US: Activists activists raise concerns over the links between public health & law enforcement surveillance

Questioning the Benefits of Molecular Surveillance

Can this HIV prevention strategy overcome mistrust and fear among marginalized communities?

In Texas, health officials recently used a new surveillance technology to identify a large HIV outbreak among gay and bisexual Latino men. In Massachusetts, officials used the same strategy to respond to an outbreak among injection drug users. And in California, researchers used the method to identify a transmission cluster among transgender women.

Led by initial proof-of-principle research at the Centers for Disease Control and Prevention (CDC), an HIV prevention strategy known as molecular surveillance is quickly expanding across the country. Since December 2015, according to an email from a CDC source who commented on background, the technique, based on sequencing and comparing individuals’ viral genetic blueprints, has identified more than 240 recent and rapidly growing HIV transmission clusters, the vast majority of which had not previously been recognized. Comparing these sequences allows researchers to determine whether individuals’ HIV is closely related, which offers clues about who transmitted the virus to whom. 

Traditional public health methods—now being used to trace the spread of COVID-19, the disease caused by the new SARS-CoV-2 coronavirus—largely rely on asking people about their contacts and getting in touch with them by phone or in person. The CDC source said molecular data analysis allows for more rapid and comprehensive cluster and outbreak detection and response. As such, molecular surveillance is seen by the agency as a key part of effective HIV prevention and a means to help hard-hit communities and the nation end the HIV epidemic.

Those idealized goals, however, are clashing with a far messier reality in which decades of mistrust and fear among marginalized communities, heightened in the current political climate, are coming to a head. The tech-aided HIV surveillance strategy, six activists told POZ, could open up new avenues for private data to be breached, exploited, subpoenaed or otherwise released through many of the HIV criminalization laws and statutes still on the books in 34 states.

Activists say the CDC-led molecular surveillance effort was launched with little or no consultation or buy-in from the communities most likely to be impacted. Several meetings ensued, including one convened in 2018 by the O’Neill Institute for National & Global Health Law at Georgetown Law School in Washington, DC, that allowed critics to air some of their concerns. Despite a subsequent round of CDC guidelines on how best to safeguard patient data, however, the controversy has only grown over the potential misuse and unintended consequences of the surveillance scheme.

Patients can’t opt out of providing their viral sequence data for the molecular tracking, critics point out. Nor does the strategy adequately consider the state-by-state patchwork of protections and penalties or the growing health implications of an erosion of immigrant, minority and LGBTQ rights, they say.

Sean Strub, POZ’s founder and the executive director of the nonprofit Sero Project, which focuses on reforming HIV criminalization laws, says he fears the CDC-led strategy will diminish trust and cooperation with public health agencies and drive more vulnerable people further from the health care system out of fear of surveillance. “I think the risk of unintended consequences is very great,” he says.

Strub and other activists see molecular surveillance as part of a broader trend in the “securitization of disease,” which is increasingly blurring the lines between the public health and criminal justice systems.

“We are potentially threatening people’s freedom just to get cleaner data, and I think it’s a clear ethical concern,” says Devin Hursey, a member of the Missouri HIV Justice Coalition and a board member of Blaq Out, a nonprofit advocacy group for Black queer and transgender people in the Kansas City region. “We can’t just look the other way or say we’re doing our best effort when we’re not really addressing that HIV criminalization still exists.”

The CDC source told POZ that the agency understands and has addressed many of the questions and concerns raised by community advocates. The CDC has strong data protections and security measures in place, the source said, and has worked for many years to provide guidance to states on reviewing and revising criminalization laws and ensuring data are well protected.

But Naina Khanna, executive director of Positive Women’s Network–USA, says the CDC hasn’t responded to specific questions about its data-sharing practices with other federal agencies, like the Department of Homeland Security and Immigration and Customs Enforcement (ICE). Khanna points out that the communities most impacted by HIV are also disproportionately affected by surveillance, policing and criminalization. “That’s extremely concerning when we think about how policing intersects with being a Black gay man or being a Latino gay man,” she says. In response, the CDC source told POZ that all HIV surveillance data are reported to the agency without names or any personal identifiers and are encrypted and protected by an Assurance of Confidentiality under Section 308(d) of the federal Public Health Service Act.

A New Surveillance Tool

When someone tests positive for HIV in the United States, a blood draw allows labs to sequence part of the viral genome, or its genetic blueprint, and use that to determine whether the virus contains mutations that might lead to drug resistance. This information can help doctors tailor the best HIV treatment regimen for each individual. But once the genetic sequencing is complete, health departments can access that data for molecular HIV surveillance. Specifically, they compare viral RNA sequences from multiple individuals to identify clusters of transmission. This is possible because HIV mutates over time; as a result, people with similar genetic sequences are more likely to have been infected around the same time as part of the same person-to-person chain of viral transmission.

Randy Mayer, MS, MPH, chief of the Bureau of HIV, STD and Hepatitis at the Iowa Department of Public Health, says the HIV resistance tests sent in by doctors around the state essentially provide his department with free surveillance data. “It’s something that we can use to try to improve our response that doesn’t really cost us anything,” Mayer says. “So from that point of view, it is cost effective.”

If a state-run computer program finds two or more individuals who share closely related viral sequences, it suggests that HIV might have passed between them or through a close intermediary. Spotting such clusters of transmission could help public health officials identify HIV-positive individuals and their close sexual or needle-sharing partners.

The surveillance approach has multiple potential benefits, researchers say. “This is just one more strategy in the toolbox of surveillance tools used to guide public practice,” says Nanette Benbow, MAS, research assistant professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine in Chicago. HIV transmission clusters identified through this method, she says, may represent only the “tip of the iceberg” of at-risk individuals, since the genetic information is available only for HIV-positive people who’ve been to a doctor and received drug resistance testing. Through contact tracing, though, public health officials can find other people associated with the cluster, contact them and offer them a range of care or prevention services, like pre-exposure prophylaxis (PrEP), if they’re not already receiving them.

Benbow says evidence suggests that the rate of HIV transmission within such clusters is much higher than that of transmissions overall, bolstering the case that public health agencies should focus on these clusters as significant sources of active viral transmission.

