US: Advocating for HIV decriminalisation and health equity at Indiana’s first HIV advocacy summit

HIV advocates, organizations talk legislative solutions at first advocacy summit

By Abigail Ruhman

Community health centers and Ryan White HIV AIDS Program centers play an important role in expanding services and care for vulnerable populations, including HIV prevention and wellness. The Damien Center – Indiana’s oldest and largest HIV service organization – hosted its first HIV advocacy summit Wednesday to develop strategies for the upcoming legislative session.

Carrie Foote, a professor of sociology at Indiana University-Indianapolis, has been living with HIV since 1988 and leads HIV Modernization Movement-Indiana. She said Indiana has several laws that lead to the inappropriate arrest or prosecution of people living with HIV — which wastes state resources and has no public health benefit.

“We can end the epidemic,” Foote said. “We can end it, so anything that’s a barrier to doing that — and these laws are — we want to get rid of and improve.”

Foote said these laws lead to stigma around HIV that act as a barrier to testing and care — which gets in the way of preventing new transmissions and optimizing wellness for people living with HIV.

There are six laws that criminalize HIV in Indiana — which include both public health and criminal codes.

Two relate to the donation, sale or transfer of semen for artificial insemination, blood or plasma when someone “knowingly” has HIV. Another two focus on alleged non-disclosure of someone’s HIV status. When the laws were originally written, they said people living with HIV have a “duty to inform” sexual and needle sharing partners of their states prior to “high-risk activity.”

“The disclosure law used to be called ‘Duty to Warn,’” Foote said. “We came with a warning label before we had sex. So first, I need to warn you that I have HIV. That’s the language. How stigmatizing is that?”

Advocates were able to work with lawmakers to revise the language to be less stigmatizing, but the disclosure law still exists in Indiana code.

The last two enhance punishments for battery or malicious mischief by bodily fluid or waste for people living with HIV. For example, Foote said for someone who doesn’t live with HIV, spitting on someone is considered a misdemeanor.

“For anybody living with viral hepatitis or HIV, it gets enhanced to a felony crime solely because of their HIV status, even though those diseases are not transmitted that way,” Foote said.

Foote said legislative reform around the issue focuses on efforts to repeal HIV specific criminal laws and remove enhanced penalties based solely on a person’s HIV status. Advocates also want to modernize or reform laws to reflect the current science of HIV transmission and HIV as a chronic manageable condition, as well as narrow the law to situations that involve the “intent to transmit” or a “substantial risk of transmission.”

Foote is collaborating with the University of California-Los Angeles School of Law’s Williams Institute to analyze the enforcement of HIV criminalization in Indiana. She said not all of the HIV criminalization laws have been used, but many have led to arrests.

“People also are being convicted under these laws, so that right there tells you that change needs to occur because we have these people being prosecuted in ways that are unfair and don’t reflect advances in modern science,” Foote said.

Foote said in addition to creating harmful stigma, HIV criminalization disproportionately affects Black people, sexual minorities and people who inject drugs, which makes health inequities worse.

The Damien Center event also focused on different challenges these community centers face when trying to provide services and how threats to a federal program can make care more complicated.

The 340B drug pricing program was created in partnership with pharmaceutical companies — which agreed to provide “significant” discounts to eligible health care providers in order to participate in the Medicaid program.

Community health centers, also known as federally qualified health centers, are designed to increase access to primary care by reducing barriers such as cost, lack of insurance and distance. Ryan White centers are a part of the federal program designed to increase access to care for HIV.

Colleen Meiman, the national policy advisor for state and regional associations of Community Health Centers, said the program allows these centers to stretch federal resources to reach more patients and provide comprehensive services to vulnerable populations.

“340B is about so much more than pharmaceuticals,” Meiman said. “340B is essential to the financial sustainability of many, many, probably the majority of health centers.”

She also said the 340B program is facing several threats at the federal level, but some states have been able to pass legislation to protect the program.

Damien Center President and CEO Alan Witchery said the event was meant to identify issues that advocates and organizations want to address moving forward.

“There really isn’t an opportunity for nonprofits to come together and think about just doing this kind of advocacy,” Witchery said.

Witchery said he wants there to be a continued conversation around lobbying, advocacy and education efforts for these organizations to promote their causes together as a group around the state.

India: Mizoram Legislative Forum on HIV/AIDS discusses possibility of mandatory HIV testing for all citizens

Mizoram legislators bat for mandatory HIV testing amid rising cases

A meeting of the Mizoram Legislative Forum on HIV/AIDS was held on Tuesday, chaired by Health Minister Lalrinpuii at the SAD Conference Hall, MINECO. The session focused on the state’s rising HIV cases and discussed the possibility of introducing a mandatory HIV testing policy for all citizens.

In her address, Lalrinpuii emphasized the importance of addressing the issue head-on, noting that HIV/AIDS, once perceived as a disease affecting certain groups, now impacts a broader section of the population. She urged legislators and MLAs to actively raise awareness in their constituencies and stressed the need for proactive measures to curb the spread of the virus.

The forum reviewed Mizoram’s HIV situation, referencing the 2023 HIV Estimation Report, which revealed the state’s adult HIV prevalence rate at 2.73%—much higher than the national average of 0.2%. Since the first detection of HIV cases in 1990, Mizoram has recorded 31,461 HIV-positive cases, including 2,541 children.

It was noted that 63.93% of HIV transmissions in the state are due to unprotected sexual intercourse, while 30.80% result from sharing needles and syringes. Currently, 16,661 people in Mizoram are receiving Antiretroviral Therapy (ART), with 5,277 deaths recorded due to HIV/AIDS complications.

The state has 39 Integrated Counselling and Testing Centres (ICTCs) and 14 ART centers providing treatment to HIV-positive individuals. However, challenges remain as many HIV-positive patients, despite being eligible for ART, stop taking their medication or lose contact with healthcare providers. To address this, the forum proposed linking patients’ treatment records to their Aadhar cards.

