Uganda: Parliament passes ‘deeply flawed’ HIV law, takes ‘giant leap backwards’: urge President Museveni to veto

After years of intensive debate and strong local and international advocacy against many of the problematic clauses found within Uganda’s omnibus HIV law, yesterday Uganda’s Parliament passed the HIV Prevention and Control Act virtually unchanged from this 2010 version.

The bill includes mandatory HIV testing for pregnant women and their partners, and allows medical providers to disclose a client’s HIV status to others. The bill also criminalises ‘wilful and intentional’ HIV transmission, attempted transmission, and behaviour that might result in transmission by those who know their HIV status. There are some excellent analyses of the problematic provisions at The Observer (Uganda) and the Science Speaks blog.

Clauses 39 (‘attempted transmission of HIV’) and 41 (‘intentional transmission of HIV’) were adopted in the debate last week, as were clauses 13, 14 and 15 on mandatory and routine testing, with unverified reports that the ambit of clause 13 (‘HIV testing for purposes of criminal proceedings’) was broadened further. (Follow Parliament Watch Uganda [@pwatchug] on Twitter for latest details of the actual text).

Today, two press releases from Human Rights Watch, HEALTH Global Advocacy Project, and Uganda Network on Law, Ethics & HIV/AIDS (UGANET) and The International Community of Women Living with HIV (ICW) condemned the passage of the law in the strongest terms. They are likely to be the first of many.

“This HIV bill is yet another step backward in the fight against AIDS in Uganda,” said Maria Burnett, senior Africa researcher at Human Rights Watch. “It is founded on stigma and discrimination and based on approaches that have been condemned by international health agencies as ineffective and violating the rights of people living with HIV.”

Mandatory HIV testing and the disclosure of medical information without consent are contrary to international best practices and violate fundamental human rights, the three groups said. The criminalization of HIV transmission, attempted transmission, and behavior that might result in transmission by those who know their HIV status is overly broad, and difficult to enforce.

[…]

“For Uganda to address its HIV epidemic effectively, it needs to partner with people living with HIV, not blame them, criminalize them, and exclude them from policy making,” said Dorah Kiconco, executive director of Uganda Network on Law, Ethics & HIV/AIDS. “The president should not sign this bill and instead ensure a rights-based approach, recognizing that people living with HIV will prevent transmission if they are empowered and supported.”

[…]

“At the upcoming international AIDS conference, Uganda will be the example to all the countries gathered of how not to write laws on the HIV response,” said Asia Russell, international policy director at Health GAP (Global Access Project). “Parliamentarians are doing precisely the opposite of what Uganda should be doing to fight HIV.”

ICW’s press release is below

Today’s passage of the HIV Prevention and AIDS Control Bill represents a dangerous backslide in Uganda’s efforts to respond to HIV. While the bill may have been intended to facilitate and improve the HIV response in Uganda, the bill contains many poorly conceived and fear- induced provisions that have no place in a public health and human-rights-based response to HIV. As passed, this bill will actually weaken Uganda’s HIV prevention efforts and will have a detrimental and disproportionate impact on the rights of women and girls and in particular women living with HIV.

The International Community of Women Living with HIV Eastern Africa is extremely concerned about the devastating impact this law will have on the daily lives of women in Uganda. “It is disappointing that the Members of Parliament that we have engaged for so long, have ignored all the evidence, science and reason that we advanced as civil society organisations together with technocrats and scientists and chose instead, to act out of fear and unfounded hysteria – betraying the very will of the people that elected them to Parliament to represent their issues” said Lillian Mworeko, Regional Coordinator ICW EASTERN AFRICA.

The bill includes outdated and dangerous provisions for mandatory testing for pregnant women and their partners under Clause 14 (b) and (c). Mandatory testing of people living with HIV is a violation of fundamental human rights and accepted principles of informed consent and will negatively impact antenatal care attendance. Women—who will likely be the frequent target of these provisions— will shy away from hospitals and medical services. The devastating result will be that more children will be infected through mother to child transmission of HIV. Uganda is currently making strong strides towards zero infections from mother to child through use of proven strategies that emphasize voluntary counseling and testing. But Uganda’s gains could be lost if women are forced to test every time they visit a health facility. HIV testing of pregnant women, their partners and victims of sexual offenses must always be voluntary and conducted with informed consent.

