US: A panel of health experts blasts HIV criminalisation laws as a failure that keep people from getting tested and ignore the current state of science

A panel of health experts blasted HIV criminalization laws in nearly three-dozen states as a failure, criticizing the statues for adding stigma to HIV, keeping people from getting tested, and oppressing already marginalized populations such as LGBT people.

And the laws – in place in Georgia and states across the South – or prosecuting people for HIV exposure using other criminal statues – which happens in Texas and four other states – also ignore that partners in consensual sex acts share responsibility for their sexual health, according to Scott Schoettes, a senior attorney and HIV Project Director at Lambda Legal.

“The story is about the AIDS monster out there trying to infect everyone and that is not the case,” Schoettes said (top photo). “Sexual health is a shared responsibility. It creates a sense of false security for the person who is negative – ‘There is this law in place and I can sit back and wait for someone to tell me.'”

He said the laws keep people with HIV from getting tested and few, if any, of the laws require prosecutors to show that an HIV-positive person had any intent to infect a sex partner. Nevermind, he adds, that it’s difficult to prove that someone did disclose their HIV status before sex and once convicted, some state laws call for them to be labeled as sex offenders.

“It becomes a he said, he said and the person with HIV, when you get into that courtroom, is naturally at a disadvantage. A lot of people think that when you have HIV, you have done something wrong. We are still fighting that misperception,” Schoettes said. “When you have a jury that is deciding the fate of someone, they are disconnected from the culture of the folks that they may be actually adjudicating.”

And that can mean steep sentences for people convicted under HIV criminalization laws. In July, Michael Johnson – a black, gay, HIV-positive college wrestler in Missouri – was sentenced to 30 years in prison for infecting a sex partner and putting four others at risk, though prosecutors didn’t show in court that Johnson was the man who infected him. In South Carolina, former gay Atlanta man Tyler Orr faces two counts of exposing another person to HIV and up to 20 years in prison – though he says he did disclose his HIV status to his sex partner.

Schoettes’ comments came during a panel discussion during the 2015 National HIV Prevention Conference in downtown Atlanta earlier this month. He was joined by Randy Mayer, chief of the HIV, STD and Hepatitis Bureau of the Iowa Department of Public Health; Tami Haught, an activist who led efforts in Iowa to reform its HIV criminalization law; David Knight, a trial attorney with the Civil Rights Division of the U.S. Department of Justice; and Terrance Moore, deputy executive director with the National Alliance of State & Territorial AIDS Directors.

‘It’s not a slam dunk’

Knight said the HIV criminalization laws don’t reflect the current state of science and risk surrounding HIV and pointed to a document released earlier this year by the Justice Department calling on states to reform their HIV criminalization laws.

“Two things that we really want to think about is that intentional transmission is atypical and uncommon, and HIV stigma hampers prevention,” Knight said.

The Justice Department document calls on states to tighten their HIV criminalization laws to scrap HIV-specific criminal penalties with two exceptions – when an HIV-positive person commits a sex crime where there is risk of transmission and when there is clear evidence that an HIV-positive person intended to infect another person and engaged in risky behaviors to do so.

But changing HIV criminalization laws in the three-dozen states that have them is a tough haul, Mayer (second photo) and Haught said. They built coalitions across groups and enlisted public health experts to help revise the law in Iowa, a measure passed in 1998 that carried harsh penalties and 25-year prison terms that were often doled out to those convicted.

“In my experience, almost everyone got the 25 years even though that was the maximum,” Mayer said. “It’s not a slam dunk. It’s not an easy sell. Many people, even people living with HIV find themselves on both sides of this issue.”

Iowa lawmakers revised the state’s HIV criminalization law in 2014 to treat HIV like other communicable diseases such as hepatitis and tuberculosis. The law also requires that prosecutors prove intent to transmit, Mayer said.

“We had to bring in the different coalitions and bring in partners. Lawmakers don’t care what is fair and what is right. But they will listen to the public health side of the law,” Haught said. “Iowa’s law was significantly modernized and everyone is better for it.”

