Canada: HIV activists form national coalition to lobby for an end to the criminalisation of people living with HIV

HIV activists form Canadian coalition to fight criminalization

Aggravated sexual assault convictions for HIV non-disclosure are unjust, members say.

A group of HIV activists, lawyers, and service providers from across Canada have formed a national coalition to call for an end to the criminalization of people living with HIV.

The Canadian Coalition to Reform HIV Criminalization, years in the making, will lobby nationally for people who have been charged for not disclosing their HIV status. Up until now, this work was only done locally and provincially, and mostly by lawyers rather than people most affected by the law.

“We have an amazing expert community of lawyers working on this issue,” says Alexander McClelland, a Montreal-based HIV criminalization researcher and member of the coalition. “But lawyers talk to other lawyers and haven’t been engaged more broadly. So hopefully we can shift things with the way the coalition is organized. We’re really centrally placing lived experience of people on our steering committee.”

Under Canadian law, a person living with HIV must disclose their status to anal and vaginal sexual partners or face the charge of aggravated sexual assault, which carries a maximum lifetime sentence and registry as a sex offender. This standard was most recently upheld in a 2012 Supreme Court of Canada ruling based on outdated science. The court ruled that to be considered safe enough not to disclose, HIV carriers must have very low viral load and wear condoms. Research now shows, however, that low viral load itself is enough to be nearly perfectly safe.

Coalition members met in October after many attended the HIV Is Not A Crime 2 Training Academy in Huntsville Alabama. Realizing the national level of organization in the United States led by people who have been charged and convicted, the attendees realized Canada needed something similar.

The coalition wants to limit prosecutions to intentional transmissions of HIV. Of over 180 known HIV prosecutions in Canada since the discovery of the virus as the cause of AIDS, there have been just two known intentional transmissions, according to Cecile Kazatchkine, senior policy analyst with the Canadian HIV/AIDS Legal Network.

The large percentage of unjust prosecutions in Canada, she says, has a chilling effect on people living with the virus.

“Many [HIV positive] people fear being prosecuted, of that happening to them at some point, like an old partner coming back to them and saying things that may not be true but it’s one word against another.”

The law is constructed to protect the sexual autonomy of women, Kazatchkine says, but it can often have the opposite effect on many HIV-positive women living in abusive relationships who fear their partners could use their status against them if they tried to leave.

“There’s a climate of fear and uncertainty that guides everything that we do and so it would be great to intervene in that and change the current situation,” adds McClelland, who lives with HIV.

Though still in its early stages, the coalition is concentrating on three areas: involving the lived experiences of those who live with the virus and have been criminally charged, lobbying provincial and federal politicians to change the Criminal Code and how it is enforced, and publicizing unjust prosecutions.

The group is also working on specific demands for the federal government, which writes the criminal law, and for provincial governments, which administer the law through the courts.

McClelland says coalition members have spoken to Minister of Justice Jody Wilson-Raybould, which he finds promising, since no such meeting took place under the previous Conservative government.

“It’s also really, really hard to get the Criminal Code reformed,” he notes, “but if we can appeal to members of parliament that it’s being applied so unjustly, then potentially there’s an option for that.”

Published in DailyXtra on Nov 14, 2016

Australia: Australian experts publish statement urging courts to consider current scientific evidence in criminal cases involving alleged HIV transmission or exposure

A group of leading HIV experts are calling for “caution to be exercised” when considering criminal charges against people who recklessly spread the disease.

In a consensus statement published in the Medical Journal of Australia, Australian researchers and scientists — including Professor Sharon Lewin and Professor Andrew Grulich — argue that “criminal cases involving HIV transmission or exposure require that courts correctly comprehend the rapidly evolving science of HIV transmission and the impact of an HIV diagnosis”.

The statement cites scientific evidence that shows the risk of HIV transmission to be negligible if a person is on treatment and has an undetectable viral load. It also claims that HIV isn’t as serious a condition as it used to be: “Most people with HIV are able to commence simple treatment providing them a normal and healthy life expectancy, largely comparable with their HIV-negative peers.”

“Given the limited risk of HIV transmission per sexual act and the limited long-term harms experienced by most people recently diagnosed with HIV, appropriate care should be taken before prosecutions are pursued,” says the statement.

While acknowledging that cases of deliberate transmission of HIV are “extremely unusual”, the group urge authorities to change behaviours through counselling rather than the courts.

“Careful attention should be paid to the best scientific evidence on HIV risk and harms, with consideration given to alternatives to prosecution, including public health management.”

The statement has been welcome by HIV advocacy groups.

“It’s incredible to see these experts come together and make a bold statement regarding HIV and the law,” said Richard Keane, President of Living Positive Victoria.

“The impact of HIV criminalisation or even the threat of it is a dangerous form of stigma and we’re still feeling the ripple effect more than two decades later.”

There have been at least 38 Australian criminal prosecutions for HIV sexual transmission or exposure since 1991.

“You don’t have to be convicted or even prosecuted for HIV criminalisation to affect you,” said Keane.

“The HIV community lives with the threat that a complaint can be made against us and the stigma that criminal prosecutions amplify and perpetuate.”

Keane hoped the statement’s focus on utilising the public health system rather the criminal courts in dealing with behaviour change would lead to better outcomes on policy.

“Most people on treatment are able to achieve an ‘undetectable’ viral load which makes it highly likely that the person will remain healthy and pose a negligible risk of transmitting HIV,” Keane said.

“The evidence outlined in this statement shows that the per-act risk of HIV transmission from even the most risky sex is still low. The message should be to encourage individuals to take care of their health and eliminate barriers to accessing treatment rather than intimidation through the justice system.

“By focusing on what the studies and science is telling us about treatments, relative risk and harm, that’s how we reduce HIV transmission whilst protecting the rights and dignity of people living with HIV. HIV is a health issue, not a criminal justice issue.”

Additional reporting Positive Living.

Published in Gay News Network on Nov 6, 2016

Vietnam: Vietnam Lawyers Association (VLA) and Global Fund for HIV/AIDS Prevention and Control Project to provide free legal aid to vulnerable groups in many areas, including civil and criminal issues

The Vietnam Lawyers Association (VLA) and Global Fund for HIV/AIDS Prevention and Control Project will implement the project on providing free legal aid services to vulnerable groups in HIV/AIDS prevention and control.

The information was given by the VLA at a conference on connection and access to legal support services for vulnerable groups in HIV/AIDS prevention and control recently organized in Hanoi.

