Nigeria's anti-gay law, condemned by US, Britain and Canada, will harm HIV response, says UNAIDS

Local and international groups fighting AIDS warned on Tuesday that a new Nigerian law criminalizing same-sex marriage and gay organizations will jeopardize the fight against the deadly disease. Activist Dorothy Aken’Ova said the new legislation, already dubbed the “Jail the Gays” law, will endanger and even criminalize programs fighting HIV / AIDS in the gay community. Aken’Ova is executive director of Nigeria’s International Center for Reproductive Health and Sexual Rights based in Minna, Niger state.

The UN agency to fight AIDS and the Global Fund to Fight AIDS, Tuberculosis and Malaria expressed “deep concern that access to HIV services for lesbian, gay, bisexual and transgender people will be severely affected by the new law in Nigeria, further criminalizing LGBT people, organizations and activities, as well as people who support them.”

UNAIDS said the law could harm Jonathan’s own presidential initiative to fight AIDS, started a year ago. Nigeria has the second largest HIV epidemic globally, with an estimated 3.4 million people living with HIV. The disease affects many more gay men than heterosexuals, with 2010 statistics estimating national HIV prevalence at 4 percent compared to 17 percent among gay men, according to UNAIDS.

President Goodluck Jonathan’s spokesman confirmed Monday that he had signed the Same Sex Marriage Prohibition Act on Jan. 7, providing penalties of up to 14 years in jail for gay marriage and up to 10 years’ imprisonment for membership or encouragement of gay clubs, societies and organizations. The U.S., Britain and Canada have swiftly condemned the law, with Secretary of State John Kerry saying Monday that it “dangerously restricts freedom” of expression and association of all Nigerians.

Human rights activists reported that dozens of gay men were being arrested in northern Nigeria in an apparent response to the law. The law also criminalizes people and groups who support “the registration, operation and sustenance of gay clubs, societies and organizations, processions or meetings in Nigeria.” Those convicted could be jailed for 10 years.

Even before it was the passed, the law was being used to persecute gays, Aken’Ova said. In Bauchi state, she said police entrapped four gay men and tortured them into naming others. She said the police have drawn up a list of 168 wanted gay men, of whom 38 have been arrested recently. An AIDS counsellor told the Associated Press he helped get bail for the men. He spoke on the condition of anonymity for fear he would be arrested as well.

Jonathan, Nigeria’s president, has not publicly expressed his views on homosexuality. But his spokesman, Reuben Abati, told The Associated Press on Monday night, “This is a law that is in line with the people’s cultural and religious inclination. So it is a law that is a reflection of the beliefs and orientation of Nigerian people … Nigerians are pleased with it.”

Uganda: New Anti-Homosexuality Bill a setback for Uganda’s HIV response

The draconian Anti-Homosexuality Bill passed by Uganda’s parliament on 20 December would deliver a major blow to the response to HIV/AIDS if it was enacted by President Yoweri Museveni, activists have warned.

Those found guilty of homosexual acts can be jailed for up to 14 years under the new law, a sentence that increases to life in “aggravated” cases, such as those committed by an HIV positive person, or those involving minors, the disabled and serious offenders.

Civil society activists fear that high-risk groups such as men who have sex with men (MSM) and sex workers – whose HIV prevalence is 13.7 and 33 percent respectively – will see their already limited access to prevention and treatment further eroded.

Amnesty International called the law “a grave assault on human rights [which] makes a mockery of the Ugandan constitution.

“President Museveni should avoid the trap of scapegoating a vulnerable minority in the interests of short-term political gain,” said Daniel Bekele, Africa director at Human Rights Watch.

“He should recognize that this repugnant bill is of no benefit to Ugandans – that it only serves to jeopardize basic rights – and reject it.”

The United States government has also called for the bill not to be enacted.

