Uganda: Latest version of HIV/AIDS Prevention and Control Act introduced, HRW analysis

Yesterday, Beatrice Rwakimari, Chairperson of the Committee on HIV/AIDS and Related Matters introduced the latest version of the 2010 HIV/AIDS Prevention and Control Act to the Ugandan parliament.

According to a press release from Human Rights Watch (HRW) issued yesterday:

“The bill contains measures that have been proven ineffective against the AIDS epidemic and that violate the rights of people living with HIV,” said Joe Amon, Health and Human Rights director at Human Rights Watch. “The HIV epidemic in Uganda is getting worse, and this bill is another example of misguided, ideological approaches and lack of leadership.”

The bill as currently written codifies discredited approaches to the AIDS epidemic and contains dangerously vague criminal provisions. Contrary to international best practices, the bill would criminalize HIV transmission and behavior that might result in transmission by those who know their HIV status.

The bill would discourage voluntary HIV testing, while making testing mandatory for pregnant women, their partners, suspected perpetrators and victims of sexual offenses, drug users, and prostitutes, in violation of fundamental principles of consent. The bill also allows medical practitioners to disclose a patient’s HIV status to others, breaching confidentiality standards. These provisions could potentially endanger those who are infected by exposing them to stigma, discrimination, and physical violence.

Last November, HRW and 50 Ugandan and international organisations commented on an earlier draft of the bill.

Since then, notes HRW, “the law was partially improved by removal of criminal penalty for the transmission of HIV from mother to child through breastfeeding.”

However, many problematic provisions remain including those relating to:

HIV testing and counseling, generally and among minors
Notification and disclosure obligations
Criminalisation of HIV transmission
Criminalisation of other conduct related to HIV/AIDS

Earlier this month, in a letter to Uganda’s Parliament, Human Rights Watch released an updated analysis of the bill which highlights:

numerous provisions that contravene the right to equal protection and non-discrimination under Uganda’s constitution and Uganda’s obligations under international human rights law. Furthermore, these provisions will ultimately prove counterproductive to reducing the burden of the HIV epidemic in the country.

HRW’s press release concludes:

“Like the anti-homosexuality bill, the HIV/AIDS bill tramples on rights and encourages stigma and intolerance,” Amon said. “The international community and Ugandan civil society have been vocal and clear about the problems in the bill. It is time for Uganda’s parliament to listen and amend these damaging provisions.”

Uganda: Minister’s turnaround on HIV bill raises concern (PLUSNews)

KAMPALA, 11 May 2010 (PlusNews) – Ugandan AIDS activists have expressed concern over a decision by the Ministry of Health to back an HIV/AIDS bill that would criminalize the deliberate transmission of HIV.

Last week, State Minister for Health in charge of General Duties, Richard Nduhura, appeared before the parliamentary committee on HIV to explain the government’s position on the HIV and AIDS Prevention and Control Bill (2009). Nduhura backtracked on his earlier position that portions of the bill would lead to discrimination and undermine the rights of people living with HIV.

“I am in support of the law as it is now,” he told IRIN/PlusNews.

Uganda’s President Yoweri Museveni has in the past stated that he “fully supports” an HIV/AIDS law that would criminalize deliberate transmission of the virus.

The bill, as well as another controversial proposed law, the Anti-Homosexuality Bill 2009, has led to widespread criticism by human rights activists.

According to Stella Kentutsi, of the National Forum of People Living with AIDS Network in Uganda, the minister’s U-turn showed there was still a lack of understanding of its clauses and how they would affect people living with HIV.

“The biggest problem we have with this bill is lack of awareness; we think [Nduhura’s] comments were biased and influenced by parliament,” she said. “He needs to sit and think carefully, then make a decision that will balance both sides.”

Nduhura said he was convinced of his new position, and had not been unduly influenced by members of the parliamentary committee.

The forum has been raising awareness across the country about the bill, which is intended to provide a legal framework for the national response to HIV, as well as protect the rights of individuals affected by HIV. Many of its clauses seek to protect the rights of people living with HIV to healthcare, criminalize discrimination on the grounds of HIV status and uphold the principles of confidentiality and consent.

