US: American Association of Nurses in AIDS Care publishes new Clinician Guidelines to HIV Criminalization

ANAC believes HIV criminalization laws and policies promote discrimination and must be reformed. The American Nurses Association (ANA) has co-endorsed ANAC’s position statement opposing HIV criminalization and joined ANAC in calling for the end to unjust laws that criminalize HIV. Thirty three states still have laws criminalizing HIV exposure. These laws fuel stigma by institutionalizing discrimination and are based on outdated beliefs. People living with HIV are still being arrested for HIV exposure. ANAC is a member of the Positive Justice Project, a national coalition to end HIV criminalization in the U.S. Read ANAC’s policy statement calling for the modernization of HIV Criminalization laws.

ANAC, with support from the Elton John AIDS Foundation has developed a downloadable tool: Clinician Guidelines to HIV Criminalization.

Download the clinician guidelines here.

BEYOND BLAME
Challenging HIV Criminalisation @ AIDS 2016, Durban

(29 min, HJN, South Africa, 2016)

On 17 July 2016, approximately 150 advocates, activists, researchers, and community leaders met in Durban, South Africa, for Beyond Blame: Challenging HIV Criminalisation – a full-day pre-conference meeting preceding the 21st International AIDS Conference (AIDS 2016) to discuss progress on the global effort to combat the unjust use of the criminal law against people living with HIV.

Attendees at the convening hailed from at least 36 countries on six continents (Africa, Asia, Europe, North America, Oceania, and South America).

Beyond Blame was convened by HIV Justice Worldwide, an initiative made up of global, regional, and national civil society organisations – most of them led by people living with HIV – who are working together to build a worldwide movement to end HIV criminalisation.

The meeting was opened by the Honourable Dr Patrick Herminie, Speaker of Parliament of the Seychelles, and closed by Justice Edwin Cameron, both of whom gave powerful, inspiring speeches. In between the two addresses, moderated panels and more intimate, focused breakout sessions catalysed passionate and illuminating conversations amongst dedicated, knowledgeable advocates

Key HIV transmission study shows no risk to HIV-negative partner when person with HIV is on suppressive antiretroviral therapy

By Simon Collins, HIV i-Base

Tuesday 12 July 2016

Published to coincide with IAS 2016 conference that opens in Durban next week, the PARTNER study showing the impact of HIV treatment (ART) on reducing transmission will benefit millions of people globally.

The results set a new challenge about whether transmission is anything other than a theoretical risk when someone is taking effective ART. This reverses the common assumption that, by definition, some level of risk always exists when one partner is HIV positive.

The PARTNER study provides good evidence that undetectable viral load might be a threshold below which sexual HIV transmission does not occur. The importance of the PARTNER study is that it included both gay and straight couples, that it measured risk in people who were not using condoms and that it estimated absolute risks.

Previous studies have been almost exclusively in heterosexual people who still reported high rates of condom use. The PARTNER study provides more than three times the amount of follow-up time from people not using condoms than all the previous studies combined. This includes 500 couple-years of follow up from people having anal sex without condoms.

Methods

Between September 2010 and May 2014 the PARTNER study prospectively enrolled 1166 serodifferent couples at 75 clinical sites in 14 European countries. Entry criteria included that the positive partner had an undetectable viral load on ART and that the couple were not always using condoms when they had sex.

Follow-up included routine sexual health checks (including HIV testing for the negative partners) and each participant also completed sexual history questionnaires to look at risk for different activities. Couples were only included in the final analysis when the most recent viral load for the positive partners was undetectable – defined as <200 copies/mL. The primary endpoint was the rate of within-partner transmissions, determined by phylogenetic analyses for all couples in which the negative partner became positive.

Results

Of 1166 couples enrolled, 1004 couples had at least one follow-up visit and 888 couples provided 1238 couple years of follow-up (median 1.3 years (IQR 0.8 to 2.0) per couple. This included 548 heterosexual (HT) couples and 340 gay male couples. The main reasons for data not being included in the follow-up analysis was: not yet reaching first follow-up visit (n=162), lack of HIV test (n=20), use of PEP or PrEP (n=9), no condomless sex (n=15), viral load >200 copies/mL (n=55) and lack of viral load result (n=17). There were no significant differences between couples who contributed to follow-up data compared to those who didn’t.

Although 11 people became HIV positive, none of these infections were phylogenetically linked transmissions. This was after at least 58,000 distinct times when couples had penetrative sex without condoms.

Baseline demographics were reported – as with all results – by categories of HIV status, gender and sexuality, with some differences between groups. This makes summarising results complex, but the median age ranged from 40 to 44 (with IQR overall ranging from 31 to 50 years). Gay men and HT women were a few years younger than HT men. Approximately 80% of the HT men were white compared to 70% of women and 90% of gay men. A higher percentage of gay men had education to college/university or higher (approximately 50% compared to 19% to 35% for heterosexuals. Although some of these differences were significant, other than there were fewer very young adults involved, they reflect the diversity of people living with HIV.

HIV positive partners had been on ART for a median of 10.6 (IQR: 4.3 to 15.6), 7.5 (IQR: 3.3 to 14.2) and 4.8 (IQR: 1.9 to 11.4) years, for HT men, HT women and gay men respectively. At baseline, couples reported having had sex without condoms for a median of 2 years (IQR 0.5 to 6.3), with differences between groups. For example, straight couples had been having sex without condoms for roughly 3 years (IQR 0.7 to 11 years) compared to 1.5 years (IQR 0.5 to 4 years) for gay couples. Approximately 23% of couples were in new/recent relationships (<6 months). Self-reported adherence to ART was similarly high at >90% in the three positive groups. Similar proportions of each group also had CD4 counts >350 cells/mm³ (85% to 91%).

Based on data from the negative partners, overall, couples reported having sex without condoms a median of 37 times a year (IQR 15 to 71), with gay couples (median 41; IQR 17 to 75) reporting condomless sex at least 22,000 times and heterosexual couples (median 35; IQR 13 to 70) more than 36,000 times. These were rough estimates from recall and partners did not always report the same numbers. Some couples reported sex outside the main relationship: 108 gay couples (33%) and 34 heterosexual couples (4%).

None of the 11 incident HIV infections in negative partners (ten gay and one heterosexual) were phylogenetically linked to the positive partner. Most people (8/11) reported having sex without condoms with people outside the main relationship. All samples (n=22) were successfully sequenced for pol and 91% (n=20) were sequenced for env. None of the partner sequences clustered together and the results were consistent after using using several different analyses. Additional details for these analyses are described in the online supplementary material. [2]

With zero transmissions, the upper limit of the 95% confidence interval (95%CI) for the overall study was 0.3 per 100 couple years of follow up (CYFU). Each category of specific risks, given that the calculations are a factor determined by study numbers and power, had different upper 95%CI boundaries: for example, 0.88 for HT sex overall vs 0.84 for gay sex overall.

