US: Advocates seek to modernise HIV laws and HIV prevention education

Experts call for modernized HIV education and decriminalization in Oklahoma

Experts said they hope to finally get legislation across the finish line to improve how students are taught about HIV and to decriminalize exposure.

Oklahoma’s current guidelines for HIV education were passed in 1987 and have not been updated since, but previous efforts to modernize them have fallen short amid misinformation and difficulties dispelling outdated stigmas surrounding the virus.

“A lot has happened since 1987 in the field of HIV that our education mandate just doesn’t include,” said Sara Raines, a sexual health educator with the Oklahoma City-County Health Department. “So not only was it written in a way that’s outdated, but it just leaves a lot out. … I think, especially when you look at Oklahoma’s current HIV epidemic, public school education is a great way that we can start making progress in other areas.”

Raines said Oklahoma is one of seven states the federal government has identified as having disproportionately high HIV diagnoses in rural areas. She also said most new HIV diagnoses in Oklahoma in 2022 were for people under the age of 34, which is on par with national trends.

“We tend to think of HIV being something that happens in other places, but it’s here as well,” she said. “Something that is unique about Oklahoma’s epidemic is that we have a pretty disproportionate rural burden of HIV.”

Oklahoma is also one of 34 states that have laws criminalizing HIV exposure, according to the Centers for Disease Control and Prevention.

Nicole McAfee, executive director of Freedom Oklahoma, said these laws are “not rooted in science.” Freedom Oklahoma is a group advocating for LGBTQ+ Oklahomans.

With modern advancements in medicine, people living with HIV who are receiving treatment can have “an undetectable viral load” which means they cannot transmit HIV sexually. Oklahoma’s state statute does not reflect these advancements.

McAfee, who uses they/them pronouns, said efforts to decriminalize the virus usually come with two parts: repealing criminalization in statute and offering a pathway for those who have been incarcerated through the law, potentially through resentencing.

“I think as we think about how we address the harms of criminalization,” they said. “It’s been really important for us, rooted in work we’re doing with the community, that in addition to repealing and thinking about how the state goes forward, we also think about steps to begin to repair harm done to communities who’ve been disproportionately targeted by criminalization.”

State law requires prevention education on HIV and AIDS, but the language of the statute is outdated, Raines said.

The state Legislature has seen few efforts to update the curriculum standards, but most have been unsuccessful. In 2019, the Legislature sent a bill to the governor’s desk that would have modernized HIV education but Gov. Kevin Stitt vetoed it.

Since then, McAfee said, the state has seen efforts to lower standards for sexual education in general, or to remove it completely. When it comes to HIV education, McAfee said some lawmakers and law enforcement have demonstrated hesitation for change because of misinformation.

“I hope that as we continue to create spaces like this and folks continue to see the harm that we will see more legislators join in introducing bills specifically to address HIV modernization,” they said.

Freedom Oklahoma will be hosting an informational session at the Oklahoma Capitol Wednesday. McAfee said it’s intended to “share information and continue trying to educate folks, both in the Legislature and in the general public, about why HIV modernization is a priority.”

Sens. Julia Kirt, D-Oklahoma City, and Carri Hicks, D-Oklahoma City, are set to attend the session.

US: New report shows that most of Indiana’s HIV criminal laws have yet to account for decades of advances in HIV science

Indiana has six HIV criminalization laws. Most criminalize conduct that cannot transmit HIV

Indiana has six laws that criminalize people living with HIV (PLWH), spanning both the public health and criminal codes. A new report by the Williams Institute at UCLA School of Law evaluates whether these laws reflect current understandings of HIV science and criminalize conduct that poses negligible or no risk of transmitting HIV.

Results show that most of Indiana’s HIV criminal laws have yet to account for decades of advances in HIV science, and none are currently written with enough specificity to prevent criminalizing behaviors that have little to no risk of transmitting HIV.

In Indiana, HIV criminal laws make potential HIV exposure a crime under specific circumstances, such as sexual activity, blood or semen donation, or battery using bodily fluids, such as spitting. All of the laws were enacted between 1988 and 2002 before effective HIV treatment options were widely available and it was established that treating PLWH could prevent the transmission of HIV.

“Scientifically outdated laws work against public health goals regarding HIV testing, prevention, and treatment,” said lead author Nathan Cisneros, HIV Criminalization Project Director at the Williams Institute. “The criminalization of HIV could undermine Indiana’s efforts to end the HIV epidemic and reach the communities most impacted, including people of color, women, and LGBTQ people.”

