UK: Whole genome sequencing shows potential as public health tool, but not yet able to definitively prove direction (or timing) in criminal cases

Potential for phylogenetic analysis to show direction of HIV transmission

24 April 2017. Simon Collins, HIV i-Base

Tentative results presented in a poster at BHIVA 2017 suggest that a new approach to phylogenetic testing might have the potential to show the direction of HIV infection between two individuals.

While the results are exciting from a scientific perspective, if the approach proves to be robust, this will raise many ethical and legal questions.

Until now, phylogenetic analysis, where sections of two viruses are compared for similarity, has been able to show similarity but crucially not direct infection (a third person could be involved) or direction of infection. Phylogenetic analysis is most useful for showing when transmissions are definitely not linked, when the two strains are unrelated. When linkage is shown, direction of infection cannot be inferred nor the possibility that both infections originated from intermediary partners.

The current study, presented as a poster by Kate El Bouzidi and colleagues from Brighton and Sussex University Hospitals Trust, used whole genome sequencing (WGS) to look at genetic diversity at each of the >9000 individual nucleotide sites in two linked viruses, with heterogeneous samples being interpreted as being the source virus for the sample which had homogeneity at the same nucleotide site.

WGS performed on 170 samples from a UK MSM cohort identified five linked pairs and these were compared to four control pairs where linkage was already established and direction inferred from clinical notes.

The direction of travel was able to be inferred using WGS for 3/4 control pairs, with the single indeterminate result linked to a sample that was taken so long after transmission took place that natural divergence was too great to determine direction.

WGS-inferred direction was consistent with clinical data for 2/5 case pairs. The lack of a signal in two further case pairs with indeterminate was able to be interpreted as not supportive direct transmission, but missing intermediary partners from whom samples were not available.

Finally, the case where WGS-inferred transmission did not match clinical route, was when the sample from the source partner was taken during primary infection (when HIV is likely to be homogenous at most points) several years before likely transmission to the second partner (whose sample was only taken during chronic infection (when heterogeneity is more likely).

This study is funded by both BHIVA and Public Health England as part of the COMPARE-HIV Study (Comparison of Molecular & Phylogenetic Approaches to Reconstruct an Epidemic of HIV), based at Brighton and Sussex University Hospitals NHS Trust.

Comment

The results are preliminary and clearly the timing of samples is likely to be important when interpreting the results from this approach.

WGS may improve our understanding of transmission networks at a population level but it cannot be used to confirm direct transmission at an individual level and sequence data should always be interpreted cautiously in conjunction with clinical information.

However, if the methodology is supported in larger analyses, the results will raise important ethical and legal concerns, especially in countries where HIV transmission is still criminalised.

Reference:

El Bouzidi K et al. Insights into the dynamics of HIV-1 transmission using whole genome deep sequencing. 23rd BHIVA, 4-7 April 2017, Liverpool. Poster abstract P31.

Canada: Alison Carter explores the negative consequences of HIV Criminalisation on women living with HIV

The Politics Of Sex For Women Living With HIV

“If I have sex, I could go to jail.”

This is the reality of life for women living with HIV in Canada.

It’s a story I heard a few weeks ago from an African woman who had recently immigrated to Vancouver and is now faced with the profoundly isolating experience of being a Black HIV-positive woman in Canadian society.

This may come as a surprise to anyone unfamiliar with HIV in Canada: Women (and men) who are living with HIV are at risk of facing a criminal charge of aggravated sexual assault for not disclosing their HIV status before engaging in consensual sex, unless they have a low HIV viral load and use a condom. Beyond serving jail time, those convicted must register as a sex offender, a title usually reserved for child molesters and rapists. “That follows you around forever,” says a woman who was herself imprisoned for HIV non-disclosure.

This woman, and many others, bravely spoke out about their experiences of being treated like a criminal for living with HIV at the annual Canadian Conference on HIV/AIDS Research, held in Montréal from April 6 to 9.

The conference included a special session on the criminalization of HIV non-disclosure, which covered a broad array of issues ranging from data on the total number of charges laid, to women’s personal testimonies of feeling ‘under surveillance’, to the latest research findings on how the law is understood and experienced by thousands of women living with HIV across Canada.

Saara Greene of McMaster University, Angela Kaida of Simon Fraser University, and Marvelous Muchenje of the Canadian Coalition to Reform HIV Criminalization co-hosted the event in partnership with HIV-positive women, which brought together dozens of community leaders, scientists, lawyers, and activists from around the country.

“Some women are suffering in silence and they don’t know what the law says,” said Muchenje.

“The law assumes that sex takes place between partners of equal power,” added Greene. “And it wholly ignores what causes women not to disclose their status, including widespread stigma and violence that are both systematically targeted at women living with this disease.”

