Kristin Bergtore Sandvik explores how the criminalisation of infectious diseases can hinder global health interventions

Governing global health emergencies: the role of criminalization

The point of departure for this blog is the apparent frequency of criminalization strategies in early government responses to the Coronavirus. While much attention has been given to the securitization of global health responses – also in the case of Corona – less systematic focus has been given to the partial criminalization of infectious diseases as a strategy of global health governance.

As the scope of the Corona outbreak is broadening, the number of countries deploying criminalization measures is also rapidly increasing. China has introduced harsh regulations to deal with the Coronavirus, including ‘medical-related crimes’ involving harassment and violence against medical personnel, refusal to submit to quarantine and obstructing dead body management. Singapore and Hong Kong have criminalized the breach of travel restrictions and misleading authorities or spreading false rumours.   Taiwan plans sentencing the violation of quarantines. Iran will flog or jail people who spread false rumours. A Russian prankster is facing jail-time for Corona ‘hooliganism’. In the US, prospective quarantine violators from the infamous cruise ship Diamond Princess were facing fines or jail time. Beyond governments’ need to be seen doing something in the face of public panic across the Global East and the Global North, how should we think about this propensity to reach for penal measures?

How we explain disease and whom we blame are highly symptomatic of who we are and how we organize our relations with others, in particular the practices and life forms of marginalized elements of society. This will also likely be the legacy of Corona. Moreover, current global health responses to infectious diseases remain bound up with both colonial-era and historical command-and control trajectories of response and needs to be understood in context.

In this blog, I map out three categories of criminalization.  My assumption is that the Corona response will likely involve all three in some form or other. I take the broad conceptualizations of criminalization in circulation in legal, policy and media discourse as the starting point: this includes criminal law sanctions  and administrative and disciplinary sanctions as well as popular perceptions of the uses of penal power and social ‘criminalization-talk’.  The idea is that criminalization can be understood as a strategic tool with multiple constitutive uses in the global health field.  

In the following, I outline three different things that criminalization ‘does’ in the global health field, which may serve as a resource for thinking about how criminalization will shape approaches to the Corona virus.

First, I am interested in the direct and indirect criminalization of health care delivery through the criminalization of individuals infected with or suspected of being infected with specific infectious diseases. The problem with this approach is that it risks aggravating humanitarian suffering because it is either premised on criminalizing the practices and attributes of groups that are already in a marginal position, or that with infection, patients immediately become  socially or economically ‘marginalized’ which allows for criminal interventions. This category of criminalization covers transmission, exposure, interaction with ‘vulnerable groups’ (such as children), failure to disclose or simply physical movement. It relies significantly on the mobilization of othering and of metaphors of fear.  The global health response may also be undermined through the de facto criminalization of individuals by way of the use of compulsory health powers such as surveillance, contact tracing, compulsory examination and treatment, regulation of public meeting places, quarantines and forced isolation of individuals.

These regimes might be so repressive as to have severe humanitarian impact on the populations concerned. Human suffering here does not emanate from the inability to offer health care but from the human rights violations arising from how fear and stigma fuel criminalization of ‘vulnerable/deviant/threat groups (such as drug users, those with precarious migration status, sex workers and the LGBTI population) and how criminalization in turn produces further deviance and marginalization.  A characteristic of early phases of epidemics is that certain groups are singled out as risky and characterized as dangerous, allowing for repressive public health interventions.

At the same time, fear of harassment, arrest and detention may deter people from using health services.  A ‘deviant’ social status combined with health status may lead to discrimination and ill-treatment by health care providers. Criminalization is linked to high levels of harassment and violence, reported by lesbian, gay, transgender people and sex workers around the world (see here and here). Notably, in the context of HIV/AIDS, criminalization, and quarantine and individual responsibility for disclosure have been considered as key tools to halt or limit transmission, despite innovations in treatment that radically transform the nature and lethality of HIV/AIDS. Globally, prosecutions for non‐disclosure, exposure or transmission of HIV frequently relate to sexual activity, biting, or spitting. At least 68 countries have laws that specifically criminalize HIV non‐disclosure, exposure, or transmission. Thirty‐three countries are known to have applied other criminal law provisions in similar cases.

For the fast-moving but relatively low-mortality Corona-virus, these lessons indicate that a marginalized social status can contribute to exacerbating transmission and constitute a barrier to adequate health care, potentially increasing mortality.

Secondly, criminalization and repressive public health measures and discriminatory barriers are also a complicating factor during emergencies caused by other factors. As seen in the context of Ebola, general violence as well as violence against health care workers undermines efforts to end outbreaks. Humanitarian emergencies confront public health systems with often overwhelming challenges. In the midst of this, criminalization of individuals who are infected or perceived as risky or dangerous further compromises the ability to address preexisting epidemics and hamper transmission, thus exacerbating the impact of the overall impact of the crisis. 

Third, in situations when the disease itself is the emergency, criminalization and the attendant practice of quarantines directly hampers efforts. Historically, quarantines have been used for a wide range of diseases including venereal disease, tuberculosis, scarlet fever, leprosy and cholera. Quarantines are co-constructed through the longstanding tradition of framing infectious disease through criminalization, whereby stigma, medicalization and incarceration have worked together to produce colonial bodies construed as racial and sexual threats to national security (see here and here). Quarantine was a widely employed tool against Ebola in Sierra Leone and Liberia.  As noted  by commentators, according to the logic underlying quarantines ‘subjects marked as abnormal, diseased, criminal, or illicit should be isolated for their own betterment and for the collective good’. While resistance becomes a proof of deviance and of the necessity of segregation, in the case of Ebola, quarantines may compel fearful communities to hide suspected cases. In the contemporary context, with an international human rights framework on health suggesting that rights-based approaches to disease prevention and mitigation should be foregrounded,  problematic tradeoffs between criminalization-oriented public health measures and fundamental rights and liberties are likely to proliferate, as illustrated by the US government’s budding ‘war on Corona’.