The meeting also discussed expanding HIV testing and treatment services. In consultation with the National AIDS Control Organisation (NACO), the forum suggested making HIV testing more accessible and floated the idea of implementing a mandatory testing policy to combat the virus’s spread.

The forum concluded that urgent action is needed to control Mizoram’s HIV epidemic and ensure better health outcomes for those affected.

Australia: Criminalisation fuels healthcare disparities for migrants living with HIV

HIV in Australia: shades of injustice remain

Elimination is the goal, but migrants living with the virus experience a criminalised environment that thwarts access to care.

Health Minister Mark Butler painted a largely rosy picture of the progress towards elimination of HIV in Australia today, speaking on the second morning of the ASHM HIV/AIDS Conference in Sydney.

A legal academic, however, said people with HIV in Australia were still living under a pall of criminalisation, none more so than migrants.

Mr Butler praised the Australian response to the epidemic, especially in NSW, which was most affected in the early days.

“Since HIV was first detected more than 40 years ago in Australia, Australia’s response has been one to be proud of,” he said.

“When you go back to those early years, AIDS was highly feared here as it was around the world. There was huge stigma, misinformation, homophobia and such loss and so much grief for communities.

“But Australia’s response early on was characterised by partnership and collaboration: governments, people living with HIV, communities affected by HIV, non-government organisations, health professionals and academics all came together and worked together.”

He said HIV notifications were declining in Australia, at one of the fastest rates in the world – “but as you have all heard, I’m sure, transmission has also gone up in 2023, reminding us there is always more work to be done”.

“Eliminating transmission of HIV here in Australia is ambitious, but I am absolutely assured it is now achievable,” he said today, citing inner Sydney – once the epicentre of the epidemic – as a place that had effectively achieved elimination.

Mr Butler set up the HIV Taskforce last year with a goal to “virtually” eliminate transmission by 2030. The Ninth National HIV Strategy covers from last year to 2030, continuing the work of the Eighth – whose goal was virtual elimination by 2022.

He said transmission rates had grown “among temporary residents who are here in Australia on work or study visas”.

“So we will provide subsidised access to PrEP to make healthcare more equitable for people who don’t have access to Medicare … We will make sure that at-risk populations can get free HIV self-testing kits through an expansion of the national HIV self-test mailout program [run by the National Association of People with HIV Australia (NAPWHA)] as well as HIV self-testing vending machine programs,” said Mr Butler.

For David Carter, Scientia Associate Professor at the faculty of Law & Justice at UNSW, the necessary changes for people on visas won’t be found in any vending machine but in immigration policy.

Professor Carter, who leads the Health+Law Research Partnership for social justice for people living with HIV or hepatitis B, walked through the history of “unjust and unhelpful” HIV criminalisation in Australia – a public policy environment that includes but is not limited to action by law enforcement and courts. It begins with the creation of a “suspect population”.

He quoted the very first National HIV Strategy in 1987, which warned of the “temptation” of criminalisation measures, including “universal or selective testing, closure of gay venues, criminal penalties for transmission, compulsory notification of HIV infection and restrictions on freedoms of infected people through limitations on employment, quarantine or compulsory detention”, and noted these would jeopardise health measures to prevent transmission.

A working party in 1992 concluded that “even in the face of decisions by individuals that generate harm, it was the wrong decision to restrict the free choice of individuals in modern society, as draconian measures would merely alienate people at risk of infection and deter them presenting for counselling, testing and treatment”.

While pressure to enforce such measures may have been largely resisted, and the situation for Australians has greatly improved, migrants living with HIV are still experiencing an alienating and hostile environment, said Professor Carter.

Characterising them as posing potential harm to Australians “establishes an adversarial relationship between the person living with HIV and the state” and compromises health care by promoting defensive behaviour.

He and his team have interviewed migrants in Australia living with HIV over the past two years, for whom “criminalisation is indeed very active, and it is producing serious, negative health and other impacts of individuals or communities and respects”.

He quoted one interviewee, “Sergio”, who told the team: “I don’t have to face any court, but I did have to prove that I wasn’t a bad person just because I have HIV.”

Others spoke of experience going through the migration process as being “subject to an unending interrogation”.

“Laurence” told his interviewer: “It’s like a tattoo on your mind. The government will treat you different for every single step of your life from here on out.”

“Manish”, who was on a temporary visa, avoided getting tested for 10 months after beginning to suspect he had HIV, for fear of having his visa revoked. His health deteriorated during this time.

“The elevated threat levels produced by the interaction of migration law and public health law … significantly harmed Manish’s health, caused psychological distress and steered him towards coping responses that denied him the testing and treatment, access to medical care and other supports that he deserves and that we all collectively affirm are essential and are his right,” said Professor Carter.

“Manish said to us: ‘I feel like if I had reassurance that nothing’s going to happen to me if I tested positive for this, I would not have been afraid to go and get a test for HIV’.”

Others described feelings of “hopelessness and depression, because there is no hope for us to stay permanently while living with HIV” (in fact there are pathways for permanent migration despite living with HIV). These people would go for weeks without medication in a form of self-sabotage “because they just don’t have hope for their future anymore”.

For these and other people like them, the Australian environment “is just a set of undifferentiated threats to autonomy, wellbeing and safety, to which they are forced to respond with adaptation, distancing and adopting a posture of self-defence”.

Professor Carter concluded that “it may be different today [from the 90s], but it is not over, and it won’t be over here or elsewhere until the stigma of HIV, unconventional sexuality and drug use are gone”.

The HIV/AIDS Conference is running in Sydney this week back-to-back with the 25th IUSTI World Congress.

Senegal: HIV advocates push to update country’s HIV law to reflect scientific advances

HIV/AIDS campaigners call for revision of HIV law

Translated via Deepl.com. Scroll down for article in French. 

