalization law or sentencing enhancement for other crimes allegedly committed by a person living with HIV. Although the language varies, 21 states have laws under which HIV-positive people who are aware of their status but don’t disclose it to sexual partners can be prosecuted (additional states have prosecuted nondisclosure under different laws); 12 states require the same disclosure among people who share needles. Some laws cover alleged HIV exposure while others cover actual transmission. Between 2009 and 2019, 24 states also prosecuted people living with HIV under other criminal statutes.

The interpretations and enforcement of laws can vary widely as well. In an April 2020 report, the Williams Institute at the UCLA School of Law documented 209 arrests and 107 convictions under Missouri’s HIV criminalization laws between 1990 and 2009. The report noted that the crimes appeared to be disproportionately enforced in St. Louis and adjacent St. Louis County. Although Black men account for 5.5% of Missouri’s population and 35% of people living with HIV, the report found, they accounted for more than half of HIV crime arrests and convictions over the 20-year period.

“We’re oftentimes targeted by not just HIV laws but by a lot of other different laws. We’re more likely to experience surveillance by law enforcement,” Hursey says of Black men. Layering on the element of molecular surveillance, he adds, only compounds the fear and lack of trust in public health and discourages the honest answers and cooperation necessary for HIV peer educators like him to do their jobs effectively. That mistrust is heightened by the legal requirement that Missouri’s health department must turn over all surveillance data to prosecutors pursuing an HIV criminalization case, he says.

“We have an epidemic of criminalization of people living with HIV, and you can only be prosecuted or convicted if you know your HIV status,” Khanna says. If people already feel marginalized and stigmatized, she and Hursey say, the added threat of criminalization based on knowing their HIV status can deter them from ever seeking out testing or care—the very opposite of stated public health goals.

Marco Castro-Bojorquez, cochair of the HIV Racial Justice Now project, says molecular HIV surveillance could likewise put undocumented immigrants at risk, especially since their existence in the United States is already criminalized. “It’s problematic, and it breaks my heart because a lot of people that could be very affected are those that are so fearful of the government and don’t really know that it’s happening,” he says.

Across the border from Missouri, Mayer says public health data are “well protected” in Iowa. They weren’t always, but in 2014, Iowa reformed its HIV criminalization law. The updated statute, Mayer says, requires proof that an HIV-positive person was negligent in exposing a partner to the virus and prohibits molecular surveillance data gathered by the state health department from being used to prosecute anyone. “I had some upset prosecutors who have tried to come to me, with subpoenas, to get information, which we don’t allow,” he says. Prosecutors can gather the data from other sources, but the health department has largely cut its tether to law enforcement.

Even so, prosecutors have found other mechanisms to gather data and enforce Iowa’s HIV criminalization law. In May, a 33-year-old Black man was sentenced to 26 years for “knowingly” exposing three women and a minor to HIV and transmitting the virus to three of them.

Activists say public health agencies also cannot divorce their molecular surveillance plans, however well intentioned, from the current rollback of LGBTQ, immigrant and minority rights. Castro-Bojorquez says the Trump administration’s anti-immigrant rhetoric and policies have not only eroded the Latino community’s trust in public officials but also worsened health outcomes. “Those attacks,” he says, “and the promotion of hatred, rolling back the few rights that we had and we fought so hard for, they have an impact, and people die.”

Numerous undocumented immigrants held in crowded detention centers have contracted COVID-19, and some deported immigrants have brought the coronavirus back to Guatemala, Mexico and other countries. Fear of HIV criminalization or deportation, Castro-Bojorquez says, has led other immigrants to avoid or delay “official” activities, including HIV testing and treatment. “Late diagnosis is a major issue in our communities,” he says, adding that it’s a big contributor to higher mortality rates among Latino men.

***

Finding Common Ground

Amid the ongoing controversy, HIV activists and public health officials may be finding common ground on the need for more community engagement and on the importance of decoupling public health and law enforcement. In a 2019 commentary in the American Journal of Public Health, Benbow joined other AIDS researchers, bioethicists and a representative of the National Alliance of State and Territorial AIDS Directors (NASTAD) in explaining how multiple aspects of existing HIV criminalization laws could confound public health goals around molecular surveillance.

Benbow and her coauthors cautioned that using identified surveillance data against the interest of patients, especially without informing them, “could jeopardize community confidence in public health agencies.” The authors also noted the CDC’s requirement that funded health departments create plans to address gaps in data protection and consider eliminating or modifying potentially counterproductive laws. “In light of the considerations we have addressed, health department leaders should consider supporting statutes that expressly limit, or even prohibit entirely, release of surveillance data for law enforcement purposes,” they wrote.

Mokotoff cautions that a health department can’t always change its state law. “But the health department can work with the community to help them understand what needs to be done and what kind of wording might be helpful,” she says. “We have to stop allowing surveillance data to be used for prosecution of people who are sick or infected.” Protecting that data from being used in law enforcement, she adds, “would change the entire discussion” with stakeholders in the HIV-positive community.

The CDC itself has avoided criticizing specific state laws, though the agency source told POZ that the CDC has worked with partners like NASTAD to review the range of legal protections, policies and procedures that can help protect HIV data. The source noted that in 2014, the Department of Justice recommended that states either reform their laws to eliminate HIV-specific criminal penalties or modernize their laws to reflect current scientific evidence. The source also pointed out that the Department of Health and Human Services 2019 initiative, “Ending the HIV Epidemic: A Plan for America,” encourages states to take similar steps to help reduce stigma.