This blog has provided an initial map of how criminalization may shape the Corona response. In sum, when criminalization is pegged directly onto suffering human bodies, criminalization hinders global health interventions in three ways. Criminalization might be so repressive that it has severe health-related impacts on the populations concerned. Criminalization also undermines and exacerbates challenges already faced by the public health infrastructure during an emergency. Finally, the repercussions of criminalization are most impactful in situations when the disease itself is the humanitarian crisis and where criminalization directly hampers efforts to contain and mitigate epidemics.

France: HIV organisations mobilise to halt sensationalism of news coverage in police violence case

Spit and HIV: the violence of words

Automatic translation via Deepl.com. For original article in French, please scroll down.

Spit and HIV: the violence of words

Following the release of an amateur video in which a police officer stopped and violently beat a demonstrator, a spokesperson for the police union Alliance, in defence of the officer involved, claimed that the person stopped spat blood in the officer’s face and said, “I have AIDS, you’re going to die. Since then, the victim has denied living with HIV and having threatened the police officers with “contamination” by spitting on them.

The case has swelled up in some media outlets, which have taken up the police unionist’s explanations without deflating the sensationalism surrounding the “danger” of spitting on an HIV-positive person.

Faced with this, many of his AIDS activists and associations of people living with HIV intervened to put the facts in their place, regardless of the position of responsibility that existed during the arrest. “The rapidity of news coverage regularly implies approximations or, worse, leaving room for false beliefs. This is particularly true with regard to HIV/AIDS. But to allow false ideas to be conveyed is to feed the serophobia that plays into the hands of the epidemic,” explains AIDES in its press release published in emergency on 20 January.

On Twitter, the president of Act Up-Paris, Marc-Antoine Bartoli, is moved and says that “aggression or “the attack on AIDS does not exist”. A few weeks ago Act Up New York had to deal with a similar case. It is important to remember that people who test positive for HIV have access to treatment that makes their viral load undetectable and cannot transmit HIV. First fact. The second is that, first and foremost, “the modes of contamination are sexual secretions, breast milk, blood. Saliva does not transmit HIV. Moreover, HIV has very low resistance to the open air. After five to ten seconds in the open air, a drop of blood no longer contains the virus,” AIDES recalls.

These simple indications would have deflated a Serophobic line of defence from the outset, continuing to play on irrational fears. “It is everyone’s responsibility to recall this information as soon as necessary. Without this, stigmatization and false beliefs will not be able to stop,” continues AIDES. And the media have their role to play in informing. This is what Fred Colby, a gay activist who is openly HIV-positive and committed to AIDES, is calling for: “People living with HIV are not walking viruses. People living with HIV are not walking viruses. The media needs to think before they publish this kind of thing or qualify it by talking about treatment and undetectable viral load. Without this prerequisite, this spitting case is likely to come back in the news, without any lessons being learned from the previous one. Again to the detriment of HIV-positive people.

Crachat et VIH : la violence des maux

À la suite de la diffusion d’une vidéo amateur, dans laquelle un policier interpelle et frappe violemment un manifestant, le porte-parole du syndicat de policiers Alliance affirmait, pour la défense de l’officier mis en cause, que la personne interpellée aurait craché du sang au visage du policier en disant : « J’ai le sida, tu vas crever ». Depuis, la victime réfute vivre avec le VIH et avoir menacé les policiers de « contamination » en leur crachant dessus. L’affaire a enflé dans certains médias, qui ont repris à leur compte les explications du syndicaliste de la police, sans pour autant dégonfler le sensationnalisme autour du « danger » d’un crachat d’une personne séropositive au VIH. Face à cela, de nombreux-ses militants-es de la lutte contre le sida et des associations de personnes vivant avec sont intervenus pour remettre les faits à leur place, peu importe la position sur les responsabilités en cours durant l’arrestation. « La rapidité de traitement de l’actualité implique régulièrement des approximations ou pire, de laisser la place à de fausses croyances. C’est particulièrement vrai concernant le VIH/sida. Or, laissez véhiculer de fausses idées, c’est nourrir la sérophobie qui fait le jeu de l’épidémie », explique AIDES dans son communiqué publié en urgence, le 20 janvier. Sur Twitter, le président d’Act Up-Paris, Marc-Antoine Bartoli, s’émeut et indique que « l’agression ou « l’attaque au sida n’existe pas ». Il y a quelques semaines Act up New-York a eu à faire à un cas similaire. Il est important de rappeler que les personnes dépistées séropositives ont accès à un traitement qui rend leur charge virale indétectable et ne peuvent pas transmette le VIH. Premier fait. Le second, c’est qu’avant toute chose, « les modes de contamination sont les sécrétions sexuelles, le lait maternel, le sang. La salive ne transmet pas le VIH. De plus, le VIH a une très faible résistance à l’air libre. Après cinq à dix secondes à l’air libre, une goutte de sang ne contient plus de virus », rappelle AIDES. Ces simples indications auraient permis de dégonfler d’emblée une ligne de défense sérophobe, continuant de jouer sur les peurs irrationnelles. « Il est de la responsabilité de toutes et tous de rappeler dès que nécessaires ces informations. Sans cela, les stigmatisations et fausses croyances ne pourront pas cesser », continue AIDES. Et les médias ont leur rôle d’information à jouer. C’est ce que réclame Fred Colby, activiste gay, ouvertement séropositif et engagé à AIDES: « Les personnes vivant avec le VIH ne sont pas des virus ambulants. Il faut que les médias réfléchissent avant de publier ce genre de choses ou nuancent en parlant du traitement et de la charge virale indétectable ». Sans ce préalable, cette affaire du crachat risque de revenir dans l’actualité, sans qu’aucune leçon ne soit tirée de la précédente. Au détriment, encore, des personnes séropositives.

Canada: Alexander McClelland’s looks at the lives of people who were criminalized due to alleged HIV non-disclosure

How HIV-positive LGBTQ2 people are criminalized in Canada

Three harrowing stories of HIV non-disclosure cases

By Alexander McClellandJan 15, 2020, 1:31 PM EST

From 2016 to 2019, Alexander McClelland, a researcher and Banting Postdoctoral Fellow at the University of Ottawa, spoke to 16 people across the country about their experience with Canada’s legal system and HIV non-disclosure laws. In Canada, those who do not disclose that they are HIV-positive to a sexual partner can face sexual assault charges, and if prosecuted, are mandated to appear on sexual offender registries.

