Remarks written for the Haverford College Research Ethics Symposium, 21 October 2016, by Laurel Sprague, Research Fellow in HIV, Gender, and Justice, HIV Justice Network.

Every theory has a human price: Ethical research is collaborative research

[Introduction]

Every theory has a human price.

Of all of the philosophical statements that I read and teach about what obligations – to accuracy or truth, to one another – might structure the inquiries of those who seek after knowledge, this statement, heard more than a decade ago from spoken word poet Alix Olson on an outdoor festival stage, has become my mental organizing principle.

Every theory has a human price.

What does this mean for ethics in research? Scientific inquiry is never neutral in its origination, its execution, or its interpretation. No research is done, not ever, in the absence of underlying theories about what questions matter, how these questions should be studied, who is a reliable witness to their own experience, what kinds of people and training are needed to interpret research results, and whether any obligations exist to use and share the outcomes. This reality is the reason that ethical research on social questions is research done in collaboration with those most affected by the questions and the outcomes.

My remarks today focus on three different research experiences: one that illustrates the pitfalls of the traditional “ivory tower” research process, one that demonstrates a concrete outcome difference between research done in isolation version with that done with affected communities and that informs diametrically opposed policies, and one that provides a fresh approach to academic-community research partnerships.

[Fiddling while Rome burns]

In 1994, I attended a conference in Atlanta, the National Skills Building conference, designed to boost the US HIV/AIDS response, in Atlanta. AIDS became the leading cause of death among all Americans age 25-44 that year. Three of my friends had died the previous month, in September 1994. I was 23 and they were the first friends I lost to AIDS. My own health was precarious. Diagnosed as HIV-positive in 1991, and with my immune system in free fall, I was five months from my own AIDS diagnosis. I share this information with you both to position myself in the examples I am about to share and to call on you to imagine – or to remember – the sense of urgency we felt, as people living with HIV and as people loving family members, partners, friends, and colleagues living with HIV, at that moment.

At that conference, one of the sessions I most highly anticipated was focused, at long last, on lesbians and HIV. As a lesbian living with HIV, and in contact with about a dozen other lesbians with HIV and their partners, we existed in an abyss of information: we had absolutely zero evidence-based information on whether women could acquire HIV from one another and, if so, what kinds of activities posed a risk. Safer sex information for women at the time was adapted from what was known about men’s sexual behaviours and risks. It centred around a strange fetish in public health messaging for dental dams (a fetish not shared by any lesbian I ever met).

As lesbians, whenever we had the chance to meet, we shared stories and any research we could get our hands on. The Lesbian AIDS Project at GMHC in NY provided a newsletter and resources that we scoured for information. As lesbian after lesbian shared stories about their own HIV acquisition from previous male partners, or drug use, or sexual assault, or transfusions, and as couple after couple shared their experiences of having no transmission between them, often despite years together without the knowledge that one partner was HIV-positive, we began to guess, but no one knew, the answers to fundamental questions about HIV transmission risks between women.

The conference session was packed. The U.S. Centers for Disease Control had finally invested resources in women-specific questions. Two women from the CDC presented their study and results.

What did they do?

They surveyed lesbians living with HIV to find out if they practiced safer sex with their female partners.

What did they learn?

A significant portion of lesbians said no.

What did they recommend?

They did not recommend paying attention to risks that HIV-positive women might pose to their partners; they did not recommend talking with HIV-positive lesbians about why they did not practice safer sex. Instead, they called for an HIV-prevention campaign to motivate lesbians to practice safer sex.

Now, if the goal was to convince lesbians living with HIV to practice safe sex with our female partners, what we needed was even one case that demonstrated that it mattered. One case that showed it was worth it to give up a level of intimacy in order to protect our partners’ health.

Imagine if that research had been done with lesbians living with HIV rather than on us. Imagine if the intelligence, concern for our partners, and agency of lesbians living with HIV had been taken seriously. We might have learned answers to our life and death questions.

Instead, researchers fiddled while Rome burned.

[From wrong questions to wrong answers to wrong policies]

My second example compares research questions written without involvement by those affected by the issue with research questions written collaboratively with those most affected.

Within the last decade plus a few years, legal and social science researchers have conducted research on whether the existence of a law that criminalizes people living with HIV for not disclosing their HIV status to a sex partner, potentially exposing another person to HIV, or transmitting HIV, has either negative or positive public health effects. Within this research program, a series of surveys has been conducted to identify the levels of support for such laws (laws which currently exist in 36 US states and territories).

While no positive public health outcomes have been identified and some small negative public health outcomes are suggested resulting from these laws, the survey results found generally high levels of support for these laws, including among gay men and people living with HIV. This has a policy effect: if constituents seem to support a law, politicians have no incentive to change the law, even when the law is discriminatory or unjust.

What was the survey question? “Should it be against the law for a person living with HIV to have sex without disclosing their HIV status?“

As part of a group of HIV advocates and researchers through the Sero Project in Milford, PA, almost all people living with HIV, we had a strong sense that public support for these criminal laws was more nuanced than the previous survey responses suggested. So we created new survey questions and asked them alongside the survey question used previously.

When we asked the original question, “should it be against the law for a person living with HIV to have sex without disclosing their HIV status?” our 3000 plus respondents, people living with and affected by HIV, showed support that mirrored that found previously (more than half thought non-disclosure should be criminalised).

But then we asked another question, of the same respondents, that gave more options. We asked: Should disclosure of one’s positive HIV status to a potential sex partner be … a norm that communities should uphold, an ethical obligation for PLHIV when safe to do so, important only when engaging in activities that pose a risk of HIV transmission, a matter for criminal or civil courts?

Suddenly, when provided with more nuanced options, support for criminalization dropped from more than half to just 11% of respondents. For those 11%, we went further and asked what kinds of penalties people ought to face for non-disclosure. While current prison sentences for non-disclosure often are 30 years or more, most respondents called for further education, counselling, and community service.

These differences – between the results from the survey question that excluded community participation, and indicated support for prosecution and incarceration of people living with HIV who are accused of non-disclosure, versus the results from the survey question created by people living with HIV, that indicated a need for counselling, education, and support – can have tremendously different effects on policy decisions about who gets prosecuted and incarcerated in our communities.

[Nothing about us, without us]

Finally, to end on a more positive note, I will describe a global research project with which I’ve been involved since 2008: the People Living with HIV Stigma Index. This project was developed by and for PLHIV and is led by an international partnership made up of the Global Network of People living with HIV, the International Community of Women living with HIV, and the Joint UN Programme on HIV and AIDS.

This project trains people living with HIV as interviewers who conduct interviews with other people living with HIV. The project focuses equally on obtaining rigorous data regarding HIV-related stigma and discrimination and on empowering local networks of people living with HIV to work together across their differences, to gain research, data literacy, and employment skills, to build relationships with national and local academics and health ministries, and to turn the resulting data into advocacy projects that challenge stigma and benefit the community. One theme throughout the project: the process is as important as the results.

Why was the project created? For one reason, it responds to a missing piece in the stigma research programme. Research focused on healthcare workers and what are known as “general populations,” in fact, everyone but PLHIV were asked about HIV stigma. The PLHIV Stigma Index fills this research gap and, crucially, recognizes that those experiencing stigma first hand have something valuable to share.

What has the PLHIV Stigma Index project achieved?

To give just a few examples: The PLHIV Stigma Index has been implemented in more than 70 countries worldwide, including recent US implementations in metropolitan Detroit and Baton Rouge and New Orleans, Louisiana. The rich data that networks have gathered in the experiences of living with HIV is used in UNAIDS reporting and as baseline data used in National AIDS Strategies around the world.

Here in Pennsylvania, the AIDS Law Project, under the direction of Ronda Goldfein, has used the PLHIV Stigma Index results to demonstrate harm caused by stigma. With this data in hand, the AIDS Law Project was able to win two separate discrimination issues in court.

In Malawi, five networks of people living with HIV worked together to advocate for care for people who are incarcerated, better anti-stigma policies. A notable success in Malawi was the removal of staduvadine (D4T) – a particularly toxic medication no longer prescribed in wealthier countries – from the national formulary.

In Estonia, the PLHIV network established the first-ever PLHIV run, stigma free, health clinic.

Everywhere the Stigma Index has been implement, we see empowerment and networking, challenges to internalized stigma, increased solidarity across different groups of people affected by HIV: gay men and other MSM, sex workers, people who use drugs, women and girls, heterosexuals, people of different faiths.

[Closing]

I tend to distrust dualisms, yet, even so, I stand by this next statement: if your research does not include those most affected by the questions you ask and the answers you receive, then your research excludes those to whom it matters most. This is not some kind of reasonable “exclusion criteria”. Rather, when engaging in research on question with social repercussions, exclusion is a refusal to accept the political and social repercussions of one’s research on people other than oneself, or to acknowledge the dignity, risk, and wisdom of those most engaged – often in physical, embodied ways and whose very lives may be at stake.

Every theory has a human price.

Deepest thanks to Professor Chris Roebuck, without whose vision this panel could not have come into being, and my sister panellists. It is truly an honour to share a stage with Waheedah Shabazz El and Cecilia Chung.

Remarks written for the “Movement to End HIV Criminalisation” panel at Concordia University, Montreal, 15 September 2016, by Laurel Sprague, Research Fellow in HIV, Gender, and Justice, HIV Justice Network.

Before beginning my remarks, allow me to note that there are so many nuances and variations in the specific instances that people face that these remarks can only scratch the surface. Still, I offer these remarks in the hope that my thoughts will add to, bring in new perspectives, and support the continuation of the dialogue already in place.

The public is often sold a compelling story about HIV criminalisation, one that fits into their ideas about how gender works and what it means to be a good citizen. People are told that criminalising people who are living with HIV and who fail to disclose that fact to a potential sex partner will protect women from acquiring HIV.

The subtext, of course, is that the people living with HIV and having sexual relationships are generally men, that the only considerations these men with HIV have are to maximize opportunities for sex, that women should be considered as passive prey for these men, and that putting a law into place will either convince men to disclose their HIV status to female partners or lock them up if it seems they have not done so, restricting their ability to transmit HIV to women, at least to other women, beyond those who bring charges.

Why are women living with HIV concerned about HIV criminalisation? If you are going to take away peoples’ freedom in my name, then you should expect that I would have something to say about that.

What I have to say is: not in my name. Do not incarcerate people living with HIV in my name.