Benbow conceded that addressing the intense mistrust of underserved individuals who may need HIV prevention or treatment services the most, including people who inject drugs and undocumented immigrants, remains a steep challenge. But identifying clusters, she says, could help health officials make the case for targeted services that benefit underserved people, like the legalization of needle exchange programs.

“A lot of what we do in public health infringes on privacy, and what we’re trying to do is balance a person’s individual freedoms and liberties and privacy with trying to improve public health and work for the common good,” Mayer says. “You really have to think very carefully about that because if you push that too far, then you’re likely to get a lot of public health interventions rolled back, and people don’t want to work with you. They don’t trust you.” And as the history of HIV shows, regaining lost trust can take decades.

US: HIV criminalisation laws increase stigma and discrimination and impede effective treatment and prevention

These laws were meant to protect people from HIV. They’ve only increased stigma and abuse.

By Anna North

Laws in many states make it a crime to have sex without disclosing your HIV status. Advocates say they may actually worsen the spread of the virus.

The policy: Criminal penalties for knowingly exposing someone to HIV

Where: Twenty-six states around the country

In place since: The 1980s

The problem:

In March 1981, an otherwise healthy Los Angeles man contracted a rare form of pneumonia usually seen only in people with severely compromised immune systems. Doctors treated him with antibiotics, but his condition worsened, and within two months, he was dead.

The Center for Disease Control, as it was then known, identified four similar cases — generally healthy young men who suddenly became very ill with the same rare lung disease — and in June 1981 published the first official report on the condition that would become known as AIDS. By the time the report was published, another of the men had died. By the end of the year, there were 337 reported cases of the condition, and 130 people had died.

Researchers discovered HIV, the virus that causes AIDS, in 1984. But the death toll kept rising, and the panic along with it. Fear and misunderstanding of the disease were such that when one student at a New York City school was thought to have the virus, 944 of the school’s 1,100 students stayed home, according to a Time magazine report. In one 1985 poll, 50 percent of people supported a quarantine of people with AIDS. Amid this panic, the idea emerged that “there were people who were intentionally spreading HIV,” Scott Schoettes, HIV project director at the LGBTQ civil rights group Lambda Legal, told Vox.

The idea may have been fueled by longstanding social prejudices, including homophobia. As journalist Steven Thrasher writes in a Guardian column on the now-debunked myth of a gay flight attendant as HIV’s “Patient Zero,” “we like to blame individuals (especially queer folks, women, immigrants and people of color) for diseases, particularly communicable ones that involve sex. Societally, it is far easier to blame them for disease rather than to deal with the complex medical, political and epidemiological causes.”

Nonetheless, states soon began instituting criminal penalties for knowingly exposing others to the virus — Florida, Washington, and Tennessee did so in 1986, Helen McDonald writes at Autostraddle. In 1990, the federal Ryan White Act, which provided funding for HIV treatment, required states to show they could prosecute people who exposed others to HIV. The laws began to proliferate, and by 2011, 33 states had one or more laws criminalizing HIV exposure. As of last year, such laws remained on the books in 26 states, according to the CDC.

How it worked:

The first problem with the laws was a simple one, according to Schoettes and others: The crime they were intended to combat didn’t actually exist. There is no evidence that a significant number of people were ever intentionally trying to infect other people with HIV.

But because many of the laws were broadly written, they were used to prosecute people who had never intended to harm anyone else — and, in some cases, who had done no harm.

Mark Hunter, for example, told Vox that he contracted HIV at the age of 7 through treatment for his hemophilia. Hunter led a healthy and active life — he had a six-figure job in Washington, DC, he said, when, in 2006, two ex-partners filed charges against him for failing to disclose his HIV status to them. Neither woman had contracted the virus, but nonetheless, he was sentenced to 12 years in prison in Arkansas, where the charges were filed.

Hunter ended up serving three years. Today, he is out on parole and living in Louisiana, but he still has to register as a sex offender. He is an outspoken advocate against laws of the kind that sent him to prison. “When we talk about criminalization, the base issue is stigma,” he told Vox. “That stigma comes from fear.”

Hunter’s is just one of many such stories. Perhaps the best-known case is that of Nick Rhoades, who had sex with another man in 2008 without disclosing his HIV status. The other man subsequently learned that Rhoades had HIV and went to a doctor for antiretroviral medication. The law in Iowa, where the men lived, required the doctor to notify police that a sex crime had occurred, according to the National Registry of Exonerations. The men had used a condom, and Rhoades’s partner had not contracted the virus. Nonetheless, Rhoades was arrested and sentenced to 25 years in prison.

Stories like these have also made people around the country afraid to get tested because “you can’t be prosecuted under one of these laws unless you know your HIV status,” Schoettes said. Testing and treatment are key ways of reducing HIV transmission, and by making people afraid to get tested, HIV criminalization laws may actually increase the spread of the virus.

A study conducted in Toronto between 2010 and 2012 (laws criminalizing HIV exposure also exist in Canada) found that 7 percent of men who had sex with men were less likely to get an HIV test for fear of future prosecution — the study authors estimated that this fear could lead to an 18.5 percent increase in HIV transmission. And in general, HIV criminalization laws likely contribute to stigma and discrimination around HIV, which world health groups like UNAIDS have identified as some of the biggest barriers to effective treatment and prevention.

