News from other sources
Canada: Alexander McClelland reports on the 8th Symposium on HIV, Law and Human Rights
Source – Positive Living Society of British Columbia
Author: Alexander McClelland
Working to end the criminalization of HIV in Canada
On June 14, I travelled to Toronto to meet with leading activists, researchers and experts working to end the criminalization of HIV in Canada for the 8th Symposium on HIV, Law and Human Rights. Organized by the Canadian HIV/AIDS Legal Network, the annual forum for the past few years has focused solely on advocacy to end Canada’s position as a global leader in the criminalization of people living with HIV for alleged non-disclosure, exposure and transmission.
At a time when HIV has lost traction on both the political and public radar, years of dedicated advocacy to reform HIV criminalization have commanded political will to address change on this issue. This year, I felt the impact of our advocacy and the increased political will in the presence of Canada’s Minister of Justice and Attorney General the Hon. David Lametti and in the remarks that he made. Mr. Lametti opened the day with a promise to continue the process, initiated by his predecessor Jody Wilson-Raybould in 2016, to reform the “over-criminalization” of HIV. He acknowledged that the recent federal directive (which is only applicable to the territories) was not enough, further committing to engage with provinces to motivate similar directives in the provinces to address ongoing criminalization.
During the Q and A, he was pressed on the Ontario government’s recent cuts to legal aid, which will have a devastating impact on people’s right to access justice, including people living with HIV who are criminalized. Lametti promised to work to support legal aid services and also told the media afterwards that, if re-elected, he would continue reform efforts, even making HIV criminalization an election issue.
The real-life impact of criminalizing HIV non-disclosure
Following Mr. Lametti came the panel on the lived experiences of people who have been criminalized. Here, I presented outcomes from my doctoral research, where I interviewed people across Canada who had been charged or prosecuted with aggravated sexual assault due to alleged HIV non-disclosure. Many of these individuals are now registered as sex offenders. Research was also presented from the Women, ART and the Criminalization of HIV (WATCH HIV) study, revealing how women with HIV live in fear, under constant surveillance due to HIV criminalization.
During this panel session of lived experiences came the most powerful moment of the day: Michelle W., a member of the Canadian Coalition to Reform HIV Criminalization and survivor of HIV criminalization, spoke of her experiences as an Indigenous woman, surviving years of sexual abuse at the hands of men, and of her life as a former sex worker and drug user in Vancouver’s Downtown East Side. She is now a registered sex offender, having served an over two-year sentence on charges of aggravated sexual assault for alleged HIV non-disclosure. The charge came about after she fled her abusive ex-boyfriend, who then went to the police out of revenge. Michelle brought the room to tears, garnering a standing ovation. Her experiences outline the vital importance of centring our advocacy efforts on lived experiences, and the need for an intersectional analysis of the issue of HIV criminalization to hold the legal system accountable for the devastating impact it has had on women, particularly Indigenous women.
Canada “one of the worst in the world”
A particularly eye-opening moment during the day was when Edwin Bernard, global coordinator for the HIV Justice Network, presented an overview of the global environment of HIV criminalization. He mentioned his own fears of the distinctively harsh context in this country, noting that as someone living with HIV, he feels scared when visiting from the United Kingdom that he could become subject of our harsh laws. He further stated, “Canada’s criminalization context for people living with HIV remains one of the worst in the world.” But he also said that activism here is mobilizing for change in inspiring and pioneering ways.
To address next steps for changing our global distinction and the ongoing harms of the criminal law, further sessions focused on how to achieve legislative reform, as well as the consequences of changing the current legal approach. This included discussions of removing the laws of sexual assault from being applied to cases of HIV non-disclosure, meaning that the sex offender registry would no longer be a mandatory outcome of prosecutions.
Next steps and potential pitfalls
Discussions also focused on the double-edged sword of mobilizing science for legal reform. Science has so far helped to inform reform efforts, such as the recommendation that criminal laws no longer be applied to people who have an undetectable viral load. However, this has the potential to turn viral suppression into a dividing line for criminalization, opening the door to further marginalize and criminalize people without (or with limited) access to medication coverage, such as migrants and homeless people.
A further complication with reform efforts is that a shift away from criminal laws may mean a greater reliance on public health authorities, who are also known to apply coercive and stigmatizing practices. This might mean intensified forms of surveillance of people living with HIV, such as mandatory viral load reporting, and the increased use of public health legislation to mandate treatment.
The week after we met, the House of Commons Standing Committee on Justice and Human Rights released their report on the criminalization of HIV non-disclosure. The report included a major positive recommendation, to remove HIV non-disclosure from the laws of sexual assault ̶ This development was many years in the making. However, the report also asks for a new law to be developed, one that would apply to all communicable diseases. There’s still more work to do.
Strategizing collectively has been a success of the movement to reform HIV criminalization in Canada, one of the inspiring things about Canada’s response that Bernard noted in this presentation. In the end, this symposium helped to continue to strengthen and galvanize our work to change Canada’s heinous distinction as a global leader in criminalizing our community.
[Update]Singapore: HIV disclosure is not enough, prospective partners must also be informed of risks and give their consent
Disclosing HIV status not enough, rules High Court
Source: Straits Times
Article Date: 02 Jul 2019
Prospective sexual partners must also be told of risks involved and give their consent.
HIV-positive offenders are duty-bound to inform prospective sexual partners of the infection risk and not just disclose their HIV status, ruled a High Court judge.
The court, in dismissing an appeal by an HIV-positive Singaporean convicted of not informing a victim, also set a new sentencing framework to deal with such first-time offenders who may face jail terms of up to 10 years if their victims get infected.
“Disclosing one’s HIV status may not in fact convey the risk of transmission in some circumstances: some victims may be ignorant, poorly informed or misinformed,” said Justice See Kee Oon in judgment grounds last week.
“In this regard, it would be undesirable for the HIV-positive person to assume or take for granted his or her sexual partner’s appreciation or knowledge of the risks involved,” he added.
In the case, the 28-year-old Singaporean had penetrative and oral sex with the victim more than once without declaring his condition or alerting him to the risk of infection and obtaining his consent to accept the risk as required by law.
The victim later contracted HIV but it is not known if it was the accused who was the cause of the infection.
All parties were not identified in the judgment grounds.