This means that the upper 95%CI for receptive anal sex for gay men (2.70 with ejaculation and 1.68 without ejaculation) needs to be interpreted as a factor of sample size: there were fewer CYFU so the upper limit is by definition higher. While this calculation is developed to define the potential range within which the true risk might lie, the 95%CI should not be interpreted as indicating a risk that has been observed in the study. To illustrate this difficulty, the higher estimated risk for heterosexual anal sex with upper 95%CI of 12.71 and 8.14 (with and without ejaculation, respectively) are driven by fewer CYFU with this as the primary risk rather than any biological reason for this to be much higher. Of note though, more than 20% of straight couples reported anal sex.

The ongoing PARTNER 2 study continues to follow up gay couples in the PARTNER study and to recruit additional gay couples, in order to produce a similarly powered evidence base for gay mean as for straight couples, with follow up until 2019. [2]

Also of note during the study, 91 HIV positive partners reported other STIs (n=16 HT men, 16 HT women and 59 gay men) – closely matching STIs in the negative partners, also without any increased risk reported for HIV transmission.

An non-technical i-Base Q&A on these results is also online. [3]

An extension of the PARTNER study is continuing to collect further data on risk for gay men. [4]

Simon Collins is a community representative on the steering committee of the PARTNER study.

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These results are simple to understand – zero transmissions from over 58,000 individual times that people had sex without condoms. They are also notable for the complexity of the analysis that was needed to prove that none of the new diagnoses were linked transmissions from within the couple.

Together, this provides the strongest estimate of actual risk of HIV transmission when an HIV positive person has undetectable viral load – and that this risk is effectively zero. While no study cannot exclude the possibility that the true risk might lie within the upper limit of the 95%CI, even if the true value is actually zero due to some as yet unproven mechanism, the 95%CI can never be zero, just becomes increasingly close. Neither the presence of STIs nor likely viral load blips between tests had any impact in enabling transmission.

The results provide a dataset to question whether transmission with an undetectable viral load is actually possible. They should help normalise HIV and challenge stigma and discrimination.

The results challenge criminalisation laws that in many countries, including the United States, continue to imprison hundreds of people based on assumptions of risk that these results disprove, even when condoms are used and viral load is undetectable.

Activist Sean Strub, from the SERO project (www.seroproject.com) said:

“Hundreds of people living with HIV in the US have been charged with criminal offences for the perceived or potential risk of HIV exposure or transmission. Some are serving or have served long prison sentences for spitting, scratching or biting and others for not being able to prove they had disclosed their HIV positive status before having sexual contact (even in the absence of any risk of HIV transmission). HIV criminalisation has created a viral underclass in the law, further burdening a disenfranchised community, putting a disproportionate share of the shared responsibility for preventing sexually-transmitted infections on one party, and discouraging people at risk from getting tested for HIV.”

The results will also positively impact on the quality of life for both HIV positive and HIV negative individuals who are in serodifferent relationships, irrespective of the choice to use condoms.

The ongoing PARTNER 2 study is continuing to follow-up gay couples and is still enrolling new couples to achieve a similar statistical power for anal sex compared to vaginal sex. For further details of sites please see the PARTNER2 website. [3]

Reference

Rodger AJ et al for the PARTNER study group. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA, 2016;316(2):1-11. DOI: 10.1001/jama.2016.5148. (12 July 2016). Full free access.
http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2016.5148
PARTNER study, supplementary material. JAMA (16 July 2016).
i-Base Q&A from the study.
http://i-base.info/qa-on-the-partner-study/
PARTNER2 website.
http://www.chip.dk/PARTNER-2

Canada: In Nova Scotia, glimmers of hope for science in the prosecution of HIV non-disclosure

Analysis by our HIV JUSTICE WORLDWIDE partner, the Canadian HIV/AIDS Legal Network.

Despite very few prosecutions, Nova Scotia has become an interesting place in Canada with respect to the criminalisation of HIV non-disclosure.

In April 2016, a trial judge from Antigonish ruled that non-disclosure before vaginal sex with a condom or a low viral load (< 1,500 copies/ml) did not amount to aggravated sexual assault.

Back in November 2013, a trial judge from Halifax acquitted a young man with an undetectable viral load who had not disclosed his HIV-positive status before sex without a condom.

These decisions represent significant developments in Canada, where the Supreme Court’s 2012 decision in R. v. Mabior opened the door to prosecutions even if a condom was used or the HIV-positive partner had a low or undetectable viral load.

Thanks to Nova Scotia judges, science might finally prevail.

In the recent Antigonish case, three medical experts testified, all aligning themselves with the Canadian consensus statement on HIV and its transmission in the context of the criminal law that was developed by eminent HIV experts in response to the 2012 Supreme Court decision.

They clearly testified that condoms are highly effective to prevent transmission (“protection is almost 100% when a condom is used,” said the Crown medical expert) and that being on treatment and having a low viral load dramatically reduce the chance of transmitting the virus.

Remarkably, they were also testimonies that the risk of HIV transmission in the absence of ejaculation is at most “negligible” and that HIV transmission from pre-ejaculate, if even possible, is not proven (there was no ejaculation with the first complainant and a reasonable doubt about ejaculation with the second complainant).

Based on the medical evidence before the Court, the trial judge concluded that the legal test of a “realistic possibility of HIV transmission” established in Mabior, which triggers the legal duty to disclose, had not been met. The accused was found not guilty of aggravated sexual assault.

Disappointingly, despite the absence of a “realistic possibility of HIV transmission,” the accused was nevertheless convicted of sexual assault causing bodily harm due to the psychological harm allegedly suffered by the complainants while waiting for their test results (neither of the complainants has contracted HIV).

Despite the progress made in acknowledging scientific evidence, this ultimate decision is highly problematic and arguably legally unfounded. It remains to be seen if the decision will be appealed.

The full decision can be downloaded from the Supreme Court of Novia Scotia’s website

Russia: Gay propaganda law especially impacting men with HIV who are being blackmailed for not disclosing their HIV status by anti-gay gangs

Russian crime gangs find gays easy targets for blackmail

By VERONIKA SILCHENKO and IRINA TITOVA

Originally published by the Associated Press on Jun. 5 2016

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In this Wednesday, May 25, 2016 photo, Alexander Loza, a legal adviser at Positive Dialogue, an organization that provides consulting services for gays, speaks to the Associated Press in St. Petersburg, Russia. Russian crime gangs find gays easy targets for blackmail. In the past two years, an increasing number of gays has fallen victim to criminal gangs operating through gay dating sites, rights groups say. (AP Photo/Dmitri Lovetsky)

“Many gay people in Russia lead a double life, unwilling to disclose their sexual orientation to their family or at work,” Loza said. “In the case of such setup dates, they are afraid to disclose their [HIV] status, to be accused of pedophilia, and therefore they are afraid to appeal to the police.”

ST. PETERSBURG, Russia (AP) — Criminal gangs in Russia, operating through gay dating sites, have found a lucrative new blackmail target: homosexual men.

A St. Petersburg economist, one of their latest victims, said several men burst into the apartment where he was meeting his date. Claiming that his date was under age, they threatened to call the police and to release a video they had secretly filmed unless he paid up.

The gay rights group Vykhod, or Coming Out, said they registered 12 such attacks in St. Petersburg in 2015 and at least six more gay men have come to them so far this year. LGBT activists believe the real number is far higher and say the attacks have increased in the past two years.