Meanwhile, “these laws were used to manipulate and coerce people to stay in abusive relationships,” Tami Haught, organizing and training coordinator for the SERO Project, a group that works to end HIV criminalization, told Vox. In Iowa, where Haught lives, it was difficult for people with HIV to definitively prove they had disclosed their status to their partners as the law required. Haught recalls a woman living with HIV whose abusive boyfriend told her, “if you call the cops or leave me I will tell them you didn’t disclose your status.” If that happened, the woman, not her abuser, could go to prison.

People with HIV were even afraid to report being raped, Haught said, for fear that they could be prosecuted for failing to disclose their status during the rape.

Those sentenced under the law, meanwhile, could face decades in prison even if they had used condoms. Once released, they were often forced to register as sex offenders. In Iowa, that meant having their HIV status disclosed publicly, sometimes with a mug shot in the newspaper, Haught said. They were subject to curfews and computer searches, had to submit to twice-yearly lie detector tests, and needed permission from authorities to leave the county, she added: “They were treated as if they were these dangerous predators rather than having a consensual sexual experience with another adult.”

In recent years, though, states have begun changing their laws. Iowa was the most high-profile example. Rhoades challenged his conviction in court in 2010, and around the same time, activists began lobbying state legislators to reform the law.

Rhoades and many others fought for years to get the Iowa law changed. Finally, in 2014, then-Gov. Terry Branstad signed a new law significantly reducing the penalties for exposing others to HIV. Under the new law, if someone intentionally infects someone else with HIV, the person can still face up to 25 years in prison. But if a person with HIV only acts with “reckless disregard” in exposing someone else to the virus — for example, by not using protection — that person can face one to five years in prison, depending on whether the other party actually contracts the virus. Meanwhile, taking “practical measures to prevent transmission” of the virus makes someone exempt from prosecution, according to the Center for HIV Law and Policy.

The law also removed the requirement that people convicted of exposing others to HIV register as sex offenders, and allowed previously convicted people to be removed from the sex offender registry. After the law was signed, two Iowans who had been forced to register as sex offenders under the old law had their ankle monitors publicly removed in celebration, Haught said. That year, Rhoades won his court case, and his conviction was set aside.

Many critics have argued the changes to Iowa’s law don’t go far enough. “HIV transmission should not be criminalized—ever,” wrote Mark Joseph Stern at Slate. “HIV criminalization laws do absolutely nothing to prevent the spread of the virus.”

But in general, Schoettes said, it’s been very difficult to convince state legislators to remove penalties completely. Also, “our concern is if you get rid of the law, prosecutors may just proceed under general criminal laws without parameters or guidance” — in some states, for example, people with HIV have been prosecuted for reckless endangerment or even assault with a deadly weapon. For that reason, Lambda Legal has backed reforming rather than removing these laws.

These efforts have had success in California, where in 2017 then-Gov. Jerry Brown signed a law ensuring that people cannot be prosecuted based on HIV status unless they actually intend to transmit the virus and do so. Colorado, Michigan, and North Carolina have also reformed their laws or regulations around HIV, Haught said. And according to Schoettes, advocates are also working to repeal or reform HIV criminalization laws in Florida, Illinois, Ohio, Indiana, and elsewhere.

Today, Mark Hunter is “in a good place,” he said. He is married, and has adopted his wife’s son from a previous relationship. He has a job with the state of Louisiana, he’s a deacon in his church, and he has started an HIV/AIDS foundation named after his brother. He will be off parole in April 2020.

But his driver’s license still has the words “sex offender” printed on it. And around the country, he still sees a lot of stigma around HIV.

“Change is coming,” he said, “but it’s coming slow.”

Anna North covers gender issues, reproductive rights, workplace discrimination, LGBTQ rights, and more for Vox. Previously, she worked for The New York Times.

US: American Medical Association adopts policy to advocate for repeal of legislation that criminalises nondisclosure of HIV status

Catch up with the news and other key moments from the AMA House of Delegates’ meeting in Chicago. The 2019 AMA Annual Meeting wrapped up on June 12.

Thursday, June 13

Prison inmates and staff should get more health education, training. Poor health outcomes are rampant in U.S. jails and prisons, thanks to subpar hand hygiene, oral health and other factors. The AMA, in a vote yesterday, also backed giving incarcerated women access to contraception. Read more.

Doctors back funding plans to end HIV epidemic. In a strong show of support for major action to “end the epidemic of HIV nationally,” delegates yesterday voted to advocate funding plans that focus on:

Diagnosing individuals with HIV infection as early as possible.
Treating HIV infection to achieve sustained viral suppression.
Preventing at-risk individuals from acquiring HIV infection, including through the use of pre-exposure prophylaxis (PrEP).
Rapidly detecting and responding to emerging clusters of HIV infection to prevent transmission.

In a separate action, AMA delegates took action to address the 32 states and two U.S. territories that have punitive laws criminalizing individuals who fail to disclose HIV status to sexual partners.

“Current criminalization laws are outdated and do not reflect the current science of HIV transmission or the fact that HIV is a chronic, but manageable medical condition—particularly since nondisclosure of other infectious diseases is not criminalized,” said AMA Board Member E. Scott Ferguson, MD.

People with HIV who take antiretroviral therapy medication as prescribed and are able to get and keep an undetectable viral load have effectively no risk of transmitting HIV to their HIV-negative sexual partners.