“The fact that Uganda is even considering mandatory testing of pregnant women or victims of sexual offenses, represents a major step backwards for a country which showed early promise as an effective responder to HIV. Unfortunately, fear and ignorance have won the day in Uganda.” said Jessica Whitbread, Global Director of the International Community of Women Living with HIV.

Despite growing international consensus that criminalization is actually counter productive to the HIV prevention strategies, the Bill creates unnecessary and ill-advised additional criminal laws that criminalize attempted and intentional transmission of HIV. The International Community of Women living with HIV unequivocally opposes the criminalization of HIV status. The existing penal code already includes sufficient provisions to address criminal acts, creating additional parallel set of laws will just serve to persecute and punish people living with HIV. Criminalization will disproportionately impact women, who are more likely to know their HIV status through pregnancy related medical care. This provision will do little else but result in increased stigma and discrimination against people living with HIV, which are key drivers of the HIV epidemic.

Furthermore, the bill empowers medical workers to disclosure a person’s HIV sero status to a third party. Clause 21 (e); “where any other person with whom an HIV infected person is in close or continuous contact including but not limited to a sexual partner, if the nature of contact, in the opinion of the sexual medical practitioner, poses a clear and present danger of HIV transmission to that person;” Not only is this provision a clear violation of human rights and confidentiality but it is ripe for abuse by medical workers. Disclosure by medical workers of a person’s HIV status based purely on an individual opinion represents an institutionalized form of stigma and discrimination and dramatically increases the likelihood of violence against women living with HIV.

These poorly considered provisions at their best violate human rights and enshrine stigma and discrimination into law and at their worst will cause many people to shy away from accessing programs that work, such as prevention, treatment and care and support services including elimination of mother to child transmission services (eMTCT). Sadly, this bill undermines the very services that Uganda needs more than any other country in the world.

“Uganda is already facing a serious backslide from its early advances in responding to HIV, Uganda is currently one of three African countries experiencing increases in their HIV prevalence rates previously from 6.5% to 7.3 %. The passage of this Bill will only serve to increase this backslide and the President must save Uganda from this backlash”, says Margaret Happy, the Sexual Reproductive Health and Rights Officer, ICW Eastern Africa.

ICW Eastern Africa urges His Excellency Yoweri Kaguta Museveni, the President of Uganda, to rise above all and not assent to this Bill which is in contradiction of the commitments made by his wise assent to the East African Community HIV & AIDS Prevention and Management Act, 2012 .

UK: Court of Appeal upholds man’s conviction for recklessly passing on genital herpes during sex with ex-girlfriend

Today, the Court of Appeal upheld David Golding’s 2011 conviction for ‘recklessly’ infecting his ex-girfriend with genital herpes (HSV-2) during a brief relationship. However, his original 14 month sentence was reduced to three months (as time served, Mr Golding was released on bail in September 2011 after spending six weeks in prison) because of the exceptional delay in bringing the case to appeal. “Accordingly,” wrote Lord Justice Treacy on behalf of fellow judges Mr Justice Bean and His Honour Judge Lakin, “notwithstanding our view as to the propriety of the initial sentence, we exercise our power to reduce that sentence in the light of what has occurred subsequently.”

The Court found that Mr Golding understood both that he had the infection and how it is transmitted, and by not preventing transmission – or disclosing his condition thereby allowing the complainant to make an informed decision whether or not she wanted to risk acquiring herpes – was guilty of reckless grievous bodily harm under Section 20 of the Offences Against The Person Act 1861.

Notably, the Court reaffirmed that in this case herpes was a “really serious bodily harm”, although it noted that in a future contested trial it would be up to a jury to consider whether the herpes infection was, indeed, really serious, on a case-by-case basis.

20. As to the impact of herpes, the evidence was that whilst it was not a life threatening condition, it is incurable. The initial infection is described as an unpleasant and painful acute illness with debilitating effects. On occasion admission to hospital may be required, (not in this case), and most affected people can return to work within a week or so. Episodes may recur throughout life. Generally when they do, they are milder and shorter in impact. Psychological disturbance is common in the immediate aftermath of the initial episode. HSV-2 has a higher recurrence rate than HSV-1.

