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!

Death penalty for unintentional HIV transmission via same-sex sex struck down by Uganda’s Constitutional Court

The recent (April 3rd) ruling by Uganda’s Constitutional Court declaring that the Anti Homosexuality Act of 2023 complies with the Constitution of Uganda – except in only four aspects – was quite rightly roundly condemned by Amnesty International, the Global Fund, Human Rights Watch, International AIDS Society, and UNAIDS, as well as the US Department of State, amongst many others.

Rather than strike down every section of this heinous, draconian anti-gay law, the Court was unanimous in ruling that most of its dangerous, overly broad, and problematic provisions remain in place. 

However, in its 200+ page ruling, the Court did find that Sections 3(2)(c), 9, 11(2d) and 14 did not “pass constitutional muster” and were struck down.

Sections 9 and 11(2d) refer to landlords allowing homosexuality to take place on their premises, and section 14 refers to a “duty to report acts of homosexuality” to the police.

But section 3(2)(c) was one of the most heinous of all of the Act’s horrendous provisions, proscribing the death penalty for someone living with HIV who engaged in same-sex sex and where HIV is allegedly passed on.

  1. Aggravated homosexuality (1) A person who commits the offence of homosexuality in any of the circumstances specified in subsection (2) commits the offence of aggravated homosexuality and is liable, on conviction, to suffer death. (2) (c) the person against whom the offence is committed contracts a terminal illness as a result of the sexual act.

Read the full text of the law here

Both the Court, several petitioners, and UNAIDS – who provided an amicus brief to the Court – correctly interpreted this section as criminalising unintentional HIV transmission when two people of the same sex had sex.

In paragraphs 510-512, the Court referred to several key documents – including the 2011 Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health and UNAIDS 2013 Guidance Note, Ending overly broad criminalisation of HIV non-disclosure, exposure and transmission: Critical scientific, medical and legal considerations – and were persuaded that the section did not provide for “the element of criminal intent or mens rea, which is a vital component of the concept of crime.”

The Constitutional Court ruling went on to say:

“This indeed is the approach that was adopted in section 43 of the HIV and AIDS Prevention and Control Act, 2015, which criminalizes the intentional transmission of HIV as follows: ‘a person who wilfully and intentionally transmits HIV to another person commits an offence.’

“Finding no justification for the criminalization of the unintentional transmission of HIV under section 3(2)(c) of the Anti-Homosexuality Act we take the view that it compounds the susceptibility of persons that are HIV+ to mental health issues and thus impedes their right to enjoy the highest attainable standard of mental health, with potential ramifications to their physical health as well. This is a violation of the right to health as envisaged under Article 12(1) of the ICESCR and is inconsistent with Articles 45 and 287 of the Uganda Constitution.”

 

However, people living with HIV are already over-criminalised in Uganda by various sections of the HIV and AIDS Prevention and Control Act, as summarised in our Global HIV Criminalisation Database.

What is termed as “wilful and intentional” transmission of HIV is punishable by a fine and/or up to ten years’ imprisonment. Section 43 provides a defence if the accused’s partner was aware of, and accepted, the risk of transmission, or transmission occurred during sexual intercourse and protective measures were used. Attempted transmission is punishable by a fine and/or up to five years’ imprisonment. The scope of section 41 is undefined, but cases demonstrate that the law criminalises perceived HIV ‘exposure’ broadly.

Both Section 41 and 43 are known to have been used in a broad range of circumstances, including prosecution of a man for ‘defilement’ (2013), prosecution of a teacher for alleged transmission to his student (2013), the alleged injection of a toddler/needle stick injury (2014), alleged transmission by a woman to a number of young men (2014), alleged breastfeeding of an employer’s child (2018), the arrest, conviction and acquittal of a nurse wrongfully convicted of injecting a baby with HIV-infected blood (2018), and the alleged defilement of a boy by a woman (2019). An earlier prosecution from 2008 involved a man charged with alleged transmission. In the most recent case in 2023, a woman living with HIV pled guilty to charges under section 43 after injecting her 5-year-old son with her blood and was sentenced to seven years’ imprisonment. Cases have generally not used scientific evidence to prove allegations, with convictions at lower-level courts relying only on testimony.