Contradictions

However, AIDS activists say the parts that criminalize the deliberate transmission of the virus are counter-productive; for instance, the bill outlaws attempted transmission of HIV and recommends life in prison for people found guilty of intentional transmission of HIV. Many activists have questioned how the government would prove deliberate transmission.

The bill further recommends that intravenous drug users, sex offenders and their victims, people charged with offences related to prostitution, and pregnant women and their partners be automatically tested for HIV. If passed, it would authorize medical practitioners to inform, at their discretion, people they felt were at risk of contracting HIV, such as an HIV-positive person’s spouse.

“If you push for a more severe or lesser punishment because someone is infected you are discriminating and undermining the rights of people living with HIV,” Kentutsi said. “Those who are HIV-infected should not be treated any differently.”

The bill is due to be tabled before parliament imminently, and stakeholders will have a chance to put forward their positions on its clauses.

“People should not lose sleep over the bill; that phrase [deliberate transmission] could be dropped or retained – there is still a lot of room to review it,” said Chris Baryomunsi, a member of parliament’s select committee on HIV.

East Africa: Move Towards Common HIV/AIDS Law (IPS)

Another excellent piece from the Inter Press Service News Agency, whose mission is to give voices to the voiceless.

EAST AFRICA: Move Towards Common HIV/AIDS Law
by Wambi Michael

ARUSHA, Dec 4 (IPS) – All HIV-positive east Africans could soon access free anti-retroviral treatment even as they move freely from country to country, if a new proposed law comes into effect.The East African Community (EAC) is currently developing a law to guide the region’s response to HIV/AIDS.

This comes as the regional block moves towards an integration process that would see more citizens cross the boarders in the five states of Kenya, Uganda, Tanzania, Burundi, and Rwanda.

“With the signing of the protocol on customs union that will enable free movement of persons, you are actually going to see free movement of the virus because people will be interacting more easily as they transact business. The effect of that is that HIV must be seen regionally,” said Catherine Mumma, a Kenyan Human Rights Lawyer, who works with consultancy group Africa Vision Integrated Strategies. She led a consultation in the EAC states before the drafting of the new proposed law.

Based upon the consultations, the proposed law aims to provide joint treatment policies for people in the region while they move freely across the borders.

“One other thing is that east Africans would want a law that would enable them to access services anywhere they go in east Africa. So that if you were in Nairobi and you were on ARVs and you only brought two days ARVs and Kenya Airways went on strike, you should be able on the third day to walk into a treatment centre and get treated.”

The law will allow for a common stance on HIV/AIDS, which aims to be non-discriminatory. Currently some countries in the region criminalise the treatment of HIV-positive sex workers and gay men.

The presidents of the five member states agreed in November to commence the East Africa common market protocol, which beings in early in 2010. It will allow for the free movement of labour and trade across borders, similar to the Southern African Development Community trade agreement.

Lucy Ng’ang’a, the executive director for the Eastern African National Networks of AIDS Service Organisations (EANNASO) said the proposed law will take on the good parts of the existing laws in the region but also tackle some of the silent issues and make better the areas that are controversial.

For example, Kenya has as a law providing for the free treatment and counselling for HIV-positive people.

One of the controversial areas is the criminalisation of the transmission of HIV/AIDS being suggested by countries like Uganda.

Another controversial area is that in the Penal Codes of Kenya, Rwanda, Burundi and Tanzania prostitutes and gay men, who are considered high risk in HIV/AIDS transmission, are not allowed access to treatment.

Member states like Kenya, Tanzania and Burundi already have laws on HIV/AIDS.

Uganda’s law, the HIV/AIDS Control Bill 2009, was tabled before Parliament in 2008 as a Private Member’s Bill. It has already caused a public outcry because of a clause relating to the criminalisation of HIV transmission between adults.

EANNASO contracted consultancy group Africa Vision Integrated Strategies to study the existing HIV laws within the region and advise on a draft bill for an East African Law on HIV.

The report by the Kenyan-registered consultancy was presented at a regional consultative meeting held between December 3rd and 4th, 2009.

Participants at the meeting in Arusha voiced concern at provisions in the member states laws relating to the rights of People Living With HIV/AIDS and criminalisation of HIV transmission.