Some public health experts say the growth of surveillance is inevitable. “You’re not going to stop technology. All you can do is try to get it implemented in an ethical manner,” says Eve Mokotoff, MPH, managing director of HIV Counts, a consulting business based in Ann Arbor, Michigan, that assists with HIV surveillance.

Andrew Spieldenner, PhD, vice chair of the U.S. People Living with HIV Caucus and an assistant professor of communications at California State University San Marcos, rejects that argument. “Just because technology exists doesn’t mean we have to use it,” Spieldenner says. “We have to balance it with the harms it does to individuals.”

Newer technology that could extend molecular HIV surveillance is giving activists more pause. One method, called ultra-deep whole-genome next-generation sequencing, isn’t yet part of the CDC strategy. But emerging study data suggest that it could predict the directionality of linked HIV transmissions, potentially adding new evidence to suggest who infected whom. Researchers at Johns Hopkins University School of Medicine, in fact, recently described how they correctly predicted HIV transmission from an index case to a sexual partner in more than 90% of 105 sample pairs. The direction couldn’t be established in the remaining cases, but the method didn’t incorrectly predict any transmissions.

Other research the CDC is pursuing may help estimate the recency of an infection, meaning whether one person acquired HIV more recently than another. Together, the data could enable additional predictions about when and how HIV infections occurred within transmission clusters. Benbow says the data on their own don’t prove direct transmission, since another individual could have been an intermediary in the chain, but Khanna points out that judges and juries wouldn’t necessarily take these scientific caveats into account. “We see a lot of potential for opening the door to criminalization,” she says.

Despite privacy assurances, Strub maintains that data collected for one purpose is being unethically used for another without patient consent. “It’s not being used evenly across the society. Molecular surveillance focuses on the communities that are already highly marginalized, communities where there is the greatest risk of serious, harmful consequences,” he says. “People of privilege don’t see this.”

In a 2019 letter in the journal Lancet, researchers at the University of California, San Diego responded to criticism of their molecular surveillance study of an HIV transmission cluster involving transgender women by questioning whether informed consent is “imperative” for such analyses. “Surveillance for numerous infectious agents, including HIV, is done ethically and without consent. The public good of HIV surveillance justifies this approach,” they wrote. “Requiring consent for surveillance reporting would preclude a robust understanding of disease distribution and spread and the ensuing benefit to the health of individuals and communities.”

Alexander McClelland, PhD, a postdoctoral researcher in the Department of Criminology at the University of Ottawa, says such arguments reflect the logic that people living with HIV are an “object of risk” to be managed by public health. “We’re not considered to be people who have autonomy or rights to privacy or security of our own lives and our own bodies and our own data,” he says.

Many defenses of molecular surveillance, McClelland adds, also overlook other implications beyond the “broader public good” of repurposing patient data for public health surveillance. Among them, he says, are the criminalization, uncertainty and fear of people who are living with HIV and subject to continual privacy breaches. “People love to say, ‘We’re looking at molecules not people.’ But those molecules are connected to people, and those people are in the social world,” McClelland says, “and you can’t evacuate a virus from the social context that it’s in.”

A Climate of Fear

According to the Center for HIV Law & Policy in New York City, 34 states have enacted some form of HIV criminalization law or sentencing enhancement for other crimes allegedly committed by a person living with HIV. Although the language varies, 21 states have laws under which HIV-positive people who are aware of their status but don’t disclose it to sexual partners can be prosecuted (additional states have prosecuted nondisclosure under different laws); 12 states require the same disclosure among people who share needles. Some laws cover alleged HIV exposure while others cover actual transmission. Between 2009 and 2019, 24 states also prosecuted people living with HIV under other criminal statutes.

The interpretations and enforcement of laws can vary widely as well. In an April 2020 report, the Williams Institute at the UCLA School of Law documented 209 arrests and 107 convictions under Missouri’s HIV criminalization laws between 1990 and 2009. The report noted that the crimes appeared to be disproportionately enforced in St. Louis and adjacent St. Louis County. Although Black men account for 5.5% of Missouri’s population and 35% of people living with HIV, the report found, they accounted for more than half of HIV crime arrests and convictions over the 20-year period.

“We’re oftentimes targeted by not just HIV laws but by a lot of other different laws. We’re more likely to experience surveillance by law enforcement,” Hursey says of Black men. Layering on the element of molecular surveillance, he adds, only compounds the fear and lack of trust in public health and discourages the honest answers and cooperation necessary for HIV peer educators like him to do their jobs effectively. That mistrust is heightened by the legal requirement that Missouri’s health department must turn over all surveillance data to prosecutors pursuing an HIV criminalization case, he says.

“We have an epidemic of criminalization of people living with HIV, and you can only be prosecuted or convicted if you know your HIV status,” Khanna says. If people already feel marginalized and stigmatized, she and Hursey say, the added threat of criminalization based on knowing their HIV status can deter them from ever seeking out testing or care—the very opposite of stated public health goals.

Marco Castro-Bojorquez, cochair of the HIV Racial Justice Now project, says molecular HIV surveillance could likewise put undocumented immigrants at risk, especially since their existence in the United States is already criminalized. “It’s problematic, and it breaks my heart because a lot of people that could be very affected are those that are so fearful of the government and don’t really know that it’s happening,” he says.

Across the border from Missouri, Mayer says public health data are “well protected” in Iowa. They weren’t always, but in 2014, Iowa reformed its HIV criminalization law. The updated statute, Mayer says, requires proof that an HIV-positive person was negligent in exposing a partner to the virus and prohibits molecular surveillance data gathered by the state health department from being used to prosecute anyone. “I had some upset prosecutors who have tried to come to me, with subpoenas, to get information, which we don’t allow,” he says. Prosecutors can gather the data from other sources, but the health department has largely cut its tether to law enforcement.

Even so, prosecutors have found other mechanisms to gather data and enforce Iowa’s HIV criminalization law. In May, a 33-year-old Black man was sentenced to 26 years for “knowingly” exposing three women and a minor to HIV and transmitting the virus to three of them.