More than 10 years after the law on HIV was passed, those involved in the fight against the disease are calling for it to be revised. They believe that the law is obsolete and needs to be updated to take account of new issues. According to Massogui Thiandoum, Executive Director of the National Alliance of Communities for Health (ANCS), the law on HIV needs updating. ‘It is over 10 years old. There have been many advances in the fight against HIV, as well as scientific developments that show that certain aspects of the law need to be updated, or that new issues have emerged that need to be taken into account’, he explains.

A request has been made to this effect. Mr Thiandoum said: ‘We have already contacted the National Assembly to organise a training session to present the limitations of the law and the new scientific advances that it has not taken into account. We will be proposing amendments to MPs to update the law on HIV in Senegal.

He also advocates the decentralisation of HIV care services, saying: ‘We have trained community players, with the support of the health districts, so that they can help the health system to distribute antiretrovirals (ARVs) at community level. In some very remote areas, or depending on the context and particular situations, certain categories of people do not go to health facilities. The mediators we have trained, under the supervision of the health districts, have the responsibility and the opportunity to bring the treatment to these people and provide them with the medicines under the supervision of qualified health professionals’.

Les acteurs de la lutte contre le VIH/Sida demandent une révision de la loi sur le VIH

Plus de 10 ans après le vote de la loi sur le VIH, les acteurs de la lutte contre cette maladie réclament sa révision. Ils estiment que le texte est obsolète et nécessiterait une mise à jour pour prendre en compte les nouvelles problématiques. Selon Massogui Thiandoum, directeur exécutif de l’Alliance nationale des communautés pour la santé (ANCS), la loi sur le VIH nécessite d’être actualisée. “Elle date de plus de 10 ans. Il y a eu beaucoup d’avancées dans la lutte contre le VIH, ainsi que des évolutions scientifiques qui montrent que certains aspects de la loi doivent être mis à jour, ou que de nouvelles problématiques ont émergé et nécessitent d’être prises en compte”, explique-t-il.

Une demande a été formulée en ce sens. M. Thiandoum a déclaré : “Nous avons déjà pris contact avec l’Assemblée nationale pour organiser une session de formation afin de présenter les limites de la loi et les nouvelles avancées scientifiques qu’elle n’a pas prises en compte. Nous proposerons aux députés des modifications pour mettre à jour la loi sur le VIH au Sénégal.

Il plaide également pour la décentralisation des services de prise en charge du VIH, en déclarant : “Nous avons formé des acteurs communautaires, avec l’encadrement des districts sanitaires, pour qu’ils puissent aider le système de santé dans la distribution des antirétroviraux (ARV) au niveau communautaire. Dans certaines zones très éloignées ou en fonction des contextes et des situations particulières, certaines catégories de personnes ne se rendent pas dans les structures de santé. Les médiateurs que nous avons formés, sous l’encadrement des districts sanitaires, ont la responsabilité et la possibilité d’amener le traitement à ces personnes et de leur fournir les médicaments sous la supervision de professionnels de santé qualifiés”.

Tajikistan: Rising HIV cases among migrants highlight urgent need for testing and repeal of HIV criminalisation law

Every third person with HIV in Tajikistan is a labour migrant

Translated with Deepl.com. For article in Russian, please scroll down. 

There are more and more people living with HIV among migrants

In Tajikistan, every third person with HIV is a labour migrant. Over the past five years, 5,463 cases of HIV infection have been detected, according to data from the Republican Centre for HIV/AIDS Prevention and Control. Of these, migrants account for 22 per cent of those infected. While in 2019 migrants accounted for only 17 per cent of those infected, by 2023 that figure had risen to 32.5 per cent.
Balajon Davlatov, a specialist of the dispensary department of the Republican HIV Centre, strongly recommends to take a free test at one of the HIV prevention and control centres in Tajikistan immediately after arrival.

“Every migrant, after returning home, should be tested for HIV infection if they have doubts about it,” Davlatov said.
More than 300 migrants are already on the Republican HIV Centre’s dispensary register, he said. Their identities and test results are not disclosed to third parties.
“Any information about each person should be confidential. It is possible to get express tests, which within 15 minutes by analysing saliva report the patient’s HIV status – completely anonymously,” he says.
Such tests are available free of charge at one of the 67 government HIV prevention and control centres in all regions of Tajikistan.
In addition to testing through blood at AIDS centres, self-testing using near-blood fluid is now available. Self-test kits are available in Dushanbe, Rudaki, Khujand and B.Gafurov through online ordering at hivtest.tj.

The ordering process involves filling out a simple form with a few questions. This platform helps people confidentially find out their HIV status and provides up-to-date information on protection and prevention methods.
Those who test positive for HIV can learn more about their result and get a follow-up confirmatory test at the AIDS Centre.

We had a case with a woman who tested positive for HIV,” says Balajon Davlatov, “after treatment with antiretrovirals, she gave birth to two HIV-negative children. Now she lives in Russia, and we send her the necessary medication and counselling.
This proves that HIV-infected people can give birth to healthy children and live a full life.

It is an offence to infect another person with HIV

However, a positive HIV status can carry certain risks, which are not only related to the state of health. If a person knows that he or she is HIV-positive but hides it from his or her sexual partner, he or she can be fined from 720 to 1440 somoni under Article 120 of the Code of Administrative Offences (CAO).

Evasion of treatment for HIV or other infectious diseases is also punishable by a fine of 1,440 to 2,160 somoni. This liability is stipulated in Article 119 of the Code of Administrative Offences.

If a person deliberately infects another person with HIV, he or she may be punished with restriction of freedom for up to 3 years or imprisonment for up to 2 years. If, knowing his/her HIV status, he/she infects another person, he/she may face 2 to 5 years in prison. The term of imprisonment can be longer, from 5 to 10 years, if more than one person was infected or if the victim was a minor. This punishment is already stipulated in article 125 of the Criminal Code, which characterises these actions not as an offence but as a criminal offence.

Therefore, it is very important to periodically take tests and check your status, especially if you are in a risk group.