Mumma told IPS that most people consulted felt that the issue of wilful transmission of HIV/AIDS should be punishable, but not in the context of the HIV law. It should be dealt with separately because if it was included in the HIV law, it will stigmatise people who may use this law to seek protection and treatment, the East Africa Law Society said.

“HIV should be seen as any other diseases including hepatitis B. And it would better for it to be dealt with in the context of the penal code even if it meant drafting another clause in the penal code,” Mumma said.

Sarah Bonaya, a Kenyan Representative at East African Legislative Assembly and also a member of the General Purposes Committee in the parliament, said she was sure that her colleagues in the assembly would support the Bill which may be tabled as a Private Member’s Bill to the East African Assembly.

She was happy that consultations had gone on through the five states to ensure a harmonised law that would address some of the negative provisions within each member state law that would affect management of HIV/AIDS as a region.

The new proposed law on HIV/AIDS would be the second in Africa after the SADC HIV law adapted in November 2008. The SADC law provides a comprehensive framework for harmonisation of HIV and human rights in southern Africa.

China: New law punishes non HIV disclosure as “deliberate spread of AIDS” (update)

Update: December 3rd

Xinhuanet.com reports that a new law has been passed in Gansu province in north-western China mandating disclosure within a month of diagnosis. The short article makes it clear that non-disclosure will result a prosecution for “deliberate” HIV transmission, although the penalties are not clear.

A regulation adopted by the provincial health department requires HIV carriers and AIDS patients to inform their sexual partners within a month after they get their HIV test results, said Wang Xiaoming, vice director of the department on Wednesday. It also stipulates that HIV carriers and AIDS patients have a responsibility to persuade their sexual partners into receiving counselling and test. Violation of the regulation would be seen as deliberate spread of AIDS and the violators would be punished according to law, Wang said.

Original post: November 13th

Policymakers in Gansu province in north-western China are proposing to pass a law that makes disclosure of HIV-positive status mandatory within four weeks of diagnosis; if not they “face a lawsuit.”

China Daily reports that the measures are “widely considered well-intentioned but unrealistic.”

The regulation, now still a draft, issued by the Gansu health department on Monday, stipulates that upon getting the HIV confirmation from the clinics, the sufferer must tell his or her partners within a month about the infection, or face a lawsuit.

“The requirement featuring a one-month time limit is not human-oriented as sufferers who first learn of their HIV status need time to accept the harsh reality, let alone informing others of their condition,” said He Tiantian, who heads the Women’s Network against AIDS – China, a civil society supporting females living with HIV/AIDS.

[…]

“Some give fake documents to protect their privacy,” said Professor Jing Jun with Tsinghua University.
Among the 700,000 HIV/AIDS sufferers in China, only 270,000 can be tracked, he said. Regional surveys in the country showed that only one-third of the newly diagnosed HIV sufferers would disclose their infection to their partners.
“The Gansu regulation is good in intention while unrealistic in practice,” he noted. Those most likely to tell their partners are those who have been married for a long time. Other sufferers, especially prostitutes, often fail to inform their partners about the infection, he said.

Of note, the report does not mention a law proposed by the Chinese government in 2006, to prosecute “deliberate” HIV transmission. The two, are, of course related: in too many jurisdictions non-disclosure (even in the absence of significant risk, and definitely in the absence of transmission) is currently criminalised.

Brazil: Health ministry says no to criminalisation following two high-profile prosecutions

Brazil’s Ministry of Health is preparing a public statement in which it recommends that prosecutions for negligent or reckless HIV exposure or transmission cease. Rather, only intentional transmission where both intent and transmission are proven, in accordance with UNAIDS guidance, should ever be prosecuted. The statement follows two high-profile prosecutions in São Paulo.

I first heard of this yesterday when the legal correspondent of Veja Magazine, the largest circulation magazine in Brazil (and fourth largest in the world), contacted me for information about other countries’ approaches to criminalisation for an article she is writing about the issue.