Nevertheless, the recognition of key legal and rights-based arguments against punishing unintentional HIV transmission with the death penalty(!) as part of an otherwise anti-rights, morality-based ruling should be seen as a small but welcome victory. Although this might be seen as similar to the 2022 Lesotho High Court decision on the unconstitutionality of the death penalty in the context of HIV transmission following rape, the difference of course is that that rape is an act of violence that should be criminalised regardless of any other circumstances, whereas consensual sex between two men or two women should never, ever be a crime.

UK Parliament Commemorates HIV Is Not A Crime Day

On Tuesday 5th March the HIV Justice Network hosted a reception with the All Party Parliamentary Group for HIV, AIDS and Sexual Health (APPGA) to mark the first global HIV Is Not A Crime Awareness Day.

Baroness Barker, co-chair of the APPGA, Lisa Power former Policy Director at the Terrence Higgins Trust and the first chair of the HIV Justice Network’s Supervisory Board, spoke alongside our Executive Director, Edwin J Bernard. The SERO Project’s, Kerry Thomas, an HIV criminalisation survivor and activist, appeared via video.

The event was attended by MPs and members of the House of Lords, as well as representatives of the UK and US governments, the Global Fund, UNAIDS, HIV philanthropic funders, and UK and international HIV policy organisations.

Edwin presented global and Commonwealth data, based on a briefing paper especially undertaken for the event by our policy analyst, Elliot Hatt, which demonstrated that the Commonwealth is far behind global HIV criminalisation law reform trends.

In the past five years, there were more adoptions of HIV criminalisation laws than there were repeals or reforms in the Commonwealth, whilst globally this was reversed.  Notably, the United States – formerly a world leader and exporter of HIV criminalisation – was now a world leader in ending it.

“It’s time for the UK to do the same, domestically, and throughout the Commonwealth,” he said.

[Show picture list]
UPDATE 22nd March: The Parliamentary event and our Commonwealth analysis led to questions being asked in Parliament by APPGA co-chair, Florence Eshalomi MP. 

To ask the Minister of State, Foreign, Commonwealth and Development Office:

What steps he is taking to help encourage the repeal of HIV specific laws in the 20 jurisdictions in the Commonwealth that still have them.

Whether his Department is providing support to (a) the HIV Justice Network and (b) other organisations working to repeal HIV-specific laws globally.

 

These questions were answered by Andrew Mitchell MP Minister of State for Development and Africa with the same answer for both questions:

Addressing stigma, discrimination and criminalisation is critical to ensuring equality of access to HIV prevention, testing and treatment services and to achieving progress in the global HIV response.

The UK is a champion of human rights around the world and we are committed to the principle of non-discrimination on any grounds, including on the basis of sexual orientation or gender identity. The UK’s network of over 280 Diplomatic Missions monitor human rights in host countries.

At the UN High Level Meeting on HIV in June 2021, the UK worked hard to secure the highest level of commitment from our global partners and garner support for the ambitious, rights-based Global AIDS Strategy 2021-2026, so the world has the best chance of meeting the 2030 goal to end AIDS. We also endorse the Global Fund’s 2023-2028 Strategy, with a focus on addressing inequities and structural drivers of HIV infection and AIDS-related deaths including barriers to services due to stigma, discrimination and criminalisation.

Our funding to the Robert Carr Fund and to UNAIDS helps to support legal and policy reform to combat stigma, discrimination and criminalisation, and to improve access to HIV services for those most at risk, as well as supporting civil society and grassroots organisations to challenge harmful policies and attitudes that exclude minorities and put them at greater risk of HIV infection and increase access to services for these groups.