Среди мигрантов всё больше людей, живущих с ВИЧ

В Таджикистане каждый третий человек с ВИЧ – это трудовой мигрант. За последние 5 лет выявлено 5463 случая заражения ВИЧ инфекцией, говорят данные Республиканского центра по профилактике и борьбе с ВИЧ/СПИД. Из них 22% инфицированных приходится на мигрантов. Если в 2019 году мигранты составляли всего 17% зараженных, то к 2023 году эта цифра увеличилась до 32,5%.
Баладжон Давлатов, специалист диспансерного отделения Республиканского центра ВИЧ, настоятельно рекомендует сразу после прибытия пройти бесплатный тест в одном из центров по профилактике и борьбе с ВИЧ-инфекцией в Таджикистане.

«Каждый мигрант после возвращения на родину должен пройти обследования на факт заражения ВИЧ, если у него есть сомнения по этому поводу», – говорит Давлатов.
По его словам, уже более 300 мигрантов находятся на диспансерном учете республиканского центра ВИЧ. Их личность и результаты теста не разглашаются третьим лицам.
«Любая информация о каждом лице должна быть конфиденциальной. Можно получить экспресс-тесты, которые в течение 15 минут путем анализа слюны сообщают о ВИЧ-статусе пациента – полностью анонимно», – говорит он.
Такие тесты можно получить бесплатно в одном из 67 государственных центров по профилактике и борьбе со ВИЧ во всех регионах Таджикистана.
В дополнение к тестированию через кровь в Центрах СПИД, сегодня доступно самотестирование с использованием околодесновой жидкости. Наборы для самотестирования можно получить в городах Душанбе, Рудаки, Худжанд и Б.Гафуров через онлайн-заказ на сайте hivtest.tj.
Процесс заказа включает заполнение простой формы с несколькими вопросами. Эта платформа помогает людям на конфиденциальной основе узнать свой ВИЧ-статус и предоставляет актуальную информацию о методах защиты и профилактики.
Те, у кого тест на ВИЧ оказался положительным, могут узнать о своем результате подробнее и пройти повторное подтверждающее тестирование в Центре СПИД.

«У нас был случай с женщиной с положительным ВИЧ статусом, – рассказывает Баладжон Давлатов, – после лечение антиретровирусными препаратами она родила двоих детей с отрицательным ВИЧ-статусом. Сейчас она живёт в России, и мы отправляем ей нужные медикаменты и даём консультации».
Это доказывает, что ВИЧ инфицированные люди могут рожать здоровых детей и полноценно жить.

Заражение ВИЧ другого человека – это преступление

Однако положительный ВИЧ-статус может нести определенные риски, которые связаны не только с состоянием здоровья. Если человек знает, что у него положительный ВИЧ-статус, но скрывает это от своего сексуального партнера, то в рамках статьи 120 Кодекса об административных правонарушениях (КоАП) РТ ему могут выписать штраф от 720 до 1440 сомони.

За уклонение от лечения от ВИЧ или других инфекционных заболеваний тоже выписывается штраф от 1440 до 2160 сомони. Эта ответственность предусмотрена статьей 119 КоАП.
Если человек умышленно заражает другого ВИЧ, он может быть наказан ограничением свободы до 3 лет или лишением свободы до 2 лет. Если, зная о своем ВИЧ-статусе, он заразил другого человека, ему может грозить от 2 до 5 лет тюрьмы. Срок лишения свободы может быть больше – от 5 до 10 лет, если было заражено более одного человека или жертвой стало несовершеннолетнее лицо. Это наказание предусматривается уже в статье 125 Уголовного кодекса РТ, что характеризует эти действия не как правонарушение, а как уголовное преступление.
Поэтому очень важно периодически сдавать анализы и проверять свой статус, особенно, если человек находится в группе риска.

US: Legislative study in Oklahoma could lead to repeal of STI and HIV criminalisation laws

Interim study will examine Oklahoma laws that criminalize spreading STIs, HIV

An interim legislative study will evaluate the criminalization of sexually transmitted infections and HIV in Oklahoma.

State Sens. Julia Kirt and Carri Hicks, both Democrats representing Oklahoma City, are co-sponsors of the study with the goal of educating and correcting misinformation on sexually transmitted infections (STI) and HIV. The study could also lead to renewed legislation to repeal several laws that criminalize intentionally spreading transmitted diseases.

Advocates say a public health response is more appropriate than a criminal sentence. Oklahoma’s laws currently carry a felony charge and two to five years in prison if a person is found to have intentionally or recklessly spread HIV, smallpox, syphilis or gonorrhea.

Kirt said her district covers an area with some of the most active testing facilities for HIV and sexually transmitted diseases (STD), and her constituents are concerned because the laws that criminalize intentional spreading also bring with them several stigmas that tend to stop people from getting tested.

“If adding a crime for those is what helps get people better, we wouldn’t have such problems,” she said.

Freedom Oklahoma Executive Director Nicole McAfee said she agreed with Kirt and said the study has been several years in the making.

Freedom Oklahoma, a local advocacy organization, started the conversation with local and national partners in public health, direct service providers and others involved with public health criminalization to look at Oklahoma’s laws that establish criminal penalties for intentionally tansmitting diseases such as HIV.

McAfee said Oklahoma needs “a sex education one-on-one and some of that real public health discussion so that we can better talk about sexually transmitted infections in ways that are a public health response and not a criminalization or sort of moralistic response.”

Some lawmakers, including Rep. Toni Hasenbeck, R-Elgin, say the reasons for criminalization relate to domestic violence. House Bill 3098, introduced this year, would have added several more diseases that could be criminalized. The bill passed the House to the Senate Public Safety Committee but did not advance further. It was sponsored by Sen. Jessica Garvin, R-Duncan.

In a written statement to The Oklahoman, Hasenbeck said she wants to pursue the legislation in the future and follow the study closely.

“Throughout my years of working on legislation addressing domestic abuse, I’ve heard countless stories from Oklahomans who were deliberately infected with diseases by a sexual partner,” she said. “These diseases sometimes cause severe, long-lasting consequences, like liver disease and infertility. Beyond the physical health implications, there’s the profound emotional distress of discovering that a trusted partner has knowingly and willfully inflicted harm.”