She told me that the first prosecution actually took place in 2004, but that the case has become a national issue since the man’s retrial, which ended two weeks ago. The case involves a married man who was charged with attempted murder for not disclosing his HIV status to his mistress during their three year affair, and who subsequently tested HIV-positive. His wife of 25 years knew he was HIV-positive and they always used condoms, and she is not a complainant. In the first trial, the Grand Jury found him guilty of attempted murder and he was sentenced to eight years in prison. This was upheld on appeal, but a second appeal based on a legal technicality led to a second trial in which he was charged, and found guilty of, the lesser charge of assault and sentenced to two and half years – time he had already served.

A second case involves another heterosexual man who has also been charged with attempted murder for having unprotected sex without disclosure with three women, two of whom subsequently tested HIV-positive. This case is ongoing and awaiting a decision from the Supreme Court.

What is significant is that Brazil’s government appears to be on a collision course with the judiciary. Although my Veja correspondent was vague about the Ministry of Health’s statement (she had not yet been able to interview them), I found this report from Odia/Terra online published on Tuesday which includes a quote from the Ministry of Health’s Eduardo Barbosa

According to Eduardo Barbosa, Deputy Director of the Department of STD, AIDS and Hepatitis from the Ministry of Health, in order for HIV transmission to be considered a crime the court must, in addition to proving intent, consider the existence of “psychosocial factors”, the stage of treatment of disease and the responsibility of the partner to protect themselves.

A ministry statement goes against a global trend to criminalize those who transmit the disease, according to Barbosa. “Some countries end up adopting such measures as if it were possible to isolate and blame in order to control the epidemic.”

This fits well with Brazil’s history of focusing on a human rights approach to HIV. In fact, the government is about to pass a new (protective) law which will punish anyone who discriminates against someone with living with HIV with up to four years in prison.

Bill 6124/05 criminalises anyone who promotes any act of discrimination, exclusion or restriction of people living with HIV in schools and kindergartens; in the workplace; and in healthcare settings. It also criminalises third party disclosure of someone’s HIV-positive status in these settings.

O reporter.com reports that

Bill 6124/05 was approved unanimously today [17 November] by the Committee on Constitution and Justice (CCJ) of the House of Representatives. The approval of the project, which was approved by the rapporteur, Congressman Regis de Oliveira (PSC-SP), will benefit about 630 thousand infected in Brazil…

“Nearly a decade after we first attempted to pass this law, the House of Representatives is finally close to creating a law that punishes any act of distinction, exclusion or restriction to people who are HIV-positive,” said Regis de Oliveira. During the debate, the proposition, which is being handled in the Committee on Constitution and Justice (CCJ), had the support of most lawmakers…

“It is important that society should identify the various forms of discrimination in order to eliminate them, helping to respect, protect and fulfill human rights. Discrimination threatens the rights of these citizens live in dignity, so that often they become victims of irreversible psychological damage, ” he concludes.

The bill now goes to the vote on the House floor.

I should have more details on the cases and the government’s official response next week.

South Korea: Korean man gets 18 months for HIV exposure; calls for HIV-specific laws (updated)

Update: October 27th

The 26 year-old Korean taxi driver arrested in March was found guilty earlier this month under South Korea’s public health law for having unprotected sex without disclosure and has been sentenced to 18 months in prison.

Original post: 16th March

The arrest of an HIV-positive taxi driver in Jecheon, North Chungcheong Province last week – originally for “habitually stealing women’s underwear” but now charged under public health law for having unprotected sex without disclosure with at least ten women – has resulted in a resurgence of panic around criminal HIV transmission in South Korea, and calls for HIV-specific criminal laws.

The case was first reported in English on March 13th in the Korea Times.

An AIDS patient in his 20s has had sex with dozens of women in Jecheon, North Chungcheong Province, over the last six years, police have revealed. The Jecheon Police Station said Friday that the patient, identified as Chun, 27, had sexual relationships with waitresses and drunken passengers while working as a taxi driver since 2003.

More details emerged on March 14th at Donga.com.

Police said he neither told his sex partners of his infection nor used contraceptives. A police search of his house found packets of medicine along with women’s underwear. Police grilled Jeon on what the medicine was for and he confessed to being HIV-positive. Police sought an arrest warrant for him yesterday for violating an AIDS prevention law and began tracking the women who had sex with him.