 

We are grateful to the UK’s leadership, and its support of the Robert Carr Fund – which funds much of our work, and that of the HIV JUSTICE WORLDWIDE coalition – which is currently seeking replenishment for the next funding round, 2025-7, and we hope that the UK will be the first to commit to supporting the Fund once again.

HIV Is Not A Crime Awareness Day goes global!

Next Wednesday 28th February is HIV Is Not A Crime Awareness Day.

For the first time, HIV Is Not A Crime Awareness Day – which began two years ago in the United States – has gone global! This year’s theme is: “You care about ending HIV criminalisation – you just don’t know it yet!”

That’s why we’ll be producing a very special episode of our webshow, HIV Justice Live! on this important new date for global HIV decriminalisation activism, where I’ll be joined on my ‘virtual sofa’ by an inspiring group of community-based expert activists – Florence Riako Anam (GNP+); HIV and human rights consultant, Michaela Clayton; Mikhail Golichenko (HIV Legal Network); and Andy Tapia and Kerry Thomas (SERO Project) – to explain why HIV criminalisation impacts us all, and what you can do about it.

We’ll be streaming live to YouTube and Facebook, so you’ll be able to interact with us during our Q&A session. By March 1st, Zero Discrimination Day, the show will also be available on our YouTube channel where it will be subtitled in English, allowing for automatic translation into any language.

HIV Is Not A Crime Awareness Day was the brainchild of our long-time HIV JUSTICE WORLDWIDE partner, the SERO Project’s co-Executive Director, Kamaria Laffrey. HIV Is Not A Crime Awareness Day was launched two years ago in collaboration with the Elizabeth Taylor AIDS Foundation, community activists and public policy organisations across the United States and grown in size and prominence ever since.

HIV Is Not A Crime Awareness Day takes place on 28th February for several reasons. It’s a date that bridges two major US awareness months – Black History Month in February and Women’s History Month in March. And it’s also a symbolic nod to the legacy of the late Hollywood icon and early AIDS activist, Elizabeth Taylor, who was born on 27th February.

HIV Is Not A Crime Awareness Day is an opportunity to amplify the voices of those who have been criminalised based on their HIV status; to remind people of the negative impacts of HIV criminalisation on health and rights; to celebrate the work of many individuals who are part of the growing global movement to end HIV criminalisation; and to recognise that there’s still much to do to achieve HIV JUSTICE WORLDWIDE.

You can find out what other events are taking place on and around HIV Is Not A Crime Awareness Day by visiting a dedicated Facebook page or by following the hashtag #HINACDay.

2023 in review: A delicate balance

A DELICATE BALANCE

Working to end punitive laws and policies that impact people living with HIV is never easy, but this year has been especially hard, as we fought to maintain that delicate balance between moving forward in our advocacy and preventing the erosion of our previous gains fuelled by the anti-rights movement and the growth of right-wing populism.

For the first time since the COVID-19 pandemic hit, we saw an increase in the number of reported HIV-related prosecutions: 86 cases in 18 countries. This compares with 49 cases in 16 countries last year and 54 cases in 20 countries in 2021. This year, as in previous years, the highest number of case reports come from the EECA region (Uzbekistan and Russia), followed by the United States (10 cases – a significant decrease) and the United Kingdom (5 cases – a worrying increase).

It is possible that we were seeing more case reports because there were actually more cases, but we must always consider these reported cases to be illustrative of what is likely to be a far more widespread, poorly documented use of criminal law against people living with HIV.

Although many people arrested or prosecuted were heterosexual men, we also saw a range of intersectional identities impacted by HIV criminalisation – particularly sex workers who may also have been transgender and/or people of colour and/or with a migration background.  It is clear that a convergence of multiple levels of criminalisation, discrimination and other vulnerabilities leads to over-policing of the bodies and behaviours of people living with HIV.

LATIN AMERICA

Some of the most exciting and promising developments in 2023 came from Latin America. In June, Belize repealed its HIV-specific criminal law, enacted in 2001 but never applied, primarily to enable the country to be certified as having eliminated vertical transmission. And in August, Costa Rica’s People Living with HIV organisation pushed back against a parliamentarian’s proposal to reinstate an HIV criminalisation law.