The women who have participated in their research, which involved telling stories through participatory arts-based Body Mapping, say “disclosure is not always safe or positive for women’s health and safety.” And for many, the fear of being abused, rejected, or worse jailed, is a significant barrier to even thinking about the idea of getting involved with someone.

Eighteen women have been charged for HIV non-disclosure in Canada, many of whom come from marginalized backgrounds and are survivors of sexual violence.

“Beyond the number of prosecutions, however, is the threat of prosecution,” said Kaida. “And this threat compromises both women’s interactions with healthcare providers and their sexual health.”

Kaida analyzed survey data collected from over 1000 women living with HIV in Canada, and found that for most women (65 per cent), the law affects the amount and type of information they are willing to share with providers, particularly as it relates to their sexual lives.

Kaida also found that 51 per cent of women were not having sex and of these, 78 per cent were intentionally abstinent. Women’s reasons for intentional abstinence were diverse though many (33 per cent) worried about HIV criminalization and disclosing their status to sexual partners.

“Laws criminalizing HIV non-disclosure have been defended as a means of protecting the sexual well-being of women,” Kaida said. “However, our findings show women are protecting themselves from the law by intentionally abstaining from sex.”

It goes without saying that women living with HIV shouldn’t have to live in fear of having sex. Sex is a normal part of life. It feels good. It has health benefits. And it’s a human right, one that this law violates.

The law also ignores groundbreaking new science that shows a person with HIV who is on treatment with undetectable levels of the virus in their blood has zero chance of passing HIV to their sexual partners. Put simply, Undetectable=Untransmittable.

Wedged in between science, on the one hand, and society on the other, are decades of cultural discourses of risk, danger, and stigma.

Stigma is a dangerous construct. It deters people from accessing testing and treatment. It leads to anxiety, depression, isolation, and loneliness. And it creates a social and legal environment that fosters abuse, harassment, and discrimination against women living with the condition.

In the face of a mountain of evidence of medical advances and human rights violations, many people are calling (shouting, really) for policy markers in Canada to update the laws and de-criminalize HIV. Doing so would also help to de-stigmatize sex for women living with HIV.

“The discrimination I face because of I live with HIV is ridiculous,” says Peggy Frank, an openly positive woman and researcher. “It’s a small virus that has little to do with who we are. I am a human being and I have the rights that every other human being has, and that includes sex.”

Allison Carter is a feminist epidemiologist conducting sex-positive research with women living with HIV. She is working with women on building a new online resource, called Life and Love with HIV, dedicated to building conversation and community around sexuality and relationships for women and couples with HIV around the world. Sign up to be notified when the website launches.

Published on April 10, 2017 in the Huffington Post

 

[Update] India: Parliament passes landmark bill ensuring equal rights to people living with HIV and giving them the right not to disclose their status

Lok Sabha passes ‘historic’ bill ensuring equal rights to HIV-affected people

The Lok Sabha on Tuesday passed a crucial bill that ensures equal rights to the people affected by HIV and AIDS in terms of getting treatment, jobs or admissions to educational institutions.

Moving the Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) (Prevention and Control) Bill, 2017 for passage, health minister JP Nadda said the government stood for free treatment to HIV patients.

The Rajya Sabha had passed the bill last month.

The “historic” and “people centric” legislation will strengthen rights of people infected with HIV, Nadda said.

Various clauses pertaining to prohibition of discrimination against HIV-positive patients have been enlisted in the bill. “Whosoever does not adhere to the provisions of the bill, will be penalised. Civil and criminal proceedings will be launched against such persons”, Nadda said, adding that action would also be taken against those who attempted to block the implementation of the bill.

The legislation, he added, has provisions to safeguard the property rights of HIV positive people.

“Every HIV infected or affected person below the age of 18 years has the right to reside in a shared household and enjoy the facilities of the household”, Nadda said.

Further, the bill prohibits any individual from publishing information or advocating feelings of hatred against HIV positive persons and those living with them.

Nadda said the government will also promote research to check the spread of HIV virus and come out with aggressive strategies, especially in high risk areas.

Opposition members had several suggestions and observations during the Bill’s passage, TMC member Ratna De Nag regretted that stigma related to HIV remains intense . P Ravindra Babu (TDP) emphasized that the stigma associated with the disease could not be eradicated by laws alone. Varaprasad Rao (YSR Congress) pitched for insurance cover for the affected people with the premium being paid by the government.

Heena Gavit (BJP) said couples affected with HIV should be given the right to adopt children.