McAfee said that when Hasenbeck’s bill was discussed, it was clear that a stigma against people with STIs and HIV still existed. She said topics like testing status, dirty versus clean language, and intentionality were difficult “to dig into when there’s inadequate sex education and sexual health resources for many people.”

“I think we can all agree that we’ve learned a lot about sexual health since 1910, and maybe the responses that we had and came up with at that point in time should not be the same ones that we utilize today,” she said.

As of 2023, 34 states have laws that criminalize HIV exposure, but 13 states have “modernized” or repealed these laws, according to the Centers for Disease Control and Prevention.

Not the first time decriminalization has been proposed

Last year, Rep. Mauree Turner, D-Oklahoma City, introduced House Bill 2343 that would have repealed two 1910 laws that criminalized public exposure with a contagious disease and intentionally spreading smallpox, syphilis and gonorrhea, as well as a 1988 law that criminalized the intentional spreading of HIV/AIDS. The bill died in the House Criminal Justice and Corrections Committee.

McAfee said the conversation showed how little a lot of legislators know about HIV, especially in the modern sense.

“We heard a lot of misinformation repeated as fact from folks,” she said.

Old stigmas surface in modern politics

McAfee said the highest number of STI and HIV cases are often in rural areas where access to health services can be farther away and that Oklahoma ranks in the top seven states for rural transmission. She said people in smaller communities who receive services from providers at clinics who might be people they encounter on a regular basis might not want to risk having everyone know their health status.

“It’s really disappointing that all of these decades later when we know so much more, when there is a lot more prevention and treatment accessible, that we still have legislators whose knowledge of HIV/AIDS is rooted in sort of mid-’80s stigma and misinformation,” she said, adding that some “are governing from that basic fear or this desire to sort of impose morality on your folks, in particular, instead of realizing that this is a public health conversation.”

Kirt and McAfee said they want people to be more educated on the science and health aspects of STIs and HIV, reduce the stigma attached to the problems and encourage more testing.

Kirt said she would be interested in introducing legislation in the next session to address the laws. No date for holding the interim study has yet been set.

“We have to look at true bipartisan approaches to really solve problems instead of kind of short-term, short-sighted ways of approaching problems,” Kirt said.

US: American Academy of Pediatrics clarifies breastfeeding guidelines for people with HIV

New guidelines clear the way for HIV-positive people to breastfeed

Parents with HIV who want to breastfeed are now able to — with the blessing of their pediatrician — after a game-changing report was released this spring.

The 11-page report, “Infant Feeding for Persons Living With and at Risk for HIV in the United States: Clinical Report” was published in the medical journal Pediatrics in May by Drs. Lisa Abuogi and Christiana Smith, both pediatricians with the University of Colorado School of Medicine, and Dr. Lawrence Noble, a pediatrician at Icahn School of Medicine at Mt. Sinai in New York.

“The American Academy of Pediatrics for the first time is fully supporting breastfeeding for women and other parents with HIV who are on treatment and virally suppressed,” said Dr. Abuogi in a recent virtual interview. “And that’s a result of increasing research showing that it can be done safely and improving antiretroviral regimens that improve the chances of staying virally suppressed.”

She added: “I think it opens up having the choice and having the ability to be supported to do that, which for decades they have not had. So it’s a pretty big sea change that’s happening in the field of HIV.”

The change came as welcome news to Ci Ci Covin, an HIV-positive mother who, because of her status, was devastated not to be allowed to breastfeed her son, Zion, now a teenager. She did, however, breastfeed her 3-year-old daughter Zuri secretively, with the support of clandestine providers who promised not to turn her in to child protective services for planning to breastfeed while living with HIV, something women in other countries have long been able to do.

Now that it doesn’t have to be done in secret, she said, the new guidelines brought a wave of relief.

“It felt like a breath that I was finally able to exhale on,” she said, “that I had been holding in for so many years.”

Breastfeeding with HIV has traveled a long road to acceptance. In 1985, the American Association of Pediatrics recommended parents who were HIV-positive not breastfeed, because of the slim chance of transmission of the infection via the breast milk to the baby. Those choosing to disregard the guidelines could be reported to state child protective agencies.

Others didn’t see the risk in the same way — in some African countries for example, babies were breastfeeding from HIV-positive parents on antiretroviral drugs whose load was so low as to be undetectable while also receiving prophylaxis drugs that blocked the transmission of the virus to the baby; studies there were finding no HIV transmission.

But the U.S. stood fast on its ban — until January 2023, when the National Institutes of Health released a paper “Update to Clinical Guidelines for Infant Feeding Supports Shared Decision Making: Clarifying Breastfeeding Guidance for People with HIV.”

“Clinicians should support the choices of people with HIV to breastfeed (if they are virally suppressed) or to formula/replacement feed,” the paper stated, adding: “It is inappropriate to engage child protective services (CPS) or similar services in response to infant feeding choices of [people with HIV].”

The NIH influenced the Department of Health and Human Services, which that year relaxed its own guidelines against restricting HIV-positive people from breastfeeding, but the HHS has a smaller audience, and it’s the American Association of Pediatrics from whom pediatricians specializing in labor and delivery take their cues, not HHS.

The paper Abuogi and her co-researchers published about a year and a half later was what made the change in the AAP guidelines. Their report, she said, consisted less of original research on the topic and more of a distillation of research. “We review all of the literature, the history, and the latest research to inform the guidelines,” she said.

According to the paper, health care professionals should plan to talk with patients who want to breastfeed their child, and when they do, they should explore the parents’ reasoning, suggest possible alternatives that allow a bond with the infant, and validate the parent’s role, regardless of how the infant will be fed. The paper also recommends that parents know the risk of HIV transmission — which is about 1 percent or less — and are aware that antiretroviral drugs suppress the chance of transmission, but don’t completely eliminate the risk.

