US: Iowa Supreme Court rejects ‘theoretical’ HIV risk, reverses ‘HIV exposure’ conviction

Last Friday, June 13, the Iowa Supreme Court set aside the ‘HIV exposure’ conviction of Nick Rhoades, who was initially sentenced to 25 years in prison, with required registration as a sex offender, after having a one-time sexual encounter with another man comprising anal sex with a condom and oral sex without whilst his viral load was undetectable.

In reversing the conviction, the Court recognised that sexual HIV exposure risks should not be based on outdated beliefs or theoretical risks and must be specific to the individual acts and situations that are before the Court.

Read the entire written judgement from the Iowa Court of Appeal

The Court’s ruling sends the case back to Black Hawk County District Court, where prosecutors could have another chance to claim Mr Rhoades actions leading up to his arrest violated the law. However, it is difficult to imagine that prosecutors would be able to establish that there is a factual basis to sustain a conviction in light of the Iowa Supreme Court’s decision, and much more likely that a District Court judge will allow his initial guilty plea – which the Court accepted was due to being poorly advised by his initial lawyer – to be withdrawn.

[Update October 1st: Assistant Black Hawk County Attorney Linda Fangman has filed a motion to dismiss the case against Mr Rhoades, meaning his six year ordeal is finally over]

The ruling came two weeks after Iowa’s Governor repealed the draconian HIV-specific law under which Mr Rhoades was convicted, replacing it with an infectious disease law that, amongst other significant improvements, provides a defence of taking “practical means to prevent transmission”, defined as “substantial good faith compliance with a treatment regimen prescribed by the person’s health care provider” and use of “a prophylactic device”.

[See this just published news story in ProPublica and Buzzfeed for more on Mr Rhoades’s case, the new Iowa law, and what else is happening in terms of US HIV criminalisation reform.]

HIV risks must be shown to be more than theoretical

The Iowa Court of Appeal’s decision was celebrated in press releases from Lambda Legal and the Center for HIV Law and Policy and in an editorial by the Des Moines Register. As well as personal victory for Nick (who last week had his GPS monitoring device removed by Senator Matt McCoy, during a moving ceremony at the HIV is not a crime conference in Grinnell, Iowa, following the new law’s retrospective removal of all people convicted of ‘HIV exposure’ in Iowa from the sex offender registry) it may also lead to judges and prosecutors revisiting outdated assumptions about HIV risk in future HIV-related prosecutions in other US states and jurisdictions.

“The importance of the Iowa Supreme Court’s decision cannot be overstated,” said Christopher Clark, Counsel for Lambda Legal. “We look forward to making these arguments again and to taking this Court’s clear guidance on the interpretation and application of these types of laws to the many jurisdictions in which HIV criminalization remains a pressing issue.”

In 2010, Mr Rhoades filed a petition in the District Court for post-conviction relief arguing that his attorney did not inform him of the specifics of the law, allowing him to plead guilty to charges that were not supported by the actual events and facts. After his petition was denied Rhoades appealed to the state Supreme Court.

Lambda Legal joined forces with Rhoades’ appellate attorneys, Joseph C. Glazebrook and Dan L. Johnston with Glazebrook & Moe, LLP based in Des Moines, Iowa, and The Center for HIV Law and Policy took the lead with the HIV Law Project in drafting a friend-of-the-court brief on the science of HIV treatment and transmission. The brief supporting Rhoades’ appeal was filed on behalf of The Center for HIV Law and Policy, the National Alliance of State and Territorial AIDS Directors (NASTAD), and the HIV Law Project.

In its ruling, the Iowa Supreme Court held that the criminal law required that a defendant “intentionally expose” another person to HIV. The court noted that the fact that HIV primarily is transmitted through sexual intercourse and contact with blood, semen or vaginal fluid is not a legally acceptable substitute for the facts necessary to say that a particular individual acted with the intent to expose someone to HIV in a manner that actually posed a real risk of HIV transmission.

Watch Lambda Legal’s Christopher Clark make his oral arguments before the Court of Appeal

Justice Wiggins, writing for the majority opinion, highlighted the specifics of the HIV risks involved in this case in three different places:

Based on the state of medicine both now and at the time of the plea in 2009, we are unable to take judicial notice that an infected individual can transmit HIV, regardless of an infected individual’s viral load, when that individual engages in protected anal or unprotected oral sex with an uninfected person. (page 3)

Today we are unable to take judicial notice that an infected individual can transmit HIV when an infected person engages in protected anal sex with another person or unprotected oral sex, regardless of the infected person’s viral load. (page 17)

At the time of the plea, Rhoades’s viral count was nondetectable, and there is a question of whether it was medically true a person with a nondetectable viral load could transmit HIV through contact with the person’s blood, semen or vaginal fluid or whether transmission was merely theoretical. The judicial notice we took in previous cases is subject to reasonable dispute here; thus, it is improper for us to similarly take judicial notice in this case. With the advancements in medicine regarding HIV between 2003 and 2008, we are unable to take judicial notice of the fact that HIV may be transmitted through contact with an infected individual’s blood, semen or vaginal fluid, and that sexual intercourse is one of the most common methods of passing the virus to fill in the gaps to find a factual basis for Rhoades’s guilty plea. Thus, there was not a sufficient factual basis for the district court to accept the plea. Therefore, trial counsel was ineffective for allowing the district court to accept the plea without a factual basis. (page 18)

In addition, the Court found that prosecutors must establish something more than that HIV transmission is theoretically plausible. The court rejected prior courts’ treatment of “possible” as meaning any likelihood of occurrence, no matter how remote. “Could” or “possible” in this context should mean, as the Iowa Supreme Court said, “the reality of a thing occurring, rather than a theoretical chance.” It also said that prosecutions must rely on expert testimony about actual transmission likelihood in these cases, and defendants don’t have to show that transmission would never occur in order to successfully defend against charges of HIV exposure.

