US: Trump’s promise of mass deportations is deepening mistrust of the health care system among California’s immigrants

Community health workers say fear of deportation is already affecting participation in California’s Medicaid program.

President-elect Donald Trump’s promise of mass deportations and tougher immigration restrictions is deepening mistrust of the health care system among California’s immigrants and clouding the future for providers serving the state’s most impoverished residents.

At the same time, immigrants living illegally in Southern California told KFF Health News they thought the economy would improve and their incomes might increase under Trump, and for some that outweighed concerns about health care.

Community health workers say fear of deportation is already affecting participation in Medi-Cal, the state’s Medicaid program for low-income residents, which was expanded in phases to all immigrants regardless of residency status over the past several years. That could undercut the state’s progress in reducing the uninsured rate, which reached a record low of 6.4% last year.

Immigrants lacking legal residency have long worried that participation in government programs could make them targets, and Trump’s election has compounded those concerns, community advocates say.

The incoming Trump administration is also expected to target Medicaid with funding cuts and enrollment restrictions, which activists worry could threaten the Medi-Cal expansion and kneecap efforts to extend health insurance subsidies under Covered California to all immigrants.

“The fear alone has so many consequences to the health of our communities,” said Mar Velez, director of policy with the Latino Coalition for a Healthy California. “This is, as they say, not their first rodeo. They understand how the system works. I think this machine is going to be, unfortunately, a lot more harmful to our communities.”

Alongside such worries, though, is a strain of optimism that Trump might be a boon to the economy, according to interviews with immigrants in Los Angeles whom health care workers were soliciting to sign up for Medi-Cal.

Selvin, 39, who, like others interviewed for this article, asked to be identified by only his first name because he’s living here without legal permission, said that even though he believes Trump dislikes people like him, he thinks the new administration could help boost his hours at the food processing facility where he works packing noodles. “I do see how he could improve the economy. From that perspective, I think it’s good that he won.”

He became eligible for Medi-Cal this year but decided not to enroll, worrying it could jeopardize his chances of changing his immigration status.

“I’ve thought about it,” Selvin said, but “I feel like it could end up hurting me. I won’t deny that, obviously, I’d like to benefit — get my teeth fixed, a physical checkup.” But fear holds him back, he said, and he hasn’t seen a doctor in nine years.

It’s not Trump’s mass deportation plan in particular that’s scaring him off, though. “If I’m not committing any crimes or getting a DUI, I think I won’t get deported,” Selvin said.

Petrona, 55, came from El Salvador seeking asylum and enrolled in Medi-Cal last year.

She said that if her health insurance benefits were cut, she wouldn’t be able to afford her visits to the dentist.

A street food vendor, she hears often about Trump’s deportation plan, but she said it will be the criminals the new president pushes out. “I’ve heard people say he’s going to get rid of everyone who’s stealing.”

Although she’s afraid she could be deported, she’s also hopeful about Trump. “He says he’s going to give a lot of work to Hispanics because Latinos are the ones who work the hardest,” she said. “That’s good, more work for us, the ones who came here to work.”

Newly elected Republican Assembly member Jeff Gonzalez, who flipped a seat long held by Democrats in the Latino-heavy desert region in the southeastern part of the state, said his constituents were anxious to see a new economic direction.

“They’re just really kind of fed up with the status quo in California,” Gonzalez said. “People on the ground are saying, ‘I’m hopeful,’ because now we have a different perspective. We have a businessperson who is looking at the very things that we are looking at, which is the price of eggs, the price of gas, the safety.”

Gonzalez said he’s not going to comment about potential Medicaid cuts, because Trump has not made any official announcement. Unlike most in his party, Gonzalez said he supports the extension of health care services to all residents regardless of immigration status.

Health care providers said they are facing a twin challenge of hesitancy among those they are supposed to serve and the threat of major cuts to Medicaid, the federal program that provides over 60% of the funding for Medi-Cal.

Health providers and policy researchers say a loss in federal contributions could lead the state to roll back or downsize some programs, including the expansion to cover those without legal authorization.

California and Oregon are the only states that offer comprehensive health insurance to all income-eligible immigrants regardless of status. About 1.5 million people without authorization have enrolled in California, at a cost of over $6 billion a year to state taxpayers.

“Everyone wants to put these types of services on the chopping block, which is really unfair,” said state Sen. Lena Gonzalez, a Democrat and chair of the California Latino Legislative Caucus. “We will do everything we can to ensure that we prioritize this.”

Sen. Gonzalez said it will be challenging to expand programs such as Covered California, the state’s health insurance marketplace, for which immigrants lacking permanent legal status are not eligible. A big concern for immigrants and their advocates is that Trump could reinstate changes to the public charge policy, which can deny green cards or visas based on the use of government benefits.

“President Trump’s mass deportation plan will end the financial drain posed by illegal immigrants on our healthcare system, and ensure that our country can care for American citizens who rely on Medicaid, Medicare, and Social Security,” Trump spokesperson Karoline Leavitt said in a statement to KFF Health News.

During his first term, in 2019, Trump broadened the policy to include the use of Medicaid, as well as housing and nutrition subsidies. The Biden administration rescinded the change in 2021.

KFF, a health information nonprofit that includes KFF Health News, found immigrants use less health care than people born in the United States. And about 1 in 4 likely undocumented immigrant adults said they have avoided applying for assistance with health care, food, and housing because of immigration-related fears, according to a 2023 survey.

Another uncertainty is the fate of the Affordable Care Act, which was opened in November to immigrants who were brought to the U.S. as children and are protected by the Deferred Action for Childhood Arrivals program. If DACA eligibility for the act’s plans, or even the act itself, were to be reversed under Trump, that would leave roughly 40,000 California DACA recipients, and about 100,000 nationwide, without access to subsidized health insurance.

On December 9, a federal court in North Dakota issued an order blocking DACA recipients from accessing Affordable Care Act health plans in 19 states that had challenged the Biden administration’s rule.

Clinics and community health workers are encouraging people to continue enrolling in health benefits. But amid the push to spread the message, the chilling effects are already apparent up and down the state.

“¿Ya tiene Medi-Cal?” community health worker Yanet Martinez said, asking residents whether they had Medi-Cal as she walked down Pico Boulevard recently in a Los Angeles neighborhood with many Salvadorans.

“¡Nosotros podemos ayudarle a solicitar Medi-Cal! ¡Todo gratuito!” she shouted, offering help to sign up, free of charge.

“Gracias, pero no,” said one young woman, responding with a no thanks. She shrugged her shoulders and averted her eyes under a cap that covered her from the late-morning sun.

Since Election Day, Martinez said, people have been more reluctant to hear her pitch for subsidized health insurance or cancer prevention screenings.

“They think I’m going to share their information to deport them,” she said. “They don’t want anything to do with it.”

Senegal: “The application of criminal law is an injustice against people living with HIV”

A magistrate laments the ‘unfair’ criminalisation of HIV transmission

Translated from French with Deepl.com. Scroll down for the original article.

The deputy director of human rights, Babacar Diouf, deems it unfair to criminalise the transmission of HIV-AIDS, except in cases of intentional transmission.

‘The application of criminal law is an injustice against people living with HIV, unless a person deliberately decides to infect another person’, said the magistrate.

He was hosting a conference on the theme of ‘Following the path of rights to eliminate AIDS in Senegal’, an event organised on Wednesday as part of the celebration of World AIDS Day by the National AIDS Council.

According to the deputy director of human rights at the Ministry of Justice, the right to health in Senegal is not subject to judicial review. ‘What’s not working is criminalisation. This is an obstacle to the fight against AIDS’, he maintained.