Women living with HIV are also concerned about HIV criminalisation because, once these laws are passed, we are caught up in their dragnet. Frequently, we live in fear of prosecution, even when we closely follow the law. Too often, like our brothers living with HIV, we find ourselves facing prosecution. The same gendered impulse to “protect” women by passing laws, judges women harshly when we acquire HIV ourselves.

In Uganda, in 2014, police, accompanied by a mob, pursued nurse Rosemary Namubiro, a woman living with HIV, after an accusation that she stuck a child with a needle that might have pricked her own skin when the child flailed. Rather than responsible media coverage of the incident, Rosemary was characterized repeatedly before trial as a “killer nurse,” and a “witch” seeking to intentionally infect children. Her HIV status turned her, in the eyes of the media, society, and the legal system, from the epitome of good womanhood — a licensed nurse with decades of exemplary service — to the epitome of bad womanhood – dangerous, unrestrained, supernatural. Women living with HIV in Uganda and around the world stood with Rosemary to support her and because we knew in our bones that stigma against women living with HIV means each of us is only one accusation away a prison sentence.

The impact of these laws against women living with HIV are usually not so far away geographically. To give just a few examples, two women living with HIV, Cicely Bolden and Elisha Henson, were brutally murdered after disclosing their HIV status to a boyfriend or sexual partner. Each of their killers admitted to the murder. Each claimed that their HIV-status made the murders justifiable. When, in place after place, laws are passed requiring people with HIV to disclose their status no matter what, then we will see, place after place, further violence against women living with HIV.

Here in Quebec, a woman living with HIV went to police for protection for her and for her young son from her violent male partner. When the police arrested him, he claimed that she had HIV and had not disclosed her status to him. Despite all evidence to the contrary, he was released and she was sentenced to prison, only released in 2012 by the Canadian Supreme Court, not because the sentence was found to be unjust or unwarranted, simply due to a technicality.

Women living with HIV expect that the words of any abusive, but HIV-negative, partner will be believed over our words in a court of law.

Why do women living with HIV care about HIV criminalisation? Because we want the laws to stop condemning us to violence. We want you to stop locking us up.

In Canada, there is no HIV-specific law that criminalises people living with HIV for non-disclosure, alleged exposure or transmission. This is, seemingly, in line with the consensus from the Joint United Nations Programme on HIV and AIDS (UNAIDS), the Oslo Declaration, and multiple recommendations from other global organizations and researchers.

Global guidance, such as that released by the Global Commission on HIV and the Law in 2012, calls for an end to HIV-specific laws, citing extensive research showing that these laws fulfill no public health goals but do succeed in furthering discrimination against people living with HIV. Unfortunately for Canadians living with HIV, Canada serves as a prime example of what can go dreadfully awry even in the absence of HIV-specific laws.

In Canada, if I, as a woman living with HIV, engage in sexual intercourse with another person without disclosing my HIV status, I can be charged with aggravated sexual assault. This means that, for consensual sex with another adult, I can be charged as the worst form of rapist. In fact, I can be prosecuted for aggravated sexual assault whether or not my partner acquires HIV from me and no matter how low the risk of transmission.

In fact, as of 2012, only if I can prove both that my viral load is undetectable and that a condom was used, can I fight the charge of sexual assault. It is a chilling reality that condom use is impossible for a woman to guarantee without the cooperation of her partner and that, in Canada, women living with HIV are significantly less likely to receive the quality of care and support needed to bring their viral load to an undetectable level.

The legal leap from a claim of HIV non-disclosure to a prosecution for aggravated sexual assault is not obvious: the rationale behind this leap is that if a person has not disclosed her positive HIV-status to a sexual partner, then she has made it impossible for her partner to consent to possible sexual exposure to HIV. Without this consent, sex between them is labeled rape. Within Canada, the law goes one step further because failing to disclose one’s HIV status is also considered to be fraud. When fraud is added to the rape charge, then the charge is increased to aggravated sexual assault. The Canadian Supreme Court decided in R. v. Mabior (2012), that only when the person with HIV has both an undetectable viral load and uses a condom, are they protected from the charge of aggravated sexual assault.

Within Canada, there has been a robust feminist response to the way in which the law on sexual assault has been used to prosecute alleged non-disclosure of one’s HIV status. Briefly summarized, feminists attentive to the laws have argued that it is egregious to conflate HIV non-disclosure with rape, much less aggravated rape and that the law waters down the hard won gains in Canada regarding consent in sexual relationships. Further, feminists explain that the law is likely to discriminate against the most vulnerable and to be applied arbitrarily, pointing to cases across the country that make that very point.

Of course, there are many strands of feminism and not all Canadian feminists echo these concerns. In many ways, HIV criminalisation highlights a critical fault line amongst both feminists and queer theorists and activists. This fault line is the tension surrounding the appropriate use of State power for protection versus emancipation of people who are vulnerable to violence enacted against them by other members of society.

Women living with HIV across the world have responded to this theoretical debate with a strong assertion of our own: creating laws specifically to protect women does not work. Long practice in country after country demonstrates that equal protection under the law is rare, instead, those most marginalized in a society will be those most often targeted for incarceration. Women’s vulnerability to violence has not been, and will not be, reduced by further laws purporting to protect women

Let me situation myself in this conversation: I am a woman living with HIV, who acquired HIV shortly after my 20^th birthday during a relationship with a male partner in his late 30s. It is a common story globally of a young woman acquiring HIV from an older man. We would like to stop those things from happening, right?

What happens to the story if I add some context? What if I share that I was a sexual assault survivor from my high school years, which was traumatic, shameful, and normal within my circle of high school friends? What if I add that I was raised within a fundamentalist religious community, with the lower status as a girl and the judgment and scrutiny that exist in those communities? Does it matter that I felt safer and more protected by this partner than I had previously in my life?

So, just what is it that we would like to stop from happening?

Would locking him up solve the problem of gender inequality?

Let’s complicate the story further, with more truths: does it make a difference that he disclosed his status to me? Does it make a difference that he was also a survivor of sexual and physical assault?

Was he careful with me? No, he wasn’t. Should he go to jail? Not legally, he disclosed his HIV status. What about ethically: is this the answer?

The easy answer, the one that allows every one of our social inequalities to continue, is to say: lock him up.

Now, think to yourself: what if he hadn’t disclosed his status? Does that change anything? Everything? Could I have been any more or less empowered to advocate for my own sexual health? Could he have been any better or worse at advocating for his own well being? Neither of us was skilled at self care. Both of us were skilled at self injury.

Now, what if I went to the police and claimed the he had HIV and did not disclose?

In the United States, 25 years later, it’s likely he would still be in prison. In Canada, there is no reason to believe that he would not have served years in prison as well.

What if I claimed, instead of HIV non-disclosure, that he physically beat me or raped me (he did not)? He probably would not be prosecuted, or, if prosecuted and convicted, would not serve nearly the same sentence length. That should give up pause.

We know that exactly this scenario happens here, including here in Quebec, where the woman living with HIV, mentioned earlier, after being severely and repeatedly beaten by husband over period of years was jailed herself when she tried to prosecute him – because he alleged that she didn’t disclose her status. He walked free.

Why would we treat HIV non-disclosure more seriously than physical attacks? The question is puzzling: non-disclosure charges arise only in the context of non-coerced sexual activity between adults. In this situation, unlike physical assault, either partner could walk away or suggest condoms or other barriers. If a physical assault has happened, and the assailant is HIV-positive, then the laws on assault are more than adequate to handle that situation.

So are we, as it seems, trying to protect women and others from HIV but not from real violence enacted against their bodies? Why would that be?

If we analyse prosecutions for HIV non-disclosure with the understanding that the rhetoric about protecting women fails under examination, then what is left is naked stigma and the desire to regulate certain bodies deemed outside of the boundaries of respectable society: those bodies perceived as likely to have HIV. Notably, the only legal requirements are for those living with HIV. There are no legal requirements for those perceived to be HIV-negative to take safer sex precautions or even to have a conversation about sexual transmitted infections they or their partners might have acquired. What we see is an effort to control and punish the bodies perceived to be HIV-positive and an effort to ensure complete freedom from responsibility for those bodies perceived to be HIV-negative.

This is a situation of immense injustice. What the laws does is to scapegoat vulnerable people instead of addressing real and difficult social problems such as the gender inequality that persists across classes and countries, which make it difficult for women to protect their health and well-being and for people living with HIV to do the same. The meme of a heterosexual man living with HIV exposing an unsuspecting heterosexual woman to HIV disregards everything we know about this epidemic: that most people acquire HIV because they are themselves part of a vulnerable group; that reducing new infections happens most effectively when safer sex practices become normal rather than exceptional; that once people learn their positive HIV status, they seek to avoid transmitting to others; and that most new infections occur from transmissions between people who do not know their HIV status.

To return to my story, I tested positive for HIV after I became pregnant. Immediately, under the law, I became the person vulnerable to criminal penalties. Like so many of my male friends, my HIV diagnosis gave me the courage to come out. I remember waiting in fear for a partner to call the police. I remember the end of a short relationship when I was 24 or 25, she was angry that I didn’t want to continue the relationship. I had disclosed my status; we had practiced safer sex; I went with her to get tested and was sick to my stomach with fear she would somehow test positive. Although, I was certain that I was the only person she had ever practiced safe sex with; I was equally certain that her anger with me would motivate her to go to the police.

She did not test positive. She did not go to the police. If she had, what would have happened? Of course, luckily, we do not know. However, based on the data we have from the States, I expect I would have gone to prison.

The stigma that exists, indeed is flamed, against people with HIV would have intersected with the other marginal statuses most of us have, and then been combined with laws that single us out — laws which say to the police, judges, prosecutors, and world at large that we are a particular group of people with disregard for others, a danger, and must be controlled – these factors added together would have made my chance of being heard, of the truth being heard, minimal.

It is important to remember that the law has only one edge. The law is designed to protect the status quo. It is not revolutionary.

HIV criminalisation singles out people living with HIV — people who already face high levels of stigma and discrimination simply for having a medical condition that is associated with groups subjected to social prejudice — for criminal prosecutions for consensual sex among adults. Is this the liberation that we, as feminists, have been fighting for?

To end my remarks, allow me a moment to give credit to the Canadian HIV/AIDS Legal Network, the Positive Women’s Network-USA, the Sero Project, the International Community of Women Living with HIV, and the many other feminist people of all genders working on HIV, criminalisation, mass incarceration, gender-based violence, prison abolition, and human rights with whom I have been fortunate to have soul-searching discussions about the issues that I have addressed here. I also need to thank Edwin Bernard and the HIV Justice Network for all of these reasons and more, especially for taking the chance and hiring me to focus on the issues of gender, justice, and HIV that matter to me so deeply.