Key Findings

  • None of Indiana’s laws require actual HIV transmission or the intent to transmit HIV. The laws also criminalize conduct that cannot transmit HIV, such as spitting.
  • Two laws criminalizing the donation of blood, plasma, or semen penalize conduct that does not transmit HIV. All bodily fluid donations are tested for HIV, and positive units are destroyed.
  • Two laws impose enhanced penalties for PLWH who knowingly expose another person to their bodily fluids or waste in an aggressive or malicious manner—conduct that poses no HIV transmission risk. HIV cannot be transmitted externally through contact with body fluids or waste.
  • Two laws that criminalize a person’s failure to disclose their HIV status have been partially modernized in recent years to reflect advances in HIV science. They limit criminal conduct to high-risk forms of sexual contact and needle sharing.
    • Nevertheless, these laws fail to clarify which sexual activities are considered low or no risk and whether a person who has an undetectable viral load—and therefore cannot transmit HIV through sex—is safe from prosecution.

In recent years, public health and medical experts, including the Indiana State Medical Association, have agreed that to effectively end the HIV epidemic, it is essential to update the state’s HIV criminal laws in line with current scientific understanding of HIV. A key aspect of Indiana’s plan to significantly reduce the number of new transmissions by 2030 involves prioritizing the modernization of these laws.

This report is part of a series by the Williams Institute examining HIV criminalization in Indiana.

Read the current report

US: First hearing imminent on two bills aiming to overhaul HIV criminalisation laws in line with modern science

Sweeping language introduced to modernize Ohio’s HIV laws proposed by an unlikely lawmaker
Decades of efforts to update six unscientific Ohio laws are being (sort of) championed by one conservative Republican lawmaker.

Earlier this year, Ohio Rep. Sara Carruthers (R-Hamilton) surprised many LGBTQ+ advocates when she introduced two bills to protect the rights of people living with HIV.

There are no co-sponsors on either bill, just Carruthers: a conservative Ohio Republican with only seven weeks left in office who is also a primary sponsor of one of the most anti-LGBTQ+ bills currently being considered by the Ohio legislature.

Still, Carruthers’ office sent out a press release on May 10 that LGBTQ+ advocates had been waiting many years to read:

“State Rep. Sara Carruthers will hold a press conference to discuss the recent introduction of House Bill 498. The legislation will remove the criminal offense related to donating blood when the donor has HIV.”

Just a few weeks earlier and after she lost her March primary, Carruthers introduced both HB 498 and HB 513. These two bills aim to overhaul the Ohio Revised Code to bring laws affecting living with HIV more in line with modern science and research.

Then, the day before the press conference was to be held, Carruthers canceled the event with no explanation. She subsequently did not respond to multiple requests – phone calls, emails and website submission forms – to comment on the legislation.

But now, six months later, a first hearing on the two bills appears imminent, and Carruthers is speaking out – a little – on the legislation that so many Ohioans have fought for years to see proposed.

Enforcement without science

Currently Ohio has six laws on the books that either criminalize certain acts for people living with HIV – including sexual acts with zero possibility of HIV transmission – or substantially increase sentences for this population compared to people who do not have the virus.

In February, Equality Ohio and Ohio Health Modernization Movement (OHMM), a coalition of advocacy groups and community leaders, released results of a three-year effort to count prosecutions in Ohio’s 88 counties. Compiling information from court dockets and public records requests to court clerks and prosecutors, the groups tallied 214 cases prosecuted over a six-year period, from 2014 to 2020.

Notable recent cases have included Caymir Weaver, a 23-year-old Mahoning County resident who was sentenced in 2023 to a year in prison for exposing someone to HIV even though he couldn’t transmit the virus.

With Ohioans actively being prosecuted under the six laws, advocates say the sense of urgency to reform the statutes is clear.

“It’s finally time to have the laws match the science,” said Bryan Jones, steering committee member of OHMM.

But the path forward to this much-needed reform?

“That’s definitely less clear,” said Jones.

Updating Ohio’s laws

Ohio’s laws that criminalize living with HIV were first passed in 1989. That year, AIDS-related complications were the second leading cause of death among men between 25 and 44 years.

The original laws did not specifically reference HIV status, instead requiring prosecutors to prove that having sex while living with “the virus that causes acquired immunodeficiency syndrome” was akin to carrying a deadly weapon.

Several high-profile examples of HIV transmission dominated the country’s attention in the 1990s, notably the New York case of Nushawn Williams, who had sex with over 100 women.

Following the media panic caused by cases like that of Williams, many states updated their HIV laws. In 2000, Ohio’s laws were changed to more specifically add HIV status into the language and criminalize exposure, not transmission.

Carruthers’ two bills would modernize the law and reduce prosecutions:

  • HB 498 (“To remove criminal offense related to donating blood with AIDS virus”): This bill would repeal the following language in the Ohio Revised Code that currently charges individuals living with HIV with a fourth-degree felony if they sell or donate their blood or blood plasma knowing that it is being accepted for possible transfusion to another individual.
  • HB 513 (“To revise criminal and disciplinary provisions relating to HIV, AIDS”): This expansive bill would reform or repeal several state laws currently criminalizing living with HIV, including:
    • Repealing the law that imposes a felony charge on those who engage in sexual conduct before disclosing their HIV status.
    • Repealing the mandatory testing requirements for people accused of committing felonious assault and causing someone to come into contact with bodily fluids.
    • Eliminating several felony enhancements for people living with HIV, including for people engaging in sex work after an HIV diagnosis.
    • Providing an expungement process for those who had previously been convicted of HIV-specific felonious assault and a process by which individuals can be removed from the sex offender registry due to an HIV-specific felonious assault conviction.
    • Removing stigmatizing and inaccurate language.
    • Providing protections against non-consensual HIV testing and HIV information disclosure.