Since homosexuality finds little acceptance in Russian society, many gays keep their sexual orientation hidden from their families, friends and co-workers. This makes them easy extortion targets for criminals.

Vykhod spokeswoman Nika Yuryeva said most of the recent attacks have followed the same pattern as the one seen by the St. Petersburg economist.

Alexander Loza, a legal adviser at Positive Dialogue, an organization that provides consulting services for gays, particularly those living with the HIV virus, has heard similar stories.

“Many gay people in Russia lead a double life, unwilling to disclose their sexual orientation to their family or at work,” Loza said. “In the case of such setup dates, they are afraid to disclose their status, to be accused of pedophilia, and therefore they are afraid to appeal to the police.”

The activists said Russian criminals have been emboldened by a 2013 law that made it a crime to expose children to gay “propaganda,” part of a Kremlin-backed effort to defend traditional family values and counter the influence of what it considers a decadent West.

Alexander Zhelezkin, who manages outreach programs at Positive Dialogue, said the law was what made him decide to become a gay activist.

“Now, my coming out is my defense,” he said.

For prominent television journalist Anton Krasovsky, however, that move ended his career in Russia. He was fired after he came out on the air in 2013 and hasn’t been able to find a job in television since.

Krasovsky said it will be a long time before gays in Russia feel protected enough to speak publicly about their sexual orientation.

“To stop being afraid, they need to begin to trust the state where they live, but they don’t trust the state where they live now,” he said.

The St. Petersburg economist, however, did go to the police. He spoke to The Associated Press on condition of anonymity out of fear that his attackers, who know where he lives, would seek retribution if they learned that he had reported them.

The economist, who gave his age as “about 30,” said he thought they were lying about his date being a minor. But he said the attackers beat and threatened him — and suggested they had friends in the police force who they said would lock him up on fabricated charges.

He said they demanded more than 100,000 rubles ($1,500). One of them took his bank card and cleaned out his account, and they released him only after he agreed to transfer the balance the next day, he said.

The crime gangs who carry out such attacks are not necessarily anti-gay, but have identified a profitable niche where they feel they can operate with impunity, Loza and Yuryeva said.

The economist agreed.

“They commit these crimes not because they are homophobes — they are simply taking advantage of the situation,” knowing that few people would go to the police after such an experience, he said. “I think they are just common criminals who chose this kind of method.”

St. Petersburg police spokesman Vyacheslav Stepchenko said he had not heard about these blackmail cases and said he wasn’t aware of any anti-gay attacks being registered in the city in recent years.

He offered to check with the specific police station that the economist reported the crime to, but the economist didn’t want to draw public attention to his case by disclosing which station it was.

Timur Bulatov, an anti-gay activist who claims to have helped get a number of teachers fired after outing them as homosexuals, said he sees no need to resort to the blackmail used by criminal gangs.

“Why attack a sick person? Such a person needs treatment,” he said. “I have a bunch of legal methods to use to influence such a person, to put pressure on him.”

Bulatov, who wears camouflage outfits and carries a handgun in a hip holster, said gays are the “enemies” of Russian society and its children, but should be opposed only through legal means.

He said the law banning gay propaganda among minors was intentionally made vague so it can be applied in a wide range of circumstances. The law, for instance, has made it easy to target gay and lesbian teachers in Russia because they work directly with children.

The federal law was modeled on a 2012 St. Petersburg law authored by Vitaly Milonov, a city lawmaker and outspoken opponent of LGBT rights.

“This law is a preventive measure. It was introduced not to punish anyone, but to prevent such public actions as gay parades, because parents in Russia don’t want their children to see these things,” Milonov told the AP.

Milonov, who has a large portrait of the Russian Orthodox Church patriarch on his office wall, said his mission was to promote “normal” families with many children.

“There is no oppression of homosexual people in Russia,” he said. “When gay organizations complain of such harassment, they do it in order to get more money from soft-hearted Europeans.”

New report shows HIV criminalisation is a growing, global concern but advocates are fighting back

A new report released today shows that HIV criminalisation is a growing, global phenomenon. However, advocates around the world are working hard to ensure that the criminal law’s approach to people living with HIV fits with up-to-date science, as well as key legal and human rights principles.

Click on this link to read or download Advancing HIV Justice 2: Building momentum in global advocacy against HIV criminalisation.

What do we mean by ‘HIV criminalisation’?

HIV criminalisation describes the unjust application of the criminal law to people living with HIV based solely on their HIV status – either via HIV-specific criminal statutes, or by applying general criminal laws that allow for prosecution of unintentional HIV transmission, potential or perceived exposure to HIV where HIV was not transmitted, and/or non-disclosure of known HIV-positive status.

Such unjust application of the criminal law in relation to HIV is (i) not guided by the best available scientific and medical evidence relating to HIV, (ii) fails to uphold the principles of legal and judicial fairness (including key criminal law principles of legality, foreseeability, intent, causality, proportionality and proof), and (iii) infringes upon the human rights of those involved in criminal law cases.

What is the impact of HIV criminalisation?

Understanding the potential negative impact of HIV criminalisation on public health is critical to making informed policy decisions.

The last few years have seen increasing interest among researchers in the area of HIV criminalisation and a push into new areas of enquiry to examine the impacts of the unjust application of criminal law.

The report summarises a body of research which shows that instead of delivering a public health benefit, HIV criminalisation is a poor public health strategy, exacerbating racial and gender inequalities and negatively impacting a number of key areas including: testing; disclosure; sexual behaviour; and healthcare practice.

How many countries around the world have HIV criminalisation laws?

Since our last report, we found an increase in the number of countries that specifically allow for HIV criminalisation: these could be stand-alone HIV-specific criminal laws, part of omnibus HIV laws, or criminal and/or public health laws that specifically mention HIV.

Some of this increase is due to laws enacted since 2013 in Botswana, Cote d’lvoire, Nigeria, Uganda and Veracruz state (Mexico), and some is due to improved reporting and research methodology.

Our analysis shows that a total of 72 countries have adopted laws that specifically allow for HIV criminalisation, either because the law is HIV-specific, or because it names HIV as one (or more) of the diseases covered by the law. This total increases to 101 jurisdictions when the HIV criminalisation laws in 30 of the states that make up the United States are counted individually.

AHJ2-Where HIV criminalisation laws exist (as of April 2016)_6

How many countries have prosecuted people living with HIV?

Prosecutions for HIV non-disclosure, potential or perceived exposure and/or unintentional transmission have now been reported in 61 countries. This total increases to 105 jurisdictions when individual US states and Australian states / territories are counted separately.

Of the 61 countries, 26 applied HIV criminalisation laws, 32 applied general criminal or public health laws, and three (Australia, Denmark and United States) applied both HIV criminalisation and general laws.

AHJ2-Where HIV criminalisation laws exist (as of April 2016)_7

Where have prosecutions recently taken place?

We found reports of at least 313 arrests, prosecutions and/or convictions in 28 countries during the report period, covering 1 April 2013 to 30 September 2015.