The man was charged in the State Courts under the Infectious Diseases Act in 2016 and contested the case, unlike nine past cases cited by the prosecution where all the accused pleaded guilty.
After a trial, the man was convicted last year and sentenced to two years’ jail by a district judge.
On appeal to the High Court, his lawyers Choo Zheng Xi and Priscilla Chia, had argued that the question of whether the man had provided sufficient disclosure of the risk of HIV infection was to be decided by the courts on the facts of each case. They urged the High Court to cut the jail term.
However, Deputy Public Prosecutors Peggy Pao and Mansoor Amir countered that the district judge had found that the offender did not tell the victim his HIV status at all.
In dismissing the appeal, Justice See ruled it is the risk of contracting HIV that must be communicated and not merely one’s HIV status based on the law.
The judge also rejected the suggestion that because the offender was a relatively young first offender at the time of the offences, the jail term should be reduced.
Noting sentencing precedents involved guilty pleas, unlike the present case, Justice See set a three-band sentence range for first-time offenders who claim trial. At its lowest, conviction could lead to a fine and at its highest, an accused could be sentenced to a 10-year jail term.
Based on the parameters of harm and culpability, a fine or sentence of up to two years may be meted out in a case where there is low risk of transmission and low culpability, with adjustments made for aggravating or mitigating factors.
Similarly, higher risks and greater culpability could lead to jail terms ranging between two and six years. The third band of sentences ranging between six and 10 years would be applied where actual harm occurs and HIV is transmitted, said the judge.
Noting that the law is aimed at deterring HIV persons from placing others at risk through irresponsible behaviour, Justice See held the starting point of a six-year jail term is when actual harm results.
This, he said, would appropriately address the sentencing concerns of deterrence and retribution.
Disclosing one’s HIV status may not in fact convey the risk of transmission in some circumstances: some victims may be ignorant, poorly informed or misinformed.
JUSTICE SEE KEE OON, in judgment grounds.
Source: Yahoo News Singapore – 26/06/2019
SINGAPORE — A HIV-positive man who was convicted of having sex with a male partner without informing him of the risks of infection had his appeal against his conviction and two-year jail term dismissed on Wednesday (26 June).
Delivering his judgement in the High Court, Justice See Kee Oon said the 29-year-old man clearly knew that he had an obligation to disclose his HIV status to the victim.
“The fact that he did not do so therefore indicated a heightened level of culpability.” said Justice See.
The judge also dismissed the man’s claim that he had taken precautionary measures before having sex with the victim. He noted that the man had unprotected sex with the victim on multiple occasions.
The victim tested positive for HIV and was interviewed for contact tracing several years after his encounters with the man.
The man, who cannot be named due to a court gag order, challenged his conviction and sentence in April this year.
Represented by lawyers Choo Zheng Xi and Priscilla Chia, the man argued that the district judge who presided over his trial had erred in several areas. These include the district judge believing the victim’s evidence despite his contradictory testimonies.
The victim had initially testified that the man withheld information of his HIV status. But he later conceded that the man may have mentioned about his HIV status while they were chatting through an app. The victim also could not remember significant details about his encounter with the man, according to the lawyers.
Justice See noted, however, that these inconsistencies were not “sufficient to raise reasonable doubt”.
“In context, the victim’s evidence was clear: he did not agree that he could have consented to sexual activity with the (man) knowing the latter had HIV.”
The victim’s evidence that he might have forgotten some exchanges showed that he was a “candid witness”, stated Justice See.
The man’s lawyers argued that the district judge had erred in concluding that disclosing one’s HIV-positive status was insufficient to discharge the duty of informing the victim of the risk.
Justice See rejected the argument, saying that the risk of contracting HIV “must be communicated, and not merely one’s HIV status.”
“Disclosing one’s HIV status may not in fact convey the risk of transmission in some circumstances: some victims may be ignorant, poorly informed or misinformed.
“In this regard, it would be undesirable for the HIV- positive person to assume or take for granted his or her sexual partner’s appreciation or knowledge of the risks involved.”
The man’s lawyers submitted for a sentence of not more than 16 months, arguing that the original sentence of two years was “manifestly excessive”.
Facts of the case
The man was found to have engaged in repeated sexual activity with the victim, sometime in 2012 or 2013, after having tested positive for HIV.
A public health officer advised the man to inform his sex partners of his HIV positive status.
He did not do so when he met the victim online and later had sex with him on five to six occasions in 2012 and 2013. While the pair used protection for their first few encounters, they subsequently did not.
Yahoo News Singapore had earlier reported that the man had been infected by HIV while working in a camp in Thailand. He had inadvertently pricked himself with a contaminated tool while assisting a patient. He noticed the symptoms two to three weeks after the incident and later tested positive for HIV.
The man testified during his trial that he would inform his partners of his HIV status ahead of any sexual activity and would ask his partners of theirs in return.
After testing positive for HIV, the victim provided the contact details of the man and six other sex partners to a public health officer in 2015. He told the officer that none of his partners had told him they had HIV.
The victim only found out that the man was HIV positive after he was informed by an investigating officer.
The district judge convicted the man and jailed him two years on August last year.
For not informing the victim of the risk of contracting HIV infection, the man would have been jailed up to 10 years or fined a maximum $50,000.
[update]Pakistan: Doctor found guilty of medical negligence released on bail
LARKANA: The Larkana circuit bench of the Sindh High Court on Saturday released on bail a doctor who was arrested on charges of spreading HIV in Ratodero.
Advocate Athar Abbas Solangi had pleaded the doctor’s bail application before the single bench of Justice Mohammad Faisal Kamal Alam on Friday and granted him bail for a sum of Rs200,000, asking him to deposit the surety in the trial court of fifth additional sessions judge.
On Saturday, he submitted the surety amount and was released from sub-jail of Ratodero, said the doctor’s advocate and sources in Ratodero.
Mr Solangi relied on different rulings and submitted that the petitioner was entitled to bail. Deputy prosecutor general Mohammad Noonari vehemently opposed the grant of bail to the applicant.
The order said that if the applicant misused the concession of bail then the trial court might take strict action against him in accordance with law. The trial court would not be influenced by any of the observations contained in the order and decide the case on its merits, it said.