‘The criminalisation of HIV is detrimental to rights. It is unfair when it targets a person who cannot disclose his or her status’, he argued.

‘We need to be aware that proclaimed rights that are not effective are of no use’, he said, pointing out that “the law on AIDS is unknown to some judicial actors”.

‘The lack of information among the judiciary is a hindrance to the fight against AIDS. They have no information about certain health data’, he said.

With this in mind, Babacar Diouf called on the National AIDS Council to ‘equip the judiciary’ so that they can play a greater role in the fight against AIDS.

He believes it is imperative to combat stigmatisation and discrimination.

Samba Cor Sarr, Director of Cabinet at the Ministry of Health and Social Action, pointed out that the theme of World AIDS Day, ‘Following the path of rights to eliminate AIDS in Senegal’, revived the issue of human rights in the fight against HIV.

‘The path of the fight against AIDS is strewn with rights-related issues: the right to health, the right to access to care and treatment, the right to a favourable environment, the right to a fairer, more equitable world’, listed the representative of the Minister of Health.

He also spoke of ‘the right to life, to a positive life for all those directly or indirectly affected by HIV’.

He also emphasised that Senegal, like other countries, still faces ‘significant challenges in the fight against HIV/AIDS’, including strengthening the fight against HIV at community level.

These challenges include stepping up the fight against HIV at community level. These challenges include stepping up care for children living with HIV, engaging young people and combating stigma and discrimination. Samba Cor Sarr also cited the fight against inequalities in access to care and the strengthening of support mechanisms.

In the Senegalese context, he added, this year’s theme ‘takes on its full meaning insofar as it enables a more specific and tailored response to the needs of communities affected by HIV/AIDS in order to reduce stigma and discrimination’.

Un magistrat déplore la pénalisation de la transmission du Sida, « une injustice »

Dakar, 12 déc (APS) – Le directeur adjoint des droits humains, Babacar Diouf, juge injuste la pénalisation de la transmission du VIH Sida, sauf dans les cas de contamination intentionnelle.

« L’application du droit pénal est une injustice contre les personnes vivant avec le VIH, sauf si une personne décide délibérément de contaminer une autre personne », a déclaré le magistrat.

Il animait une conférence sur le thème « Suivre le chemin des droits pour l’élimination du Sida au Sénégal », une activité organisée mercredi dans le cadre de la célébration de la Journée mondiale de lutte contre le Sida par le Conseil national de lutte contre le Sida.

Selon le directeur adjoint des droits humains au ministère de la Justice, le droit de la santé n’est pas judiciarisé au Sénégal. « Ce qui ne va pas, c’est la pénalisation. Il s’agit d’un obstacle à la lutte contre le Sida », a-t-il soutenu.

« La pénalisation du VIH nuit au droit. Elle est injuste lorsqu’elle vise une personne qui ne peut pas dévoiler son statut », a-t-il argumenté.

« Nous devons savoir que des droits proclamés qui ne sont pas effectifs n’ont pas d’utilité », a-t-il dit, en faisant observer que « la loi sur le Sida est inconnue de certains acteurs judiciaires ».

« Le manque d’information des acteurs judiciaires est un frein à la lutte. Les acteurs n’ont pas d’information sur certaines données sanitaires », a-t-il indiqué.

Dans ce sens, Babacar Diouf invite le Conseil national de lutte contre le Sida à « outiller les acteurs judiciaires », afin qu’ils puissent mieux participer à la lutte contre le Sida.

Il juge impératif de lutter contre la stigmatisation et la discrimination.

Samba Cor Sarr, directeur de cabinet du ministère de la Santé et de l’Action sociale, a pour sa part relevé que le thème consacré à la Journée mondiale de lutte contre le Sida, à savoir « Suivre le chemin des droits pour l’élimination du Sida au Sénégal », fait renaitre la question des droits humains dans la lutte contre le VIH.

« Le chemin de la lutte contre le Sida est parsemé de problématiques liées aux droits : droit à la santé, droit à l’accès aux soins et aux traitements, droit à un environnement favorable, droit à un monde plus juste, plus équitable », a énuméré le représentant du ministre de la Santé.

Il a également évoqué « le droit à la vie, à une vie positive pour toutes les personnes touchées directement ou indirectement par le VIH ».

Il a par ailleurs souligné que le Sénégal, à l’instar des autres pays, demeure « confronté à des défis significatifs dans la lutte contre le VIH/Sida », parmi lesquels le renforcement de la lutte contre le VIH au niveau communautaire.

Le renforcement de la prise en charge des enfants vivant avec le VIH fait partie de ces défis, de même que l’engagement de la jeunesse, la lutte contre la stigmatisation et la discrimination. Samba Cor Sarr a également cité la lutte contre les inégalités en matière d’accès aux soins et le renforcement des mécanismes de soutien.

Dans le contexte sénégalais, ajoute-t-il, le thème retenu cette année « prend tout son sens dans la mesure où il permet une réponse plus spécifique et plus adaptée aux besoins des communautés touchées par le VIH/Sida afin de réduire la stigmatisation et la discrimination »

Uzbekistan: Successful advocacy is reshaping HIV legislation and profession bans

“‘A woman came to us, she asked for help with the legal process’” – Interview with Evgenia Korotkova

Translated from Russian with Google translate. Scroll down for the original article. 

Do you want to know how an activist living with HIV went from a public defender in cases under Article 113 of the Criminal Code to a community expert who, after speaking at a feminist forum, is influencing the humanisation of legislation on people living with HIV in Uzbekistan?

Read about it in Svetlana Moroz’s interview with Yevgeniya Korotkova on the significant reduction of the list of prohibited professions for people living with HIV in Uzbekistan.

S.M.: Zhenya, let’s start from the beginning. In 2020, a woman who faced criminal prosecution for working as a hairdresser came to your organisation for help. Tell us about this woman, why did she come to you specifically?

E.K.: I remember very well when we first started to focus on the issue of HIV criminalisation under Article 113 of the Criminal Code. At that time, we were actively collecting cases of people who had been prosecuted under this article. At some point we came across an article on the website of the Ministry of Internal Affairs. It said that an orphaned teenager living with HIV had sexual relations with a teenage girl and she became pregnant. The main message of the article was directed at parents – they should keep an eye on their children and have preventive conversations with them.

However, the article was full of stigmatising, incorrect and distorted information. Amidst the outrage, we decided to write a post on our organisation’s page, where I gave my comments. This post also included an appeal to people living with HIV who were affected by Part 4 of Article 113 of the Criminal Code of the Republic of Uzbekistan. We informed that they could contact us for legal assistance and counselling.

The response to the post did not take long. One of the first to appeal was a woman who worked as a hairdresser. She told us that her case had already been taken to court and at the time of the investigation she didn’t even have money for a lawyer. We started looking for ways to help and were able to find money to pay for a lawyer. The lawyer took on her case and filed a request to review the materials.

In the process of discussions with the woman, we came to the conclusion that I would participate in the court as a public defender from our organisation. It was the first such experience for me. We did not know that we even had the opportunity to represent someone’s interests in this way. So we prepared a motion in which we indicated that in addition to the lawyer, the interests of the woman would be represented by a public defender – that is me.

This case was a serious test for me. We discovered a new form of assistance that we had not even realised existed before.Now we know that the involvement of a public defender can be key in such cases and really helps people.

S.M.: How did this case get to court? Who sued this woman? How did they find out about her HIV status?