Activists say public health agencies also cannot divorce their molecular surveillance plans, however well intentioned, from the current rollback of LGBTQ, immigrant and minority rights. Castro-Bojorquez says the Trump administration’s anti-immigrant rhetoric and policies have not only eroded the Latino community’s trust in public officials but also worsened health outcomes. “Those attacks,” he says, “and the promotion of hatred, rolling back the few rights that we had and we fought so hard for, they have an impact, and people die.”

Numerous undocumented immigrants held in crowded detention centers have contracted COVID-19, and some deported immigrants have brought the coronavirus back to Guatemala, Mexico and other countries. Fear of HIV criminalization or deportation, Castro-Bojorquez says, has led other immigrants to avoid or delay “official” activities, including HIV testing and treatment. “Late diagnosis is a major issue in our communities,” he says, adding that it’s a big contributor to higher mortality rates among Latino men.

***

Finding Common Ground

Amid the ongoing controversy, HIV activists and public health officials may be finding common ground on the need for more community engagement and on the importance of decoupling public health and law enforcement. In a 2019 commentary in the American Journal of Public Health, Benbow joined other AIDS researchers, bioethicists and a representative of the National Alliance of State and Territorial AIDS Directors (NASTAD) in explaining how multiple aspects of existing HIV criminalization laws could confound public health goals around molecular surveillance.

Benbow and her coauthors cautioned that using identified surveillance data against the interest of patients, especially without informing them, “could jeopardize community confidence in public health agencies.” The authors also noted the CDC’s requirement that funded health departments create plans to address gaps in data protection and consider eliminating or modifying potentially counterproductive laws. “In light of the considerations we have addressed, health department leaders should consider supporting statutes that expressly limit, or even prohibit entirely, release of surveillance data for law enforcement purposes,” they wrote.

Mokotoff cautions that a health department can’t always change its state law. “But the health department can work with the community to help them understand what needs to be done and what kind of wording might be helpful,” she says. “We have to stop allowing surveillance data to be used for prosecution of people who are sick or infected.” Protecting that data from being used in law enforcement, she adds, “would change the entire discussion” with stakeholders in the HIV-positive community.

The CDC itself has avoided criticizing specific state laws, though the agency source told POZ that the CDC has worked with partners like NASTAD to review the range of legal protections, policies and procedures that can help protect HIV data. The source noted that in 2014, the Department of Justice recommended that states either reform their laws to eliminate HIV-specific criminal penalties or modernize their laws to reflect current scientific evidence. The source also pointed out that the Department of Health and Human Services 2019 initiative, “Ending the HIV Epidemic: A Plan for America,” encourages states to take similar steps to help reduce stigma.

Benbow conceded that addressing the intense mistrust of underserved individuals who may need HIV prevention or treatment services the most, including people who inject drugs and undocumented immigrants, remains a steep challenge. But identifying clusters, she says, could help health officials make the case for targeted services that benefit underserved people, like the legalization of needle exchange programs.

“A lot of what we do in public health infringes on privacy, and what we’re trying to do is balance a person’s individual freedoms and liberties and privacy with trying to improve public health and work for the common good,” Mayer says. “You really have to think very carefully about that because if you push that too far, then you’re likely to get a lot of public health interventions rolled back, and people don’t want to work with you. They don’t trust you.” And as the history of HIV shows, regaining lost trust can take decades.

New date for Beyond Blame: Challenging Criminalisation for HIV JUSTICE WORLDWIDE @ HIV2020 Online

New date – Wednesday 8 July 2020

Registration for Beyond Blame at HIV2020 Online now open

Last September, the nine organisations comprising the HIV JUSTICE WORLDWIDE Steering Committee announced that we had unanimously agreed to support HIV2020, and that Beyond Blame, our flagship meeting for activists, advocates, judges, lawyers, scientists, healthcare professionals and researchers working to end HIV criminalisation, would be integrated into the HIV2020 programme.

Now that the HIV2020 conference has been reimagined as a series of virtual convenings that will take place between July and October, we are delighted to announce that Beyond Blame: Challenging Criminalisation for HIV JUSTICE WORLDWIDE has been selected by the HIV2020 programme committee to take place on Wednesday 8 July 2020, from 3pm-5pm Central European Time.  See the time in your time zone here.

This year, the online version of Beyond Blame is a unique opportunity for both new and long-established activists to learn why HIV criminalisation matters, as well as hear about the wide range of initiatives and strategies that have been used by activists around the world to end the inappropriate use of criminal law to regulate and punish people living with HIV.

The first part of this interactive web show will be hosted by HJN’s Executive Director, Edwin J Bernard, and features interviews with various members of the HIV JUSTICE WORLDWIDE Steering Committee, as well as members of the HIV Justice Network’s Global Advisory Panel (GAP).

The second part of the session is an interactive Q&A, hosted by PWN-USA’s Naina Khanna. Throughout the session attendees will be further engaged with polls, video clips, and a surprise guest.

By the end of the session, attendees will be equipped with a greater understanding of the importance of HIV criminalisation, knowledge of strategies used for advocacy, and a set of follow-up actions.

Register now at HIV2020 Online

Programme (subject to change)

Welcome to Beyond Blame 2020

Edwin J Bernard (HJN)

“Nothing about us without us”

Sean Strub (Sero)

Women challenging HIV criminalisation in Africa

Michaela Clayton (GAP) and Sarai Chisala-Tempelhoff (GAP)

The impact of HIV criminalisation on women and people who use drugs in EECA

Alexandra ‘Sasha’ Volgina (GNP+) and Svitlana ‘Sveta’ Moroz (Eurasian Women’s Network on AIDS / ICW)

Building networks to challenge criminalisation in Mexico and across Francophone Africa

Gonzalo Aburto (Sero) and Cécile Kazatchkine (Canadian HIV/AIDS Legal Network)

HIV criminalisation and key populations: who gets prosecuted, where, and why?