The panelists argued that rather than criminalizing HIV-positive people, and adding to the stigma they face, they should be pushed to treatment options. The Centers for Disease Control & Prevention has said getting HIV-positive people tested and connected to care and treatment is key to controlling the disease. Undiagnosed HIV infections fuel the HIV epidemic, Eugene McCray, director of CDC’s Division of HIV/AIDS Prevention, said during the Atlanta conference.

“Getting people into care is a better way to reduce transmission than these laws,” Mayer said.

Originally published in Project Q

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.

In 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

Bahrain: HIV-specific law would include criminalising HIV non-disclosure to 'authorities, their partners or relatives'

Bahrain: A new law that both punishes and protects the rights of people with HIV could soon be introduced in Bahrain, reports Gulf Digital News.

[In 2012, it was reported in the Khaleej Times that lawmakers in Bahrain had proposed a penalty of 10 years in prison for people who intentionally transmit HIV to another person. It is not clear if intentional transmission is still criminalised in the latest draft bill, or whether the scope has been broadened to non-disclosure.]

It includes jail sentences and fines for those who fail to disclose they have the virus, as well as employers who penalise HIV-positive staff or job candidates.

The Shura Council yesterday gave the law initial approval, after it was earlier given the green light by the Cabinet.

It is a merger of two bills proposed by parliament and obliges the government to offer free medical and psychological care to those with HIV, as well as conduct awareness programmes.

Under the bill, those who discover they are HIV-positive should immediately report to the Health Ministry, but they can do so anonymously.

Anyone who does not inform authorities, their partners or relatives could be sentenced up to six months in jail and fined up to BD1,000.

The same punishment would apply to those who discriminate against people with HIV, including employers who sack staff who test positive and use it as an excuse for disqualifying a job candidate.

It also stipulates that prisoners with HIV should be housed separately from other inmates, but not held in isolation or treated as outcasts.

“There is a huge misunderstanding within the community regarding those with HIV and people’s reactions are unfair,” said council services committee chairwoman Dr Jehad Al Fadhel, who recommended approval of the law.

“People have to learn to deal with those with transmittable dangerous diseases, not as outcasts but as victims.

“Inhumanity is unacceptable and those who mistreat others due to HIV will be punished severely in accordance with the law – and the same applies to those who fail to inform their partners about their condition.”

The council will continue discussing the law during its session next Monday.

Bahrain has already taken steps to confront HIV and Aids, with the Cabinet last year reforming the National Committee for the Prevention of Aids.

It is tasked with coming up with strategies and programmes to prevent the disease – and ensure confidentiality of medical testing.

Duties and tasks of the committee are outlined in the draft bill currently at the Shura Council.

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.

Is Louisiana's 'AIDS exposure' statute outdated? Advocates say it needs an update

Richard Covington of Baton Rouge was accused earlier this year of breaking into the house of someone who apparently owed him money and then fighting the resident. During the scuffle, Covington allegedly bit the man’s arm.

Russia: Chechen parliamentarian proposes mandatory HIV testing prior to marriage; has been policy in Chechnya since 2011

The lower house of the Russian parliament is considering legislation that would force couples wishing to get married to agree to mandatory HIV testing. The bill was submitted to the Duma by Magomed Selimkhanov, a Chechen deputy from the ruling United Russia party.

The legislation’s memorandum states that such a law would help identify cases of HIV infection that are currently going unrecorded, allow people get medical attention earlier, reduce the number of children infected with the disease, and contribute to the fight against the spread of HIV in Russia.

The Duma’s committee on health has supported mandatory HIV testing as a requirement for marriage. Anna Popova, the head of Russia’s Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, has also signaled her support for such regulations.

According to Popova’s agency, more than 160,000 cases of HIV infection have been recorded in Russia over the past two years. Almost half of these cases are among Russians between the ages of 30 and 40. Roughly 20,000 HIV-infected people in Russia die every year.

Ramzan Kadyrov, the head of Russia’s Chechen Republic, is appealing on Instagram to Russian lawmakers, asking them to back the legislation. Chechnya has enforced such a policy since 2011, testing more than 95,000 people and discovering 94 cases of HIV infection, Kadyrov says.

Coalition Pushes To Soften HIV Laws In California

A coalition including the American Civil Liberties Union and Equality California have joined together in an effort to change certain state laws they say criminalize people living with HIV. At a forum held in Fresno last week, a dozen activist and medical professionals talked about a number of goals including reducing the penalty for intentionally spreading HIV from a felony to a misdemeanor.