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

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

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

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

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

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

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

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

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

African HIV criminalisation achievements and challenges highlighted at ICASA 2013

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

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

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

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

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

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

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

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

Tanzania: Official urges government leaders to create mandatory HIV testing law

A Ward Executive Officer in Mkanyenge ward, in Kishapu District, Sima Philbert, has urged the government to come up with a law for mandatory HIV testing in order to effectively combat the pandemic.

http://www.dailynews.co.tz/index.php/local-news/25417-call-for-law-for-mandatory-hiv-testing

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

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

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

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

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

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

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

Major policy shift

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

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

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

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

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

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

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

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

Coaltion of HIV experts

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

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

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

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

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

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

Minister for Social Affairs will consider reviewing application of law

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

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

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

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

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

EATG seeks to ensure that Europe-wide standards of up-to-date scientific evidence limit overly broad HIV criminalisation

EATG’s new position paper on prosecutions for HIV non-disclosure, exposure and/or transmission published last week recommends that the criminal law should only be used in extremely rare and unusual cases where HIV is maliciously and intentionally transmitted and that Europe-wide standards of up-to-date scientific evidence limit overly broad use of the crimnal law.

Prosecutions for HIV non-disclosure, exposure and non-intentional transmission have been reported in 28 countries in Europe and Central Asia, but only eight of these countries have a specific criminal law relating to HIV.  The remaining 20 countries use laws not created to deal with HIV, such as those dealing with physical or sexual assault or, inappropriate laws relating to homicide or attempted murder.

According to the Global Criminalisation Scan, the following countries have reported at least one criminal case (countries in bold have used an HIV-specific criminal law): Austria, Azerbaijan, Belarus, Belgium, Cyprus, Czech Republic, Denmark, Estonia, England & Wales, Finland, France, Georgia, Germany, Greece, Hungary, Italy, Malta, Netherlands, Norway, Poland, Portugal, Romania, Scotland, Spain, Sweden, Switzerland, Turkey and Ukraine.  In addition, the following countries have an HIV-specific criminal law but there have been no reported prosecutions: Armenia, Moldova, Russia and Slovakia.

Many of these laws and prosecutions – as well as inflammatory media coverage of these cases – misrepresent and overstate the risks of HIV transmission and the harm of living with HIV, contributing to increasing HIV-related stigma and perpetuating myths about HIV. Important scientific developments, including the significant impact of treatment on infectiousness – reducing the risk to nearly zero and improving life expectancy – are rarely taken into account. In turn, this may be deterring people with undiagnosed HIV from wanting to know their HIV status.

These laws and prosecutions are also having a negative impact on people aware they are living with HIV by creating confusion and fear over rights and responsibilities under the law, creating and sustaining disincentives to disclose HIV-positive status to sexual partners, and creating and sustaining disincentives to disclose HIV-related risk behaviours to healthcare professionals. These unintended negative impacts of the overly broad use of the criminal law are highlighted in the HIV Justice Network’s new documentary, ‘More Harm Than Good‘.

Earlier this year, the Joint United Nations Programme on HIV/AIDS (UNAIDS) released updated, detailed guidance to limit the overly broad use of criminal laws to regulate and punish people living with HIV who are

  • alleged not to have told a sexual partner of their HIV-positive status (‘HIV non-disclosure’)’ and/or
  • perceived to have placed another person at risk of HIV transmission (‘HIV exposure) and/or
  • deemed to be criminally liable for a new infection (‘HIV transmission’).

EATG supports the UNAIDS position that all HIV-specific criminal laws should be repealed and that prosecutorial and police guidance be created to limit the overly broad application of other criminal laws applied to HIV non-disclosure, exposure or transmission to only the most egregious cases, where malicious intent to transmit HIV can be proven, taking into account scientific, legal and human rights principles.

EATG applauds recent developments in several Western European countries in response to increased advocacy and attention to the above mentioned concerns, including Denmark and Switzerland, where HIV-related criminal laws have been suspended or modernised; in England and Wales, and Scotland where prosecutorial guidelines have been implemented, and in Norway and Sweden where there is significant political interest in reassessing their HIV-related criminal policies.