It’s also clear that sustained advocacy by civil society in Mexico – which began in earnest when the HIV JUSTICE WORLDWIDE coalition supported the creation of the Mexican network in 2017 – is really making a difference. In March, the state of Nayarit repealed its infectious disease law that had mostly applied to people with HIV. The district of Mexico City is on its way to repeal a similar law. And another Mexican state, Baja California Sur, modernised the wording of the same law to attempt to destigmatise it, by removing the concept that communicable diseases are only prosecutable if sexually transmitted.

In November, a proposal for a new HIV criminalisation law in the state of Puebla was withdrawn following criticisms from HIV and human rights organisations, and a month later there are now proposals to reform the existing law. And civil society pressure to remove the federal HIV criminalisation law on constitutional grounds may have led to Mexico’s first trans congresswomen advocating for the repeal of the law in parliament. Given Mexico’s rights-based approach to SRHR – the country decriminalised abortion earlier this year – at least one of these repeal pathways are likely to succeed next year.

NORTH AMERICA

In the United States, we continued to see a marked reduction in the number of cases as the movement to repeal or modernise HIV criminalisation laws continued to grow due to ongoing, sustained advocacy by networks of people living with HIV with support from philanthropic funders as well as federal and state political leaders and public health institutions. Although, no states fully repealed their HIV-specific laws in 2023, and law reform proposals in Indiana, Minnesota, and North Dakota failed to pass, there were some important victories in Tennessee. Here, both law reform and strategic litigation bore fruit, the former by removing mandatory sex offender registration for those convicted under the HIV law, and the latter resulting in a ruling that Tennessee’s ‘aggravated prostitution’ statute violated the Americans with Disabilities Act.

Canada – another former global HIV criminalisation leader – continued to report fewer cases, with just one new reported case in 2023. As in the United States, this is the result of many years of sustained advocacy, although the federal government has still not responded formally to its 2022 public consultation on substantially reforming its approach to HIV criminalisation. The Canadian Coalition to Reform HIV Criminalization, led by HIV JUSTICE WORLDWIDE coalition partner, the HIV Legal Network, issued a strong statement on World AIDS Day calling for action.

AFRICA

Unlike previous years, the only country on the African continent with reported new HIV criminalisation cases in 2023 was Kenya, where lawmakers are still planning to follow Uganda in enacting even more criminalisation aimed at LGBTI people – as are Botswana, Ghana, and Niger. Following the December 2022 dismissal of the constitutional challenge to Kenya’s HIV-specific provisions in the Sexual Offences Act, there are plans to appeal and to continue to lobby for change.

Strategic litigation led by KELIN was ultimately successful in establishing that women living with HIV possess the inherent right to make informed choices regarding their reproductive decisions following a nine-year process, so sustained advocacy – and patience – may be required. Patience may also be needed in South Africa where long-awaited sex work decriminalisation was further postponed, although parliament did agree to clear COVID lockdown criminal records. Elsewhere, another positive development in the region was the repeal of Mauritius’ colonial-era sodomy law which means that the number of nations with laws against gay sex has now fallen to 66.

EASTERN EUROPE / CENTRAL ASIA

People living with HIV in the EECA region continue to face multiple challenges. In just the first six months of 2023, there were 20 cases of alleged “intentional HIV transmission” to sexual partners in Uzbekistan’s Tashkent region – the highest HIV criminalisation case count anywhere in the world. The majority of those prosecuted appeared to be women. This comes as no surprise given that an analysis of cases and laws across the ECCA region by our HIV JUSTICE WORLDWIDE partners, the Eurasian Women’s Network on AIDS (EWNA), found that women living with HIV bear the brunt of the “legalised stigma” of HIV criminalisation in the region.