Since 1989, more than 200 Canadians have been criminally prosecuted for HIV non-disclosure; in most of those cases, HIV was not transmitted, and many involve situations in which transmission was not possible—whether because their viral load was undetectable or because they used condoms. Despite reforms over the years, many HIV-positive folks remain vulnerable to criminalization.

The culmination of McClelland’s research is a new booklet, The Criminalization of HIV Non-Disclosure: Experiences of People Living with HIV in Canada. In it, McClelland features interviews with nine Canadians who were criminalized for their HIV status. They are all recent cases, with the earliest stemming back to 2000 and the latest in 2015. Below are three of those stories.

Matteo: “They didn’t know what undetectable meant”

When I met him, Matteo was still under curfew as part of the conditions of his release. His parents were his sureties—he was mandated to live with them in the suburbs. A gay white man in his early 20s, Matteo was still in college, and only allowed out of his parents’ house to attend school for the day. He only recently found out his HIV-positive status. In fact, we met on the one-year anniversary of his diagnosis. He told me about how he had used hook-up applications like Grindr and Scruff. He met a guy that way, and they had sex.

Matteo did not tell the guy his status. He had been told by his doctor that since he was virally undetectable it was impossible for him to transmit HIV. Matteo concluded that he only had to disclose his status if there was a risk of transmission: “I thought if I was taking medication I didn’t have to disclose. Apparently, that is not the case.” A few weeks later, he was at work and the police came to arrest him. Matteo was arrested in front of his staff, coworkers and customers. “I felt really shitty, like I, like I had just robbed a liquor store,” he says. “They [the police] said, ‘You know why we are here. You are being charged and arrested.’

He ended up educating the detectives on the risk factors for transmission. Fundamentally, the police tasked with arresting Matteo did not know the current science behind the actual risks of HIV transmission. The police then released his picture, biometric details including his height, weight, eye and hair colour, any visible identifying marks, the charges filed against him, and his HIV-positive status. They also released a picture of Matteo as part of a public safety warning, asking his past sexual partners to come forward. The warning was widely covered in the media. As a result, it was also shared online, including on Facebook, targeting Matteo’s profile. One such negative post read, “If we still had the lash in Canada for punishment, this would be a case for its proper application.”

While talking at his place, Matteo told me more about what it was like to live under curfew at his parents’ house and the other conditions of his release. He felt constantly surveilled, isolated and depressed. He pulled out a piece of paper and read to me the more than 20 conditions of his release. Among the many conditions, he was barred from socializing in the gay community or going out to participate in social events. The condition that most bothered him was that he was mandated to contact authorities 24 hours before any potential sexual conduct, providing them with the name and contact information of the person. The police would then directly verify that the person knew Matteo’s HIV-positive status and that they consented to sex with him. “Like, who is going to want to do that? How am I going to meet anyone?” He felt extremely isolated and lonely.

Cynthia: “If I had not called the police, I would not have this charge hanging over my head”

I met Cynthia in her neighbourhood on the outskirts of a large Canadian urban centre. She told me about her move to Canada a few years earlier from a South American country. She felt that living as a transsexual woman in her home country was impossible. She feared that had she remained, she would have faced life-threatening violence.

Since moving to Canada, Cynthia had been working as a sex worker. She told me she generally had clients she liked, and she worked out of her home. She was warm and engaged when talking to me. In her late 30s, Cynthia was well-dressed and had a gentle demeanour. As we sat together drinking tea, she began telling me about how she was threatened with a charge of aggravated sexual assault. She was on anti-HIV medications, was undetectable and regularly used condoms with her clients. She knew that she was protecting them and also herself.

One of her regulars came over one night more intoxicated than was typical for him. He pulled a knife on Cynthia and raped her, holding the knife to her neck. He did not use a condom. She was terrified and called the police afterwards. During the police investigation, Cynthia told police about her HIV-positive status. Later, when speaking with the man who raped her, the police told him that he could press charges against Cynthia. She had previously not disclosed her status to the man, thinking that the use of a condom and being undetectable was more than sufficient. A few weeks later, she received a letter from a detective, stating that she was under investigation and they were considering pressing criminal charges of aggravated sexual assault. She was scared and didn’t know what to do. The man knew where she lived and had been violent toward her, and now she was potentially facing criminal charges. She told me that because she was a sex worker, her rape and assault were not being further pursued by the police. But now she was under threat of a charge of aggravated sexual assault for not disclosing her HIV status to her rapist.

After receiving the letter about the investigation from the authorities, Cynthia felt constantly surveilled, scared and worried. Moreover, now that he knew she was HIV-positive, the client who assaulted her began stalking and harassing her. She was terrified in her own neighbourhood, isolating herself and rarely venturing out. She deactivated her social media accounts because he also began posting messages, harassing her and her friends online. She was extremely fearful in her own neighbourhood but also scared to call the police again. “If I had not called them, I would not have this charge hanging over my head,” she says. She felt as though she was under constant watch, but with no means to protect herself. She knew the police were not going to help her and was worried she would face additional violence from her former client.

George: “This rape charge and HIV was worse than being a murderer in their eyes”

I met George in his apartment. He is a warm and gregarious white gay man in his late 50s, with a self-described long history of problematic prescription drug use, gambling and mental health issues. When George began a specific relationship around 10 years earlier, he initially did not tell his boyfriend about his HIV-positive status. At the time, he told me, he was himself uncertain about how HIV was transmitted. He told me that he was often depressed and in denial about aspects of his life. One day, a few months after his own diagnosis, George told me that his boyfriend came home with an HIV-positive test result from the clinic after a routine sexually transmitted infection screen. George then finally told his boyfriend his status in a letter: “There is a possibility that you may have gotten it from me, and I’m very deeply sorry for not disclosing [it to you].” His boyfriend went into a rage and went to police.