“After over 30 years of HIV research and significant biomedical advancements to treat and prevent HIV transmission, many state laws are now outdated and do not reflect our current understanding of HIV,” Carruthers said in a statement on November 8.

Carruthers said that the current laws increase stigma, exacerbate disparities and may discourage HIV testing: the very opposite of how to approach a public health issue.

“It is crucial for Ohioans to recognize that HIV is not a crime; it is a health condition that requires that supportive network of healthcare professionals across the state dedicated to ending the HIV epidemic,” Carruthers said.

An unlikely sponsor 

Carruthers lost a March primary 53.1% to 46.9% to Pastor Diane Mullins, a pastor at Calvary Church who openly espouses anti-LGBTQ+ views and conspiracy theories in her sermons and who went on to win the Ohio House seat in the general election in November.

Carruthers was one of 22 Republicans who joined all House Democrats in voting to seat Jason Stephens as House Speaker, a move which caused her to be condemned by the Ohio Republican party and made her the subject of funding efforts that successfully defeated her in favor of a more conservative Republican candidate.

Which is not to say that Carruthers isn’t a staunch conservative, including on LGBTQ+ issues.

Carruthers is the primary co-sponsor of HB 8, the Parents Bill of Rights, a bill that would force all teachers and school staff – including school social workers, counselors and psychologists – to out LGBTQ+ students to their parents.

The bill also requires parental notification for any LGBTQ+ content in the curriculum and bans LGBTQ+ content in grades K through 3, which could include same-sex parents or gay penguinsin children’s books.

Despite the provisions of the bill that would forcibly out LGBTQ+ students, Carruthers declared during a House session in June 2023 that the bill was solely about protecting the rights of parents.

“The Parents’ Bill of Rights is not anti-LGBTQ, nor does it have anything to do with the LGBTQ+ community,” she said, contradicting the specific language of the bill regarding LGBTQ+ youth. HB 8 passed the House in 2023 and now sits in the Education Committee of the Senate.

She has spoken out against the sports participation of trans females and voted for HB 68, the ban on trans female athletes and gender-affirming care for Ohio minors.

Thus on paper, her sponsorship of these HIV decriminalization bills may look surprising, but advocates of the bills say she had personal motivation to get involved.

“She was immediately on board because she had her own personal experiences having lost friends because of HIV. She took this up and we’re grateful that she did,” said Maria Bruno, then public policy director of Equality Ohio, in March.

Carruthers’ sudden cancellation of the press conference left advocates scrambling to put together an event with medical experts and community leaders to speak on behalf of the bills, minus the presence of the state representative actually sponsoring the legislation.

“She wanted to have the press conference after a first hearing so that it could be more finite and comprehensive,” Carruthers’ office told The Buckeye Flame.

The path forward

Carruthers’ office has said that HB 498 and 513 will have a first hearing in the Criminal Justice committee during this upcoming lame duck session: the period of time after the November election when legislators execute a mad dash to pass legislation. On January 1, bills that have not yet been passed have to start the legislative process from scratch, minus legislators who lost their elections, which includes Carruthers.

“She is actively looking and hopeful to find a representative who will continue with this legislative journey in the upcoming GA,” said a representative from Carruthers’ office.

Decriminalization advocates say they are committed to HIV law modernization, no matter how long it takes.

“We all know this might take a few years, but we are willing to stick together and do this work,” said Kim Welter of OHMM.

Still, there is hope that HB 498 and 513 will resonate with legislators.

“What we have seen is an appetite for criminal justice reform,” said Bruno. “We have faith that [legislators] will see this for what it is, which is ultimately criminal justice reform.”

In order to be successful, advocates say education for Ohio legislators will be critical.

“Basically we need to do the education and to help our legislators get out of the 80s and into the 2020s to learn about things like [undetectable = untransmittable], PrEP and other things they might not know,” said Welter.

Although they are in it for the long haul, advocates’ appetite for change is not new. Bryan Jones has been working on introducing modernization legislation since 2009. He is pleased with this burst of progress with HB 498 and 513, but noted the finish line is off in the distance.

“This is as close as we have ever gotten to modernizing Ohio’s laws, but we clearly have so much further to go,” said Jones.