Cecilia Chung (Transgender Law Center / GAP), Jules Kim (Scarlet Alliance / GAP) and Elie Ballan (M-Coalition / GAP)

Bringing science to justice, and justice to science

Sally Cameron (HJN) and Alexander McClelland (GAP)

Interactive Q&A

Naina Khanna (PWN-USA) with Paul Kidd (HJN Supervisory Board)

Closing message

Edwin Cameron (former South African Constitutional Court Justice / GAP)

All virtual sessions offered as part of the HIV2020 Online series will be entirely FREE and made available later as recordings online. The webinar will be in English, but HIV2020 will provide simultaneous translation in Spanish, Portuguese, French, and Russian.

Previous Beyond Blame meetings were held in Melbourne (2014), Durban (2016), and Amsterdam (2018).

In Amsterdam, more than 150 attendees from 33 countries attended the one-day meeting. Participation was extended to a global audience through livestreaming of the meeting on the HIV JUSTICE WORLDWIDE YouTube Channel.

US: New initiative to combat Anti-Black racism, end criminalisation of pandemics and abolish systems of imprisonment

Announcing the Health Not Prisons Collective

As Calls for Justice Echo Around the United States, National Groups Led by Most-Policed Communities Affected by HIV and COVID-19 Join in Partnership

The Health Not Prisons Collective Vows to Combat Anti-Black Racism, End Criminalization of Pandemics and Abolish Systems of Imprisonment

 June 18, 2020: The Health Not Prisons Collective is a new, three year national initiative of longtime collaborators led by, and accountable to, communities most affected by HIV criminalization in the United States: Counter Narrative Project, Positive Women’s Network – USA (PWN), Sero Project, Transgender Law Center, and the U.S. Caucus of People Living with HIV (The Caucus).

HIV criminalization is the wrongful use of a person’s HIV-positive status in a criminal prosecution, including charging people living with HIV (PLHIV) under HIV-specific criminal statutes, or under general criminal statutes, for behaviors which would not be crimes if the person did not have HIV. There is little legal or other support available for those charged with HIV crimes, yet the consequences of being charged under an HIV criminalization law are severe, even without conviction, and persist long after a person leaves the criminal justice system.

Collectively, and with steadfast allies, the founders of the Collective have pushed criminalization to the forefront of the HIV policy agenda. Now, in the first year of the COVID-19 pandemic, the Collective will build the power of the intersectional national HIV movement led by Black, Indigenous and people of color (BIPOC), women, LGB people, and transgender and gender non-conforming people (TGNC) to refocus our efforts instead of blame, punishment and the denial of basic needs.

Criminalization is never a solution to health challenges. Communities that are already heavily surveilled, policed, and criminalized bear the brunt of HIV criminalization are at the highest risk of harm from COVID-19 related surveillance, policing, criminal charges and/or penalty enhancements. A response rooted in policing and criminalization not only undermines public health and human rights, but jeopardizes the long-term survival of our communities.

“The specifics of the COVID-19 pandemic may be unprecedented — but the racial disparities, intensification of stigma and marginalization, and threats of criminalization in the COVID-19 pandemic are sadly not unanticipated to those of us living with HIV,” said Andrew Spieldenner of the U.S. Caucus of People Living with HIV. “As we work together to overturn the criminalization of HIV baked into policies and laws decades ago, we will also urge our communities and leaders to repudiate the panic and reactive thinking that says police, prosecutors and prisons are the way to handle public health emergencies like COVID-19.”

With support from Gilead Sciences, the Collective’s three-year strategy incorporates political education and training; grassroots and grasstops organizing; policy analysis and advocacy; legal intervention; and narrative change designed to shift discourses about HIV, risk, blame, responsibility, and the role of the carceral state in public health, centering racial and gender justice.

SIGN UP FOR UPDATES HERE

“Most HIV criminalization laws in the U.S. were established at a time when less was understood about HIV transmission. There’s no evidence it has ever contributed to HIV transmission reduction. Today, it directly contradicts current public health efforts to encourage people to know their HIV status and engage in health care and treatment; very few laws have been updated in light of advances in scientific advancements,” explained Tami Haught of Sero Project.

“We can’t stop HIV or COVID-19 criminalization without recognizing the underlying politics of racism, blame and bias that fuel them,” said Charles Stephens of Counter Narrative Project “Only a strategic and sustained movement led by those most targeted by criminalization ourselves and that changes the very narratives of blame in our society will overcome the root conditions that make it politically feasible to pin harm on vulnerable individuals from targeted communities.”

“Successful advocacy to end HIV criminalization requires centering PLHIV and those from overpoliced communities. Despite limited resources, members of the Collective have already had significant success in advancing the community and public discourse as well as influencing policy,” explained Cecilia Chung of Transgender Law Project. “We must now remove the remaining barriers that stop our leaders, including transgender and gender non-conforming Black and brown people, disabled people and others, from scaling up our movement and winning the freedom to thrive as we are.”

Due to lack of resources, work on HIV criminalization to date has largely been episodic, resulting in less coordination and varying results. This coordinated, strategic, multi-year effort will fill a critical gap at the nexus of policy, grassroots organizing, movement building, increasing political will to decriminalize, and culture change at a vital time. The Collective urges funders and people of privilege to invest in multi-year initiatives, honoring the passion and truths of communities with the resources it takes to rapidly scale efforts to win significant, lasting change.

“Our members are on the frontlines of pandemics, and they’re also deep in the resistance to overturn the system that profits from anti-Black racism and violence,” said Naina Khanna of Positive Women’s Network – USA. “We need to honor their commitment and vision with resources. Ongoing dedicated funded initiatives have the best chance to shift the social, legal and political landscape of our nation.”

 If you need help with a pandemic-related prosecution or threat, contact Sero Project for HIV-related issues and Community Resource Hub for COVID-19-related issues.

LEARN MORE ABOUT THE HEALTH NOT PRISONS COLLECTIVE HERE

The Elizabeth Taylor AIDS Foundation leads multi-state effort to decriminalise HIV and modernise laws leading to discrimination

The Elizabeth Taylor AIDS Foundation Launches Initiative for Modernization of Laws and Criminal Penalties for People Living with HIV

The Foundation partners with Gilead Sciences, Inc. and the Health Not Prisons Collective on a major, multi-state effort to decriminalize HIV and modernize laws that lead to the discrimination of people living with HIV.

