US: States with HIV criminalisation laws have a lower PrEP-to-need ratio, which is detrimental to HIV prevention efforts, study shows

State Laws Key To HIV Prevention Efforts

PHILADELPHIA (September 8, 2020) – HIV prevention remains a public health priority in the United States. Pre-exposure prophylaxis (PrEP) is a drug regimen recommended for individuals who have engaged in behaviors that place them at elevated risk for HIV. When used consistently, daily oral PrEP has been shown to reduce HIV transmission by 99 percent. However, despite increases in PrEP awareness and uptake over the past several years, data show that four of five people who could benefit from PrEP did not access the medication in 2018.

In an article for the September issue of Health Affairs, researchers from the University of Pennsylvania School of Nursing (Penn Nursing) explored associations between state-level policies and PrEP uptake. They found that states with HIV criminalization laws (i.e., statutes that criminalize status non-disclosure) had a lower PrEP-to-need ratio, and states with comprehensive nondiscrimination laws for sexual and gender minorities had a higher PrEP-to-need ratio.

“Our study corroborates the growing consensus that HIV criminalization laws offer little to no public health benefit and inhibit HIV prevention efforts,” says Stephen Bonett, PhD, RN, the first author of the article, and postdoctoral fellow at Penn Nursing’s Program for Sexuality, Technology and Action Research (PSTAR).

“Given the evolving state of HIV prevention and the growing body of evidence showing that HIV criminalization may hinder public health efforts, state governments should move toward repealing HIV criminalization laws,” the authors write. “In addition, legislative efforts should be directed toward improving access to HIV treatment and prevention and reducing stigma and discrimination against people living with HIV.”

The article, “State-Level Discrimination Policies and HIV Pre-exposure Prophylaxis Adoption Efforts in the U.S.” is set for publication this fall. Co-authors of the article include Steven Meanley, PhD, MPH, and José Bauermeister, PhD, MPH, both of Penn Nursing; Steven Elsesser, MD of Penn Medicine.

About the University of Pennsylvania School of Nursing

The University of Pennsylvania School of Nursing is one of the world’s leading schools of nursing. For the fifth year in a row, it is ranked the #1 nursing school in the world by QS University and is consistently ranked highly in the U.S. News & World Report annual list of best graduate schools. Penn Nursing is currently ranked # 1 in funding from the National Institutes of Health, among other schools of nursing, for the third consecutive year. Penn Nursing prepares nurse scientists and nurse leaders to meet the health needs of a global society through innovation in research, education, and practice. 

US: Criminalizing and stigmatizing HIV only leads to more HIV infections

For transgender Floridians, stigma and fear of arrest could lead to new HIV crisis | Opinion

There’s another public health crisis laying in the shadows of COVID-19, and it’s completely preventable: HIV. More than 20,000 people are living with HIV in Fort Lauderdale – and more than 100,000 across Florida. New HIV infections have been increasing in Florida every year since 2013, and the state’s budget for combating HIV increased 15% between 2015 and 2018.

HIV currently has a disproportionate impact on certain communities. Only one in four people in Fort Lauderdale are Black, but they represent nearly half the city’s population of people living with HIV. Latinas are twice as likely as white women in Fort Lauderdale to be living with HIV. Transgender people are 49 times more likely than cisgender people to have HIV.

Transgender people also face high rates of violence, with transgender people of color being particularly impacted. In 2019, more than 20 transgender people were killed, virtually all of them Black or Latinx. Far too often, their names don’t make the news, names like Tony McDade or Bree Black, both of whom were killed in Florida this year.

Transgender people of color, and in particular transgender women of color, face layers of stigma. Transphobia, racism, and sexism all take a toll on a person and make them more vulnerable in many aspects of their life, including being more likely to contract HIV.

We have the tools and knowledge to stop HIV in its tracks. Taking simple precautions greatly minimizes transmission. Testing can offer quick results. And drug regimens can treat people living with HIV and prevent it from spreading. But a lack of understanding and prejudice against people living with HIV prevents us from taking advantage of these tools. Money is not the issue – the law is.

Florida’s very tough HIV criminalization laws have made a bad situation worse. In Florida, having consensual sex, donating blood or organs, or engaging in sex work without disclosing one’s HIV status is a third-degree felony, which could lead to five years in prison and a $5,000 fine. The law doesn’t take into account whether protection is used, if people maintain a drug regimen that virtually eliminates any chance of passing on the disease, or the fact that blood is screened – for many diseases, including HIV – before being donated.

Not only are HIV criminalization laws antiquated and discriminatory, they have a devastating impact on public health and the perception of HIV. When our own state government is labeling those living with HIV as criminals, it perpetuates stigma. It creates a fear of basic education, getting tested or talking about HIV, even with friends and family. It’s hard to blame them considering five years in jail is a possibility.

Our state has created a vicious cycle: people choose to not know their status out of fear of repercussions. Therefore, they don’t receive treatment, leading to more people unknowingly spreading the disease. Criminalizing and stigmatizing HIV only leads to more HIV infections.

Earlier this month, the results of the “GLAAD-Gilead State of HIV Stigma Survey” were published, measuring attitudes towards HIV, and the results showed we still have a long way to go. Nearly 6 in 10 Americans wrongfully believe that “it is important to be careful around people living with HIV to avoid catching it.” That’s not true and the medical community has known this for decades. But when it’s difficult to educate people on the disease, misinformation spreads and has a damaging impact on public health.

Knowing that transgender people are more likely to be affected by HIV, at TransInclusive, we spend a considerable amount of time reaching out to that community. When you add the stigma transgender people face to the stigma that surrounds HIV, it makes our outreach efforts that much harder. Moreover, it becomes even more difficult to ensure transgender people have the resources needed to prevent the spread of HIV.

The survey found that one in two Americans would be uncomfortable with a partner or spouse living with HIV, which only increases the disproportionate impact HIV has on transgender people, considering they have the highest rates of infection. Ignoring these disparities will only continue to harm the communities most at risk of contracting HIV.