On March 15th, the Korea Times reported that the local sexual health clinic had been flooded with requests for HIV testing following reports of the man’s arrest.

According to the regional office, 61 people have undergone HIV tests, about 12 times the usual figure, since the arrest of 27-year-old cab driver Jeon, Friday. The official said no one was yet found to have the virus, but it will forward test samples to a higher institute for close examination.

On a positive note, public health officials are being extremely responsible and informing the public that the risk of transmission from a single act of unprotected sex is low, particularly since the man is on effective treatment.

According to health authorities, however, chances are low that his sex partners were infected with the deadly virus. Since he was put under monitoring, he has got counseling and medical checkups 30 times and taken regular medication. This means he is as healthy as an ordinary person, a source at the disease control center said. (Donga.com)

However, experts said the likelihood of catching HIV from unprotected sexual activity with someone who is HIV-positive is a mere 0.5 percent. “Since Jeon had been taking drugs to control the virus, the odds could be even lower,” a health expert said. (Korea Times, 15/3/09)

Nevertheless, according to Donga.com.

Domestic law only prohibits those who are HIV-positive from working at entertainment establishments that require regular medical checkups of their employees. Calls are rising for authorities to draw up countermeasures to control the jobs and private lives of HIV-positive people.

And a Donga.com editorial on March 16th appears to support these calls.

The news of an HIV-infected taxi driver who had sex with scores of women has rocked the nation. Medical Web sites are being bombarded with inquiries about AIDS symptoms and applications for the HIV test have jumped ten-fold. Generally, HIV/AIDS patients avoid contact with people because contracting the disease is lethal for their weakened immune system. If a HIV-positive person attempts to purposely spread the disease, however, there is no way to block him or her from doing so. In the wake of the news, calls are rising that the 1987 AIDS prevention law is ineffective to stem the spread of the deadly disease. The country’s AIDS control and prevention system should be urgently revamped.

Update: March 16th, 5pm: An editorial today in the Korea Times blames the public health authorities rather than the individual himself.

It goes without saying that prevention is the best way of containing the spread of HIV/AIDS. Therefore, the government and the health authorities should establish a firm preventive system before it is too late.

France: Appeal court upholds three year sentence for HIV transmission

The Court of Appeal in Aix-en-Provence has upheld the three year sentence handed down by a Marseille Criminal Court in June 2008 to a man who pleaded guilty to “administering a harmful substance causing disability or permanent disability” after having been accused of sexually transmitting HIV without disclosing his status to his former girlfriend.

Although the story was covered by several newspapers in France, none make it clear why there was an appeal when the man had pleaded guilty. His original sentence – three years, with a minimum of two years in prison – was upheld during the appeal but he now must serve all three years. If the appeal was called by the man’s lawyer, then it has backfired somewhat.

However, one of the articles, from AFP, mentions that the complainant

avait déposé plainte pour “tentative d’homicide involontaire” et “mise en danger d’autrui” (had filed a complaint for “attempted manslaughter” and “endangering others.”)

Perhaps it was the prosecution who had appealed. According to the report in Le Figaro

Le procureur avait lancé au mis en cause, lors du premier procès: “Vous êtes un salaud!”. (The prosecutor had launched into the respondant at the first trial: “You are a bastard!”.)

The report with the most details of the case appeared in Le Provence. Highlights in French (with rough English translation) below.

Gilles, 42 ans, ancien toxicomane, et Laurence, 41ans, avaient entretenu, en 1998 et 1999, une relation amoureuse durant près de dix mois. (Gilles, 42, a former drug addict, and Laurence, 41, had been in relationship for almost ten months between 1998-1999).

En avril 1999, la jeune femme apprenait tout à la fois sa contamination par le VIH et que toute la famille de son compagnon savait qu’il était séropositif depuis six ans et suivait un traitement. (In April 1999, the young woman learned she had been infected with HIV and that the entire family of her partner knew he had HIV for six years and was receiving treatment.)

Avant d’abandonner l’usage des préservatifs, Laurence avait pourtant demandé à son ami s’il avait récemment pratiqué un test VIH. Ce à quoi, il avait répondu par l’affirmative et qu’il n’y avait aucun problème. (Before abandoning condoms, Laurence had asked her partner if he had recently performed an HIV test. To which he replied in the affirmative and that there was no problem.)