“Breastfeeding should be supported for people with HIV who strongly desire to breastfeed after comprehensive counseling,” the paper recommends, “if all of the following criteria are met: (anti-retroviral therapy) was initiated early in or before pregnancy; there is evidence of sustained viral suppression in the parent; the parent demonstrates a commitment to consistently taking their own (anti-retroviral drugs) and to giving infant (anti-retroviral) prophylaxis; and the parent has continuous access (to those drugs).”

The new guidelines are being made widely known through email blasts, the AAP’s podcast, and social media posts to the country’s 39,000 pediatricians who specialize in labor and delivery, about 2,000 of whom practice in Colorado, according to Dr. Aguobi.

Ci Ci Covin, 36, a mother of two who has a bachelor’s and master’s degrees, now lives outside Philadelphia, Pennsylvania, with her partner, son, and daughter. She had been diagnosed with HIV in her early 20s — she said she got the virus having unprotected sex with men growing up in rural Georgia. She didn’t breastfeed her son because she had the virus, and was told she should be happy to give birth at all, given her status.

Her first-born child, Zion, was born premature and spent nine days in the NICU, during which time Covin stayed in a nearby Ronald McDonald House. One day, she recalled, “I stood in that shower with my breasts full of milk and in pain and just watched it all just waste down the drain, knowing that HIV was the only thing that was causing that right now. It was so painful.”

She spiraled into post-partum depression, “beating myself up again for this diagnosis because that was what was stopping me from being able to feed my child … all of my parental autonomy had been taken away from me. That was a rough time.”

Guidelines shared with her by her health care provider kept her from breastfeeding. Over the next few years, she began hearing that women who were living with HIV were breastfeeding in some African countries. About a decade later, she found a new partner and became pregnant again, this time with a baby girl she’d call Zuri, now 3 years old. This time, she wanted things to be different. She had befriended an HIV-positive mother in Virginia for whom things were different: Her new friend Heather’s health care provider had asked her how she wanted to feed her newborn, rather than telling her that her choice was limited so as not to include breastfeeding — a shocking statement to Ci Ci’s ears.

Heather’s disclosure made Covin think she could do the same, so she ran the possibility past her provider. She was shocked by what she was told: There was “no provider in America who would work with me if that’s what I wanted to do,” Coving explained, her voice quivering with emotion.

“And she told me that if that was something that I wanted to do, then I was going to have to be quiet about it because their facility is known to call child protective services on parents who breastfeed while living with HIV.”

The threat left her stunned. “I’m only six weeks pregnant; we don’t even know if this baby’s going to stick yet, and I’m being threatened by CPS … which really put a fork in that relationship that I had built with that provider.”

With her friend Heather’s help, Covin found a new health care team in Philadelphia consisting of an OB-GYN, a social worker, a high-risk nurse, and a pediatrician — all of whom felt the benefits of breastfeeding with HIV outweighed the slim risk of transmission. In the small community of HIV-positive parents, this team was known through whispers as the ones to go to if you had HIV and wanted to breastfeed without getting reported to child protective services.

Initially, she was undecided on breastfeeding the daughter she was expecting.

“Some days I would go in there and say, ‘Yes, I’m doing it.’ Then other days I’d be like, ‘No I’m not doing this.’ And they did that tango with me, just informing me of all of the things, the research, what they’ve seen in previous patients and children. It was awesome. I had options. I could choose what life was going to look like for me and my baby moving forward.”

Under the new provider’s care, Covin gave birth to Zuri, then spent the next seven months breastfeeding her daughter, who also received prophylactic medications during and after that time period.

“It felt beautiful. It felt so natural. I couldn’t believe that it was happening, that I was able to do it in front of people in scrubs,” she said, rather than hiding it from them.

Per protocol, Covin and Zuri both took medications to lower the transmission risk.

“We started on one type of treatment for the first four weeks after she was born, and then we switched into another treatment that had less medication in it, less types of drugs,” she said. “We did that for the length of time that we breastfed plus a month afterwards,” she said, adding that both children are now thriving and doing well and that neither has the virus.

Covin now works as a senior manager of community programming with The Well Project in Philadelphia (a nonprofit organization that serves women living with HIV and those vulnerable to it across the gender spectrum). She is one of a small subset of HIV-positive parents who want to breastfeed — estimated to be about 5,000 large annually nationwide — who are potentially impacted by the AAP’s new guidelines. The new rules mean that people like Covin won’t have to go to the trouble of finding a doctor breaking guidelines to be supportive of women breastfeeding while living with HIV; instead, doctors will just start openly presenting doing so as a legitimate option.

“The 5,000 number is the number of women living with HIV that we think become pregnant annually in the United States, and in Colorado, that number is probably closer to 50 or 60,” said Dr. Abuogi, who added that many are women of color. But the number and background of the people impacted isn’t the point.

“All women and mothers want to have the full range of choices and options to make the best infant feeding decisions for their children,” she said.

Of the new guidelines, she said they could make a difference in the parenting experience. “This gives these women that option if they’re able to be on their treatment and doing well.”

US: New report from the Williams Institute examines the enforcement of Indiana’s HIV-related criminal donation laws

Enforcement of HIV Criminalization in Indiana: Donation Laws

The Williams Institute analyzed data from the Indiana courts regarding individuals arrested and prosecuted for an HIV-related donation crime in that state. Indiana has six laws criminalizing people living with HIV (PLWH), spanning the criminal code and public health code. This report—one in a series examining HIV criminalization in Indiana—analyzes the enforcement of two laws that criminalize the donation of blood, plasma, and semen for artificial insemination if the person knows they have HIV:

  • Indiana Criminal Code § 35-45-21-1 Transferring Contaminated Body Fluids (enacted in 1988)
  • Indiana Health Code § 16-41-14-17 Donation, Sale, or Transfer of HIV Infected Semen; penalties (enacted in 1989)

The data were obtained between January 2022 and March 2024 and cover enforcement of the laws between 2001 and 2023. We identified 18 unique individuals charged with 21 violations of the state’s criminal donation law related to HIV, resulting in 18 court cases. While other states have similar HIV-related criminal donation laws, Indiana had the greatest number of convictions under a donation law documented in a single state.