First, we recognize this statute requires expert medical testimony on the likelihood of transmission of HIV. Experts are not required to testify in absolutes when it comes to causation….Second, and more importantly, we would not want to deprive a person of his or her liberty on the basis the defendant’s actions caused something that can only theoretically occur. (page 8 )

Of note, bearing in mind that only 25 percent of the more than 1 million individuals in the US who are living with HIV are achieving viral suppression, the amicus (friend of the court) brief was careful not rely too much on treatment’s impact on viral load, and rather emphasised the already low per act risk of transmission via various forms of sexual contact, regardless of whether the person was on treatment.

Rhoades v. State of Iowa, Amicus Brief, Supreme Court of Iowa

Iowa Governor Terry Branstad signs 'Contagious or Infectious Disease Transmission Act', replacing draconian, unscientific HIV-specific law

Des Moines, Ia. — Today, Iowa Governor Terry Branstad signed into law Senate File 2297, bi-partisan legislation that will modernize Iowa’s HIV criminal transmission statute to make the statute consistent with contemporary science, improve public health and lessen stigmatization of people with HIV.

See more at: http://www.thebody.com/content/74558/iowa-first-to-reform-hiv-criminalization-statute.html

US: On eve of national HIV criminalisation conference Iowa's remarkable advocacy success is the model for other states to follow

If Gov. Terry Branstad signs Senate File 2297 on Friday as planned, Iowa will become the first state in the country to repeal and replace its criminal transmission of HIV law, activists say.

The law being reformed had been on the books since 1998. A broad coalition of groups, led by the Community HIV and Hepatitis Advocates of Iowa Network (CHAIN), has been working for the past five years to modernize it.

Advocates said the new law better reflects advances in science, medicine and understanding of how HIV is transmitted.

Until now, Iowa has had one of the harshest HIV transmission laws in the country. Under the 1998 law, persons with HIV could face 25 years in prison and inclusion on the sex offender registry if they could not prove they disclosed their status to a sexual partner — even if no transmission occurred and precautions such as condoms were used.

Under the new law, there is a tiered penalty system, which takes into account whether a person took precautions, whether transmission of HIV actually occurred and whether or not the person intended to transmit HIV.

The new law also adds other infectious diseases to the bill such as hepatitis, tuberculosis and meningococcal disease, which causes meningitis — so the law is no longer HIV-specific.

Finally, it removes the requirement those convicted register as sex offenders, and it will allow people convicted under the old law to be expunged from the registry.

Both the Iowa House and Senate unanimously approved the bill this year, a stark contrast to the four previous years, when similar bills languished in the legislature.

“You have to be in it for the long haul. It’s not an easy process,” CHAIN community organizer Tami Haught said of the group’s lobbying efforts. “We’re still dealing with a lot of the stigma that was around in the ’80s.”

She said when activists set out to change the law five years ago, they hoped to simply see the criminalization law repealed. But that wasn’t palatable to some lawmakers and county prosecutors, who said they still wanted to hold people with HIV accountable for protecting their sexual partners.

Finding ways to compromise was key to getting the sweeping bipartisan support needed, Haught said. Other tactics included meeting frequently with lawmakers, engaging in community education and gathering as many organizations to voice their support as possible.

CHAIN partnered with groups ranging from the Iowa Attorney General’s Office and the Iowa Department of Health to the League of Women Voters, the Family Planning Council and the Interfaith Alliance.

“We were up at the capitol almost every day it was in session talking with legislators. and that’s what needed to happen,” Haught said. “In 2014, maybe there was only one legislator who was not familiar with the law. When we started, a majority of legislators didn’t even know the law existed.”

NATIONAL ACTIVISTS LOOK TO IOWA

CHAIN’s tactics will be on display next week. The changes to Iowa’s law made national news, and activists hope to replicate those efforts in other states.

National group the Sero Project, founded by Iowa City native Sean Strub, is organizing a conference, HIV Is Not a Crime, to be held in Grinnell starting on Monday of next week.

Numerous laws similar to Iowa’s were passed in different parts of the country in the late 1990s in the wake of a high profile 1996 incident in New York. In that case, a man was charged with intentionally infecting 13 women and girls with HIV.

Additional pressure came from the federal government, which at the time required states to have an HIV transmission law on the books to access federal funding for HIV prevention and treatment through the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act.

Today, there are 34 states with a HIV-specific criminalization on the books. Only two had harsher penalties than Iowa. Now, Iowa has become a model for how change could happen elsewhere.