 Text of the full bill is available here

 

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The new HIV and AIDS Bill will work to reduce stigma and discrimination

By JP Nadda

Two decades ago India was considered a hotspot and emerging centre of the world’s HIV epidemic. Since then, India has made tremendous progress in controlling HIV. Through its continuing efforts including targeted programmes and support of affected communities, India has demonstrated that the course of an epidemic can be reversed by public education, mass awareness and wide scale availability of testing and treatment.

Today, approximately 21 lakh people are living with HIV, as per government estimates. The adult prevalence is in the range of 0.3%, of which around 40% are women. Despite this enormous progress and the availability of testing and treatment, stigma and discrimination against HIV affected individuals in India remains widespread.

India made some efforts at stigma reduction in the early part of the epidemic. Yet social attitudes do not transform easily. The HIV AIDS bill approved by the Cabinet and pending approval in Parliament is an important step in ensuring that the progress made against HIV is not halted and discrimination against HIV affected individuals is reduced.

How is this being done? It’s important to reflect on the many progressive aspects of the bill. To start with, numerous provisions of this bill ensure government accountability and commitment into providing HIV prevention, testing, treatment and care to those at risk. Why is this necessary? Because every government irrespective of political affiliations must commit to fighting HIV. For the first time, the bill brings together a human-rights perspective to public health, and makes antiretroviral treatment a right of HIV/AIDS patients. The central and state governments are duty bound to provide for treatment and also arrange for the management of risk reduction of vulnerable populations. This will ensure that in the future no Indian has to struggle for diagnosis or treatment.

Considering widespread stigma and the need for privacy, the bill also mandates that no HIV test, medical treatment, or research can be conducted on a person without their informed consent. This ensures that those affected by HIV have the right to privacy and confidentiality. The bill also mandates that no person can be compelled to disclose their HIV status except with informed consent, and if required by a court order.

The bill also addresses discrimination in everyday life through numerous provisions especially at the workplace and within communities. It prohibits discrimination against HIV positive persons and those affected in numerous aspects. These include the denial, termination, discontinuation or unfair treatment with regard to employment and in educational establishments, health care services, residing or renting property, standing for public or private office, and provision of insurance (unless based on actuarial studies). The bill also prohibits the requirement for HIV testing as a pre-requisite for obtaining employment or accessing health care or education.

The intention is to ensure that no HIV infected individual is the subject of discrimination and there is legal accountability and recourse for them. The bill also mandates the appointment of an ombudsman in every state to inquire into complaints related to the violation of the Act and the provision of health care services. This ombudsman will submit reports every six months stating the number and nature of complaints received and the actions taken on them.

Populations who are most vulnerable to HIV/AIDS are female sex workers (FSWs), men who have sex with men (MSMs), transgenders and intravenous drug-users. The bill seeks to protect these high-risk groups from discrimination, both through administration of treatment for their infections as well as improving their access to welfare schemes and services.

The bill also mandates that cases relating to HIV positive persons shall be disposed off by the court on a priority basis. If an HIV infected or affected person is a party in any legal proceeding, it shall be conducted so as to supress the identity of the person, and restrain any person from publishing information that discloses the identity of the applicant. Also when passing any order with regard to a maintenance application filed by an HIV infected or affected person, the court shall take into account the medical expenses incurred by the applicant.

While social change will take time and stigma will not end immediately, this bill is a step in the right direction. It is a much needed and long awaited measure that will work to reduce stigma and discrimination towards people living with HIV. It will also ensure enhanced access to and privacy for those seeking care.

The foundation of every significant legislation is that it must safeguard civil liberties. This is exactly what this bill intends to do. It intends to ensure that those living with HIV do so with dignity and respect enjoying all their rights as citizens.

In the long-term, our goal is an India where no new HIV infection occurs and where living with HIV is neither a matter of fear or of shame.

Originally published in Hindustan Times on 24 March 2017

India: HIV/AIDS (Prevention & Control) Bill strongly criticised for not guaranteeing universal access to HIV treatment

Delhi, Gaborone, New York – The International Treatment Preparedness Coalition (ITPC) and its global coalition partners are outraged following a decision by the Indian Parliament to absolve itself from responsibility of providing treatment for people living with HIV in India. The HIV/AIDS (Prevention & Control) Bill was passed in the upper house of the Indian Parliament yesterday, 21 March 2017. The Bill states that the government will provide treatment for people living with HIV ‘as far as possible’ (see full text below) absolving the government from its responsibility to protect the right to life.

“This is a step backwards for human rights, and a tremendous blow for all people living with HIV in India,” said Gregg Gonsalves, Chair of ITPC-Global. “It is extremely concerning that the India government has given itself this loophole at a time when the government program is in disarray, with the worst period of antiretroviral drug stock outs.”