A few days later, he received a text message from his boyfriend that he was at the police station giving them his story. George immediately went to the station. “The next thing I knew, they were taking me into custody, and they said, ‘You have the right to call a lawyer,’ and they told me that ‘you are being arrested for sexual assault.’” George told me that a constable initially told him, “You’ve never had a criminal charge before. You will probably just have to stay overnight and tomorrow we’ll get your bail sorted.” But, a few hours later, the same constable came to see him and told him his charges had been elevated to attempted murder: “‘You aren’t going anywhere,’ she says, and she was right.” Due to the severity of the charge, George was denied bail even though he had no previous criminal record.

Due to the fear, shame and anxiety he experienced, George decided to plead guilty. He had never been incarcerated. The Crown Prosecutor asked for 10 years. George’s lawyer told George to plea, that he had no case because he had admitted his crimes. If he pleaded out, he would be sentenced to a lot less time incarcerated. He listened to his lawyer.

While incarcerated, George was placed in the general population with men facing all types of charges. He started facing verbal and physical harassment. Prisoners began calling him a rapist and asked why he took medication. After days of harassment, he was brutally assaulted by other prisoners. Those assaulting him said they knew he was trying to spread HIV. George said the guards watched and did nothing. (Under an institutional directive, prisoners’ charges and health status should remain confidential, and the only people with access to the information are guards.)

While in protective custody, George remained unsafe and was beaten again and again: “I went into the protective custody wing, and there are all kinds of sex offenders there and murderers and everything else like that. And when I got there, they found out my charge. So, they beat the shit out of me as well. I never fought a day in my life. I have never lifted a hand to anybody… I was on an isolated range for violent murderers and would still get harassed. You know, this rape charge and HIV was worse than being a murderer in their eyes.”

He told me that other sex offenders and murderers were left alone. But he was continually attacked for having HIV combined with a “dirty charge”—that is, aggravated sexual assault. One day, George was being harassed by another prisoner when a guard intervened. George told me he felt the guard had it out for him, and he was scared of the guard who had said demeaning things to him in the past. After the altercation with the other prisoner, George started to have a panic attack. While hyperventilating, that same guard forced George to strip naked and made him lay down on the cold concrete floor, holding him down on the floor with his boot. The guard pushed his boot into George’s chest hard and said, “I don’t touch anyone with AIDS,” as a nurse arrived to sedate George, sticking a syringe in his arm.

Ultimately, he served the rest of his sentence in administrative segregation, where he only had a concrete floor with no bed until night time. He was given just one sheet of paper and a pencil to occupy his time while locked down alone in a cell. He served approximately one year in those conditions.

 

US: Reporter fired for pushing misleading information in story about man who allegedly spat at Port Authority Officer

WCBS Fires Reporter for Pushing False HIV Fears in Arrest Story

TV outlet, Port Authority police union linked suspect’s alleged spitting to infection risk.

CBS New York confirmed to Gay City News that it has fired a reporter who stoked fear and pushed misinformation about HIV transmission in a story about the arrest of a man who allegedly spit at a Port Authority police officer.

CBS New York has fired a reporter they say was responsible for pushing insensitive and misleading narratives about HIV/ AIDS in a story that blew up on social media on December 8 and 9, a spokesperson confirmed to Gay City News.

As reported by Gay City News, the local CBS affiliate in New York published an article and social media posts implying that an HIV-positive man who allegedly spit on a Port Authority police officer was somehow putting the cop at risk for the virus, despite the fact that HIV cannot be transmitted by saliva.

The reporter described the alleged spitting incident as an “HIV ATTACK” in a tweet, and wrote in the article that the “suspect admitted they spit into an officer’s mouth knowing they had HIV.”

“This online story should not have been published,” CBS New York wrote to Gay City News in a written statement. “It does not meet our journalistic standards, nor does it reflect our core values. The person who wrote and published the story and social media post failed to review the copy with our news managers. This individual is no longer employed by CBS New York.”

A CBS New York spokesperson declined comment when asked, for purposes of transparency, who was fired. The article in question did not have a byline, though the name of one reporter, Tony Aiello, was listed under the “filed under” section of the article and drew attention from some folks on social media who believed he was behind the story. The spokesperson said he was not the reporter who was fired.

However, the other key piece of the story — that the Port Authority Police Benevolent Association (PAPBA) also pushed false claims about HIV and shared the suspect’s HIV status with CBS — remains unresolved. A union spokesperson interviewed by Gay City News on December 9 tried framing the man who allegedly spit on the officer as someone who tried using his HIV status as some sort of weapon.

“The problem is when a person with an infectious disease has a weapon, we have a problem with that,” said PAPBA public information officer Bob Egbert. “A guy who knowingly has an infectious disease — that’s a problem.”

The union has not apologized or retracted any comments, raising the likelihood that advocates who have strongly condemned the news story and the PAPBA comments will continue raising concerns and the controversy will continue to metastasize.

The stigmatization and misinformation infuriated the LGBTQ community and local advocacy organizations who reacted with shock and outrage toward CBS New York and the PAPBA when the article and tweets surfaced. On the afternoon of December 9, ACT UP NY, Bailey House, Gay Men’s Health Crisis, Housing Works, and VOCAL-NY were among those who vowed to raise their concerns in a demonstration at CBS headquarters in Manhattan on December 10.

Human rights are key to ending the epidemics

OPINION: End epidemics by breaking down human rights barriers to health

Access to healthcare is a right, not a luxury. We have an historic opportunity to rid the world of HIV, TB and malaria. Let’s seize that opportunity.

Peter Sands is the executive director of The Global Fund to Fight AIDS, Tuberculosis and Malaria and Antonio Zappulla is the chief executive of the Thomson Reuters Foundation.

Among the many challenges involved in improving health services, one is both pervasive and largely hidden. Human rights-related barriers to health, some explicit, others expressed in behaviours and norms, prevent millions of people from access to lifesaving prevention and treatment.