In light of that, delegates adopted new policy to:

Advocate for repeal of legislation that criminalizes nondisclosure of HIV status for people living with HIV.
Work with other stakeholders to develop a program whose primary goal is to destigmatize HIV infection through educating the public, physicians and other health care professionals on current medical advances in HIV treatment that minimize the risk of transmission due to viral load suppression and the availability of PrEP.

Canada: The Women’s Legal Education and Action Fund (LEAF) publishes a position paper proposing a feminist approach to law reform on HIV non-disclosure

The Women’s Legal Education and Action Fund (LEAF) has written a position paper proposing a feminist approach to law reform on HIV non-disclosure.

LEAF supports the federal government’s recent prosecutorial directive intended to reduce the over-criminalization of those living with HIV/AIDS. Canadian law currently criminalizes HIV non-disclosure where a person who is HIV-positive exposes their sexual partner to a significant risk of serious bodily harm—which in law includes a realistic possibility of HIV transmission. Most cases are prosecuted as aggravated sexual assaults, which is punishable by a maximum life sentence. As of December 2018, the Attorney General of Canada will not prosecute charges of HIV non-disclosure if a person living with HIV has maintained a suppressed viral load, used condoms, or engaged only in oral sex.

Women’s rights are also engaged by this area of law. Women are often complainants in these cases—nearly 20% of women with HIV report having acquired the virus through sexually coercive experiences. And HIV non-disclosure prosecutions have led to an increase in women, particularly marginalized women, being convicted of aggravated sexual assault. Almost 80% of women living with HIV are Indigenous or racialized, and they already face serious over-criminalization. Prosecuting HIV non-disclosure as a sexual offence has distorted concepts about sex and consent that are foundational to women’s equality – in an attempt to fit HIV non-disclosure into sexual assault law, courts have narrowed the scope of sexual activity that requires consent in law and risked introducing discriminatory myths and stereotypes into the criminal trial.

This is why LEAF is recommending further reforms that will ensure meaningful protections for women’s equality rights—especially for marginalized women. Most importantly, HIV non-disclosure should not be treated as a sexual offence. This would protect the equality-enhancing purpose of sexual assault law by affirming a concept of consent that is rooted in sexual autonomy. Where HIV non-disclosure results in actual transmission of the virus, prosecution may be appropriate under non-sexual Criminal Code offences. This would reduce the punitive over-criminalization of people living with HIV, while protecting women who contract HIV from partners who take no care to prevent transmission. There are no Canadian cases where an accused responsibly used a condom or had an undetectable viral load and the virus was nonetheless transmitted. Finally, prosecutorial guidelines should ensure that HIV positive women who are victims of violence, coercion or sexual assault are not prosecuted for their failure to disclose their HIV status when that failure is a result of the violence or threats of violence committed against them.

“In addition to raising significant concerns for the equality and dignity of those living with HIV, the law of HIV non-disclosure also impacts women’s equality rights,” says Karen Segal, LEAF Counsel. “LEAF seeks to ensure that women’s equality is specifically attended to in any future law reform initiatives, so that women are protected from sexual violence and from punitive over-criminalization, and so that the right to bodily and sexual autonomy remains the foundational concept in the law of sexual offences.”

Read LEAF’s position paper here

The Women’s Legal Education and Action Fund (LEAF) works to advance the substantive equality rights of women and girls through litigation, law reform, and public education. Since 1985, we have intervened in landmark cases that have advanced equality in Canada—helping to prevent violence, eliminate discrimination in the workplace, provide better maternity benefits, ensure a right to pay equity, and allow access to reproductive freedoms. For more information, please visit www.leaf.ca.

For media inquiries, please contact:

Karen Segal, Counsel

Women’s Legal Education and Action Fund

416.595.7170 x2003

k.segal@leaf.ca

Webinar: Molecular HIV Surveillance (PWN-USA, 2019)

PWN’s Barb Cardell’s webinar on Molecular HIV Surveillance and its implications for marginalized communities living with HIV, including intersections with HIV criminalization.

Beyond Blame 2018 Meeting Report and Evaluation Now Available

Beyond Blame 2018: Challenging HIV Criminalisation was a one-day meeting for activists, advocates, judges, lawyers, scientists, healthcare professionals and researchers working to end HIV criminalisation. Held at the historic De Balie in Amsterdam, immediately preceding the 22nd International AIDS Conference (AIDS 2018), the meeting was convened by HIV JUSTICE WORLDWIDE and supported by a grant from the Robert Carr Fund for Civil Society Networks.

The Meeting Report and Evaluation, written by the meeting’s lead rapporteur, Sally Cameron, Senior Policy Analyst for the HIV Justice Network, is now available for download here.

The meeting discussed progress on the global effort to combat the unjust use of the criminal law against people living with HIV, including practical opportunities for advocates working in different jurisdictions to share knowledge, collaborate, and energise the global fight against HIV criminalisation. The programme included keynote presentations, interactive panels, and more intimate workshops focusing on critical issues in the fight against HIV criminalisation around the world.

The more than 150 attendees at the meeting came from 30 countries covering most regions of the world including Africa, Asia and the Pacific, Eastern Europe and Central Asia, Latin and North America and Western Europe. Participation was extended to a global audience through livestreaming of the meeting on the HIV JUSTICE WORLDWIDE YouTube Channel, with interaction facilitated through the use of Twitter (using the hashtag #BeyondBlame2018) to ask questions of panellists and other speakers. See our Twitter Moments story here.