Training and resources from allies are part of the solution. Grants from private-sector partnerships like the Gilead COMPASS Initiative have helped us build a grassroots effort to prevent the spread of HIV by going into the Fort Lauderdale community to educate people and hosting group sessions where individuals can learn without fear of judgment. During the social distancing measures of the COVID-19 pandemic, we’ve held our “Open Night Thursday” series virtually to allow people from our community to talk to one another, learn about the resources available to them, and feel a sense of belonging.

But we must reach beyond our community, and to our lawmakers, to make the impact we need.

Changing misperceptions has to happen on the frontlines of health care and in the halls of state houses. Stigma will not go away if laws that criminalize HIV remain. Florida can’t end the HIV epidemic overnight, but the state can take steps now to stop the rise of HIV infections and avoid another health crisis. Ending the criminalization of HIV and educating our state about how to prevent its spread will help fight the pervasive stigma that still exists – and gets us that much closer to ending HIV in Florida.

Tatiana Williams is the co-founder and executive director of Transinclusive Group in Fort Lauderdale.

Watch all the videos of Beyond Blame @HIV2020 – our “perfectly executed…deftly curated, deeply informative” webshow

Earlier this month, advocates from all over the world came together for two hours to discuss the successes and challenges of the global movement to end HIV criminalisation.

All of the recordings of Beyond Blame: Challenging HIV Criminalisation for HIV JUSTICE WORLDWIDE are now available on the HIV Justice Network’s YouTube Channel.

“HUGE pleasure 2B at #BeyondBlame2020 conference – deftly curated, deeply informative; speakers were great; the passion & commitment to #HIVjustice was palpable. Much progress yet a sober reminder that the work is far from over.”

Kene Esom, Policy Specialist: Human Rights, Law and Gender, United Nations Development Programme (UNDP)

 

The full-length director’s cut version – with enhanced audio and video – is now available in English as well as with the audio track of the recorded simultaneous translation in French, Spanish, Russian, and Portuguese.

The English version is also available as a YouTube playlist in ‘bite-size’ chunks, with each segment of the webshow available as standalone videos.  This means, for example, if you just want to watch (or share) the segment on ‘women challenging HIV criminalisation in Africa‘, or on ‘bringing science to justice, and justice to science‘, it’s now possible.

“That webinar was perfectly executed. Great sound, engaging transitions (they actually played people on and off!), and multiple speakers in various collections. Having ALL OF THEM back at the end showed the breadth of this technical accomplishment and the depth of the speakers’ field of expertise. Not everyone may notice these things but boy, I sure do, and it was totally pro. I’ve seen big name conferences who couldn’t get this right… Congratulations all around, and especially to [director] Nicholas Feustel.

Mark S King, My Fabulous Disease

 

We have also made available for the first time the standalone recording of Edwin Cameron’s closing speech, which inspired so many.  The transcript is included in full below.

“We have been being battling this fight for many years. Since the start of the HIV epidemic we as gay men, as gay women, as queers, as transgender people, as sex workers, as people using drugs, have been persecuted by the criminal law. And I’m here to say, “Enough! Enough!

We have achieved a great deal with our movement, with the HIV Justice Network. We have achieved a great deal in conscientizing law makers, law givers and the public. It is now time for us to join in unison to demand the end of these stigmatising, retrograde, unproductive, hurtful, harmful laws.

It is a long struggle we’ve engaged in. And it’s one that has hurt many of us. Some of us here today, some of us listening in, some of us who have spoken, have felt the most brutal brush of the law. They have been imprisoned, unjustly prosecuted, unjustly convicted, and unjustly sent away.

HIV is not a crime. But there is more to it. Criminalising HIV, criminalising the transmission or exposure of HIV, as many countries on my own beautiful continent Africa do, is not just stupid and retrograde. It impedes the most important message of the HIV epidemic now, which is that this epidemic is manageable. I’ve been on antiretroviral treatment now for very nearly 23 years. My viral load has been undetectable for more than 20.

We can beat this, but we have to approach this issue as public health issue. We have to approach it rationally and sensibly, and without stigma, and without targeting people, and without seeking to hurt and marginalise people.We’ve made calamitous mistakes with the misapplication of the criminal law over the last hundred years, in the so-called ‘war on drugs’. We continue to make a calamitous mistake in Africa and elsewhere by misusing the criminal law against queer people like myself. We make a huge mistake by misusing the criminal law against people with HIV.

Let us rise today and say, “Enough!”

 

When considering the criminalisation of COVID-19, lessons from HIV should be retained

Marginalised communities will not get justice from criminalising Covid-19 transmission

The criminalisation of the virus would create greater barriers to accessing healthcare systems already preventing many people from getting treatment.

After it was announced that no further action would be taken by police regarding the death of Belly Mujinga, a railway worker who contracted coronavirus after reportedly being spat on, there was national outcry. Her name has been plastered on placards at Black Lives Matter protests, while the public has pointed out that a man in Scotland who spat on a police officer while “joking” about coronavirus in April has been jailed for a year. But while this outrage is valid in the face of a government who continues to show their blatant disregard for black lives, criminalisation of diseases has been proven to be an ineffective tool for justice.

Over the past few months, parallels have been drawn between the Covid-19 pandemic and the HIV epidemic. Both viruses are communicable (they can be passed between people); both have been racialised, leading to racist and xenophobic attacks and stereotyping; community mobilisation has demanded adequate government public health responses for both health emergencies; and the impact of both viruses has highlighted the need for a global health approach which transcends borders. 

When the World Health Organisation (WHO) declared Covid-19 a pandemic, many HIV organisations and activists advocated that the transmission of the novel coronavirus should not be criminalised. As public fear of Covid-19 grew, HIV advocates predicted the negative impact on public health and possibility of human rights violations, similar to those seen for people living with HIV. 

