At SADC-PF parliamentarians meeting in South Africa, Patrick Eba of UNAIDS says HIV criminalization is a setback to regional AIDS efforts

The criminalisation of HIV simply undermines the remarkable global scientific advances and proven public health strategies that could open the path to vanquishing AIDS by 2030, Patrick Eba from the human rights and law division of UNAIDS told SADC-PF parliamentarians meeting in South Africa.

Restating a remark made by Justice Edwin Cameron of the Constitutional Court of South Africa, Eba said: “HIV criminalisation makes it more difficult for those at risk of HIV to access testing and prevention. There is simply no evidence that it works. It undermines the remarkable scientific advances and proven public health strategies that open the path to vanquishing AIDS by 2030.”

SADC-PF has undertaken, as part of its commitment to advocacy for sexual reproductive health rights, an ambitious 90-90-90 initiative in east and southern Africa, with the help of the media, to ensure that all people living with HIV should know their status by 2020; that by 2020 90 percent of all people diagonised with HIV will receive sustained antiretroviral therapy; and that by 2020 90 percent of all people living with HIV and receiving antiretroviral therapy will have viral suppression.

He implored parliamentarians from SADC-PF member states to advocate for laws that would decriminalise HIV after he noted several African countries had HIV-specific criminal laws that resulted in arrests and prosecutions of those convicted of spreading HIV intentionally.

Eba said calls for the criminalisation of intentional or wilful spreading of HIV stem from the fact there are high rates of rape and sexual violence, and most notably in post-conflict countries such as the DRC there exist promises of retribution, incapacitation, deterrence and rehabilitation.

He gave an example of one case of miscarriage of justice involving a woman in Gabon who was wrongfully arrested after a man accused her of having infected him with HIV, but after spending several months in detention she was actually found to be HIV-negative after she went for testing.

Eba appealed to SADC-PF parliamentarians to consider decriminalisation of HIV on the basis that antiretroviral treatment (ART) has a 96 percent rate in reducing the risk of HIV transmission.

“End criminalisation to end AIDS,” he implored SADC-PF parliamentarians who included Agnes Limbo of the RDP, Ida Hoffmann of Swapo and Ignatius Shixwameni of APP, all delegated by Namibia to the conference.

Eba also referred to the motion unanimously adopted in November 2015 that was moved by Duma Boko of Botswana and that was seconded by Ahmed Shaik Imam of South Africa who reaffirmed SADC member states’ obligation to respect, fulfil and promote human rights in all endevours undertaken for the prevention and treatment of HIV.

That motion had also called on SADC member states to consider rescinding and reviewing punitive laws specific to the prosecution of HIV transmission, exposure and non-disclosure. It also reiterated the role by parliamentarians to enact laws that support evidence-based HIV prevention and treatment interventions that conform with regional and international human rights frameworks.

Eba said since HIV infection is now a chronic treatable health condition, no charges of “murder” or “manslaughter” should arise and that HIV non-disclosure and exposure should not be criminalised in the absence of transmission, and that significant risk of transmission should be based on best available scientific and medical evidence.

On the other hand, he said, there is no significant risk in cases of consistent condom use practice or other forms of safer sex and effective HIV treatment.

The SADC-PF joint sessions also addressed the issues of criminalisation of termination of pregnancy. The joint sessions ended on Thursday with a raft of recommendations for the ministerial meetings.

Originally published in New Era.

Justice Edwin Cameron: ‘Why HIV criminalisation is bad policy and why I’m proud that advocacy against it is being led by people living with HIV’

[This is the foreword to Advancing HIV Justice 2: Buiding momentum in global advocacy against HIV criminalisation, which will be published by the HIV Justice Network and GNP+ tomorrow, Tuesday May 10th.]

 

Since the beginning of the HIV epidemic, 35 long years ago, policymakers and politicians have been tempted to punish those of us with, and at risk of, HIV. Sometimes propelled by public opinion, sometimes themselves noxiously propelling public opinion, they have tried to find in punitive approaches a quick solution to the problem of HIV. One way has been to use HIV criminalisation – criminal laws against people living with HIV who don’t declare they have HIV, or to make potential or perceived exposure, or transmission that occurs when it is not deliberate (without “malice aforethought”), criminal offences.