E.K.: How exactly this case ended up in court, we learnt only during the trial. It turned out that a police officer came to the woman’s workplace with some list. He showed her that she was on the list and said that it included people who violated the law. In particular, it was about those who were HIV-positive and worked in a hairdresser’s shop, which was allegedly against the law.

In fact, it meant the transfer of health data to law enforcement agencies without the consent of the patient. And at the trial they did not even tried to hide this fact. During the trial, the prosecutor who was in charge of the case directly stated that the information about her HIV status had been obtained from the AIDS Centre.

S.M.: How was the trial? What was the verdict?

E.K.: The trial was held in closed mode, because the case concerned doctor-patient confidentiality and confidentiality of the diagnosis. We were very lucky that we managed to attract doctors who supported our side and defended the woman.She was strictly following the ARV regimen, so she had an undetectable viral load. In court, a doctor acted as an expert who clearly explained that under such conditions, infection was impossible. He also emphasised that there were no casualties at the time of trial.

Even the investigator pointed out in the case file that the woman did not use scissors or razors in her work – only a haircutting machine. She did not use cutting or stabbing objects that could theoretically create a threat of infection. It is important to note that the witnesses who were called from her work did not testify negatively. They confirmed that the woman performed her duties professionally and without impropriety.

In my arguments, I relied on this evidence to argue that our defendant could not have transmitted HIV infection while working as a hairdresser. During the hearing, the judge asked me, ‘As a public defender, would you, yourself,  have gone to this woman to cut your hair?’ I explained that HIV transmission would have required a number of unlikely conditions: she would have had to be off therapy, and she would have cut herself and me badly. Only then could there be a theoretical threat of infection. But even then, the probability of transmission would be extremely low.

I would like to note separately that the Makhali committee gave our defendant serious support. They filed many petitions in her defence, despite knowing her HIV status. The women’s committee also got involved in the process and filed additional motions in favour of our client.

However, the woman was still given a suspended sentence of two and a half years. This decision was taken because of the existence of Article 113, under which she was tried. The court took into account that she had a minor child, and this influenced the mitigation of the sentence.

I still remember how the judge, while announcing the verdict, emphasised the importance of our advocacy work. He said that our organisation should work on changing the list of prohibited professions because it contradicts modern legislation. These words were the starting point for a great advocacy process that took us three years. This case not only showed us the need to protect people in specific situations, but also gave a start to changes at the systemic level.

S.M.: How does this woman live now? How does she feel?

E.K.: You can imagine, she worked in her favourite profession for more than 30 years. It was a terrible blow for her – to lose the job on which she had built her whole life. Given that she had a minor child and was a single mother and the sole breadwinner in the family, all the responsibility fell on her shoulders. After the trial, it was very difficult for her to find a suitable job. She did everything she could: she cleaned houses, worked as a governess, tried a lot of professions.

It was not easy for her to recover from the trial. She underwent a long psychological rehabilitation, and we, on our part, also supported her by providing the services of a psychologist. This period was very difficult for her. When the legislation was finally changed, I was the first to send her the amended document. But unfortunately, she never returned to the profession. Instead, she started her own small business, determined to start her life with a clean slate.

We continued and still maintain a relationship with her. After the trial, she took part in the Judges’ Forum where she spoke openly and told her story. She shared how an unfair piece of legislation had affected her life and it was an act of courage and hope for change. She was motivated by the desire to help others who are HIV-positive so that they would no longer have to face the hardships and humiliation that she went through.

We realised that this case was not only about criminal law issues, but also touched on socio-economic rights. It showed how much stigma and restrictive laws can affect a person’s life, depriving them of a source of income and the ability to work in a profession. Nevertheless, her story has become an important part of our advocacy work and has helped draw attention to the need for change in the law.

S.M.: We have another milestone in this story – in 2022, Uzbekistan, the third country in Central Asia (after Tajikistan and Kyrgyzstan) to receive, among other things, a recommendation to decriminalise HIV transmission from the UN CEDAW committee. Your country received this recommendation, largely due to your participation and our joint shadow report from the community. Can we assume that the recommendations received have influenced the advocacy process in the context of HIV decriminalisation, namely the revision of the list of prohibited professions?

E.K.: I had only three minutes to address the CEDAW Committee and I remember very well how we prepared my oral statement. Every second mattered. It seems to me that all our efforts were interconnected, especially considering how seriously the state takes the recommendations of international structures. In recent years, the country has really seen progress in supporting women.

From 2019, laws have started to be adopted to ensure equal rights for men and women and to combat discrimination and violence against women. I see that the country is emphasising women’s economic independence and expanding our educational and professional opportunities. Special attention is being paid to women’s access to leadership positions, which opens up new perspectives for us.

I believe that the final recommendations of the CEDAW Committee may have played a role in the state’s attention to the list of prohibited professions. This list has long been in need of revision, as it restricted women’s rights and hindered their professional development. The work in this direction is ongoing, and I hope that our efforts will help more women to avoid such restrictions and achieve justice.

S.M.: So, the year is 2024. Something has happened that probably you and we ourselves did not expect – the list of prohibited professions for people living with HIV in Uzbekistan has been changed (reduced) by the order of the Minister of Health. How did this become possible?

E.K.: According to the new order, HIV-positive people can now work as dentists, as long as they are not involved in surgical interventions. This move was a significant change, especially for us, as we had a case where a man working as a dental technician was prosecuted just because of his HIV status.

In November 2023, there was a big feminist forum where I gave a speech that was well received. One of the newspapers wrote about me as a leader living with HIV. After this publication, the presidential administration became interested in my story. I was invited to a meeting to discuss the most pressing issues facing women and people living with HIV.

At the meeting, I tried to use this opportunity to draw attention to the list of prohibited professions. I explained that this piece of legislation is not only of no public benefit, but also destroys people’s lives by restricting their ability to work in their profession. My arguments resonated. I had the impression that I was able to convince them that this order had long ago lost its relevance.

In the course of the discussion, it became clear that the officials with whom I spoke had a progressive approach and were ready to support the initiative to review and amend the list of prohibited professions. Their readiness for dialogue and understanding of the importance of the issue inspired me and gave me hope for further positive changes.

S.M.: Do I understand correctly that officials of the Ministry of Health had no resistance to this initiative? Before that, doctors used to hand over data on people with HIV to the police. I can’t forget the case when a woman (nurse) was simply summoned to the district department in the middle of the working day, checked the list of her contacts in the phone book, asked who she was sleeping with, threatened with an article, etc. – such ‘preventive’ humiliating methods.

E.K.: After the adoption of the new, shortened list of prohibited professions, we started to conduct trainings for medical workers. In the process, we encountered some resistance – among the participants there were epidemiologists who did not support the changes. They argued that the risk of HIV transmission still existed despite the new data and international standards. Such statements rather demonstrated their lack of awareness of the issue. Later, their colleagues, doctors with more experience, even advised them to refrain from making such statements in order not to mislead other participants.

Particularly important for us was the participation of the chief epidemiologist of the Republican AIDS Centre in these trainings. He presented information about the changes in the list of professions in the most professional and accessible way possible, which helped to reduce mistrust and resistance among health workers. His presentations played an important role in disseminating correct knowledge.

We also held meetings with the staff of the Ministry of Internal Affairs, in particular with representatives of the moral department, which supervised cases related to Article 113 of the Criminal Code. They were the ones who had previously initiated cases against HIV-positive hairdressers, leading to their criminal prosecution. These discussions were important for us because they allowed us to convey to law enforcement officials that the old norms no longer meet modern realities and only contribute to the stigmatisation of people living with HIV.

S.M.: We know that you worked on the bill that has already been submitted from your NGO Ishonch va Haet to the parliament. You have also received a response, thankfully. How do you assess the prospect of amending the Criminal Code with regard to Article 113?