The doctor was picked up after registration of FIR on behalf of Sindh Health Care Commission under sections 324, 337L PPC on April 30. Subsequently, a joint investigation team was constituted to probe the contents of the FIR.
Later, DIG Irfan Baloch told a press conference on May 29 that the JIT found the doctor had not “intentionally” spread the deadly virus in the town and changed sections 324, 322 PPC.
Nearly 500 children in a single Pakistani city have tested positive for HIV, in an outbreak that has led to the arrest of at least one doctor and highlighted gross inadequacies in the local health care system.
As of mid-May, 410 children and 100 adults in Larkana, a city in Pakistan’s Sindh province, had tested positive for HIV, the Associated Press reported. Those numbers have since climbed to 494 children and 113 adults, according to NPR.
How did more than 600 people in one area become infected with HIV? Here’s what to know.
When did the outbreak start?
According to reports from NPR and the AP, parents in April began to notice lasting fevers in their children and took them to a nearby medical center for testing. By around April 24, 15 children ages 2 to 8 had tested positive for HIV, according to an op-ed written by Larkana Deputy Commissioner Muhammad Nauman Siddique. “Recognising the seriousness of this issue,” local officials shortly thereafter set up a “healthcare camp” where children and their parents could be screened for the virus, Siddique wrote.
“The results of the screening within the first few days were shocking,” he wrote. “The tests revealed that the parents of the HIV-positive children were HIV negative”—raising questions about how so many children became infected.
By May 14, after screening more than 10,000 people, the number of diagnosed individuals had grown to more than 400, according to the country’s National AIDS Control Programme. As testing continued, that number only grew.
How did so many people get infected with HIV?
A web of unsanitary and unsafe medical practices seems to be to blame, according to local officials.
Many of the children who originally tested positive for HIV had been treated in a Larkana clinic run by Dr. X, NPR reports. After demands from parents, X was eventually tested for HIV. The results came back positive, “and here is when it was suspected that he was the source of spreading HIV in their kids through bad practices,” a district police officer told NPR.
X was arrested on suspicion of intentionally infecting his patients with HIV, the BBC reports. Pakistan’s SAMAA TV reported Thursday that he was cleared of that charge, but found guilty of “criminal medical negligence.” X denied the original accusations in a video filmed in jail.
Officials have pointed to medical negligence across the local health care system as a likely cause of the outbreak. Many local officials have blamed “quacks,” in apparent reference to the large number of unqualified individuals who practice medicine in the area.
“Possible causes included clinics run by quacks, use of a single syringe for multiple patients, and use of the same drip set for multiple patients,” Siddique wrote in his op-ed. He added that at least 61 unsafe clinics have been “sealed” and 29 more health care centers warned in the wake of the outbreak.
Sindh health officials also suggested that barbershops, where razor blades are sometimes reused, could be a possible transmission source, NPR reports. Siddique also pointed to unsafe circumcisions, which sometimes take place in barbershops, in his op-ed.
This is not the first time Larkana’s medical system has been at the center of an HIV outbreak. An outbreak among dialysis patients, which infected about 50 people, was reported in 2016. Years earlier, there was also an outbreak among intravenous drug users in Larkana.
What’s being done about the Larkana HIV outbreak?
National and international health authorities, including the World Health Organization, UNAIDS and UNICEF, are collaborating on a response in Larkana, which includes ongoing free testing of individuals who may be infected, crackdowns on unsafe clinics and barbershops and public education campaigns about preventing the spread of HIV. Siddique has also urged medical professionals to use auto-lock syringes, which cannot be reused, and called for better labs for conducting medical blood work.
Pakistan Health Minister Dr. Zafar Mirza also announced on May 23 that three new HIV/AIDs treatment centers would be established throughout Sindh.
Source: The News, May 2, 2019
Doctor arrested for allegedly spreading HIV in Larkana
HYDERABAD: Police Tuesday arrested a doctor in Larkana on charges of spreading HIV amongst his patients.
The accused Dr X, who himself is an HIV patient, was employed at a public hospital in Ratodero district of Larkana. He was allegedly responsible for spreading the Human Immunodeficiency Virus (HIV) among his patients.
The doctor’s arrest came after the authorities tried to ascertain the causes behind the spread of the virus among the residents of Larkana, Sindh.
The panic had gripped the district early this month when the number of HIV-positive cases rose to 39 including more than a dozen children, according to Geo TV.
Children are among the patients diagnosed with HIV, the virus that causes the deadly AIDS disease which claimed a million lives worldwide.
However, Dr X denied the charges and termed the case a “conspiracy” against him. He said that he was not aware of his condition. Adding, “If I had known about [HIV/AIDS] I would have sought treatment.”
Dr Sikander Memon, in-charge of the Aids Control Programme in Sindh, said a team will arrive in Ratodero next week to determine the causes behind the transmission of the HIV among the residents.
According to an estimate by Dr Memon, there are estimated to be more than 100,000 HIV-positive people in Sindh province. However, the Aids Control Programme has only 10,350 registered patients who are provided treatment.
According to WHO, Pakistan is registering approximately 20,000 new HIV infections annually, the highest rate of increase among all countries in the region.
UNAIDS and UNDP urge countries to lift all forms of HIV-related travel restrictions
New data show that in 2019 around 48* countries and territories still have restrictions that include mandatory HIV testing and disclosure as part of requirements for entry, residence, work and/or study permits
GENEVA, 27 June 2019—UNAIDS and the United Nations Development Programme (UNDP) are urging countries to keep the promises made in the 2016 United Nations Political Declaration on Ending AIDS to remove all forms of HIV-related travel restrictions. Travel restrictions based on real or perceived HIV status are discriminatory, prevent people from accessing HIV services and propagate stigma and discrimination. Since 2015, four countries have taken steps to lift their HIV-related travel restrictions—Belarus, Lithuania, the Republic of Korea and Uzbekistan.
“Travel restrictions on the basis of HIV status violate human rights and are not effective in achieving the public health goal of preventing HIV transmission,” said Gunilla Carlsson, UNAIDS Executive Director, a.i. “UNAIDS calls on all countries that still have HIV-related travel restrictions to remove them.”