“Despite the evolving scientific knowledge, criminalisation laws have been written and implemented across the world faster than the development of the general understanding of the virus itself”

This strain of coronavirus is new and scientists are developing their understanding of it. In the past few weeks, there has been confusion about the probability of asymptomatic transmission (transmitting the virus when a person does not have Covid-19-like symptoms), as the WHO had previously commented that it was “very rare” and later stated that this wording had misled people. Despite the evolving scientific knowledge, criminalisation laws have been written and implemented across the world faster than the development of the general understanding of the virus itself. Globally, countries have implemented or have proposed laws against Covid-19 transmission and even exposure, without transmission, including Canada, France, India, and South Africa.

Often, the aim of criminalisation is to facilitate a tool for prevention and deterrence (to discourage people from passing on a virus) or as punishment for those who have or may have passed on a virus. HIV advocacy has illustrated over the years that the criminalisation of transmission or exposure is ineffective, and disproportionately impacts marginalised communities and negatively impacts public health.

In their Statement on Covid-19 Criminalisation, published in March, the HIV Justice Worldwide Steering Committee wrote that hastily drafted laws, as well as law enforcement, driven by fear and panic, are unlikely to be guided by the best available scientific and medical evidence – especially where such science is unclear, complex and evolving. “Given the context of a virus that can easily be transmitted by casual contact and where proof of actual exposure or transmission is not possible, we believe that the criminal justice system is unlikely to uphold principles of legal and judicial fairness, including the key criminal law principles of legality, foreseeability, intent, causality, proportionality and proof.”  

Since that statement was issued, internationally coronavirus laws have been weaponised against the most marginalised within society, as is the case with HIV criminalisation laws. The Ugandan government, for example, has used coronavirus laws to target marginalised LGBTQI+ groups, and in the UK, people of colour are fined more than the white population under coronavirus laws, in some cases leading to unlawful charges. In some cases people were even charged under the wrong law (e.g. enforcing Welsh law in England).

The director of legal services at the Crown Prosecution Service (CPS), the public agency that conducts criminal prosecutions in England and Wales, found that 24% of cases reviewed had been charged incorrectly. In May a CPS press statement cited the speed and pressure to implement the laws as the cause of the wrongful charges. Across the Global North, it has been well documented that racialised communities are disproportionately impacted by Covid-19 and the Human Rights Campaign Foundation anticipates that LGBTQI communities will be disproportionately impacted by the virus. This is due to a myriad of reasons underpinned by systemic discrimination.

“Criminalisation of transmission or exposure is ineffective, and disproportionately impacts marginalised communities and negatively impacts public health”

HIV research has shown little evidence that criminalisation laws prevent transmission, in fact, it’s evidenced that such laws are bad for public health and fuel reluctance to get tested and treated. In the UK, testing and treatment of Covid-19 is free, as is the case with many other communicable diseases to remove the barrier to testing and treatment. Free testing and treatment access, irrespective of immigration status, is important, however, a briefing paper from Medact, Migrants Organise and New Economics Foundation (NEF), has shown that migrant communities blocked from healthcare because of the hostile environment, that “the coronavirus ‘exemption’ from charging and immigration checks is not working” and people have been asked to show their passports, and that people face additional obstacles such as language barrier and digital exclusion from emergency services. 

Criminalisation exacerbates public health issues: in a Channel 4 report, Migrants Organise spoke of a man who died at home for fear of being reported to immigration authorities if he accessed healthcare. The threat of immigration enforcement disproportionately impacts those in precarious work and those with precarious migration status, all of whom are more likely to come from racialised groups and in some cases groups which are hyper-surveilled and criminalised.

The role of healthcare and access to it needs to be reimagined, where people are viewed as patients not passports and healthcare professionals are not the extended arm of the Home Office. Governments must implement better employment rights, so that employers are held to account and do not put staff such as Belly Mujinga, in harmful positions. Governments must provide better statutory sick pay so those in precarious work do not have to choose between their health and putting food on the table. We need to overhaul systemically discriminatory processes that don’t look after the most vulnerable, rather than implementing laws – such as criminalisation – that will systematically punish them.

New Francophone Africa HIV criminalisation advocacy factsheet published today

Today, HIV JUSTICE WORLDWIDE releases a new advocacy factsheet developed by and for Francophone activists engaged in the fight against HIV criminalisation in Francophone Africa.

Co-authored by Cécile Kazatchkine of the Canadian HIV/AIDS Legal Network and Alain Kra, an expert in HIV and human rights Expert from Côte d’Ivoire, on behalf of HIV JUSTICE WORLDWIDE, the factsheet is the first of several that will be published throughout the year focusing on a particular language and region.

“We are delighted to share this new resource with you today,” Cécile Kazatchkine writes below. “In it, you will find everything you need to know about HIV criminalisation in francophone Africa, the issues it raises and the strategies adopted by activists to address it. Many thanks to Alain Kra, an expert in human rights and HIV from Côte d’Ivoire, who co-authored this factsheet, and to our colleagues from the Francophone HIV JUSTICE WORLDWIDE network for their contributions and for sharing their experiences.”

Nous sommes heureux de partager aujourd’hui cette nouvelle ressource développée par et pour les militants francophones engagés dans la lutte contre la pénalisation du VIH. Vous y trouverez tout ce que vous devez savoir sur la pénalisation en Afrique francophone, les enjeux qu’elle soulève et les stratégies adoptées par les militants pour y répondre. Un grand merci à Alain Kra, Expert en droits humains et VIH de Côte d’Ivoire et co-auteur de ce feuillet d’information ainsi qu’à nos collègues du réseau francophone HIV Justice Worldwide pour leurs contributions et le partage de leurs expériences.

Cécile Kazatchkine, le Réseau juridique canadien VIH/sida

 

To provide a taste of the content to English-speakers, here are some of the introductory paragraphs from the 16-page PDF.

“African HIV legislation was drafted on the basis of the N’Djamena model law developed during a three-day workshop in 2004 organised by Action for West Africa Region-HIV/ AIDS (AWARE-HIV/AIDS) and funded by the United States Agency for International Development (USAID).  This model, presented as a tool for the rapid dissemination of “good practices”, has led to a veritable “legislative contagion” in terms of HIV criminalisation across the continent, particularly in francophone Africa.