The project, supported by the Vietnam Union of Science and Technology Associations (VUSTA), will be implemented in five localities, including Hanoi, Ho Chi Minh city, Dong Nai, Quang Ninh and Thai Binh.

It aims to support and guarantee legitimate rights and interests of groups such as injection drug users, prostitutes, homosexuals and transgenders.

Their understanding of law and basic knowledge about HIV/AIDS is limited, leading to stigma and discrimination. Besides, these groups are not beneficiaries of free legal aid under the provisions of the law on legal aid. Therefore, it is essential to build the model of consultation and legal aid free of charge for these groups.

Speaking at the workshop, Doctor and Lawyer Trinh Thi Le Tram, Director of the centre for legal counselling and health policy for HIV/AIDS, said vulnerable people in HIV/AIDS prevention and control include: people infected with and affected by HIV/AIDS, injection drug users, prostitutes and homosexuals.

According to Ms. Tram, the number of customers calling the hotline 18001521, requiring counselling on HIV/AIDS and related legislation, continued to increase over the years. In 2009, there were more than 1,900 calls but in 2014, the figure rose to more than 3,000. However, these numbers are still very small compared to the total of more than 200,000 people living with HIV across the country today.

Demand for legal consulting and aid is there in many areas, such as labor, job, marriage and family, criminal and civil issues.

According to Ms. Tram, legal counselling and aid for people living with HIV at state’s centres for legal aid meet many difficulties and shortcomings, such as procedure, identification public issues, and centres are often located within the campus of government agencies with no separate living space.

In addition, interdisciplinary agencies and VLAs of 63 localities nationwide should have activities to consult and support legislation for local people infected with and affected by HIV/AIDS.

In particular, the national target program on HIV/AIDS prevention and control every year should structure the budget for the legal consultancy and assistance for people infected with and affected by HIV/AIDS

Sweden: Civil societies organisations call for guidelines to prosecutors in cases of HIV-criminalisation

“Major Uncertainty about HIV in Courts – The Prosecutor must act”

Open letter to the Prosecutor General Anders Perklev:

The organizations Hiv-Sweden, RFSL and RFSU call for guidelines for prosecutors for prosecutions against people living with HIV who are at risk of transmitting the virus via sexual contacts.

Signatory organizations promote the development of HIV in Sweden, how people living with HIV perceive their situation, the way in which case law looks and the medical successes in the field. Since 2013, the knowledge base “Infectiousness in Treated HIV Infection” has been developed by the Public Health Authority and the Reference Group for AntiViral Therapy (RAV), which shows that there is a negligible risk of HIV transmission during well-treated treatment.

Since 2016, there is also a document written by medical experts in which the disability rate in HIV is reduced from 40-60% to 0-10%.

These documents should have a major impact on the prosecution of persons, for whom crimes are prosecuted, how damages for a possible transfer should be measured and how seriously the chronic disease HIV should be considered.

RFSU, RFSL and Hiv-Sweden can say that there is great uncertainty in courts and justice in general how to handle the progress made in the medical field regarding HIV. There is no precedent since the knowledge base came and, as the Prosecutor is aware, no trial was given in the Supreme Court for Case B 2152-13, the Court of Appeal over Skåne and Blekinge, in which a person living with HIV and had a so-called well-treated treatment was released from criminal liability.

Signatory organizations welcome the Court of Appeal’s judgment, which clearly takes into account medical success, contagiousness and other facts in the case. Unfortunately, the Supreme Court (in connection with the grant of a review) did not refer to the decision NJA 2004 p. 176, which means that the judgment of the Court of First Instance can not be regarded as prejudicial.

Signatory organizations find it deeply unfortunate that the Supreme Court did not test the case partly referring to precedents no longer based on current knowledge. This means that the legal situation is unchanged and unclear, which creates legal uncertainty for people living with HIV.

Regrettably, we can say that the courts have begun to take care of the medical successes that have been made since 2004, and in the days a new intelligence judgment in which a man living with HIV and standing on a well-treated treatment is released from criminal liability (see Day’s Juridics 2016- 05-31 ). We hope that Objective B 212-15 from Uppsala District Court will proceed in the judicial system and create a new practice in this area.

The judgment states that the risk of HIV transmission to unprotected intercourse is so small in case of well-being treatment that one can not reasonably expect the effect of transfer and thus does not fulfill the objective crimes for the development of danger to another.

Even though the profession assesses the risk of HIV transmission to be neglected in well-preserved HIV even in unprotected intercourse, prosecutors continue to famble as to which acts will lead to prosecutions and which crimes are prosecuted. For example, some prosecutors choose to prosecute people living with HIV, with well-treated treatment, without the intention of transmitting HIV and there was no transfer for attempted abuse, which is neither reasonable nor correct.

RFSU, RFSL and HIV-Sweden want guidelines from the RA to the prosecutor who takes into account the major medical achievements and the knowledge base available to create a fairness in how the judicial system manages this already vulnerable group of people living in our society HIV.

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“Stor osäkerhet om HIV hos domstolar och rättsväsende – riksåklagaren måste agera“

Öppet brev till riksåklagaren Anders Perklev:

Organisationerna Hiv-Sverige, RFSL och RFSU efterlyser riktlinjer för åklagare avseende åtal mot personer som lever med hiv och som riskerar att överföra viruset via sexuella kontakter.

Undertecknande organisationer följer utvecklingen noga avseende hiv i Sverige, hur personer som lever med hiv uppfattar sin situation, hur rättspraxis ser ut och de medicinska framgångar som görs på området. Sedan år 2013 finns kunskapsunderlaget “Smittsamhet vid behandlad hivinfektion” framtaget av Folkhälsomyndigheten och Referensgruppen för AntiViral terapi (RAV), i vilket det framgår att det föreligger försumbar risk för överföring av hiv vid välinställd behandling.

Sedan år 2016 finns det även ett dokument skrivet av medicinska experter i vilket invaliditetsgraden vid hiv sänks från tidigare 40-60 % ned till 0-10 %.

Dessa dokument borde få stor inverkan på när personer åtalas, för vilka brott personer åtalas, hur skadestånd vid en eventuell överföring bör mätas och hur allvarlig den kroniska sjukdomen hiv skall betraktas vara.