Évoquant des regrets, présentant des excuses, Gilles a expliqué son attitude par son “inconscience” , par le fait qu’il traversait à l’époque “une période critique” . “Je me cachais la maladie à moi-même, je n’arrivais pas à me l’avouer, à y faire face”. (Full of regret, apologizing, Gilles explained his attitude by his “unconscious” by the fact that he was crossing at the time a “critical period”. “I hid the disease from myself, I couldn’t admit it to myself in order to cope.“)

Cependant, l’instruction avait démontré qu’il se soignait en prenant ses trithérapies au domicile de sa mère. “Il a cru qu’il suffisait de ne plus penser à la maladie pour qu’elle n’existe plus” , avait expliqué son défenseur Me Gérard Bismuth, selon lequel on pouvait le considérer comme “responsable mais pas coupable”. (However, investigation showed that he had treated himself by taking his triple therapies in the home of his mother. “He thought it sufficient to stop thinking about the disease so that it no longer exists,” explained his defender Gérard Bismuth, that it could be considered “responsible but not guilty”. )

À la barre, Gilles avait répété ne jamais avoir eu l’intention de transmettre le virus. “Je ne voulais pas nuire à la santé de Laurence, je regrette d’avoir été imprudent”. (At the bar, Gilles repeated that never intended to transmit the virus. “I did not want to harm the health of Laurence, I regret having been imprudent.)

[…]

Pour Jean-Pierre Binon, avocat de la victime, “la peine est sévère mais semble-t-il juste. Elle reconnaît Laurence comme une victime ce qui va lui permettre de passer à autre chose, de refaire sa vie en espérant qu’il n’y ait pas de maladies opportunistes, de cancers dont le risque est augmenté par la maladie. C’est sans aucun sentiment de vengeance qu’elle a agi et qu’elle tourne aujourd’hui la page judiciaire”. (Jean-Pierre Binon, the victim’s lawyer [says], “the punishment is severe but seems right. It recognises Laurence as a victim which will enable her to move on, to rebuild her life in the hope that there are no opportunistic diseases or cancers whose risk is increased by the disease. This is not been about revenge and now the legal battle is over.”)

Africa: HIV Laws Do More Harm Than Good by Miriam Mannak (IPS)

I received an email last week from Miriam Mannak, a freelance writer based in Cape Town, South Africa who keeps on blog on AIDS in Africa. She recently contributed this excellent piece on the spectre of criminalisation on her continent to the Inter Press Service News Agency, whose mission is to give voices to the voiceless.

AFRICA: HIV Laws Do More Harm Than Good by Miriam Mannak (IPS)

CAPE TOWN, Jul 30 (IPS) – In Sierra Leone, a mother who transmits HIV to her child can be fined, jailed for up to seven years, or both. Human Rights Watch reports that in 2008, several men were arrested in Egypt simply for being HIV positive. New legislation is currently being discussed in Angola that could lead to a three to ten year jail sentence for those who knowingly pass on HIV.

The legislation is inspired by a September 2004 workshop organised by the influential reproductive health organisation Family Health International developed an “African Model Law” intended to protect those who are infected and exposed to HIV.

But various civil society organisations fear that these legislative measures will hurt more than help the fight against HIV/AIDS.

Discourages testing, delays treatment

“If being HIV positive is being regarded as a crime, people will be less likely to get themselves tested,” said Johanna Kehler, director of the Aids Legal Network (ALN) – a South African non-governmental organisation that aims to protect the human rights of people living with and affected by HIV/AIDS.

“This means that they are more likely to spread the disease unknowingly, and will not have access to antiretrovirals that may help to prolong their lives.”

Jennifer Gatsi Mallet – coordinator of the Namibian branch of the International Community of Women Living with HIV/AIDS (ICW), a global network run for and by HIV positive women – agrees with Kehler’s statements.

“The criminalisation of HIV will be yet another reason why people will stay away from testing facilities and clinics,” she said.

The International Planned Parenthood Federation, a global organisation that advocates sexual and reproductive health and rights, counts 58 countries around the world with laws in place to prosecute HIV transmission and 33 others that are considering passing such legislation. Of these, twenty are in Africa.