Networks of people living with HIV and other civil society organizations lobbied Members of Parliament to amend the draft Bill that was first tabled in February 2014. In response to civil society concerns, senior Members of Parliament urged the Union Minister JP Nadda to make the amendment. HIV treatment activists were stunned when these parliamentarians withdrew their amendment at the last minute, thus giving way to the Bill passing into legislation.

“As the biggest supplier of generic medicines to the developing world, India could be the leading light in HIV treatment, an example to the rest of the world,” said Solange Baptiste, ITPC-Global’s Executive Director. “Instead this new Bill fails to enshrine the rights of its own people. I fear it’s an omen of things to come. We, HIV treatment activists, will be watching and monitoring to make sure the Indian government upholds its responsibility to all its citizens living with HIV.”

“Nothing in the world is more important than securing treatment for me, and my community of people living with HIV,” said Loon Gangte Regional Coordinator ITPC-South Asia. “I earnestly appeal to the government to delete the loophole ‘as far as possible’ and assure our right to life”.

Editor’s Note:

HIV/AIDS Bill Final Text

The provision for HIV treatment in Section 14 of the HIV/AIDS Bill, reads as follows:

1. The measures to be taken by the Central Government or State Government under section 13 shall include the measure for providing, as far as possible, Anti-Retroviral and Opportunistic Infection Management to people living with HIV or AIDS.

2. The Central Government shall issue necessary guidelines in respect of protocols for HIV and AIDS relating to Anti-Retroviral Therapy and Opportunistic Infection Management which shall be applicable to all persons and shall ensure their wide dissemination.

About International Treatment Preparedness Coalition

International Treatment Preparedness Coalition (ITPC) is a global coalition of HIV treatment activists formed in 2003 to respond to the needs of communities worldwide. The global network is driven by individual activists, peer support groups, grassroots networks, community-based organizations, and non-governmental organizations. Each of our partners share our values and vision and come together to address issues around access to treatment issues in their countries, regions and at the global level.

New Zealand: Ex-partner of the first person prosecuted for HIV transmission in New Zealand believes HIV prosecutions are harmful

HIV prosecutions are harmful, says victim

By Amelia Wade

A victim of the first person prosecuted for infecting others with HIV says she is against making criminals out of transmitters.

Marama Mullen believes it only pushes the issue further underground.

The Waikato woman was given HIV by Kenyan musician Peter Mwai who was jailed for seven years in 1994 for having unprotected sex with seven women and infecting two.

Just 22 years old at the time, Mullen said she couldn’t “really fathom” what the trial would mean.

“Quite a few times I wanted to stop and back out because of the lack of support for being the person who was doing it. There was a lot of media and a lot of people had differing views and opinions.

“But a lot has changed for me since then – I’ve actually become an advocate for not criminalising the spread of HIV because I truly believe it creates more stigma.”

She’s now spent more than a decade working with agencies for HIV aids as well as indigenous groups. She said the stigma of infection was especially harmful for Maori and Pasifika people.

“You’re disappointing your family double – it’s one thing if you’re gay but to add to that the stigma of being HIV positive is another.”

Mullen said it was common for people of Maori or Pasifika descent to go into denial about their condition and believes that may have been the case for Mikio Filitonga.

“When you tell someone you’re positive, it gives them the power to do what they want with that information.”

Mullen said she “felt for” Filitonga because if he was in denial, being publicly identified in a criminal trial as a HIV positive person was the “worst thing that could have happened to him”.

Usually when people didn’t disclose their status it was more to do with the fear of rejection rather than a criminal intent to infect, Mullen said.

She doesn’t think prosecutions are the best approach unless the person actively intended to infect someone.

Making someone a criminal as well as HIV positive only worsened the problem, she said.

Mullen has worked on a management plan – similar to one in Australia – which refers people suspected of infecting others to an agency.

It would to establish whether there are any mental health or cultural reasons behind their actions and whether a prosecution is necessary.

Mullen said it was “sitting on a bureaucrat’sdesk somewhere” yet to see the light of day.

Today’s medication is able to suppress the virus to the point it is undetectable and non transmittable so it was questionable as to whether someone even needed to disclose their status to partners.

Mullen said she believed if a person was dutifully taking their medication, they were taking enough precautions not to pass on HIV.

Within two months of taking the antiviral drugs, Mullen said her viral load – the amount of HIV in someone’s blood – dropped from 1000 which was “heading towards Aids” to it being undetectable.

She’s since been able to have two children – who are both HIV negative – and live a totally normal life.

Except for the stigma.

After being an outspoken advocate for acceptance, she’s considering moving from the Waikato to live incognito for the sake of her children.