E.K.: I am an optimist and I am sure that the changes will definitely happen, it is only a matter of time. It is already evident that people involved in legislative reforms realise that some laws are outdated and need to be revised. It is good to see that the country is actively aiming to update the legislative systems and bring them in line with modern realities.

I believe that our voice will be heard. Especially since these changes are being called for not only by civil society, but also by the scientific and medical community, as well as international organisations. These are not just recommendations invented in a narrow circle of activists/v – they are a global agenda, reflecting progress and the realisation that HIV infection is now a chronic disease that can be lived with thanks to affordable and effective treatment.

Importantly, positive developments are already taking place in the country. Progressive initiatives on gender equality, protection of the rights of women and people living with HIV demonstrate the state’s commitment to improving the quality of life of its citizens. These changes give me confidence that the reform will also affect the legislative acts that still restrict people in their rights and freedom of choice of profession.

I believe in my state and its rational approach. I see that there is a dialogue going on and it is bearing fruit. We are moving towards change, and I am convinced that it will be positive for everyone.

S.M.: One last question. Looking back at your path from a public defender to a community expert who submits a draft of legislative changes to the parliament, tell us how you came to this? Who/what is behind it?

E.K.: Behind all our efforts there are always people – people who need help and support. I myself am a woman living with HIV, and although I have not experienced criminalisation directly, I have had many examples of stigma and discrimination in my life. One of the people I defended in court is now an employee of our organisation. It is stories like these that give me the strength and inspiration to keep going.

Deep down, I dream of a perfect world. No one can stop me from at least trying to make it so. My main motivation has always been to ensure that people living with HIV no longer face discrimination and stigma, that their rights are respected and not violated just because of their diagnosis.

I am convinced that the state should work in the interests of those who live in it. And today we really have good prospects.We see the existence of political will and civil society, which is actively involved in promoting change and has real weight.This is a favourable time for change.

The state is showing a desire to hear us and understand our problems. Moreover, we are not just talking about problems, we are helping to find solutions, and this process becomes an additional motivation for me. When we are listened to and really heard, it is inspiring. It means that our efforts matter and lead to change.

Order of the Minister of Health of the Republic of Uzbekistan

On approval of the List of types of professional activities prohibited for persons infected with the human immunodeficiency virus

[Registered by the Ministry of Justice of the Republic of Uzbekistan on May 07, 2014. Registration № 2581]

Order of the Minister of Health of the Republic of Uzbekistan

On approval of the List of types of professional activities prohibited for persons infected with the human immunodeficiency virus

[Registered by the Ministry of Justice of the Republic of Uzbekistan on February 19, 2024. Registration № 3497]

Types of professional activities prohibited for persons infected with the human immunodeficiency virus

List:

1. Professions related to the procurement and processing of blood and its components.

2. Professions related to the production of blood and its components, sperm and breast milk.

3. Professions related to blood transfusion.

4. Professions related to the following medical procedures: injections; dialysis; venesection;, catheterization.

5. Professions related to cosmetic and plastic surgery.

6. Professions related to dental procedures.

7. Professions related to childbirth.

8. Professions related to abortions and other gynecological operations.

9. Professions related to hair and shaving, piercing, manicure, pedicure and tattooing.

Types of professional activities prohibited for persons infected with the human immunodeficiency virus

List:

1. Professions related to the procurement, processing and transfusion of human blood and/or its components.

2. Professions related to all types of surgery.

3. Professions related to childbirth.

4. Professions related to the following medical procedures: dialysis; venesection; catheterization.

«К нам пришла женщина, она просила помощи с судебным процессом»

Интервью с Евгенией Коротковой

Хотите узнать, как активистка, живущая с ВИЧ, прошла путь от общественной защитницы по делам по 113-й статье Уголовного Кодекса до экспертки сообщества, которая после выступления на феминистском форуме влияет на гуманизацию законодательства в отношении людей, живущих с ВИЧ, в Узбекистане?

Читайте об этом в интервью Светланы Мороз с Евгенией Коротковой, посвященном существенному сокращению списка запрещенных профессий для людей, живучих с ВИЧ, в Узбекистане.

С.М.: Женя, давай начнем с начала. В 2020 году к вам в организацию за помощью обратилась женщина, которая столкнулась с уголовным преследованием за то, что она работала парикмахером. Расскажи про эту женщину, почему она пришла именно к вам?

Е.К.: Я хорошо помню, как мы только начали уделять внимание проблеме криминализации ВИЧ в рамках статьи 113 Уголовного кодекса. Мы тогда активно собирали кейсы людей, которые были привлечены по этой статье. В какой-то момент наткнулись на статью на сайте МВД. В ней говорилось о том, что подросток-сирота, живущий с ВИЧ, вступил в половую связь с подростком девочкой, и она забеременела. Основной посыл статьи был направлен на родителей — мол, следите за детьми и проводите с ними профилактические беседы.

Однако статья была переполнена стигматизирующей, некорректной и искаженной информацией. На фоне возмущения мы решили написать пост на странице нашей организации, где я дала свои комментарии. В этом посте также было обращение к людям, живущим с ВИЧ, которые пострадали по части 4-й статьи 113 УК РУз. Мы сообщали, что они могут обратиться к нам за юридической помощью и консультациями.

Реакция на пост не заставила себя долго ждать. Одной из первых обратилась женщина, работавшая парикмахером. Она рассказала, что ее дело уже передано в суд, а на момент расследования у нее даже не было средств на адвоката. Мы начали искать возможности помочь и смогли найти деньги на оплату адвокатских услуг. Адвокатка взялась за ее дело и подал запрос на ознакомление с материалами.

В процессе обсуждений с этой женщиной мы пришли к выводу, что я буду участвовать в суде как общественная защитница от нашей организации. Это был для меня первый такой опыт. Мы не знали, что у нас вообще есть возможность представлять чьи-то интересы таким образом. И мы подготовили ходатайство, в котором указали, что помимо адвоката интересы женщины будет представлять общественная защитница — то есть я.

Этот случай стал для меня серьезным испытанием. Мы открыли для себя новую форму помощи, о существовании которой раньше даже не догадывались. Теперь мы знаем, что участие общественного(ой) защитника/цы может оказаться ключевым в подобных делах и реально помогает людям.

С.М.: Как это дело попало в суд? Кто подал в суд на эту женщину? Как они узнали о ее ВИЧ статусе?

Е.К.: То, как именно это дело оказалось в суде, мы узнали только в ходе судебного процесса. Оказалось, что к женщине на работу пришел сотрудник милиции с каким-то списком. Он показал ей, что она числится в этом списке, и заявил, что туда включены люди, нарушающие закон. В частности, речь шла о тех, кто имеет ВИЧ-положительный статус и работает в парикмахерской, что якобы противоречит закону.

Фактически это означало передачу данных о состоянии здоровья правоохранительным органам без согласия пациентки. И на суде этот факт даже не пытались скрыть. В ходе разбирательства прокурор, который вел дело, прямо заявил, что сведения о ее ВИЧ-статусе были получены из Центра СПИДа.

С.М.: Как проходил суд? Какой был приговор?

Е.К.: Судебное разбирательство проходило в закрытом режиме, поскольку дело касалось врачебной тайны и конфиденциальности диагноза. Нам очень повезло, что удалось привлечь врачей, которые поддержали нашу сторону и встали на защиту женщины. Она строго следовала режиму приёма АРВ-терапии, благодаря чему у нее была неопределяемая вирусная нагрузка. В суде в качестве эксперта выступил врач, который ясно объяснил, что при таких условиях инфицирование было невозможно. Он также подчеркнул, что на момент разбирательства не было ни одного пострадавшего.