Women lose more

“Women will be the first ones in line to be prosecuted, as they are more likely to know their status compared to men, simply because they visit clinics more often, for instance during and after their pregnancy,” Kehler explained.

Gatsi Mallet added that in “many parts of Africa, clinics and men are like water in fire. While some accuse health facilities of being unfriendly to men because most of the health care workers are female, others consider visiting as unmanly, especially when it comes to HIV and other sexual related transmitted diseases,” she added.

“They therefore rather prefer to go to traditional healers, whom are in general more male orientated.”

Because women are more likely to discover they are HIV positive, their male partners often blame them for bringing the virus home – regardless of the fact that the infection may well have travelled the other way.

“Women across the world, including in Africa, experience difficulties negotiating safe sex,” Kehler said. “If a man does not want to use a condom, they often are left with no choice.”

Angela from Cape Town, who requested anonymity – contracted the virus a few years ago. “I never had sex with anyone else but my husband, but I suspected that he was sleeping around. I just knew. So sometimes I asked him to use a condom, but he always blatantly refused,” she explained.

“He said that a wife is supposed to trust her husband. When I went for prenatal care two years ago, I was told I was HIV-positive. After confronting my husband, he accused me of sleeping around and of infecting him. He threw me out of the house.”

In countries like Egypt, such an accusation could lead to prosecution. The same is true in Togo, where HIV-positive people are prohibited by law from having unprotected sex, regardless of whether they have disclosed their status to their partner.

“In case of prosecution, women are left in a terribly vulnerable position, as many do not have the resources to, for instance, prove that they were HIV negative before intercourse,” Kehler noted. “Neither can they prove if they did not do it deliberately.”

Laws against mother to child transmission (MTCT) should also be banned, the ALN argues.

An HIV-positive mother can pass the virus to her child during pregnancy, whilst giving birth, or through breast feeding. Of the 370,000 cases of MTCT each year, about 90 percent occur in Africa, according to UNAIDS.

In countries like Guinea, Guinea-Bissau, Mali and Niger, a mother can be criminally charged if she does not take steps to prevent HIV transmission to baby, including taking antiretrovirals during the pregnancy.

MTCT is almost entirely preventable, by taking antiretrovirals and giving birth in a sterile environment. Breast feeding poses certain risks: WHO studies indicate that a mother who is HIV positive risks passing the virus on to her child. But in certain situations – for example where a mother does not have access to clean water to mix formula and sterilise bottles, but is on antiretrovirals – exclusive breastfeeding is recommended.

Formula-fed babies in developing countries are six times more likely to die from diseases like diarrhoea and respiratory infections than breast-fed babies, according to WHO.

“The problem is that many African women do not have access to proper health care facilities and cannot afford formula,” Kehler said. “These are things governments should provide. If they fail, they should be the ones that are to be held accountable for MTCT.”

SIDEBAR: Who’s responsible for MTCT?Chantelle Heunis* from Overcome Heights – an informal settlement near Cape Town – was infected by her now ex-husband with the disease in 1999. At the time she was pregnant with her second daughter.

“I only found out after my baby was three months old, after I went for a check-up as she was ill due to lactose intolerance. The nurse offered to test me for HIV – which was not a routine procedure back in the days. The results came back positive.”

The next step was to test the baby. “It was dreadful, but thank god she was found HIV negative,” Heunis said. “She is ten years old now, and as healthy as can be.”

According to Heunis, it should not be allowed for women to be punished for MTCT. “I was lucky because I was in good hands, but many women do not have this privilege. They transmit the virus through unhygienic birthing practices, for instance, or because they do not have access to ARVs to prevent MTCT.”

She also rejects the notion that HIV positive women should not be allowed to have children. “It is within our rights to have children. Besides, if a mother is HIV positive, that does not mean the baby is also.”

* not her real name.

Switzerland: Federal Court confirms Geneva HIV exposure acquittal, but does not mention viral load (updated)

UPDATE July 8th 2009

The Federal Court has now confirmed the recent HIV exposure acquital in Geneva, but shied away from explicitly discussing the link between an undetectable viral load and risk of transmission. In effect: they lacked the courage to change HIV exposure law throughout Switzerland.