Following the meeting, participants were surveyed to gauge the event’s success. All participants rated Beyond Blame 2018 as good (6%), very good (37%), or excellent (57%), with 100% of participants saying that Beyond Blame 2018 had provided useful information and evidence they could use to advocate against HIV criminalisation.

A video recording of the entire meeting is available on HIV JUSTICE WORLDWIDE’s YouTube Chanel.

Key points

The experience of HIV criminalisation was a poor fit for individual’s actions and the consequences of those actions, particularly where actions included little or no possibility of transmission or where courts did not address scientific evidence
The consequences of prosecution for alleged HIV non-disclosure prior to sex are enormous and may include being ostracised, dealing with trauma and ongoing mental health issues, loss of social standing, financial instability, multiple barriers to participation in society, and sex offender registration
Survivors of the experience shared a sense of solidarity with others who had been through the system, and were determined to use their voices to create change so that others do not have to go through similar experiences
Becoming an advocate against HIV criminalisation is empowering and helps to make sense of individuals’ experiences

The movement against HIV criminalisation has grown significantly over the last decade but as the movement has grown, so has understanding of the breadth of the issue, with new cases and laws frequently uncovered in different parts of the world.
As well as stigma, there are multiple structural barriers in place enabling HIV criminalisation, including lags in getting modern science into courtrooms and incentives for police to bring cases for prosecution.
Community mobilisation is vital to successful advocacy. That work requires funding, education, and dialogue among those most affected to develop local agendas for change.
Criminalisation is complex and more work is required to build legal literacy of local communities.
Regional and global organisations play a vital role supporting local organisations to network and increase understanding and capacity for advocacy.
There have already been many advocacy successes, frequently the result of interagency collaboration and effective community mobilisation.

It is critical to frame advocacy against HIV criminalisation around justice, effective public health strategy and science rather than relying on science alone, as this more comprehensive framing is both more strategic and will help prevent injustices that may result from a reliance on science alone.
There have been lengthy delays between scientific and medical understanding of HIV being substantiated in large scale, authoritative trials, and that knowledge being accepted by courts.
Improving courts’ understanding that effective treatment radically reduces HIV transmission risk (galvanised in the grassroots ‘U=U’ movement) has the potential to dramatically decrease the number of prosecutions and convictions associated with HIV criminalisation and could lead to a modernisation of HIV-related laws.
Great care must be exercised when advocating a ‘U=U’ position at policy/law reform level, as doing so has the potential to deflect attention from issues of justice, particularly the need to repeal HIV-specific laws, stop the overly broad application of laws, and ensure that people who are not on treatment, cannot access viral load testing and/or who have a detectable viral load are not left behind.
Courts’ poor understanding of the effectiveness of modern antiretroviral therapies contributes to laws being inappropriately applied and people being convicted and sentenced to lengthy jail terms because of an exaggerated perception of ‘the harms’ caused by HIV.
HIV-related stigma remains a major impediment to the application of modern science into the courtroom, and a major issue undermining justice for people living with HIV throughout all legal systems.
HIV prevention, including individuals living with HIV accessing and remaining on treatment, is as much the responsibility of governments as individuals, and governments should ensure accessible, affordable and supportive health systems to enable everyone to access HIV prevention and treatment.
New education campaigns are required, bringing modern scientific understanding into community health education.
Continuing to work in silos is slowing our response to the HIV epidemic.

HIV criminalisation plays out in social contexts, with patriarchal social structures and gender discrimination intersecting with race, class, sexuality and other factors to exacerbate existing social inequalities.
Women’s efforts to seek protections from the criminal justice system are not always feminist; they often further the carceral state and promote criminalisation.
Interventions by some purporting to speak on behalf of women’s safety or HIV prevention efforts have delivered limited successes because social power, the structuring of laws and the ways laws are administered remain rooted in patriarchal power and structural violence.
Feminist approaches must recognise that women’s experiences differ according to a range of factors including race, class, types of work, immigration status, the experience of colonisation, and others.
For many women, HIV disclosure is not a safe option.
More work is needed to increase legal literacy and support for local women to develop and lead HIV criminalisation advocacy based on their local context.
When women affected by HIV have had the opportunity to consider the way that ‘protective’ HIV laws are likely to be applied, they have often concluded that those laws will be used against them and have taken action to advocate against the use of those laws.

At the end of the meeting, participants were asked to make some closing observations. These included:

Recognising that the event had allowed a variety of voices to be heard. In particular, autobiographical voices were the most authentic and most powerful: people speaking about their own experiences. This model which deferred to those communicating personal experiences, should be use when speaking to those in power.
Appreciating that there was enormous value in hearing concrete examples of how people are working to address HIV criminalisation, particularly when working intersectionally. It is important to capture these practical examples and make them available (noting practical examples will form the focus of the pending Advancing HIV Justice 3 report).
Understanding that U=U is based on a degree of privilege that is not shared by all people living with HIV. It is vital that accurate science informs HIV criminalisation as a means to reduce the number of people being prosecuted, however, people who are not on treatment are likely to become the new ‘scapegoats’. It is important that we take all opportunities to build bridges between U=U and anti-HIV criminalisation advocates, to create strong pathways to work together and support shared work.
Noting the importance of calling out racism and colonialism and their effects.
Observing that more effort is required to better understand and improve the role of police, health care providers and peer educators to limit HIV criminalisation.
Exploring innovative ways to advocate against HIV criminalisation, including community education work through the use of art, theatre, dance and other mechanisms.
Concluding that we must challenge ourselves going forward. That we must make the circle bigger. That next time we meet, we should challenge ourselves to bring someone who doesn’t agree with us. That we each find five people who aren’t on our side or don’t believe HIV criminalisation is a problem and we find ways and means (including funding) to bring them to the next Beyond Blame.