RFSU, RFSL och Hiv-Sverige kan konstatera att det råder stor osäkerhet i domstolar och rättsväsendet i övrigt hur de ska hantera de framsteg som görs på det medicinska området gällande hiv. Det saknas prejudikat sedan kunskapsunderlaget kom, och som riksåklagaren väl känner till gavs inte prövningstillstånd i högsta domstolen för mål B 2152-13, Hovrätten över Skåne och Blekinge, i vilket en person som lever med hiv och hade en så kallad välinställd behandling friades från straffansvar.

Undertecknande organisationer välkomnar hovrättens dom, som tydligt tar hänsyn till medicinska framgångar, smittsamhetsdokumentet och fakta i övrigt i målet. Dessvärre hänvisade Högsta domstolen (i samband med att prövningstillstånd inte gavs) till avgörandet NJA 2004 s. 176 vilket innebär att hovrättens dom inte kan anses vara prejudicerande.

Undertecknande organisationer finner det djupt olyckligt att Högsta domstolen dels inte prövade målet dels hänvisade till prejudikat som inte längre baserar sig på aktuell kunskap. Detta innebär att rättsläget är oförändrat och otydligt, vilket skapar en rättsosäkerhet för personer som lever med hiv.

Glädjande nog kan vi konstatera att domstolarna ändock har börjat ta till sig av de medicinska framgångar som gjorts sedan 2004 och i dagarna kom en ny underrättsdom i vilken en man som lever med hiv och står på välinställd behandling frias från straffansvar (se Dagens Juridik 2016-05-31) . Vi hoppas att mål B 212-15 från Uppsala tingsrätt skall gå vidare inom rättsväsendet och skapa en ny praxis på området.

I domen konstateras att risken för överföring av hiv vid oskyddade samlag är så pass liten vid välinställd behandling att man inte rimligen kan förvänta sig effekten att överföring sker, och att det därmed inte uppfyller de objektiva brottsförutsättningarna för framkallande av fara för annan.

Trots att professionen bedömer risken för överföring av hiv vara försumbar vid välinställd hiv även vid oskyddade samlag fortsätter åklagare att famla när det gäller vilka gärningar som skall leda till åtal och vilka brott som åtalas för. Vissa åklagare väljer till exempel att åtala personer som lever med hiv, med välinställd behandling, utan uppsåt att överföra hiv och där ingen överföring skett för försök till misshandel vilket varken är rimligt eller korrekt.

RFSU, RFSL och Hiv-Sverige önskar riktlinjer från RÅ till landets åklagare som tar hänsyn till de stora medicinska framgångar som gjorts och det kunskapsunderlag som finns, för att skapa en rimlighet i hur rättsväsendet hanterar denna redan utsatta grupp personer i vårt samhälle som lever med hiv.

US: Teleconference on HIV Criminal Laws on Thursday – May 5, 2016 from 10:30 to 11:30 a.m. ET

CHLP, The American Bar Association AIDS Coordinating Committee and the National Association of Criminal Defense Lawyers present a teleconference on HIV Criminal Laws on Thursday, May 5 from 10:30 to 11:30 am ET on HIV Criminal Law for criminal defense lawyers, service providers in the legal, medical and social work communities and people living with HIV.

Sponsoring organizations: The ABA AIDS Coordinating Committee, The Center for HIV Law and Policy, and The National Association of Criminal Defense Lawyers.

Audience: Criminal defense lawyers, service providers in the legal, medical and social work communities and people living with HIV

Format:  Interactive–speaker presentations followed by audience Q and A

Date and Time:  May 5, 2016 from 10:30 to 11:30 a.m. ET

How to Participate: There is NO COST to participate. The morning of the event simply dial the Conference Call number 1 (877) 317-0419 and enter Access Code 2244415. To be sent the documents that will be referenced during the Teleconference please send your e-mail address toidominguez@nacdl.org or anichol@hivlawandpolicy.org

Summary:  Thirty-four U.S. states and territories have criminal statutes that allow prosecutions for allegations of non-disclosure, exposure and (although not required) transmission of the HIV virus. Prosecutions have occurred in at least 39 states under HIV-specific criminal laws or general criminal laws. Most of these laws treat HIV exposure as a felony, and people convicted under these laws are serving sentences as long as 30 years or more. Learn from experts about these laws and how to defend against them.

Opening Remarks:  Norman L. Reimer, Executive Director of the National Association of Criminal Defense Lawyers (NACDL).

Moderator: Richard A. Wilson, Chair ABA AIDS Coordinating Committee.

Presentation One: Department of Justice Civil Rights Division’s Guide to Reform HIV-Specific Criminal Laws to Align with Scientifically-Supported Factors by Allison Nichol, CHLP Co-Executive Director.

In May 2013 the United States Department of Justice, Civil Rights Division (CRD) issued guidance on how to reform HIV-specific criminal laws to bring them into alignment with current science, from actual routes and risks of transmission to the transformation of HIV treatment and prevention with the development of highly effective antiretroviral therapy (ART).

Presentation Two

Defending Against HIV State Law Prosecutions by Mayo Schreiber, CHLP Deputy Director.

Two recent cases in which CHLP participated, one in Missouri and one in Ohio, will be discussed, along with the HIV criminal statutes in those states. These cases and statutes are illustrative of the fundamental injustice of the statutes as drafted and the punishments provided for violating them. Defense trial and sentencing strategy will be analyzed, including identification of experts and supporting resources, and current thinking on legal challenges to these laws.

A Q&A Session Will Follow.

For more info, go to: http://www.hivlawandpolicy.org/fine-print-blog-news/when-sex-a-crime-and-spit-a-dangerous-weapon-a-teleconference-hiv-criminal-laws

France: National Aids Council President, Patrick Yeni, on why HIV criminalisation remains a problem for France

A year ago, in April 2015, the French National AIDS and Viral Hepatitis Council (Conseil national du sida et des hépatites virales, known simply as ‘CNS’) following extensive research into the law, nature of complaints and prosecutions, and their impact, issued a report, opinion and recommendations.

An English language version of the report, opinion and subsequent recommendations is still being prepared.

Earlier this year, Professor Patrick Yeni (pictured), chair of the CNS, was interviewed by Jean-François Laforgerie on the French language HIV website, seronet.info. His interview is eye-opening and powerful.

It highlights that although they had only found 23 convictions up to the end of 2014, surveys of people living with HIV suggest that up to 2000 complaints may have been made since the start of the epidemic.