Think of a girl who is forced to get married at 15 and needs her husband’s permission to undergo an HIV test, or to get a bed net to protect herself and her children from malaria. Or a gay man who is beaten up by police and charged with sodomy when he secretly visits the home of a community health care worker to obtain condoms. Or a group of miners working 14 hours a day deep in a mine without ventilation and health insurance despite widespread tuberculosis.

Money alone cannot ensure and protect basic human rights for people most at risk from infectious diseases.

If the media stokes the appetite for a witch hunt against LGBT+ people or condones violence against women, how will society behave? If laws allow abuse and discrimination to be justified, how can social justice be achieved?

Stigma, ignorance, prejudice and lack of opportunities are some of the toughest road blocks to remove. But the combined power of the law and the media can make a difference.

Fair and balanced news coverage is critical in informing public opinion. Respect for human rights is essential to ensure access to health services. Combined, they become the key to unlocking systemic change.

In sub-Saharan Africa, women and girls are twice as likely to be HIV-positive compared to young men. Contributing factors include gender inequality, violence and limited access to education. Meanwhile, men who have sex with men, people who inject drugs, sex workers and transgender people often lack access to health programmes. The root cause? Social taboos, punitive laws and fear of arrest.

Framing health as a human right creates an obligation on states to ensure accessible, acceptable and affordable health care of appropriate quality. But this conception of health as a human right is not shared around the world. You have only to look, for example, at how HIV non-disclosure, exposure and transmission is still criminalized in 86 jurisdictions worldwide.

We will never end the epidemics of HIV, TB and malaria –  which killed 3 million people in 2017 alone – unless we dismantle social and human rights barriers to health services.

Everyone has a right to healthcare, encompassing dignity and respect. Not only is this a basic human right, but it is critical to fostering social stability and boosting economic growth. It is predicted that drug-resistant TB will cost the global economy approximately US$17 trillion by 2050 if progress is not made fast enough.

The Global Fund and the Thomson Reuters Foundation are joining forces to combine the power of an international health financing organization with global media and legal expertise, to help break down barriers to health services.

Each year, the Global Fund mobilizes and invests more than US$4 billion to support health programs run by local experts in more than 100 countries. Through its “Breaking Down Barriers” Initiative, the Global Fund is working with countries to reduce human rights-related barriers to health services: to ensure that everybody, including the most marginalized, also have access to prevention, treatment and care services; to see that health care workers are trained not to discriminate against, turn away, or fear people living with HIV or TB; to ensure that police are sensitized to support LGBT people to access prevention and treatment, rather than subject them to extortion, arbitrary arrest and violence; and to inform women, girls and others most affected by disease and violence about their rights and access to legal support. In the last three years, over US$120 million have gone to these and other programs to reduce stigma and discrimination and increase access to justice, an unprecedented investment in human rights as a critical component of our efforts to end HIV, TB, and malaria.

But more needs to be done. In its new partnership with the Global Fund, the Thomson Reuters Foundation will facilitate legal services and support for civil society partners in key countries, including development of “know your rights” training, capacity-building for health practitioners, services providers and their clients, plus guidance for NGOs and civil society groups working in challenging social contexts. The Thomson Reuters Foundation will also train journalists on human rights and health issues, and support awareness-raising on human rights-related barriers to health. Our hope is that by combining forces, we can achieve real impact.

Access to healthcare is a right, not a luxury. We have an historic opportunity to rid the world of HIV, TB and malaria. Let’s seize that opportunity.

On Human Rights Day, please endorse the EECA Statement against HIV Criminalization

Today, December 10, 2019, Human Rights Day, National and Regional Networks and Civil Society Organizations on HIV Criminalization in the EECA Region are asking you to support the movement against HIV criminalization by endorsing the following Statement.

Download a pdf of the Statement in English or Russian.

Endorse the Statement in English here.  EПодпишите заявление на русском языке здесь.

On November 25-26, 2019, the “Decriminalization of HIV transmission in the EECA region: the role of civil society and advocacy tools” meeting was held in Minsk, Belarus, by the Eurasian Women’s Network on AIDS (EWNA), the Global Network of People Living with HIV (GNP+) and CO “100 PERCENT LIFE”. Activists representing national, regional and international networks discussed the current situation with HIV criminalization in the EECA region and options available to strengthen the movement in order to counter that HIV criminalization in the EECA region.

HIV criminalization is a global issue that undermines human rights and impedes the development of public health and, as a result, weakens the efforts to eradicate the HIV epidemic. An analysis of recent HIV criminalization cases shows that they do not reflect the demographics of local epidemics, and the likelihood of persecution is compounded by discrimination against marginalized groups on the basic of drug use, ethnicity, gender identity, immigration status, sex work and sexuality.

The Global Commission on HIV and the Law, the United Nations Development Program (UNDP) and the Joint United Nations Program on AIDS (UNAIDS), among others, declare that any use of criminal law against people living with HIV should be strictly limited to exceptional cases of intentional and malicious HIV transmission to another person and only where real harm occurred. However, the law and law enforcement practice go beyond this limitation in many countries.

According to HIV Justice Worldwide, Europe and Central Asia is the region with the second highest number of laws criminalizing HIV exposure, non-disclosure and transmission. 18 of the 19 countries where such laws have been adopted are in the EECA region. Many of them allow criminal prosecution for actions that do not pose a risk of HIV or pose a low risk only. These laws do not recognize condom use or low viral load as a means of protection against prosecution. They criminalize oral sex, individual breastfeeding cases, as well as bites, scratches, bites, or spitting. Such laws were developed in the times when efficient ARV therapy was not yet available and the HIV diagnosis was equated with a death sentence. The implementation of such laws is most often informed by myths, misconceptions on HIV transmission ways, and stigma against people living with HIV and vulnerable communities.

The laws of the EECA countries criminalizing the HIV transmission vary in their severity and in specific sanctions. The Russian Federation and Belarus are global and regional leaders in terms of the number of criminal cases related to HIV6. In Uzbekistan, a person living with HIV can be prosecuted regardless of whether his/her partner wants to initiate a criminal case. In 2019, a punishment was introduced in the law in Tajikistan for those who refuse to receive HIV therapy7. In many EECA countries, the punishment for any crime involving an HIV-positive person is exacerbated by the positive HIV status.