LOS ANGELES, June 18, 2020 /PRNewswire/ — The Elizabeth Taylor AIDS Foundation (ETAF) announced today a new national initiative focused on the modernization of criminal laws and penalties for people living with HIV. The effort will launch in partnership with Gilead Sciences, Inc., and a national alliance of advocacy partners including The Counter Narrative Project, Positive Women’s Network, The Sero Project, Transgender Law Center, and the US People Living with HIV Caucus. The Artemis Agency, a Los Angeles-based social impact firm, will be working with ETAF on the public education and awareness campaign. ETAF will also partner with state-based organizations as needed to ensure the initiative’s success.

Catherine Brown, ETAF Executive Director explains, “Very simply, science and the law have not caught up with each other on this issue, there is a disparity between what science tells us and what the laws and statutes in more than 30 states believe. HIV is not a crime, and those living with HIV are being held back by harmful laws and policies that discourage people from getting tested and treated.”

Gilead Sciences, Inc., a research-based biopharmaceutical company with headquarters in Foster City, California, is committed to the initiative and to supporting ETAF and The Health Not Prisons Collective.

“Gilead is proud to support this critical work against the criminalization of HIV,” said Brett Pletcher, Executive Vice President of Corporate Affairs and General Counsel. “These outdated and unjust laws disproportionately affect marginalized communities and further perpetuate the misinformation and stigma that result in decreased testing and poorer health outcomes. This collaborative initiative creates the possibility for systemic change that moves us closer to our collective vision of a more just society, free from discrimination and othering.”

On June 25th, ETAF will host a virtual town hall event to launch the initiative and address the effects of the current environment on the HIV community, as racial inequality and COVID-19 have disproportionately affected and threatened the lives of those who have been incarcerated as a result of their HIV status.

The campaign to modernize criminal laws and penalties that target people living with HIV will focus its initial efforts in Nevada and Ohio, where staffers will work with local advocates to prepare and introduce legislation. The effort also intends to address issues of insurance discrimination against people living with HIV in California, and will support legislation introduced in Missouri once COVID-19 restrictions are lifted for lawmakers in that state.

Read more about The Town Hall on July 25, 2020 and ETAF here: https://elizabethtayloraidsfoundation.org

More information about Gilead’s community work in HIV here: https://www.gilead.com/purpose/partnerships-and-community

About The Elizabeth Taylor AIDS Foundation
Working tirelessly on the AIDS crisis through the 1980s, Elizabeth Taylor established The Elizabeth Taylor AIDS Foundation (ETAF) in 1991 to reach her vision of an AIDS-free world. ETAF works to provide the direct care needed for people living with and affected by HIV and AIDS. Emphasizing Elizabeth’s commitment to marginalized communities, ETAF’s work ensures that HIV prevention education and access to treatment are available through domestic and international initiatives. HIV Decriminalization nationally, is ETAF’s primary advocacy initiative. We now have the necessary tools to stop the spread of HIV and end the AIDS crisis with sufficient resources.

Media Contacts
Catherine A. Brown
Executive Director
cbrown@etaf.org
310-339-3643

SOURCE The Elizabeth Taylor AIDS Foundation

When considering the criminalisation of COVID-19, lessons from HIV should be retained

Marginalised communities will not get justice from criminalising Covid-19 transmission

The criminalisation of the virus would create greater barriers to accessing healthcare systems already preventing many people from getting treatment.

After it was announced that no further action would be taken by police regarding the death of Belly Mujinga, a railway worker who contracted coronavirus after reportedly being spat on, there was national outcry. Her name has been plastered on placards at Black Lives Matter protests, while the public has pointed out that a man in Scotland who spat on a police officer while “joking” about coronavirus in April has been jailed for a year. But while this outrage is valid in the face of a government who continues to show their blatant disregard for black lives, criminalisation of diseases has been proven to be an ineffective tool for justice.

Over the past few months, parallels have been drawn between the Covid-19 pandemic and the HIV epidemic. Both viruses are communicable (they can be passed between people); both have been racialised, leading to racist and xenophobic attacks and stereotyping; community mobilisation has demanded adequate government public health responses for both health emergencies; and the impact of both viruses has highlighted the need for a global health approach which transcends borders. 

When the World Health Organisation (WHO) declared Covid-19 a pandemic, many HIV organisations and activists advocated that the transmission of the novel coronavirus should not be criminalised. As public fear of Covid-19 grew, HIV advocates predicted the negative impact on public health and possibility of human rights violations, similar to those seen for people living with HIV. 

“Despite the evolving scientific knowledge, criminalisation laws have been written and implemented across the world faster than the development of the general understanding of the virus itself”

This strain of coronavirus is new and scientists are developing their understanding of it. In the past few weeks, there has been confusion about the probability of asymptomatic transmission (transmitting the virus when a person does not have Covid-19-like symptoms), as the WHO had previously commented that it was “very rare” and later stated that this wording had misled people. Despite the evolving scientific knowledge, criminalisation laws have been written and implemented across the world faster than the development of the general understanding of the virus itself. Globally, countries have implemented or have proposed laws against Covid-19 transmission and even exposure, without transmission, including Canada, France, India, and South Africa.

Often, the aim of criminalisation is to facilitate a tool for prevention and deterrence (to discourage people from passing on a virus) or as punishment for those who have or may have passed on a virus. HIV advocacy has illustrated over the years that the criminalisation of transmission or exposure is ineffective, and disproportionately impacts marginalised communities and negatively impacts public health.

In their Statement on Covid-19 Criminalisation, published in March, the HIV Justice Worldwide Steering Committee wrote that hastily drafted laws, as well as law enforcement, driven by fear and panic, are unlikely to be guided by the best available scientific and medical evidence – especially where such science is unclear, complex and evolving. “Given the context of a virus that can easily be transmitted by casual contact and where proof of actual exposure or transmission is not possible, we believe that the criminal justice system is unlikely to uphold principles of legal and judicial fairness, including the key criminal law principles of legality, foreseeability, intent, causality, proportionality and proof.”  