Даже следователь указал в материалах дела, что женщина не пользовалась в работе ножницами или бритвами — только машинкой для стрижки. Она не применяла режущие и колющие предметы, которые могли бы теоретически создать угрозу заражения. Важно отметить, что свидетели, которых вызывали с ее работы, не давали негативных показаний. Они подтверждали, что женщина выполняла свои обязанности профессионально и без нарушений.

В своих прениях я опиралась на эти доказательства, утверждая, что наша подзащитная не могла передать ВИЧ-инфекцию, работая парикмахером. Во время заседания судья задал мне вопрос: «Вы, как общественная защитница, сами бы пошли стричься к этой женщине?» Я объяснила, что для передачи ВИЧ потребовался бы целый ряд маловероятных условий: она должна была бы не принимать терапию, при этом и себя, и меня сильно порезать. Только в таком случае могла бы возникнуть теоретическая угроза заражения. Но даже тогда вероятность передачи была бы крайне низкой.

Отдельно хочу отметить, что махалинский комитет оказал нашей подзащитной серьезную поддержку. Они подали множество ходатайств в ее защиту, несмотря на знание ее ВИЧ-статуса. К этому процессу также подключился комитет женщин, который внес дополнительные ходатайства в пользу нашей клиентки.

Однако женщине все же назначили условный срок — два с половиной года. Это решение было принято из-за существования статьи 113, по которой ее судили. Суд учел, что у нее есть несовершеннолетний ребенок, и это повлияло на смягчение приговора.

До сих пор помню, как судья, оглашая приговор, подчеркнул важность нашего адвокационного направления. Он сказал, что наша организация должна работать над изменением списка запрещенных профессий, потому что он противоречит современному законодательству. Эти слова стали отправной точкой для большого адвокационного процесса, который занял у нас три года. Это дело не просто показало нам необходимость защиты людей в конкретных ситуациях, но и дало старт изменениям на системном уровне.

С.М.: Как сейчас живет эта женщина? Как она себя чувствует?

Е.К.: Представляешь, она проработала в своей любимой профессии более 30 лет. Для нее это было страшным ударом — лишиться работы, на которой она строила всю свою жизнь. Учитывая, что у нее был несовершеннолетний ребенок, а она — мать-одиночка и единственная кормилица в семье, вся ответственность легла на ее плечи. После суда ей было очень тяжело найти подходящую работу. Она бралась за все, что могла: убирала дома, работала гувернанткой, перепробовала массу профессий.

Восстановиться после судебного процесса ей было нелегко. Она проходила длительную психологическую реабилитацию, и мы со своей стороны также оказывали ей поддержку, предоставив услуги психолога. Этот период был очень непростым для нее. Когда наконец изменили законодательство, я первой отправила ей документ с поправками. Но, к сожалению, она так и не вернулась в профессию. Вместо этого она открыла свой маленький бизнес, решив начать жизнь с чистого листа.

Мы продолжали и до сих пор поддерживаем с ней отношения. После суда она приняла участие в Форуме судей, где выступила с открытым лицом и рассказала свою историю. Она поделилась тем, как несправедливая законодательная норма отразилась на ее жизни, и это стало для нее своего рода актом мужества и надеждой на перемены. Её мотивацией было желание помочь другим людям с ВИЧ-положительным статусом, чтобы они больше не сталкивались с теми трудностями и унижениями, через которые прошла она.

Мы понимали, что этот случай касался не только вопросов уголовного права, но и затрагивал социально-экономические права. Он показал, как сильно стигматизация и ограничительные законы могут повлиять на жизнь человека, лишив его источника дохода и возможности работать по профессии. Тем не менее, ее история стала важной частью нашей адвокационной работы и помогла привлечь внимание к необходимости изменений в законодательстве.

С.М.: У нас есть еще одна веха в этой истории — в 2022 году, Узбекистан, третья страна в ЦА (после Таджикистана и Кыргызстана), которая среди прочего получила рекомендацию декриминализировать передачу ВИЧ от комитета ООН CEDAW. Твоя страна получила эту рекомендацию, во многом, благодаря твоему участию и нашему совместному теневому отчету от сообщества. Можем ли мы считать, что полученные рекомендации повлияли на адвокационные процесс в контексте декриминализации ВИЧ, а именно пересмотр списка запрещенных профессий?

Е.К.: У меня было всего три минуты на выступление перед членами Комитета CEDAW, и я прекрасно помню, как мы готовили мое устное заявление. Каждая секунда имела значение. Мне кажется, что все наши усилия были взаимосвязаны, особенно с учетом того, насколько серьезно государство относится к рекомендациям международных структур. В последние годы в стране действительно заметен прогресс в вопросах поддержки женщин.

С 2019 года начали приниматься законы, направленные на обеспечение равноправия мужчин и женщин и борьбу с дискриминацией и насилием в отношении женщин. Я вижу, что в стране делается акцент на экономическую независимость женщин и расширение наших возможностей в образовании и профессиональной деятельности. Особое внимание уделяется доступу женщин к руководящим должностям, что открывает новые перспективы для нас.

Я верю, что заключительные рекомендации Комитета CEDAW могли сыграть свою роль в том, что государство обратило внимание на перечень запрещенных профессий. Этот список давно нуждался в пересмотре, так как он ограничивал права женщин и препятствовал их профессиональному развитию. Работа в этом направлении продолжается, и я надеюсь, что наши усилия помогут еще большему числу женщин избежать подобных ограничений и добиться справедливости.

С.М.: Итак, 2024 год. Случилось то, что, наверное, вы и мы сами не ожидали – приказом министра здравоохранения изменен (сокращен) список запрещенных профессий для людей, живущих с ВИЧ, в Узбекистане. Как это стало возможным?

Е.К.: Согласно новому приказу, ВИЧ-положительные люди теперь могут работать стоматологами, если они не занимаются хирургическими вмешательствами. Этот шаг стал значимым изменением, особенно для нас, поскольку у нас был случай, когда мужчину, работающего зубным техником, привлекли к уголовной ответственности только из-за его ВИЧ-статуса.

В ноябре 2023 года прошел большой феминистский форум, на котором я выступила с речью, вызвавшей широкий отклик. В одной из газет обо мне написали как о лидерке, живущей с ВИЧ. После этой публикации моей историей заинтересовались в администрации президента. Меня пригласили на встречу, чтобы обсудить наиболее острые проблемы, с которыми сталкиваются женщины и люди, живущие с ВИЧ.

На встрече я постаралась использовать этот шанс, чтобы привлечь внимание к списку запрещенных профессий. Я объяснила, что этот законодательный акт не только не приносит общественной пользы, но и разрушает жизни людей, ограничивая их возможности работать по профессии. Мои доводы нашли отклик. У меня сложилось впечатление, что я смогла убедить их в том, что этот приказ давно утратил свою актуальность.

В процессе обсуждения стало очевидно, что чиновники, с которыми я общалась, проявили прогрессивный подход и готовы поддержать инициативу по пересмотру и изменению списка запрещенных профессий. Их готовность к диалогу и понимание важности вопроса вдохновили меня и дали надежду на дальнейшие позитивные изменения.

С.М.: Я правильно понимаю, что у чиновников Минздрава не было сопротивления этой инициативе? До этого врачи передавали милиции данные о людях с ВИЧ. Не могу забыть случай, когда женщину (медсестру) просто посредине рабочего дня вызвали в райотдел, проверяли список ее контактов в телефонной книге, спрашивали с кем она спит, угрожали статьей, и т.д. — такие «профилактические» унизительные методы.