“HIV-related travel restrictions fuel exclusion and intolerance by fostering the dangerous and false idea that people on the move spread disease,” said Mandeep Dhaliwal, Director of UNDP’s HIV, Health and Development Group. “The 2018 Supplement of the Global Commission on HIV and the Law was unequivocal in its findings that these policies are counterproductive to effective AIDS responses.”
Out of the 48 countries and territories that maintain restrictions, at least 30 still impose bans on entry or stay and residence based on HIV status and 19 deport non-nationals on the grounds of their HIV status. Other countries and territories may require an HIV test or diagnosis as a requirement for a study, work or entry visa. The majority of countries that retain travel restrictions are in the Middle East and North Africa, but many countries in Asia and the Pacific and eastern Europe and central Asia also impose restrictions.
“HIV-related travel restrictions violate human rights and stimulate stigma and discrimination. They do not decrease the transmission of HIV and are based on moralistic notions of people living with HIV and key populations. It is truly incomprehensible that HIV-related entry and residency restrictions still exist,” said Rico Gustav, Executive Director of the Global Network of People Living with HIV.
The Human Rights Council, meeting in Geneva, Switzerland, this week for its 41st session, has consistently drawn the attention of the international community to, and raised awareness on, the importance of promoting human rights in the response to HIV, most recently in its 5 July 2018 resolution on human rights in the context of HIV.
“Policies requiring compulsory tests for HIV to impose travel restrictions are not based on scientific evidence, are harmful to the enjoyment of human rights and perpetuate discrimination and stigma,” said Dainius Pūras, Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of health. “They are a direct barrier to accessing health care and therefore ineffective in terms of public health. I call on states to abolish discriminatory policies that require mandatory testing and impose travel restrictions based on HIV status.”
The new data compiled by UNAIDS include for the first time an analysis of the kinds of travel restrictions imposed by countries and territories and include cases in which people are forced to take a test to renew a residency permit. The data were validated with Member States through their permanent missions to the United Nations.
UNAIDS and UNDP, as the convenor of the Joint Programme’s work on human rights, stigma and discrimination, are continuing to work with partners, governments and civil society organizations to change all laws that restrict travel based on HIV status as part of the Global Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination. This is a partnership of United Nations Member States, United Nations entities, civil society and the private and academic sectors for catalysing efforts in countries to implement and scale up programmes and improve shared responsibility and accountability for ending HIV-related stigma and discrimination.
*The 48 countries and territories that still have some form of HIV related travel restriction are: Angola, Aruba, Australia, Azerbaijan, Bahrain, Belize, Bosnia and Herzegovina, Brunei Darussalam, Cayman Islands, Cook Islands, Cuba, Dominican Republic, Egypt, Indonesia, Iraq, Israel, Jordan, Kazakhstan, Kuwait, Kyrgyzstan, Lebanon, Malaysia, Maldives, Marshall Islands, Mauritius, New Zealand, Oman, Palau, Papua New Guinea, Paraguay, Qatar, Russian Federation, Saint Kitts and Nevis, Samoa, Saudi Arabia, Saint Vincent and the Grenadines, Singapore, Solomon Islands, Sudan, Syrian Arab Republic, Tonga, Tunisia, Turkmenistan, Turks and Caicos, Tuvalu, Ukraine, United Arab Emirates and Yemen.
The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.
South Africa: Constitutional Court Justice Edwin Cameron, a leading figure on HIV and the law, to retire in August
Justice Edwin Cameron is expected to retire as a judge on August 20, the Constitutional Court announced on Twitter on Thursday.
Cameron is expected to step down from the apex court on the 25th anniversary of his appointment as a judge.
Cameron, who worked as a human rights lawyer during apartheid, defended ANC members and fought for gay and lesbian equality, according to his profile on the Constitutional Court’s website.
He revealed that he was HIV positive in 1999, at a time when many people living with the virus faced significant stigma from a deeply ignorant public. He contracted the virus in the late 1980s.
In 2017, he told the Constitutional Hill website: “The stigma is still enormous. It would be helpful if we had more [prominent people open about being HIV positive], but each has to take that decision personally.”
Cameron, a keen cyclist, was appointed to the Constitutional Court in 2008 by then acting president Kgalema Motlanthe.
The announcement about him stepping down has been met with sadness. There were also expressions of admiration for what he accomplished over the years.
Canada: In response to the new Quebec approach to the criminalisation of HIV non-disclosure, COCQ-SIDA states that reforms must go further
Nouvelle approche québécoise concernant la criminalisation de la non–divulgation du VIH : il faut aller plus loin
New Quebec approach to criminalizing HIV non-disclosure: we must go further
Montréal, June 27, 2019 – The Ministère de la Santé et des Services sociaux, through the Institut national de Santé publique, has published a brief on what seems to indicate a new Quebec approach to criminalizing the non-disclosure of HIV status. This new approach represents a step forward for the rights of people living with HIV in Quebec, which are disproportionately criminalized because of their HIV status. Nevertheless, this new approach has worrying shortcomings and does not offer the same guarantees as a directive to prosecutors such as the one requested by the COCQ-SIDA for several years.
Until very recently, there was no evidence that Quebec deviated from the test set out by the Supreme Court in R. v. Mabior, which requires a person living with HIV to disclose his or her HIV status before any sexual relationship involving a “realistic possibility of transmission”. The only sexual intercourse for which the Supreme Court has clearly indicated that there is no “realistic possibility of transmission” of HIV is vaginal penetration when a condom is used and when the person living with HIV has a low or undetectable viral load. This meant that a person living with HIV could be charged and convicted of aggravated sexual assault for not disclosing his or her HIV status, regardless of whether or not there was HIV transmission, whether or not he or she intended to transmit HIV to his or her partner, and even though his or her viral load alone made it impossible to transmit the virus.
Based on this brief, it can be concluded that a person living with HIV is no longer required to disclose his or her HIV status before sexual intercourse if he or she takes antiretroviral therapy as prescribed and that his or her viral load, measured by consecutive laboratory tests every 4 to 6 months, remains below 200 copies per millilitre of blood. This new position is consistent with the scientific consensus that there is no risk of HIV transmission in heterosexual or homosexual couples in which one of the partners is living with HIV and maintains an undetectable viral load. The Coalition is pleased to see that the most up-to-date scientific data will now be able to prevent unjustified prosecutions of people living with HIV, at a time when it is unequivocally stated that “undetectable=intransmissible”.