Русский текст читайте, пожалуйста, ниже

Today, Sunday, October 23, 2016, Positive Women’s Network – USA observes the third National Day of Action to End Violence Against Women Living with HIV.

This is an event to create awareness about the levels of violence faced by women living with HIV, and to mobilise action to end that violence. As PWN-USA Executive Director, Naina Khanna, describes it: for women, violence is both a cause and a consequence of living with HIV.

The 2016 Day of Action takes as its focus a pernicious form of violence: the criminalisation of women living with HIV.

From the other side of Atlantic Ocean, in Eastern Europe and Central Asia, raising attention to HIV criminalisation as a form of violence against women living with HIV presents a new angle from which to examine how both of these phenomena are understood. Let us consider this intersection, where HIV-related stigma, HIV criminalisation and gender inequality place women at greater risk of violence, maltreatment and injustice.

To date, the HIV Justice Network has documented prosecutions of women under HIV-specific laws criminalising alleged HIV non-disclosure, potential or perceived exposure, and non-intentional transmission in Russia (12 cases); Belarus (5 cases); Kazakhstan (2 cases); Kyrgyzstan (1 case); Moldova (1 case); Tajikistan (1 case); and Ukraine (4 cases). The actual number of prosecutions is certainly much higher.

Let’s take a closer look at Russia’s 12 cases against women living with HIV. In Russia, alleged HIV non-disclosure, potential or perceived exposure, and non-intentional transmission are penalized by up to a maximum of eight years in jail.

Examining the media coverage, none of these women had an opportunity to speak for herself publicly, and at least half of them were subjected to public ‘slut shaming’ in the media because it was alleged they had multiple intimate partners.

The other half of the women were prosecuted by their intimate male partners. The language of the publications depicts the women as irresponsible and unaccountable subjects, highlights their neglect of barrier contraception measures and of their responsibility to disclose, and characterises the women as the ‘source of HIV transmission’. Although it seems that the media were trying to be sympathetic toward these women, the media authors fail to excite pity with stories by adding details about their poor state of health, bearing children a young age, and/or that they pleaded guilty.

Stigma and discrimination, particularly where women’s moral conduct is judged, play a major role in the severe social and physical consequences that women suspected of being HIV-positive can face, impacting media, the legal system and community.

HIV-related stigma and discrimination switches the media’s focus away from the perpetrators of sexual violence and their punishment to speculations about the culpability of a woman-survivor.

HIV-related stigma and discrimination creates HIV-specific laws based on the assumption that women living with HIV are potential perpetrators in need of state control.

HIV-related stigma and discrimination impacts how communities see women living with HIV, potentially legitimizing even murder. This is especially relevant to religious and traditional communities, where the whole family may feel shamed because of the HIV-status of a female family member, and may fuel higher levels of domestic violence, but it goes beyond this.

In Russia, with its 400,000 women who have tested HIV-positive, the fear of partner violence persists as a daily reality. NGOs assess the number of sexual assaults and gender-based violence crimes against women- as 30,000 – 50,000 per year with only 10% of them reported to the police. In the Russian People Living with HIV Stigma Index study, one-fifth of the people with HIV who faced violence said it was perpetrated by their partner.

Indeed, starting from 2007, we have documented at least eight cases of brutal killings of women who either disclosed their HIV-positive status to their partners or were alleged by the killers or police to be HIV-positive. Thus, non-disclosure might be a coping strategy that women develop to try to survive against violence at home, while simultaneously risking prosecution as criminals because of the criminalisation of HIV non-disclosure.

Similarly, in Belarus, the five women who were prosecuted under HIV criminal laws were characterised in the media as frivolous women of easy virtue, alcohol abusers, and unable to take measures to prevent HIV transmission. Given that two of them were prosecuted for potential or perceived HIV exposure, although no transmission occurred, it is important to see how the prosecution started: the women informed their lovers of their HIV status after the sexual activity. In all media reports and comments by the prosecutor’s office, the women were depicted as those actively taking steps to transmit HIV to others; all are described in an active voice as criminals. In Belarus, law enforcement registers a low number of cases of violence against women along with high rates of women dying from violence at home, women with HIV were much more likely to report being physically abused by their spouses and partners.

In Ukraine, at least four women were prosecuted both for HIV transmission to their intimate partners or to both to their partners and their children, and for HIV exposure. There has been a glimmer of hope and reason from Ukraine, however, which might represent a less punitive turn since 2011.

We recently received information about a case in which a woman, accused of alleged non-disclosure, was acquitted. The court argued that “the relations that developed between the partners in their nature was about HIV exposure. Firstly, the crime didn’t constitute the HIV exposure, but only actions that could have been considered as exposure. Second, the pre-trial investigation and the prosecutor falsely assigned responsibility for creating such a threat of exposure to the accused.”

Further, the verdict found that the guilt of the sexual partner of the HIV-positive defendant in creating the threat of HIV exposure was greater than the guilt of the defendant, given that he was 16 years older than her, had more experience, including in relationships with women and had children from different women, and was characterized as having a promiscuous sexual behaviour. Overall, in Ukraine, the courts tended to respond to HIV criminalisation cases against women by reducing the penalty from time in prison to a suspended sentence.

In Kazakhstan, a woman living with HIV from Karaganda, was taken by the police to the AIDS Center to force her to take antiretroviral medication during her pregnancy. The media response discussed only the public health perspective, making the woman appear irrational and uncaring toward her baby. The media said nothing about the reasons why the woman was avoiding treatment, failed to give her a voice, and provided no information about whether social and psychological services were offered to her prior to police involvement.

Further, as documented by us, women in Kazakhstan, Kyrgyzstan and Tajikistan who are marginalized because they do sex work, have been disproportionately targeted by police, and found themselves subjected to forced HIV testing.

The criminalisation of sex work along with public characterisations of sex workers as ‘latent reservoirs for HIV’, sets sex workers up for police harassment, arrest, and unwarranted seizures in the name of public health.

In Kazakhstan, Almaty police identified 98 sex workers as HIV-positive and conducted a search for their clients. However, it remains unknown if the search brought further charges.

In Kyrgyzstan, the practice of illegal HIV testing in association with police raids on sex workers persists. Law enforcement personnel, in order to provide for the formal requirements of the law, summon AIDS center staff members, who obtain written consent to HIV testing under conditions of arbitrary detention. There are also known cases where the police detained sex workers and illegally sent them for forced medical testing, including for STIs and HIV.

Similarly, in Tajikistan, 505 sex workers were detained and forced to undergo HIV and STI testing. Community organizations report that often the test results are disclosed in front of other detainees and police staff.

One way or another, all of these can be also framed in terms of structural or cultural violence, in which social structures are used to justify direct violence or situations that drastically increase the vulnerability of women living with HIV to violence.

In the cases that we know, HIV-related stigma and HIV criminalisation evolve to a form of cultural violence that makes the communities and media audiences feel ‘right’ about blaming the women with HIV who experience an HIV-related prosecution, making this acceptable in our societies.

There is no doubt that gender shapes HIV disclosure motivations and reactions. Disclosure is not a gender-neutral event because women face the possibility of increased violence afterwards. It is an impossible choice: choosing between the immediate need to protect themselves from partner violence, or a risk that they can go to prison for alleged HIV non-disclosure, exposure, or transmission.

No matter where it occurs, it is time to claim justice for women living with HIV.

Evgenia Maron is the HIV Justice Network’s EECA Consultant

The HIV Justice Network is a founding partner of HIV Justice Worldwide, together with the Positive Women’s Network-USA, AIDS Rights Alliance of Southern Africa (ARASA), the Sero Project, the Canadian HIV/AIDS Legal Network, Global Network of People Living with HIV (GNP+), and the International Community of Women Living with HIV (ICW). More information about HIV Justice WorldWide is available here.

Сегодня, в воскресенье, 23 октября 2016 года, “Сеть позитивных женщин – США” объявила третий Национальный день действий для прекращения насилия против женщин, живущих с ВИЧ.

Этот день предназначен для повышения осведомленности о насилии, с которыми сталкиваются женщины, живущие с ВИЧ, а также для мобилизации и действий по прекращению насилия. Как отмечает исполнительный директор PWN-США, Наина Кханна: “Для женщин, насилие является как причиной, так и следствием жизни с ВИЧ”.

В 2016 году темой дня выбрана губительная форма насилия – криминализация женщин, живущих с ВИЧ.

По другую сторону Атлантического океана, в Восточной Европе и Центральной Азии, повышение внимания к проблеме криминализации ВИЧ как одной из форм насилия против женщин, живущих с ВИЧ, представляет собой новый взгляд на исследования, обсловленный тем, как понимаются оба эти явления. Рассмотрим это пересечение, где стигма в связи с ВИЧ, криминализация ВИЧ и гендерное неравенство помещают женщину в ситуацию наибольшего риска насилия, жестокого обращения и несправедливости.

На сегодняшний день Сеть “Правосудие и ВИЧ” задокуменитировала случаи судебного преследования женщин в рамках ВИЧ-специфических законов, вводящих уголовную ответственность за предполагаемое неразглашение ВИЧ-статуса, потенциальную или воспринимаемую постановку в опасность заражения и ненамеренную передачу в России (12 случаев); Беларуси (5 случаев); Казахстане (2 случая); Кыргызстане (1 случай); Молдове (1 случай); Таджикистане (1 случай); и в Украине (4 случая). Фактическое число судебных дел, несомненно, гораздо выше.

Давайте подробнее рассмотрим 12 российских случаев преследования женщин, живущих с ВИЧ. В России предполагаемое нераскрытие ВИЧ-статуса, потенциальная или воспринимаемая постановка в опасность заражения и ненамеренная передача ВИЧ наказываются максимальным сроком до восьми лет в тюрьме.

В результате изучения публикации в СМИ можно сделать вывод, что ни одна из этих женщин не имела возможность говорить за себя публично, и, по крайней мере, половина из них были подвергнуты публичному «слатшеймингу» в СМИ, так как утверждалось, что они имели несколько интимных партнеров.

Другая половина женщин была привлечена к ответственности своими интимными партнерами-мужчинами. Язык публикаций изображает этих женщин как безответственных и немотивированных субъектов, подчеркивает их пренебрежение барьерными мерами контрацепции и своей ответственностью за раскрытие диагноза, и характеризует этих женщин как «источник передачи ВИЧ-инфекции». Хотя кажется, что СМИ пытаются вызвать симпатию к этим женщинам, авторам не удается пробудить жалость рассказами об их плохом состоянии здоровья, рождении детей в молодом возрасте, и / или тем, что они признали свою вину.