“We believe the punishment is not proportionate to the crime,” says Craig Pulsipher, with the AIDS Project Los Angeles.

“I would just point to similar offenses that are felony in California statutes. This puts intentional transmission of HIV on par with voluntary manslaughter and so we really believe a misdemeanor is sufficient consequence,” he says.

The group also wants to repeal a handful of laws including being charged with a felony for soliciting sex while knowingly having HIV. In this case, the law doesn’t require any sexual contact or transmission of HIV just the act of soliciting while being positive. Other laws make it a felony for HIV positive people to donate blood or breast milk. In many cases, people convicted under these laws could face jail time.

Dr. Simon Paul with Community Regional Medical Center specializes treating those with HIV and AIDS in the Central Valley. He says these laws aren’t up to date with modern science.

“A lot of these things are crime even if no harm was done,” Paul says. “The fact that if you have HIV, and if you sleep with someone you’re practically at zero risk if you’re on treatment. The way the laws are written now it’s just as bad as if the person had HIV in the 80’s and had no treatment. That’s the part to me seems the craziest.”

Today people living with HIV can take a pill on a daily basis to reduce the amount of the virus in their body to minimal levels. Paul says this makes the patient highly unlikely to pass the virus to someone else.

With the current state laws dealing with HIV, a person can only be convicted of charges if they are aware of their status. Paul says this creates unintended consequences.

“These laws make people less likely to get tested and into care which is the way you’ll actually get HIV to decrease. I think the laws are passed out of fear and not helpful at this point,” he says.

In Fresno County alone, only around half of those living with HIV are linked intro treatment. And there many that don’t know their status.

Many advocates like Pulsipher say these laws actually discourage people from getting tested.

“Some of these sites that specifically talk about HIV criminalization laws, one of the pieces of advice they give is: the best way to not be prosecuted under these statutes is to not know their HIV status. So that’s the exact opposite of what we would like to do. We want to encourage people to know their status.”

The coalition is hosting forums throughout the state and they’re working on a bill they plan to introduce next year in Sacramento.

Uganda: Community Health Alliance Uganda (CHAU) board chairman, Dr Stephen Watiti calls for repeal of clauses on disclosure, mandatory testing and transmission in HIV and AIDS Prevention and Control Act

Community Health Alliance Uganda (CHAU) board chairman, Dr Stephen Watiti, has called for an amendment of the 2014 HIV and AIDS Prevention and Control Act.

Watiti, who was speaking at the launch of CHAU’s 2016-2020 Strategic Plan last week in Kampala, wants clauses on disclosure, mandatory testing and intentional transmission repealed.

CHAU is one of the local non-governmental organizations (NGOs) involved in anti-HIV/Aids campaigns in the country. Enacted last year amidst protests from civil society and activists, the HIV and AIDS Prevention and Control Act criminalizes intentional transmission of HIV, enforces mandatory testing and requires spouses to disclose results to their partners, among others.

“In most of our communities if a woman tested positive and told her husband as stipulated in this law, it sparks domestic violence and stigmatization. So, my appeal is to review and scrap such clauses,” said Watiti, also plans to join elective politics in his bid to push for the aforesaid changes in parliament next year.

He also noted that it would be difficult to prove whether someone set out to intentionally infect their partners in a love affair.

“Preventing new infections should be a responsibility of both HIV positive and negative people,” Watiti argued, adding that testing should be voluntarily because making it mandatory is a violation of human rights.

His comments were directed to chief guest at the function, Dr Chris Baryomunsi, the state minister for health in charge of general duties and also MP for Kinkiizi East.

In response, Baryomunsi assured guests the parliamentary health committee would consider such appeals upon reviewing the HIV/Aids Act and also address concerns about the NGO Bill, which many civil society activists claim is intended to curtail their work.

Noting that some NGOs such as CHAU have done a good job as government partners in the battle against HIV/Aids, Baryomunsi said they would consider progressive provisions to ensure work is not stifled.

Baryomunsi explained that the law is intended to clamp down on NGOs that registered to health-related work but deviate from their mandate along the way.