Concerned by the fact that prosecutions are not always informed by the best available scientific and medical evidence, 20 of the world’s leading HIV scientists have presented the Expert consensus statement on the science of HIV in the context of criminal law.

The criminalization of HIV transmission is a growing human rights issue in Eastern Europe and Central Asia. This fact is also confirmed by the first regional report, prepared in 2017 using the data of the communities of women living with HIV. The study was organized and conducted by EWNA with the support of GNP+ and HIV Justice Worldwide.

The study has shown that HIV criminalization is a gender issue10. The stories and cases documented in the report and other recently conducted studies illustrate that women are more likely to be persecuted, as they are often the first to become aware of their status through regular HIV testing during pregnancy, but they are less likely to safely disclose their HIV positive status to their partner due to gender inequality in the family, economic dependence and high levels of violence. In addition, women living with HIV are less likely to receive adequate legal assistance and to have competent representation in court. In their stories, women talk about violence, threats, and blackmail associated with their HIV-positive status. The laws adopted were designed to protect women from HIV. Unfortunately, this is not the case in the reality as HIV criminalization makes women more vulnerable to violence and structural disparities. HIV criminalization increases the vulnerability of women to deprivation of parental rights, property loss, and poverty.

EECA activists make essential efforts to advocate for the decriminalization of HIV infection. Thus, the active advocacy work conducted by the community of people living with HIV pushed Belarus to adopt an important legislative amendment: the HIV-positive partner should be exempt from criminal liability if he or she has timely warned the HIV-negative partner about HIV and the latter has voluntarily agreed to take actions, which created a risk of infection. However this step alone is not sufficient to solve the issue of HIV criminalization.

We call attention of the EECA countries to the fact that in a society with low stigma and discrimination, people are more likely to be voluntarily tested for HIV and, learning about their status, begin ARV treatment.

We urge communities of people living with HIV and other criminalized and marginalized communities, in particular sex workers, LGBT people, people who use drugs, to unite and take a consolidated position to counter HIV criminalization, presenting a united front against HIV stigma and discrimination embedded in the law.

We urge governments and parliamentarians to use general law to prevent HIV transmission in the harm to health context and, instead of applying criminal law in any cases other than actual infection transmission by malicious intent, take steps to encourage people to be tested, take ARV treatment, communicate their HIV status and have safe sex without fear of stigma, discrimination and violence. This can be achieved by adopting and applying anti-discrimination laws and organizing public information campaigns to dispel myths about HIV, as such campaigns are evidence-based and are led by people living with HIV.

We urge prosecution agencies and prosecutors, to use scientific evidence and evidence-based medicine, in particular the evidence included in the Expert consensus statement on the science of HIV in the context of criminal law, in pre-trial and trial proceedings, in order to limit or prevent abuse of criminal prosecution in cases of allegations of HIV transmission or exposure or in cases of non-disclosure of HIV status.

We urge the media to stop demonizing people living with HIV, presenting us as criminals and as sources of infection. We request the media to consider HIV related issues from the perspective of human rights and use facts and evidence-based medicine while covering such issues.

We encourage donors to invest in communities and advocates opposing HIV criminalization, which undermines human rights and public health.

South Africa: African migrants face dual challenge of navigating HIV care and social stigma

The social management of HIV: African migrants in South Africa

HIV is the most common chronic illness in South Africa. One in every five is infected and one in every 13 takes antiretroviral drugs daily. Managing HIV medically has become more of a part of normal life.

Amid this public health emergency, some 2.5 million foreign-born African immigrants live in South Africa. They largely come from countries with the highest HIV prevalence rates in the world, such as Lesotho. Yet their access to health care and services is limited, because they are vulnerable in various ways. Though entitled to inclusion and care in South Africa, they may face deportation, xenophobia, exploitation, language barriers, cultural estrangement and social isolation.

In spite of these challenges, migrants do manage HIV medically. But we do not really know how they manage socially in communities where the stigma of the disease affects all dimensions of life. HIV is often referred to today as a “manageable” chronic illness, but it is not just a medical condition. It is also very much a social condition as living with HIV comprises both clinical features of care and experiences of stigma and social angst.

Understanding how migrants manage this social dimension of their condition matters because it shapes the landscapes and outcomes of their care. It directly influences when and where people seek treatment, and how well they adhere to it if they do. This in turn affects critical issues such as drug resistance and prevention of transmission.

In a recent journal article, I unravel complexities of stigma and perceptions of HIV in Mozambican migrant communities. My research exposes layers and shades of stigma across different social networks and locations, which influence how HIV is managed socially. It shows how an individual’s HIV status determines how other community members are regarded and interacted with in daily life.

Perceptual contrasts

Nowhere in South Africa is the migrant population as dense as in inner-city Johannesburg. In their urban enclaves, community members inevitably lead lives entwined with those of people receiving care for HIV, whether aware of their infection or not.

HIV is spoken of here in ways that acknowledge, perpetuate and replicate stigma. For instance, Mozambicans may allude to HIV as “stepping on the mine”, as “being poisoned” or as “getting stung”. Open conversation about HIV is avoided, which in turn creates an anxiety that motivates secrecy. This is so because disclosure of HIV serostatus may put social life at risk.

I explore perceptions of HIV among two groups of Mozambican migrants in Johannesburg: one consisting of patients receiving care for HIV in a hospital; and the other of community members unaware of their own serostatus.

The contrast between how these two groups perceive of each other is staggering. The patients apprehensively conceal their status for fear of what others might think of them. But these others express mostly empathy and understanding for their condition.

I identify two reasons for such stark perceptual contrasts. The first lies in a transformation of identity, which results in a division between an “us” and a “them”, between the HIV-positive and the HIV-negative.

This process creates a schism between “patienthood” and “personhood”. When a person tests positive for HIV, fears of physical death in the future transform into fears of social disruption in the present. Loneliness and isolation then result from the person keeping her HIV status secret.