Стигма и дискриминация, особенно если судят безнравственное поведение женщин, играют важную роль в тяжелых социальных и физических последствиях, с которыми могут столкнуться женщины, подозреваемые в том, что они ВИЧ-инфицированы, оказывают влияние на мнение СМИ, правовой системы и общества.

Стигма и дискриминации в связи с ВИЧ переключают внимание СМИ от лиц, совершивших сексуальное насилие, и их наказания к спекуляциям о виновности женщины, пережившей насилие.

Стигма и дискриминация в связи с ВИЧ создают определенные законы, основанные на предположении, что женщины, живущие с ВИЧ, являются потенциальными злоумышленниками, над которыми необходим государственный контроль.

Стигма и дискриминация в связи с ВИЧ влияют на то, как общество смотрит на женщин, живущих с ВИЧ, потенциально оправдывая даже убийство. Это особенно актуально для религиозных и традиционных общин, где вся семья может быть опозорена из-за ВИЧ-статуса члена семьи женского пола, а также может повысить уровень насилия в семье, и даже больше.

В России для 400 000 женщин, которые оказались ВИЧ-инфицированными, страх насилия со стороны партнера стал повседневной реальностью. НПО оценивают число сексуальных нападений и гендерных преступлений, связанных с насилием в отношении женщин, в 30 000 – 50 000 ежегодно, и только о 10% из них сообщают в полицию. В исследовании “Индекс стигмы” среди российских людей, живущих с ВИЧ, одна пятая часть людей, живущих с ВИЧ, которые столкнулись с насилием, отметили, что оно было совершено их партнером.

Действительно, начиная с 2007 года, мы задокументировали по меньшей мере восемь случаев жестоких убийств женщин, которые либо сообщили о своем ВИЧ-позитивном статусе своим партнерам или якобы обладали ВИЧ-положительным статусом по мнению убийц или полиции. Таким образом, нераскрытие диагноза может быть копинг-стратегией, которую женщины приобретают, чтобы попытаться выжить после домашнего насилия, одновременно рискуя подвернуться преследованию как преступники из-за криминализации нераскрытия ВИЧ-статуса.

Аналогичным образом, в Беларуси пять женщин, которые были привлечены к ответственности в соответствии с уголовным законодательством о ВИЧ, были охарактеризованы в СМИ как легкомысленные женщины легкого поведения, злоупотребляющие алкоголем, которые были не в состоянии принять меры по предотвращению передачи ВИЧ-инфекции. Учитывая, что двое из них были привлечены к ответственности за потенциальную или предполагаемую постановку в опасность заражения ВИЧ, заражения как такового не произошло, важно рассмотреть, как началось преследование: женщины проинформировали своих любовников о своем ВИЧ-статусе после сексуальной активности. Во всех сообщениях СМИ и комментариях прокуратуры женщины изображались так, как будто они активно принимают меры для передачи ВИЧ другим; все описаны как активно действующие преступники. В Беларуси, где правоохранительные органы регистрируют низкое число случаев насилия в отношении женщин, наряду с высокими показателями смертности женщин от домашнего насилия, женщины с ВИЧ были гораздо более склонны сообщать о физическом насилии со стороны своих супругов и партнеров.

В Украине по меньшей мере четыре женщины подверглись преследованию за передачу ВИЧ своим интимным партнерам или своим партнерам и детям и за постановку в опасность заражения. Можно сказать, что в Украине есть проблеск надежды и разума, однако, что проявляется в менее карательном подходе с 2011 года.

Недавно мы получили информацию о случае, в котором женщина, обвиняемая в предполагаемом нераскрытии статуса, была оправдана. Суд утверждал, что “отношения, которые сложились между партнерами по своей природе были связаны с постановкой в опасность заражения ВИЧ. Во-первых, преступление не представляет собой постановку в опасность ВИЧ, а только действия, которые могли бы рассматриваться в качестве постановки в опасность. Во-вторых, предварительное расследование и прокурор ложно возложили ответственность за создание такой угрозы на обвиняемую”.

Кроме того, в приговоре говорится, что вина полового партнера ВИЧ-положительной ответчицы в создании угрозы заражения ВИЧ была больше, чем вина обвиняемой, при условии, что мужчина был на 16 лет ее старше, у него было больше опыта, в том числе в отношениях с женщинами, он имел детей от разных женщин, и характеризовался как ведущий беспорядочную сексуальную жизнь. В целом, украинские суды, как правило, реагируют на случаи криминализации ВИЧ в отношении женщин, уменьшая подожительность наказание в местах лишения свободы и заменяя на условный приговор.

В Казахстане, женщину, живущую с ВИЧ, из Караганды, полиция силой доставила в Центр СПИДа, чтобы принимать антиретровирусные препараты во время беременности. СМИ осветили случай только с точки зрения общественного здравоохранения, что вынуждает женщину казаться иррациональной и безразличной к своему ребенку. СМИ ничего не рассказывают о причинах, почему женщина избегала лечения, не дают ей говорить за себя, не предусматривают никакой информации о том, были ли ей предложены социальные и психологические услуги до вмешательства полиции.

Кроме того, как задокументировано нами, женщины в Казахстане, Кыргызстане и Таджикистане, которые являются маргинализованными, потому что они занимаются секс-работой, несоразмерно подверглись преследованиям полиции и принудительному тестированию на ВИЧ.

Криминализация секс-работы наряду с общественной характеристикой секс- работников как «латентных резервуаров для ВИЧ», делает секс-работников беззащитными перед произволом сотрудников полиции, арестами и неоправданными задержаниями во имя общественного здоровья.

В Казахстане, полиция Алматы выявила 98 секс- работников как ВИЧ-положительных и провела поиск их клиентов. Однако, остается неизвестным, были ли выдвинуты дополнительные обвинения в результате этого поиска.

В Кыргызстане продолжается практика незаконного тестирования на ВИЧ секс-работников в связи с рейдами полиции. Сотрудники правоохранительных органов, чтобы соответствовать формальным требованиям закона, вызвали сотрудников Центра по борьбе со СПИДом, которые получили письменное согласие на тестирование на ВИЧ в условиях произвольного задержания. Также известны случаи, когда полиция задерживала секс-работников и противозаконно отправляли их на принудительное медицинское тестирования, в том числе на ИППП и ВИЧ.

Кроме того, в Таджикистане, 505 секс- работников были задержаны и вынуждены пройти тестирование на ВИЧ и ИППП. Организации сообщества знают о случаях, когда полиция задерживала секс-работников, незаконно отправляла их на принудительное медицинское обследование, включая ИППП и ВИЧ.

Так или иначе, все это также можно выразить в терминах структурного или культурного насилия, в котором социальные структуры используются, чтобы оправдывать прямое насилие или ситуации, которые кардинальным образом увеличивают уязвимость женщин, живущих с ВИЧ, перед насилием.

В случаях, которые нам известны, стигма в связи с ВИЧ и криминализация ВИЧ приобретают форму культурного насилия, которое заставляет общество и аудиторию СМИ чувствовать себя «правыми», когда обвиняемые женщины, живущие с ВИЧ, подвергаются преследованию в связи с ВИЧ, делая это приемлемым в нашем обществе.

Нет сомнений в том, что гендер определяет мотивацию для раскрытия ВИЧ-статуса и реакции на это. Раскрытие ВИЧ не является гендерно-нейтральным событием, потому что впоследствии женщины сталкиваются с возможностью возросшего насилия. Это невозможный выбор: между немедленной необходимостью защитить себя от насилия со стороны партнера или рисковать тем, что они могут попасть в тюрьму за предполагаемое нераскрытие ВИЧ, постановку в опасность заражения или передачу ВИЧ.

Неважно, где это происходит, пришло время потребовать справедливости для женщин, живущих с ВИЧ.

Евгения Марон – консультант сети “Правосудие и ВИЧ” в Восточной Европе и Центральной Азии

Сеть “Правосудие и ВИЧ” – партнер-основатель инициативы “Правосудие и ВИЧ во всем мире”, вместе с “Сетью позитивных женщин – США”, Альянсом по СПИДу и правам с Южной Африке (ARASA), и “Серо Проджект”, а также Канадской правовой сетью по ВИЧ/СПИду, Глобальной сетью людей, живущих с ВИЧ (GNP+), и Глобальной сетью женщин, живущих с ВИЧ (ICW). Больше информации об инициативе “Правосудие и ВИЧ во всем мире” доступно здесь.

Русский текст читайте, пожалуйста, ниже

On May 30 this year, a publication appeared in the Russian media with a sensational headline: in Dagestan, police stated that unknown men killed a woman after suspecting her of transmitting HIV to others.

Without any explanation of why the police would claim knowledge of a motive when the killers are unknown and without any verification of the claim that the woman transmitted HIV or even knew of her HIV status, the story was reproduced with the same allegations in over 30 Russian newspapers, and even made it to the UK right-wing tabloid, The Daily Mail.

Although the men were unnamed, the publications disclosed the identity of the murdered young woman as Tangaru Ramazanova, 25, from the city of Kizlyar in Russia’s southwestern Republic of Dagestan.

According to the police, she was beaten and stabbed repeatedly. She was found with her body wrapped in plastic and dumped close to the Terek River. Rather than focusing on the brutality of her murder, the stories focused on her alleged HIV status and cast aspersions against her moral character.

No report examined whether she actually was HIV-positive or whether the allegations were, in fact, true.

No report discussed concepts of mutual responsibility or safer sex or, most notably, countered the narrative that legitimized her murder.

Underlying the human tragedy for Tangaru and her family is Russia’s stigmatizing Article 122 which, in direct contradiction to global recommendations on HIV and the law, characterizes sexual contact involving a person living with HIV as a criminal act on the part of the person living with HIV unless proven otherwise. This national law, as in 72 other countries, creates a legal and social environment within which a person who is HIV-positive faces assumptions that she has somehow brought any violent or damaging actions upon herself.

This case in Dagestan is not an isolated event in which violence against women, or violence specifically against women (apparently) living with HIV, is publicly justified in the North Caucuses.