Е.К.: После принятия нового, сокращенного списка запрещенных профессий мы начали проводить тренинги для медицинских работников. В процессе мы столкнулись с определенным сопротивлением — среди участников встречались эпидемиологи, которые не поддерживали изменения. Они утверждали, что риск передачи ВИЧ все равно существует, несмотря на новые данные и международные стандарты. Такие заявления, скорее, демонстрировали их недостаточную осведомленность в вопросе. Позже их коллеги, врачи с большим опытом, даже советовали им воздержаться от таких высказываний, чтобы не вводить в заблуждение других участников.

Особенно важным для нас стало участие главного эпидемиолога Республиканского центра СПИД в этих тренингах. Он представил информацию об изменениях списка профессий максимально профессионально и доступно, что помогло снизить уровень недоверия и сопротивления среди медработников. Его выступления сыграли важную роль в распространении правильных знаний.

Мы также проводили встречи с сотрудниками МВД, в частности с представителями нравственного отдела, который курировал дела, связанные со статьей 113 УК. Именно они ранее инициировали дела против ВИЧ-положительных парикмахеров, приводя к их уголовному преследованию. Эти обсуждения были для нас важны, поскольку позволили донести до сотрудников правоохранительных органов, что старые нормы больше не отвечают современным реалиям и только способствуют стигматизации людей, живущих с ВИЧ.

С.М.: Мы знаем, что ты работала над законопроектом, который уже подан от вашей неправительственной организации «Ишонч ва Хает» в парламент. Вы еще ответ получили, с благодарностью. Как ты оцениваешь перспективу внесения изменений в УК в отношении 113-й статьи?

Е.К.: Я — оптимистка и уверена, что изменения непременно произойдут, это лишь вопрос времени. Уже сейчас видно, что люди, занимающиеся реформами в области законодательства, осознают, что некоторые законы устарели и требуют пересмотра. Приятно видеть, что страна активно нацелена на обновление законодательных систем и приведение их в соответствие с современными реалиями.

Я верю, что наш голос будет услышан. Тем более, что к этим изменениям призывает не только гражданское общество, но и научное и медицинское сообщество, а также международные организации. Это не просто рекомендации, придуманные в узком кругу активисток/в — это глобальная повестка, отражающая прогресс и понимание того, что ВИЧ-инфекция сегодня является хроническим заболеванием, с которым можно жить благодаря доступному и эффективному лечению.

Важно, что в стране уже происходят позитивные сдвиги. Прогрессивные инициативы в области гендерного равенства, защиты прав женщин и людей, живущих с ВИЧ, демонстрируют стремление государства к улучшению качества жизни своих граждан. Эти перемены дают мне уверенность, что реформа затронет и законодательные акты, которые до сих пор ограничивают людей в их правах и свободе выбора профессии.

Я верю в свое государство и его рациональный подход. Вижу, что идет диалог, и он приносит плоды. Мы движемся в сторону перемен, и я убеждена, что они будут положительными для всех.

С.М.: Последний вопрос. Оглядываясь на твой путь от общественной защитницы до экспертки сообщества, которая подает в парламент проект законодательных изменений, расскажи, как ты к такому пришла? Кто/что за этим стоит?

Е.К.: За всеми нашими усилиями всегда стоят люди — люди, которые нуждаются в помощи и поддержке. Я сама женщина, живущая с ВИЧ, и, хотя напрямую не сталкивалась с криминализацией, в моей жизни было немало примеров стигмы и дискриминации. Один из тех, кого я защищала в суде, теперь стал сотрудником нашей организации. И такие истории дают мне силы и вдохновение двигаться дальше.

В глубине души я мечтаю об идеальном мире. Никто не может запретить мне хотя бы пытаться сделать его таким. Моя главная мотивация всегда была в том, чтобы люди, живущие с ВИЧ, больше не сталкивались с дискриминацией и стигмой, чтобы их права уважались и не нарушались только из-за их диагноза.

Я убеждена, что государство должно работать в интересах тех, кто в нем живет. И сегодня у нас действительно есть хорошие перспективы. Мы видим наличие политической воли и гражданского общества, которое активно участвует в продвижении изменений и имеет реальный вес. Это благоприятное время для перемен.

Государство проявляет желание услышать нас и понять наши проблемы. Более того, мы не просто говорим о проблемах, мы помогаем находить решения, и этот процесс становится для меня дополнительной мотивацией. Когда нас слушают и действительно слышат — это вдохновляет. Это значит, что наши усилия имеют значение и ведут к изменениям.

Приказ Министра здравоохранения Республики Узбекистан

Об утверждении Перечня видов профессиональной деятельности, запрещенных для лиц, зараженных вирусом иммунодефицита человека

[Зарегистрирован Министерством юстиции Республики Узбекистан 07 мая 2014 года. Регистрационный № 2581]

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Об утверждении Перечня видов профессиональной деятельности, запрещенных для лиц, зараженных вирусом иммунодефицита человека

[Зарегистрирован Министерством юстиции Республики Узбекистан 19 февраля 2024 года. Регистрационный № 3497]

Виды профессиональной деятельности, запрещенные лицам, инфицированным вирусом иммунодефицита человека

СПИСОК

1. Профессии, связанные с заготовкой и переработкой крови и ее компонентов.

2. Профессии, связанные с получением крови и ее компонентов, спермы и грудного молока.

3. Профессии, связанные с переливанием крови.

4. Профессии, связанные со следующими медицинскими процедурами: инъекции; диализ; венесекция; катетеризация.

5. Профессии, связанные с косметическими и пластическими операциями.

6. Профессии, связанные со стоматологическими процедурами.

7. Профессии, связанные с родами.

8. Профессии, связанные с абортами и другими гинекологическими операциями.

9. Профессии, связанные с прической и бритьем, пирсингом, маникюром, педикюром и татуировкой.

Виды профессиональной деятельности, запрещенные лицам, инфицированным вирусом иммунодефицита человека

СПИСОК

1. Профессии, связанные с заготовкой, переработкой и переливанием крови человека и (или) ее компонентов.

2. Профессии, связанные со всеми видами хирургии.

3. Профессии, связанные с родами.

4. Профессии, связанные со следующими медицинскими процедурами: диализ; венесекция; катетеризация.

 

 

 

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.

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!

Powerful and important new book, ‘Criminalized Lives’ published this week

This week sees the publication of a powerful and important new book, Criminalized Lives.

Based on 24 interviews conducted across Canada over two years with 16 people who were criminally accused of not disclosing their HIV-positive status, author Alexander McClelland, details the many complexities of disclosure, and the violence that results from being criminalised.

McClelland, who is living with HIV, works as a criminologist at Carleton University, in Ottawa, Canada. He is also a member of HJN’s Global Advisory Panel (GAP) and the Canadian Coalition to Reform HIV Criminalization.

Canada has long been a hot spot for HIV criminalisation where the act of not disclosing one’s HIV-positive status to sex partners has historically been regarded as a serious criminal offence. The book describes how this approach has disproportionately harmed Black and Indigenous people, women, gay men, and the poor.

While the book focuses on Canada, it presents lessons for those of us working around the world to end HIV criminalisation, especially in contexts where general criminal laws – like bodily harm, sexual assault and even attempted murder – are being applied to instances of alleged HIV non-disclosure.

Accompanied by a foreword by fellow HJN GAP member, US-based leading HIV criminalisation activist Robert Suttle, and portraits from queer comic artist Eric Kostiuk Williams, the book’s moving interviews illustrate that criminal legal systems are unprepared to handle the nuances and ethical dilemmas faced everyday by people living with HIV. 