Samoa: HIV criminalisation is a threat to public health indicates the Ministry of Health in its 2017 National HIV Policy report

M.O.H. against criminalization of HIV

The criminalization of the transmission of HIV in Samoa is a threat to public health. This is one of the highlights by the Ministry of Health indicated in their 98 page National HIV, AIDS, and STI Policy 2017-2022 report that was obtained by the Samoa Observer.

According to the prevention segment of the report, it points to some countries where criminal law is being applied to those who transmit or expose others to HIV infection.

“The Ministry of Health does not recommend nor endorse legislative measures to criminalize the transmission of HIV that is unintentional and views such measures as threats to public health.

“There is no data indicating that the broad application of criminal law to HIV transmission will achieve either criminal justice or prevent HIV transmission.

“Rather, such application risks undermine public health and human rights.

“Because of these concerns, UNAIDS urges governments to limit criminalization to cases of intentional transmission i.e. where a person knows his or her HIV positive status, acts with the intention to transmit HIV, and does in fact transmit it.

“Willful spread of HIV has been so rarely documented worldwide that it is largely hypothetical,” the report says.

According to the MOH Policy, since there are no cases have been processed in Samoa or Australia and New Zealand Commonwealth case law, legally it is urban myth and no legislation exists regarding the legal handling of such a case.

“Presently Samoan legal priorities regarding HIV, AIDS, and STI’s are primarily concerned with protecting the individual rights and confidentiality of people as well as safeguarding public health.

“Prosecuting a case of willful spread of HIV would necessarily involve addressing legal criteria in Sections 120-121 of the Crimes Act 2013.

“Supplying evidentiary support for a claim would entail 1) proving a person knew their HIV status prior to exposing other individual(s), 2) the individual did not disclose their HIV status to exposed person(s), 3) and the exposure resulted in HIV infection.

“Any action taken against to quarantine and accuse a case of a wilful spread of HIV would fall under the authoritative powers of MoH within Part 4 Section 36 of the Health Ordinance 1959 “Isolation of persons likely to spread infectious diseases” as well as Section 37 , Offenses in regards to infectious diseases,” according to the report.

The M.O.H. Policy also emphasized that all rights of people living with AIDS, national and international, must not be violated in the investigation, prosecution and sentencing of individuals involved in such a potential case.

The report can be downloaded here

Global Commission on HIV and the Law and partners urge governments to promote progressive legislation based on science and human rights

Evidence- and rights- based laws and policies are key to ending AIDS

On the five-year anniversary of the Global Commission on HIV and the Law’s groundbreaking report, former members of the Commission and partners commend 88 countries for advancing the report’s recommendations and urge other countries to enact progressive legislation and protect human rights

NEW YORK – Five years ago, a landmark report published by the Global Commission on HIV and the Law urged governments to promote laws and policies grounded in evidence and human rights in order to turn the tide against AIDS. This week, members of the Commission and representatives of UN Member States, civil society, academia and international organizations came together to assess the progress made in advancing the report’s recommendations, look at the barriers that remain and discuss opportunities for further progress.

The Commission – comprised of former heads of state, human rights, public health and legal experts – released a report that has led a multi-year effort to ensure that national laws, policies and practices that impede the AIDS response are overturned. Laws that stigmatize people living with and vulnerable to HIV perpetuate discrimination and block people from seeking health services and undermining public health goals.

“HIV is still one of the deadliest diseases in the world and it’s unforgivable that national governments have failed to address legislation that fuels the AIDS pandemic,” said former Commissioner Michael Kirby, a former Justice of the High Court of Australia. “Laws that criminalize HIV are anti-science, unjust and unconstructive.”

It’s not all bad news – the Commission also pointed out several success stories, noting that legislation based on science and human rights has helped advance the global commitment in the Sustainable Development Goals to end HIV for good and leave no one behind. Today, there’s still reason to be optimistic.

“It is time for countries to think proactively about designing laws and policies that will help end the HIV epidemic,” said former Commissioner Bience Gawanas, a lawyer and human rights expert. “We’ve seen that some countries, including Ghana and Mozambique, have been able to improve HIV responses by adopting more progressive policies. If we’re going to defeat HIV, other countries need to do the same.”

Since the release of the Commission’s report, the United Nations Development Programme (UNDP) and its partners have helped advance the report’s recommendations in 88 countries. Several countries have conducted comprehensive assessments of laws, policies and practices affecting people with HIV and have changed legislation as a result. National conversations on the rights of people living with and vulnerable to HIV have led countries to reform discriminatory practices against people living with HIV. Judges, civil society organizations and partners have been instrumental in helping to overturn discriminatory legislation and counter HIV stigma.