In this region of Russia alone, women’s NGOs and individual women’s rights activists report that women have been victims of ‘honour killings’, bride kidnappings, forced and child marriage and other traditional practices for the past 20 years, exacerbated by a climate of lawlessness, impunity and corruption. Norms, upholding patriarchy, deny women and girls full legal personhood for their entire lives, deprive them of property and inheritance rights, enshrine men’s control over women’s lives and bodies, and treat many forms of violence against women as permissible and justified ‘punishment’.

Mari Davtyan, a Human Rights Lawyer working on issues of violence against women in Russia, describes the connections between this murder, HIV stigma, and patriarchal control:

“Taking into account the experience of my colleagues there, there is a suspicion that a possible HIV status is just a horror story, which can justify the killing of women. There allegation communicated by the source of the media report that she was killed for transmitting HIV to somebody has now become a comfortable story, defining an approach to the investigation, looking for an excuse for the criminal. So called ‘honour killings’ are not always ‘honour killings’, as it is men alone who decide in the North Caucasus whether it is an honour killing or not. I’m pretty sure that the killer(s) will not be found.

The horror is that that the woman was completely dehumanised, because someone who has HIV is not (perceived to be) a person, and thus we are not looking for someone who infected or killed her. This is only possible in a relation to a woman; a man cannot be punished for the same thing. Women living with HIV are exposed to strong stigma, especially in the North Caucasus. In Dagestan, the public disclosure of her name is a great stigma on the family. It demonstrates well that, if a woman has HIV, one can justify anything, from shaming to killing. In the eyes of society, a woman (with HIV) is vicious, not a man.”

Outside the North Caucus region, a similarly concerning case took place in Moscow.  The media published a story on a group rape of a young HIV-positive woman who pleaded with the perpetrators to stop as she had HIV. Rather than a story about the crime of rape, the media focus was on the HIV status of the rape survivor. There is no reason other than HIV stigma that could make journalists present this case, not as a rape case, but as a story focused on the potential harm faced by the perpetrators. Some of the media reports go so far as to claim that all of the perpetrators tested HIV-positive after the rape, but there is no analysis or confirmation of this. Instead, the media focused on whether the woman might be culpable for potentially transmitting HIV to her attackers, as HIV transmission is punishable, with up to eight years in prison for infecting two or more persons, under Article 122 of the Russian Criminal Code.

In both of these recent cases, stigma around HIV proved stronger than all the horror of the facts: the readers’ attention is switched to the girls’ behaviour and possible – not proved – risk to male “others.”  In Tangaru Ramazanova’s murder, the killing is ‘justified’ by claims that the killers were ‘provoked’ by her because of an assumption that she lived an “immoral” lifestyle. Like the woman raped in Moscow, Tangaru, who can no longer speak for herself, is presented as a contagious person who transmitted HIV to others.

The narrative about both women serves to reduce the severity of punishment deemed appropriate for the perpetrators and to reduce the pressure on the police to identify or charge the perpetrators. At the same time, the narrative limits any space for discussions of the effects of HIV-related stigma and discrimination multiplied by gender inequality.

HIV stigma is so great in Russian societies that it becomes a tool to further control and terrorize women. The particular beliefs in traditional societies about women’s lower status and their obligation to symbolize family and community morality, combined with HIV stigma, becomes deadly.

The focus of Russia’s HIV response should be on ending deaths, stigma, discrimination and suffering. However, the power of HIV stigma is that it does not matter who committed the crime when the police, the killers and the media, all are convinced that people living with HIV are bad, immoral people. HIV stigma appears to justify murder.

HIV-specific laws, such as Russia’s Article 122, cement a stigma-laden view of people with HIV within the criminal code. Here, gender inequality and the HIV criminalisation law come together to create this dangerous environment, where violent acts target a specific group: women living with HIV — because they are women and they live with HIV.

Russia’s HIV-specific law contributes much to this stigma; rather than empowering women to enjoy human rights, this law victimizes, oppresses and endangers women; rather than offering women protection and justice in the face of violence, this law legitimizes their murder.

Evgenia Maron is the HIV Justice Network’s EECA Consultant

ВИЧ-стигма: терроризируя женщин в российских традиционных общинах

30 мая этого года в российских СМИ появилась публикация с сенсационным заголовком: в  Дагестане полиция заявила, что неизвестные мужчины убили женщину, подозревая её в распространении ВИЧ.

Без каких-либо объяснений, почему полиция утверждает, что знает мотив, когда убийцы неизвестны, без какой-либо проверки информации, что женщина передала ВИЧ или вообще знала о своём ВИЧ-статусе, историю с такими же обвинениями воспроизвели более 30 российских газет, она даже попала в таблоид правого толка в Великобритании, The Daily Mail.

Хотя мужчины остались неназванными, в публикации раскрывается личность убитой молодой женщины: Тангару Рамазанова, 25 лет, из города Кизляр на юго-западе российской республики Дагестан.

По данным полиции, её многократно избивали и резали. Она была найдена выброшенной неподалёку от реки Терек, тело, завёрнутое в пластик. Вместо того, чтобы говорить о жестокости её убийства, новости были сосредоточены на её предполагаемом ВИЧ-статусе и выдвигали обвинения в аморальности её репутации.

Ни в одной истории не изучался вопрос, была ли она ВИЧ-позитивной на самом деле, были ли эти утверждения, по сути, верными.

Ни в одной истории речь не шла о концепции взаимной ответственности или о безопасном сексе, в первую очередь, этому противопоставлялся нарратив, который оправдывал её убийство.

В основе человеческой трагедии Тангару и её семьи – российская стигматизирующая статья 122, которая прямо противоречит глобальными рекомендациями по ВИЧ и законодательству, характеризуя сексуальный контакт с участием человека, живущего с ВИЧ, как преступное деяние со стороны человека, живущего с ВИЧ, если не доказано иное. Такое национальное законодательство, как и законы ещё 72 стран, создаёт правовую и социальную среду, в которой человек, который является ВИЧ-позитивным, сталкивается с подозрением, что она каким-то образом осуществила какие-то насильственные или прочие наносящие ущерб действия.

Этот случай в Дагестане не является единичным случаем, в котором насилие в отношении женщин, или насилие конкретно в отношении женщин (предположительно), живущих с ВИЧ, публично оправдывается на Северном Кавказе.

Только на основе данных из этого региона России, женские НГО и активисты, которые защищают права женщин, сообщают, что женщины были жертвами “убийств чести”, похищений невест, брака без согласия и детского брака и других видов традиционных практик за последние 20 лет, усугубляется обстановка беззакония, безнаказанности и коррупции. Нормы, поддерживающие патриархат, отказывают женщинам и девочкам в полной юридической право- и дееспособности на протяжении всей их жизни, лишают их прав собственности и наследования, закрепляют мужской контроль над жизнью и телом женщины, считают разные формы насилия в отношении женщин допустимыми, оправдывают «наказание».

Мари Давтян, юрист, который работает в области прав человека, в частности по вопросам насилия против женщин в России, описала связь между этим убийством, ВИЧ-стигмой и патриархальным контролем:

 “Принимая во внимание опыт моих коллег там, есть подозрение, что предполагаемый ВИЧ-статус – просто страшилка, которая может оправдать убийство женщин. Подозрения, которыми источник делится со СМИ , что она была убита за передачу ВИЧ кому-то, теперь становятся удобной историей, которая определяет подход следствия, ищется повод для оправдания преступника. Так называемые “убийства чести” – не всегда “убийства чести”, так как только мужчины на Северном Кавказе решают в одиночку, является ли это “убийством чести” или нет. Я вполне уверена, что убийца(ы) не будет(ут) найден(ы).

Ужас в том, что, что женщина была полностью дегуманизирована, потому что кто-то, у кого есть ВИЧ, не воспринимается как человек, не является человеком, и, таким образом, мы не ищем тех, кто заразил или убил её. Это возможно только по отношению к женщине; мужчина не может быть наказан за то же самое. Женщины, живущие с ВИЧ, подвергаются сильной стигматизации, особенно на Северном Кавказе. В Дагестане, публичное раскрытие её имени – очень большое клеймо для семьи. Это хорошо демонстрирует, что если у женщины есть ВИЧ, можно оправдать что угодно, от посрамления до убийства. В глазах общества, женщина (с ВИЧ) порочна, но не мужчина.”

За пределами Северного Кавказа такой же вопиющий случай произошёл в Москве. СМИ опубликовали историю о групповом изнасиловании молодой ВИЧ-позитивной женщины, которая умоляла преступников остановиться, так как у неё была ВИЧ-инфекция. Вместо того, чтобы опубликовать новость о преступлении –  изнасиловании, – в центре внимания СМИ оказался ВИЧ-статус женщины, пережившей изнасилование. Нет никаких оснований, кроме ВИЧ-стигмы, которые могли бы заставить журналистов представить этот случай не как случай изнасилования, а как историю с акцентом на потенциальном вреде, с которым столкнулись преступники. Некоторые из сообщений СМИ заходят настолько далеко, чтобы утверждать, что все преступники оказались ВИЧ-позитивными после изнасилования, но нет никакого анализа или подтверждения этого. СМИ сосредоточены на том, может ли женщина быть виновной в потенциальной передаче ВИЧ нападавшим, поскольку передача ВИЧ наказуема сроком до восьми лет тюрьмы за заражение двух или более лиц в соответствии со статьёй 122 Уголовного кодекса Российской Федерации.

В этих недавних случаях, стигма в отношении ВИЧ оказалась сильнее, чем весь ужас фактов: внимание читателей переключилось на поведение девушек и возможных – не доказанных, – рисков для “других” мужского пола. В деле Тангару Рамазановой, её убийство “оправдывается” утверждениями, что убийцы были “спровоцированы” ею из-за предположения, что она вела “аморальный” образ жизни. Как женщина, изнасилованная в Москве, Тангару, которая уже не может высказаться от собственного имени, предстаёт как заразный человек, который передавал ВИЧ другим.

Два этих нарратива о женщинах служат для уменьшения тяжести наказания, которое целесообразно для преступников, и снижения давления на полицию, чтобы та нашла и привлекла преступников к ответственности . В то же время, эти нарративы ограничивают любое пространство для обсуждения последствий стигмы и дискриминации в отношении ВИЧ, умноженной на гендерное неравенство.

Стигматизация ВИЧ настолько велика в российском обществе, что становится инструментом для ещё большего контроля и террора в отношении женщин. Конкретные верования в традиционных обществах о более низком положении женщины и её обязанности символизировать семью и мораль общества в сочетании с ВИЧ-стигмой становятся смертельными.