“Nineteen countries in francophone Africa currently have HIV-specific laws. Sixteen of these laws, which are supposed to guarantee the rights of people living with HIV, also criminalise HIV transmission or exposure. Criticism of the model law and a better understanding of the risks associated with HIV criminalisation have led to the revision of some laws in Togo, Guinea and Niger to limit the scope of HIV criminalisation.

“Similarly, criminal provisions in HIV laws adopted in 2010 in Senegal, 2011 in the Congo and 2014 in Côte d’Ivoire are more protective of the rights of people living with HIV. Like the revised laws, they include provisions expressly excluding criminalisation in certain circumstances, such as where condoms have been used or in cases of mother-to-child transmission. Congolese law precludes criminal liability in the greatest number of circumstances. In Cameroon and Gabon, HIV bills with provisions criminalising HIV were eventually abandoned, while in Comoros and Mauritius, HIV laws have never included criminalising provisions. Finally, in the Democratic Republic of Congo (DRC), the section of the HIV law criminalising the ‘deliberate’ transmission of HIV was repealed in 2018.”

The information sheet goes on to cover the disproportionate impact of HIV criminalisation on women across Africa; shows the many reasons why HIV criminalisation does more harm than good to the HIV response; explores the impact of science on laws and prosecutions; and includes links to further resources including those contained in the French-language version of the HIV Justice Toolkit.

HIV criminalisation laws affect women negatively and impede the effectiveness of implementing state programmes

Can HIV criminalisation protect women from becoming infected?

Translated from Original article in Russian via Deepl.com – For article in Russian, please scroll down.

In many countries, HIV-related criminal liability still exists. At least 68 countries have laws that specifically criminalize hiding information about HIV infection from your sex partner, putting another person at risk of HIV infection, or transmitting HIV. The leaders in the number of criminal cases related to HIV in the region of Eastern Europe and Central Asia are Belarus and Russia.

In 2018, 20 scientists from around the world developed an Expert Consensus Statement on the Science of HIV in the context of Criminal Law. It describes a detailed analysis of the available scientific and medical research data on HIV transmission, treatment efficacy, and evidence to better understand these data in a criminal law context.

Legislation regarding HIV transmission should be reviewed. I point out various facts to this – HIV treatment is available, antiretroviral therapy (ART) effectively reduces the viral load to undetectable and reduces the risk of HIV transmission during sexual contact to zero [1,2,3,4], criminalization initially stigmatizes people who are HIV-positive people and violates their human rights.

One of the arguments in favour of criminal liability for HIV transmission is the alleged protection of women in situations where their husbands or partners become infected with HIV. This argument is often used in Central Asian countries. Let’s look at real-life examples and statistics on how much women are actually protected by existing laws.

In early 2018, thanks to human rights defenders and human rights defenders, the article “Vikino Delo” appeared in the media, about a 17-year-old pupil of an orphanage, who was convicted under subsection 122 (1) of the Criminal Code of the Russian Federation for knowingly putting another person at risk of HIV infection. In 2017, Vika met a man F. (31 years old) on a social network. When they had an intimate relationship, the girl offered to use a condom, but F. refused. Vika did not tell F. that she had HIV. From the girl’s testimony provided in court, it was clear that she did not want to put the victim at risk of infection, and did not say the diagnosis because she was afraid. She tried to hint at him, telling about her HIV-infected friend. F. proposed to be tested for HIV together. As a result, he has a minus, she has a plus. F. filed a complaint with Vic to the police. The man decided to punish the girl for insufficient, in his opinion, sincerity. Following the verdict, Vicki’s lawyer filed a complaint with the Supreme Court. On the recommendation of the Supreme Court, given that at the time of the commission of the “crime” she was a minor, apply a sentence of warning to her. At the same time, no one took the blame from her. The leading role in protecting and supporting Vicki was played by the female community in the guise of Association “EVA”.

The situation with the Vicki case is commented on by human rights activist Elena Titina, head of the Vector of Life Charity Fund, who acted as a public defender in court: “Women are subjected to even greater stigma, condemnation, and therefore do not protect themselves. Vicki’s case is very revealing in this. For three years, during the whole trial, the girl simply had to listen to insults, humiliation against her, the remarks were incorrect – and on the part of the plaintiff, this 31-year-old man, on the part of judges, prosecutors, even lawyers sometimes behaved like elephants in a china shop. She, in my opinion, is the heroine. I’m not sure that an adult woman would have endured what Vick had endured and come to the end, defending her rights. Her criminal record was removed. A unique thing, I am very proud that I participated in it. “This is the only thing that has ended so far because I don’t know of any more such precedents with a conditional happy ending. ”

In the Criminal Code of the Russian Federation , in which almost one and a half million cases of HIV infection among citizens are only officially registered, there is article 122 “Transmission of HIV infection”. Disaggregation of data began in 2017, from 01/01/2017 to 12/31/2019, in total, within the framework of 122 articles, 150 sentences were sentenced according to the main qualification in parts 1-4. 93 sentences were pronounced against men (62%), 57 (38%) – against women. It is noteworthy that in Part 1, “Knowingly putting the other person at risk of HIV infection” is condemned by more women: 56.4% versus 43.6% of men.

According to the Ministry of Health of the Republic of Tajikistan for 2018, there were 10.7 thousand people with HIV in the whole country, of which about 7 thousand were men. It was noted that in 54.6% the virus was transmitted sexually, and in some regions, the proportion of such cases reaches 70%.

For reference: since July 2015, to register a marriage in Tajikistan, you must undergo a medical examination, which includes an HIV test.

