US: Florida State Senate Committee Supports Public Health Measure To Modernize HIV Laws (Press Release)

Press release from the Sero Project

Tallahassee March 22, 2017

The Florida HIV Justice Coalition today applauded members of the Florida State Senate’s Criminal Justice Committee for voting unanimously yesterday in favor of Senate Bill 628.

SB 628 will modernize Florida statutes regarding sexually transmissible infections (STIs) to reflect advances in scientific knowledge and medical treatment, particularly as they concern prevention and treatment of HIV.

The Florida HIV Justice Coalition, comprised of physicians, healthcare workers, legal, public health and policy professionals, people living with HIV and other allies, has led a statewide effort to raise awareness and mobilize support for reform.

Senator Rene Garcia (R-Hialeah), the SB 628’s chief sponsor, said, “Florida doesn’t want to be first in new HIV cases; we want to be first in the effort to end the HIV epidemic. With the support of public health leaders, prosecutors, major HIV service providers in Florida, like the AIDS Healthcare Foundation, the Sero Project (a national network of people living with HIV) and others, we are going to get there. Today’s unanimous vote by the Senate Criminal Justice Committee is an important step.”

Leaders in providing services for people with HIV in Florida, as well as nationally, agree that early testing and ongoing adherence to treatment can stop the spread of HIV.

“Virtually all HIV transmission in Florida is from people who have HIV but do not know it, because they have not been tested, or are not on treatment,” said David Poole, Director of Legislative Affairs at AIDS Healthcare Foundation, Florida’s leading HIV service provider. “Getting tested, treated and virally suppressed prevents HIV transmission. That’s why updating these statutes is a vital HIV prevention strategy for Florida.”

“Public health policies and criminal statutes should be aligned to incentivize HIV testing and treatment. Any criminal act concerning transmission of sexually transmitted infections should be based on an intent to harm, a significant risk of harm and actual infliction of harm,” said Mrs. Kamaria Laffrey, a Winter Haven resident who has led the Florida HIV Justice Coalition and is a woman living with HIV. “We will continue to work with Senator Garcia and other legislators to improve SB 628 as it continues through the legislative process.”

“We commend and thank Senator Garcia for his leadership. We look forward to working with the legislature and our allies to improve public health and ensure equality and justice for all Floridians,” said Tami Haught, a woman living with HIV who coordinates state organizing for the Sero Project, a national organization working to modernize HIV-specific criminal statutes in 32 states.

The bill next moves to the Senate Health Policy Committee. Similar legislation, HB 605, has been filed in the House and will be heard first by that chamber’s Criminal Justice Committee.

Further information:

Kamaria Laffrey, Coordinator, Florida HIV Justice Coalition Kamaria.laffrey(at)seroproject.com

David Poole, Director of Legislative Affairs, AIDS Healthcare Foundation david.poole(at)aidshealth.org

Sweden: Government tasks Public Health Agency with HIV review to include "what need is there to provide specific information to the courts and other law enforcement authorities about the state of knowledge on the infectivity of HIV infection in a well-functioning treatment."

Knowledge State of the risk of infection by HIV should be followed up

 (Google translated English, Swedish original from Govemernment website below)
 

The Public Health Agency is commissioned to monitor how their knowledge base Infectivity in treated HIV infection have been applied. The Authority shall review the importance of documentation has been for health care initiatives related to disease transmission of HIV infection.

Monitoring should especially see how the surface influenced the conduct as a doctor under the Infectious Diseases Act announces to a patient, as well as the team’s importance in assessing the risks of transmitting HIV infection to a so-called in vitro fertilization (IVF).

– Knowledge of HIV has made great strides since the first cases were discovered. Today there are both more knowledge about the risks of infection and significantly better treatment to get. Therefore, we need to ensure that the knowledge is effectively applied so that people with HIV should be able to get as good treatment and good a life as possible, says health minister Gabriel Wikström.

The Public Health Agency shall also review what need is there to provide specific information to the courts and other law enforcement authorities about the state of knowledge on the infectivity of HIV infection in a well-functioning treatment.

In those parts of the mission involving the Public Health Agency IVF should consult with the National Board of Health and the Public Health Agency will also seek to involve other relevant stakeholders in the HIV field for the assignment.

The final report is due by 30 March 2018


 

Kunskapsläget om smittorisker vid HIV ska följas upp

 Folkhälsomyndigheten får i uppdrag att följa upp hur deras kunskapsunderlag Smittsamhet vid behandlad hivinfektion har tillämpats. Myndigheten ska se över vilken betydelse underlaget har fått för hälso- och sjukvårdens insatser som rör smittoöverföring av hivinfektion.