One of the main reasons for the high number of cases in the EECA region is the integration of HIV criminalisation within healthcare policies: newly diagnosed individuals are made to sign a paper acknowledging their legal liability for HIV prevention often without receiving adequate or meaningful counselling or support. In Russia – where the second highest number of cases were reported – a study found that most HIV clinicians support HIV criminalisation, and in Kazakhstan it was revealed that 1-in-1000 people newly diagnosed with HIV in 2022 filed a police report blaming someone else for their infection.

The legal environment for people living with HIV in Russia continues to worsen, as it does for all its citizens, especially LGBTI people – with trans women sex worker migrants facing the brunt of the Russia’s anti-LGBT “propaganda” law. And in Tajikistan, homophobic and HIV-phobic law enforcement practices resulted in ten gay men being arrested Dushanbe on suspicion of “infecting 86 people with HIV.” The only positive news for the region came from Ukraine, where a new protective HIV law was adopted earlier this year, although criminal liability for HIV exposure or transmission remains a possibility.

WESTERN EUROPE

December saw two contrasting developments in Western Europe. Just as Ireland’s Supreme Court overturned the country’s first-ever sexual HIV criminalisation case  – partially based on now well-established limitations of scientific evidence being able to prove who infected whom – a lower court in Latvia convicted someone of alleged HIV transmission for the first time.

And although in the United Kingdom, a long-awaited update to the Crown Prosecution Service’s guidance now unequivocally states that an undetectable viral load stops HIV transmission, five HIV criminalisation cases still took place, along with a highly publicised civil case. Per capita, this meant that in 2023 the UK had a five-fold incidence of reported HIV criminalisation cases compared to the United States!

ASIA PACIFIC

Singapore continues to lead the Asia Pacific region with four reported HIV criminalisation cases in 2023: one for blood donation, two for biting, and one involving a transgender sex worker for alleged HIV exposure. Although South Korea’s constitutional court ended up declaring most of its HIV criminalisation provisions constitutional, their recognition that U=U suggests the law may evolve to recognise up-to-date science.

Although ending HIV criminalisation cannot rely on science alone, it can help limit unjust prosecutions while we work to end the HIV-related stigma, discrimination and structural inequalities that drive criminalisation.

BRINGING SCIENCE TO JUSTICE

This year, we celebrated five years since the publication of the ‘Expert Consensus Statement on the Science of HIV in the Context of Criminal Law’ with our ‘Five-Year Impact Report’ and an HIV Justice Live! webshow focused on bringing science to justice. Both proved that the Expert Consensus Statement remains relevant, accurate and extremely useful.

Given this delicate balance between moving forward and preventing the erosion of hard-won rights there is still so much more to do to reach the global target of fewer than 10% of countries with punitive laws and policies that negatively impact the HIV response.

LET COMMUNITIES LEAD

To ensure that communities continue to lead, and to further enable the building of an intersectional movement to end punitive laws and policies that impact people living with HIV in all diversity, we made our online platform for e-learning and training, the HIV Justice Academy, more widely available in Spanish and Russian, to complement our English and French versions.

In 2023, the HIV Justice Academy was visited by several thousand learners from 110 countries. We were thrilled to learn that graduates of our flagship HIV Criminalisation Online Course told us that they really benefitted from the course, finding it relevant, interesting, and engaging.

RENEWED FOCUS FOR 2024

We will begin 2024 with a renewed focus to achieving HIV justice as we continue to:

  • build the evidence base by gathering relevant data and information from around the world. 
  • raise awareness across multiple platforms and communities of the harms of HIV criminalisation. 
  • create, collate, and disseminate advocacy tools and resources to foster more effective responses to damaging laws, policies, and media narratives; and
  • bring individuals and national, regional, and global networks and organisations together, as part of the HIV JUSTICE WORLDWIDE coalition, to catalyse change.

Announcing Living 2024:
The People Living with HIV Pre-conference at AIDS2024!