Since that statement was issued, internationally coronavirus laws have been weaponised against the most marginalised within society, as is the case with HIV criminalisation laws. The Ugandan government, for example, has used coronavirus laws to target marginalised LGBTQI+ groups, and in the UK, people of colour are fined more than the white population under coronavirus laws, in some cases leading to unlawful charges. In some cases people were even charged under the wrong law (e.g. enforcing Welsh law in England).

The director of legal services at the Crown Prosecution Service (CPS), the public agency that conducts criminal prosecutions in England and Wales, found that 24% of cases reviewed had been charged incorrectly. In May a CPS press statement cited the speed and pressure to implement the laws as the cause of the wrongful charges. Across the Global North, it has been well documented that racialised communities are disproportionately impacted by Covid-19 and the Human Rights Campaign Foundation anticipates that LGBTQI communities will be disproportionately impacted by the virus. This is due to a myriad of reasons underpinned by systemic discrimination.

“Criminalisation of transmission or exposure is ineffective, and disproportionately impacts marginalised communities and negatively impacts public health”

HIV research has shown little evidence that criminalisation laws prevent transmission, in fact, it’s evidenced that such laws are bad for public health and fuel reluctance to get tested and treated. In the UK, testing and treatment of Covid-19 is free, as is the case with many other communicable diseases to remove the barrier to testing and treatment. Free testing and treatment access, irrespective of immigration status, is important, however, a briefing paper from Medact, Migrants Organise and New Economics Foundation (NEF), has shown that migrant communities blocked from healthcare because of the hostile environment, that “the coronavirus ‘exemption’ from charging and immigration checks is not working” and people have been asked to show their passports, and that people face additional obstacles such as language barrier and digital exclusion from emergency services. 

Criminalisation exacerbates public health issues: in a Channel 4 report, Migrants Organise spoke of a man who died at home for fear of being reported to immigration authorities if he accessed healthcare. The threat of immigration enforcement disproportionately impacts those in precarious work and those with precarious migration status, all of whom are more likely to come from racialised groups and in some cases groups which are hyper-surveilled and criminalised.

The role of healthcare and access to it needs to be reimagined, where people are viewed as patients not passports and healthcare professionals are not the extended arm of the Home Office. Governments must implement better employment rights, so that employers are held to account and do not put staff such as Belly Mujinga, in harmful positions. Governments must provide better statutory sick pay so those in precarious work do not have to choose between their health and putting food on the table. We need to overhaul systemically discriminatory processes that don’t look after the most vulnerable, rather than implementing laws – such as criminalisation – that will systematically punish them.

Launch of GNP+ PLHIV Stigma Index Advocacy Toolkit

PLHIV Stigma Index Advocacy Toolkit – People Living with HIV Stigma Index

A toolkit to equip networks of people living with HIV to take forward advocacy actions based on key findings and recommendations from PLHIV Stigma Index Reports

The People Living with HIV (PLHIV) Stigma Index is a standardised tool to gather evidence on how stigma and discrimination impact the lives of people living with HIV. It was developed to provide much-needed data and evidence that could be used to advocate for the rights of people living with HIV. Importantly, it was designed to be used by and for people living with HIV and was created to reflect and support the Greater Involvement of People living with HIV and AIDS (GIPA) principle, where PLHIV networks are empowered to lead the whole implementation of the study. The updated and strengthened PLHIV Stigma Index 2.0 (2018) reflects the latest context in the HIV response globally and has now been completed in 10 countries as per March 2020.

For over a decade, the PLHIV Stigma Index has been a catalyst for change in over 100 countries around the world and the results and recommendations used in evidence-driven advocacy at all levels of the HIV response. National networks of people living with HIV are using Stigma Index Reports creatively in a variety of ways – as a tool for fundraising, community education and anti-stigma campaigns.

PLHIV Stigma Index Reports are already guiding changes to HIV service delivery and informing national health legislation and treatment policy. However, to date, they have not been used as fully as they could have been to challenge wider societal and legal norms or to tackle institutionalised discrimination in the areas of education, workplaces or the justice system.

Why this advocacy toolkit?

The purpose of this advocacy toolkit is to complement and strengthen ongoing work by supporting community advocates to develop advocacy strategies that target discriminatory policies and practices head-on, take ownership of the advocacy agenda, demand their rights and hold those in power to account.

Specifically, the toolkit has been developed to:

● Provide a set of practical tools that support community advocates to take concrete steps to turn the data and key findings of PLHIV Stigma Index Reports into practical advocacy actions

● Help networks of people living with HIV
to identify and take forward advocacy actions based on the key findings and recommendations from PLHIV Stigma Index Reports

● Support Stigma Index teams who are at the data analysis stage of the project or who are in the process of developing reports

● Build the capacity of advocates to use data on stigma to make a case for change

The toolkit can be downloaded here. 

New Francophone Africa HIV criminalisation advocacy factsheet published today

Today, HIV JUSTICE WORLDWIDE releases a new advocacy factsheet developed by and for Francophone activists engaged in the fight against HIV criminalisation in Francophone Africa.

Co-authored by Cécile Kazatchkine of the Canadian HIV/AIDS Legal Network and Alain Kra, an expert in HIV and human rights Expert from Côte d’Ivoire, on behalf of HIV JUSTICE WORLDWIDE, the factsheet is the first of several that will be published throughout the year focusing on a particular language and region.

“We are delighted to share this new resource with you today,” Cécile Kazatchkine writes below. “In it, you will find everything you need to know about HIV criminalisation in francophone Africa, the issues it raises and the strategies adopted by activists to address it. Many thanks to Alain Kra, an expert in human rights and HIV from Côte d’Ivoire, who co-authored this factsheet, and to our colleagues from the Francophone HIV JUSTICE WORLDWIDE network for their contributions and for sharing their experiences.”