The Commission’s recommendations contributed to several success stories over the last five years. These include:

After analyzing its laws and legal practices around HIV, health and human rights, Mozambique revised its laws on criminalizing unintentional HIV transmission.
In Pakistan, protections for people living with HIV were included in the Sindh Province HIV/AIDS Control Treatment and Protection Act.
Seychelles decriminalized consensual same-sex relationships.
A national dialogue in Peru highlighted the need for a gender identity law, which spurred the development of a draft Gender Identity Bill that was presented to the National Assembly in December 2016.
The High Court of Botswana ruled that foreign prisoners living with HIV are entitled to receive life-saving antiretroviral treatment.
In Ghana, partners developed a stigma and discrimination reporting system that allows key populations, including people living with HIV, to file formal complaints about human rights abuses and seek redress.

“Equality, inclusion and non-discrimination are at the heart of the 2030 Agenda for Sustainable Development,” said Achim Steiner, UNDP Administrator. “Laws and policies that protect rather than punish, combined with programmes that reduce stigma and discrimination, exist and need to be scaled up if we are to achieve our goal of ending the AIDS epidemic by 2030.”

By replacing legal practices rooted in stigma with legislation based on science, these countries are among the frontrunners taking steps to protect the human rights of people living with and affected by HIV.

“It’s incredible to see the progress that some countries have made over the past five years,” said Michel Sidibé, Executive Director of UNAIDS. “They’ve taken important strides to protect the rights of women and people living with and vulnerable to HIV.”

These countries have shown us that laws and policies grounded in evidence and human rights, combined with programs that reduce stigma and discrimination, can help accelerate progress to end the AIDS epidemic by 2030.

About the Global Commission on HIV and the Law:

The Global Commission on HIV and the Law was launched in June 2010 by UNDP on behalf of the Joint UN Programme on HIV/AIDS (UNAIDS) to provide global leadership on HIV-related legal and human rights issues by analyzing what is known about the interactions between the legal environments, human rights and HIV; fostering evidence-informed public dialogue on the need for rights-based law and policy in the context of HIV; and identifying clear and actionable recommendations with a concrete plan for follow-up. (www.hivlawcommission.org)

Contact informationSangita Khadka, Communications Specialist, UNDP Bureau for Policy and Programme Support, email: sangita.khadka@undp.org tel: +1 212 906 5043

[Update] India: Parliament passes landmark bill ensuring equal rights to people living with HIV and giving them the right not to disclose their status

Lok Sabha passes ‘historic’ bill ensuring equal rights to HIV-affected people

The Lok Sabha on Tuesday passed a crucial bill that ensures equal rights to the people affected by HIV and AIDS in terms of getting treatment, jobs or admissions to educational institutions.

Moving the Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) (Prevention and Control) Bill, 2017 for passage, health minister JP Nadda said the government stood for free treatment to HIV patients.

The Rajya Sabha had passed the bill last month.

The “historic” and “people centric” legislation will strengthen rights of people infected with HIV, Nadda said.

Various clauses pertaining to prohibition of discrimination against HIV-positive patients have been enlisted in the bill. “Whosoever does not adhere to the provisions of the bill, will be penalised. Civil and criminal proceedings will be launched against such persons”, Nadda said, adding that action would also be taken against those who attempted to block the implementation of the bill.

The legislation, he added, has provisions to safeguard the property rights of HIV positive people.

“Every HIV infected or affected person below the age of 18 years has the right to reside in a shared household and enjoy the facilities of the household”, Nadda said.

Further, the bill prohibits any individual from publishing information or advocating feelings of hatred against HIV positive persons and those living with them.

Nadda said the government will also promote research to check the spread of HIV virus and come out with aggressive strategies, especially in high risk areas.

Opposition members had several suggestions and observations during the Bill’s passage, TMC member Ratna De Nag regretted that stigma related to HIV remains intense . P Ravindra Babu (TDP) emphasized that the stigma associated with the disease could not be eradicated by laws alone. Varaprasad Rao (YSR Congress) pitched for insurance cover for the affected people with the premium being paid by the government.

Heena Gavit (BJP) said couples affected with HIV should be given the right to adopt children.

Text of the full bill is available here

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The new HIV and AIDS Bill will work to reduce stigma and discrimination

By JP Nadda

Two decades ago India was considered a hotspot and emerging centre of the world’s HIV epidemic. Since then, India has made tremendous progress in controlling HIV. Through its continuing efforts including targeted programmes and support of affected communities, India has demonstrated that the course of an epidemic can be reversed by public education, mass awareness and wide scale availability of testing and treatment.

Today, approximately 21 lakh people are living with HIV, as per government estimates. The adult prevalence is in the range of 0.3%, of which around 40% are women. Despite this enormous progress and the availability of testing and treatment, stigma and discrimination against HIV affected individuals in India remains widespread.

India made some efforts at stigma reduction in the early part of the epidemic. Yet social attitudes do not transform easily. The HIV AIDS bill approved by the Cabinet and pending approval in Parliament is an important step in ensuring that the progress made against HIV is not halted and discrimination against HIV affected individuals is reduced.

How is this being done? It’s important to reflect on the many progressive aspects of the bill. To start with, numerous provisions of this bill ensure government accountability and commitment into providing HIV prevention, testing, treatment and care to those at risk. Why is this necessary? Because every government irrespective of political affiliations must commit to fighting HIV. For the first time, the bill brings together a human-rights perspective to public health, and makes antiretroviral treatment a right of HIV/AIDS patients. The central and state governments are duty bound to provide for treatment and also arrange for the management of risk reduction of vulnerable populations. This will ensure that in the future no Indian has to struggle for diagnosis or treatment.