IGNITE ACTION

  • Contact the members of the Criminal Justice Committee here to weigh in on HB 498 and 513.
  • Read the OHMM (“Enforcement of HIV Criminalization in Ohio: Analysis of Court Cases from 2014 to 2020”) report here.
  • Read the Williams report (“Enforcement of HIV Criminalization in Ohio HIV-related criminal incidents from 2000 to 2022”) here.
  • Catch up on all of Ohio’s current LGBTQ-related legislation by checking out our Legislative Guide here.

Mexico: Congresswoman presents HIV decriminalisation bill in Tlaxcala Congress

A bill to repeal the crime of the danger of contagion was presented before the Plenary of the Congress.

Translated via Deepl. For the original article in Spanish, scroll down.

Congresswoman Aurora Villeda Temoltzin presented before the Plenary of the State Congress, a bill that seeks to decriminalise patients with Human Immunodeficiency Virus (HIV) and other diseases, in line with the recommendations of the State Human Rights Commission of Tlaxcala. In this sense, the legislator stressed that people living with HIV are entitled to the same human rights enshrined in the Political Constitution of the United Mexican States.

In her explanatory statement, the deputy of the Redes Sociales Progresistas party argued that, although the current provision that typifies the crime of danger of contagion in the Criminal Code of the State of Tlaxcala seeks to protect public health, its application may result in violations of the fundamental rights of a group that already faces discrimination because of their health status. She also pointed out that the population in treatment for HIV represents only 0.8% at the national level, which makes the revision of these norms even more urgent.

Following working groups held with the Office of Attention to Sexual Diversity of the Ministry of Culture of Tlaxcala, activists from the LGBTTTI Collective and various NGOs involved, Villeda Temoltzin proposed the repeal of Chapter I of Title Eleven of Book Two, as well as article 302 and section V of article 434 of the Penal Code of the Free and Sovereign State of Tlaxcala.

After its presentation in the Plenary, the bill was passed to the Commission of Constitutional Issues, Governance, Justice and Political Affairs of the LXV Legislature for its study, analysis and corresponding ruling.

Presentan ante el Pleno del Congreso, proyecto para derogar el delito del peligro de contagio

Ante el Pleno del Congreso del Estado, la diputada Aurora Villeda Temoltzin presentó un proyecto de decreto que busca descriminalizar a los pacientes con Virus de Inmunodeficiencia Humana (VIH) y otras enfermedades, alineándose con las recomendaciones de la Comisión Estatal de Derechos Humanos de Tlaxcala. En este sentido, la legisladora subrayó que las personas que viven con VIH son titulares de los mismos derechos humanos consagrados en la Constitución Política de los Estados Unidos Mexicanos.

En su exposición de motivos, la diputada del partido Redes Sociales Progresistas argumentó que, aunque la disposición vigente que tipifica el delito de peligro de contagio en el Código Penal del Estado de Tlaxcala busca proteger la salud pública, su aplicación puede resultar en violaciones a los derechos fundamentales de un grupo que ya enfrenta discriminación por su estado de salud. Señaló además que la población en tratamiento por VIH representa apenas un 0.8% a nivel nacional, lo que hace aún más urgente la revisión de estas normas.

Derivado de mesas de trabajo celebradas con la Oficina de Atención a la Diversidad Sexual de la Secretaría de Cultura de Tlaxcala, activistas del Colectivo LGBTTTI y diversas ONG involucradas, Villeda Temoltzin propuso la derogación de la denominación del Capítulo I del Título Décimo Primero del Libro Segundo, así como el artículo 302 y la fracción V del artículo 434 del Código Penal del Estado Libre y Soberano de Tlaxcala.

Tras su presentación en el Pleno, el proyecto de decreto fue turnado a la Comisión de Puntos Constitucionales, Gobernación, Justicia y Asuntos Políticos de la LXV Legislatura para su estudio, análisis y dictaminación correspondiente.

US: Advocating for HIV decriminalisation and health equity at Indiana’s first HIV advocacy summit

HIV advocates, organizations talk legislative solutions at first advocacy summit

By Abigail Ruhman

Community health centers and Ryan White HIV AIDS Program centers play an important role in expanding services and care for vulnerable populations, including HIV prevention and wellness. The Damien Center – Indiana’s oldest and largest HIV service organization – hosted its first HIV advocacy summit Wednesday to develop strategies for the upcoming legislative session.

Carrie Foote, a professor of sociology at Indiana University-Indianapolis, has been living with HIV since 1988 and leads HIV Modernization Movement-Indiana. She said Indiana has several laws that lead to the inappropriate arrest or prosecution of people living with HIV — which wastes state resources and has no public health benefit.

“We can end the epidemic,” Foote said. “We can end it, so anything that’s a barrier to doing that — and these laws are — we want to get rid of and improve.”

Foote said these laws lead to stigma around HIV that act as a barrier to testing and care — which gets in the way of preventing new transmissions and optimizing wellness for people living with HIV.

There are six laws that criminalize HIV in Indiana — which include both public health and criminal codes.