As the identity of a community member shifts from personhood to patienthood, as she receives counselling and care, she comes to associate disclosure with her own (and others’) social death. Her serostatus then becomes a secret in her life, while her notion of others’ perceptions of HIV becomes confined to the realm of the suspected and nervously anticipated. Expecting social misfortunes should others learn of her status, she opts for concealment as a strategy of survival in the community.

Secondly, I find that stigma is tied to location, because of the ways in which location is tied to social networks. In different social networks such as family at home, friends, work colleagues, acquaintances in the community or the nightlife, the stakes of disclosure vary considerably.

For instance, one focal point of stigma is the local HIV clinic. It is supposed to care for its patients, but at the same time it also estranges them, because others might recognise them there and so become antagonists rather than fellow patients.

In fact, Mozambicans largely prefer to avoid clinics in South Africa and go home to Mozambique for treatment. The stakes of disclosure, involving livelihoods, partners and identities, are far too high to risk being seen receiving care in South Africa. Disclosure may be less hurtful in certain locations where social networks are more sympathetic.

This may further complicate the therapeutic journey of migrants in terms of costs, retention in treatment or simply having to explain away the true purpose of one’s absence.

Medicalised, not socialised

HIV may have become easier to manage medically, but stigma continues to cause distress and remains severely challenging to manage. This is also a challenge for health care provision, as it sways choices of when and where to seek care: a South African clinic, for example, or a distant, socially safer treatment option.

HIV may have been medicalised, yes, but not socialised.

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

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

By Anna North

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

The policy: Criminal penalties for knowingly exposing someone to HIV

Where: Twenty-six states around the country

In place since: The 1980s

The problem:

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

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

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

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

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

How it worked:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Uganda: HIV law deters communities from seeking HIV services and should be reformed

Kaleba scolds Parliament: The AIDS law is poisonous

“Whereas the law contains important commitments by government for the HIV and AIDS response in Uganda, there are some “poisonous” clauses that could deter all the benefits realised in the fight against the scourge,” she said.

HEALTH  HIV/AIDS 

The founder of The Aids Support Organization (TASO), Noerine Kaleeba, has castigated members of parliament, saying they approved the AIDS law which is awash with numerous contentious clauses.

“Whereas the law contains important commitments by government for the HIV and AIDS response in Uganda, there are some “poisonous” clauses that could deter all the benefits realised in the fight against the scourge,” she said.

In 2014, Parliament endorsed the HIV and AIDS Prevention law, which came into effect the same year on July 31, when President Yoweri Museveni assented to it. The law seeks to provide for a legal framework geared towards the prevention and control of HIV.

Kaleeba said the contentious clauses (41 and 43) of the law provide for prosecution on grounds of attempted and intentional transmission of HIV, respectively. Among the provisions of the piece of legislation is criminal penalty for risk and intentional transmission of the virus.

The law requires mandatory disclosure of one’s HIV status, failure of which would be regarded as “criminal”, and attempting to or, intentionally transmitting the virus. Failure to use a condom where one knows their HIV status would constitute a criminal offence, making them liable for prosecution.

Speaking during the 29th Centre General Meeting (CGM) of TASO Mulago last week, Kaleeba regretted that these provisions in the law do not only stigmatise and discriminate against people living with HIV but also deter communities from seeking HIV services such as HIV Testing and subsequently HIV treatment.

TASO founder Noeline Kaleebu together with another founder Peter Ssebanja take to the flow during the 29 AGM for TASO Mulago 

She said that the clauses have fueled domestic violence in homes since the couples each blame one another for intentionally transmitting the virus. She said it is naïve to think that the person who tests first is the one who infects the other, it could be the other way round.

“Honestly, how can it be proven that indeed the HIV of the accuser was got from the accused? There is fear that public knowledge of one’s HIV positive status would be used against them due to personal differences,” she says.

She argued that this will ultimately discourage people from testing to know their status fearing that if found positive, their status could be used against them in courts of law at any point in time. It should thus be noted that one who does not know their status cannot be held liable under this law.

“We should avoid creating scenarios where people living with HIV/AIDS are looked at as criminals or potential criminals,” She says. Adding, “People will inadvertently live with the virus without accessing treatment and by the time they get to know their status it will be too late.”

Kaleeba says that both members of the previous parliament and the President (who signed the law) acted out of ignorance, and therefore made a mistake. She prays that the 10th parliament doesn’t have to keep the error, and this is urgent.

She also hailed the appointment of Winnie Byanyima as the new executive director of UNAIDS, saying it has come at the right time as we are closing the chapter of HIV/AIDS. She said Byanyima is an exceptionally good manager, and her appointment will elevate our country.

“She will definitely give a mirage to Uganda even for those who didn’t know Uganda, will come to know the country, whether they like it or not. The world will say the new UNAIDS ED comes from Uganda, and that way our reputation will be elevated. People living with HIV, therefore, need to double their efforts especially on issues of taking their medication,” she said.

“Strict adherence to treatment is where the war is. When you religiously adhere to your medication, your viral load becomes undetectable, meaning you will not transmit to others. Let us be exemplary and merit Bwanyima’s confidence.”

Responding to Kaleeba’s concerns, the guest of honour, Florence Nambozo, who is also woman MP for Sironko and chairperson HIV/AIDS committee, assured over 800 people who turned up for the CGM that she will talk to her fellow members of parliament to make sure that the law is amended.

She said Uganda is making good progress in the HIV fight and urged people living with HIV to stick to treatment since the ARVs are available and free in all government health facilities.

The Centre Program Manager TASO Mulago, Godfry Mafabi revealed that by end of July TASO Mulago had recorded a cumulative total of 7754 compared to last years’ 1145 in care against a target of 8371 to be achieved by September 2019.

Mafabi said that since the last AGM 918 clients were initiated on ART, of these 23 were children and 139 adolescents, and 756 were adults compared to 663 who were started on ART between 17 August- July 18. The suppression rate is currently at 97% surpassing the new national target of 95% target.

However, the institution is still faced with challenges of funding since the time the donors pulled out. The number of staff was also reduced at the facility to 27 from 75, which is a big setback. We are using expert clients to handle new clients, he said.