62. ….The evidence of the painful symptoms, their effect at the time, their recurrence, and the prospect of their recurrence without effective cure for an indefinite period was in our judgment sufficient for a jury to consider that it amounted to really serious bodily harm.

During the Appeal, Mr Golding testified that he had not been given clear information that genital herpes might be transmtted even in the absence of a “flare up”. The Court did not believe Mr Golding, and because there were no medical notes regarding how he had been counselled (despite him testifying that he only received confirmation of his herpes diagnosis over the phone from a GUM receptionist and a general leaflet on STIs at his initial visit) and because both medical experts – Dr Kenneth Mutton (for the Crown) and Professor George Kinghorn (for the defence) – said that “best practice” would be for a newly diagnosed person to be counselled about “the possibility of infectivity even when a person is asymptomatic” the Court found Mr Golding was, in fact, reckless.

22. The available medical notes were not specific as to advice provided to the appellant. According to Dr Mutton, he would have expected a full discussion to have taken place in April 2008 at the Genito-urinary Clinic following the guideline of the British Association for Sexual Health and HIV. This refers to condom use when lesions are present, the possibility of infectivity even when a person is asymptomatic, and disclosure of the condition to a partner.

23. Professor Kinghorn, in the absence of particular evidence as to the advice given to the appellant, thought that it was less likely that the appellant would have been told that he was infectious when no lesions were present. However, he conceded that since the turn of the century, the state of medical knowledge in this respect available to general practitioners had improved. He also acknowledged that a GP following best practice would have included advice about asymptomatic transfer.

This will have important future implications for the clinician-patient relationship, not only at GUM clinics, but also for GPs. It suggests that courts will assume this “best practice” has taken place – even if it hasn’t – and it will be hard for a future defendant to prove that he or she hadn’t been counselled in this way if there is nothing in their medical notes.

Given the public policy implications of this ruling, there may well be an application to appeal the case to the Supreme Court.

Unusually, it was the CPS that had initiated this appeal after seeing a report from Dr Mutton, produced after Mr Golding was sentenced (following an initial guilty plea) which raised the issue of whether genital herpes could be described as “really serious bodily harm” so as to come within Section 20. In the latest (unpublished) version of its legal guidance on prosecuting Intentional or Reckless Sexual Transmission of Infection it had suggested that genital herpes could be prosecuted under Section 47 of the OAPA 1961, actual bodily harm.

Mr Golding had been prepared to plead guilty under Section 47 in his original trial, but the judge had made it clear that he would only accept a plea (or a full trial) under Section 20. In effect, however, the Court of Appeal has dodged a bullet by avoiding a clear statement that sexual herpes transmission is always serious bodily harm.

As it stands, the reckless (or intentional) transmission of any sexually transmitted infection (whether or not it is considered to be objectively serious by, for example, BASHH or other medical experts) could be prosecuted in England & Wales and a jury will decide whether the infection is subjectively serious according to the testimony of the complainant and medical experts.

It should be recalled that the original draft of the CPS guidance, published in 2006, covered not only the intentional or reckless sexual transmission of HIV, but also chlamydia; genital herpes; gonorrhoea; hepatitis A, B and C; LGV (lymphogranuloma venereum); non-specific urethritis (NSU), and syphilis.

Back in 2007, in response to the draft, the Government’s Expert Advisory Group on AIDS (EAGA) noted that including so many non-serious STIs was “one of the most disturbing aspects of the document.” It conceded that “broadening the policy to cover other infections may be desirable to avoid stigmatising HIV,” but added that “there is a danger of confusion because of significant differences between the infections listed.” It questioned the CPS’s understanding of the nature of STIs, how they are transmitted and whether they actually cause any serious harm in pragmatic terms.

As an example it used the case of genital herpes, which “is simply a cold sore on the genitals, indeed half of all cases in the UK are thought to be caused by transmission of herpes from the mouth to the partner’s genitals during oral sex. It causes little serious physical harm and most people who contract it are not even psychologically disturbed by it in the longer term. Even given the definition in the document, it seems to defy common sense that this could constitute grievous bodily harm.”

EAGA added that HSV, the virus that causes genital herpes, is often passed from parent to child with a kiss on the cheek. “Why should it be grievous bodily harm to infect a partner with genital herpes through sex, but not when an adult infects a child by kissing their cheek, or another adult by kissing their mouth?”