Two relate to the donation, sale or transfer of semen for artificial insemination, blood or plasma when someone “knowingly” has HIV. Another two focus on alleged non-disclosure of someone’s HIV status. When the laws were originally written, they said people living with HIV have a “duty to inform” sexual and needle sharing partners of their states prior to “high-risk activity.”

“The disclosure law used to be called ‘Duty to Warn,’” Foote said. “We came with a warning label before we had sex. So first, I need to warn you that I have HIV. That’s the language. How stigmatizing is that?”

Advocates were able to work with lawmakers to revise the language to be less stigmatizing, but the disclosure law still exists in Indiana code.

The last two enhance punishments for battery or malicious mischief by bodily fluid or waste for people living with HIV. For example, Foote said for someone who doesn’t live with HIV, spitting on someone is considered a misdemeanor.

“For anybody living with viral hepatitis or HIV, it gets enhanced to a felony crime solely because of their HIV status, even though those diseases are not transmitted that way,” Foote said.

Foote said legislative reform around the issue focuses on efforts to repeal HIV specific criminal laws and remove enhanced penalties based solely on a person’s HIV status. Advocates also want to modernize or reform laws to reflect the current science of HIV transmission and HIV as a chronic manageable condition, as well as narrow the law to situations that involve the “intent to transmit” or a “substantial risk of transmission.”

Foote is collaborating with the University of California-Los Angeles School of Law’s Williams Institute to analyze the enforcement of HIV criminalization in Indiana. She said not all of the HIV criminalization laws have been used, but many have led to arrests.

“People also are being convicted under these laws, so that right there tells you that change needs to occur because we have these people being prosecuted in ways that are unfair and don’t reflect advances in modern science,” Foote said.

Foote said in addition to creating harmful stigma, HIV criminalization disproportionately affects Black people, sexual minorities and people who inject drugs, which makes health inequities worse.

The Damien Center event also focused on different challenges these community centers face when trying to provide services and how threats to a federal program can make care more complicated.

The 340B drug pricing program was created in partnership with pharmaceutical companies — which agreed to provide “significant” discounts to eligible health care providers in order to participate in the Medicaid program.

Community health centers, also known as federally qualified health centers, are designed to increase access to primary care by reducing barriers such as cost, lack of insurance and distance. Ryan White centers are a part of the federal program designed to increase access to care for HIV.

Colleen Meiman, the national policy advisor for state and regional associations of Community Health Centers, said the program allows these centers to stretch federal resources to reach more patients and provide comprehensive services to vulnerable populations.

“340B is about so much more than pharmaceuticals,” Meiman said. “340B is essential to the financial sustainability of many, many, probably the majority of health centers.”

She also said the 340B program is facing several threats at the federal level, but some states have been able to pass legislation to protect the program.

Damien Center President and CEO Alan Witchery said the event was meant to identify issues that advocates and organizations want to address moving forward.

“There really isn’t an opportunity for nonprofits to come together and think about just doing this kind of advocacy,” Witchery said.

Witchery said he wants there to be a continued conversation around lobbying, advocacy and education efforts for these organizations to promote their causes together as a group around the state.

India: Mizoram Legislative Forum on HIV/AIDS discusses possibility of mandatory HIV testing for all citizens

Mizoram legislators bat for mandatory HIV testing amid rising cases

A meeting of the Mizoram Legislative Forum on HIV/AIDS was held on Tuesday, chaired by Health Minister Lalrinpuii at the SAD Conference Hall, MINECO. The session focused on the state’s rising HIV cases and discussed the possibility of introducing a mandatory HIV testing policy for all citizens.

In her address, Lalrinpuii emphasized the importance of addressing the issue head-on, noting that HIV/AIDS, once perceived as a disease affecting certain groups, now impacts a broader section of the population. She urged legislators and MLAs to actively raise awareness in their constituencies and stressed the need for proactive measures to curb the spread of the virus.

The forum reviewed Mizoram’s HIV situation, referencing the 2023 HIV Estimation Report, which revealed the state’s adult HIV prevalence rate at 2.73%—much higher than the national average of 0.2%. Since the first detection of HIV cases in 1990, Mizoram has recorded 31,461 HIV-positive cases, including 2,541 children.

It was noted that 63.93% of HIV transmissions in the state are due to unprotected sexual intercourse, while 30.80% result from sharing needles and syringes. Currently, 16,661 people in Mizoram are receiving Antiretroviral Therapy (ART), with 5,277 deaths recorded due to HIV/AIDS complications.

The state has 39 Integrated Counselling and Testing Centres (ICTCs) and 14 ART centers providing treatment to HIV-positive individuals. However, challenges remain as many HIV-positive patients, despite being eligible for ART, stop taking their medication or lose contact with healthcare providers. To address this, the forum proposed linking patients’ treatment records to their Aadhar cards.

The meeting also discussed expanding HIV testing and treatment services. In consultation with the National AIDS Control Organisation (NACO), the forum suggested making HIV testing more accessible and floated the idea of implementing a mandatory testing policy to combat the virus’s spread.