However, the addition of conditions to achieve a viral load of less than 200 copies, such as treatment and laboratory tests every 4 to 6 months, excludes a significant number of people living with HIV who, without treatment, manage to maintain a viral load of less than 200 copies or who have medical follow-up only every 6 to 12 months. By way of comparison, the federal government, in its directive to prosecutors, states that there should be no prosecutions in this context without conditions.
In addition, the new approach is much less clear about the risks of prosecution for people who, without maintaining a viral load of less than 200 copies, used a condom or only had oral sex. The new approach indicates that in the absence of evidence that could increase the risk of HIV transmission, the risk of transmission in these situations is negligible, even if the person is not taking antiretroviral treatment. In these cases, prosecutions are said to be unlikely, but cannot be excluded. It is specified that the presence of elements likely to increase the risk of transmission (e.g., expired or torn condom, oral or genital lesions) will be assessed on a case-by-case basis by an expert to determine whether there was a “realistic possibility of HIV transmission”. Although it is the only province to require expert advice to determine the presence of factors likely to increase the risk of transmission, Quebec’s position on oral sex is otherwise consistent with the guidelines in British Columbia and the territories. On the issue of condoms, Quebec’s position is also consistent with the federal directive, which states that prosecutions should generally not be brought against a person who has used condoms, unless other risk factors are present.
However, COCQ-SIDA regrets that Quebec has not, like the federal directive, provided that there should generally not be a prosecution for non-disclosure of HIV status in cases where the person living with
However, COCQ-SIDA regrets that Quebec has not provided, as the federal directive does, that there should generally be no prosecution for non-disclosure of HIV status in cases where the person living with HIV was undergoing treatment, without having reached a viral load of less than 200 copies. In addition, COCQ-SIDA is concerned that, in the new Quebec approach, there is nothing to encourage prosecutors to favour the use of non-sexual offences, contrary to the federal directive adopted last December, and contrary to the recommendations made by the House of Commons Standing Committee on Justice and Human Rights. Thus, Quebeckers living with HIV who remain at risk of being prosecuted can still be charged with aggravated sexual assault and entered on the sex offender registry for life, even when this offence does not reflect the act committed.
COCQ-SIDA would like to highlight the efforts undertaken to improve the response of the Quebec criminal justice system to the criminalization of HIV. It considers that the new approach is a first step towards the abolition of all criminalisations of HIV or other STIs, which must first and foremost be addressed from a public health perspective. COCQ-SIDA will therefore continue to work with its partners and the government to improve Quebec’s approach to HIV criminalization.
In addition, while it welcomes several aspects of the new approach, it remains concerned about many of its facets. At this time, this publication offers no guarantee to people living with HIV that investigators or prosecutors will deal with complaints of non-disclosure of HIV status in the recommended manner, except that it is stated that all justice actors affected by this case have “already been informed of this recent data on the risk of HIV transmission”. COCQ-SIDA regrets the lack of transparency surrounding the implementation of the new approach, and the lack of certainty as to its sustainability and dissemination to police forces and prosecutors in the coming weeks, months and years. It also raises doubts about the accountability of the prosecutor if the new approach is not followed and people living with HIV end up in court incorrectly.
In order for Quebec to effectively end the HIV epidemic in its territory and combat stigma and discrimination against people living with HIV, COCQ-SIDA believes that the Director of Criminal and Penal Prosecutions (DPCP) must put in place a clear and public directive for prosecutors, as Ontario, British Columbia, and the federal government have done in the territories. Only a directive would act as a guarantee and allow people living with HIV to truly know how the criminal law would be likely to apply to their behaviour, especially in a context where the criminalization of non-disclosure stems not from the Criminal Code itself, but from jurisprudential interpretations of it. Despite all our efforts and repeated requests to this effect, no directive to this effect has yet been adopted. COCQ-SIDA has difficulty explaining the DPCP’s reluctance to adopt such a directive for prosecutors, a directive that would ensure that only cases of real and intentional transmission of HIV fall within the scope of criminal law. Quebec must position itself as a leader in the fight against HIV and the discrimination and stigmatization of people living with HIV, and only the adoption of a clear directive preventing the unfair use of criminal law against people living with HIV will allow this.
Nouvelle approche québécoise concernant la criminalisation de la non-divulgation du VIH : il faut aller plus loin
Montréal, le 27 juin 2019 – Le Ministère de la Santé et des Services sociaux, via l’Institut national de Santé publique, a publié une brève sur ce qui semble indiquer une nouvelle approche québécoise en matière de criminalisation de la non-divulgation du statut sérologique. Cette nouvelle approche constitue une avancée pour les droits des personnes vivant avec le VIH au Québec, lesquelles sont disproportionnellement criminalisées en raison de leur statut sérologique. Néanmoins, cette nouvelle approche comporte des lacunes préoccupantes et n’offre pas les mêmes garanties qu’une directive aux procureur·es comme celle demandée par la COCQ-SIDA depuis plusieurs années.
Jusqu’à tout récemment, rien ne démontrait que le Québec s’écartait du critère établi par la Cour suprême dans l’arrêt R. c.Mabior, lequel exige qu’une personne vivant avec le VIH divulgue son statut sérologique avant toute relation sexuelle comportant une « possibilité réaliste de transmission ». Le seul rapport sexuel pour lequel la Cour Suprême a clairement indiqué qu’il n’y avait pas de « possibilité réaliste de transmission » du VIH est la pénétration vaginale lorsqu’un condom est utilisé etlorsque la personne vivant avec le VIH a une charge virale faible ou indétectable. Ce qui fait en sorte qu’une personne vivant avec le VIH pouvait être accusée et déclarée coupable d’agression sexuelle grave pour ne pas avoir divulgué son statut sérologique, peu importe qu’il y ait eu transmission du VIH ou non, peu importe qu’elle ait eu l’intention de transmettre le VIH à son partenaire ou non, et alors même que sa charge virale à elle seule rendait impossible toute transmission du virus.