Of note, we are now able to include data on reported prosecutions in Belarus and Russia, which are likely to have been taking place at least since the enactment of a Belarusian public health law in 1993 and a Russian HIV criminalisation law in 1995.

The highest number of cases during this period were reported in:

• Russia (at least 115) • United States (at least 104) • Belarus (at least 20) • Canada (at least 17) • France (at least 7) • United Kingdom (at least 6) • Italy (at least 6) • Australia (at least 5) • Germany (at least 5).

AHJ2-Where HIV criminalisation laws exist (as of April 2016)_8

HIV criminalisation in sub-Sarahan Africa of increasing concern

Where there was no HIV criminalisation at the start of the 21st century, 30 sub-Saharan African countries have now enacted overly broad and/or vague HIV-specific criminal statutes.

Most of these statutes are part of omnibus HIV-specific laws that also include protective provisions, such as those relating to non-discrimination in employment, health and housing. However, they also include a number of problematic provisions such as compulsory HIV testing and involuntary partner notification, as well as HIV criminalisation.

During the period covered by this report four countries in sub-Saharan Africa passed new HIV criminalisation laws: Botswana, Cote d’lvoire, Nigeria and Uganda.

Very few countries in Africa are now unaffected by problematic HIV criminalisation laws. The rise of reported prosecutions in Africa during this period (in Botswana, South Africa, Uganda, and especially Zimbabwe), along with the continuing, growing number of HIV criminalisation laws on this continent, is especially alarming.

AHJ2-Where HIV criminalisation laws exist (as of April 2016)_9

Where has advocacy improved legal environments?

Important and promising developments in case law, law reform and policy have taken place in many jurisdictions, most of which came about as a direct result of advocacy.

During the report period, although an additional 13 jurisdictions in nine countries proposed new HIV criminalisation laws, seven of these were not passed, primarily due to swift and effective advocacy against them at an early stage. Advocacy in another ten jurisdictions in seven countries challenged, improved or repealed HIV criminalisation laws.

The legal environment relating to HIV criminalisation has improved in a small number of countries in sub-Saharan Africa, most notably in Kenya. On 18 March 2015, Kenya’s High Court ruled that its HIV criminalisation provision – Section 24 of the HIV Prevention and Control Act 2006 – was unconstitutional because it was vague, overbroad and lacking in legal certainty, particularly in respect to the term ‘sexual contact’.

The Court also found it contravened Article 31 of the Kenyan Constitution which guarantees the right to privacy because the law created an obligation for people with HIV to disclose their status to their ‘sexual contacts’, with no corresponding obligation for recipients of such sensitive medical information to keep it confidential.

AHJ2-Where HIV criminalisation laws exist (as of April 2016)_10

Using science as an advocacy tool

Increased knowledge about reduced infectiousness due to antiretroviral therapy has led to advocacy that resulted in a number of jurisdictions revising or revisiting their criminal laws or prosecutorial policies relating to HIV criminalisation, although progress has been frustratingly slow.

Following the ‘Swiss statement’, published in January 2008, a growing number of courts, government ministries and prosecutorial authorities have accepted antiretroviral therapy’s impact on reducing the risk of both HIV exposure and transmission.

However, scientific advances alone will neither ‘end AIDS’ nor end HIV criminalisation. Although the impact of antiretroviral therapy on infectiousness is an important advocacy tool, it must be remembered that many people with HIV do not have access to treatment (or are unable to achieve an undetectable viral load when on treatment) and that everyone has a right to choose not to know their status and/or start treatment and should not be stigmatised nor considered ‘second class citizens’ should they wish to delay diagnosis or antiretroviral therapy.

More work required

Despite the many incremental successes of the past few years, much more work is required to strengthen advocacy capacity. This is why a coalition of seven organisations launched HIV Justice Worldwide in April 2016.

We also need to be aware that HIV criminalisation does not exist in vacuum, and is often linked to punitive laws and policies that impact sexual and reproductive health and rights, especially those aimed at sex workers and/or men who have sex with men and other sexual minorities.

And, bearing in mind the stigma faced by those with, for example, hepatitis C and concerns over the sexual transmission of the Ebola and Zika viruses, as we move forward to eliminate – or modernise – HIV criminalisation laws, we must ensure that our work does not inadvertently lead to the further criminalisation of other communicable and/or sexually transmitted infections.

Click on this link to read or download Advancing HIV Justice 2: Building momentum in global advocacy against HIV criminalisation.

A note about the limitations of the data

The data and case analyses in this report covers a 30-month period, 1 April 2013 to 30 September 2015. This begins where the original Advancing HIV Justice report – which covered the 18-month period, 1 September 2011 to 31 March 2013 – left off. Our data should be seen as an illustration of what may be a more widespread, but generally undocumented, use of the criminal law against people with HIV.

Australia: Southern Australia new legislation to soon enforce mandatory blood testing of offenders for spitting at, or biting police officers

MORE than 100 police officers are being spat at each year, exposing them to infectious diseases and raising the concerns of their union.

Police figures show 111 officers were spat at in 2013 and that total has remained steady each year since, although they refused to release new figures.

South Australian Police Association president Mark Carroll said he hoped new legislation, which is expected to soon become law, enforcing mandatory blood testing of offenders who assault police would protect his members.

“When, in the course of duty, officers are spat on, bitten or otherwise assaulted in a way involving an exchange of bodily fluids, it’s essential that these officers have access to blood samples from the assailant that can be tested,” he said.

The comments come after the sentencing of Brandon William Peter Humes who spat on an officer during an arrest him and told him ‘I don’t give a f — k … I have HIV AIDS and now you’ve got it too’.

In sentencing Humes, 27, this month District Court Judge Rauf Soulio said the officer had to restrain Humes which left him unable to immediately “decontaminate himself”.

“Your comments about HIV caused him great distress,” Judge Soulio said.

“He felt unable to hold his infant daughter, who was born prematurely, for fear of passing on a communicable disease.

“He had to deal with the fear of waiting for blood results, which were, fortunately, negative.”

Humes was sentenced to four years and six months jail with a non-parole period of two years for armed robbery and the spitting offence in June last year.

Also, Senior Sergeant Alison Coad contracted oral herpes after being spat on by a criminal.

SAPOL would not comment on the medical history of officers but said “this type of incident (spitting) is always of concern.”

“This type of behaviour is totally inappropriate and can result in offenders facing very serious charges,” a spokeswoman said.

The WA Police Union has recently requested officers be equipped with spit hoods because of a spike in incidents there.

Orginally published in The Advertiser

US: Study published in the Journal Medicine finds a level of bias due to assumptions about the criminal intent of HIV-positive people and outdated laws

A recent study examining current HIV criminalization laws found a level of bias due to assumptions about the criminal intent and violent nature of HIV-positive people, according to a study published in the journal Medicine.

Currently, states can hold a person liable if they know they are HIV-positive and commit a sex crime that has the possibility of transmission. An HIV-positive person can also face criminal charges if they demonstrate intent to transmit the virus, whether or not transmission actually occurred. HIV criminalization laws were created during the era prior to antiretroviral therapy when the risk for transmission was extremely high. Although HIV treatment and prevention has advanced, these laws have not evolved, the study found. However, the Department of Justice recommended that states modernize laws to reflect the low risk of HIV transmission from biting, spitting, throwing body fluids, insertive/receptive oral intercourse, and antiretroviral therapy.