The survey shows that slightly more than one person living with HIV in ten claims to have been tempted to complain against the person that they believed to be the source of infection. According to the same source, 1.4% of people living with HIV surveyed reported having actually complained. Based on these figures, we estimate an order of magnitude from 1 500 to 2 000 complaints that could be filed in total since the beginning of the epidemic.

He also notes that the law currently only recognises condom use as a way to show lack of a guilty mind, and he and his colleagues are concerned that up-to-date science is not reflected in the law. He also highlights that in France disclosure of known HIV-positive status – and subsequent consent to ‘risky’ sex – is not actually a defence, although in practice only cases where no disclosure took place and where no condoms were used have reached the court.

It seems unthinkable that what is obvious in terms of public health today on the promotion of biomedical preventions is lagging behind legally.

Given the importance of this body of work, we have decided to publish the interview and a summary of the main CNS recommendations beneath it, despite no official English translation.

It is interesting that the people who complain and go to trial are not part of the so-called risk groups where prevalence is high. For example, there is virtually no migrants among the complainants. Moreover, today there is a much greater legalisation of intimacy, including sexual facts than existed in the past. Perhaps this plays on the fact that people complain more now than twenty years ago.

Below is the English translation of the seronet.info interview, further improved from Google translate’s version by Sylvie Beaumont. Version anglaise via Google translate. Le texte français est après la traduction.

Q: In 2006, the National AIDS and viral hepatitis Council (CNS) published their review of the criminalisation of HIV transmission. What led you to work again on this issue and publish, in 2015, a second opinion?

Patrick Yeni [PY]: The media coverage of some trials in France and, secondly, the situation internationally. In other countries, there was an active debate on the criminalisation of HIV transmission, while in France this reflection seemed stalled. These are the two reasons that led us to revisit this issue, trying to understand and think about how things had changed since our first review.

Q: In your 2015 recommendations, you noted that the attention paid to legal, ethical and health issues relating to criminalisation of HIV transmission was low, both on the part of public authorities and civil society actors. How do you explain that?

PY: We have no clear answer to that. This is also why we wanted to restart the debate. If one takes the point of view of government and we take stock of court cases – 23 convictions for HIV transmission since the beginning of the epidemic throughout France – one can imagine that for the state this is not a national major problem at the criminal level, at least quantitatively. I guess the debate on criminal justice focuses primarily on other issues. For HIV organisations, it is probably more complicated because legal proceedings – as we attempt to analyse them in the recommendations – somewhat undermined the historical foundations on which the fight against HIV is based. By that I mean solidarity between people living with HIV and the refusal to distinguish between “patients as victims” allegedly infected and others who simply became infected. I imagine that this problem could have induced some inertia in advancing the debate. One recommendation from the CNS is to urge organisations to resume this discussion today, because it is a lever to act on issues of stigma, discrimination … and HIV prevention in general.

Q: What is prosecuted today? And what is a crime under the law?

PY: Primarily the fact that a person who knows s/he is HIV-positive, transmits HIV to a partner while s/he has not taken preventive measures to prevent this, i.e used a condom. In almost all trials in France, this is what has been prosecuted. We have had discussions on other issues as lawyers who supported us explained that the scope of what could be prosecuted or what could be an offence is probably wider than what is actually applied today.

Q: What are you referring to?

PY: One must think on several levels. The first criterion is that they are people who know they are HIV-positive. But it’s more complicated. Thus, from a legal point of view, we cannot know that a person, while not knowing officially that they are HIV-positive would consider themselves to be negative while they are engaged in repeated risky sexual behaviour. Justice may consider that even if they did not know their status officially, their sexual behaviour should have pushed them to consider themselves as potentially HIV-positive, and therefore to do a test and take preventive measures. In this case, the absence of screening does not guarantee the absence of criminal risk. The second criterion is that there must be proof that the person has transmitted HIV. Our analysis of judgments shows that exposing someone to HIV transmission, even without actual transmission can also be penalised. There have been convictions in France for exposure to the risk of transmission. This has occurred in the case of additional convictions to convictions for actual transmission, but it exists.

Q: So you think we could one day have a conviction on the sole ground of the risk of exposure to HIV transmission?

PY: Yes. The legal elements are there. That is, according to our analysis, another possibility of expanding the criminal field. The third criterion is that the ‘victim’ is not aware of the HIV status of their partner. In criminal law, whether or not the victim is informed does not exempt the defendant from liability. One cannot argue that the partner was informed and has agreed not to protect themselves and therefore would not be responsible. The information is not enough.

Fourth criterion. In all cases today, sexual prevention is understood as the use of condoms. It is the condom which is retained as the manifestation of concerns relating to the risk of transmission. We do not know what will happen when there will be proceedings for transmission or exposure by people who do not use condoms, but are treated effectively. Some lawyers have told us that if there was transmission despite condom use, it would be a case of force majeure which is exculpatory of responsibility. We can not guarantee the same thing about treatment. In other words, even with a good track treatment, a viral load of less than 20 copies, one cannot guarantee that there is not occasionally a little HIV in semen … and therefore transmission is possible even if  treatment is adhered to, and viral load is undetectable … other lawyers tell us that we are, in this case, in a random situation, which does not exempt the person with HIV from responsibility. We must think about this. It seems unthinkable that what is obvious in terms of public health today on the promotion of biomedical preventions is lagging behind legally. This is a warning that we mention in the recommendation. But unfortunately we fear that this debate will only take place when a case of transmission from someone on effective treatment will come to court.

Q: How do you explain that the role of treatment as prevention is recognised in Switzerland with all the legal consequences that this entails, and yet the same argument does not hold legally with us?

PY: We wanted to alert on this point precisely so the conclusions of judges, when they have to decide, are identical to the public health conclusions we know today. We must not get to this contradiction where a person who is effectively treated is found guilty because s/he would not use a condom. With these examples, we can see the narrow scope of what is actually prosecuted and that it is imperative to have a debate on the possible expansion of what is a crime.

Q: The argument is often made that further criminalisation would deter people from testing?

PY: The review analysed the consequences of the criminalisation of HIV transmission on testing. All the studies to which we had access, mainly foreign, do not indicate that criminal risk linked to knowing one’s status would lead to decreased use of testing.

Q: You note the paradox that legal proceedings have developed in a context of “normalisation” of the disease. In other words, cases flourished in the 2000s, after the most acute phase of the epidemic. How do you explain it?