When they started work on the conference, organizers were hoping for perhaps 50 people to attend. As of earlier this week, more than 170 activists from across the United States and four other countries have signed up to spend June 2 through 5 to learn and share lobbying and education techniques related to HIV transmission decriminalization.

“We wanted to bring advocates to one place and give them the tools to go home and try to modernize the laws,” Haught said.

Foremost of those tools should be a willingness for people living with HIV to share their own stories, she said.

“We need to speak up and show we are your neighbors, your friends, your family members,” she said. “Sharing our stories had a great impact on legislators.”

Some of those who has shared their stories include Iowans convicted under the 1998 law. One of those is Donald Bogardus, 43, of Waterloo.

GETTING HIS LIFE BACK

Bogardus was convicted under the old law after authorities said he had unprotected sex with a man three times in 2009.

The man didn’t contract HIV. Bogardus had an undetectable viral load, which means the virus could not be detected in his blood.

People with an undetectable viral load have almost no chance of transmitting the virus. The new law takes that into consideration when sentencing — the old law did not.

“It was not my intent to hurt him by far,” Bogardus said in a video the Sero Project made to tell his story. “The reason I didn’t disclose was I was afraid of rejection. I was afraid of being talked about. I was afraid of losing a friend.”

He spent two months in prison — he was facing 25 years — before receiving a suspended sentence in February, with two to five years of probation. He also had to register as a sex offender, which meant he lost his job as a certified nursing assistant at Country View, a Black Hawk County-owned nursing and mental health care center.

Now that his name will be taken off the registry, effective July 1, he’s hopeful he will be able to return to his old job.

“It has lifted a burden off of me. I’m just being able to get my life back,” he told The Gazette. “I felt like I was in a big cage, and now I feel some relief.”

He also believes the changed law will encourage more people to get tested in the first place because, under the old law, the only defense was not knowing you were HIV positive. The new law also encourages behavior public health officials are pushing, Haught said.

“Now we are incentivizing doing the right thing. If you are taking your medication and using protection, you can’t be prosecuted,” she said.

She said she wants HIV to be treated just as any other communicable disease.

“We’re hoping this will help reduce the stigma associated with being HIV positive and encourage testing and treatment,” she said.

Read more: http://thegazette.com/subject/news/new-hiv-transmission-law-makes-iowa-model-for-nation-20140529#ixzz33CDVnzKV

US: Iowa modernises its HIV-specific law, SF 2297 passes unanimously

(Press release from One Iowa.  Further detailed analysis will be available soon)

DES MOINES–After a series of negotiations, a historic bill passed through the Iowa House early this morning that will modernize Iowa’s discriminatory HIV law. Iowa’s current law, 709c, is based on outdated science and beliefs that actually discourages testing and disclosure because of severe penalties associated with simply knowing one’s status. The new bill, Senate File 2297 (SF2297), will change the law so that it is no longer HIV specific, and converts sentencing into a tiered system instead of the “one size fits all” approach used in 709c. The bill unanimously passed the Iowa Senate in February, and moved to the House for debate this morning. The bill, which also passed unanimously in House chambers, will now head to Governor Terry Branstad’s desk for his signature.

The proposed changes to the law are supported by One Iowa, the state’s leading lesbian, gay, bisexual and transgender (LGBT) organization, and by Community HIV/Hepatitis Advocates of Iowa Network (CHAIN), an organization that has spent the last 5 years trying to reform Iowa’s HIV law. Iowa currently has one of the harshest laws in the nation that targets people living with HIV and AIDS.

“After 5 long years of fighting to change Iowa’s law, those of us living in Iowa with HIV and AIDS can finally breathe a sigh of relief,” said Tami Haught, Community Organizer with CHAIN. “We commend the leadership in the Senate and the House for understanding the importance of this bill and the need to modernize Iowa’s draconian 709c law. None of this would be possible without the bipartisan support of Senators Matt McCoy, Steve Sodders, Charles Schneider and Rob Hogg; in addition to Representatives Beth Wessel-Kroeschell, Chris Hagenow and Chip Baltimore. The changes in this new bill are a step in the right direction.

“While the bill that passed today will have a lasting and positive effect on the lives of many Iowans who currently live with HIV and AIDS in our state, our work is far from over,” Haught added. “We must continue our outreach and education within the public sphere about the realties of those living with HIV, to dispel the harmful stereotypes, stigma and misinformation often associated with the disease. Our hope is that by beginning to modernize the laws in Iowa, it will signal other states with similar legislation to do the same. HIV is not a crime; our laws here in Iowa and across the country need to reflect this fact.”

“We are pleased to see Iowa’s policy makers move this bill forward,” said Donna Red Wing, Executive Director for One Iowa. “The changes proposed in this bill will have a profound impact on the lives of Iowans living with HIV and AIDS. This bill will send an important message across the nation, most significantly to those states that still operate under the misinformation of the past. We applaud CHAIN’s efforts, but especially the work of Community Organizer Tami Haught. Tami has fearlessly and passionately shared her story with legislators and community members alike. She has changed hearts and minds, and should be commended as one of the many unsung heroes of this movement. After 5 years of conversations and perseverance, today we celebrate a victory for Iowa’s HIV community.”