Other parents have tried to get her 10- and 7-year-old kicked out of school, they’ve been bullied, had people refuse to go to their home and have been excluded from birthday parties – despite both being negative.

“The biggest message we want to get out there is that if we’re on medication we can’t infect people and we’re not transmittable.”

THE AIDS FOUNDATION AGREES

The New Zealand Aids Foundation said the broad application of criminal law to HIV transmission risks undermining public health and human rights.

Executive director Jason Myers said a prosecution should only happen if someone acted with the express intent to transmit the virus.

“Broad application of criminal law to the transmission of HIV has the potential to do significant damage to the public health and human rights based HIV response in New Zealand.

“It also increases the HIV stigma and discrimination experienced by people living with HIV, the vast majority of whom take care of themselves and their sexual partners.”

Myers said they knew the vast majority of people living with HIV who know their status act responsibly to take care of the health of both themselves and their sexual partners.

PREVIOUS HIV PROSECUTIONS:

1994 – In a highly publicised case, Kenyan musician Peter Mwai was the first person charged with infecting someone with HIV. He sentenced to seven years jail for having unprotected sex with five women and infecting two with HIV. Deported in June 1998 having served four years in jail here, Mwai died in Uganda in September 1998.

1999 – Former male prostitute Christopher Truscott held in “secure” care (he has escaped many times) in Christchurch after being prosecuted in 1999 for having unprotected sex with four men.

1999 – David Purvis, a 31-year-old Pakuranga invalid beneficiary, sentenced to four months jail for committing a criminal nuisance by having unprotected sex with another man. Pleaded guilty.

2004 – Zimbabwean Shingirayi Nyarirangwe, 25, was jailed in Auckland for three years after pleading guilty to four charges of criminal nuisance and three of assault.

2004 – Justin William Dalley, an unemployed 35-year-old of Lower Hutt, was sentenced to 300 hours of community work, six months’ supervision and to pay a woman $1000 in costs because he did not wear a condom during sex with her, despite knowing his HIV positive status. The woman did not contract HIV.

Soon after, he was acquitted of a similar charge because he wore a condom and thus set the legal precedent that by wearing protection an HIV positive man is taking “reasonable precautions” against infection and need not disclose his HIV status.

2009 – Auckland train driver Glenn Mills took his own life facing re-trial for 28 charges relating to 14 people. He had been in custody for over six months.

November 2016 – Christchurch man Johnny Lumsden, 26, is arrested and charged with criminal nuisance following accusations he had unprotected sex with several men without telling them he was HIV-positive.

THE LAW AND HIV

• If you are HIV positive, you do not have to disclose your status before having intercourse as long as you are using a condom.

• If the sex is unprotected, the HIV-positive person has a legal duty to disclose his/her status.

HIV IN NZ

During Mikio Filitonga’s trial, the court heard from Dr Graham Mills, an infectious diseases expert at Waikato Hospital. He said the most common mode of HIV transmission in New Zealand is male gay sex with 80 per cent of positive people believed to have been infected that way.

More than 50 per cent those who are HIV positive – 1500 to 2000 people – in New Zealand are believed to be living within the Auckland District Health Board’s boundaries.

Current estimates are that there are up to 4000 people in NZ who are HIV positive, he said.

Published in the New Zealand Herald on March 24, 2017

Mexico: Roberto Guzman on why HIV criminalisation laws do not protect women from HIV or violence and are inappropriate

Women and HIV criminalisation(Google translation – For the original Spanish version, please scroll down)

By Roberto Guzmán

Despite the fact that HIV infection has no cure, it has now become treatable and mortality has fallen. HIV has become a chronic disease with a higher quality of life and life expectancy. However, social perceptions have not significantly changed and HIV transmission and its gender-implications are still the cause of associated stigma and strong discrimination throughout the infection process and have become a major obstacle for prevention and medical care.

If a woman lives with HIV, her discrimination inhibits personalization of the risks for fear of distrust or of criticisms in her social environment, a situation that reduces the possibility of negotiating preventive measures and undermines her willingness towards her partners, by limiting a systemic diagnosis, by not wanting to share her results and her new life condition and by increasing the probability of not being able to seek treatment for its control.

Although the infection rates in this sector remains stable, women who contract HIV today continue to be ostracized, not only by their own families but also by their communities. They are expelled from their homes or rejected by their spouses to live in terror or to suffer violence, even to be deprived of life as if they were criminals.

If our Congress intended to apply a criminal law to the exposure and transmission of HIV as an outlet for this, perhaps its decree resulted from a well-intentioned desire to protect them in response to a legitimate concern for its rapid expansion. But continuing to allow society to criminalize them, does not foresee the emergence of new transmissions or reduce their vulnerability to the virus, on the contrary it would hurt them rather than help them, by having a negative impact on public health needs and the protection to their human rights. Continuing to criminalize them also does not protect them from sexual violence and rape, nor from unwanted pregnancies, on the contrary, it increases the risk of “secondary criminalization” when rape survivors infected with HIV could be persecuted for a possible exposure and transmission to their babies or their partners.