Selon cette brève, il est possible de conclure qu’une personne vivant avec le VIH n’a plus l’obligation de divulguer son statut sérologique avant une relation sexuelle si elle prend un traitement antirétroviral comme prescrit et que sa charge virale, mesurée par des analyses consécutives de laboratoire toutes les 4 à 6 mois, se maintient à moins de 200 copies par millilitre de sang. Cette nouvelle position est cohérente avec le consensus scientifique qui confirme que le risque de transmission du VIH est inexistant au sein de couples hétérosexuels ou homosexuels dont l’un·e des partenaires vit avec le VIH et maintient une charge virale indétectable. La Coalition se réjouit de voir que les données scientifiques les plus à jour pourront désormais éviter les poursuites injustifiées à l’égard des personnes vivant avec le VIH, à une époque où il est sans équivoque que « indétectable=intransmissible ».
Cela dit, l’ajout de conditions à l’atteinte d’une charge virale inférieure à 200 copies telles la prise d’un traitement et les analyses de laboratoire aux 4 à 6 mois, fait en sorte d’exclure un nombre important de personnes vivant avec le VIH qui, sans traitement, parviennent à maintenir une charge virale inférieure à 200 copies ou encore, qui ont des suivis médicaux qu’aux 6 à 12 mois. À titre comparatif, le gouvernement fédéral, dans sa directive aux procureur·es, indique qu’il ne doit pas y avoir de poursuites intentées dans ce contexte sans y ajouter de conditions.
En outre, la nouvelle approche est beaucoup moins claire en ce qui a trait aux risques de poursuites pour les personnes qui, sans avoir maintenu une charge virale inférieure à 200 copies, ont utilisé un condom ou n’ont eu que des relations sexuelles bucco-génitales. La nouvelle approche indique qu’en l’absence d’éléments susceptibles d’augmenter le risque de transmission du VIH, ce risque de transmission, dans ces situations, est négligeable, et ce, même si la personne ne prend pas un traitement antirétroviral. Dans ces cas, les poursuites sont dites improbables, mais ne peuvent être exclues. Il est précisé que la présence d’éléments susceptibles d’augmenter le risque de transmission (ex. : condom périmé ou déchiré, lésions buccales ou génitales) sera évaluée au cas par cas, par un expert, afin de déterminer s’il y avait bel et bien une « possibilité réaliste de transmission du VIH ». Bien qu’elle soit la seule province à exiger un avis d’expert pour déterminer la présence d’éléments susceptibles d’augmenter le risque de transmission, la position québécoise sur le sexe oral est, pour le reste, cohérente avec les directives en vigueur en Colombie-Britannique et dans les territoires. Sur la question du condom, la position québécoise est également cohérente avec la directive fédérale qui mentionne qu’on ne devrait généralement pas intenter de poursuite contre une personne qui a utilisé des condoms, sauf si d’autres facteurs de risque sont présents.
La COCQ-SIDA regrette toutefois que le Québec n’ait pas, à l’instar de la directive fédérale, prévu qu’il ne devrait généralement pas y avoir de poursuite pour non-divulgation de la séropositivité dans les cas où la personne vivant avec le VIH suivait un traitement, sans toutefois avoir atteint une charge virale inférieure à 200 copies. Ajoutons que la COCQ-SIDA est préoccupée par le fait que, dans la nouvelle approche québécoise, rien n’invite les poursuivant·es à privilégier le recours à des infractions d’ordre non sexuel, contrairement à la directive fédérale adoptée en décembre dernier, et contrairement aux recommandations émises par le Comité permanent de la Justice et des droits de la personne de la Chambre des communes. Ainsi les Québécoises et les Québécois vivant avec le VIH qui demeurent à risque d’être poursuivis pourront toujours être accusé.es d’agression sexuelle grave et inscrit·es au registre des délinquant·es sexuel·les à vie et ce, même lorsque cette infraction ne reflète aucunement l’acte commis.
La COCQ-SIDA tient à souligner les efforts entrepris pour améliorer la réponse du système de justice pénale québécois en matière de criminalisation du VIH. Elle considère que la nouvelle approche constitue un premier pas vers l’abolition de toutes criminalisations du VIH ou des autres ITSS, lesquelles doivent d’abord et avant tout être abordées sous l’angle de la santé publique. La COCQ-SIDA continuera donc de travailler avec ses partenaires et avec le gouvernement dans l’amélioration de l’approche québécoise en matière de criminalisation du VIH.
En outre, bien qu’elle salue plusieurs aspects de la nouvelle approche, elle demeure préoccupée par nombre de ses facettes. Pour l’heure, cette publication n’offre aucune garantie aux personnes vivant avec le VIH que les enquêteur·trices ou les procureur·es traiteront les plaintes en non-divulgation du statut sérologique de la manière recommandée, sinon qu’il est mentionné que l’ensemble des acteur·trices de la justice touché·es par ce dossier ont « déjà été informé[·es] de ces récentes données sur le risque de transmission du VIH ». La COCQ-SIDA regrette l’opacité entourant la mise en œuvre de la nouvelle approche, et le manque de certitude quant à sa pérennité et sa diffusion auprès des forces policières et des procureur·es dans les semaines, mois et années à venir. Cela soulève également des doutes quant à l’imputabilité du ou de la poursuivant·e si la nouvelle approche n’est pas suivie et que des personnes vivant avec le VIH se retrouvent erronément devant les tribunaux.
Pour que le Québec puisse réellement mettre fin à l’épidémie du VIH sur son territoire et combattre la stigmatisation et les discriminations à l’égard des personnes vivant avec le VIH, la COCQ-SIDA considère que la Directrice des poursuites criminelles et pénales (DPCP) doit mettre en place une directive claire et publique à l’attention des procureurs, comme l’ont fait l’Ontario, la Colombie-Britannique, et le gouvernement fédéral dans les territoires. Seule une directive agirait à titre de garantie et permettrait aux personnes vivant avec le VIH de réellement savoir comment le droit criminel serait susceptible de s’appliquer à leurs comportements, surtout dans un contexte où la criminalisation de la non-divulgation découle non pas du Code criminelen soi, mais d’interprétations jurisprudentielles de celui-ci. Malgré tous nos efforts déployés et demandes répétées en ce sens, aucune directive à cet effet n’a encore été adoptée. La COCQ-SIDA s’explique mal la réticence de la DPCP à adopter une telle directive à l’attention des procureur·es ; directive qui s’assurerait que seuls les cas de transmission réelle et intentionnelle du VIH soient du ressort du droit criminel. Le Québec doit se positionner comme leader dans la lutte contre le VIH et contre les discriminations et la stigmatisation des personnes vivant avec le VIH et seule l’adoption d’une directive claire empêchant le recours injuste au droit criminel à l’égard des personnes vivant avec le VIH le permettra.