The forum concluded that urgent action is needed to control Mizoram’s HIV epidemic and ensure better health outcomes for those affected.

Australia: Criminalisation fuels healthcare disparities for migrants living with HIV

HIV in Australia: shades of injustice remain

Elimination is the goal, but migrants living with the virus experience a criminalised environment that thwarts access to care.

Health Minister Mark Butler painted a largely rosy picture of the progress towards elimination of HIV in Australia today, speaking on the second morning of the ASHM HIV/AIDS Conference in Sydney.

A legal academic, however, said people with HIV in Australia were still living under a pall of criminalisation, none more so than migrants.

Mr Butler praised the Australian response to the epidemic, especially in NSW, which was most affected in the early days.

“Since HIV was first detected more than 40 years ago in Australia, Australia’s response has been one to be proud of,” he said.

“When you go back to those early years, AIDS was highly feared here as it was around the world. There was huge stigma, misinformation, homophobia and such loss and so much grief for communities.

“But Australia’s response early on was characterised by partnership and collaboration: governments, people living with HIV, communities affected by HIV, non-government organisations, health professionals and academics all came together and worked together.”

He said HIV notifications were declining in Australia, at one of the fastest rates in the world – “but as you have all heard, I’m sure, transmission has also gone up in 2023, reminding us there is always more work to be done”.

“Eliminating transmission of HIV here in Australia is ambitious, but I am absolutely assured it is now achievable,” he said today, citing inner Sydney – once the epicentre of the epidemic – as a place that had effectively achieved elimination.

Mr Butler set up the HIV Taskforce last year with a goal to “virtually” eliminate transmission by 2030. The Ninth National HIV Strategy covers from last year to 2030, continuing the work of the Eighth – whose goal was virtual elimination by 2022.

He said transmission rates had grown “among temporary residents who are here in Australia on work or study visas”.

“So we will provide subsidised access to PrEP to make healthcare more equitable for people who don’t have access to Medicare … We will make sure that at-risk populations can get free HIV self-testing kits through an expansion of the national HIV self-test mailout program [run by the National Association of People with HIV Australia (NAPWHA)] as well as HIV self-testing vending machine programs,” said Mr Butler.

For David Carter, Scientia Associate Professor at the faculty of Law & Justice at UNSW, the necessary changes for people on visas won’t be found in any vending machine but in immigration policy.

Professor Carter, who leads the Health+Law Research Partnership for social justice for people living with HIV or hepatitis B, walked through the history of “unjust and unhelpful” HIV criminalisation in Australia – a public policy environment that includes but is not limited to action by law enforcement and courts. It begins with the creation of a “suspect population”.

He quoted the very first National HIV Strategy in 1987, which warned of the “temptation” of criminalisation measures, including “universal or selective testing, closure of gay venues, criminal penalties for transmission, compulsory notification of HIV infection and restrictions on freedoms of infected people through limitations on employment, quarantine or compulsory detention”, and noted these would jeopardise health measures to prevent transmission.

A working party in 1992 concluded that “even in the face of decisions by individuals that generate harm, it was the wrong decision to restrict the free choice of individuals in modern society, as draconian measures would merely alienate people at risk of infection and deter them presenting for counselling, testing and treatment”.

While pressure to enforce such measures may have been largely resisted, and the situation for Australians has greatly improved, migrants living with HIV are still experiencing an alienating and hostile environment, said Professor Carter.

Characterising them as posing potential harm to Australians “establishes an adversarial relationship between the person living with HIV and the state” and compromises health care by promoting defensive behaviour.

He and his team have interviewed migrants in Australia living with HIV over the past two years, for whom “criminalisation is indeed very active, and it is producing serious, negative health and other impacts of individuals or communities and respects”.

He quoted one interviewee, “Sergio”, who told the team: “I don’t have to face any court, but I did have to prove that I wasn’t a bad person just because I have HIV.”

Others spoke of experience going through the migration process as being “subject to an unending interrogation”.

“Laurence” told his interviewer: “It’s like a tattoo on your mind. The government will treat you different for every single step of your life from here on out.”

“Manish”, who was on a temporary visa, avoided getting tested for 10 months after beginning to suspect he had HIV, for fear of having his visa revoked. His health deteriorated during this time.

“The elevated threat levels produced by the interaction of migration law and public health law … significantly harmed Manish’s health, caused psychological distress and steered him towards coping responses that denied him the testing and treatment, access to medical care and other supports that he deserves and that we all collectively affirm are essential and are his right,” said Professor Carter.

“Manish said to us: ‘I feel like if I had reassurance that nothing’s going to happen to me if I tested positive for this, I would not have been afraid to go and get a test for HIV’.”

Others described feelings of “hopelessness and depression, because there is no hope for us to stay permanently while living with HIV” (in fact there are pathways for permanent migration despite living with HIV). These people would go for weeks without medication in a form of self-sabotage “because they just don’t have hope for their future anymore”.