According to AIDS Geneva’s Deborah Glejser, the Federal Court upheld the Geneva court’s finding that HIV exposure charges were no longer possible because the two female complainants were not exposed to HIV, but they did not actually discuss why this was the case (i.e. because the defendent was on effective treatment).

A brief report (in French) on 20minutes online, notes that the Federal Court emphasized that the women were not infected with HIV during unprotected sex and accordingly are not considered by the criminal courts to be victims. They could have sued for psychological harm in the civil court, but didn’t, and so “in the absence of such a request, their action can only be ruled inadmissible.”

Deborah Glejser tells me that she is extremely disappointed in the Federal Court since this was “a great opportunity missed.” Although HIV exposure remains no crime in Geneva, it will now be down to individual cases – and prosecutors as forward-thinking as Yves Bertossa – to change the law in Switzerland’s 25 other cantons.

ORIGINAL POSTING July 1st 2009

Video and reports (in French) are now available following the May 18th meeting convened by Group SIDA Geneve (AIDS Geneva) featuring a discussion between Professor Pietro Vernazza, President of the Swiss Federal AIDS Commission (which produced the January 2008 ‘Swiss statement’ on infectiousness) and Yves Bertossa, Geneva’s deputy public prosecutor, (who pushed for the recent HIV exposure acquital in Geneva), moderated by AIDS Geneva’s Deborah Glejser.

The meeting highlighted the importance of the Geneva court’s ruling that an HIV-positive person on successful treatment, with an undetectable viral load, and no other STI, could not possibly be guilty of exposing another person to HIV if they had not disclosed their status before having unprotected sex.

The Geneva judgement has now been appealed by the complainant which means it will now be heard by the Federal Court, Switzerland’s highest court. Mr Bertossa appeared confident that the Federal Court would confirm the acquittal, making the ruling relevant throughout Switzerland (and possibly providing more legal ammunition for other jurisdictions).

Highlights of the meeting are available to watch on the AIDS Geneva blog. The meeting also received mainstream coverage, including a report in L’Hebdo (Switzerland’s answer to Time or Newsweek) and in the main Geneva broadsheet, L’evenement.

Editorial: Burden of HIV disclosure falls on Uganda’s women

An article in today’s Toronto Star highlights the heavy burden that HIV-positive women will carry under Uganda’s proposed HIV/AIDS Prevention and Control Law.

In the article, children’s rights activists, Marc and Craig Kielburger, note that many HIV-positive women in Uganda – who are likely to be tested before their husbands as part of ante-natal screening – face violence and even death for disclosing their HIV status to their husbands. They highlight the fate of Glorius Kyarihunda, 25, who was murdered by her husband within days of disclosing her HIV status to him.

According to the Ugandan branch of the International HIV/AIDS Alliance, Glorius was one of five women murdered in 2008 under similar circumstances. Thousands more suffered abuse or eviction. In a survey of just one district by ActionAid Uganda, 100 out of 465 women said they experienced domestic violence as a result of disclosing their status.Disclosure is not only difficult, it’s dangerous. Yet, just months after Glorius’ death, the Ugandan Parliament is debating a bill that gives a person six weeks after testing positive to tell their partner before the government does.

Given the inequalities in both inter-personal relationships, and the legal status of women in Uganda, this is simply unfair, they argue given:

the rules of predominantly male-dominated societies leave women unable to negotiate condom use or family planning. Many men, like Glorius’ husband, hold their wives responsible for infection.

The article then goes on to critique other criminal HIV transmission laws in Africa:

In Togo, anyone who doesn’t use a condom in “all risky sexual relations” is breaking the law while Guinea requires mandatory testing before marriage. In Zimbabwe, a woman was convicted for “deliberately infecting another person.” Her lover has never tested positive for the virus. In Sierra Leone, women can also be criminalized for exposing their infants to HIV.

That this anti-criminalisation article was published in a Canadian paper is somewhat ironic given the number of prosecutions taking place there, but then there is often a lack of joined-up-thinking in many low-prevalence countries when it comes international concern about AIDS and domestic HIV policies.