By offering personal stories of people who have faced criminalisation first-hand, McClelland questions common assumptions about HIV, the role of punishment, and the violence that results from the criminal legal system’s legacy of categorising people as either victims or perpetrators, and the complicity of public health systems in processes of criminalisation.

The book is distributed internationally via Rutgers University Press where you can purchase paperback, hardback, and ebook versions.

Five things you can do to amplify Criminalized Lives:

  1. Ask your local library to carry the book.
  2. Host a conversation on the book in your community to help mobilise for change.
  3. Share your thoughts about the book on social media to generate conversations about the harms of HIV criminalisation.
  4. Review the book in a publication or online.
  5. Include the book in a course syllabus.

Civil society statement on the proposed re-criminalisation of HIV in Zimbabwe

Download this statement as a pdf

In 2022, the Government of Zimbabwe was celebrated nationally and internationally for repealing the country’s HIV-specific criminal law, Section 79 of the Criminal Code.

When announcing the repeal in Parliament, Minister Ziyambi Ziyambi, Zimbabwe’s Minister of Justice, Legal and Parliamentary Affairs noted: “…the global thinking now is that that law stigmatises people living with HIV and studies have shown that it does not produce the intended results. What the ministry is going to do is to repeal that section of the law and ensure that we keep up to speed with modern trends in the world.”

HIV JUSTICE WORLDWIDE is shocked, saddened and extremely disappointed that only two years later, the Ministry of Justice, Legal and Parliamentary Affairs is now proposing to re-criminalise HIV by adding HIV to the list of sexually transmitted infections (STIs) currently criminalised in Section 78 of the Criminal Code.

That they are proposing to do so as part of the Criminal Laws Amendment (Protection of Children and Young Persons) Bill is both cynical and unwarranted. Amendments to the Criminal Code are meant to codify the Supreme Court decision on the age of consent to sex. Amending Section 78 of the Criminal Code to re-criminalise HIV is out-of-step with the 2021 Political Declaration on HIV/AIDS agreed on by UN Member States, including Zimbabwe. Of note, Section 80 of the Criminal Code already provides for aggravated sentencing in cases of exposure to HIV during “sexual intercourse or performing an indecent act with a young person.”

Section 78, like the repealed Section 79, criminalises anyone who “does anything or causes or permits anything to be done with the intention or realising that there is a real risk or possibility of infecting any other person with” syphilis, gonorrhoea, herpes and “all other forms of sexually transmitted diseases”. It is overly broad and extremely vague. 

Adding HIV to this already problematic provision would be a retrograde and harmful step backwards for the following reasons:

  1. Criminalisation does not prevent HIV or STI transmission. Communicable diseases – including those that are sexually transmitted – are public health issues, not criminal issues and criminalisation is not an evidence-based response to public health issues. As UNAIDS noted in its 2022 press release congratulating Zimbabwe for repealing the HIV criminalisation law: “The criminalisation of HIV transmission is ineffective, discriminatory and undermines efforts to reduce new HIV infections. Such laws actively discourage people from getting tested for HIV and from being referred to the appropriate treatment and prevention services.”
  2. The criminalisation of HIV and other STIs can violate human rights. Such laws and prosecutions threaten the rights of people living with HIV, and other STIs, to equality, freedom from discrimination, privacy, human dignity, health, liberty, and the right to a fair trial, amongst others. Based on the HIV Justice Network’s monitoring of how people living with HIV were prosecuted previously under Section 79, we believe that the criminal justice system is not well equipped to understand the science of exposure and transmission of HIV or other STIs and would therefore be unable to uphold principles of legal and judicial fairness, including the key criminal law principles of legality, foreseeability, intent, causality, proportionality and proof. Overly broad criminalisation of HIV and STIs means people with HIV or STIs risk being prosecuted and sent to prison instead of receiving care for their medical condition.
  3. The criminalisation of HIV and other STIs can increase stigma and harm public health. This is particularly so because prosecutions are often accompanied by highly stigmatising and inaccurate media reporting. By increasing stigma and driving people away from testing and healthcare services, criminalisation may therefore also prevent or delay people from accessing testing and treatment. Effective HIV and/or STI treatment not only allows people living with HIV or other STIs to lead longer, healthier lives, but also prevents HIV and STI transmission. 
  4. Criminalisation harms women. In Zimbabwe, as in many African countries, HIV criminal laws have been disproportionately applied against women living with HIV. Women are usually the first to know of their HIV status, often due to accessing testing during antenatal care. Being the first to test positive, women may be vulnerable to being falsely blamed for bringing HIV into the relationship. Women living with HIV are also vulnerable to violence and abuse in intimate relationships and the threat of prosecution only increases that vulnerability.

Rather than adding HIV to Section 78, this provision should be repealed. This would contribute to enhancing Zimbabwe’s HIV and STI response in line with a human rights-affirming approach to health that is mandated by the Constitution and recommended by public health and human rights experts internationally and regionally.

The Health Law and Policy Consortium agrees with the HJWW coalition:

Reintroducing the punitive criminalisation of  HIV transmission is counterproductive as it undermines national health objectives and the global target of ending HIV and AIDS by 2030. It will be tantamount to reenacting state endorsed stigma that will inevitably flow from the criminalisation. This amendment not only jeopardises the progress made through the successful repeal of Section 79 of the Criminal Law Codification and Reform Act, it threatens current efforts underway to prevent the spread of HIV as it reintroduces a driver for new infections of HIV. The proposed amendment creates a formidable legal barrier that will severely undermine full access to essential healthcare services. It will deter individuals from seeking regular HIV testing, adhering to HIV treatment and medication, and disclosing their HIV status to enable their sexual partners to take preventive measures such as PrEP.

Sonke Gender Justice also agrees with the above and adds the following:

It is Sonke’s considered view that the reintroduction of the impugned provisions providing for the criminalisation of HIV in Zimbabwe will harm rights of women. The amendment of Section 78 of the Criminal Code on sexually transmitted diseases to include HIV will bring back the narrative of unjust arrests and prosecutions. Under this new provision, women tested as HIV-positive will face prosecution and eventual violence. Criminalisation of HIV reinforces gender barriers to accessing treatment, care and support for women who test HIV-positive, driving them underground, unable to disclose their status to the detriment of family health resulting in infant HIV acquisition, ART non-adherence for both the mother and infant. Criminalisation of HIV impairs public health goals that seek to promote health rights of women leading to poor health outcomes and HIV related health disparities.

HJWW, HLPC and Sonke conclude that re-criminalising HIV, as well the existing criminalisation of STIs, is a threat to Zimbabwe’s HIV and SRHR response and to the rights, security and dignity of people living with HIV, particularly women living with HIV.

Section 78 is vague and overly broad and risks being applied in a way that is unjust and discriminatory. It will not prevent HIV or STI transmission, instead perpetuating stigma and misinformation, risking driving people away from HIV and STI testing and treatment and filling prisons.

 

About the authors of this statement

HIV JUSTICE WORLDWIDE is a coalition of 16 global and regional civil society networks and human rights defenders working to end HIV criminalisation.

Health Law and Policy Consortium (HLPC) is a health policy advocacy organisation leveraging a network of experts across various disciplines. HLPC aims to facilitate rights-based policy formulation, implementation, and monitoring within Zimbabwe’s public health system.

Sonke Gender Justice is a South African-based non-profit organisation working throughout Africa. Sonke believes women and men, girls and boys can work together to resist patriarchy, advocate for gender justice and achieve gender transformation.