Baryomunsi lauded the organization for its work of supporting people living with HIV in 20 districts including Kayunga, Luweero, Nakasongola, Mukono, Wakiso, Kamuli, Mayuge, Mityana, Gulu and Mbarara.

CHAU also provides family planning and sexual reproductive health education services.

Prison time for HIV?

Prison time for HIV? It’s possible in Veracruz

El Daily Post, August 6th 2015

New legislation passed by the Veracruz state Congress calls for up to five years in prison for “willfully” infecting another with HIV, which can lead to AIDS. The measure is fraught with legal, medical, public health and human rights problems, but supporters insist it will help protect vulnerable women.

The Veracruz state Congress has unanimously approved legislation that calls for prison time for anyone who intentionally infects another person with the HIV virus or other sexually transmitted diseases.

The amendment to the state penal code makes Veracruz the second Mexican state (after Guerrero) to criminalize the sexual transmission of illnesses. Another 11 states have sanctions in the books for infecting others with “venereal diseases,” a term and concept no longer used in the medical community.

But Veracruz has stipulated a more severe punishment than the other states — from six months to five years in prison. Guerrero also has a maximum of five years, but it’s minimum is three months.

The bill was promoted by Dep. Mónica Robles Barajas, a member of the Green Party, which is allied with the ruling Institutional Revolutionary Party. She said the legislation is aimed at protecting women who can be infected by their husbands.

“It’s hard for a woman to tell her husband to use a condom,” she said in an interview with the Spanish-language online news site Animal Político.

The legislation, however, raises serious questions, both legal and medical, as well as concerns about human rights.

The most obvious problem is the notion of “intentional” infection. Robles emphasizes that the bill is based on a “willful” passing of the virus, which she defines as a carrier having sexual relations when he or she is aware of his or her HIV infection.

But the notion of intentionality in such cases is a complicated one for prosecutors, legal experts say. The he-said/she-said factor can be a sticking point, according to Luis González Plascencia, a former head of the Mexico City human rights commission, with the accusation likely to be based on one person’s testimony.

“There could be ways to show through testimony that there was an express intention to infect,” González told Animal Político. “But that’s always going to be circumstantial.”

A likely abuse of the law, he said, is attempted revenge or blackmail. An angry spouse or other partner can, with a simple declaration, create a legal nightmare.

Even if the issue of intentionality can be overcome, the very notion of criminalizing HIV infection is controversial. AIDs and human rights experts are against it.

One of them is Ricardo Hernández Forcada, who directs the HIV-AIDS program at Mexico’s National Human Rights Commission (CNDH). International experience, he says, indicates that punitive policies accomplish little besides government intrusion into private life. (Eastern Europe and Southeast Asia are regions where laws similar to the new one in Veracurz have existed.)

A Veracruz non-governmental organization called the Multisectoral HIV/AIDS Group issued a communiqué in response to the new legislation, declaring, “Scientific evidence shows that legislation and punishment do not prevent new infections, nor do they reduce female vulnerability. Instead, they negatively affect public health as well as human rights.”

González concurred. “The only thing that’s going to happen is that there will be another crime in the penal code that won’t accomplish anything except generate fear,” he said.

The Multisectoral Group also pointed out a disconnect between the law and medical science. It’s virtually impossible, the group says, to determine with certainty who infected whom with a sexually transmitted disease.

“Phylogenetic analyses alone cannot determine the relationship between two HIV samples,” the group said in its release. “They cannot establish the origin of an infection beyond a reasonable doubt, or how it occurred, or when it occurred.”

Robles, for her part, objects to the notion that the legislation criminalizes HIV carriers, insisting that the target is the intentional infection of another through sex. She emphasized that the aim of the new law is to protect women, who are often in a vulnerable situation.

“It’s directed much more at protecting women than homosexual groups,” she said. “There is a high incidence among women because there is no awareness of the risk they run.”

Opponents, however, see the new law as a step backward for men and women, and for public health in general, insisting that penalization comes at the expense of prevention.

“Knowing that they could be at risk of prosecution, people won’t get tested,” the CNDH’s Hernández Forcada said. “These measures inhibit people’s will to know their diagnosis.”