Tajikistan became one of the few countries (and the only one in the EECA region) to which CEDAW issued a recommendation dated November 9, 2018: “Decriminalize the transmission of HIV / AIDS (Article 125 of the Criminal Code), and repeal government decrees of September 25, 2018 and October 1, 2004 years prohibiting HIV-positive women from getting a medical degree, adopting a child, or being a legal guardian. ”

Instead, on January 2, 2019, President Emomali Rahmon signed a series of laws, including those aimed at “strengthening the responsibility of doctors, beauty salons, hairdressers and service enterprises, which are due to non-compliance with sanitary, hygiene, anti-epidemic rules and regulations caused HIV / AIDS. ” From that moment, a lot of publications appeared in the media, illustrating not only the widespread informing of Tajik citizens about the requirements being followed but also the increase in the number of publications on criminal penalties related to HIV.

According to the results of media monitoring conducted by the Eurasian Women’s AIDS Network, in 2019, 23 publications on HIV were registered in the electronic media of Tajikistan. Among them, two topics were divided equally: general information on the responsibility for HIV transmission and statistics, as well as publications that women are accused of, such as:

“27-year-old woman suspected of having HIV / AIDS deliberately infecting”,

“Two women in northern Tajikistan convicted of HIV infection”,

“In Tajikistan, a woman convicted of“ deliberate HIV infection ”by 23 men was sentenced”,

“A resident of Kulyab of Tajikistan is suspected of intentionally acquiring HIV”,

“Two women in Khatlon have infected dozens of men. ”

Among these publications, there is not one that describes particular cases of men. We already wrote about the vulnerability of women in August last year in our interview with attorney Zebo Kasimova.

We could not obtain statistical data on the number of cases brought under article 125 of the Criminal Code of the Republic of Tajikistan, “HIV infection”. Particularly important would be information disaggregated by sex – that is, disaggregated data, the collection of which makes special sense, in view of the state’s argument for the protection of women. The importance of disaggregated statistics is stated in the Sustainable Development Goals – the Resolution adopted by the UN General Assembly in 2015: only accurate, reliable, comprehensive thematic data will help us understand the problems we are facing and find the most suitable solutions for them.

Olena Stryzhak, one of the founders of the Eurasian Women’s AIDS Network and the head of the Positive Women BO, is actively promoting the decriminalization of HIV in Ukraine  “I have been on the committee for the second year in the validation of elimination of mother-to-child transmission of HIV and syphilis at the Ministry of Health of Ukraine, and actively participate not only in the activities of the committee in our country but also attend international meetings of the Committee at WHO, communicate with many people working in this field.

One of the obstacles for women to seek medical help and treatment on time is the fear of prosecution, the fear of possible criminal liability. In Ukraine, I was able to obtain statistics on the number of criminal cases under article 130 of the Criminal Code of Ukraine, disaggregated by sex. I was surprised by the statistics, because, starting in 2015, only women were convicted under this article. This negatively affects not only the women themselves but also the effectiveness of implementing state programs, including the process of validating the elimination of mother-to-child transmission of HIV. ”

From the last case in Ukraine, for 2018: “… Since the defendant refused, the specialist for child services extended her hands to the child in order to pick her up, but the defendant bit her left hand.” From the conviction: “The court decided to qualify the actions of the defendant … Part 4 of Art. 130 of the Criminal Code of Ukraine as a complete attempt on intentional infection of another person with human immunodeficiency virus. “

Does it mean that if only women were convicted, the fact that only women are sources of infection? From an alternative shadow report of the Tajikistan Network of Women Living with HIV, presented at the 71st session of the UN Committee on the Elimination of All Forms of Discrimination against Women in November 2018: “In violation of their rights, as a rule, women do not go anywhere. During the study of the situation when writing this report, violations of the rights of women living with HIV and women from affected groups were identified, only a few decided to defend their rights and because they were provided with a lawyer at the expense of the project. The reasons for this behaviour are different. One of the main reasons is the lack of financial resources to pay for the services of a lawyer. Secondly, many women living with HIV and women from HIV-affected groups have low legal literacy; they do not have information about who to contact on a particular issue. Thirdly, self-stigmatization and the fear of confidentiality also prevent women living with HIV and women from HIV-affected groups from defending their rights. ”

It is clear from the report that women do not defend their rights, especially on such sensitive issues, for fear of feeling even more condemned and becoming even more vulnerable. In addition, in the countries of Central Asia, families have traditions when a daughter-in-law must tell her husband or mother-in-law where she goes and what she is going to spend or spent money on (by the way about paying a lawyer). Women depend on other family members, and often do not have their own money.

Violence against women increases their risk of HIV infection, while the very presence of HIV infection in a woman also increases the risk of violence, including from relatives, due to her vulnerability and low self-esteem.

The criminalization of HIV does not work, either as a preventive measure nor as a way to protect women from infection, as decision-makers try to imagine. On the contrary, with specific examples, we observe that women are more vulnerable.

Sources:

[1] – Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011 Aug 11; 365: 493-505.

[2] – Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, van Lunzen J, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA. 2016; 316: 171-81.

[3] – Grulich A, Bavinton B, Jin F, Prestage G, Zablotska, Grinsztejn B, et al. HIV transmission in male serodiscordant couples in Australia, Thailand and Brazil. Abstract for 2015 Conference on Retroviruses and Opportunistic Infections, Seattle, USA, 2015.

[4] – Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour M, Kumarasamy N, et al. Antiretroviral Therapy for the Prevention of HIV-1 Transmission. N Engl J Med. 2016 Sep 1; 375 (9): 830-9. 

Может ли криминализация ВИЧ защитить женщин от инфицирования?

Во многих странах все еще существует уголовная ответственность, связанная с ВИЧ. По меньшей мере 68 стран имеют законы, которые специально предусматривают уголовную ответственность за сокрытие информации о наличие ВИЧ-инфекции от своего партнера по сексу, поставление другого лица в опасность инфицирования ВИЧ или передачу ВИЧ. Лидерами по количеству уголовных дел, связанных с ВИЧ, в регионе Восточной Европы и Центральной Азии являются Беларусь и Россия.