Most of these laws are appallingly broad. And many of the prosecutions under them have been wickedly unjust. Sometimes scientific evidence about how HIV is transmitted, and how low the risk of transmitting the virus is, is ignored. And critical criminal legal and human rights principles are disregarded. These are enshrined in the International Guidelines on HIV and Human Rights. They are further developed by the UNAIDS guidance note, Ending overly-broad criminalisation of HIV non-disclosure, exposure and transmission: Critical scientific, medical and legal considerations. Important considerations, as these documents show, include foreseeability, intent, causality, proportionality, defence and proof.

The last 20 years have seen a massive shift in the management of HIV which is now a medically manageable disease. I know this myself: 19 years ago, when I was dying of AIDS, my life was given back to me when I was able to start taking antiretroviral medications. But despite the progress in HIV prevention, treatment and care, HIV continues to be treated exceptionally for one over-riding reason: stigma.

The enactment and enforcement of HIV-specific criminal laws – or even the threat of their enforcement – fuels the fires of stigma. It reinforces the idea that HIV is shameful, that it is a disgraceful contamination. And by reinforcing stigma, HIV criminalisation makes it more difficult for those at risk of HIV to access testing and prevention. It also makes it more difficult for those living with the virus to talk openly about it, and to be tested, treated and supported.

For those accused, gossiped about and maligned in the media, investigated, prosecuted and convicted, these laws can have catastrophic consequences. These include enforced disclosures, miscarriages of justice, and ruined lives.

HIV criminalisation is bad, bad policy. There is simply no evidence that it works. Instead, it sends out misleading and stigmatising messages. It undermines the remarkable scientific advances and proven public health strategies that open the path to vanquishing AIDS by 2030.

In 2008, on the final day of the International AIDS Conference in Mexico City, I called for a sustained and vocal campaign against HIV criminalisation. Along with many other activists, I hoped that the conference would result in a major international pushback against misguided criminal laws and prosecutions.

The Advancing HIV Justice 2 report shows how far we have come. It documents how the movement against these laws and prosecutions – burgeoning just a decade ago – is gaining strength. It is achieving some heartening outcomes. Laws have been repealed, modernised or struck down across the globe – from Australia to the United States, Kenya to Switzerland.

For someone like me, who has been living with HIV for over 30 years, it is especially fitting to note that much of the necessary advocacy has been undertaken by civil society led by individuals and networks of people living with HIV.

Advancing HIV Justice 2 highlights many of these courageous and pragmatic ventures by civil society. Not only have they monitored the cruelty of criminal law enforcement, acting as watchdogs, they have also played a key role in securing good sense where it has prevailed in the epidemic. This publication provides hope that lawmakers intending to enact laws propelled by populism and irrational fears can be stopped. Our hope is that outdated laws and rulings can be dispensed with altogether.

Yet this report also reminds us of the complexity of our struggle. Our ultimate goal – to end HIV criminalisation using reason and science – seems clear. But the pathways to attaining that goal are not always straightforward. We must be steadfast. We must be pragmatic. Our response to those who unjustly criminalise us must be evidence-rich and policy-sound. And we can draw strength from history. Other battles appeared “unwinnable” and quixotic. Think of slavery, racism, homophobia, women’s rights. Yet in each case justice and rationality have gained the edge.

That, we hope and believe, will be so, too, with laws targeting people with HIV for prosecution.

Edwin Cameron, Constitutional Court of South Africa, May 2016.

US/Canada: Elton John AIDS Foundation on why they support civil society organisations working to end HIV criminalisation

Australia: Queensland people living with HIV organisation, QPP, issues position statement on HIV criminalisation (press release)

Queensland Positive People (QPP) is a peer-based advocacy organisation which is committed to actively promoting self-determination and empowerment for all people living with HIV (PLHIV) throughout Queensland.

Below is their press release issued on 6 April 2016 in the light of the recent High Court ruling related to intent in HIV transmission cases.