As we commemorate World AIDS Day, a coalition that so far includes: the Global Network of People Living with HIV (GNP+), the International Community of Women Living with HIV (ICW), the Global Network of Young People Living with HIV (Y+ Global), the HIV Justice Network (HJN), AIDS Action Europe (AAE), and the European AIDS Treatment Group (EATG) are delighted to announce our plans to host the People Living with HIV Pre-conference at AIDS2024.

Living 2024 is planned for 20th and 21st July 2024 ahead of the AIDS2024 conference in Munich. 
 
Looking back to 1983, when the very first gathering of people living with HIV developed the Denver Principles, setting the path to the greater involvement, engagement and leadership of people living with HIV in the AIDS response, we are committed to sustain that legacy and make Living 2024 a platform for people living with HIV and our close allies and partners to connect, and strengthen global solidarity for community leadership in the AIDS response. 
 
Living 2024 will be organised under the theme, ‘‘Communities leading: advancing health, dignity, equity”.
 
This is the first time since 2016 that the global community of people living with HIV in all our diversities will meet in person to reflect on the multiple socio-political challenges faced by people living with HIV that continue to limit the civic space needed for our advocacy, as well as the inequalities that fuel stigma, discrimination and criminalisation.

We plan to build power together and identify opportunities to strengthen access to affordable and optimised treatment and diagnostics including for addressing the unique challenges of ageing with HIV.

Living 2024, is also an opportunity for people living with HIV and affected communities to come together to reflect, re-imagine and define the future of the HIV movement, as well as  our place within the broader global health and development platforms in shaping the HIV sustainability plans beyond 2030. 
 
The organisers of Living 2024 call on countries and decision-makers to refocus, recommit, and ensure that communities lead. AIDS isn’t over, our lives and dignity are still under threat, and stigma, discrimination and criminalisation still prevent us from fully benefiting from the remarkable progress of HIV science. 
 
As we prepare for this crucial convening, we invite other networks, communities, partners, and potential funders to join us in making this event successful and historic. In the coming weeks, we will share more details. For any inquiries please reach out to us on email: living2024@gnpplus.net

Download this press release as a pdf

What do our HIV Justice Academy graduates think of the HIV Criminalisation Online Course?

The HIV Criminalisation Online Course is the centrepiece of our free online learning hub, the HIV Justice Academy, which launched just over a year ago.

More than 500 HIV justice advocates from around the world have since enrolled in the HIV Criminalisation Online Course. Those who have completed the course – and told us their thoughts in the end-of-course survey – are extremely positive about the experience, finding it relevant, interesting, and engaging. They especially liked the video content and personal testimonies which they tell us brought the issues to life. And we heard from both beginners and experts alike that the course was pitched right for them – no mean feat!

“Although I have been working on HIV discrimination for years, it was spectacular to refresh the memory,” wrote one. “The course met my expectations fully…now I really feel strongly equipped to continue doing my community work,” said another. “The course took a holistic approach to explaining HIV criminalisation. It lends legal, scientific, and social perspective, it also went further to touching on how I could be an advocate,” said a third.

 

One recent Academy graduate is HIV advocate and HIV criminalisation survivor, Lashanda Salinas, from the US state of Tennessee. She told us that the HIV Criminalisation Online Course “helped me learn things that I didn’t know, including how people are criminalised in other countries.” She also tells us that she found the course’s comprehensive Glossary and the Academy’s Resource Library “amazing and helpful”.

Like all the advocacy tools and resources contained within the HIV Justice Academy, the HIV Criminalisation Online Course is free to all, and available in English, French, Russian and Spanish.

The course can be done at your own pace, and you will receive a certificate of completion once you have passed the end-of-course test. 

We’re delighted that Lashanda and all the other graduates of the HIV Justice Academy’s HIV Criminalisation Online Course have learned new information and gained new skills as we work together to achieve HIV justice.

Do you know someone who might benefit from the HIV Criminalisation Online Course, or the other resources in the HIV Justice Academy – our Action Toolkits and Resource Library? Why not share this link with them today: academy.hivjustice.net