PY: We had discussions about it. Some of us were reluctant to say that there was an increase in the number of cases. One thing is certain, we are on a low figure: 23 convictions. Especially if we compare the data of the ANRS-Vespa 2 survey. The survey shows that slightly more than one person living with HIV in ten claims to have been tempted to complain against the person that they believed to be the source of infection. According to the same source, 1.4% of people living with HIV surveyed reported having actually complained. Based on these figures, we estimate an order of magnitude from 1,500 to 2,000 complaints that could be filed in total since the beginning of the epidemic. We do not know why some complaints were accepted and others not, why some were eventually classified and others have prospered. We have, unfortunately, no way to evaluate it. We just know that few cases reach a conviction.

To respond more specifically, one must take into account the fact that there is a significant delay, sometimes ten years from the time a complaint is filed to the time when an appeal judgment is pronounced. It might be possible to say that today there is an increase in the number of procedures, but it is not certain. We must be careful about this point. If this is true, how can we explain it? One hypothesis is that in the early days of the epidemic, when many people died of AIDS, a complaint against a person who was likely to die did not make much sense. Today the situation is different. For people, this may appear more “logical” to do so. We advance this hypothesis, but we don’t have the figures to confirm it. One can also look at who is complaining. It is interesting that the people who complain and go to trial are not part of the so-called risk groups where prevalence is high. For example, there is virtually no migrants among the complainants. Moreover, today there is a much greater legalisation of intimacy, including sexual facts than existed in the past. Perhaps this plays on the fact that people complain more now than twenty years ago.

Q: What goals did you set by publishing this new advice?

PY: Firstly: to inform people living with HIV about the conditions under which their criminal responsibility may be engaged. Our thinking has focused on being able to contribute to a fair justice. How? By raising awareness of the investigators in this matter through the National Schools of Police and Gendarmerie. By working with judges and lawyers. It is not possible for judges to have the technical knowledge about different diseases, we admit. Similarly, we can not consider today that under the pretext that people no longer die of AIDS, HIV is commonplace. This is not possible even today because there is a context of social representations that make it a special disease. However, the situation is not the same today, in particular medical progress has taken place. It is very important that judges and lawyers are aware of this. We propose that the National School of Magistrates opens this debate in its initial training as well as in continuing education. We asked the school director to include a discussion on HIV in its knowledge training. A problem that does not concern judges, is that of upgrading one’s knowledge to contribute to a fair trial. One of our wishes is also to allow a reflection on the position of criminal justice. Prison sentences predominate in cases of HIV transmission and issues of rehabilitation and prevention of relapses are not taken into account, even though the court must ensure both aspects in its approach.

Q: Specifically what do you recommend?

PY: For the Department of Justice to develop a form of observatory monitoring  of judgments, to document the characteristics of procedures. The tool does not exist and we had to carry out considerable work to realise our new advice and to find all cases that resulted in convictions. We must create an interdepartmental committee to work on the development and provision of information tools tailored to professional (police, lawyers, judges) and other persons concerned, so that the procedures take account of available scientific and medical data, and for doctors to be better informed about the criminal risk of HIV transmission. It’s lobbying work which we pursue, including with HIV organisations. They must reclaim this question on which they were at a standby. We must recognise that the right to resort to justice is a right for all citizens, that our struggle is not against criminal law, but rather to ensure a fair process and prevent risks of criminalisation.

Summary of the CNS’s 2015 recommendations on HIV criminalisation

No. Objectives Recommendations Competent authorities

and/or recommendation targets
1 Contribute to better information of judges Promote initial and continuing education of magistrates and future magistrates on HIV related issues French National School for the Judiciary (école nationale de la magistrature)
2 Bolster the quality of police investigations Promote training actions of police officers and future officers on HIV related issues Ministry of the Interior
3 Prevent reoffending, enable the integration and reintegration of convicted people and improve their support Apply alternatives to custodial sentences Ministry of Justice
4 Promote the prevention of the prosecution risk Contribute to a better understanding of legal issues by the people and communities concerned HIV/AIDS associations
Support actions aiming to provide information on the legal rights and responsibilities of people living with HIV. Ministry of HealthFrench National Institute for Health Prevention and Education (INPES)
Promote actions to fight PLHIV stigmatisation and discrimination and prevention actions towards the general population Ministry of Health, Regional Health Agencies (ARS), French National Institute for Health Prevention and Education (INPES)Other competent ministriesHIV/AIDS associations
5 Provide access to up-to-date and high-quality legal and scientific information Implement a reporting tool to follow-up the rulings issued in France and to document the characteristics of the related proceedings Ministry of Justice
Initiate the creation of a working group in charge of designing and provisioning of information tools suitable for professionals and people involved Health/Justice Interministerial Committee

 

 

Article original

PÉNALISATION DE LA TRANSMISSION DU VIH : GARANTIR UNE PROCÉDURE ÉQUITABLE

Où en est-on aujourd’hui en France sur la pénalisation de la transmission de VIH ? Le professeur Patrick Yéni, président du Conseil national du sida (CNS) fait le point. Interview.

In 2006, le Conseil national du sida et des hépatites virales (CNS) avait publié un premier avis sur la pénalisation de la transmission du VIH. Qu’est-ce qui vous a conduit à travailler de nouveau sur ce sujet et à publier, en 2015, un second avis ?

Patrick Yeni : Il y a la médiatisation de certains procès en France et, d’autre part, le constat sur le plan international, dans d’autres pays concernés, qu’il y avait une réflexion active sur la pénalisation de la transmission de l’infection par le VIH alors qu’en France cette réflexion semblait marquer le pas. Ce sont ces deux raisons qui nous ont conduits à retravailler sur cette question, en essayant de comprendre et de réfléchir à la façon dont les choses avaient évolué, depuis notre premier avis.

Dans l’avis de 2015, vous jugez que l’attention apportée aux enjeux juridiques, éthiques et sanitaires de la pénalisation de la transmission est faible, tant de la part des pouvoirs publics que des acteurs associatifs. Comment l’expliquez-vous ?