В центре внимания мер по борьбе с ВИЧ в России должно быть прекращение смертей, стигмы, дискриминации и страданий. Тем не менее, сила стигмы в отношении ВИЧ в том, что не имеет значения, кто совершил преступление, когда полиция, убийцы и средства массовой информации, все убеждены в том, что люди, живущие с ВИЧ, – это плохие, безнравственные люди. Стигматизация ВИЧ в таком случае оправдывает убийство.

ВИЧ-специфические законы, такие как российская статья 122, накрепко цементируют предвзятое восприятие людей, живущих с ВИЧ, в рамках уголовного кодекса. Здесь гендерное неравенство и криминализация ВИЧ соединяются воедино, создавая эту опасную среду, где насильственные действия нацелены на определённую группу: женщины, живущие с ВИЧ, – потому, что они женщины, и потому, что они живут с ВИЧ.

ВИЧ-специфическое законодательство России вносит серьёзный вклад в эту стигму; вместо того, чтобы развивать потенциал женщин, чтобы они могли пользоваться своими правами, этот закон делает женщину жертвой, подавляет и ставит её в опасность; вместо того, чтобы предложить женщине защиту и правосудие в ситуации насилия, этот закон оправдывает её убийство.

Евгения Марон является консультантом сети “Правосудие и ВИЧ” в регионе ВЕЦА

(R-L) Paul Kidd, Trevor Hoppe, Edwin Bernard and Nicholas Feustel in front of some of the many posters on HIV criminalisation presented at AIDS 2016

Participants at AIDS 2016 saw a remarkable number of posters on HIV criminalisation and legal reform, with 22 posters presented, providing data and strategies from 19 countries, three regions, and the global response. While the conference included some strong panels that focused on advocacy and legal environments, for the most in-depth information on movements to address HIV criminalisation and other human rights abuses, the action was in the poster hallways.

Of these posters, eight focused specifically on HIV criminalisation.  The poster on “Global Trends in HIV Criminalisation”, documented 72 countries with HIV-specific criminal laws, including 2 recent, overly broad, criminal laws passed in Uganda (2014) and Nigeria (2015). Between April 2013 and October 2015, 313 arrests and prosecutions were identified in 28 countries, with the highest numbers of arrests occurring in Russia, US, Belarus, and Canada (see Advancing HIV Justice 2 for more details).

From Victoria, Australia, Paul Kidd and colleagues described the successful advocacy process they followed to repeal the discriminatory HIV law. Their strategy for success combined four key factors: drawing attention to the disproportionately high numbers of prosecutions in Victoria, combined with international attention resulting from the AIDS 2014 conference, plus joining their efforts to the momentum from the global movement to end HIV criminalisation, with, above all, dedicated and strategic local activists willing to work tirelessly with parliamentarians, judges, and other civil society organizations.

download all the posters in one pdf file here

The role of scientific evidence in legal reform was highlighted in Kazatchkine and colleagues’ description of a scientific consensus statement on HIV and the criminal law by 6 Canadian scientists and clinicians. Organized to counter the troubling 2012 Canadian Supreme Court interpretation of the law, the consensus statement has been successful in mobilizing experts (with 75 expert sign-ons) and in gaining lower court decisions to reduce or drop HIV C charges.

Disparities in the use of the criminal law on HIV against racial and key population groups were the focus points of two posters from the US: in a study of HIV-specific laws in five Southern and Midwestern states, African American men with HIV received prison sentences that were three years longer, on average, than those to which white men were subjected; an examination of California’s HIV-specific laws found that sex workers were charged in 95% of the cases and were found guilty 100% of the time.

Another two posters closely examined the provisions of specific criminal laws.  Eba and colleagues found that 24 of the 26 laws passed in the last 15 years in sub-Saharan Africa contained provisions that ran contrary to the six guidelines in the 2013 UNAIDS guidance note on ending overly broad HIV criminalisation. The most frequent problematic provisions were those that allowed prosecutions even if the person with HIV: did not know her/his status, was on effective treatment or had a low viral load, disclosed her/his status, or used a condom. Further, in 16 countries, the provisions of the law were so vague that women could be charged for HIV transmission to their children during pregnancy, delivery, or breastfeeding.  An analysis of the French law by Celse and colleagues showed similarly problematic provisions, namely, that the law allows prosecution in the absence of transmission and that, although condom use can be a defense, neither disclosure, consent, nor the lack of knowledge of one’s HIV status are total defenses under French law.

Posters from Jamaica and from Canada examined strategies for legal reform. These provide lessons for HIV criminalisation movements: through a description of the on-going legal challenge in Jamaica to prohibit LGBT discrimination by private actors (the media, in this case), Tomlinson and Elliott demonstrated the importance of long-term vision, funding, and ability to sustain the struggle. From Canada, Hon Chu and colleagues described the byzantine process of legal reform for sex workers. The message for marginalized groups: be prepared for a long struggle, maintain strong ally relationships, and recognize that two steps back may follow one step forward.

While not specific to HIV-criminalisation, six posters discussed tools for legal reform.

• Strategic litigation was the focus of work supported by OSF. This poster highlighted lessons learned — lessons that could be useful for challenges to HIV criminal laws – including to integrate strategic litigation into a longer-term advocacy strategy, to build a broad partnership base in social movements and with health and economics experts; to consider incremental approaches to litigation; and to develop an implementation plan before litigation starts.
• Other posters focused on the use of “mapping” legal environments and successes in using the resulting evidence for empowering rights holders (multiple African countries), challenging discriminatory HIV laws (DR Congo), and passing protective laws against gender-based violence (in Nigeria).
• In a close look at advocacy to combat anti-LGBT laws, two posters supported by UNDP highlighted the critical importance of creating national multi-stakeholder groups –including people living with HIV, key populations, civil society organizations, UN agencies, academics, lawyers, and others – who can respond rapidly to engage parliamentarians and ministries of justice. One notable success of these groups is found in DR Congo and Burkina Faso: after a strong stakeholder group in DR Congo fought back a bill to criminalise same-sex sexual relationships in 2013, the same stakeholder group was able to reconvene quickly to assist their peers in Burkina Faso: LGBT, HIV, and UN stakeholders, to fight back a similar proposed bill in 2015.

An additional five posters shared strategies for providing legal services and knowledge of rights for marginalized groups of people, including:

• The REAct programme, supported by the International HIV/AIDS Alliance in Myanmar, Lebanon, Uganda, Senegal, South Africa and Zimbabwe, which allows online reporting of human rights violations and links those who report these violations to legal and social support.
• Programmes supported by the Open Societies Foundation and by the International Development Law Organization, as well as a provincial project by COCQ-SIDA in Quebec, Canada, to bring legal assistance into communities and increase rights education to people from key populations as well as to those working in legal and health systems.

A final group of posters shared important work linking punitive legal environments to negative health outcomes for people who are members of key populations groups:

• In Burundi and Nigeria, anti-gay legislation has led to stigma and discrimination in health care facilities and resulting avoidance of care by LGBT people (Burundi) and increased HIV prevalence among gay men and other MSM, avoidance or delays in accessing health care for STI symptoms, and coercion to pay double or more costs for health care to avoid being reported to the police (Nigeria).
• In South Africa, researchers measured the differences in the numbers of human rights violations against people who inject drugs, between 2 cities with vocal political and community resistance to needle and syringe exchange programmes (NSP) and one city without this resistance. The cities with resistance had higher numbers of human rights violations (confiscation of injecting equipment, arrest without cause, and physical assault) and decreased numbers of people accessing NSP services.

HIV Criminalisation and Justice Posters at AIDS 2016 by HIV Justice Network on Scribd

By Laurel Sprague Ph.D.

Global Research Fellow on HIV, Gender, and Justice, HIV Justice Network

As the dust settles from the 2016 High Level Meeting on Ending AIDS, our communities need to take stock of where we are now and what we have to work with in the 2016 Political Declaration[1].

This blog post, focused primarily on the paragraphs dealing with legal environments, is one contribution to that effort.

Good analyses are available already about the overall advances and inadequacies in the Declaration; the disregard for the leadership of key populations and the refusal to call for protective legal environments or anti-stigma initiatives from MSMGF[2] and GNP+[3]; and the importance of realising the commitments on access to medicines from MSF[4].

Communities have been united overall in our resistance to the Political Declaration’s claim to be part of “a virtuous cycle of progress” in responding to HIV/AIDS. However, when it comes to support for enabling legal environments, we can identify progress from the 2011 Political Declaration[5] to the 2016 Declaration.

In 2016, the UN Member States greatly increased their focus on the role of laws and policies in the HIV response.

HIV criminalisation finally recognised as an important barrier to ‘Ending AIDS’

Both the 2011 and 2016 declarations highlight the importance of:

• removing unequal legal status of women and the relationship between discriminatory laws and violence against women;
• ensuring legal frameworks to protect the rights of young people, including addressing barriers to HIV prevention created by age of consent laws;
• ending barriers to HIV prevention, treatment, care, and support that are created by discriminatory legal environments; and
• removing restrictions on the free movement of people with HIV.

In the 2011 Declaration, explicit attention was focused only on one kind of restrictive law: laws regarding entry, travel, and stay restrictions based on HIV status. By contrast, in the 2016 Declaration, UN Member States specifically committed:

To review and reform:

• Laws related to HIV non-disclosure, exposure and transmission; and
• Laws related to mandatory testing, including of pregnant women

To adopt, review and accelerate:

• Effective implementation of laws that criminalize violence against women and girls, as well … prosecutorial measures … to eliminate and prevent all forms of violence against all women and girls

As well as continuing to focus on eliminating:

• Restrictions on entry based on HIV status

The 2016 Political Declaration also extends recognition of the importance of the law in protecting the fundamental human rights and freedoms of children and adolescents, with Member States committing to promote:

• Laws and policies that ensure the enjoyment of all human rights and fundamental freedoms for children, adolescents and young people, particularly those living with, at risk of, and affected by HIV.

A similar provision existed in the 2011 Political Declaration but only included young people within its purview.

Perspective shifts in legal environments

Regarding legal environments for people living with HIV, an important shift in perspective is found in the 2016 Declaration. The 2011 Declaration noted the need for “legal literacy and legal services.”

In 2016, the same paragraph has been reworked in much stronger language. It now commits Member States to empower PLHIV, those at risk, and those affected “to know their rights and to access justice and legal services to prevent and challenge violations of human rights.”

Further, as in 2011, the paragraph commits Member States to train and sensitize law enforcement officials, judges, and health care workers, but it now also includes a commitment to sensitize members of the legislature.