US: Second attempt to modernise Iowa's HIV-specific criminal law during current legislative session

A new bill, introduced Monday by Senator Rob Hogg, along with bi-partisan support, seeks to reform Iowa’s 709c HIV law. Iowa’s 709c law states a person has committed criminal transmission of HIV if that person knowingly engages in intimate contact without disclosing his or her positive status, whether infection occurs or not. If passed, the new law would no longer be specific to HIV, and would rely on a tiered sentencing system, rather than the current “one size fits all” approach.

Tami Haught of Community HIV/Hepatitis Advocates of Iowa Network (CHAIN) explains the tiered system of sentencing, “If someone intends to transmit and transmission takes place it is still a class B felony, if there is intent but no transmission it is a [class] D felony and if there is no intent but transmission takes place it is a class D felony.”

Haught also goes on to explain that under the new bill, Iowans would no longer be sentenced as sex offenders and a retroactive clause in the bill would remove anyone sentenced under 709c from the sex offender registry. Prosecutors would also have to prove substantial risk, rather than the current law which simply requires non-disclosure.

CHAIN along with One Iowa, the state’s leading lesbian, gay, bisexual and transgender organization, are both supportive of the changes proposed in the bill, and CHAIN has worked hard to reform the law, which they describe as discriminatory.

“This bill is a step in the right direction and will have a profound impact on the lives of Iowans living with HIV and AIDS,” says Haught. “This bill, if passed through the Senate and the House, will be a significant victory for Iowa and Iowans living with HIV. Our work is far from over, however. We must continue to dispel the stigma and misinformation that surrounds HIV and those who live with it each and every day. HIV is not a crime, and this bill would reflect that. It would lift a burden from Iowans living with HIV and AIDS, and is a vast improvement from the current law.”

“We commend Senator Hogg for his efforts and we support this important move forward,” says One Iowa Executive Director Donna Red Wing. “In addition, we thank Senators Matt McCoy, Charles Schneider and Steve Sodders for bringing much-needed public attention to this important issue. We congratulate members of CHAIN on this victory, and are sincerely grateful for Community Organizer Tami Haught’s tireless efforts. Tami is one of the many unsung heroes of this movement. None of this would have been possible without her passion and perseverance, but more importantly her willingness to share her personal story with legislators and community members. Today is a step forward for Iowa, as we continue to work with the state legislature on both sides of the aisle to ensure equality and justice for all Iowans.”

The bill will be up for discussion Tuesday afternoon in a judiciary subcommittee hearing at 4:30.

US: Will Donald Bogardus be the last person to be convicted under Iowa’s overly draconian HIV-specific law?

Earlier this month, Donald Bogardus, 42, was given the lightest-ever sentence for HIV non-disclosure in Iowa.  He had faced up to 25 years in prison but was given a suspended sentence with two to five years of probation. However, he will also have to register as a sex offender and will likely lose his job as a certified nursing assistant as a result.

Watch Donald tell his story to the SERO Project.

Donald, who was diagnosed in 2007, was arrested in 2009 for having consensual unprotected sex three times with a male partner (who remained HIV-negative) without disclosing that he was HIV positive.

He was charged under Iowa Code § 709C.1, which states: “a person commits criminal transmission of [HIV] if the person, knowing that the person’s [HIV] status is positive … [e]ngages in intimate contact with another person.” The statute defines “intimate contact” as “the intentional exposure of the body of one person to a bodily fluid of another person in a manner that could result in the transmission of [HIV].”

As recently as July 2013, the Eighth Circuit Court of Appeals ruled that Iowa’s HIV law was not unconstitutionally vague and upheld the conviction of Adam Musser, who was sentenced to 50 years for not disclosing his HIV-positive status to four women.

Donald was supported through this ordeal by fellow criminalisation survivor, Nick Rhoades, who used a condom, had an undetectable viral load and did not transmit HIV but was sentenced to 25 years by an Iowa court for not disclosing his HIV-positive status to his male partner.  Later reduced to a year served, he now must register as a sex offender for the rest of his life.

(Nick’s story has been covered sympathetically by mainstream news outlets, including CNN, and formed the basis of a major ProPublica investigation, published last December 1st.)

Last September, the Iowa Court of Appeals upheld Nick’s conviction, finding that because he did not use a condom during oral sex there was stll a chance of transmission.

However, Rhoades and his attorneys at Lambda Legal will have another opportunity to argue that the charge and conviction is not based on current science, and the case will soon be heard at the Iowa Supreme Court.

These three cases are the tip of the iceberg, however. There are only 2000 people living with diagnosed HIV in Iowa and yet

Between January 1999 and June 2011, 25 people were charged and 15 were convicted. In 2012, Iowans were paying for the prison sentences of eight Iowans because of this law.

This quote comes from one of two editorials published this week in Iowa newspapers that are supporting a change in the law. The Des Moines Register‘s editorial, entitled ‘Lawmakers should correct Iowa’s HIV mistake‘ begins

During an election year, Iowa lawmakers are reluctant to do anything that could be construed as remotely controversial. it should not be controversial for them to fix a mistake they made 15 years ago that is ruining the lives of innocent Iowans. Lawmakers and Gov. Terry Branstad should repeal a statute that criminalizes the actions of Iowans who are HIV-positive when they have harmed no one.