Position Statement

The criminal law is an ineffective and inappropriate tool to address HIV non-disclosure, exposure or transmission. International best practice acknowledges that public health frameworks are best placed to encourage a shared responsibility for HIV transmission, and public health interventions seek to effect change in risk-taking behaviour among those who have difficulty taking appropriate precautions to prevent the transmission of HIV.

Urgent legal review of State and National guidelines for determining if an individual poses a reckless risk of HIV transmission is required following the scientific acceptance that PLHIV on treatment with an undetectable viral load pose a negligible risk of transmitting HIV via sexual intercourse. Despite scientific consensus on this issue, Australian criminal law has failed to acknowledge the contemporary science of HIV transmission and instead relies on incorrect, out of date and stigmatising perspectives of HIV that do not acknowledge that with proper adherence to HIV medication, it is a manageable chronic illness with a full life expectancy.

To explain why Australian criminal law lags behind United Nation recommendations and criminalises HIV transmission, Cipri Martinez, President of the National Association of People with HIV Australia (NAPWHA) states “stigma, fear and discriminatory perceptions of HIV influence the decision to proceed with criminal charges– a statement clearly evidenced by a lack of criminal prosecution or media attention regarding the transmission of other notifiable conditions such as syphilis or hepatitis.” HIV is treatable, but criminal charges perpetuate the inaccurate position that HIV is still a death sentence and therefore deserving of a severe punishment.

Current Status

A decision has been handed down in the High Court regarding a Queensland criminal HIV transmission case.

Whilst inappropriate to comment on the specifics of the case, the NAPWHA and Queensland Positive People (QPP) highlight that the trying of HIV transmission through the courts is a complex and fraught issue.

The overly broad use of the criminal law has far reaching negative impacts upon the HIV response. In line with UNAIDS guidance, NAPWHA and QPP urge that any application of the criminal law in the context of HIV must not undermine public health objectives.

Cipri Martinez states that “The use of the criminal law in responding to HIV transmission has been widely regarded as a blunt and ineffective tool with adverse implications for public health. In line with the recommendations of the UN Global Commission on HIV and the Law, the criminal law should only be reserved for cases where an individual exhibits clear malicious intent to transmit HIV with the purpose of causing harm.”

“There are alternatives to the criminal justice system to address HIV transmission or allegations that a person living with HIV is placing other people at risk of HIV, such as public health legislation” Martinez said.

Public health interventions are intended to prioritise education; support behaviour change; provide management as required; and actively utilise affected communities as a far more effective alternative to punitive and stigmatising legal sanctions.

NAPWHA and QPP support HIV prevention strategies being driven by an evidence-based, best practice model of public health interventions.

Criminalising HIV transmission sends unbalanced messages about the shared responsibility for prevention, creates disincentives for people to get tested and does, in fact, discourage disclosure of HIV status. These outcomes undermine prevention efforts and actually increase the risk of further HIV transmission.

Criminalising transmission does not acknowledge the complex factors that may impact an individual’s ability to disclose status or take the necessary precautions to prevent HIV transmission.

QPP President, Mark Counter agrees with NAPWHA’s position, saying “Public health interventions acknowledge the complex factors unique to each case, such as power imbalances, impairment, discrimination or other social determinants of health that may confuse or limit an individual’s ability to prevent transmission.”

National and State HIV strategies have identified the shared goals of achieving virtual elimination of HIV transmission in Australia by 2020.

“We are all working towards the shared goal of reducing HIV transmissions. The only way we are going to achieve this goal is by continuing to implement evidence-based human rights responses to HIV. These responses include educating the public about HIV and empowering people to avoid transmission or live successfully with HIV. The broad use of the criminal law does not help us achieve these goals” Counter says.

We need to be expanding programs which have been proven to reduce HIV transmission whilst protecting the human rights of people living with HIV and those who are HIV negative. Further, we need to encourage and empower people living with an unknown status to get tested and to ensure HIV prevention services are available to all that need them.

One of the unfortunate side effects of criminal prosecutions is the misinformed and stigmatising media that can accompany the reporting of these cases.

“We call on media outlets to appropriately report on HIV transmission cases with facts and not fear. Inaccurate statements not only undermine our efforts to educate the public about HIV, but also create an environment of fear for people living with HIV or people thinking about testing. It is vital that we encourage people to test – not discourage or frighten them from testing” Counter said.