Key Findings

  • Indiana’s HIV-related donation crimes were created nearly four decades ago (1988 and 1989) before effective and easily accessible testing and treatment for HIV was available.
  • All 18 cases stemmed from an attempt to donate at a plasma center.
  • No cases (0) involved attempts to donate whole blood or semen.
  • No people (0) were charged under the provision of the code penalizing actual HIV transmission.
  • Marion County—home to Indianapolis, the state capital and largest city—was substantially overrepresented in arrests: it accounted for about 14% of the state’s population and 41% of PLWH in 2021 but nearly 80% of all donation-related arrests. Only three other counties had arrests.
  • Alleged violations of the donation laws regularly occurred between 2001 and 2018, with the most recent arrest happening in 2019 for an incident in 2018. On average, one court case was filed per year for an alleged violation of Indiana’s HIV blood donation law during this time period.
  • The demographic data reveal that:
    • The range for age at time of arrest was between 20 and 58 years old; the mean (average) age at time of arrest was 33 years old.
    • Men were 72% of people arrested while women were 28%.
    • Black people were nearly eight in ten (78%) of all people arrested. White people were the remainder (22%) of those arrested. However, Black people were only 38% of PLWH in Indiana in 2021 and just 10% of the state’s population. No other race/ethnicity group was represented among those arrested.
  • In total, 17 of the 18 people charged were found indigent and assigned a public defender.
  • More than four-fifths (89%) of people arrested were convicted of at least one HIV-related crime.
  • The Indiana Department of Health (IDOH) devoted resources to determining whether a possible crime was committed—a public health investigator (PHI) routinely referred cases to law enforcement and provided them with personal HIV information in accordance with IDOH policy at the time.
  • • The criminal law has not been enforced since the last court case was filed in 2019, suggesting a recent decline in the use of Indiana’s HIV-related donation crime laws.

To our knowledge, this report is the first comprehensive look at the enforcement of HIV criminal donation laws in a single U.S. state, and it demonstrates one of the highest levels of enforcement observed in any state to date.

This report found that people who know they have HIV can, and have, been prosecuted under Indiana’s HIV criminalization donation laws for acts that pose no HIV transmission risk. Because of universal screening for HIV antibodies, donated blood, plasma, and semen are now safe from HIV for recipients. Moreover, plasma—which represented 100% of attempted donations in this study—is heat treated, which inactivates all bloodborne pathogens, including HIV. There has not been a reported case of HIV transmission from plasma donation in nearly 40 years. Yet, as recently as 2019, Indiana arrested, prosecuted, and convicted a person for attempting to donate at a plasma center in the state.

Further, HIV criminalization laws could undermine the state’s efforts to work cooperatively with the communities most impacted by the HIV/AIDS epidemic. In recent years, there has been growing consensus among public health and medical experts that ending the HIV epidemic requires modernizing a state’s HIV criminal laws to reflect what is known about HIV science today. Indiana’s own statewide plan to end the HIV epidemic in the state by 2030, called Zero is Possible, includes criminal law modernization as one of the current approaches and priorities. The plan echoes the Centers for Disease Control and Prevention (CDC) and the White House’s Office of National AIDS Policy (ONAP) position on HIV-specific criminal laws, both of which call on states to modernize their HIV criminal laws to reflect advances in treatment and what we know today about how HIV is—and is not—transmitted.

Download the full report

US: Sex workers convicted of aggravated prostitution because of their HIV status to be removed from Sex Offender Registry

Tennessee agrees to remove sex workers with HIV from sex offender registry

The Tennessee government has agreed to begin scrubbing its sex offender registry of dozens of people who were convicted of prostitution while having HIV, reversing a practice that federal lawsuits have challenged as draconian and discriminatory.

For more than three decades, Tennessee’s “aggravated prostitution” laws have made prostitution a misdemeanor for most sex workers but a felony for those who are HIV-positive. Tennessee toughened penalties in 2010 by reclassifying prostitution with HIV as a “violent sexual offense” with a lifetime registration as a sex offender — even if protection is used.

At least 83 people are believed to be on Tennessee’s sex offender registry solely because of these laws, with most living in the Memphis area, where undercover police officers and prosecutors most often invoked the statute, commonly against Black and transgender women, according to a lawsuit filed last year by the American Civil Liberties Union and four women who were convicted of aggravated prostitution. The Department of Justice challenged the law in a separate suit earlier this year.

Both lawsuits argue that Tennessee law does not account for evolving science on the transmission of HIV or precautions that prevent its spread, like use of condoms. Both lawsuits also argue that labeling a person as a sex offender because of HIV unfairly limits where they can live and work and stops them from being alone with grandchildren or minor relatives.

“Tennessee’s Aggravated Prostitution statute is the only law in the nation that treats people living with HIV who engage in any sex work, even risk-free encounters, as ‘violent sex offenders’ subjected to lifetime registration,” the ACLU lawsuit states.

“That individuals living with HIV are treated so differently can only be understood as a remnant of the profoundly prejudiced early response to the AIDS epidemic.”

In a settlement agreement signed by Tennessee Gov. Bill Lee on July 15 and filed in both lawsuits on July 17, the Tennessee Bureau of Investigation said it would comb through the state’s sex offender registry to find those added solely because of aggravated prostitution convictions, then send letters alerting those people that they can make a written request to be removed. The language of the settlement suggests that people will need to request their removal from the registry, but the agency said in the agreement it will make “its best effort” to act on the requests “promptly in the order in which they are received.”

The Tennessee attorney general’s office, which represents the state in both the ACLU and DOJ lawsuits and approved the settlement agreement, said in an email statement it would “continue to defend Tennessee’s prohibition on aggravated prostitution.”