Uppföljningen ska särskilt se över hur underlaget påverkat vilka förhållningsregler som en behandlande läkare med stöd av smittskyddslagen meddelar till en patient, samt underlagets betydelse för att bedöma riskerna för att överföra en hivinfektion vid en så kallad in vitro fertilisering (IVF).

– Kunskapen kring HIV har tagit stora steg framåt sedan de första fallen upptäcktes. I dag finns både mer kunskap om smittoriskerna och betydligt bättre behandling att få. Därför behöver vi säkerställa att den kunskap som finns verkligen tillämpas så att personer med HIV ska kunna få så bra behandling och goda liv som möjligt, säger folkhälsominister Gabriel Wikström.

Folkhälsomyndigheten ska också se över vilket behov det finns att ta fram särskild information till domstolar och andra rättsvårdande myndigheter om kunskapsläget kring smittsamhet av hivinfektion vid en välfungerande behandling.

I de delar av uppdraget som berör IVF ska Folkhälsomyndigheten samråda med Socialstyrelsen och Folkhälsomyndigheten ska också sträva efter att involvera andra relevanta aktörer inom hivområdet för uppdraget.

Uppdraget ska slutredovisas senast den 30 mars 2018.

US: In-depth review of scientific studies on the criminalisation of HIV exposure

The Center for Interdisciplinary Research on AIDS (CIRA) at Yale University has completed an in-depth review of scientific studies on the criminalization of HIV exposure in the United States. The review appears in the current issue AIDS and Behavior.  Dini Harsono, Assistant Director for Clinical Health Services Research at CIRA, is the lead author of the article. Collaborating authors include two prominent members of CIRA’s longstanding work group on the Criminalization of HIV Non-Disclosure, Carol Galletly of the Center for AIDS Intervention Research in Wisconsin and Zita Lazzarini, UConn Health, and CIRA’s Executive Director, Elaine O’Keefe. This is the first comprehensive examination of empirical research on this topic in the US, examining studies conducted between 1990 and 2014. In addition to describing the research and key findings, the review discusses implications for practice and policy that emerge from the studies reviewed, identifies gaps in our current knowledge, and sets the course for future research in this area.

You can read the article here.

US: Mark S. King explores why the breakthrough message equating "HIV undetectable to untransmittable" matters

Five Reasons ‘HIV Undetectable’ Must Equal ‘Untransmittable’

December 15, 2016

We are not dirty, we are not a threat, and we are not disease vectors. In fact, we are the solution. People living with HIV who achieve viral suppression, who become undetectable, are the solution to the end of new HIV infections in the United States. … When we look back 20 years from now we’re going to judge ourselves in terms of how well we responded to this opportunity.

Dr. Rich Wolitski, person living with HIV and acting director for the Office for HIV/AIDS and Infectious Disease Policy at the U.S. Department of Health and Human Services

When Dr. Wolitski delivered his speech at the closing plenary of the 2016 United States Conference on AIDS (USCA), he received a standing ovation. He was referring to this year’s newest findings of HPTN 052 and the PARTNER study, which showed that people living with HIV who are undetectable are not transmitting the virus to their negative partners.

How wonderful that something many of us have assumed for years has been proven to be true. So now we can spread the news and encourage people with HIV to seek treatment and stick with it. And hey, there’s nothing like a little intercourse a la natural with your partner to reward yourself for being undetectable, am I right?

Not so fast. There is some strong resistance to a message that equates undetectable to untransmittable, and it’s not coming from where you might think.

Here are five reasons why this breakthrough message matters.

1. The science is solid.

The PARTNER Study has recorded 58,000 acts of penetrative sex without condoms between 1,000 positive/negative couples, in which the HIV positive partner had an undetectable viral load. There were no infections between the couples. Not a single one. The same results were reported in the HPTN 052 study and the empirical evidence to date. As Dr. Wolitiski said in his USCA speech, “this is a game-changing moment in the history of the HIV epidemic.”

Resistance to the conclusion that undetectable people pose no risk of infection has been either a matter of scientific data scrutiny or a fear that people may not actually be undetectable when they think they are. Let’s break that down.

A review of the argument against saying “zero risk” is enough to make you cross-eyed. It is based on the premise that nothing, really, is without risk. Detractors of the non-infectious message will calmly explain the perils of placing any risk at zero and then hypnotize you with statistical origami. Suffice it to say that proving zero risk is statistically impossible. You risked electrocution by turning on your device to read this article.