For assistance in reporting appropriately on HIV, journalists should refer to the Australian Federation of AIDS Organisations HIV Media Guide.

US: New York Public radio produces empathatic audio feature story on HIV criminalisation

Last summer, in a Missouri courtroom, a college wrestler named Michael Johnson was sentenced to 30 years in prison for “recklessly infecting a partner with HIV.”

Johnson, who also goes by “Tiger Mandingo”, was accused of knowingly infecting his partners with HIV, although at least one of them said Johnson called to tell him the diagnosis when Johnson tested positive for the virus.

The case shed light on the stigmas surrounding sexually transmitted infections, or STIs, and especially HIV/AIDS. In more than 30 states there is a legal requirement for HIV positive individuals to disclose their status to whomever they’re having sex with. And while most people agree that honest conversation is a good practice, the laws allow people with HIV to be imprisoned for even spitting, biting or oral sex.

“Every person with HIV in the country who knows they have HIV is one accusation away from finding themselves in a courtroom,” said Sean Strub, director of The Sero Project.

Strub was diagnosed with HIV in the 1980s. Since then, treatments for STIs like HIV/AIDS has made significant progress across the globe. But Strub argues that an HIV diagnosis has continued to carry a stigma, perhaps even worse than before. And Strub said forcing people to disclose their status can backfire, and alienate a population that needs support.

While Strub is working to change the policy, New York University sex researcher and educator, Zhana Vrangalova, is focused on challenging society’s perception of risky sex.

“People really fear that STIs are more prevalent than they are…and that once you catch it you may always keep it,” she said.

Vrangalova is on a mission to de-stigmatize safe sexual behavior. Her website, for example, is about casual sex and provides a forum for people to talk about the flings and one-night stands that are usually dismissed in traditional sex education. Students in her class learn how to balance health and protection with redefining normal sexual behavior.

Jake Hernandez, a 23-year-old nursing student taking her class, has had personal experience with the same situation that got Michael Johnson behind bars. His ex-boyfriend called him to tell him he was HIV positive after they had oral sex, and luckily, Hernandez tested negative.

While he felt betrayed by his boyfriend, Hernandez still believes society needs to challenge the stereotypes surrounded STIs and the people who have them, especially gay men. While visiting a sex shop for his class with Vrangalova, he said the assumption is, “that we just walk around having sex all the time.”

“I mean I would probably say I’ve had casual sex once in my life. If I was dating a girl would you be saying all these things?”

Listen here

Originally published at WNYC.com

US: Bernie Sanders “absolutely opposed” to HIV criminalisation

In the plan that Clinton articulated to achieve an “AIDS-free generation” the day after her gaffe, she came out against state HIV criminalization laws penalizing perceived transfer of the disease.

Although his plan doesn’t address them, a Sanders spokesperson said he’s “absolutely opposed” to those laws.

From Washington Blade.

US: Republican Senator highlights Florida’s “archaic” HIV-specific criminal law, advocates for law reform in 2017

Last Thursday, March 10th Senator Rene Garcia introduced an amendment in the Florida Senate to an amendment of a bill he was co-sponsoring (SB 314) to highlight the damage done to the HIV response by the state’s overly broad HIV criminalisation law.

Senator Garcia, a Republican, withdrew the amendment following his three minute intervention, but noted that he intends to work with the Senate in the next legislative session, 2017, in order to reform Florida’s overly broad HIV non-disclosure law.

In order words, the amendment was presented strategically in order to give the issue of HIV criminalisation some exposure to his colleagues.

Tami Haught of the Sero Project, who is working closely with colleagues in Florida to modernise the law, noted:

“We are delighted that Senator Garcia is taking leadership on this issue and look forward to an ongoing dialogue. Sero and our Florida partners will be soliciting comments and a legal review of what Senator Garcia has proposed as well as continuing to organize statewide to build support for change. We have a lot of work to do between now and next year’s legislative session.”

Watch Senator Garcia speak about why it is crucial to reform Florida’s HIV criminalisation law below.

US: Hillary Clinton: "We should call on states to reform outdated and stigmatizing HIV criminalization laws."