I believe that instead of responding to HIV by raising fears or laws, a human rights approach would emphasize protecting the dignity of all of them by creating conditions for free and informed taking of their health and life.

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EL CIELO DE LA OPOSICIÓN

Por Roberto Guzmán

La mujer y su criminalización por VIH

Pese a que la infección del VIH no tiene cura, hoy se vuelve tratable y disminuye su mortalidad al tornarse crónica y con mayor calidad y esperanza de vida. Sin embargo, los cambios en la percepción social que aún continúan son menos significativos ya que su transmisión y sus implicaciones respecto al género son causa de un estigma asociado y motivo de una fuerte discriminación en los distintos ámbitos del proceso de la infección al volverse obstáculo importante para la prevención y su asistencia médica.

Sí una mujer vive con VIH, su discriminación inhibe la personalización que tiene frente al riesgo por miedo a generarse desconfianza o crítica en su entorno social, situación que reduce la posibilidad de que se negocien medidas preventivas y el socavar su predisposición con sus parejas, al limitar su detección sistémica al no querer compartir su resultado y nueva condición de vida y la  probabilidad de no poder buscar tratamiento para su control.

Pese a que la tasa de infección de este sector permanece estable, las mujeres que hoy contraen VIH continúan siendo condenadas a un ostracismo, no solo por sus propias familias sino por sus comunidades que las expulsan de sus casas o al ser rechazadas por sus cónyuges teniendo que vivir aterradas o sufrir violencias, incluso ser privadas de la vida como si fuesen criminales.

Si nuestro Congreso tuviera la intención de aplicar una ley criminal a la exposición y transmisión del VIH como una salida a esto, quizá su decreto resultaría un bien intencionado deseo por protegerlas como respuesta a una preocupación legítima por su rápida expansión. Pero el continuar permitiendo que la sociedad las criminalice, no prevé la aparición de nuevas transmisiones ni reduce con ello su vulnerabilidad frente al Virus, al contrario las perjudicaría más que ayudarlas, al lograr un impacto negativo en las necesidades de salud pública y en la protección a sus derechos humanos. El seguir criminalizándolas tampoco las protege de la violencia sexual y la violación, ni de los embarazos no deseados, por el contrario, aumenta el riesgo a una “criminalización secundaria” cuando las sobrevivientes de violación si fuesen infectadas por VIH pudieran verse perseguidas por una posible exposición y transmisión a sus bebes o a sus parejas.

Considero que en lugar de responder al VIH generando temor o leyes, un enfoque de derechos humanos pondría énfasis en la protección a la dignidad de todas ellas al crearse condiciones para la toma libre e informada en relación a su salud y su vida.

 

US: Article (including quotes from Sero's Sean Strub) highlights how movement against HIV criminalisation is growing stronger in 2017

HIV Criminalization Is Detrimental to Public Health. It’s Time for the Law to Catch Up. By Matt Baume. Outward: Expanding the LGBTQ Conversation on Slate.com

It was in the summer of 2015 that then-23-year-old Michael Johnson was sentenced to thirty 30 years in prison for transmitting HIV. Since 1988, his home state of Missouri has imposed harsh penalties for what prosecutors call “reckless infection,” and it’s hardly alone: Most states have, at some time, prosecuted people for transmitting the virus. But those prosecutions may soon come to an end.

Laws that establish HIV-specific crimes date back to the dark years of the epidemic: “Everyone detected with AIDS should be tattooed in the upper forearm, to protect common-needle users,” wrote William F. Buckley Jr. in the New York Times in 1986, “and on the buttocks, to prevent the victimization of other homosexuals.” At the time, hysteria over AIDS produced a national wave of stigmatizing laws—laws that have now been shown to have worsened the epidemic.

“If people are so concerned with HIV transmission, then perhaps the Missouri legislature and Governor Nixon should start by repealing this law,” wrote Kenyon Farrow, the U.S. and global health policy director for the Treatment Action Group, in response to Michael Johnson’s prosecution.

Though it may seem appropriate to discourage HIV transmission, laws that create HIV-specific crimes “are unjust and harmful to public health around the world,” according to the Infectious Diseases Society of America. Rather than discouraging transmission, the laws actually discourage patients from seeking testing and care, which in turn leads to more transmissions. Numerous other public health experts and political leaders have called for an end to HIV prosecutions, including the American Medical Association, the National Association of County and City Health Officials, the U.S Conference of Mayors, and the Obama administration’s Department of Justice.