Nous n’avons pas de réponse claire à cela. C’est aussi pour cela que nous avons voulu reprendre cette réflexion. Si l’on se place du point de vue des pouvoirs publics et que l’on fait le bilan des affaires judiciaires — soit 23 condamnations pour transmission du VIH depuis le début de l’épidémie pour toute la France —,  on peut imaginer que pour l’Etat il ne s’agit pas là d’un problème majeur national au niveau pénal, du moins sur le plan quantitatif. J’imagine que la réflexion sur la justice pénale porte prioritairement sur d’autres questions. Pour les associations de lutte contre le sida, c’est probablement plus compliqué parce que les procédures judiciaires — comme nous essayons de l’analyser dans l’avis — mettent quelque peu à mal les fondements historiques de la lutte contre le VIH. Je citerai la solidarité entre les personnes atteintes et le refus de distinguer entre des “malades victimes” qui auraient été contaminés et d’autres qui se seraient infectés. J’imagine que cette difficulté a pu introduire de l’inertie dans la progression de la réflexion. C’est justement une recommandation du CNS que d’exhorter les associations à reprendre aujourd’hui cette réflexion, parce qu’elle constitue un bras de levier pour agir sur les stigmatisations, les discriminations… et la prévention en général.

Qu’est-ce qui est condamné aujourd’hui ? Et qu’est-ce qui est condamnable sur le plan pénal ?

C’est avant tout le fait pour une personne qui se sait séropositive d’avoir transmis le VIH à un ou une partenaire alors qu’elle n’avait pas pris de mesure de prévention pour prévenir cette transmission, en l’occurrence l’utilisation de préservatif. Dans la quasi-totalité des procès en France, c’est cela qui est condamné. Nous avons eu des réflexions sur d’autres points car les juristes qui nous ont accompagnés ont expliqué que le champ de ce qui est condamnable, de ce qui pourrait représenter un délit, est sans doute plus large que celui qui est effectivement appliqué aujourd’hui.

A quoi faites-vous référence ?

Il faut raisonner sur plusieurs niveaux. Le premier critère retenu est que ce sont des personnes qui se savent séropositives. Mais c’est plus compliqué. Ainsi, d’un point de vue juridique, on ne peut assurer qu’une personne bien que ne se sachant pas formellement séropositive puisse se considérer comme séronégative alors qu’elle est engagée dans des comportements sexuels à risques, répétés. La justice peut considérer que même si elle ne sait pas de façon formelle quel est son statut, son comportement sexuel aurait du l’inciter à se considérer comme potentiellement séropositive, donc à se tester et à mettre en œuvre des moyens de prévention. Dans ce cas, l’absence de dépistage ne garantit pas l’absence de risque pénal. Le deuxième critère est qu’il faut la preuve que la personne ait transmis le VIH. Notre analyse des jugements montre que le fait d’exposer à la transmission du VIH, même sans transmission effective, peut également être pénalisé. Il y a eu des condamnations en France pour exposition au risque de transmission. Cela s’est produit dans des cas de condamnations additionnelles à des condamnations pour transmission effective, mais cela existe.

Vous estimez donc qu’on pourrait se trouver un jour avec une condamnation au seul motif du risque d’exposition à la transmission du VIH ?

Oui. Les éléments juridiques sont là. C’est, selon notre analyse, une autre possibilité d’élargissement du champ pénal. Le troisième critère est le fait que la victime ne soit pas informée de la séropositivité du ou de la partenaire. En droit pénal, le fait que la victime soit informée ou pas n’exonère pas le prévenu de sa responsabilité. On ne peut pas arguer que le partenaire était informé et qu’il a accepté de ne pas se protéger et donc qu’on ne serait pas responsable. L’information ne suffit pas.

Quatrième critère. Dans toutes les affaires aujourd’hui, la prévention des rapports sexuels est comprise comme l’usage du préservatif. C’est le préservatif qui est retenu comme la manifestation de la préoccupation face au risque de transmission. Nous ne savons pas ce qui se passera lorsqu’il y aura des procédures engagées pour transmission ou exposition concernant des personnes qui n’utilisent pas de préservatifs, mais qui sont traitées efficacement. Certains juristes nous ont expliqué que s’il y avait transmission malgré l’usage du préservatif, il s’agirait d’un cas de force majeure qui est exonératoire de la responsabilité. On ne peut pas garantir la même chose concernant le traitement. Autrement dit, avec un traitement bien suivi, une charge virale dans le sang inférieure à 20 copies, on ne peut pas garantir qu’il n’y ait pas de temps en temps un peu de VIH dans le sperme… et donc qu’une transmission soit possible même si le traitement est bien suivi, la charge virale indétectable… D’autres juristes nous disent que nous sommes, dans ce cas-là, dans une situation d’aléa, qui, elle, n’est pas exonératoire de la responsabilité. Nous devons réfléchir à cela. Il paraîtrait impensable que ce qui est une évidence en termes de santé publique aujourd’hui sur la promotion des préventions biomédicales, soit en décalage sur le plan juridique. C’est un motif d’alerte que nous mentionnons dans l’avis. Mais il est à craindre malheureusement que cette réflexion n’ait lieu que le jour où un cas de transmission concernant une personne sous traitement efficace vienne au tribunal.

Comment expliquer que le rôle du Tasp dans la protection du rapport soit reconnu en Suisse avec toutes les conséquences juridiques que cela implique et que ce même argument ne tienne pas juridiquement chez nous ?

Nous avons souhaité alerter sur ce point afin que justement les conclusions de la justice, lorsqu’elle aura à se prononcer, soient identiques aux conclusions de santé publique que nous connaissons aujourd’hui. Nous ne devons pas arriver à cette contradiction qu’une personne qui se traiterait efficacement soit condamnée parce qu’elle n’utiliserait pas le préservatif. Avec ces exemples, on voit bien l’espace assez restreint de ce qui est effectivement condamné aujourd’hui et le fait qu’il faut absolument avoir une réflexion sur le possible élargissement de ce qui est condamnable.

L’argument est souvent avancé qu’un engagement plus avant dans la pénalisation dissuaderait les personnes de faire le dépistage ?

L’avis a analysé les conséquences de la pénalisation de la transmission en matière de recours au dépistage. Toutes les études auxquelles nous avons eu accès, essentiellement étrangères, n’indiquent pas que le risque pénal lié à la connaissance de son statut sérologique conduirait à une diminution du recours au dépistage.

Vous notez le paradoxe que les recours en justice se sont développés dans un contexte de “normalisation” de la maladie. Autrement dit, les affaires ont prospéré dans les années 2000, postérieurement à la phase la plus aigüe de l’épidémie. Comment l’expliquez-vous ?