Yesterday, at Nancy Reagan’s funeral, I said something inaccurate when speaking about the Reagans’ record on HIV and AIDS. Since then, I’ve heard from countless people who were devastated by the loss of friends and loved ones, and hurt and disappointed by what I said. As someone who has also lost friends and loved ones to AIDS, I understand why. I made a mistake, plain and simple.

I want to use this opportunity to talk not only about where we’ve come from, but where we must go in the fight against HIV and AIDS.

To be clear, the Reagans did not start a national conversation about HIV and AIDS. That distinction belongs to generations of brave lesbian, gay, bisexual, and transgender people, along with straight allies, who started not just a conversation but a movement that continues to this day.

The AIDS crisis in America began as a quiet, deadly epidemic. Because of discrimination and disregard, it remained that way for far too long. When many in positions of power turned a blind eye, it was groups like ACT UP, Gay Men’s Health Crisis and others that came forward to shatter the silence — because as they reminded us again and again, Silence = Death. They organized and marched, held die-ins on the steps of city halls and vigils in the streets. They fought alongside a few courageous voices in Washington, like U.S. Representative Henry Waxman, who spoke out from the floor of Congress.

Then there were all the people whose names we don’t often hear today — the unsung heroes who fought on the front lines of the crisis, from hospital wards and bedsides, some with their last breath. Slowly, too slowly, ignorance was crowded out by information. People who had once closed their eyes opened their hearts.

If not for those advocates, activists, and ordinary, heroic people, we would not be where we are in preventing and treating HIV and AIDS. Their courage — and their refusal to accept silence as the status quo — saved lives.

We’ve come a long way. But we still have work to do to eradicate this disease for good and to erase the stigma that is an echo of a shameful and painful period in our country’s history.

This issue matters to me deeply. And I’ve always tried to do my part in the fight against this disease, and the stigma and pain that accompanies it. At the 1992 Democratic National Convention, when my husband accepted the nomination for president, we marked a break with the past by having two HIV-positive speakers — the first time that ever happened at a national convention. As First Lady, I brought together world leaders to strategize and coordinate efforts to take on HIV and AIDS around the world. In the Senate, I put forward legislation to expand global AIDS research and assistance and to increase prevention and education, and I proudly voted for the creation of PEPFAR and to defend and protect the Ryan White Act. And as secretary of state, I launched a campaign to usher in an AIDS-free generation through prevention and treatment, targeting the populations at greatest risk of contracting HIV.

The AIDS crisis looks very different today. There are more options for treatment and prevention than ever before. More people with HIV are leading full and happy lives. But HIV and AIDS are still with us. They continue to disproportionately impact communities of color, transgender people, young people and gay and bisexual men. There are still 1.2 million people living with HIV in the United States today, with about 50,000 people newly diagnosed each year. In Sub-Saharan Africa, almost 60 percent of people with HIV are women and girls. Even though the tools exist to end this epidemic once and for all, there are still far too many people dying today.

That is absolutely inexcusable.

I believe there’s even more we can — and must — do together. For starters, let’s continue to increase HIV and AIDS research and invest in the promising innovations that research is producing. Medications like PrEP are proving effective in preventing HIV infection; we should expand access to that drug for everyone, including at-risk populations. We should call on Republican governors to put people’s health and well-being ahead of politics and extend Medicaid, which would provide health care to those with HIV and AIDS.

We should call on states to reform outdated and stigmatizing HIV criminalization laws. We should increase global funding for HIV and AIDS prevention and treatment. And we should cap out-of-pocket expenses and drug costs—and hold companies like Turing and Valeant accountable when they attempt to gouge patients by jacking up the price of lifesaving medications.

We’re still surrounded by memories of loved ones lost and lives cut short. But we’re also surrounded by survivors who are fighting harder than ever. We owe it to them and to future generations to continue that fight together. For the first time, an AIDS-free generation is in sight. As president, I promise you that I will not let up until we reach that goal. We will not leave anyone behind.

Australia: New campaign launched by state PLHIV organisation to amend HIV disclosure requirement in New South Wales’ Public Health Act

Positive Life’s Communications and Policy Officer, Scott Harlum (pictured), explains why the organisation will advocate for changes to HIV disclosure requirements in the Public Health Act as part of the review.