В 2018 году, 20 ученых из разных стран мира разработали Заявление об экспертном консенсусе в отношении использования научных данных о ВИЧ в системе уголовного правосудия. В нем описан подробный анализ имеющихся данных научных и медицинских исследований о передаче ВИЧ, эффективности лечения и доказательства, позволяющие лучше понять эти данные в уголовно-правовом контексте.

Законодательные нормы в отношении передачи ВИЧ должны быть пересмотрены. На это указываю различные факты — лечение ВИЧ-инфекции доступно, антиретровирусная терапия (АРТ) эффективно снижает вирусную нагрузку до неопределяемой и снижает риски передачи ВИЧ при сексуальном контакте до нуля [1,2,3,4], криминализация изначально клеймит людей ВИЧ-положительных людей и нарушает их права человека.

Один из аргументов в пользу существования уголовной ответственности в отношении передачи ВИЧ — это якобы защита женщин, в тех ситуациях, когда их мужья или партнеры инфицируют их ВИЧ. Этот аргумент довольно часто используют в странах Центральной Азии. Давайте рассмотрим на реальных примерах и статистических данных, насколько женщины на самом деле защищены существующими законами.

В начале 2018 года, благодаря правозащитницам и правозащитникам, в СМИ появилась статья «Викино дело», о 17-ти летней воспитаннице детского дома, которую осудили по части 1 статьи 122 УК Российской Федерации за заведомое поставление другого лица в опасность заражения ВИЧ-инфекцией. В 2017 году Вика познакомилась в социальной сети с мужчиной Ф. (31 год). Когда у них была интимная связь, девушка предложила использовать презерватив, но Ф. отказался. Вика не сказала Ф., что у нее ВИЧ. Из показаний девушки, предоставленных в суде, было видно, что она не желала ставить потерпевшего в опасность заражения, и не сказала о диагнозе, потому что боялась. Она пыталась намекнуть ему, рассказывая о ВИЧ-инфицированной подруге. Ф. предложил вместе сдать анализы на ВИЧ. В результате у него — минус, у нее — плюс. Ф. подал на Вику заявление в полицию. Мужчина решил наказать девушку за недостаточную, на его взгляд, искренность. После вынесенного приговора адвокатом Вики была подана жалоба в Верховный Суд. По рекомендации Верховного Суда, учитывая, что на момент совершения «преступления» она была несовершеннолетней, применить к ней наказание в виде предупреждение. При этом вину с неё никто не снял. Ведущую роль в защите и поддержке Вики сыграло женское сообщество в лице Ассоциации “ЕВА”.

Ситуацию с делом Вики комментирует правозащитница Елена Титина, руководительница БФ «Вектор жизни», которая выступала общественой защитницей в суде: «Женщины подвергаются еще большей стигме, осуждению, поэтому не защищают себя. Дело Вики очень показательно в этом. Девочке пришлось в течение трех лет, пока длился весь судебный процесс, просто выслушивать оскорбления, унижения в свой адрес, реплики некорректные — и со стороны истца, этого 31-летнего мужчины, со стороны судей, прокуроров, даже адвокаты порой вели себя как слоны в посудной лавке. Она, на мой взгляд, героиня. Я не уверена, что взрослая женщина выдержала бы то, что выдержала Вика, и дойти до конца, защищая свои права. С нее сняли уголовную статью. Уникальное дело, я очень горжусь, что я в нем участововала. Это единственное на сегодняшний момент дело, которое так закончилось, потому что больше таких прецедентов, с условным хэппи-эндом я не знаю».

В Уголовном кодексе Российской Федерации, в которой только официально зарегистрировано почти полтора миллиона случаев ВИЧ-инфекции у граждан, существует статья 122 “Заражение ВИЧ-инфекцией”. Дезагрегация данных начата в 2017, с 01.01.2017 по 31.12.2019 всего в рамках 122 статьи вынесено 150 приговоров по основной квалификации по частям 1-4. 93 приговора вынесено в отношении мужчин (62%), 57 (38%) — в отношении женщин. Примечательно, что по части 1 “Заведомое поставление другого лица в опасность заражения ВИЧ-инфекцией” осуждается больше женщин: 56,4% против 43,6% мужчин.

По данным Министерства здравоохранения Республики Таджикистан за 2018 год, всего по стране насчитывалось 10,7 тысяч людей с ВИЧ, из них порядка 7 тысяч — мужчины. Отмечено, что в 54,6% вирус передался половым путем, а в некоторых регионах доля таких случаев достигает 70%.

Для справки: с июля 2015 года для регистрации брака в Таджикистане необходимо пройти медицинское обследование, которое включает тест на ВИЧ.

Таджикистан стал одной из немногих стран (и единственной в регионе ВЕЦА), которой КЛДЖ дал рекомендацию от 09 ноября 2018 года: “Декриминализировать передачу ВИЧ/СПИДа (статья 125 Уголовного кодекса), и отменить постановления правительства от 25 сентября 2018 года и 1 октября 2004 года, запрещающие ВИЧ-положительным женщинам получать медицинскую степень, усыновлять ребенка или быть законным опекуном”.

Вместо этого, 02 января 2019 года президент страны Эмомали Рахмон подписал ряд законов, в том числе направленных на «усиление ответственности врачей, работников салонов красоты, парикмахерских и предприятий по обслуживанию, которые из-за несоблюдения санитарно-гигиенических, санитарно-противоэпидемических правил и норм стали причиной заражения вирусом ВИЧ/СПИД». С этого момента в СМИ появилось множество публикаций, иллюстрирующих не только широкое информирование граждан Таджикистана о выполняемых предписаниях, но и увеличение количества публикаций об уголовных наказаниях в связи с ВИЧ.