Nous sommes heureux de partager aujourd’hui cette nouvelle ressource développée par et pour les militants francophones engagés dans la lutte contre la pénalisation du VIH. Vous y trouverez tout ce que vous devez savoir sur la pénalisation en Afrique francophone, les enjeux qu’elle soulève et les stratégies adoptées par les militants pour y répondre. Un grand merci à Alain Kra, Expert en droits humains et VIH de Côte d’Ivoire et co-auteur de ce feuillet d’information ainsi qu’à nos collègues du réseau francophone HIV Justice Worldwide pour leurs contributions et le partage de leurs expériences.

Cécile Kazatchkine, le Réseau juridique canadien VIH/sida

 

To provide a taste of the content to English-speakers, here are some of the introductory paragaphs from the 16-page PDF.

“African HIV legislation was drafted on the basis of the N’Djamena model law developed during a three-day workshop in 2004 organised by Action for West Africa Region-HIV/ AIDS (AWARE-HIV/AIDS) and funded by the United States Agency for International Development (USAID).  This model, presented as a tool for the rapid dissemination of “good practices”, has led to a veritable “legislative contagion” in terms of HIV criminalisation across the continent, particularly in francophone Africa.

“Nineteen countries in francophone Africa currently have HIV-specific laws. Sixteen of these laws, which are supposed to guarantee the rights of people living with HIV, also criminalise HIV transmission or exposure. Criticism of the model law and a better understanding of the risks associated with HIV criminalisation have led to the revision of some laws in Togo, Guinea and Niger to limit the scope of HIV criminalisation.

“Similarly, criminal provisions in HIV laws adopted in 2010 in Senegal, 2011 in the Congo and 2014 in Côte d’Ivoire are more protective of the rights of people living with HIV. Like the revised laws, they include provisions expressly excluding criminalisation in certain circumstances, such as where condoms have been used or in cases of mother-to-child transmission. Congolese law precludes criminal liability in the greatest number of circumstances. In Cameroon and Gabon, HIV bills with provisions criminalising HIV were eventually abandoned, while in Comoros and Mauritius, HIV laws have never included criminalising provisions. Finally, in the Democratic Republic of Congo (DRC), the section of the HIV law criminalising the ‘deliberate’ transmission of HIV was repealed in 2018.”

The information sheet goes on to cover the disproportionate impact of HIV criminalisation on women across Africa; shows the many reasons why HIV criminalisation does more harm than good to the HIV response; explores the impact of science on laws and prosecutions; and includes links to further resources including those contained in the French-language version of the HIV Justice Toolkit.

HIV criminalisation laws affect women negatively and impede the effectiveness of implementing state programmes

Can HIV criminalisation protect women from becoming infected?

Translated from Original article in Russian via Deepl.com – For article in Russian, please scroll down.

In many countries, HIV-related criminal liability still exists. At least 68 countries have laws that specifically criminalize hiding information about HIV infection from your sex partner, putting another person at risk of HIV infection, or transmitting HIV. The leaders in the number of criminal cases related to HIV in the region of Eastern Europe and Central Asia are Belarus and Russia.

In 2018, 20 scientists from around the world developed an Expert Consensus Statement on the Science of HIV in the context of Criminal Law. It describes a detailed analysis of the available scientific and medical research data on HIV transmission, treatment efficacy, and evidence to better understand these data in a criminal law context.

Legislation regarding HIV transmission should be reviewed. I point out various facts to this – HIV treatment is available, antiretroviral therapy (ART) effectively reduces the viral load to undetectable and reduces the risk of HIV transmission during sexual contact to zero [1,2,3,4], criminalization initially stigmatizes people who are HIV-positive people and violates their human rights.

One of the arguments in favour of criminal liability for HIV transmission is the alleged protection of women in situations where their husbands or partners become infected with HIV. This argument is often used in Central Asian countries. Let’s look at real-life examples and statistics on how much women are actually protected by existing laws.

In early 2018, thanks to human rights defenders and human rights defenders, the article “Vikino Delo” appeared in the media, about a 17-year-old pupil of an orphanage, who was convicted under subsection 122 (1) of the Criminal Code of the Russian Federation for knowingly putting another person at risk of HIV infection. In 2017, Vika met a man F. (31 years old) on a social network. When they had an intimate relationship, the girl offered to use a condom, but F. refused. Vika did not tell F. that she had HIV. From the girl’s testimony provided in court, it was clear that she did not want to put the victim at risk of infection, and did not say the diagnosis because she was afraid. She tried to hint at him, telling about her HIV-infected friend. F. proposed to be tested for HIV together. As a result, he has a minus, she has a plus. F. filed a complaint with Vic to the police. The man decided to punish the girl for insufficient, in his opinion, sincerity. Following the verdict, Vicki’s lawyer filed a complaint with the Supreme Court. On the recommendation of the Supreme Court, given that at the time of the commission of the “crime” she was a minor, apply a sentence of warning to her. At the same time, no one took the blame from her. The leading role in protecting and supporting Vicki was played by the female community in the guise of Association “EVA”.

The situation with the Vicki case is commented on by human rights activist Elena Titina, head of the Vector of Life Charity Fund, who acted as a public defender in court: “Women are subjected to even greater stigma, condemnation, and therefore do not protect themselves. Vicki’s case is very revealing in this. For three years, during the whole trial, the girl simply had to listen to insults, humiliation against her, the remarks were incorrect – and on the part of the plaintiff, this 31-year-old man, on the part of judges, prosecutors, even lawyers sometimes behaved like elephants in a china shop. She, in my opinion, is the heroine. I’m not sure that an adult woman would have endured what Vick had endured and come to the end, defending her rights. Her criminal record was removed. A unique thing, I am very proud that I participated in it. “This is the only thing that has ended so far because I don’t know of any more such precedents with a conditional happy ending. ”

In the Criminal Code of the Russian Federation , in which almost one and a half million cases of HIV infection among citizens are only officially registered, there is article 122 “Transmission of HIV infection”. Disaggregation of data began in 2017, from 01/01/2017 to 12/31/2019, in total, within the framework of 122 articles, 150 sentences were sentenced according to the main qualification in parts 1-4. 93 sentences were pronounced against men (62%), 57 (38%) – against women. It is noteworthy that in Part 1, “Knowingly putting the other person at risk of HIV infection” is condemned by more women: 56.4% versus 43.6% of men.