There will always be somebody who claims a terminally unique HIV infection, even if the precise circumstances of their claim may be murky. Weird things happen. Some folks are convinced that people who drink alcohol sometimes spontaneously combust. But you don’t see warning labels about it slapped on every bottle of Wild Turkey by overzealous worrywarts.

And yes, there is the possibility that someone might develop a viral load if they are not adherent to treatment and then transmit the virus. But the message here is that people who are undetectable cannot transmit HIV. If you stay on treatment and are undetectable you will not transmit HIV. Can we please celebrate this simple fact without remote qualifiers?

It is also important to note that a Canadian consensus statement concluded that any “viral blips” or sexually transmitted infections (STIs) were “not significant” to HIV transmission when someone is undetectable.

2. Major health experts are on board (but not all community leaders).

Public health leaders, from the New York Department of Health to the National Institutes of Health (NIH), have embraced these findings and its meaning to people with HIV, while community advocates and organizations have been reluctant to get on board, citing a theoretical risk of infection. Or maybe they consider changing their fact sheets and web sites an enormous bother.

The Prevention Action Campaign and their seminal message “U=U” (undetectable equals untransmittable) was founded on the energetic efforts of a man named Bruce Richman. He entered the HIV advocacy scene a few years ago, seemingly out of nowhere, carrying aloft the banner of undetectability. Richman gathered signatures of health experts the world over for a consensus statement about the research, while cajoling every U.S. HIV organization in sight to adopt language that removes the stigma of infectiousness from people who are undetectable.

My review of the web sites and statements from major HIV organizations includes no strong language about undetectable people not transmitting HIV. Worse, some exaggerate the risk from those who are undetectable. How could such a new research breakthrough be met with such ignorance and apathy by our own leaders? I will defer shaming anyone by name while they take a little time to update their official language. (Notable exceptions to this sad rule include work going on in the United Kingdom and France that flatly states that undetectable means non-infectious.)

This skepticism from our own community reduces people with HIV, again, to a problem that must be managed. It suggests that those of us who have achieved undetectability don’t have the judgment to keep taking our medications or to see our physician regularly to be sure our treatment plan is still effective. It keeps us in the role of untrustworthy victims unable to make decisions that will keep the rest of you safe from us. What infuriating, stigmatizing nonsense.

3. This is about HIV. Only HIV.

Auxiliary issues often creep into this debate that may be well-meaning but only muddy the waters, such as the fear that promoting the message of non-infectiousness will lead to more sexually transmitted infections (STIs) because of the freedom it allows (see also: critics of PrEP, the birth control pill, and any other vehicle that might lead to unbridled sexual pleasure).

Rates of STIs — which were on the rise before the advent of PrEP or news from the PARTNER Study — are deeply concerning but ultimately tangential. We are in desperate need of comprehensive sexual health programs, to be sure, but in this instance I feel compelled to “kill the alligator closest to the boat.” This is about being HIV undetectable, not syphilis impermeable. Being undetectable will not prevent other infections or address promiscuity or remove stubborn stains.

Advocates are also sensitive to the continued compartmentalization of our community, between those who are positive or not, who is on PrEP or not, and now, between those with HIV who are able to achieve viral suppression and those who cannot, despite their best efforts. I sympathize with this new divide among HIV positive people but believe the greater good — removing shame and stigma from those who are not capable of transmitting — shouldn’t be downplayed. All HIV positive people of good will can and should celebrate this development, regardless of their own viral load.

4. This is a major victory for HIV criminalization reform.

Terribly important work is being done to repeal and reform HIV criminalization laws that prosecute people with HIV for not disclosing their status to a sexual partner. Our lead defense is often that the defendant never posed a risk to their partner in the first place, due to their use of protection or the fact the defendant was undetectable and therefore rendered harmless.

Imagine the glee with which prosecutors might punch holes in this defense, based on statistical mumbo-jumbo saying “zero risk” is impossible and using it to explain to a jury that Joe Positive did, in fact, pose a risk to his sexual partner and should be jailed for it. Put that doubt into the heads of a jury, and another person with HIV gets a 30-year sentence for daring to have sex at all.

5. This profoundly changes how people with HIV view themselves.

Internalizing the fact that I cannot transmit HIV to anyone has had an effect on me that is difficult to describe. I can only liken it to the day the Supreme Court voted for marriage equality. Intellectually, I knew I was a gay man and a worthy human being. But on the day of the court’s decision I walked through the streets of my neighborhood with my head held higher. Something had changed. I felt whole.