For these and other people like them, the Australian environment “is just a set of undifferentiated threats to autonomy, wellbeing and safety, to which they are forced to respond with adaptation, distancing and adopting a posture of self-defence”.

Professor Carter concluded that “it may be different today [from the 90s], but it is not over, and it won’t be over here or elsewhere until the stigma of HIV, unconventional sexuality and drug use are gone”.

The HIV/AIDS Conference is running in Sydney this week back-to-back with the 25th IUSTI World Congress.

Meet HJN at AIDS 2024

Starting this coming weekend, and continuing until Friday 26th, seven HJN team members will join an estimated 15,000 participants at the 25th International AIDS Conference in Munich to advocate for the rights and health equity of people living with HIV globally.

We are grateful to our scholarship providers and funders for making it possible for so many of us to attend AIDS 2024. We are mindful of the many individuals who have been unjustly denied visas to enter Germany and know we are privileged to be able to attend in person.

We’ll do our very best to make sure that everyone’s voices are heard, both at our sessions and at others’.

If you are also fortunate enough to be in Munich, please come and say hello, and tell us about your work and how we might support each other in the global struggle for HIV justice.

Sunday 21st July

11:30am-12:30pm. LIVING Pre-Conference Workshop: Everything You Ever Wanted to Know About Challenging HIV Criminalisation: The HIV Justice Academy. Room 13b/Channel 7.  This interactive session, featuring most of the HJN team, HJN’s Global Advisory Panel (GAP) member, Robert Suttle, and Sero’s Andy Tapia, covers the realities of HIV criminalisation and strategies to challenge unjust laws.

Monday 22nd July

1:00pm-2:30pm. Global Village Workshop: Denied, Discriminated Against, and Deported: The Global Realities of Migration, Mobility, and Health Equity for People Living with HIV. Global Village Session Room 2. This workshop, co-hosted by HJN, Queensland Positive People, NAPWHA and hivtravel.org addresses HIV-related travel restrictions and advocates for global change, featuring the latest status on HIV migration worldwide from HJN GAP member, David Haerry.

Tuesday 23rd July

12:00pm-1:00pm. Poster Presentation, Prepared for Action: Lessons Learned from the First Year of the HIV Justice Academy presented by HJN’s Sofia Varguez.

3:00pm-4:00pm. Symposium: Equity in Focus: Tackling Inequalities, Room 13a/Channel 6. This session highlights the role of community-led organisations in challenging criminalisation, discrimination and inequalities. HJN’s Edwin Bernard will speak on “Legal Landscapes: The Influence of Legislation on the Lives and Rights of the HIV Community”.

Wednesday 24th July

8:30am-10:00am. Plenary session: Addressing structural barriers: How can we do better? Hall C1/Channel 1. This morning plenary session includes HJN GAP member, Michaela Clayton, presenting “Breaking Barriers: Challenging HIV Criminalization to Counter Inequalities”.

[Rescheduled from Tuesday] 12:00pm-12:30pm. Discussion: U=U in HIV Decriminalisation Advocacy, U=University Networking Zone, Global Village, Featuring a conversation between HJN’s Edwin Bernard, and Kamaria Laffrey and Andy Tapia of the Sero Project.

2:30pm-4:30pm. Workshop: Getting Decriminalisation Right: What do good laws look like? Room 14a/Channel 9. This workshop from UNAIDS, UNDP and GNP+ will facilitate knowledge exchange on good practices in decriminalisation in relation to HIV outcomes and includes HJN’s Edwin Bernard and HJN GAP member, Alexander McClelland.

Thursday 25th July

12.00pm-1.00pm. Poster presentations. HJN team members Sylvie Beaumont, Elliot Hatt and Sofia Varguez will present four posters: Global Trends in HIV Criminalisation; The Relevance of Gender to Potential or Perceived HIV ‘Exposure’ Charges in HIV Criminalisation Cases; The ABCs of HIV Law Reform in Latin America and the Caribbean: Case Studies on HIV (De)criminalisation in Argentina, Belize, and Colombia; and Challenging Coercion and Misplaced Punishment: HIV and Infant Feeding Choices.

3:00pm-4:00pm: Workshop: Doing HIV Justice in Europe. Global Village 555 Zone. This workshop, led by HJN’s Julian Hows and featuring most of the HJN team, will focus on HIV decriminalisation advocacy across the WHO Europe region.

All Week (Sunday-Thursday)

Global HIV Migration, Global Village Exhibition Booth ADO4

This booth has been designed to capture a short video in a safe and secure space for anyone to tell us their story about travelling or relocating with HIV with a highly experienced film maker, HJN’s video and visuals consultant, Nicholas Feustel. Co-hosted by HJN, Queensland Positive People, NAPWHA and hivtravel.org.