По результатам медиа-мониторинга, который проводит Евразийская Женская сеть по СПИДу, в 2019 году в электронных СМИ Таджикистана зарегистрировано 23 публикации по теме ВИЧ. Среди них поровну разделили места две темы — это общая информация относительно ответственности за передачу ВИЧ и статистика, а также публикации, в которых обвиняются женщины, как, например:

“27-летняя женщина подозревается в преднамеренном заражении ВИЧ/СПИД”,

“Двух женщин на севере Таджикистана осудили за заражение ВИЧ-инфекцией”,

“В Таджикистане вынесли приговор женщине, обвиняемой в «умышленном заражении ВИЧ» 23 мужчин”,

“Жительница Куляба Таджикистана подозревается в преднамеренном заражении ВИЧ”,

“Две женщины в Хатлоне заразили десятки мужчин”.

Среди этих публикаций нет ни одной, описывающей частные случаи в отношении мужчин. Об уязвимости женщины мы уже писали в августе прошлого года в нашем интервью с адвокатессой Зебо Касимовой.

Статистические данные о количестве дел, возбужденных по статье 125 УК Республики Таджикистан, “Заражение ВИЧ-инфекцией”, нам получить не удалось. Особенно важной была бы информация с разбивкой по полу — то есть дезагрегированные данные, сбор которых имеет особый смысл, ввиду аргументации государства о защите женщин. О важности дезагрегированной статистики говорится в Целях устойчивого развития — Резолюции, принятой Генеральной Ассамблеей ООН в 2015 году: только точные, достоверные, всесторонние тематические данные позволят понять проблемы, стоящие перед нами, и найти для них самые подходящие решения.

Елена Стрижак, одна из основательниц Евразийской Женской Сети по СПИДу и руководительница БО “Позитивные женщины”, активно продвигает тему декриминализации ВИЧ в Украине: “Я уже второй год состою в комитете по валидации элиминации передачи ВИЧ и сифилиса от матери к ребенку при Министерстве здравоохранение Украины, и активно принимаю участие не только в деятельности комитета в нашей стране, но и посещаю международные заседания Комитета в ВОЗ, общаюсь со многими людьми, работающими в этой сфере.

Одним из препятствий к тому, чтобы женщины вовремя обращались за медицинской помощью и за лечением, служит страх обвинения, страх перед возможной криминальной ответственностью. У нас в Украине я смогла получить статистические данные о количестве уголовных дел по статье 130 УК Украины, с разбивкой по полу. Была удивлена статистикой, потому что, начиная с 2015 года, по этой статье были осуждены исключительно женщины. Это негативно отражается не только на самих женщинах, но и на эффективности реализации государственных программ, в том числе на процессе валидации элиминации передачи ВИЧ от матери к ребенку”.

Из последнего кейса по Украине, за 2018 год: «…Так как подсудимая отказалась, специалист службы по делам детей протянула руки к ребенку с целью забрать ее, но подсудимая укусила ее за левую руку». Из обвинительного приговора: «Суд принял решение квалифицировать действия подсудимой … ч. 4 ст. 130 УК Украины как оконченное покушение на умышленное заражение другого лица вирусом иммунодефицита человека».

Означает ли, что если осужденными оказались только женщины, тот факт, что только женщины являются источниками инфицирования? Из альтернативного теневого доклада Таджикистанской сети женщин, живущих с ВИЧ, представленного на 71-й сессии Комитета ООН по ликвидации всех форм дискриминации в отношении женщин в ноябре 2018 года: “При нарушении их прав, как правило, женщины никуда не обращаются. В ходе изучения ситуации при написании данного отчета выявлены нарушения прав женщин, живущих с ВИЧ, и женщин из затронутых групп, только единицы решились защищать свои права и то, потому что им был предоставлен адвокат за счет проекта. Причины такого поведения различны. Одна из основных причин, это отсутствие финансовых средств на оплату услуг адвоката. Во-вторых, многие женщины, живущие с ВИЧ, и женщины из затронутых ВИЧ групп имеют низкую правовую грамотность, у них нет информации о том, к кому обратиться по тому или иному вопросу. В-третьих, самостигматизация и боязнь разглашения конфиденциальности также мешает женщинам, живущим с ВИЧ, и женщинам из затронутых ВИЧ групп защищать свои права.”

Из доклада ясно, что женщины не защищают свои права, особенно по таким чувствительным вопросам, из-за страха почувствовать еще больше осуждения и стать еще более уязвимыми. Кроме того, в странах Центральной Азии, в семьях есть традиции, когда невестка должна сказать мужу или свекрови, куда она идет, и на что она собирается тратить или потратила деньги (к слову об оплате адвоката). Женщины зависят от других членов семьи, и часто не имеют своих собственных денег.

Насилие в отношении женщин увеличивает для них риск инфицирования ВИЧ, в то же время само наличие ВИЧ-инфекции у женщины также увеличивает опасность насилия, в том числе и со стороны родственников, из-за ее уязвимости и заниженной самооценки.

Криминализация ВИЧ, ни как превентивная мера, ни как способ защиты женщин от инфицирования не работает, как это пытаются представить люди, принимающие решения. Наоборот, на конкретных примерах мы наблюдаем, что женщины оказываются более уязвимыми.

Источники:

[1] — Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011 Aug 11; 365:493-505.

[2] — Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, van Lunzen J, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA. 2016; 316:171-81.

[3] — Grulich A, Bavinton B, Jin F, Prestage G, Zablotska, Grinsztejn B, et al. HIV transmission in male serodiscordant couples in Australia, Thailand and Brazil. Abstract for 2015 Conference on Retroviruses and Opportunistic Infections, Seattle, USA, 2015.

[4] — Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour M, Kumarasamy N, et al. Antiretroviral Therapy for the Prevention of HIV-1 Transmission. N Engl J Med. 2016 Sep 1; 375(9):830-9. 

HIV JUSTICE WORLDWIDE COVID-19 criminalisation statement now available in Arabic

Today, the HIV JUSTICE WORLDWIDE Steering Committee statement on lessons learned from HIV criminalisation as it relates to COVID-19 criminalisation, has been published in a fifth language, Arabic.