But reform comes slowly, and advocates for repeal have found themselves toiling for years to overturn the harmful statutes. Now, at last, a coordinated nationwide effort is taking shape, and 2017 is likely to see significant advances in the decriminalization of HIV.

“There’s two big shifts over the last five or six years,” said Sean Strub, executive director of the Sero Project, a group that advocates for repeal. “One, the people in the LGBT community … have an understanding of what HIV criminalization is. It’s a general awareness of the phenomenon in the communities most directly affected.” He estimates that his organization has had over a thousand speaking engagements in the last half-decade.

“Second: The issue is increasingly seen in public health terms,” he said. “To be fair, there wasn’t a lot of hard evidence [until recently]. We now know that 25 percent of people with HIV in the U.S. know one or more individuals who are afraid to get tested for HIV for fear of getting criminalized.” That statistic is based on a Sero Project survey of over 2,000 people, designed to determine how the partners of people with HIV access health care. Their findings indicate that criminalization has a public health impact beyond people who already have HIV.

Organizations like Sero Project have learned some valuable lessons over the last few years about harm reduction, and they’re now leveraging those best-practices in communities and legislatures around the country. Those strategies include coordinated educational efforts that simultaneously hit multiple communities: Faith, LGBTQ, public health, and legal. In addition, advocates are establishing local coalitions so that legislative pressure comes from constituents, rather than national groups. And they’re engaging with individual prosecutions around the country.

This year will see particularly intense focus in midwestern and southern states: Mississippi, Tennessee, Georgia, the Carolinas, Ohio, and Indiana will see intensive outreach efforts. California is making great strides, with a bill announced earlier this month to modernize the state’s laws. That effort has included a detailed study of prosecutions, with an analysis of demographic data that could become a model for modernization in other states.

Customized approaches are key to the approach in each state. In Florida, for example, advocates have reached out to members of the criminal justice system, from police officers all the way up to judges. Iowa’s decriminalization effort included a collaboration between hepatitis and HIV groups.

Another important evolution is how closely reform advocates are working with advocates for other forms of social change. “Whether it’s trans activists or drug policy people or sex work activists or Black Lives Matter or penal system reform, HIV decriminalization seems to be a nexus for those efforts,” said Strub. “It’s so closely tied to the criminalization of bodies. … Five or six years ago, other organizations were not involved in this work.”

At the national level, advocates are sponsoring a Congressional lobbying campaign in March. Top priorities include reforms to Army policy, as well as the creation of incentives for states to modernize their laws. (An old provision in the Ryan White CARE Act, a 1990 law that provided funding for HIV programs, prompted many states to impose criminalization in the first place.) The Repeal HIV Discrimination Act, sponsored by Barbara Lee (D-CA) and Ileana Ros-Lehtinen (R-FL), would provide a framework for state-by-state repeal—and although it’s languished since 2013, it will see a renewed push next month.

Among the states to watch: Missouri, home of Michael Johnson. The state is in the midst of an organizing effort that Strub estimates could take two or three years. Johnson’s conviction was recently overturned due to prosecutorial misconduct, and he’s been remanded for a retrial likely to happen sometime this year. That’s encouraging news, though Missouri Court of Appeals refused to rule on the constitutionality of the law under which Johnson was convicted.

As a result, Johnson and many others like him will remain tangled in a maze of trials, legislation, and lobbying efforts, trapped by misguided laws that impose preventable harm—for now.

Nigeria: On Zero Discrimination Day, Coalition of Lawyers for Human Rights strongly denounce judicial HIV stigma in ongoing child custody case (Press release)

Breach of HIV status confidentiality and discrimination by the Hon Justice Olagunju of the Oyo State Judiciary 

Federal Capital Territory, Abuja. March 1, 2017.

Coalition of Lawyers for Human Rights, COLaHR, is a Coalition of Human Rights Lawyers working on issues of Persons Living With, Affected By or Most at Risk of HIV.

COLaHR has been following and monitoring a case involving a mother living with HIV, which is being adjudicated upon before the Hon Justice Olagunju of Court 7 of the Oyo State High Court of Justice.

Our interest in the matter is basically to monitor how courts, in the dispensation of justice involving persons living with HIV, respect their confidentiality and possible traces of stigma and discrimination, in accessing justice.

COLaHR is concerned with the attitude of the Honourable Justice on all fronts in this regard. On the 20th of February 2017, while lawyers on both sides were delivering their final addresses, the presiding Judge, publicly made comments which publicly revealed the HIV status of the plaintiff. Not only was this wrong and a gross breach of confidentiality, the Judge also made comments obiter in the case of custody of the child, which exhibited gross stigmatisation and discrimination.