Download this statement as a pdf

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.

US: New report published on the enforcement of HIV criminalisation in Ohio

‘Antiquated’ and unscientific laws enforced against Ohioans living with HIV: Report

Across the country, a growing coalition of advocates is pushing to repeal or update state laws that criminalize people living with HIV or AIDS.

In Ohio, six laws on the books either criminalize certain acts – including sex – for people living with HIV or substantially increase sentences for them compared to people who do not have the virus.

Most of the laws were passed decades ago, fueled by fear, absent scientific understanding about how HIV is transmitted and before advancements in HIV-related treatment were widely introduced. Laws still remain in place in 34 states.

There are no national reporting requirements that track arrests or prosecutions under the laws. Until now, it was unclear how frequently Ohio prosecutors have charged people under the laws, which also apply to people living with hepatitis or tuberculosis.

A report released today by Equality Ohio and the Ohio Health Modernization Movement (OHMM), two groups pushing for legal reform, reveals that more than half of the prosecutions over a six-year period were for acts – such as spitting or throwing bodily fluids – that were unlikely to transmit HIV. It also found a disproportionate number of people charged were Black compared to Ohio’s overall population of Black residents.

“Ohio is unique in that these antiquated laws are actually being utilized and enforced against everyday Ohioans who are living with HIV,” Kate Mozynski, an attorney with Equality Ohio and one of the co-authors of the report told the Buckeye Flame.

In 2022, about 25,000 people in Ohio had an HIV diagnosis. The rate of Black residents diagnosed with HIV was more than six times the rate of white residents.

The groups spent three years gathering information from prosecutors and courts in all 88 Ohio counties and identified 214 cases charged under the six laws. Often, the records lacked or had conflicting information on race or ethnicity, and the gender captured in law enforcement records didn’t always reflect a person’s gender identity.

That prevents researchers from fully understanding the impact that these laws are having on some of the most vulnerable populations in Ohio, including LQBTQ+ people, people experiencing incarceration and people of color, according to the report. The federal Centers for Disease Control and Prevention has warned that laws criminalizing HIV exposure are outdated and may discourage testing, increase stigma and exacerbate disparities in Black and Latino communities.

Cuyahoga County had the highest number of charges

 The report found that:

  • Prosecutions are concentrated in Ohio’s more populous counties, including Cuyahoga, Hamilton, Franklin and Lucas counties.
  • Cuyahoga County charged four times the number of people under the six laws than Franklin County, which has a higher population and more people living with HIV and AIDS. Cuyahoga County accounted for 26% of the cases identified.
  • The largest share of prosecutions involved Black men, based on recorded race and gender included in records.

A separate Marshall Project review of prosecutions under the six laws in Cuyahoga County from 2016 through 2022 examined 36 charges involving 35 defendants. That doesn’t didn’t include charges for solicitation, prostitution or loitering, which are generally misdemeanor crimes.

The cases involved 18 law enforcement agencies, including three hospital police departments and public transit police.

The Cuyahoga County Prosecutor’s office, which decides whether to prosecute felony cases under Ohio’s laws, said these charges are determined on a “case-by-case basis” after considering input from victims, according to Lexi Bauer, communications manager. Bauer noted that the majority of the “harassment by bodily fluid” charges in recent years were related to hepatitis and not HIV.

Ohio penalties among the harshest

Ohio’s laws remain among the harshest when it comes to HIV criminalization, not just based on the conduct that is criminalized but also the penalties, said Jada Hicks, staff attorney for The Center for HIV Law and Policy.

In Ohio, people living with HIV (or viral hepatitis or tuberculosis) can be charged whether or not they:

  • Engaged in sex practices or other acts that could transmit the virus.
  • Transmitted HIV.
  • Used protection, such as condoms and/or dental dams.
  • Had an undetectable level of virus in their blood and were unable to transmit HIV.

Most of the charges examined in the report fall under two Ohio laws.

One law makes it a crime for a person living with HIV (or hepatitis or tuberculosis) to “harass” someone with their bodily fluids. That would include spitting or throwing urine, feces or blood at another person.

Under the other law, a person can be charged with felonious assault if they have sex with another person without telling them that they are living with HIV.

The penalties for failing to disclose HIV status in Ohio are stiff regardless of whether the virus was actually transmitted or whether it was even possible for a person to transmit the virus. Possible sentences for individuals living with HIV can be anywhere from two to 29 times longer than those for Ohioans who are HIV-negative.

Ohio is also one of six states that require individuals convicted under one of these statutes to register as a sex offender.

“Ohio’s HIV laws don’t require actual transmission or even the intent to transmit,” said Nathan Cisneros, a researcher with the Williams Institute, which does legal and public policy research on sexual orientation and gender identity. “Conduct that couldn’t transmit HIV – like spitting and biting, loitering while having a conversation about sex work – can land you in prison.”

The Williams Institute also published a report today that looked at arrests under Ohio’s six laws over two decades and felony prosecutions in Cuyahoga County from 2009 to 2022. Researchers identified at least 530 separate allegations under the six laws since 2000. Having consensual sex without disclosing an HIV-positive status made up nearly half of the total cases. Incidents related to sex work and bodily fluid exposure each accounted for nearly one-fifth of the total.

Changing legal landscape

Thirteen states have either repealed or modernized their HIV laws, according to the Center for HIV Law and Policy, including Illinois in 2021 and New Jersey in 2022.

Ohio advocates have been at the forefront of efforts to challenge the laws as discriminatory. In 2022, the Center for HIV Law and Policy filed a complaint with the Department of Justice on behalf of people living with HIV in Ohio and Tennessee.

In December, the DOJ notified Tennessee it was violating the Americans with Disabilities Act (ADA) by enforcing the state law that increases penalties for people convicted of prostitution if they also have HIV. On Feb. 15, the Justice Department filed charges against the state in federal court..

Combing state records for HIV-related charges

OHMM researchers gathered information from county-level online court records and local county clerk and prosecutors’ offices in Ohio’s 88 counties for a six-year period ending in 2020. The project identified 214 cases prosecuted under the six laws.

Behind each one of the cases, there is a “real, everyday Ohioan who happens to have a medical condition,” Mozynski said.

Where in Ohio are people being charged?

The highest concentration of charges are in the state’s larger metropolitan areas.

  • 26% in Cuyahoga County (Cleveland)
  • 12% in Hamilton County (Cincinnati)
  • 7% in Lucas County (Toledo)
  • 7% in Franklin County (Columbus)
  • Montgomery (Dayton) and Warren (Lebanon) counties, about 5% each.

What charges are most common?

More than half of the cases identified were for the charge of “harassment with a bodily substance,” which carries with it a penalty of up to 5 years in prison and a $10,000 fine. Cases with this charge are often related to acts against law enforcement or corrections officers or healthcare workers.

Charges don’t distinguish between bodily fluids that can transmit HIV, such as blood, and those that do not, such as saliva, urine or feces. People can also be charged if they are living with hepatitis, regardless of whether it is transmitted.

Prosecutors also don’t have to prove whether a person is capable of transmitting the virus or determine whether it is scientifically impossible to transmit the virusdue to prescription-drug treatments that have reduced the presence of the virus in a person’s blood – called a viral load – to undetectable levels.

A third of the cases were for “felonious assault,” which carries the most severe penalty of any HIV-related charge – up to eight years of incarceration and a $15,000 fine. Each sexual act can be charged separately. It also doesn’t require that the virus be transmitted.

OHMM found no cases where people were charged with “selling or donating contaminated blood.” The Williams Institute found six arrests over a 20 year period related to blood donation.

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.