It stressed that “the CPS needs to take the advice of experts regarding the seriousness of [STIs]. In the vast majority of cases, seeking to prosecute transmission would be an entirely disproportionate response.”

The Herpes Viruses Association (HVA) issued a press release following today’s verdict which stated that “we are appalled at the court’s failure to overturn the guilty verdict. Herpes virus transmission should not be in the legal arena at all.”

HVA charity director Marian Nicholson said: “This charity represents around forty million people in the UK who carry herpes simplex infections. Over half the cases of genital herpes are caused by the common facial cold sore type (HSV-1) usually by oral sex. The implications of the judgment are that any of them could be sent to prison if they transmit this infection to a partner.”

She said: “I am pleased that David Golding has not been sent back to prison – but this ruling is inappropriate. It is not in anyone’s interest to send people to prison for passing on such a common and usually unnoticed condition.”

She continued, “We should take responsibility for our own sexual health and not assume that a partner is infection-free. Many infections are caught from people who don’t know they have them so blaming someone else is pointless.”

R v Golding [2014] EWCA Crim 889

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.”

Canada: Supreme Court rules that unwanted pregnancy is a similar 'harm' to HIV

Men who sabotage condoms may turn an otherwise consensual act with a woman into sexual assault, and women who lie about using birth control have been left with some uncertainty about whether they, too, could face charges, under a Supreme Court ruling yesterday on deception before sex.

See also Court avoids making HIV prosecutions easier

From http://dailyxtra.com/canada/news/supreme-court-accepts-reasoning-hiv-groups-in-condom-case

The Supreme Court of Canada heeded the warnings of HIV groups in a narrow 4-3 judgment March 7.

The court upheld the conviction of Craig Hutchinson for aggravated sexual assault. Hutchinson poked holes in condoms he used with his girlfriend. He did this without her consent, hoping that she would become pregnant, which she did. There are parallels with HIV -ondisclosure cases, which also involve keeping information from someone before a sexual encounter.

The court had two legal routes available to it to convict. One route would have used the fraud provisions in the Criminal Code. This is essentially the same legal principle used in HIV-nondisclosure cases and requires both a dishonest act and some harm, or risk of harm. The majority of the Supreme Court endorsed this approach today.

The other route could have further crowbarred open HIV-nondisclosure prosecutions. A minority of judges at the Supreme Court would not have required any proof of harm in order to secure a conviction in Hutchinson’s case. This was also the reasoning of the majority of the Nova Scotia Court of Appeal.

The Canadian HIV/AIDS Legal Network and the HIV and AIDS Legal Clinic Ontario (HALCO) intervened last year to argue that the Court of Appeal’s approach would unfairly extend the criminal law to cases where there was no realistic risk of HIV transmission.

Chief Justice Beverley McLachlin agreed, saying that the court must act to protect the existing legal test and avoid “replac[ing] the clarity and restraint achieved by [HIV-nondisclosure] decisions with confusion and over-criminalization.”

This will likely seem insufficient for those who believe courts already go too far to criminalize the lives of HIV-positive people. But the court did accept the reasoning of HIV groups that intervened in the case — which it refused to do the last two times HIV nondisclosure was before the Supreme Court.

Cecile Kazatchkine, a lawyer at the Legal Network, says that the court avoided setting a bad precedent.

“This case doesn’t have any implications for people living with HIV,” Kazatchkine says. “There was a danger that it would, but it didn’t.”

“The Legal Network and HALCO have been really diligent; we decided to intervene, and put all of our energy into this case, even though it wasn’t an HIV case, to make sure the court didn’t reach a decision that makes things worse for people living with HIV.”

In December 2012, the Supreme Court released its decision in the HIV non-disclosure case of Mabior. Panned by HIV groups, a unanimous court required HIV positive people to inform their partners about their health status, unless they have both a low viral load and wear a condom.

In Mabior, the Crown asked the court to criminalize non-disclosure, regardless of whether there was any risk of transmission. That approach was rejected by the court at the time, and rejected again in the March 7 decision. Kazatchkine says that the decision will send a message to Crowns to stop trying to equate non-disclosure in all cases with sexual assault.

Kyle Kirkup, a doctoral student at the University of Toronto Faculty of Law, agrees.