Canada: Further reform is needed to redress the harms HIV criminalization brings to the lives of women living with HIV

Recommendations on changes to HIV criminalization don’t go far enough

Earlier this summer, the House of Commons Standing Committee on Justice and Human Rights released a report on Canada’s approach to criminalizing those who don’t disclose that they’re living with HIV to sexual partners.

If the Standing Committee’s recommendations are adopted, they could diminish the harms experienced by women living with HIV under Canada’s current approach to criminalization.

But further consideration and consultation are required in order to fully address the harms that the law introduces to the lives of women living with HIV.

The Supreme Court of Canada articulated the current legal approach in 2012. In so doing, the court interpreted consent and fraud provisions of Canada’s sexual assault laws and ruled that people diagnosed with HIV must disclose their status to sexual partners before engaging in sexual acts that pose a “realistic possibility of transmission.”

The court also stated that there is no legal obligation to disclose prior to sex if a condom is used and the person living with HIV has a consistently low measure of HIV in their blood. This legal understanding of a “realistic possibility” contradicts current scientific knowledge that just one of these conditions is sufficient to eliminate transmission risk.

Scientific evidence endorsed by the federal government demonstrates that an undetectable viral load eliminates the risk of sexual transmission of HIV, regardless of condom use. Similarly, there is a negligible risk of transmission when condoms are used properly, no matter an individual’s viral load.

Today, in addition to being inconsistent with current scientific evidence, HIV nondisclosure prosecutions are widely seen as unjust as they can result in harsh sentences for actions that result in little or no harm.

Canadian prosecutors and courts apply the criminal offences of sexual assault and aggravated sexual assault to prosecute cases of HIV nondisclosure. The latter — one of the most serious offences in Canada’s Criminal Code — carries the possibility of a lifetime sentence and mandatory registration as a sexual offender.

Experts discuss the misuse of sexual assault law in prosecuting cases of HIV nondisclosure in Canada. From Canadian HIV/AIDS Legal Network & Goldelox Productions.

Women living with HIV & the law

“The law is a bigger risk to us than HIV.” Sophie

The criminalization of HIV nondisclosure was purportedly intended to protect women while reducing HIV transmission risk by promoting disclosure and safer sex practices. Instead, research indicates that punitive approaches have the opposite effects, many of them significantly harmful.

As health scientists at Simon Fraser University, we work alongside experts on two studies: the Canadian HIV and Women’s Sexual and Reproductive Health Study (CHIWOS), with researchers also from the University of Toronto, McGill University, University of Manitoba, University of Saskatchewan and McMaster University; and the Women, ART and the Criminalization of HIV (WATCH) study with health partners based at McMaster University.

Findings from these studies indicate that criminalization reinforces socially dominant power dynamics, stigma, marginalization and fear experienced by women living with HIV. Specifically, the current legal requirements ignore the dangers women face in both negotiating the use of condoms and status disclosure due to power inequities, particularly in dependent, violent and non-consensual relationships.

À lire aussi : Why a fulfilling sexual life with HIV matters

“I was raped by three [people …] And if I had told [them] I was HIV positive, I would have been dead. I know it. So where does that fit in the picture?” Julie

Women living with HIV who don’t disclose their status when they are sexually assaulted may themselves be convicted of a sexual offence.

Not only does criminalization contradict scientific evidence around HIV transmission risk, it compromises women’s health-care engagement and deters HIV testing since those who do not know their status cannot be prosecuted. Yet access to HIV testing, treatment and support services is scientifically proven to decrease transmission risk.

Furthermore, women who aren’t prosecuted are still harmed by the law. For example, women who have experienced emotional and physical violence by abusive partners may face the threat of partners falsely reporting that the woman didn’t disclose her HIV status.

Living under the fear of being charged has significant consequences for women’s emotional, mental and physical well-being. This is particularly important given the high rates of physical and sexual violence experienced by women living with HIV in Canada.

“It seems like an impossible situation to prove your innocence.” Miranda

These findings were shared with the Standing Committee through expert testimony by members of CHIWOS and WATCH. Such contributions are integral in moving toward an approach to criminalization that considers the realities of people living with HIV.

Women living with HIV and others share their experiences and knowledge of the criminalization of HIV nondisclosure in Canada. From Canadian HIV/AIDS Legal Network & Goldelox Productions.

Recommendations could go further

The Standing Committee’s report makes recommendations in a positive direction, but the recommendations need to go further to reduce harms to women living with HIV.

Firstly, the committee recommends creating a new offence in the Criminal Code for nondisclosure of an infectious disease where transmission happens. This recommendation says prosecutions should never be pursued in cases where: an individual has an undetectable viral load; condoms were used; the sexual partner of a person living with HIV is taking pre-exposure prophylactics; or the sexual act carries a negligible risk of transmission (oral sex, for example).

This suggested requirement of a new offense where actual transmission occurs would minimize, though not fully eliminate, opportunities for the law to be used as a tool of violence against women.

Though the creation of a new offence would address the current problematic use of sexual assault laws, failing to consider the intent of not disclosing is significant. In 2008, the United Nations urged states to limit prosecution of HIV nondisclosure to extremely rare cases of actual and intentional transmission.

Heed women’s experiences

Without including the element of intent, the committee has not fully addressed the vulnerability of women who may unintentionally transmit HIV during their own sexual assault or an unprotected sexual encounter. Given the widespread violence experienced by women living with HIV in Canada, this is a substantial deficiency in the recommendations.

And, given the report’s recognition that criminalization has not achieved its public-health goal of reducing HIV transmission, transmission of any infectious disease should be addressed by public-health mechanisms rather than the law.

Secondly, the report recommends ensuring that the same conditions are applied cross-country to consider whether prosecutions should proceed in cases where people haven’t disclosed that they are living with HIV. This recommendation would address the disparities in prosecutions of HIV nondisclosure and reduce various harms to people living with HIV.

Finally, the report recommends a review of all past convictions for HIV nondisclosure and increased access to anonymous testing. These measures are significant in beginning to redress the harms introduced by the current legal approach.

But to fully do that, Canada must heed all the experiences of women living with HIV.