The current study examined data from males aged 20 to 49-years-old from 1999 to 2012. The researchers sought to determine whether a national state-specific survey overstates estimates of HIV is due to the exclusion of inmates and whether or not HIV-positive inmates are more violent than HIV-negative inmates, thus creating bias. Researchers gathered data from the National Health and Nutrition Examination Survey (NHANES). The data gathered by the surveys included demographic, dietary, and health-related markers of a representative sample of 5000 per year. Data was also collected from the Survey of Inmates in State, Federal, and Local custody from 1997 to 2004. Data from the Survey of Inmates in Local Jails was collected in 1996 and 2002. In both surveys, inmates were asked whether or not they had been tested for HIV and what the results of the test were.

Researchers found approximately 65% of the inmates were non-Hispanic Whites. The data from NHANES showed non-Hispanic Whites declined almost 5% over the period of time, while the non-Hispanic Other group doubled. In 1999, about 41.4% of inmates had a high school diploma, which increased to about 55.7% by 2012. Researchers said this could be due to the fact that inmates with a high school diploma decreased from 47.4% in 1999 to 35.4% in 2012. Highly advantaged respondents increased their responsiveness for NHANES, with about 62.1% of respondents having some college education in 2012. Researchers state that the shift in educational distribution between the 2 surveys could be indicative of HIV prevalence being concealed and distorted when institutions concentrate on disadvantage and do not include inmates in the samples. Inmates with HIV increased to 3.3% in 2012, while lab work by NHANES showed that HIV prevalence went down to .42% in 2012. In 1999, 14.5% of HIV-positive inmates were incarcerated for violent crimes and 22.1% of non-HIV infected were incarcerated for those crimes. In 2012, HIV-positive inmates incarcerated for violent crimes was 8.1% lower than the overall population. Researchers said that HIV-positive inmates were more likely to be incarcerated for drug and property crimes.

The data indicated that HIV-positive inmates are much less violent than HIV-negative inmates. Due to poverty and low levels of education, inmates are typically excluded in national-based surveys. Researchers said a bias is present due to this exclusion, which indicates a need for a reexamination of HIV prevalence rates.

Researchers said that HIV criminalization laws are very presumptuous about HIV-positive people due to the laws being created over 30 years ago when there was quite a bit of fear and mystery surrounding the disease. To make these surveys more representative, the study concluded social scientists and legislators need to reassess the evidence that claims HIV-positive individuals are dangerous and have harmful intentions.

Originally published in Specialty Pharmacy Times

Study abstract available here

France: National Aids Council President, Patrick Yeni, on why HIV criminalisation remains a problem for France

A year ago, in April 2015, the French National AIDS and Viral Hepatitis Council (Conseil national du sida et des hépatites virales, known simply as ‘CNS’) following extensive research into the law, nature of complaints and prosecutions, and their impact, issued a report, opinion and recommendations.

An English language version of the report, opinion and subsequent recommendations is still being prepared.

Earlier this year, Professor Patrick Yeni (pictured), chair of the CNS, was interviewed by Jean-François Laforgerie on the French language HIV website, seronet.info. His interview is eye-opening and powerful.

It highlights that although they had only found 23 convictions up to the end of 2014, surveys of people living with HIV suggest that up to 2000 complaints may have been made since the start of the epidemic.

The survey shows that slightly more than one person living with HIV in ten claims to have been tempted to complain against the person that they believed to be the source of infection. According to the same source, 1.4% of people living with HIV surveyed reported having actually complained. Based on these figures, we estimate an order of magnitude from 1 500 to 2 000 complaints that could be filed in total since the beginning of the epidemic.

He also notes that the law currently only recognises condom use as a way to show lack of a guilty mind, and he and his colleagues are concerned that up-to-date science is not reflected in the law. He also highlights that in France disclosure of known HIV-positive status – and subsequent consent to ‘risky’ sex – is not actually a defence, although in practice only cases where no disclosure took place and where no condoms were used have reached the court.

It seems unthinkable that what is obvious in terms of public health today on the promotion of biomedical preventions is lagging behind legally.

Given the importance of this body of work, we have decided to publish the interview and a summary of the main CNS recommendations beneath it, despite no official English translation.

It is interesting that the people who complain and go to trial are not part of the so-called risk groups where prevalence is high. For example, there is virtually no migrants among the complainants. Moreover, today there is a much greater legalisation of intimacy, including sexual facts than existed in the past. Perhaps this plays on the fact that people complain more now than twenty years ago.

Below is the English translation of the seronet.info interview, further improved from Google translate’s version by Sylvie Beaumont. Version anglaise via Google translate. Le texte français est après la traduction.

Q: In 2006, the National AIDS and viral hepatitis Council (CNS) published their review of the criminalisation of HIV transmission. What led you to work again on this issue and publish, in 2015, a second opinion?

Patrick Yeni [PY]: The media coverage of some trials in France and, secondly, the situation internationally. In other countries, there was an active debate on the criminalisation of HIV transmission, while in France this reflection seemed stalled. These are the two reasons that led us to revisit this issue, trying to understand and think about how things had changed since our first review.

Q: In your 2015 recommendations, you noted that the attention paid to legal, ethical and health issues relating to criminalisation of HIV transmission was low, both on the part of public authorities and civil society actors. How do you explain that?

PY: We have no clear answer to that. This is also why we wanted to restart the debate. If one takes the point of view of government and we take stock of court cases – 23 convictions for HIV transmission since the beginning of the epidemic throughout France – one can imagine that for the state this is not a national major problem at the criminal level, at least quantitatively. I guess the debate on criminal justice focuses primarily on other issues. For HIV organisations, it is probably more complicated because legal proceedings – as we attempt to analyse them in the recommendations – somewhat undermined the historical foundations on which the fight against HIV is based. By that I mean solidarity between people living with HIV and the refusal to distinguish between “patients as victims” allegedly infected and others who simply became infected. I imagine that this problem could have induced some inertia in advancing the debate. One recommendation from the CNS is to urge organisations to resume this discussion today, because it is a lever to act on issues of stigma, discrimination … and HIV prevention in general.

Q: What is prosecuted today? And what is a crime under the law?

PY: Primarily the fact that a person who knows s/he is HIV-positive, transmits HIV to a partner while s/he has not taken preventive measures to prevent this, i.e used a condom. In almost all trials in France, this is what has been prosecuted. We have had discussions on other issues as lawyers who supported us explained that the scope of what could be prosecuted or what could be an offence is probably wider than what is actually applied today.

Q: What are you referring to?