The Public Health Act is a key piece of NSW legislation which impacts the lived experience of people living with HIV. For many years, Positive Life has advocated for a number of key changes to the Act to reflect the current reality of HIV as a chronic manageable health condition, to better support efforts to end HIV transmission and to acknowledge prevention of HIV transmission is a shared responsibility regardless of sero-status. With charges under the Crimes Act laid against a man relating to the alleged infection of another man in January, now unrelated accusations against a sex worker extradited to Western Australia, Positive Life will again advocate for change to the Public Health Act as part of a required review of the legislation.

Despite an update in 2010, Positive Life argues some sections of the Public Health Act need change, and even removal from the Act to protect the interests of people living with HIV, reduce stigma and discrimination and enhance HIV prevention and testing in the broader community. A key example is the removal of Section 79, known as the ‘disclosure provision’.

Section 79 requires anyone who knows they have a sexually transmissible infection (STI) including HIV to inform a person before they have sex, and for that person to voluntarily accept the risk of acquiring that infection. In NSW, if you are HIV-positive and don’t disclose your status before sex you are guilty of an offence under the Act. The requirement to disclose your HIV status before sex hasn’t changed from the 1991 version of the Act, except for the inclusion of a ‘reasonable precautions’ provision.

This provision provides a defence to prosecution if ‘reasonable precautions’ have been taken during sex to prevent transmission. However, the definition of ‘reasonable precautions’ remains unclear and this amendment falls short of the current reality of HIV. Removing Section 79 will provide a more comprehensive approach to the rights and responsibilities of the community regardless of sero-status.

With today’s HIV treatments, if a HIV-positive person is on treatments and has an ‘undetectable viral load’, the chances of condomless sex resulting in HIV infection are extremely low. However under the current Section 79, without change to the law or a court deciding that an undetectable viral load is a ‘reasonable precaution’, a person with HIV could still be committing an offence under the Act for not disclosing their status before sex.

Under Section 79, criminalising HIV discourages testing and encourages anonymous sex. Put simply, if you don’t know you have HIV you cannot be found guilty of an offence under the Act for not disclosing your status. Equally, anonymous sex reduces your chances of being identified for prosecution. In an era where more than 90% of people with HIV are on treatment and have an undetectable viral load, people who are infected with HIV but unaware of their status are more of a risk for transmission than people on treatment with a suppressed viral load.

Fear of prosecution inhibits honesty with sexual partners and medical providers, so Section 79 may actually increase the transmission of HIV and other STIs, rather than decrease it. An honest and open relationship with our doctor is crucial to maintain good health regardless of our sero-status. For example, contracting an STI such as gonorrhoea is a risk for anyone who is sexually active, and if the symptoms are hidden, we don’t know we’ve picked up an STI. If we can’t speak openly about the sex we have, it’s likely we won’t be tested for STIs and instead transmit any unknown infection to others.

Under Section 79, forced disclosure of our status as a person with HIV can encourage HIV-related stigma and discrimination, both real and perceived. Disclosure of our status as a person with HIV can, in rare circumstances, lead to violence. More often forced disclosure leads to rejection, loss of control over who knows of our status, discrimination on the basis of our status, or the premature ending of relationships.

Section 79 as it stands does not account for PrEP. Today, many HIV-negative people are already importing pre-exposure prophylaxis or ‘PrEP’, and following the announcement on World AIDS Day last year of an expanded trial of the HIV-prevention medication, many more will be taking PrEP as the trial is rolled out in coming months. A benefit of PrEP is it encourages HIV-negative people to take control of their own health and reduce their own risk of acquiring HIV. Reducing HIV transmission is a shared responsibility and Positive Life believes this principle should be reflected in the Public Health Act.

With the coming review of the Public Health Act, Positive Life will share more about other changes we believe should be made to the Act to reflect the modern reality of HIV as an ongoing manageable health condition. In the meantime, if you have questions or comments about our proposed changes to HIV disclosure requirements in the Act, please make contact on 1800 245 677 (freecall) or by email.

Originally published on Gay News Network