“I think maybe this shows that Mabior is the high water mark of criminalization and that’s the message that the Supreme Court of Canada is trying to send, that the court is not willing to go further.

“If you adopted a broader definition of consent, the concern was that people with HIV would have to disclose in all kinds of situations where there is not a realistic possibility of transmission, like oral sex and mutual masturbation.”

Nonetheless, the reaction to today’s decision is a far cry from years past, when HIV groups called for an end to criminal prosecutions altogether.

Kazatchkine admits that the Legal Network was in an awkward position when it argued for the court to uphold its earlier decision — a decision which the Legal Network publicly denounced at the time.

The case nonetheless may prove to be an important one in the development of the law of sexual assault. While Hutchinson may have opened the door to other non-HIV related fraud charges, the facts in the case were so unusual that it’s hard to know how broad the impact of the case will be, says Kirkup.

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.

Uganda: ‘Trial by media’ of nurse accused of exposing a child to HIV via injection sets a ‘dangerous precedent’

The ongoing case of Rosemary Namubiru, the Ugandan nurse accused of exposing a child to HIV during the course of administering an injection, is highlighted in a powerful press release issued yesterday by AIDS Free World. Fortunately, Ms Namubiru is being supported by several advocacy and human rights organisations as well as by individual HIV advocates in Uganda.

The inflammatory media coverage (an example of which is this horribly invasive TV news story, above) not only increased HIV-related stigma and violated Ms Namubiru’s right to a fair trial, but is also being used to help justify the passing of the draft HIV Prevention and AIDS Control Bill 2010 which includes a number of problematic provisions including mandatory HIV tests for pregnant women and their partners, and forced disclosure of HIV status to a newly diagnosed person’s partner by a medical practitioner. In addition, the Bill contains two overly broad and problematic HIV-specific criminal statutes.

In late 2009, a group of more than 50 Ugandan and international organisations and individuals released a report criticising many of the provisions of an earlier draft. That early advocacy resulted in the removal of a criminal penalty for the transmission of HIV from mother to child through breastfeeding.

Advocacy co-ordinated by the Uganda Network on Law, Ethics and HIV/AIDS (UGANET), continues to argue that the unfavourable clauses must be completely removed and that Uganda must assent to the East African Community (EAC) HIV & AIDS Prevention and Management Act which contains provisions meant to supersede Ugandan law.

Read the entire press release below and download the PDF version here.

HIV-Positive Nurse Tried by Media

––Uganda’s first court case dealing with criminalization of HIV transmission could have far-reaching consequences––

February 11, 2014 (Kampala, Uganda)––Rosemary Namubiru, a Ugandan nurse, stands accused of exposing a child to HIV during the course of administering an injection. The incident incited a media firestorm, leading to Namubiru’s arrest and trumped-up charges of attempted murder. That these were baseless charges was confirmed at the opening of the trial today when the charge was changed to criminal negligence; charges that could still carry up to seven years in prison. As the trial begins, it is clear that the damage has already been done. Namubiru was tried and convicted in the public eye by the media, violating her rights and presumption of innocence.

The implications of this case are far-reaching: the Namubiru case appears to be the first in Uganda’s courts dealing directly with HIV exposure and transmission. Efforts to criminalize HIV transmission, and the failure of both the media and the prosecutors office to act responsibly, set a dangerous precedent and could have grave consequences for the fundamental rights of people living with HIV and AIDS in Uganda and beyond.

Case Summary

Rosemary Namubiru, 64, a nurse with 35 years of experience, was working at the Victoria Medical Centre in Kampala, Uganda. On January 7, 2014, Namubiru was attempting to give an injection to an ill 2-year-old patient. Neither she nor the mother could calm the distraught child. With the child writhing and kicking, the needle accidentally pricked Namubiru’s finger; she stopped what she was doing, washed and bandaged her pricked finger, and returned to the child. She was eventually able to administer the injection.

Uncertain about whether the same needle was used throughout, the mother became concerned about the possibility that her child had been exposed to HIV. It was confirmed that Namubiru is HIV-positive and is on anti-retroviral drugs. The child was given an HIV test; the results were negative. A precautionary 2-month post-exposure prophylaxis regimen was initiated, after which the child will be re-tested.