Nous avons eu des discussions à ce sujet. Certains d’entre nous étaient réticents à affirmer qu’il y avait une augmentation du nombre de cas. Une chose est sûre, nous sommes sur un chiffre bas : 23 condamnations. D’autant plus si on le rapporte aux données de l’enquête ANRS-Vespa 2. L’enquête montre qu’un peu plus d’une personne vivant avec le VIH sur dix déclare avoir été tentée de porter plainte contre la personne qu’elle estimait être à l’origine de sa contamination. Selon la même source, 1,4 % des personnes vivant avec le VIH interrogées déclaraient avoir effectivement porté plainte. Sur la base de ces chiffres, nous avons estimé un ordre de grandeur de 1 500 à 2 000 plaintes qui auraient pu être déposées au total depuis le début de l’épidémie. Nous ne savons pas pourquoi certaines plaintes ont été acceptées et d’autres pas, pourquoi certaines ont finalement été classées et d’autres ont prospéré. Nous n’avons, hélas, aucun moyen d’évaluer cela. Nous savons juste que peu d’affaires arrivent à une condamnation.

Pour répondre plus précisément, il faut prendre en compte le fait qu’il y a un délai important, parfois dix ans, entre le moment où une plainte est déposée et celui où un jugement en appel est prononcé. Dire qu’aujourd’hui nous sommes sur une augmentation du nombre de procédures, c’est possible, mais pas certain. Nous devons être prudents sur ce point. Si c’est vrai, comment l’expliquer ? Une des hypothèses, c’est qu’aux premiers temps de l’épidémie, lorsque beaucoup de monde décédait du sida, porter plainte contre une personne qui allait sans doute mourir n’avait pas grand sens. Aujourd’hui, la situation est différente. Pour des personnes, cela peut apparaître plus “logique” de le faire. Nous avançons cette hypothèse, mais aucun chiffre ne permet de la confirmer. On peut aussi regarder quels sont ceux qui portent plainte. C’est intéressant de voir que les personnes qui portent plainte et arrivent au procès ne font pas partie des groupes dits à risques où la prévalence est très forte. Par exemple, il n’y a quasiment pas de personnes migrantes parmi les plaignants. Par ailleurs, il existe aujourd’hui une judiciarisation bien plus importante de l’intime, notamment des faits sexuels, qu’elle n’existait dans le passé. Peut-être cela joue-t-il dans le fait de porter plainte plus aujourd’hui qu’il y a vingt ans.

Quels objectifs vous êtes-vous fixés en publiant ce nouvel avis ?

Tout d’abord : informer les personnes vivant avec le VIH sur les conditions dans lesquelles leur responsabilité pénale peut être engagée. Notre réflexion a surtout porté sur le fait de pouvoir contribuer à une justice équitable. Par quels moyens ? Par une sensibilisation des enquêteurs à cette question par les écoles nationales de police et de gendarmerie. Par un travail auprès des magistrats et des avocats. Il n’est pas possible que les juges aient des connaissances techniques sur les différentes maladies, nous l’admettons. De la même façon, on ne peut pas considérer aujourd’hui, au prétexte qu’on ne meure plus du sida, que l’infection par le VIH est banale. Ce n’est pas possible parce qu’il existe un contexte de représentations sociales qui en font une maladie particulière. Pour autant, la situation n’est plus la même aujourd’hui, des progrès notamment médicaux ont eu lieu. C’est très important que les magistrats et les avocats aient connaissance de cela. Nous proposons que l’Ecole nationale de la magistrature ouvre cette réflexion dans sa formation initiale, comme dans sa formation continue. Nous avons sollicité le directeur de cette école pour lui demander d’inclure une réflexion autour du VIH dans la formation des connaissances. Un problème, qui ne concerne pas que les juges, est celui de la mise à niveau des connaissances pour contribuer à une justice équitable. Un de nos souhaits est aussi de permettre de réfléchir à la position de la justice pénale. Les peines de prison ferme prédominent dans les affaires de transmission du VIH et les questions de réinsertion et de prévention de la récidive ne sont pas du tout prises en compte, alors même que la justice doit veiller à ces deux aspects dans sa démarche.

Concrètement que préconisez-vous ?

Pour le ministère de la Justice, de se doter d’une forme d’observatoire de suivi des jugements rendus, de documenter les caractéristiques des procédures. L’outil n’existe pas et nous avons dû effectuer un travail considérable pour réaliser notre nouvel avis et retrouver tous les cas ayant abouti à des condamnations. Il faut créer un comité interministériel pour qu’il travaille à la création et la mise à disposition d’outils d’information adaptés aux professionnels (policiers, avocats, magistrats) et aux personnes concernées, pour que les procédures tiennent compte des données scientifiques et médicales disponibles, pour que les médecins soient mieux informés sur le risque pénal de la transmission du VIH. C’est du travail de lobbying que nous menons, y compris auprès des associations de lutte contre le sida. Elles doivent se réapproprier cette question, sur laquelle elles étaient un peu en situation de veille. Nous devons admettre que le droit au recours à la justice est un droit des citoyens, que notre combat n’est pas contre la justice pénale, mais plutôt pour garantir une procédure équitable et prévenir le risque pénal.

Propos recueillis par Jean-François Laforgerie.

UK: Law Commission considers HIV criminalisation in great depth, but recommends no change for HIV/STI prosecutions in England & Wales, pending a wider review

Following a scoping consultation which ran from autumn 2014 to spring 2015, the Law Commission (of England and Wales) has now published its report containing their final recommendations to the UK Government.

It recommends the adoption of a modified version of a 1998 draft Bill to replace the outdated Offences Against the Person Act 1861.

However, whereas the 1998 Bill only criminalised intentional disease transmission, their recommendation is to keep the existing law relating to HIV and other serious diseases ((based on Dica and Konzani and clarified through prosecutorial policy and guidelines) which criminalises reckless as well as intentional disease transmission, pending a wider review.

Both in the scoping consultation paper and in this report, we have considered the criminalisation of disease transmission at great length. Many consultees supported fundamental reform of the law in this area. However, we conclude that the issues were more complex than time or space allowed without delaying the main aim of reforming the law of offences against the person. For this reason, we suggest modifications to the draft Bill to preserve the present position pending a wider review involving more input from healthcare professionals and bodies.

The full report, (chapter six: ‘transmission of disease’ is excerpted in full below), includes a detailed discussion of their proposals and the responses of 35 concerned stakeholders (most of them experts in law, public health and human rights. The HIV Justice Network was one of them, and our opinions are quoted throughout.)