PY: One must think on several levels. The first criterion is that they are people who know they are HIV-positive. But it’s more complicated. Thus, from a legal point of view, we cannot know that a person, while not knowing officially that they are HIV-positive would consider themselves to be negative while they are engaged in repeated risky sexual behaviour. Justice may consider that even if they did not know their status officially, their sexual behaviour should have pushed them to consider themselves as potentially HIV-positive, and therefore to do a test and take preventive measures. In this case, the absence of screening does not guarantee the absence of criminal risk. The second criterion is that there must be proof that the person has transmitted HIV. Our analysis of judgments shows that exposing someone to HIV transmission, even without actual transmission can also be penalised. There have been convictions in France for exposure to the risk of transmission. This has occurred in the case of additional convictions to convictions for actual transmission, but it exists.

Q: So you think we could one day have a conviction on the sole ground of the risk of exposure to HIV transmission?

PY: Yes. The legal elements are there. That is, according to our analysis, another possibility of expanding the criminal field. The third criterion is that the ‘victim’ is not aware of the HIV status of their partner. In criminal law, whether or not the victim is informed does not exempt the defendant from liability. One cannot argue that the partner was informed and has agreed not to protect themselves and therefore would not be responsible. The information is not enough.

Fourth criterion. In all cases today, sexual prevention is understood as the use of condoms. It is the condom which is retained as the manifestation of concerns relating to the risk of transmission. We do not know what will happen when there will be proceedings for transmission or exposure by people who do not use condoms, but are treated effectively. Some lawyers have told us that if there was transmission despite condom use, it would be a case of force majeure which is exculpatory of responsibility. We can not guarantee the same thing about treatment. In other words, even with a good track treatment, a viral load of less than 20 copies, one cannot guarantee that there is not occasionally a little HIV in semen … and therefore transmission is possible even if treatment is adhered to, and viral load is undetectable … other lawyers tell us that we are, in this case, in a random situation, which does not exempt the person with HIV from responsibility. We must think about this. It seems unthinkable that what is obvious in terms of public health today on the promotion of biomedical preventions is lagging behind legally. This is a warning that we mention in the recommendation. But unfortunately we fear that this debate will only take place when a case of transmission from someone on effective treatment will come to court.

Q: How do you explain that the role of treatment as prevention is recognised in Switzerland with all the legal consequences that this entails, and yet the same argument does not hold legally with us?

PY: We wanted to alert on this point precisely so the conclusions of judges, when they have to decide, are identical to the public health conclusions we know today. We must not get to this contradiction where a person who is effectively treated is found guilty because s/he would not use a condom. With these examples, we can see the narrow scope of what is actually prosecuted and that it is imperative to have a debate on the possible expansion of what is a crime.

Q: The argument is often made that further criminalisation would deter people from testing?

PY: The review analysed the consequences of the criminalisation of HIV transmission on testing. All the studies to which we had access, mainly foreign, do not indicate that criminal risk linked to knowing one’s status would lead to decreased use of testing.

Q: You note the paradox that legal proceedings have developed in a context of “normalisation” of the disease. In other words, cases flourished in the 2000s, after the most acute phase of the epidemic. How do you explain it?

PY: We had discussions about it. Some of us were reluctant to say that there was an increase in the number of cases. One thing is certain, we are on a low figure: 23 convictions. Especially if we compare the data of the ANRS-Vespa 2 survey. The survey shows that slightly more than one person living with HIV in ten claims to have been tempted to complain against the person that they believed to be the source of infection. According to the same source, 1.4% of people living with HIV surveyed reported having actually complained. Based on these figures, we estimate an order of magnitude from 1,500 to 2,000 complaints that could be filed in total since the beginning of the epidemic. We do not know why some complaints were accepted and others not, why some were eventually classified and others have prospered. We have, unfortunately, no way to evaluate it. We just know that few cases reach a conviction.

To respond more specifically, one must take into account the fact that there is a significant delay, sometimes ten years from the time a complaint is filed to the time when an appeal judgment is pronounced. It might be possible to say that today there is an increase in the number of procedures, but it is not certain. We must be careful about this point. If this is true, how can we explain it? One hypothesis is that in the early days of the epidemic, when many people died of AIDS, a complaint against a person who was likely to die did not make much sense. Today the situation is different. For people, this may appear more “logical” to do so. We advance this hypothesis, but we don’t have the figures to confirm it. One can also look at who is complaining. It is interesting that the people who complain and go to trial are not part of the so-called risk groups where prevalence is high. For example, there is virtually no migrants among the complainants. Moreover, today there is a much greater legalisation of intimacy, including sexual facts than existed in the past. Perhaps this plays on the fact that people complain more now than twenty years ago.

Q: What goals did you set by publishing this new advice?

PY: Firstly: to inform people living with HIV about the conditions under which their criminal responsibility may be engaged. Our thinking has focused on being able to contribute to a fair justice. How? By raising awareness of the investigators in this matter through the National Schools of Police and Gendarmerie. By working with judges and lawyers. It is not possible for judges to have the technical knowledge about different diseases, we admit. Similarly, we can not consider today that under the pretext that people no longer die of AIDS, HIV is commonplace. This is not possible even today because there is a context of social representations that make it a special disease. However, the situation is not the same today, in particular medical progress has taken place. It is very important that judges and lawyers are aware of this. We propose that the National School of Magistrates opens this debate in its initial training as well as in continuing education. We asked the school director to include a discussion on HIV in its knowledge training. A problem that does not concern judges, is that of upgrading one’s knowledge to contribute to a fair trial. One of our wishes is also to allow a reflection on the position of criminal justice. Prison sentences predominate in cases of HIV transmission and issues of rehabilitation and prevention of relapses are not taken into account, even though the court must ensure both aspects in its approach.

Q: Specifically what do you recommend?

PY: For the Department of Justice to develop a form of observatory monitoring of judgments, to document the characteristics of procedures. The tool does not exist and we had to carry out considerable work to realise our new advice and to find all cases that resulted in convictions. We must create an interdepartmental committee to work on the development and provision of information tools tailored to professional (police, lawyers, judges) and other persons concerned, so that the procedures take account of available scientific and medical data, and for doctors to be better informed about the criminal risk of HIV transmission. It’s lobbying work which we pursue, including with HIV organisations. They must reclaim this question on which they were at a standby. We must recognise that the right to resort to justice is a right for all citizens, that our struggle is not against criminal law, but rather to ensure a fair process and prevent risks of criminalisation.

Summary of the CNS’s 2015 recommendations on HIV criminalisation

No.	Objectives	Recommendations	Competent authorities and/or recommendation targets
1	Contribute to better information of judges	Promote initial and continuing education of magistrates and future magistrates on HIV related issues	French National School for the Judiciary (école nationale de la magistrature)
2	Bolster the quality of police investigations	Promote training actions of police officers and future officers on HIV related issues	Ministry of the Interior
3	Prevent reoffending, enable the integration and reintegration of convicted people and improve their support	Apply alternatives to custodial sentences	Ministry of Justice
4	Promote the prevention of the prosecution risk	Contribute to a better understanding of legal issues by the people and communities concerned	HIV/AIDS associations
		Support actions aiming to provide information on the legal rights and responsibilities of people living with HIV.	Ministry of HealthFrench National Institute for Health Prevention and Education (INPES)
		Promote actions to fight PLHIV stigmatisation and discrimination and prevention actions towards the general population	Ministry of Health, Regional Health Agencies (ARS), French National Institute for Health Prevention and Education (INPES)Other competent ministriesHIV/AIDS associations
5	Provide access to up-to-date and high-quality legal and scientific information	Implement a reporting tool to follow-up the rulings issued in France and to document the characteristics of the related proceedings	Ministry of Justice
5		Initiate the creation of a working group in charge of designing and provisioning of information tools suitable for professionals and people involved	Health/Justice Interministerial Committee

Article original

PÉNALISATION DE LA TRANSMISSION DU VIH : GARANTIR UNE PROCÉDURE ÉQUITABLE

Où en est-on aujourd’hui en France sur la pénalisation de la transmission de VIH ? Le professeur Patrick Yéni, président du Conseil national du sida (CNS) fait le point. Interview.