The 2016 Declaration also contains weaker paragraphs that “call attention to” the restrictive laws that marginalise and discriminate against people who use drugs, and “note grave concern” about legal discrimination against people with disabilities.

What about other key populations?

The 2016 Declaration is weak in its attention to key populations, scarcely improved from 2011. The few bright spots are that transgender people and people who are incarcerated are included in the list of key population groups for the first time (and the term “key populations” makes its first appearance in a General Assembly document). Yet, if we are smart in our approach, there can be more than meets the eye for key populations and we can do our best to push for strong interpretations of the Declaration’s language.

Throughout the Declaration, variations of the phrase “people living with and affected by HIV and those at higher risk” can be found. Although clearer wording would have been preferable, it can[6] and should be argued that this phrase includes key populations every time it is used. The Declaration describes key populations as those “at higher risk of infection” and specifically includes people who inject drugs, sex workers, men who have sex with men, transgender people, and prisoners.

When understood in this way, the Declaration calls for all of the following for people living with HIV and for key populations:

• realisation of the GIPA principle for greater and meaningful involvement in the HIV response;
• protection of human rights for all ages;
• recognition of the right to equal participation in civil, political, social, economic and cultural life;
• empowerment to know one’s rights and to access justice and legal services to prevent and challenge violations of human rights; and
• removal of prejudice, stigma, or discrimination.

Something to watch out for regarding the Declaration language and key populations: conservative Member States were successful in getting language that would appear to allow individual countries to make their own determinations regarding who counts as a key population.

This language includes phrases such as, “populations at highest risk, depending on local circumstances,” and “taking into account national context.” However, it is crucial for civil society groups working in this space to consistently press the point that these determinations must be evidence based.

In the Declaration, key populations are described as those that epidemiological evidence shows are at higher risk of HIV infection. Further, Member States agreed to emphasize, “that each country should define the specific populations that are key to its epidemic and response based on the local epidemiological context.”

Call to action

In concluding this blog, I have a few reflections on the political environment in which we find ourselves: the extent of open and unabashed global hostility toward people living with HIV and key populations, especially toward gay men – combined with what was either a lack of political will by friendlier UN Member States or a genuine belief that they could do no better – was and should continue to be sobering.

More than sobering, it is an urgent call to action.

We are not going to get better commitments without an immense, intensified, and well-coordinated effort to move governments at national levels. And while we wait, and waste time bemoaning the outcome of the Declaration, members of our communities who live under these hostile governments suffer, facing threats to their dignity, liberty, and survival.

Further, the level of discord amongst UN Member States regarding this Declaration run very deep. This was demonstrated by the reservations expressed by Member States after the adoption of the Declaration and by paragraphs throughout the Declaration that are packed with so many clauses as to make them incomprehensible. This is evidence that every word and punctuation point was debated to its death.

Championing the advocacy successes in the Declaration

Some quick initial thoughts about next steps:

If advocacy organisations can let go of the dreadful experience of the High Level Meeting, then we can get busy championing the advocacy successes in the Declaration. It will be critical to lead the conversation with our understanding and interpretations, turning them into facts on the ground before there can be any reversal.

In addition to the progress on legal frameworks, one key advocacy success – with years of planning behind it — is the call for funding for civil society organizations.

UN Member States called for “at least 6%[7] of all global AIDS resources [to be] allocated for social enablers including advocacy, community and political mobilization, community monitoring, public communication, outreach programmes … as well as human rights programmes such as law and policy reform, and stigma and discrimination reduction” and called for “community-led service delivery to cover at least 30% of all service delivery.”

Finally, it is worth keeping in mind that the UNAIDS Strategy, 2016-2021,[8] has much stronger commitments in the areas of SRHR and key populations than those in the Declaration and can be used whenever possible to advocate for the things that communities need to survive this epidemic.

Footnotes

[1] http://www.unaids.org/sites/default/files/media_asset/2016-political-declaration-HIV-AIDS_en.pdf

[2]http://msmgf.org/gay_men_transgender_people_and_sex_workers_express_outragemsmgf-expresses-outrage-unacceptably-weak-political-declaration-adopted-today-united-nations-high-level-meeting-ending-aids/

[3] http://www.gnpplus.net/political-declaration-will-not-end-aids/

[4] http://www.doctorswithoutborders.org/article/doctors-without-borders-response-2016-united-nations-political-declaration-ending-aids

[5] http://www.unaids.org/sites/default/files/sub_landing/files/20110610_UN_A-RES-65-277_en.pdf

[6] Tremendous debt of gratitude to Richard Elliot of the Canadian HIV/AIDS Legal Network for first noticing this link.

[7] In 2014, UNAIDS estimated that only 1% of global AIDS funding went to the civil society and community response.  See: http://www.unaids.org/sites/default/files/media_asset/JC2686_WAD2014report_en.pdf

[8] http://www.unaids.org/sites/default/files/media_asset/20151027_UNAIDS_PCB37_15_18_EN_rev1.pdf

Two weeks ago, thanks to generous funding for 2016-18 from the Robert Carr civil society Networks Fund, a group of committed activists from all over the world came together in Brighton, the home of the HIV Justice Network, so we could strategise how to work closer together in order to end HIV criminalisation.

[Show as slideshow]

1 2 ... 4 ►

It’s been a long journey to get to this point.  I first started writing about HIV criminalisation in 2003 when, in my first months as editor of NAM’s AIDS Treatment Update, we had our first prosecutions in England and Wales for ‘reckless’ HIV transmission.

After writing my first book on the subject for NAM in 2007 – Criminal HIV Transmission, which aimed to educate the criminal justice system about the latest medical and social science developments relating to HIV – I began a blog of the same name which, almost by accident, became a global de facto information and advocacy hub.

In 2008, on the final day of the International AIDS Conference in Mexico City, Justice Edwin Cameron gave a powerful speech entitled ‘HIV is a virus not a crime’ that vocalised a burgeoning movement using many examples culled from the blog. At its rousing conclusion, he called for a sustained and vocal campaign that would lead to major international pushback against misguided criminal laws and prosecutions.

I took Justice Cameron’s call to action utterly and complelely to heart, and have made this the focus of my life’s work ever since: highlights of which include writing a second book for NAM in 2010; working with UNAIDS on their 2013 guidance; and, of course, launching the HIV Justice Network.

Today, marks a new milestone for my vocation. As part of a group of seven global, regional and national civil society organisations that have worked closely, but informally, together on HIV criminalisation for a number years, I can proudly announce a brand new initiative, HIV JUSTICE WORLDWIDE.

HIV JUSTICE WORLDWIDE comes at a time when there is an urgent need to capitalise on current advocacy successes in some parts of the world and to resist new and proposed laws in others. It is also evident that preventing and remedying HIV criminalisation is going take many years, if not decades, and so we need to work together because:

• HIV criminalisation is an international issue, having grown in scope and severity over the last two decades;
• international actors such as UNAIDS, UNDP, the Global Commission on HIV and the Law and others have been – or need to be – involved in this issue, and civil society needs to be able to effectively engage with these actors;
• international pressure can often be helpful in responding to problematic regional or national developments; and
• a global movement can help raise awareness and build capacity of local actors around the world by sharing knowledge, experience, strategies, tools and mobilising resources.

The organisations that make up the founding partners, along with the HIV Justice Network, are:

• AIDS and Rights Alliance for Southern Africa (ARASA)
• Canadian HIV/AIDS Legal Network
• Global Network of People Living with HIV (GNP+)
• International Community of Women Living with HIV (ICW)
• Positive Women’s Network – USA (PWN-USA)
• Sero Project (SERO)

We also have the support of UNAIDS and UNDP and global HIV organisations such as the International HIV/AIDS Alliance. As time goes on we will will announce new projects and partners – all with the goal of ending HIV criminalisation by empowering people living with HIV and those who advocate on our behalf to ensure policymakers, criminal justice actors and other relevant stakeholders abolish existing laws and oppose the passage of proposed laws designed to regulate, control, and punish people living with HIV on the basis of their HIV status.

HIV JUSTICE WORLDWIDE will enhance and build on contributions its founding partners have previously made: monitoring, informing, connecting and engaging with People Living with HIV networks, civil society organisations and others who advocate against HIV criminalisation, and engaging policy-makers in pursuit of protecting against HIV criminalisation.

The initiative allows us to:

• Avoid duplication by bringing together the many existing resources on this issue, sharing information and coordinating advocacy efforts.
• Build broader consensus amongst People Living with HIV networks, civil society, policymakers, key scientists/clinicians, criminal justice actors and funders that ‘ending AIDS’ will not happen unless we put an end to HIV criminalisation.
• Create new energy and action, ‘riding the wave’ of recent advocacy successes, pushing for commitment to change at the highest level.
• Develop and strengthen much-needed civil society capacity to ensure continued advocacy against HIV criminalisation, and to sustain this capacity in order to further advocate against related punitive laws, policies and practices aimed at people living with HIV and which impede the HIV response.

To find out more about what HIV JUSTICE WORLDWIDE is all about, please visit the website, and watch the video.

Last week, at the 15th European AIDS Clinical Society (EACS) Conference in Barcelona, I presented a poster on behalf of the HIV Justice Network, that showed where the prevention benefit of treatment has impacted HIV criminalisation in Europe. The reality is that since the Swiss statement in 2008, progress has been frustratingly slow.

During the 30-month period covered by the forthcoming Advancing HIV Justice 2 report (April 2013 to October 2015), we found a total of 176 reported arrests and/or prosecutions in 24 countries. Of these, 37 (21%) were in Europe: Austria, Czech Republic, England & Wales, Finland, France, Germany, Iceland, Ireland, Italy, Russia, Slovakia, Spain, Sweden and Switzerland. Where laws, practices or legal precedents are outdated there is an urgent need for reform in line with UNAIDS 2013 guidance.

Although there have been some positive developments in many of these jurisdictions – where lower or even regional appeal courts have accepted the new science – few have clear, established legal guidance at the highest level regarding the prevention impact of treatment, and therefore unjust prosecutions continue. There is, therefore, an urgent need for scientists and clinicians to work closely with HIV and human rights activists, advocates and lawyers in Austria, Finland, France, Germany, Iceland, Ireland, Italy, Russia, Slovakia and Spain to ensure that either the law itself, or legal precedent and/or prosecutorial guidance reflects up-to-date science on HIV-related risk (and harm).

The abstract is below.  The e-poster can be read online or the poster as displayed at the conference can be read and downloaded as a pdf.