In my thirty-five years living with HIV, I have never felt exactly that way. I deserve to. And so do millions of other people with HIV.

Of all the arguments to adopt the message that undetectable people cannot transmit HIV, that enhanced feeling of self-worth may be the most important reason of them all.

 

US: New Report from the William Institute finds HIV criminalisation laws in California do not reflect medical science

LOS ANGELES —  In California, outdated HIV criminalization laws do not reflect the highly effective medical advances for reducing the risk of HIV transmission and extending the quantity and quality of life for people living with HIV.

HIV criminalization is a term used to describe laws that either criminalize otherwise legal conduct or that increase the penalties for illegal conduct based upon a person’s HIV-positive status.  California has four HIV-specific criminal laws.

In HIV Criminalization in California: Evaluation of Transmission Risk, researchers Amira Hasenbush and Dr. Brian Zanoni suggest that these HIV criminal laws in California are not in line with medical science and technology related to HIV and may, in fact, work against best public health practices.

“Nine out of ten convictions under an HIV-specific criminal law or sentence enhancement have no proof of exposure to HIV, let alone transmission,” said Amira Hasenbush.  “No HIV criminal laws in California require transmission for a conviction.”Key findings include:

  • From 1988 until June 2014, 379 incidents resulted in convictions for an HIV-specific felony or sentence enhancement.
    • Of those, 100 percent required no actual transmission of HIV.
    • 98 percent did not require intent to transmit HIV.
    • 93 percent involved no specific allegation of conduct that is likely to have transmitted the virus:
      • Ninety percent of convictions were in solicitation incidents in which it is unknown whether any contact beyond a conversation or an exchange of money was initiated, thus possibly not having any exposure to HIV.
      • Three percent of incidents involved oral sex, a sex act whose transmission risk is estimated as “low” by the CDC.
      • Only seven percent of incidents involved vaginal or anal sex by definition of the crime.

HIV criminal laws have been disproportionately applied to sex workers. This has a disproportionate impact on women and people of color. Since solicitation by definition includes survival and subsistence sex work, these laws are also likely to disproportionately impact LGBT youth and transgender women of color.

Laws that criminalize conduct of a person who knows that they are HIV-positive may disincentivize testing and work against best public health practices.

The Williams Institute, a think tank on sexual orientation and gender identity law and public policy, is dedicated to conducting rigorous, independent research with real-world relevance.

Full report can be read here

 

Australia: Despite absence of risks, mandatory HIV testing of people who spit at police officers will remain

Police Minister Liza Harvey says the government stands by it’s mandatory blood test laws for offenders who spit at police officers.

On Friday leading HIV experts criticized the 2014 law brought in by the Barnett Government saying it had no basis in scientific fact.

Currently an offender who spits at a police officer can be forced to have a blood test to see if they are carrying the HIV virus.

Delegates at the Australasian HIV & AIDS Conference said they had “profound disappointment” in state government’s that brought in laws forcing blood tests for offenders who spit at police.

Scientists say its not possible for the HIV virus to be transmitted via saliva.

“Australia has a proud record of basing its HIV response on evidence-based policy,” Associate-Adjunct Professor Levinia Crooks, CEO of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) said yesterday.

“These laws are anti-scientific. The risk of transmission of HIV or other blood-borne viruses from saliva is practically zero. There is no justification for invading the privacy of people in custody by forcing them to undergo blood tests when there is no risk to the officer.”

“We understand the considerable risks faced by police and emergency services when they go about their jobs, but this is not the solution. There has never been a case of HIV transmission from spitting or biting in Australia,” she said.

Harvey, who is the Deputy Premier and Minister for Police, said the Barnett government has listened to the concerns of police officers and brought in the laws for their protection.

“The Liberal National Government had listened to the concerns of police officers.” the Minister said, arguing that in 2013 there had been a high level of instances where police could have potentially been exposed to infectious diseases.

“In 2013, 147 police were exposed to bodily fluids in a way that they could contract an infectious disease.

“This legislation allows for the taking of blood samples from the offender which helps in diagnosis, clinical management and treatment of the exposed police officer.

Minister Harvey said people were only forced to have a blood test when there was a possibility that an officer may have been exposed to infection.   

“The testing will only happen if there is a possibility of the transfer of an infectious disease – for example the transfer of bodily fluid through broken skin.” Minister Harvey told OUTinPerth. “We are committed to protecting our officers on the front line, who are committed to protecting us.”

Published in Out in Perth