HJN’s Executive Director’s remarks at the UNAIDS Board Meeting on the sustainability of the HIV response

UNAIDS Programme Coordination Board (PCB) Thematic Meeting on the Sustainability of HIV Response

Round Table 1: The context and urgency of sustainability planning and response

Remarks from Edwin J Bernard, Executive Director, HIV Justice Network, Netherlands on community leadership to address human rights barriers

I am a gay man who acquired HIV 41 years ago in 1983. It was a significant year in other ways too:

  • HIV was first identified as the cause of AIDS
  • WHO held its first global AIDS meeting
  • Richard Berkowitz and Michael Callen published ‘how to have sex in an epidemic’ inventing condom-based safer sex
  • And a small group of people living with AIDS became the first community leaders in the HIV response, creating the Denver Principles, the blueprint for GIPA and MIPA principles now embedded in UNAIDS’ approach to community leadership to address human rights barriers.

Communities involve many different groups, working locally, nationally, regionally and globally. We are communities of women, men and youth living with HIV in all our diversities, as well as communities of gay men and other men who have sex with men, communities of sex workers, communities of transgender people, communities of people who use drugs. We are the key populations

And then there are communities of allies – human rights defenders who understand that public health is human rights and vice versa.

Despite member states committing to removing these human rights barriers in the 2021 Political Declaration – the 10-10-10 targets – we are far from getting anywhere close to achieving these targets because there are still far too many human rights barriers.

These are far too numerous to list, but they include gender inequality and gender-based violence; discrimination when receiving healthcare, in the workplace, in education, and in humanitarian settings; not being able to enter or migrate to a country of which you are not a citizen because of your HIV status; and the growing number of countries with so called ‘foreign agent’ laws that are closing civic space and stifling community leadership.

On top of these, every single member state criminalises one or more of the key populations, fully or partially, and 79 countries have HIV-specific criminal laws that unjustly criminalise HIV non-disclosure, exposure or unintentional transmission.

Ending HIV criminalisation is the focus of my organisation, the HIV Justice Network, and the global HIV JUSTICE WORLDWIDE coalition that we co-ordinate.

We can do this work thanks primarily to the Robert Carr Fund, which recognises the importance of community-led regional and global networks and our key role in addressing human rights barriers impacting the HIV response.

Dismantling discriminatory systems that have been built over decades and that oppress people living with and affected by HIV takes time and money – and needs community leadership.

So, if sustainability means a move to country-led integrated health systems, this will also mean that all the criminalised and marginalised people I’ve just mentioned will be even more left behind than they currently are.

But there’s a cheap and simple solution: decriminalisation!

A 2022 study from the Alliance for Public Health found that cost savings from decriminalisation of drug use could greatly reduce HIV transmission through increased coverage of opioid agonist therapy and antiretroviral therapy among people who use drugs in eastern Europe and central Asia.

Another 2022 study, from the Williams Institute, on the enforcement of HIV criminalisation laws in Tennessee of so called ‘aggravated prostitution’ – when a sex worker arrested for soliciting is found to be living with HIV – and criminal HIV ‘exposure’ – when a person living with HIV is prosecuted for allegedly not disclosing their HIV status before sex that may or may not risk transmission – estimated that the total cost of incarceration in prison for these unjust HIV-related crimes was $3.8 million.

And a 2021 study found that decriminalising sex work in Washington DC would generate over USD 5000 paid in income taxes by each sex worker – because sex work is work, after all! – plus more than USD20,000 in criminal legal system savings per sex worker a year.

If you decriminalise you not only save money you also ensure that every single person living with, or affected by HIV, gets the HIV services they need.

Following the science and basing laws and policies on public health and not morality or stigma saves money.

So, member states, if you just stop wasting money on ineffective, counterproductive criminalisation and invest in proven treatment and prevention programmes, sustainability of the HIV response is within sight.

To get to 2030, and beyond, to end AIDS as a public health threat, we need to ensure that we don’t forget the dignity and rights of people living with and affected by HIV  – easy to cut funding for, and hard to measure – and make sure that we include ending all of forms of HIV-related stigma, discrimination and criminalisation and strive for all forms of equality and empowerment.

In the drafting room on Tuesday, the NGO Delegation added criminalisation to the list that included stigma and discrimination, but the final draft you will vote on later today no longer includes mention of criminalisation as a barrier to testing. I implore you commit to ensure that my recommendation to decriminalise to sustain the HIV response is included in any and all decision points that will come out of this meeting.

Key messages summary

  • Human rights, gender justice and all the other10-10-10 societal enabler targets are essential, non-negotiable aspects of sustainability.
  • Community leadership is essential to reach 2030 and to sustain the HIV response beyond that date.
  • Don’t underestimate – or create more barriers for – communities. We are the experts in understanding what is needed to successfully achieve the end of AIDS.
  • Support communities by funding us, including replenishing the Robert Carr Fund.
  • The single most cost-effective intervention for every member state is to decriminalise, decriminalise, decriminalise!