Download the statement in Arabic / تحميل البيان باللغة العربية

We are grateful to our Global Advisory Panel member, Elie Balan, head of the LGBT Health Department (M-Coalition) at the Arab Foundation for Freedoms and Equality, for undertaking the translation. 

The statement was originally published on 25 March in English, French and Spanish, and on 26 March in Russian.

The HIV Justice Network (HJN) continues to monitor the many ways legal, policy and police responses to COVID-19 is negatively impacting the human rights of people living with HIV, as well as individuals and communities most impacted by HIV. 

Each week, Sylvie Beaumont, HJN’s Research / Outreach Co-ordinator, curates our HIV Justice Weekly newsletter. She ensures that all of the previous week’s key articles and podcasts critiquing punitive responses to HIV and/or COVID-19, as well as HIV and COVID-19 criminalisation cases can be found in one place.

If you haven’t already signed up to receive the newsletter, published each Friday, you can do so at: https://www.hivjustice.net/hiv-justice-weekly

 

UNAIDS “extremely concerned” by new COVID-19 laws that target people living with or vulnerable to HIV

This week, echoing the concerns of the HIV JUSTICE WORLDWIDE Steering Committee, amongst others, UNAIDS issued a strongly worded press release condemning governments for abusing the current state of emergency over the COVID-19 pandemic for overreaching their powers and enacting laws that target people who are living with, or vulnerable, to HIV.

“In times of crisis, emergency powers and agility are crucial; however, they cannot come at the cost of the rights of the most vulnerable,” said Winnie Byanyima, Executive Director of UNAIDS. “Checks and balances that are the cornerstone of the rule of law must be exercised in order to prevent misuse of such powers. If not, we may see a reversal of much of the progress made in human rights, the right to health and the AIDS response.”

Notably, UNAIDS singles out EU member states, Hungary and Poland.

In Hungary, a new bill has been introduced to remove the right of people to change their gender and name on official documents in order to ensure conformity with their gender identity, in clear breach of international human rights to legal recognition of gender identity.

In Poland, a fast-tracked amendment to the criminal law that increases the penalties for HIV exposure, non-disclosure and transmission to at least six months in prison and up to eight years in prison has been passed—a clear contravention of international human rights obligations to remove HIV-specific criminal laws.

In addition, UNAIDS condemns overly zealous policing that is especially targeting key populations already stigmatised, marginalised, and criminalised.

UNAIDS is also concerned by reports from a number of countries of police brutality in enforcing measures, using physical violence and harassment and targeting marginalized groups, including sex workers, people who use drugs and people who are homeless. The use of criminal law and violence to enforce movement restrictions is disproportionate and not evidence-informed. Such tactics have been known to be implemented in a discriminatory manner and have a disproportionate effect on the most vulnerable: people who for whatever reason cannot stay at home, do not have a home or need to work for reasons of survival.

They single out Uganda where “23 people connected with a shelter for providing services for the LGBTI community have been arrested—19 have been charged with a negligent act likely to spread infection or disease. Those 19 are being held in prison without access to a court, legal representation or medication.”

They also highlight Kenya as a model of cjvil society rapid response to human rights concerns following the release of an advisory note “calling for a focus on community engagement and what works for prevention and treatment rather than disproportionate and coercive approaches.”

The statement concludes:

While some rights may be limited during an emergency in order to protect public health and safety, such restrictions must be for a legitimate aim—in this case, to contain the COVID-19 pandemic. They must be proportionate to that aim, necessary, non-arbitrary, evidence-informed and lawful. Each order/law or action by law enforcement must also be reviewable by a court of law. Law enforcement powers must likewise be narrowly defined, proportionate and necessary.

UNAIDS urges all countries to ensure that any emergency laws and powers are limited to a reasonable period of time and renewable only through appropriate parliamentary and participatory processes. Strict limits on the use of police powers must be provided, along with independent oversight of police action and remedies through an accountability mechanism. Restrictions on rights relating to non-discrimination on the basis of HIV status, sexual and reproductive health, freedom of speech and gender identity detailed above do not assist with the COVID-19 response and are therefore not for a legitimate purpose. UNAIDS calls on countries to repeal any laws put in place that cannot be said to be for the legitimate aim of responding to or controlling the COVID-19 pandemic.

UNAIDS recently produced a new guidance document that draws on key lessons from the response to the HIV epidemic: Rights in the time of COVID-19: lessons from HIV for an effective, community-led response.   

US: New report by the Williams Institute finds that Florida’s HIV criminal laws undermine pubic health efforts

Florida’s HIV criminal laws undermine public health efforts

For Immediate Release
March 12, 2020

Media Contact
Rachel Dowd
dowd@law.ucla.edu
(310) 206-8982 (office) | (310) 855-2696 (cell)

The laws deter testing, disclosure, and other HIV prevention strategies

Florida’s HIV criminal laws may undermine the state’s public health efforts by deterring people from seeking HIV testing and treatment, stigmatizing those with HIV, and disproportionately affecting the communities most impacted by HIV, including people of color, women, LGBTQ people, and the formerly incarcerated, according to a new report by the Williams Institute at UCLA School of Law.

HIV criminalization is a term used to describe laws that either criminalize otherwise legal conduct or that increase the penalties for illegal conduct based upon a person’s HIV-positive status. Florida has four HIV-specific criminal laws.

Using data from the Criminal Justice Information Services at the Florida Department of Law Enforcement, researchers found that from 1986 to 2017, there were 266 convictions under Florida’s HIV criminal laws—approximately eight convictions per year.

None of the convictions required intent to transmit HIV as an element of the crime, and none required actual transmission of HIV.

“HIV is treatable, preventable, and harder to transmit than was thought in the early years of the AIDS epidemic when Florida’s HIV criminal laws were passed,” said lead author Brad Sears, the David Sanders Distinguished Scholar of Law and Policy at the Williams Institute. “Enforcement of these laws disproportionately stigmatizes the very communities Florida needs to engage to combat HIV.”

This research was generously funded by a grant from the Elton John AIDS Foundation.

Read the report