In 2006, le Conseil national du sida et des hépatites virales (CNS) avait publié un premier avis sur la pénalisation de la transmission du VIH. Qu’est-ce qui vous a conduit à travailler de nouveau sur ce sujet et à publier, en 2015, un second avis ?

Patrick Yeni : Il y a la médiatisation de certains procès en France et, d’autre part, le constat sur le plan international, dans d’autres pays concernés, qu’il y avait une réflexion active sur la pénalisation de la transmission de l’infection par le VIH alors qu’en France cette réflexion semblait marquer le pas. Ce sont ces deux raisons qui nous ont conduits à retravailler sur cette question, en essayant de comprendre et de réfléchir à la façon dont les choses avaient évolué, depuis notre premier avis.

Dans l’avis de 2015, vous jugez que l’attention apportée aux enjeux juridiques, éthiques et sanitaires de la pénalisation de la transmission est faible, tant de la part des pouvoirs publics que des acteurs associatifs. Comment l’expliquez-vous ?

Nous n’avons pas de réponse claire à cela. C’est aussi pour cela que nous avons voulu reprendre cette réflexion. Si l’on se place du point de vue des pouvoirs publics et que l’on fait le bilan des affaires judiciaires — soit 23 condamnations pour transmission du VIH depuis le début de l’épidémie pour toute la France —, on peut imaginer que pour l’Etat il ne s’agit pas là d’un problème majeur national au niveau pénal, du moins sur le plan quantitatif. J’imagine que la réflexion sur la justice pénale porte prioritairement sur d’autres questions. Pour les associations de lutte contre le sida, c’est probablement plus compliqué parce que les procédures judiciaires — comme nous essayons de l’analyser dans l’avis — mettent quelque peu à mal les fondements historiques de la lutte contre le VIH. Je citerai la solidarité entre les personnes atteintes et le refus de distinguer entre des “malades victimes” qui auraient été contaminés et d’autres qui se seraient infectés. J’imagine que cette difficulté a pu introduire de l’inertie dans la progression de la réflexion. C’est justement une recommandation du CNS que d’exhorter les associations à reprendre aujourd’hui cette réflexion, parce qu’elle constitue un bras de levier pour agir sur les stigmatisations, les discriminations… et la prévention en général.

Qu’est-ce qui est condamné aujourd’hui ? Et qu’est-ce qui est condamnable sur le plan pénal ?

C’est avant tout le fait pour une personne qui se sait séropositive d’avoir transmis le VIH à un ou une partenaire alors qu’elle n’avait pas pris de mesure de prévention pour prévenir cette transmission, en l’occurrence l’utilisation de préservatif. Dans la quasi-totalité des procès en France, c’est cela qui est condamné. Nous avons eu des réflexions sur d’autres points car les juristes qui nous ont accompagnés ont expliqué que le champ de ce qui est condamnable, de ce qui pourrait représenter un délit, est sans doute plus large que celui qui est effectivement appliqué aujourd’hui.

A quoi faites-vous référence ?

Il faut raisonner sur plusieurs niveaux. Le premier critère retenu est que ce sont des personnes qui se savent séropositives. Mais c’est plus compliqué. Ainsi, d’un point de vue juridique, on ne peut assurer qu’une personne bien que ne se sachant pas formellement séropositive puisse se considérer comme séronégative alors qu’elle est engagée dans des comportements sexuels à risques, répétés. La justice peut considérer que même si elle ne sait pas de façon formelle quel est son statut, son comportement sexuel aurait du l’inciter à se considérer comme potentiellement séropositive, donc à se tester et à mettre en œuvre des moyens de prévention. Dans ce cas, l’absence de dépistage ne garantit pas l’absence de risque pénal. Le deuxième critère est qu’il faut la preuve que la personne ait transmis le VIH. Notre analyse des jugements montre que le fait d’exposer à la transmission du VIH, même sans transmission effective, peut également être pénalisé. Il y a eu des condamnations en France pour exposition au risque de transmission. Cela s’est produit dans des cas de condamnations additionnelles à des condamnations pour transmission effective, mais cela existe.

Vous estimez donc qu’on pourrait se trouver un jour avec une condamnation au seul motif du risque d’exposition à la transmission du VIH ?

Oui. Les éléments juridiques sont là. C’est, selon notre analyse, une autre possibilité d’élargissement du champ pénal. Le troisième critère est le fait que la victime ne soit pas informée de la séropositivité du ou de la partenaire. En droit pénal, le fait que la victime soit informée ou pas n’exonère pas le prévenu de sa responsabilité. On ne peut pas arguer que le partenaire était informé et qu’il a accepté de ne pas se protéger et donc qu’on ne serait pas responsable. L’information ne suffit pas.

Quatrième critère. Dans toutes les affaires aujourd’hui, la prévention des rapports sexuels est comprise comme l’usage du préservatif. C’est le préservatif qui est retenu comme la manifestation de la préoccupation face au risque de transmission. Nous ne savons pas ce qui se passera lorsqu’il y aura des procédures engagées pour transmission ou exposition concernant des personnes qui n’utilisent pas de préservatifs, mais qui sont traitées efficacement. Certains juristes nous ont expliqué que s’il y avait transmission malgré l’usage du préservatif, il s’agirait d’un cas de force majeure qui est exonératoire de la responsabilité. On ne peut pas garantir la même chose concernant le traitement. Autrement dit, avec un traitement bien suivi, une charge virale dans le sang inférieure à 20 copies, on ne peut pas garantir qu’il n’y ait pas de temps en temps un peu de VIH dans le sperme… et donc qu’une transmission soit possible même si le traitement est bien suivi, la charge virale indétectable… D’autres juristes nous disent que nous sommes, dans ce cas-là, dans une situation d’aléa, qui, elle, n’est pas exonératoire de la responsabilité. Nous devons réfléchir à cela. Il paraîtrait impensable que ce qui est une évidence en termes de santé publique aujourd’hui sur la promotion des préventions biomédicales, soit en décalage sur le plan juridique. C’est un motif d’alerte que nous mentionnons dans l’avis. Mais il est à craindre malheureusement que cette réflexion n’ait lieu que le jour où un cas de transmission concernant une personne sous traitement efficace vienne au tribunal.

Comment expliquer que le rôle du Tasp dans la protection du rapport soit reconnu en Suisse avec toutes les conséquences juridiques que cela implique et que ce même argument ne tienne pas juridiquement chez nous ?