Meanwhile the Press-Citizen argues that there is ‘Still time to fix Iowa’s HIV law this session’. It covers both Nick’s appeal and the law reform process.

We can only hope the Iowa Supreme Court will be more inclined than the lower court to take new scientific evidence into consideration and move away from past rulings. But whatever the state Supreme Court decides, it’s time for state lawmakers to fix the law. At the very least, lawmakers need to clarify that both intention to transmit and actual transmission is needed for prosecution. They also should specify that the type of sex act, condom usage and the defendant’s viral load need to be taken into account for decisions on prosecution and sentencing. At best, they could repeal the misguided law completely.

These editorials are the result of extremely hard work undertaken by a broad coalition of local and national advocates, and were timed to coincide with yesterday’s “Day on the Hill” when HIV advocates in Iowa visited the Capitol in Des Moines to talk with State legislators about modernising Iowa’s HIV specific legislation.

According to Tami Haught, of CHAIN (the Community HIV/Hepatitis Advocates of Iowa Network) they were able to speak with half of all state Representatives and nearly two thirds of all Iowa Senators.  This may create the final push for law reform this legislative session (which ends in April).

Immediately following Donald Bogardus’ sentencing, according to the Waterloo Cedar Falls Courier

Sen. Steve Sodders, a Democrat from State Center, proposed changes to “modernize the draconian law.” The bill has been referred to the Senate Judiciary Committee, causing a ripple of Capitol support. “It’s important that we decriminalize some of the effects of this old law. It’s just outdated, and we have to keep up with modern medicine,” Sodders said.

Sen. Charles Schneider, a Republican from West Des Moines and ranking member on that committee, said GOP members in both chambers agree there should be changes to the law. “What I think we need to do is just educate people that the current penalty is more punitive than it needs to be for people who are treating effectively the transmittable disease that they have,” he said.

Attorney General Tom Miller, who supported changes to the law last year, reaffirmed his support this session. Miller said he’s “firmly convinced the statute needs to be changed” and that his office is working with lawmakers to update the statute.

The full text of Senate File 2086, which would create a new law, The Contagious or Infectious Disease Transmission Act, can be found here.

This is a summary what they are proposing.

The proposed Contagious or Infectious Disease Transmission Act would try people who transmit diseases like HIV, Hepatitis C and tuberculosis under the same statute.

It aims to delineate between someone with a criminal intent to infect and simply failing to disclose their status, taking into account whether an infected person used protection or is taking medications to limit the risk of transmission.

Under the new law, a person does not act with criminal intent necessary for a conviction simply by knowing their status and having sex.

Offenders who knew their status would get up to 10 years incarceration — a class C felony — for intentionally transmitting a disease. If they didn’t infect their partner, the sentence would drop to a class D felony or 5 years in prison.

If a person who knew their status and didn’t intend to infect their partner, but acted with a reckless disregard for their health, the violation becomes an aggravated misdemeanor.

The bill eliminates the requirement to register as a sex offender.

With a groundswell of support for modernisation, it seems very likely that Iowa will soon become the first state in the United States to achieve HIV criminalisation law reform.

Switzerland: New handbook for parliamentarians on effective HIV laws includes case study and interview with Green MP Alec von Graffenried

A new publication from the Inter-Parliamentary Union (IPU) and United Nations Development Programme (UNDP), written by Veronica Oakeshott, is an excellent new resource to help inform advocacy efforts to remove punitive laws and policies that impede the HIV response.

Aimed at parliamentarians, ‘Effective Laws to End HIV and AIDS: Next Steps for Parliaments’ (aussi disponible en français) is a practical handbook showing which types of laws are helpful and unhelpful in the HIV response, and provides examples of legislation from around the world that have been effective in limiting new HIV infections.

It also includes case studies and interviews with some of the parliamentarians involved in law reform, most notably with Swiss MP Alec Von Graffenried whose last minute amendment resulted in the new Law on Epidemics containing a clause that only criminalised intentional disease transmission.

Other case studies highlighted in the handbook include: decriminalisation of sex work in New Zealand; decriminalisation of personal drug use in Portugal; ending discrimination against people living with HIV in Mongolia: and legal recognition for transgender and intersex people in South Africa.

The Swiss Law on Epidemics was finally passed, following a national referendum, in September 2013.  However, it won’t come into effect until January 2016.

Below is the section explaining how and why the Swiss law reform process took place. It’s an excellent example of how advocates saw an opportunity to work with clinicians, scientists and key parliamentarians in order to make a difference.  It also shows that the law reform process can be a slow and complex undertaking. Patience here is definitely a virtue.

Switzerland: Decriminalisation of unintentional HIV transmission and exposure

Alec Von Graffenried, MP, Switzerland, 2013. “I am delighted my amendment was successful. We can still prosecute for malicious, intentional transmission of HIV. But I expect those cases will be very rare. What has changed is that now people living with HIV – which these days is a manageable condition – will be able to go about their private relations without the interference of the law. They can access medical services without fear. All the evidence suggests that this is a better approach for public health.”