The entire report is of interest not just to those working on this issue in England & Wales, but globally.  It rehearses, in great detail, nearly all of the arguments for and against HIV (and other STI) prosecutions, and finds that “there is a strong body of opinion, especially in the medical profession and groups concerned with HIV and sexually transmissible infections, that the transmission of these diseases should never be criminal unless done intentionally.”

The report helpfully summarises the five main arguments against overly broad HIV criminalisation:

(1)  an offence of reckless transmission encourages people to choose not to be tested, so as not to have the awareness of risk that might constitute recklessness;

(2)  it discourages openness with (and by) medical professionals, because they may have to give evidence against their patients;

(3)  it encourages people to think that disclosure of HIV status is always a duty, and that if a potential partner has not mentioned his or her status then he or she is not infected;

(4)  because of the difficulty of proving transmission, the existence of the offence leads to very wide-ranging and intrusive investigations affecting a great many people, out of all proportion to the small number who will be found deserving of prosecution; and

(5)  the whole topic of HIV/AIDS is affected by an atmosphere of fear (often irrationally so), and there is still an undesirable stigma against people.

Nevertheless, although the report states that “it would be preferable to revert to the law as it stood in 1998” when prosecutions were not possible and to use the draft 1998 Bill as it stands (which would only criminalise the intentional transmisison of disease), it comes to a more conservative conclusion.

The discussion of this issue has almost exclusively concerned the transmission of disease by consensual sexual intercourse, and the transmission of HIV in particular. (Also, most of the evidence for the harmful effects of criminalisation is drawn from countries where there are specific offences concerned with HIV and STIs, and may not be relevant to the use of general offences of causing injury.) The same reasoning may well not apply to other diseases and other means of transmitting them, but the draft Bill excludes disease as a whole.

For these reasons, on the evidence we have we do not feel justified in recommending a change to the position in existing law, in which the reckless transmission of disease is in principle included in an offence of causing harm. If there is to be a change, this should follow a wider review which compares the position in different countries and gives full consideration to the transmission of diseases other than by sexual means.

Of note, and of global relevance, following a great deal of discussion (and a broad range of consultation responses) regarding whether not to create an HIV/STI-specific law and/or broaden the scope of the current law to include non-disclosure and/or potential or perceived exposure, the Law Commission is clear.

We do not recommend the creation of specific offences concerned with disease transmission, either in relation to disease in general or in relation to HIV and STIs in particular: this too would require a wider review of all the available evidence. Nor do we recommend an offence of putting a person in danger of contracting a disease, or an offence of failing to disclose an infection to a sexual partner.

Law Commission Scoping Report: TRANSMISSION OF DISEASE (November 2015)

New IAPAC guidelines to achieving 90-90-90 targets recommend ending HIV criminalisation

New guidelines from the International Association of Providers of AIDS Care (IAPAC) are the first to highlight that HIV criminalisation is a critical barrier to optimising the HIV care continuum.

Currently only half of people living with HIV globally are aware of their status. Of the remaining 50% many are not yet engaged in care, receiving antiretroviral therapy (ART) in a timely manner or – the ultimate goal of HIV treatment and prevention – achieving sustained viral suppression.

These new guidelines are the first to include HIV criminalisation as one of eight key critical barriers that prevent people living with HIV from enjoying both the therapeutic and preventive effects of ART.

Screenshot 2015-11-06 11.49.50In many settings, optimizing the HIV care environment may be the most important action to ensure that there are meaningful increases in the number of people who are tested for HIV, linked to care, started on ART if diagnosed to be HIV positive, and assisted to achieve and maintain long-term viral suppression. Overcoming the legal, social, environmental, and structural barriers that limit access to the full range of services across the HIV care continuum requires multistakeholder engagement, diversified and inclusive strategies, and innovative approaches. Addressing laws that criminalize the conduct of key populations and supporting interventions that reduce HIV-related stigma and discrimination are also critically important. People living with HIV also require support through peer counseling, education, and navigation mechanisms, and their self-management skills reinforced by strengthening HIV literacy across the continuum of care.

The full HIV criminalisation recommendation (Recommendation 2) is below.

  • Recommendation 2: Laws that criminalize the conduct of PLHIV based on perceived exposure to HIV, and without any evidence of intent to do harm, are not recommended and should be repealed where they have been enacted. (A IV)

Numerous countries have enacted laws that criminalize behaviors associated with HIV exposure, many of which pose a low or negligible HIV transmission risk. No differences in behavior have been noted between settings that enact such laws and those that do not. Many of these laws do not take into account measures that reduce HIV transmissibility, including condom use, and were enacted before the preventive benefit of ART or antiretroviral (ARV)-based preexposure prophylaxis (PrEP) was fully characterized. Most PLHIV who know their status take steps to prevent transmitting HIV to others.HIV-specific laws thus primarily exacerbate HIV-related stigma and decrease HIV service uptake.

IAPAC Guidelines for Optimizing the HIV Care Continuum for Adults and Adolescents

Australia: Academic article explores the prevention impact of treatment on criminal 'exposure' laws and prosecutions

Evidence that treating people with HIV early in infection prevents transmission to sexual partners has reframed HIV prevention paradigms. The resulting emphasis on HIV testing as part of prevention strategies has rekindled the debate as to whether laws that criminalise HIV transmission are counterproductive to the human rights-based public health response. It also raises normative questions about what constitutes ‘safe(r) sex’ if a person with HIV has undetectable viral load, which has significant implications for sexual practice and health promotion. This paper discusses a recent high-profile Australian case where HIV transmission or exposure has been prosecuted, and considers how the interpretation of law in these instances impacts on HIV prevention paradigms. In addition, we consider the implications of an evolving medical understanding of HIV transmission, and particularly the ability to determine infectiousness through viral load tests, for laws that relate to HIV exposure (as distinct from transmission) offences. We conclude that defensible laws must relate to appreciable risk. Given the evidence that the transmissibility of HIV is reduced to negligible level where viral load is suppressed, this needs to be recognised in the framing, implementation and enforcement of the law. In addition, normative concepts of ‘safe(r) sex’ need to be expanded to include sex that is ‘protected’ by means of the positive person being virally suppressed. In jurisdictions where use of a condom has previously mitigated the duty of the person with HIV to disclose to a partner, this might logically also apply to sex that is ‘protected’ by undetectable viral load.