Canada: The justice system is evolving in Quebec when it comes to the duty to disclose one’s HIV status
Obligation de divulguer son statut sérologique à ses partenaires sexuels ? Le système de justice pénale évolue.
Au Canada, une personne vivant avec le VIH peut être déclarée coupable d’agression sexuelle parce qu’elle n’a pas divulgué sa séropositivité à un partenaire sexuel et ce, même en l’absence de transmission ou lorsque le risque de transmission est négligeable (voir la Vidéo Criminalisation du VIH). La criminalisation de l’exposition au VIH, en plus de contribuer à la stigmatisation des personnes vivant avec le VIH, nuit aux efforts de la santé publique pour prévenir cette infection.
Depuis plusieurs années, des démarches visent à amener le système de justice pénale à tenir compte des données scientifiques concernant la transmission du VIH. Heureusement, ces démarches ont porté fruit et le système de justice pénale en tient dorénavant davantage compte. Cette manchette présente ce qui s’applique au Québec en termes d’obligation de divulguer son statut sérologique selon différents contextes.
En 2012, la Cour suprême du Canada a rendu deux jugements sur la question de la divulgation du statut sérologique (les affaires R. c. Mabior et R. c. D.C.). Selon ces décisions, toute personne se sachant infectée par le VIH a l’obligation légale de divulguer sa séropositivité à ses partenaires sexuels avant d’avoir des relations sexuelles qui comportent une « possibilité réaliste de transmission du VIH ».
La Cour a établi qu’il n’y a pas de « possibilité réaliste de transmission du VIH », lors d’une pénétration vaginale, lorsqu’il y a port du condom ET que la charge virale de la personne séropositive est faible ou indétectable. Une personne vivant avec le VIH n’a donc pas d’obligation de divulguer son statut sérologique dans ce premier contexte. En outre, la Cour a précisé qu’il faut tenir compte des futures avancées de la science médicale en matière de transmission du VIH pour déterminer s’il existe une « possibilité réaliste de transmission ».
Des données scientifiques récentes démontrent que le risque de transmission du VIH associé aux relations sexuelles orales, vaginales ou anales non protégées par un condom est négligeable lorsque la personne vivant avec le VIH prend un traitement antirétroviral comme prescrit et que sa charge virale, mesurée par des analyses consécutives de laboratoire tous les quatre à six mois, se maintient à moins de 200 copies par millilitre de sang (voir L’effet du traitement des personnes vivant avec le VIH sur le risque de transmission sexuelle de l’infection). Dans ces circonstances, le critère de la « possibilité réaliste de transmission du VIH » n’est pas satisfait et des poursuites criminelles ne seraient pas justifiées.
D’autres données scientifiques (voir Expert consensus statement on the science of HIV in the context of criminal law)montrent que lors des relations orales, vaginales ou anales adéquatement protégées par un condom ou lors de relations sexuelles orales non protégées par un condom, en l’absence d’éléments susceptibles d’augmenter le risque de transmission du VIH (ex. : condom périmé ou déchiré, lésions à la bouche ou aux organes génitaux), le risque de transmission est négligeable, et ce, même si la personne ne suit pas un traitement antirétroviral. Il est difficile de statuer sur l’obligation légale de divulguer son statut sérologique dans ce troisième contexte; la présence d’éléments susceptibles d’augmenter le risque de transmission sera évaluée au cas par cas par un expert afin de vérifier si le critère de « possibilité réaliste de transmission » est satisfait.
L’ensemble des acteurs de la justice du Québec touchés par ce dossier a déjà été informé de ces récentes données sur le risque de transmission du VIH. Une mise à jour de l’annexe « L’obligation légale de divulguer son statut sérologique à ses partenaires sexuels » du Guide québécois de dépistage des ITSS sera publiée sous peu. La section Que doivent faire les professionnels de la santé? demeure inchangée.
Nous profitons de l’occasion pour rappeler l’importance de :
- Soutenir la personne atteinte d’une infection par le VIH pour qu’elle avise ses partenaires;
- Intervenir auprès des personnes vivant avec le VIH qui, pour diverses raisons, ne peuvent prendre ou ne prennent pas les précautions pour éviter la transmission.
La direction de santé publique de votre territoire peut vous aider à offrir ce soutien et à effectuer cette intervention. En plus de prévenir la transmission et de protéger la santé de la population, ce soutien et cette intervention pourraient contribuer à limiter la criminalisation de l’exposition au VIH.
Pour en savoir plus sur la criminalisation de l’exposition au VIH :
- La criminalisation du VIH au Canada : tendances clés et particularités
- Rapport du ministère de la Justice du Canada : Réponse du système de justice pénale à la non-divulgation de la séropositivité
Pour en savoir plus sur les démarches en cours :
- Rapport du Comité permanent de la justice et des droits de la personne du parlement canadien La criminalisation de la non-divulgation de la séropositivé au Canada
- Coalition canadienne pour réformer la criminalisation du VIH
Rédigée par :
US: American Medical Association adopts policy to advocate for repeal of legislation that criminalises nondisclosure of HIV status
Catch up with the news and other key moments from the AMA House of Delegates’ meeting in Chicago. The 2019 AMA Annual Meeting wrapped up on June 12.
Thursday, June 13
Prison inmates and staff should get more health education, training. Poor health outcomes are rampant in U.S. jails and prisons, thanks to subpar hand hygiene, oral health and other factors. The AMA, in a vote yesterday, also backed giving incarcerated women access to contraception. Read more.
Doctors back funding plans to end HIV epidemic. In a strong show of support for major action to “end the epidemic of HIV nationally,” delegates yesterday voted to advocate funding plans that focus on:
- Diagnosing individuals with HIV infection as early as possible.
- Treating HIV infection to achieve sustained viral suppression.
- Preventing at-risk individuals from acquiring HIV infection, including through the use of pre-exposure prophylaxis (PrEP).