Rosemary Namubiru was arrested in front of a bevy of journalists. She was held by the Criminal Investigations Department for four days before her first appearance in court. She was charged with attempted murder, which carries a sentence of up to life imprisonment, and remanded to Luzira National Prison to await trial. On February 7, 2014, she was denied bail and returned to prison to await trial. Minutes before the trail began on February 11, 2014, the prosecutor announced the charge would be changed to “negligent act likely to spread infection of disease.” With this new charge in place, the prosecutor began to call its witnesses, and the trial is ongoing.

Trial by media

Since the moment of her arrest, Rosemary Namubiru has been found guilty in the court of public opinion. Even though research has shown that the likelihood of HIV transmission from a needle puncture is miniscule––only 0.32% of those exposed to HIV through a subcutaneous puncture became infected––Namubiru has been singled out and vilified in the press because of her HIV-positive status.

Here are just a few of the libelous accusations that appeared in the media reports in the immediate aftermath of her arrest:

* An article with the headline “Killer nurse charged with attempted murder” went on to accuse Namubiru of “maliciously infecting her patients, mainly the children with her HIV positive blood.”

* Another claimed that she “drew her own HIV-infected blood and injected it into a two-year old child.”

* Shortly after Namubiru’s arrest, one article stated that police were “investigating allegations that the woman has been engaging in the act for a pretty long time.”

* An article that appeared in The Africa Report speculated about Namubiru’s mental state, calling her “the fiendish nurse” and claiming “the baby’s incessant cries drove her mad.”

* One journalist opined that “as police struggled to find an appropriate charge to punish such an evil act, it became clearer that our laws are inadequate to cover such emerging but deadly crimes.”

* An editorial about the case declared, “The majority of our doctors and nurses may well be great professionals, but it’s also true that among them are many people who do not harbour good intentions for one reason or another. These could be inherently evil-minded, bitter or mentally unstable.”

False and sensational accounts by irresponsible media can prejudice the outcomes of trials and violate the fundamental human rights of people living with HIV and AIDS. Section 28 of Uganda’s constitution guarantees that every person charged with a criminal offence shall “be presumed to be innocent until proved guilty.”

A miscarriage of justice

Even before the trial began, serious questions surfaced regarding Rosemary Namubiru’s ability to receive a fair hearing. From the spectacle of her arrest—recorded by media who were clearly alerted in advance–-to the baseless original charge of attempted murder, and the rush to trial before the defense could prepare, it is clear that this is a sensationalized case.

Throughout the process, there have been numerous violations of Rosemary Namubiru’s rights:

* According to Section 23(4)(b) of the Ugandan constitution, an accused person can only be held for up to 48 hours before a hearing. Namubiru was held for four days before her first court appearance.

* The prosecution argued against granting bail, stating that Namubiru poses a grave risk to the public, even though there is no evidence of intent to commit any crime.

* Namubiru had no lawyer present when police extracted a statement from her; she was unable to access legal counsel until she had been in detention for a week.

* The Prosecutor claimed on February 7, 2014 that the State had completed its investigation and was ready to proceed to trial. Namubiru’s lawyers had not yet seen the State’s evidence, and were informed that they would receive the file the day before the trial was slated to begin. Section 28 of Uganda’s constitution guarantees that every person charged with a criminal offence shall “be given adequate time and facilities for the preparation of his or her defence.”

What are the broader implications of this case?

HIV advocates fear that the Namubiru case could set a dangerous precedent, in terms of both the criminalization of HIV transmission and the treatment of people living with HIV and AIDS.

Many advocates worry that the case could be used to justify passing the proposed HIV Prevention and AIDS Control Bill 2010. The bill includes two overly-broad sections on the criminalization of HIV, as well as a number of other troubling provisions that would restrict the rights of persons living with HIV and AIDS. If the government moves to legislate the criminalization of HIV, specific groups—including pregnant women, who are easily identified within the chain of transmission—could be targeted for criminal charges. (For more on the proposed bill and its implications, please visit www.uganet.org).

AIDS-Free World unequivocally disagrees with the notion of having a separate criminal code for people who are HIV-positive. If a person attempts to do bodily harm to another, regardless of the means, the existing laws should apply. By creating laws that specifically criminalize HIV transmission, the courts place the emphasis on the person, rather than the crime.