Nous avons souhaité alerter sur ce point afin que justement les conclusions de la justice, lorsqu’elle aura à se prononcer, soient identiques aux conclusions de santé publique que nous connaissons aujourd’hui. Nous ne devons pas arriver à cette contradiction qu’une personne qui se traiterait efficacement soit condamnée parce qu’elle n’utiliserait pas le préservatif. Avec ces exemples, on voit bien l’espace assez restreint de ce qui est effectivement condamné aujourd’hui et le fait qu’il faut absolument avoir une réflexion sur le possible élargissement de ce qui est condamnable.

L’argument est souvent avancé qu’un engagement plus avant dans la pénalisation dissuaderait les personnes de faire le dépistage ?

L’avis a analysé les conséquences de la pénalisation de la transmission en matière de recours au dépistage. Toutes les études auxquelles nous avons eu accès, essentiellement étrangères, n’indiquent pas que le risque pénal lié à la connaissance de son statut sérologique conduirait à une diminution du recours au dépistage.

Vous notez le paradoxe que les recours en justice se sont développés dans un contexte de “normalisation” de la maladie. Autrement dit, les affaires ont prospéré dans les années 2000, postérieurement à la phase la plus aigüe de l’épidémie. Comment l’expliquez-vous ?

Nous avons eu des discussions à ce sujet. Certains d’entre nous étaient réticents à affirmer qu’il y avait une augmentation du nombre de cas. Une chose est sûre, nous sommes sur un chiffre bas : 23 condamnations. D’autant plus si on le rapporte aux données de l’enquête ANRS-Vespa 2. L’enquête montre qu’un peu plus d’une personne vivant avec le VIH sur dix déclare avoir été tentée de porter plainte contre la personne qu’elle estimait être à l’origine de sa contamination. Selon la même source, 1,4 % des personnes vivant avec le VIH interrogées déclaraient avoir effectivement porté plainte. Sur la base de ces chiffres, nous avons estimé un ordre de grandeur de 1 500 à 2 000 plaintes qui auraient pu être déposées au total depuis le début de l’épidémie. Nous ne savons pas pourquoi certaines plaintes ont été acceptées et d’autres pas, pourquoi certaines ont finalement été classées et d’autres ont prospéré. Nous n’avons, hélas, aucun moyen d’évaluer cela. Nous savons juste que peu d’affaires arrivent à une condamnation.

Pour répondre plus précisément, il faut prendre en compte le fait qu’il y a un délai important, parfois dix ans, entre le moment où une plainte est déposée et celui où un jugement en appel est prononcé. Dire qu’aujourd’hui nous sommes sur une augmentation du nombre de procédures, c’est possible, mais pas certain. Nous devons être prudents sur ce point. Si c’est vrai, comment l’expliquer ? Une des hypothèses, c’est qu’aux premiers temps de l’épidémie, lorsque beaucoup de monde décédait du sida, porter plainte contre une personne qui allait sans doute mourir n’avait pas grand sens. Aujourd’hui, la situation est différente. Pour des personnes, cela peut apparaître plus “logique” de le faire. Nous avançons cette hypothèse, mais aucun chiffre ne permet de la confirmer. On peut aussi regarder quels sont ceux qui portent plainte. C’est intéressant de voir que les personnes qui portent plainte et arrivent au procès ne font pas partie des groupes dits à risques où la prévalence est très forte. Par exemple, il n’y a quasiment pas de personnes migrantes parmi les plaignants. Par ailleurs, il existe aujourd’hui une judiciarisation bien plus importante de l’intime, notamment des faits sexuels, qu’elle n’existait dans le passé. Peut-être cela joue-t-il dans le fait de porter plainte plus aujourd’hui qu’il y a vingt ans.

Quels objectifs vous êtes-vous fixés en publiant ce nouvel avis ?

Tout d’abord : informer les personnes vivant avec le VIH sur les conditions dans lesquelles leur responsabilité pénale peut être engagée. Notre réflexion a surtout porté sur le fait de pouvoir contribuer à une justice équitable. Par quels moyens ? Par une sensibilisation des enquêteurs à cette question par les écoles nationales de police et de gendarmerie. Par un travail auprès des magistrats et des avocats. Il n’est pas possible que les juges aient des connaissances techniques sur les différentes maladies, nous l’admettons. De la même façon, on ne peut pas considérer aujourd’hui, au prétexte qu’on ne meure plus du sida, que l’infection par le VIH est banale. Ce n’est pas possible parce qu’il existe un contexte de représentations sociales qui en font une maladie particulière. Pour autant, la situation n’est plus la même aujourd’hui, des progrès notamment médicaux ont eu lieu. C’est très important que les magistrats et les avocats aient connaissance de cela. Nous proposons que l’Ecole nationale de la magistrature ouvre cette réflexion dans sa formation initiale, comme dans sa formation continue. Nous avons sollicité le directeur de cette école pour lui demander d’inclure une réflexion autour du VIH dans la formation des connaissances. Un problème, qui ne concerne pas que les juges, est celui de la mise à niveau des connaissances pour contribuer à une justice équitable. Un de nos souhaits est aussi de permettre de réfléchir à la position de la justice pénale. Les peines de prison ferme prédominent dans les affaires de transmission du VIH et les questions de réinsertion et de prévention de la récidive ne sont pas du tout prises en compte, alors même que la justice doit veiller à ces deux aspects dans sa démarche.

Concrètement que préconisez-vous ?

Pour le ministère de la Justice, de se doter d’une forme d’observatoire de suivi des jugements rendus, de documenter les caractéristiques des procédures. L’outil n’existe pas et nous avons dû effectuer un travail considérable pour réaliser notre nouvel avis et retrouver tous les cas ayant abouti à des condamnations. Il faut créer un comité interministériel pour qu’il travaille à la création et la mise à disposition d’outils d’information adaptés aux professionnels (policiers, avocats, magistrats) et aux personnes concernées, pour que les procédures tiennent compte des données scientifiques et médicales disponibles, pour que les médecins soient mieux informés sur le risque pénal de la transmission du VIH. C’est du travail de lobbying que nous menons, y compris auprès des associations de lutte contre le sida. Elles doivent se réapproprier cette question, sur laquelle elles étaient un peu en situation de veille. Nous devons admettre que le droit au recours à la justice est un droit des citoyens, que notre combat n’est pas contre la justice pénale, mais plutôt pour garantir une procédure équitable et prévenir le risque pénal.

Propos recueillis par Jean-François Laforgerie.

Australia: Analysis of the limitations of scientific evidence to prove timing and direction of alleged HIV transmission in three criminal trials

This article by Paul Kidd in the March 2016 issue of HIV Australia examines the use of HIV phylogenetic analysis in three Australian criminal trials. It argues that courts in Australia appear to accept forensic evidence uncritically. As the forensic methodology used in phylogenetic analysis is inherently limited, it argues there is risk of miscarriage of justice where this type of evidence forms a substantial part of the prosecution case.

Read the full article at: https://www.afao.org.au/library/hiv-australia/volume-14/vol-14-no-1/phylogenetic-analysis-as-expert-evidence-in-hiv-transmission-prosecutions