In an email statement, the ACLU celebrated the settlement as “one step toward remedying the harms by addressing the sex offender registration,” but said its work in Tennessee was not done because aggravated prostitution remained a felony charge that it would “fight to overturn.”

Molly Quinn, executive director of LGBTQ+ support organization OUTMemphis, another plaintiff in the ACLU lawsuit, said both organizations would help eligible people with the paperwork to get removed from the registry.

“We would not have agreed to settle if we did not feel like this was a process that would be extremely beneficial,” Quinn said. “But, we’re sad that the statute existed as long as it did and sad that there is any process at all that folks have to go through after living with this extraordinary burden of being on the sex offender registry for really an irrelevant reason.”

Michelle Anderson, a Memphis resident who is one of the plaintiffs in the ACLU lawsuit, said in court records that since being convicted of aggravated prostitution, the sex offender label has made it so difficult to find a home and a job that she was “unhoused for about a year” and has at times “felt she had no option but to continue to engage in sex work to survive.”

Like the other plaintiffs, Anderson said her conviction kept her minor relatives at a distance.

“Ms. Anderson has a nephew she loves, but she cannot have a close relationship with him,” the lawsuit states. “Even though Ms. Anderson’s convictions had nothing to do with children, she cannot legally be alone with her nephew.”

The Tennessee settlement comes months after state lawmakers softened the law so no one else should be added to the sex offender registry for aggravated prostitution. Lawmakers removed the registration requirement and made convictions eligible for expungement if the defendant testifies they were a victim of human trafficking.

State Sen. Page Walley (R-Savannah), who supported the original aggravated prostitution law passed in 1991 and co-sponsored the recent bill to amend it, said on the floor of the legislature that the changes do not prevent prosecutors from charging people with a felony for aggravated prostitution. Instead, he said, the amendments undo the 2010 law that put those who are convicted on the registry “along with pedophiles and rapists for a lifetime, with no recourse for removal.”

“Having stood, as I mentioned, in 1991 and passed this,” Walley said, “it is a particular gratifying moment for me to see how we continue to evolve and seek what’s just and what’s right and what’s best.”

Malaysia: Latest attempt to amend the Prevention and Control of Infectious Diseases Act retains many of its controversial provisions

Act 342 Amendment Bill Treats Infection Like A Criminal Offence
By Alifah Zainuddin | 15 July 2024

The Act 342 Amendment Bill 2024 treats infection like a criminal offence, raising compounds on individuals to RM5,000 and granting Health DG vast powers over isolation and surveillance, among others, and CPC investigation powers for authorised officers.

The Ministry of Health (MOH) is making its latest attempt to amend the Prevention and Control of Infectious Diseases Act 1988 (Act 342), while retaining many of the controversial provisions that led to previous failures.

The latest attempt is supposedly in line with a recent decision by the World Health Organization (WHO) member countries to adopt critical amendments to the 2005 International Health Regulations (IHR).

This was supposed to include provisions for a National IHR Authority, an entity established at the national level to coordinate the implementation of the Regulations within the country’s jurisdiction. However, this provision is absent from the new bill.

Instead, the Prevention and Control of Infectious Diseases (Amendment) Bill 2024 curiously retains many of the contentious elements from the previous amendment.

These include a revised Section 25 proposing compounds of up to RM5,000 for individuals and RM50,000 for companies; a revised Section 24 imposing general penalties of up to two years’ imprisonment or fines of up to RM10,000 for individuals, and up to RM100,000 for companies; and a new Section 31 that stipulates penalties for specific breaches of regulations, including imprisonment for up to two years or fines of up to RM8,000 for individuals, and imprisonment for up to two years or fines of up to RM50,000 for companies.

The new bill varies slightly from the previous amendment in terms of penalty amounts. It appears to impose tougher penalties on individuals (increasing from a maximum RM1,000 in compounds and RM2,000 in general fines), while reducing fines for corporations (decreasing from a maximum RM500,000 in compounds and RM2 million in general fines).

The bill also retains controversial provisions, including Section 21(A), which grants the Health Director-General broad powers to issue directives for controlling infectious diseases, including lockdowns and isolation.

Non-compliance is a criminal offence, extending the DG’s authority beyond the current Act, which regulates diseases like Covid-19, HIV, dengue, and tuberculosis.

Section 14A allows an an authorised officer to order any person who is infected or who he has “reason to believe” has been infected with an infectious disease to “undergo isolation or surveillance” in a specified place and for a determined period as the authorised officer may think fit or until he may be discharged without danger to the public.

Section 15A enables an authorised officer to issue any order to be complied with by any person who is infected or whom he has reason to believe to be infected, or any contact, for the “purpose of tracking and monitoring”. Such order may include order to wear any form of tracking device provided by the authorised officer and to use any digital application in any digital device as determined by the authorised officer.

Section 21B empowers the authorised officers to carry out investigation under Act 342 in accordance with the Criminal Procedure Code [Act 593], while Section 21C empowers the authorised officers to require any person to furnish any information relating to the prevention and control of infectious diseases.

Although the new bill does not explicitly reference the IHR, the powers granted to the Health DG and authorised officers imply that the MOH will effectively act as both the IHR Focal Point and the National IHR Authority, as outlined in Article 4 of the IHR amendments.

Under Prime Minister Ismail Sabri Yaakob’s administration, the government tabled an Act 342 amendment bill in December 2021 – during the Covid pandemic – that raised compounds of offences from the current RM1,000 maximum to RM10,000 for individuals and up to RM500,000 for corporate bodies.

Individuals convicted of offences under Act 342 faced penalties of a maximum RM50,000 fine, up to three years’ jail, or both under Section 24 on the proposed amended general penalties. For corporate bodies, a maximum RM2 million fine upon conviction was proposed.

The bill underwent two revisions before being shelved in March 2022 due to intense public backlash. The punitive approach faced criticism from ordinary citizens, businesses, lawyers, and doctors.

Current Health Minister Dzulkefly Ahmad, among other lawmakers, opposed the bill, calling the proposed amendments a “cataclysmic failure”.