The media frenzy created by this case illustrates the degree to which HIV stigma still exists. Many advocates warn that the introduction of HIV-specific laws would be a dramatic setback in efforts to eliminate discrimination, particularly in the workplace.

Expert global guidance on the criminalization of HIV transmission

In its landmark report, the Global Commission on HIV and the Law recommended that:

“To ensure an effective, sustainable response to HIV that is consistent with human rights obligations:

2.1. Countries must not enact laws that explicitly criminalise HIV…exposure. Where such laws exist, they are counterproductive and must be repealed.

2.2. Law enforcement authorities must not prosecute people in cases of HIV…exposure where no intentional or malicious HIV transmission has been proven to take place.

2.4. Countries may legitimately prosecute HIV transmission that was both actual and intentional, using general criminal law, but such prosecutions should be pursued with care and require a high standard of evidence and proof.

—–

Rosemary Namubiru is being supported by several advocacy and human rights organizations, including the International Community of Women Living with HIV, Eastern Africa (ICWEA), Uganda Network on Law, Ethics and HIV/AIDS (UGANET), The National Forum of People Living with HIV in Uganda and AIDS-Free World (NAFOPHANU), and by individual HIV advocates including Canon Gideon Byamugisha, Milly Katana, Major Rubaramira Ruranga.

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. — 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

Global Commission on HIV and the Law Jan 2014 newsletter highlights important legal and policy developments as well as new resources

We are pleased to share this first Newsletter Issue of 2014 containing several important developments. Perhaps most significantly, there have been a number of controversial recent anti-LGBT rulings and legislation around the world. In the same week in December, both Nigeria and Uganda adopted harsh new anti-LGBT related laws, which no doubt will have repercussions on the HIV response in those countries. Also, in December in response to the Supreme Court of India’s overruling of an earlier lower court decision to strike down an anti-sodomy law, effectively recriminalizing same sex behavior, former Commissioners of the Global Commission on HIV and the Law jointly issued a statement expressing dismay at the decision of the country’s top court. On a more positive note, in October Uzbekistan lifted all restrictions on entry, stay and residence for people living with HIV – see this UNAIDS infographic on current travel restrictions for PLHIV.

Several national and local level dialogues on HIV, human rights and the law were held in recent months, including in Brazil (November), China (December), Democratic Republic of Congo (November), and Dominican Republic (June). On 28-31 October, the first Eastern and Southern Africa Regional Judicial Dialogue on HIV and the Law was held in Nairobi. Also in October, UNDP and UNAIDS organized an information session on access to affordable medicines in Nay Pyi Taw, Myanmar, attended by more than 30 parliamentarians. Visit our recently updated interactive map for more information on efforts by UN agencies, including UNDP and UNAIDS, in partnership with governments, civil society and international donors, to support countries in creating enabling legal environments for HIV responses and advance the findings and recommendations of the Global Commission on HIV and the Law.

A number of key knowledge products were published this past quarter, such as: Judging the epidemic: A judicial handbook on HIV, human rights and the law (UNAIDS, 2014); Protecting the rights of key HIV-affected women and girls in health care settings: A legal scan (UNDP, SAARCLAW, WAP+, 2013); HIV and human rights manual for the Democratic Republic of the Congo (French) (UNDP, 2013); Young people and the Law in Asia and the Pacific: A review of laws and policies affecting young people’s access to sexual and reproductive health and HIV services (UNESCO, UNFPA, UNAIDS, UNDP, Youth Lead, 2013); and Compendium of Judgments for Judicial Dialogue on HIV, Human Rights and the Law in Eastern and Southern Africa (UNDP, 2013).

Uganda: Remove mandatory testing, mandatory disclosure and criminalization clauses in draft HIV-specific law, say activists

A coalition of HIV/AIDS activists has asked parliament to amend some clauses in the HIV/AIDS Protection and Control Bill 2010 before enacted into law. The activists said the HIV Prevention and Control Bill 2010 in its current form has clauses that will deter the fight against the epidemic. The amendments they want include removing mandatory testing, mandatory disclosure and criminalization. They also want the title of the Bill changed to HIV/AIDS Prevention and Management Bill. “Policy makers should treat this matter with urgency,” said Stella Kentutsi the Executive Director, National Forum of People Living with HIV/AIDS Networks in Uganda.