Considering widespread stigma and the need for privacy, the bill also mandates that no HIV test, medical treatment, or research can be conducted on a person without their informed consent. This ensures that those affected by HIV have the right to privacy and confidentiality. The bill also mandates that no person can be compelled to disclose their HIV status except with informed consent, and if required by a court order.

The bill also addresses discrimination in everyday life through numerous provisions especially at the workplace and within communities. It prohibits discrimination against HIV positive persons and those affected in numerous aspects. These include the denial, termination, discontinuation or unfair treatment with regard to employment and in educational establishments, health care services, residing or renting property, standing for public or private office, and provision of insurance (unless based on actuarial studies). The bill also prohibits the requirement for HIV testing as a pre-requisite for obtaining employment or accessing health care or education.

The intention is to ensure that no HIV infected individual is the subject of discrimination and there is legal accountability and recourse for them. The bill also mandates the appointment of an ombudsman in every state to inquire into complaints related to the violation of the Act and the provision of health care services. This ombudsman will submit reports every six months stating the number and nature of complaints received and the actions taken on them.

Populations who are most vulnerable to HIV/AIDS are female sex workers (FSWs), men who have sex with men (MSMs), transgenders and intravenous drug-users. The bill seeks to protect these high-risk groups from discrimination, both through administration of treatment for their infections as well as improving their access to welfare schemes and services.

The bill also mandates that cases relating to HIV positive persons shall be disposed off by the court on a priority basis. If an HIV infected or affected person is a party in any legal proceeding, it shall be conducted so as to supress the identity of the person, and restrain any person from publishing information that discloses the identity of the applicant. Also when passing any order with regard to a maintenance application filed by an HIV infected or affected person, the court shall take into account the medical expenses incurred by the applicant.

While social change will take time and stigma will not end immediately, this bill is a step in the right direction. It is a much needed and long awaited measure that will work to reduce stigma and discrimination towards people living with HIV. It will also ensure enhanced access to and privacy for those seeking care.

The foundation of every significant legislation is that it must safeguard civil liberties. This is exactly what this bill intends to do. It intends to ensure that those living with HIV do so with dignity and respect enjoying all their rights as citizens.

In the long-term, our goal is an India where no new HIV infection occurs and where living with HIV is neither a matter of fear or of shame.

Originally published in Hindustan Times on 24 March 2017

India: HIV/AIDS (Prevention & Control) Bill strongly criticised for not guaranteeing universal access to HIV treatment

Delhi, Gaborone, New York – The International Treatment Preparedness Coalition (ITPC) and its global coalition partners are outraged following a decision by the Indian Parliament to absolve itself from responsibility of providing treatment for people living with HIV in India. The HIV/AIDS (Prevention & Control) Bill was passed in the upper house of the Indian Parliament yesterday, 21 March 2017. The Bill states that the government will provide treatment for people living with HIV ‘as far as possible’ (see full text below) absolving the government from its responsibility to protect the right to life.

“This is a step backwards for human rights, and a tremendous blow for all people living with HIV in India,” said Gregg Gonsalves, Chair of ITPC-Global. “It is extremely concerning that the India government has given itself this loophole at a time when the government program is in disarray, with the worst period of antiretroviral drug stock outs.”

Networks of people living with HIV and other civil society organizations lobbied Members of Parliament to amend the draft Bill that was first tabled in February 2014. In response to civil society concerns, senior Members of Parliament urged the Union Minister JP Nadda to make the amendment. HIV treatment activists were stunned when these parliamentarians withdrew their amendment at the last minute, thus giving way to the Bill passing into legislation.

“As the biggest supplier of generic medicines to the developing world, India could be the leading light in HIV treatment, an example to the rest of the world,” said Solange Baptiste, ITPC-Global’s Executive Director. “Instead this new Bill fails to enshrine the rights of its own people. I fear it’s an omen of things to come. We, HIV treatment activists, will be watching and monitoring to make sure the Indian government upholds its responsibility to all its citizens living with HIV.”

“Nothing in the world is more important than securing treatment for me, and my community of people living with HIV,” said Loon Gangte Regional Coordinator ITPC-South Asia. “I earnestly appeal to the government to delete the loophole ‘as far as possible’ and assure our right to life”.

Editor’s Note:

HIV/AIDS Bill Final Text

The provision for HIV treatment in Section 14 of the HIV/AIDS Bill, reads as follows:

1. The measures to be taken by the Central Government or State Government under section 13 shall include the measure for providing, as far as possible, Anti-Retroviral and Opportunistic Infection Management to people living with HIV or AIDS.

2. The Central Government shall issue necessary guidelines in respect of protocols for HIV and AIDS relating to Anti-Retroviral Therapy and Opportunistic Infection Management which shall be applicable to all persons and shall ensure their wide dissemination.

About International Treatment Preparedness Coalition

International Treatment Preparedness Coalition (ITPC) is a global coalition of HIV treatment activists formed in 2003 to respond to the needs of communities worldwide. The global network is driven by individual activists, peer support groups, grassroots networks, community-based organizations, and non-governmental organizations. Each of our partners share our values and vision and come together to address issues around access to treatment issues in their countries, regions and at the global level.