- Rapidly detecting and responding to emerging clusters of HIV infection to prevent transmission.
In a separate action, AMA delegates took action to address the 32 states and two U.S. territories that have punitive laws criminalizing individuals who fail to disclose HIV status to sexual partners.
“Current criminalization laws are outdated and do not reflect the current science of HIV transmission or the fact that HIV is a chronic, but manageable medical condition—particularly since nondisclosure of other infectious diseases is not criminalized,” said AMA Board Member E. Scott Ferguson, MD.
People with HIV who take antiretroviral therapy medication as prescribed and are able to get and keep an undetectable viral load have effectively no risk of transmitting HIV to their HIV-negative sexual partners.
In light of that, delegates adopted new policy to:
- Advocate for repeal of legislation that criminalizes nondisclosure of HIV status for people living with HIV.
- Work with other stakeholders to develop a program whose primary goal is to destigmatize HIV infection through educating the public, physicians and other health care professionals on current medical advances in HIV treatment that minimize the risk of transmission due to viral load suppression and the availability of PrEP.
Russia: Man sentenced to 5 years in strict regime correctional colony for alleged HIV transmission
Source: Эхо Севера, 21/06/2019
Google translation – For article in Russian, scroll down
Resident of the Nenets Autonomous District who has infected a minor with HIV, sentenced to 5 years in a strict regime colony
This includes liability for sexual intercourse with a minor. This is reported by the press service of the supervisory authority.
“At the court hearing, it was established that B. from the time of September 1 to September 30, 2017 at his place of residence, knowing knowing that he had a chronic disease, had HIV, in order to satisfy his sexual needs, without informing him of the presence of this disease the victim, entered into sexual intercourse with her, through his actions put the victim at risk of acquiring HIV infection, ”the message says.
The prosecutor’s office added that besides this, citizen B. had been having sex with another minor for four months (from February to May 2018). The result of this relationship was the infection of the girl with HIV infection.
The court, agreeing with the arguments of the public prosecutor, found B. guilty of committing the crimes provided for by the ch.ch. 1.3 Art. 122, h. 1 Art. 134 of the Criminal Code, and sentenced him to 5 years of imprisonment with a sentence being served in a strict-regime correctional colony.
The court verdict has not yet entered into force.
Житель НАО, заразивший ВИЧ несовершеннолетнюю, приговорен к 5 годам колонии строгого режима
Речь идет в том числе об ответственности за вступление в половую связь с несовершеннолетней. Об этом информирует пресс-служба надзорного ведомства.
«В судебном заседании установлено, что Б. в период времени с 01 сентября по 30 сентября 2017 года по месту своего жительства, заведомо зная о наличии у себя хронического заболевания ВИЧ-инфекция, с целью удовлетворения своих сексуальных потребностей, не сообщив о наличии данного заболевания потерпевшей, вступил с ней в половое сношение, своими действиями поставил в опасность заражения ВИЧ-инфекцией потерпевшую», — говорится в сообщении.
В прокуратуре добавили, что кроме этого, гражданин Б. на протяжении четырех месяцев (с февраля по май 2018 года) вступал в половую связь с еще одной несовершеннолетней. Результатом этих отношений стало заражение девушки ВИЧ-инфекцией.
Суд, согласившись с доводами государственного обвинителя, признал Б. виновным в совершении преступлений, предусмотренных ч.ч. 1,3 ст. 122, ч. 1 ст. 134 УК РФ, и назначил ему наказание в виде 5 лет лишения свободы с отбыванием наказания в исправительной колонии строгого режима.
Приговор суда в настоящее время не вступил в законную силу.
Canada: Criminalisation of HIV non-disclosure to be addressed if government is reelected
Liberals hope to deal with HIV non-disclosure issue if re-elected: Lametti
TORONTO — The Liberals hope to address the if re-elected in the fall, the federal justice minister said Friday as advocacy groups pushed the government to make changes to the law.
HIV non-disclosure has led to assault or sexual assault charges because it’s been found to invalidate a partner’s consent — the rationale being that if someone knew a person had HIV, they wouldn’t consent to sexual activity because of the risk of transmission.
Advocates say the justice system lags behind the science on the issue, with a growing body of evidence saying there is no realistic possibility of transmission of HIV if a person is on antiretroviral therapy and has had a suppressed viral load for six months.
A parliamentary committee has been examining the issue for months and is expected to release a report with recommendations next week. Justice Minister David Lametti said the Liberals want to address the matter but won’t have time to act before the October election.
“Our legislative runway is over,” Lametti said after speaking at a symposium on HIV criminalization in Toronto. “The house will rise at some point, perhaps as early as next week … I hope that our government will be re-elected so we’ll be able to hit the ground running.”
Lametti said the Liberals, if returned to power, could explore options that include drafting a criminal law provision that targets intentional transmission of HIV.
“We need to look at the criminal law … and look at what’s within our jurisdiction … and trying to achieve that balance, as a number of people in the room have stated, in trying to draft a criminal law provision which targets only intent and not criminalize everything else,” he said.
Richard Elliott, Executive Director of the Canadian HIV/AIDS Legal Network, said he’s concerned that the timing of the committee’s report — so close to the federal election — could mean its recommendations get lost.
“It’s unfortunate that it’s taken this long, several-year process since the last election, to get to the point of actually having a committee report with some recommendations that could then inform possible legislation,” he said. “The issue, however, isn’t going to go away for people living with HIV … we will continue to press for Criminal Code reform.”
In 2017, then-federal justice minister Jody Wilson-Raybould said she would examine how the criminal justice system dealt with people who do not disclose their HIV status to sexual partners.
Late last year, the government instructed federal prosecutors in the North that they should no longer prosecute anyone for not disclosing their HIV status to a sex partner where there is no risk of transmitting the virus. The rules apply only in the territories where federal prosecutors have jurisdiction.
Elliott said he’s hopeful that the Justice and Human Rights committee’s report will include a recommendation to establish a consistent policy for prosecutors at the provincial level.
Agencies advocating for de-criminalization of HIV non-disclosure agree that the law needs to change and it is a public health issue, not something that should be dealt with as sexual assault, he said.
“There is just a vast overreach in the Criminal Code as it’s been interpreted and applied,” he said. “Parliament needs to fix that and that will remain the case after the coming election.”