Name of act

The Epidemics Act 2013

Summary

Repeals and replaces the old Epidemics Act and in doing so, changes Article 231 of the Swiss Penal Code, which in the past has been used to prosecute people living with HIV for transmission and exposure, including cases where this was unintentional. The changes mean that a prosecution can only take place if the motive of the accused is to infect with a dangerous disease. Therefore, there should be no further cases for negligence or cases where the motive was not malicious (i.e. normal sexual relationships).

Why the law is important for HIV

Criminalization of HIV transmission, exposure or non-disclosure creates a disincentive for testing and gives non-infected individuals false confidence that they will be informed of any infection. In reality, their partner may not even know his or her HIV status and everyone should be responsible for protecting their own sexual health. The latest scientific findings have shown that people on HIV treatment who have an undetectable viral load and no other sexually transmitted infections are not infectious. Such people may want to have consensual unprotected sex. Criminalizing them for doing so has no positive public health impact and is an intrusion into their private life. UNAIDS is calling for the repeal of all laws that criminalize non-intentional HIV transmission, non-disclosure or exposure.

How and why was decriminalization of HIV transmission and exposure introduced in parliament?

In 2007, the Swiss Government decided to revise the Swiss law on epidemics. This was not an HIV-specific law and the decision to review it was not HIV-related but due to concerns that Switzerland was not well-placed to deal with other global epidemics, such as severe acute respiration syndrome (SARS) and H1N1. However, HIV campaigners and persons working in public health saw an opportunity to insert a clause into the Act that would amend Switzerland’s current Penal Code, Article 231 of which has been used to prosecute people living with HIV for transmission and exposure. Since 1989, there have been 39 prosecutions and 26 convictions under Article 231 in combination with the Swiss law on “grievous bodily harm”.

In December 2007, the government began a consultation on a draft Epidemics Bill and campaigners proposed a clause in it amending Article 231 of the Penal Code. In 2010, the government introduced the draft Bill into parliament. However, HIV campaigners were not happy with the new Bill as tabled and campaigned for changes throughout its passage through parliament. Improvements to the Bill were made at the Committee stage but it was not until the final vote at the National Council in 2013 that a last-minute amendment was tabled by Green MP Alec von Graffenried, which achieved campaigners’ core aim of decriminalizing unintentional transmission or exposure.

Was cross-party support secured and, if so, how? How was a majority vote secured?

The last-minute amendment was tabled and passed with 116 votes to 40. The key arguments made in favour of the amendment centred on the unsuitability of public health law to deal with private criminal matters. This rather theoretical argument appealed to legislators, many of whom are practising lawyers or have a legal background. However, the wider case for decriminalization had been made to parliamentarians over a period of many years inside and outside parliament and was reinforced by new sci- entific announcements and court decisions. MPs across the political divide realized that HIV is no longer a death sentence, but a manageable condition and that the right treatment can reduce an individual’s infectiousness to zero. In this context, MPs were more open to the idea of legal change.

During the campaigning period of many years, different arguments were made to appeal to different MPs across the political spectrum. Those on the right often responded best to the notion of an individual’s responsibility to protect their own sexual health and those on the left responded better to public health arguments. Efforts were also made to lobby the head of health departments at the regional level, who were then able to communicate their support for the change to colleagues at the national level.

How long did it take to pass the law?

It took almost six years from the consultation on the first draft of the Bill until it was confirmed by referendum in September 2013. The law will come into effect in January 2016.

 

Read and/or download the entire publication below.

Effective Laws to End HIV and AIDS: Next Steps for Parliaments. Inter-Parliamentary Union, 2013

Switzerland: How effective HIV treatment has impacted upon the criminalisation of HIV exposure

The preventative effect on HIV transmission of being virally suppressed due to antiretroviral therapy (ART), as recognized by the Swiss Commission for HIV/AIDS in 2008, has helped to reduce the criminalization of HIV exposure in Switzerland. Since the Swiss statement’s release, there have been acquittals of two HIV exposure cases in 2009, no further prosecutions for HIV exposure and alterations to the law used in these cases, according to study results presented at EACS 2013 in Brussels, Belgium.

Although Switzerland is not the only country to criminalize HIV, the country did have one of the most severe HIV criminal legislation in Europe, together with Sweden and Austria. Swiss law had considered exposure to HIV, defined as sex without a condom between an HIV-infected individual and an HIV-uninfected individual, a criminal offense. This was the case even if the HIV-uninfected partner gave consent, there was no transmission or the HIV-infected partner did not know his or her status.

The criminal cases were based in two articles of the Swiss penal code: 122, which concerns serious bodily harm, and 231, which covers transmission of human diseases. The latter, despite supposedly being a public health measure, had only been invoked in cases of HIV exposure or transmission. From 1990 onward, this legal apparatus had resulted in more than 80 proceedings, with 48 prosecutions — over half of them due to exposure only, with no transmission having happened.