The Judge largely stated as follows:

“putting the interest of the child first, imagine the trauma that the little girl will pass through when the news of her mother being HIV-positive spreads across her school.”

The above quote, which was made in passing (obiter) and may not be included in the courts records, is patently discriminatory and coated with stigma. It betrays lack of appreciation of the prevailing HIV and AIDS laws at the federal and state levels. Several questions arise from Justice Olagunju’s statement:

  • What happens if both parents of the child are HIV-positive? Will such a child be handed over to foster parents?
  • Are we saying that persons with HIV in Nigeria are not fit for parenthood?
  • Should all HIV-positive adults therefore be sterilised?
  • Who will spread the news of Omolara being HIV-positive all over her daughter’s school?
  • Is the right to confidentiality of HIV status not guaranteed under Nigerian laws?

COLaHR makes the following findings from our monitoring of this case:

  1. The disposition of Hon. Justice Olagunju clearly casts doubt on the ability of the court not to be swayed by the Plaintiff’s health status in coming to a decision on the matter.
  1. The Plaintiff, in her statements to COLaHR has clearly shown the fear as in above, given her Husband’s request for custody of the child is hinged on HER HIV-POSITIVE STATUS.

It is in light of the above that COLaHR calls on Hon. Justice Olagunju to excuse himself from the case as justice must not only be done, but must be seen to have being done.

We call on the Chief Justice of the State, to direct Hon. Justice Olagunju to step down from the case.

We will in consonance with the law, share our findings with the Federal Attorney General and Minister of Justice and the State Attorney General respectively.

Signed

Roseline Oghenebrume,

National Coordinator, Coalition of Lawyers for Human Rights

Canada: Toronto’s ‘Now’ weekly newspaper prominently features HIV criminalisation impact, advocacy and advocates

This week, Toronto’s weekly newspaper, ‘Now’, features four articles on HIV criminalisation and its impact in Canada.

The lead article, ‘HIV is not a crime’ is written from the point of view of an HIV-negative person who discovers a sexual partner had not disclosed to him.  It concludes:

After my experience with non-disclosure, I felt some resentment. But while researching this article, I reached out to the person who didn’t disclose to me. We talked about the assumptions we’d both made about each other. It felt good to talk and air our grievances.

 

I realized I’d learned something I’d never heard from doctors during any of my dozens of trips to the STI clinic, something I’d never heard from my family, my school, in the media or from the government – that you don’t need to be afraid of people living with HIV.

Screenshot 2017-01-13 09.48.27A second article, Laws criminalizing HIV are putting vulnerable women at greater risk, highlights the impact HIV criminalisation is having on women in Canada, notably that it is preventing sexual assault survivors living with HIV from coming forward due to a fear they will be prosecuted for HIV non-disclosure (which, ironically, is treated as a more serious sexual assault than rape).

Moreover, treating HIV-positive women as sex offenders is subverting sexual assault laws designed to protect sexual autonomy and gender equality. Front-line workers and lawyers say they’re hearing from HIV-positive women who are afraid to report rape and domestic abuse for fear of being charged with aggravated sexual assault themselves.

 

“People come to me all the time who don’t know what to do,” says Cynthia Fromstein, a Toronto-based criminal lawyer who’s worked on 25 to 30 non-disclosure cases. “Canada, unfortunately, is virulent in its zeal to prosecute aggravated sexual assault related to HIV non-disclosure.”

Screenshot 2017-01-13 09.48.41It also features a strong editorial, ‘HIV disclosure double jeopardy’ by the Canadian HIV/AIDS Legal Network’s Cecile Kazatchkine and HALCO’s Executive Director, Ryan Peck, which notes:

In a statement that mostly flew under the radar, Minister of Justice Jody Wilson-Raybould declared, on World AIDS Day (December 1), her government’s intention “to examine the criminal justice system’s response to non-disclosure of HIV status,” recognizing that “the over-criminalization of HIV non-disclosure discourages many individuals from being tested and seeking treatment, and further stigmatizes those living with HIV or AIDS.”

 

Wilson-Raybould also stated that  “the [Canadian] criminal justice system must adapt to better reflect the current scientific evidence on the realities of this disease.”

 

This long-overdue statement was the first from the government of Canada on this issue since 1998, the year the Supreme Court of Canada released its decision on R v. Cuerrier, the first case to reach the high court on the subject.

15937182_1055417094604635_6279465723502378214_oFinally, the magazine features a number of promiment HIV activists from Canada, including Alex McClelland, who is studying the impact of HIV criminalisation on people accused and/or convicted in Canada.

He contributed his first piece to HJN last month.