Issues

The additional prevention effect of antiretroviral therapy (ART) has the great potential to beneficially impact the HIV epidemic as well as the lives of people living with and at risk of HIV. However, criminal justice actors and law- and policymakers are still coming to terms with this “game changing” scientific advancement. Their reactions have the potential to either improve or harm both the HIV response as well as the human rights of people living with HIV.

Description

A desk review of criminal proceedings, policy documents and newspaper reports archived on the HIV Justice Network website (www.hivjustice.net) as part of the research for our forthcoming Advancing HIV Justice 2 report was undertaken to better understand the criminal law implications of increased knowledge and awareness of the additional prevention benefit of ART as they relate to laws, prosecutions and policies related to HIV non-disclosure, potential or percived exposure and/or transmission. .

Lessons Learned

The impact of viral load on infectiousness has resulted in a number of European jurisdictions revising or revisiting their HIV-related criminal laws or prosecutorial policies. The Netherlands was the first country to consider low viral load as a factor in assessing HIV risk in 2005, resulting in the essential decriminalisation of all but intentional exposure or transmission. Following the ‘Swiss Statement’ published in January 2008 a small number of courts, governments and prosecutorial authorities have accepted ART’s impact on reducing HIV-related sexual risk. These include: Geneva Court of Justice, Switzerland (2009); Denmark Ministry of Justice (2011); Crown Prosecution Guidance for England and Wales (2011); Crown Office and Procurator Fiscal Service Guidance for Scotland (2012); the Court of Appeal for Skåne and Blekinge, Sweden and Swedish Ministry of Health and Social Affairs (2013), and the Czech Republic Supreme Court (2015).

Next steps

UNAIDS guidance (2013) notes: “Where criminal liability is extended to cases that do not involve actual transmission of HIV, such liability should be limited to acts involving a “significant risk” of HIV transmission. The determination of whether the risk of HIV transmission from a particular act is significant should be informed by the best available scientific and medical evidence.” It is vitally important that criminal justice system actors and law- and policymakers are educated so that HIV-related criminal laws and policies are applied rationally and fairly .Scientists and clinicians must, therefore, work more closely with HIV and human rights activists, advocates and lawyers in jurisdictions where the prevention impact of ART is not currently legally recognised, in order to prevent miscarriages of justice and to ensure that the prevention benefit of ART is correctly understood by criminal justice actors, policymakers, the media and those most at risk.

Bernard EJ. “One Shouldn´t Convict People for Hypothetical Risks”: Developments in European Criminal Law an… by HIV Justice Network

Following the prosecution and conviction of Michael Johnson, the US state of Missouri is now ‘ground zero’ for both overly broad HIV criminalisation and overly zealous law enforcement.

Yesterday police arrested (and alerted media to) a man whose only ‘crime’ was to chat with an undercover cop on social media.

He allegedly suggested they meet for sex without condoms without disclosing his HIV-positive status.

Update: He is now charged with attempted (sexual) HIV exposure, which, is in fact, not actually a crime in Missouri. It is only a crime to attempt to donate blood, organs or sperm knowing you are HIV-positive. Otherwise you have to have acted in a reckless manner and engaged in sex without disclosure.  As well as the HIV-specific statute below, there is a separate Missouri law of ‘attempt’, which seems to mean that even talking about having sex without disclosing your HIV-positive status first is apparently a ‘crime’ to overzealous law enforcement officers and proseutoris in the state in Missouri.

However, the media reports asking others to contact police if they have had sex with this man may produce an actual complainant.

KMOV.com

Update: Surely what this man is alleged to have done is not a ‘crime’ in any real sense.  It is rather a heavy handed way to control and punish people living with HIV for daring to have sex lives. This is clearly possibly entrapment. Which is a crime defence to a crime in Missouri.

Missouri police, prosectors and media need to be told that this is unconstitutional, barbaric and completely unacceptable!

This week, thousands of HIV scientists and clinicians are meeting in Vancouver at the 8th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention, also known as IAS2015.

The focus is on ending the AIDS epidemic through new evidence and guidelines on the impact of antiretrovirals for both treatment and prevention.

At Monday’s press conference announcing these exciting developments, community representative Dazon Dixon Diallo, stressed that the science will not work without legal, policy and structural changes, including ending overly broad HIV criminalisation, which she described as “stigma on supersteroids.”

Fittingly, this week, the Journal of the International AIDS Society published a Viewpoint article co-authored by myself and two colleagues, Cécile Kazatchkine of the Canadian HIV/AIDS Legal Network and Patrick Eba of UNAIDS.

‘Ending overly broad HIV criminailization: Canadian scientists and clinicians stand for justice’ highlights the “Canadian consensus statement on HIV and its transmission in the context of the criminal law” which was born out of the belief that the application of criminal law to HIV non-disclosure in Canada was being driven by a poor appreciation of the science of HIV.

More than 75 HIV scientists and clinicians Canada-wide have now endorsed the statement, agreeing that “[they] have a professional and ethical responsibility to assist those in the criminal justice system to understand and interpret current medical and scientific evidence regarding HIV.”

As some 61 countries have adopted laws that specifically allow for HIV criminalization, and prosecutions for HIV non-disclosure, exposure and transmission have been reported in at least 49 countries, we hope that by highlighting this work that other scientists and clinicians who care about “ending AIDS” around the world will take similar action.

In 2012, the Supreme Court of Canada ruled that people living with HIV can be imprisoned for having sex with a condom or while having a low (or undetectable) viral load if they have not first disclosed that they are HIV-positive. According to the court, people living with HIV have a legal duty to disclose their status to a partner if the sex poses a “realistic possibility of HIV transmission”]. The court said that “as a general matter,” a realistic possibility of HIV transmission is negated where 1) the accused has a low viral load and 2) a condom is used during the sexual act. Otherwise, in Canada, a person is at risk of prosecution for aggravated sexual assault even if they had no intent to transmit HIV and no transmission occurred.

The ruling left limited legal recourse to those working to end unjust prosecutions. Yet, several months after the decision’s release, six distinguished Canadian HIV scientists and clinicians took ground-breaking action to advance justice by co-authoring the “Canadian consensus statement on HIV and its transmission in the context of the criminal law” [“the (consensus) statement”].

This effort was born out of the belief that the application of criminal law to HIV non-disclosure was being driven by a poor appreciation of the science of both HIV as a chronic manageable disease and its risks of transmission.

Aimed squarely at the justice system and informed by HIV community, public health and human rights concerns, the consensus statement was based on a review of the most relevant, reliable and up-to-date medical and scientific evidence. It sets out in clear, concise and understandable terms a collective expert opinion about HIV sexual transmission, transmission associated with biting and spitting, and HIV as a chronic manageable condition.

One key area of consensus described in the statement is that, contrary to the Supreme Court’s interpretation, both vaginal and anal sex with a condom pose a negligible possibility of transmission, whether or not the HIV-positive partner has a low viral load. In fact, “[w]hen used correctly and no breakage occurs, condoms are 100% effective at stopping the transmission of HIV”. In addition, the statement notes that “evidence suggests that the possibility of sexual transmission of HIV from an HIV-positive individual to an HIV-negative individual via unprotected [i.e., condomless] vaginal intercourse approaches zero when the HIV-positive individual is taking antiretroviral therapy and has an undetectable viral load”.

The statement is consistent with UNAIDS’ 2013 guidance, which clearly stipulates that the criminal law should never be applied in cases of alleged HIV non-disclosure when there is no intent to harm, but especially when the risks of transmission are not significant (e.g., when a condom is used consistently, the HIV-positive person is on effective treatment or has a low viral load, or in cases of oral sex).

Importantly, the consensus statement does not employ the risk categories traditionally used in public health, which often describe activities from “high risk to no risk.” Knowing that these descriptors can contribute to an exaggerated sense of risk when taken out of context, Canadian experts described the per-act possibility of HIV transmission through sex, biting or spitting along a continuum from “low possibility to negligible possibility, to no possibility of transmission”. These unique categories better reflect that so-called “risky” activities “carry a per-act possibility of transmission that is much lower than is often commonly believed”. Also noteworthy is that the conclusions in the statement expressing scientific consensus are strong and relatively free of conditions.

In 2008, Swiss HIV experts released a statement titled “HIV-positive individuals not suffering from any other STI and adhering to an effective antiretroviral treatment do not transmit HIV sexually”. Although the statement had some success in terms of influencing criminal law around perceived HIV exposure, its bold conclusions raised concerns in the international scientific community, as some considered them premature. Others worried about their implications on condom-based safer sex messages. Mindful of this controversy, the Canadian authors emphasized that their statement is meant to inform the criminal justice system and is intended neither for public health messaging nor for the development and delivery of HIV policy and programmes. They also relied on new evidence that has since confirmed the dramatic impact of treatment on viral load and HIV transmission risk.

More than 75 HIV scientists and clinicians Canada-wide have now endorsed the statement, agreeing that “[they] have a professional and ethical responsibility to assist those in the criminal justice system to understand and interpret current medical and scientific evidence regarding HIV”.

We hope that other groups around the world will take similar action as overly broad HIV criminalization is not unique to Canada. It is estimated that some 61 countries have adopted laws that specifically allow for HIV criminalization, while prosecutions for HIV non-disclosure, exposure and transmission have been reported in at least 49 countries. UNAIDS, UNDP, the UN Special Rapporteur on the right to health, and the Global Commission on HIV and the Law have all urged that the criminal law be limited to exceptional cases of intentional transmission. But in many jurisdictions, perceived or potential exposure, regardless of intent or actual transmission of HIV, is sufficient to establish a criminal offence.

Scientific evidence, while not a panacea, can influence positive change. In 2013, based on medical evidence, a trial judge in Canada acquitted a man with an undetectable viral load who had condomless sex without disclosing his status. At the same time, Swedish scientists produced a consensus statement on HIV transmission that has since been recognized by the courts in that country. In Switzerland, the Swiss statement has supported successful law reform. In 2011, Denmark suspended the only HIV-specific criminal law in Western Europe due to improved understanding of HIV-related risks and harms. And in the United States, where most prosecutions occur, science played a crucial role in both Iowa’s HIV-specific criminal law reform and a recent ruling by the Supreme Court of Iowa, with the expectation of more changes to follow given federal recognition for the need to modernize such laws based on science.

Ensuring that criminal laws and proceedings employ the best available scientific evidence relating to HIV is critical in achieving justice whilst combating discrimination against people living with HIV. Scientists and clinicians are central to this process, as is the bold, undeniable language provided in the Canadian consensus statement.