However, despite signs of progress there continue to be problematic developments within Europe, such as the arrest, forcible HIV testing and attempted prosecution for HIV transmission of 26 women in Greece in May 2012; Romania’s new HIV-specific criminal statute implemented in October 2011;and new prosecutions setting legal precedent for further prosecution under existing laws in Belgium in July 2011. In addition, many jurisdictions throughout Europe and Central Asia continue to inappropriately prosecute people living with HIV for non-disclosure, alleged exposure and non-intentional transmission.

In order to improve the situation in Europe and Central Asia, EATG

  • Supports the UN position(s) and will work with members and other stakeholders to help support change in-country, such as by working with the criminal justice system and the media on education and training, and by lobbying any relevant EU institutions.
  • Seeks to ensure that Europe-wide standards of up-to-date scientific evidence are used appropriately in criminal cases, including the impact of antiretroviral therapy (ART) on infectiousness and life expectancy.
  • Recommends that legal assessment of risk should follow epidemiological conclusions.
  • Considers as equally important education for the population at large to dismantle stigma in relation to HIV and to ensure that there truly is an equitable concept of shared responsibility.
  • Recommends adopting clear prosecutorial and police guidelines for appropriate criminal intervention in cases of HIV transmission.
  • Recommends the use of evidence-informed public health interventions rather than criminal law and adopting evidence-informed, human rights-based public health interventions rather than using criminal law sanctions.

EATG argues that while there may be a limited role for criminalising HIV transmission in terms of achieving justice and/or punishment for wrongdoing in exceptional cases of malicious and deliberate HIV transmission that causes actual harm, the criminal law is too blunt and rigid a tool for dealing effectively with public health initiatives, controlling the spread of HIV, and deterring harm-risking conduct and is, therefore, detrimental to contemporary public health goals and human rights.

The full position paper is below

EATG Position on Criminalisation of HIV transmission, exposure and non-disclosure, October 2013

Australia: South Australia Government plans mandatory HIV testing following blood or saliva exposure to police

ANY offender whose blood or saliva comes into contact with a police officer will be compelled to undergo a mandatory blood test, under new laws to be introduced by the State Government. Premier Jay Weatherill will today outline the measure – and another significant community safety initiative involving police – at the Police Association of SA annual delegates conference.

The move will ensure any officer faced with the risk of contracting a communicable disease is made aware of the possible threat much faster, instead of having to rely on their own test results – often many months later. Mr Weatherill said police needed to be protected. “We know that there are some instances where police officers are exposed to infectious diseases, such as hepatitis C or HIV when an officer is arresting, restraining or detaining an offender,” he said.

“These laws mean that if an officer is exposed to a risk of contracting these diseases, the offender will be required to undertake a blood test. While officers are already blood-tested in these situations, some diseases are not detectable for months. This means officers can be left waiting for a considerable amount of time, which can be stressful for them and their families. Test results from the offender will provide early information to reduce the anxiety about risk of infection.”

Police say that over the past year, there were 279 incidents where officers came into contact with blood, 118 incidents involving officers being spat on and two occasions where an officer suffered a needle-stick injury.

Southern African leaders warned that mandatory HIV testing is both a violation of human rights and a hinderance to public health

Windhoek, 22 August 2013 – The AIDS and Rights Alliance for Southern Africa (ARASA), a partnership of 73 non-governmental organizations working in southern and east Africa, has noted with concern reports that several SADC leaders lauded mandatory HIV testing as a viable strategy to curb the spread of HIV during a meeting of Heads of State and Government on AIDS Watch Africa, held on 17 August on the sidelines of the 33rd SADC summit in Lilongwe, Malawi.

The battle of civil society against reinstatement of mandatory HIV testing legislation in Greece

The day after he was appointed, Greek Health Minister Adonis Georgiadis brought back in to force health regulation 39A on July 1, 2013. The regulation forces mandatory testing for HIV and other communicable diseases. It specifies certain groups like people who inject drugs, sex workers and undocumented migrants as a priority, with the argument that this is in the interest of public safety.