This scenario started changing in 2008, according to Deborah Glejser and Sascha Moore Boffi, from Groupe Sida Genève, a Swiss community-based HIV organization. Glejser performed a survey that reviewed criminal judgments in Swiss cantonal and federal courts, statements by stakeholders and policy makers and records of parliamentary sessions since 2009. Glejser states that the turning point for advocacy work against criminalization was the declaration issued by the Swiss Commission for HIV/AIDS (now known as the Swiss Commission for Sexual Health) in 2008.

The Swiss statement, as it became known, stated that “HIV-positive individuals on effective antiretroviral therapy who have had an undetectable viral load for at least six months and without sexually-transmitted infections are sexually non-infectious.” Due to the worldwide controversy created by the declaration, it was not immediately used in court, with Swiss prosecutors trying to have it removed from debates so as not to be used as a defense. Although there was international acknowledgement of the Swiss statement in 2009, advocacy groups did not wait for it, using policy briefs by UNAIDS to show that criminal laws against HIV transmission had no impact on the spreading of the virus or containment of the epidemic.

A breakthrough came in December 2008 in the case of an HIV-infected man who was condemned to a year and a half of prison by a Geneva court. The man knew he had an undetectable viral load and had sex with two consenting HIV-uninfected women. Although no transmission occurred, the two women sued the man, who appealed the sentence. Three months later, the court cleared him of the charges stating that he was undergoing ART at the time and had little chance to infect his partners. This was the first decision of its kind in Switzerland, but not the only one. A second acquittal happened in 2009. Since then, no further prosecutions have been carried out for HIV exposure when the HIV-infected partner was on effective ART.

For Glejser, these acquittals were a major step forward and set a legal precedent, leading to a significant decrease in the number of prosecutions after 2009. This was supported in later years by changes in legislation, such as the 2012 reformation of article 231, preventing prosecution when informed consent is given. With the new wording, the article will only be invoked for intentional or malicious transmission.

HIV exposure can still be prosecuted under article 122, but thanks to a 2013 ruling by the Swiss federal court (equivalent to the U.S. Supreme Court), HIV transmission is no longer considered serious bodily harm, falling under common assault and making it easier for defendants to use the Swiss statement for defense, as well as resulting in lesser sentences.

African HIV criminalisation achievements and challenges highlighted at ICASA 2013

The African continent has more countries with overly broad and vague HIV-specific laws relating to HIV non-disclosure, exposure and/or transmission than any other global region, nearly all of which have been enacted in the past decade.

Although North America is the continent with the most known prosecutions, 26 African countries have overly broad and/ or vague HIV-specific criminal laws with a further three countries considering new HIV-specific criminal laws. This is worrying and disappointing given the growing evidence base and consensus of international agencies that such laws are counterproductive to HIV prevention efforts and generally fail to deliver ‘justice’.

Although there are few known prosecutions the majority of those prosecuted have been women – who are usually the first in a couple to know their HIV status due to routine antenatal testing and who are often erroneously accused of bringing HIV into a relationship.

In addition, South Africa recently prosecuted alleged criminal HIV transmission as attempted murder despite no evidence of intent to harm. (Read the judgement from the High Court of South Africa on alleged HIV exposure being attempted murder here.)

However, there have been some positive legal changes brought about by local advocacy supported by international civil society and UN agencies. Since 2010, at least four countries – Congo, Guinea, Senegal and Togo – have revised their existing HIV-related legislation or adopted new legislation that restrict use of criminal law to cases of intentional transmission.

And more recently advocacy in Malawi and Nigeria has resulted in the removal of overly broad HIV-specific criminal statutes from draft omnibus HIV Bills.

View the poster below or download the A4 double-sided printable version of the poster here.

Advancing HIV Justice: Achievements and challenges in global advocacy against HIV criminalisation – African…

Sweden: Court of Appeal acquits ‘HIV exposure’ case, recognises National Board of Health and Welfare endorsement of ‘Swiss statement’, Minister for Social Affairs will consider reviewing application of law

Today, the Court of Appeal for Skåne and Blekinge has acquitted a man from Malmö previously convicted of exposing four women to HIV on the grounds that since he had a stable undetectable viral load on antiretrovirall treatment with no other STIs he could not cause danger to another person.

He had previously been sentenced to a year in prison and and fined 150,000 kronor (€17,000) by the lower court, but was released last week pending the appeal after the Court consulted experts from the Swedish Institute for Communicable Disease Control (SMI).

A press release from the Swedish Courts notes the following (unofficial translation)

The Court of Appeal, for its assessment of the probability of transmission by sexual intercourse, had access to information other than that which existed at the district court. The Court of Appeal has obtained an expert opinion from the Swedish Institute for Infectious Disease Control (SMI) regarding the risk of transmission of HIV through unprotected sexual intercourse. Furthermore, Professor Jan Albert of the Karolinska Institute, was consulted as an expert.

For expert opinion and data Jan Albert has said it can be clearly concluded that the risk of transmission of HIV in vaginal intercourse without a condom is very low, provided that the HIV-infected party is on stable HIV treatment. For an HIV-positive patient to be considered to be on stable HIV treatment, as is apparent from the opinion, it requires that the patient has a consistently high adherence to their medication, that at least two consecutive viral measurements with 3-6 month intervals show that patient’s virus levels in the blood were below the lowest detectable levels in routine testing, and the patient does not carry any other sexually transmitted infection .

The Court of Appeal noted in its judgment that the investigation did not show anything other than the accused was on stable HIV treatment during the time that the charges related to, and based on what the SMI and Jan Albert have said about risk of infection, assessing the likelihood that sexual intercourse to which the charges relate means that the risk of HIV transmission was so small that no real danger could be presupposed. Since this does not meet the required elements of the crime of creating danger to another, the indictment was dismissed.

Major policy shift

The ruling reflects a major shift in policy announced last week by the National Board of Health and Welfare (Socialstyrelsen).

In a press release entitled, ‘Effective treatment reduces the risk of infection by HIV’, the agency, which is part of the Swedish Ministry of Health and Social Affairs, clarified the treating physician and the individual’s responsibility under the Communicable Diseases Act – which creates a ‘disclosure obligation’ for anyone with an infectious disease.

The criteria to not be legally bound to disclose are very similar to those set out in January 2008 by the Swiss Federal AIDS Commission’s ‘Swiss statement’. They are, as follows:

For treatment of HIV infection to be considered well-functioning, patients must be highly adherent to antiretroviral treatment. Virus levels in the blood should be tested regularly, verified by two measurements between three to six months apart and the result should be virus levels below 50 copies per milliliter.

Follow-up tests should be performed two to four times a year. No other ongoing sexually transmitted disease should be suspected, as this could increase the risk of infection. When these criteria are met, the SMI estimates that infectivity is minimized in a person infected with HIV similar to wearing a condom during sexual intercourse.

HIV infection is one of the dangerous diseases included under the Communicable Diseases Act. The law states that the attending physician has the responsibility to advise people with dangerous diseases of appropriate conduct. It also says that if the person knows, or has reason to suspect, that he or she is carrying a contagious disease that person is obliged to protect others from infection.

The attending physician, when he or she takes a position on the conduct that the individual should have, should consider that a person with HIV infection who is on well functioning treatment is not required to inform their sexual partners about their infection…

People who have HIV infection, however, must act on their own initiative if there is a significant risk, for example if he or she also gets another sexually transmitted infection. This is true no matter what advice the person has previously received by their treating physician. A significant risk includes situations when someone risks coming into contact with his or her body fluids, for example during blood tests, at the dentists, or during sex with a risk of bleeding.

Coaltion of HIV experts

The National Board of Health and Welfare was itself influenced by a coalition of HIV experts. An editorial by Johan Carlson (Director of SMI), Anders Tegnell  (State epidemiologist, SMI), Jan Albert (Professor of Communicable Diseases, Karolinska Institute and Senior Physician at Karolinska University Hospital) and

Anders Sönnerborg (Professor of Clinical Virology,Karolinska Institut and Senior Physician at Karolinska University Hospital) entitled ‘HIV is no longer a life-threatening disease’, also published last week, heralded this new (for Sweden) paradigm.

Today, 21 October, SMI publishes along with Reference Group for Antiviral Therapy (RAV) a report summarising the state of knowledge with regard to the significant reduction in infectivity in treated HIV infection.

SMI and RAV estimates that the infectivity of a patient living with HIV and who have been stabilized on treatment is very low by sexual contact and minimal if a condom is used in vaginal and anal intercourse. This applies provided that there is no other sexually transmitted infections that can affect the risk of HIV transmission. It is therefore important to always use a condom, especially to protect against other sexually transmitted infections, but also to minimize any residual infectious risk for HIV.

This knowledge provides two important conclusions. Firstly, we improve the chances of early diagnosis and initiate treatment as early as possible…

The second conclusion is that current knowledge about HIV will have to influence society’s attitudes to and treatment of people living with HIV. Knowledge about HIV, how the virus is transmitted and what it means to live with HIV, need to be improved in the whole society. Especially within the health care and disease control work, but it is equally important in other areas of society, such as education and social services, the media and the judiciary.

Minister for Social Affairs will consider reviewing application of law

Göran Hägglund, Sweden’s Minister for Social Affairs reacted to the report by telling Sweden’s public broadcaster, SVT, that he will consider reviewing the application of law as it relates to HIV non-disclosure, exposure and transmission.

“If you have an illness that has the potential to infect, it is reasonable to disclose,” he said. “I just think that one would like to know in this situation. But the application of law is another question. Where it is possible to discuss how the law looks and applied, it may be time to consider a change.”

This policy shift is a major victory for the advocates who have been working tirelessly to change Sweden’s draconian attitude towards people living with HIV, notably the partnership of RFSU (the Swedish Association for Sexuality Education), HIV-Sweden and RFSL (the Swedish Federation for Lesbian, Gay, Bisexual and Transgender Rights) who have been lobbying and campaigning to raise awareness and advocate against Sweden’s over-punitive HIV-related policies.

Hägglund also reacted to a recently-published editorial by Marielle Nakunzi, a lawyer at RFSU, which argued that the justice system has such an outdated view of HIV that it still lives in the 1980s.

“It is a matter of making sure that we always have laws that are in tune with the state of knowledge available,” he told SVT. “Therefore, we should always consider the knowledge we have. It’s about educating the justice system.”