According to the Ministry of Health of the Republic of Tajikistan for 2018, there were 10.7 thousand people with HIV in the whole country, of which about 7 thousand were men. It was noted that in 54.6% the virus was transmitted sexually, and in some regions, the proportion of such cases reaches 70%.

For reference: since July 2015, to register a marriage in Tajikistan, you must undergo a medical examination, which includes an HIV test.

Tajikistan became one of the few countries (and the only one in the EECA region) to which CEDAW issued a recommendation dated November 9, 2018: “Decriminalize the transmission of HIV / AIDS (Article 125 of the Criminal Code), and repeal government decrees of September 25, 2018 and October 1, 2004 years prohibiting HIV-positive women from getting a medical degree, adopting a child, or being a legal guardian. ”

Instead, on January 2, 2019, President Emomali Rahmon signed a series of laws, including those aimed at “strengthening the responsibility of doctors, beauty salons, hairdressers and service enterprises, which are due to non-compliance with sanitary, hygiene, anti-epidemic rules and regulations caused HIV / AIDS. ” From that moment, a lot of publications appeared in the media, illustrating not only the widespread informing of Tajik citizens about the requirements being followed but also the increase in the number of publications on criminal penalties related to HIV.

According to the results of media monitoring conducted by the Eurasian Women’s AIDS Network, in 2019, 23 publications on HIV were registered in the electronic media of Tajikistan. Among them, two topics were divided equally: general information on the responsibility for HIV transmission and statistics, as well as publications that women are accused of, such as:

“27-year-old woman suspected of having HIV / AIDS deliberately infecting”,

“Two women in northern Tajikistan convicted of HIV infection”,

“In Tajikistan, a woman convicted of“ deliberate HIV infection ”by 23 men was sentenced”,

“A resident of Kulyab of Tajikistan is suspected of intentionally acquiring HIV”,

“Two women in Khatlon have infected dozens of men. ”

Among these publications, there is not one that describes particular cases of men. We already wrote about the vulnerability of women in August last year in our interview with attorney Zebo Kasimova.

We could not obtain statistical data on the number of cases brought under article 125 of the Criminal Code of the Republic of Tajikistan, “HIV infection”. Particularly important would be information disaggregated by sex – that is, disaggregated data, the collection of which makes special sense, in view of the state’s argument for the protection of women. The importance of disaggregated statistics is stated in the Sustainable Development Goals – the Resolution adopted by the UN General Assembly in 2015: only accurate, reliable, comprehensive thematic data will help us understand the problems we are facing and find the most suitable solutions for them.

Olena Stryzhak, one of the founders of the Eurasian Women’s AIDS Network and the head of the Positive Women BO, is actively promoting the decriminalization of HIV in Ukraine  “I have been on the committee for the second year in the validation of elimination of mother-to-child transmission of HIV and syphilis at the Ministry of Health of Ukraine, and actively participate not only in the activities of the committee in our country but also attend international meetings of the Committee at WHO, communicate with many people working in this field.

One of the obstacles for women to seek medical help and treatment on time is the fear of prosecution, the fear of possible criminal liability. In Ukraine, I was able to obtain statistics on the number of criminal cases under article 130 of the Criminal Code of Ukraine, disaggregated by sex. I was surprised by the statistics, because, starting in 2015, only women were convicted under this article. This negatively affects not only the women themselves but also the effectiveness of implementing state programs, including the process of validating the elimination of mother-to-child transmission of HIV. ”

From the last case in Ukraine, for 2018: “… Since the defendant refused, the specialist for child services extended her hands to the child in order to pick her up, but the defendant bit her left hand.” From the conviction: “The court decided to qualify the actions of the defendant … Part 4 of Art. 130 of the Criminal Code of Ukraine as a complete attempt on intentional infection of another person with human immunodeficiency virus. “

Does it mean that if only women were convicted, the fact that only women are sources of infection? From an alternative shadow report of the Tajikistan Network of Women Living with HIV, presented at the 71st session of the UN Committee on the Elimination of All Forms of Discrimination against Women in November 2018: “In violation of their rights, as a rule, women do not go anywhere. During the study of the situation when writing this report, violations of the rights of women living with HIV and women from affected groups were identified, only a few decided to defend their rights and because they were provided with a lawyer at the expense of the project. The reasons for this behaviour are different. One of the main reasons is the lack of financial resources to pay for the services of a lawyer. Secondly, many women living with HIV and women from HIV-affected groups have low legal literacy; they do not have information about who to contact on a particular issue. Thirdly, self-stigmatization and the fear of confidentiality also prevent women living with HIV and women from HIV-affected groups from defending their rights. ”

It is clear from the report that women do not defend their rights, especially on such sensitive issues, for fear of feeling even more condemned and becoming even more vulnerable. In addition, in the countries of Central Asia, families have traditions when a daughter-in-law must tell her husband or mother-in-law where she goes and what she is going to spend or spent money on (by the way about paying a lawyer). Women depend on other family members, and often do not have their own money.

Violence against women increases their risk of HIV infection, while the very presence of HIV infection in a woman also increases the risk of violence, including from relatives, due to her vulnerability and low self-esteem.

The criminalization of HIV does not work, either as a preventive measure nor as a way to protect women from infection, as decision-makers try to imagine. On the contrary, with specific examples, we observe that women are more vulnerable.

Sources:

[1] – Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011 Aug 11; 365: 493-505.

[2] – Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, van Lunzen J, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA. 2016; 316: 171-81.

[3] – Grulich A, Bavinton B, Jin F, Prestage G, Zablotska, Grinsztejn B, et al. HIV transmission in male serodiscordant couples in Australia, Thailand and Brazil. Abstract for 2015 Conference on Retroviruses and Opportunistic Infections, Seattle, USA, 2015.

[4] – Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour M, Kumarasamy N, et al. Antiretroviral Therapy for the Prevention of HIV-1 Transmission. N Engl J Med. 2016 Sep 1; 375 (9): 830-9. 

Может ли криминализация ВИЧ защитить женщин от инфицирования?

Во многих странах все еще существует уголовная ответственность, связанная с ВИЧ. По меньшей мере 68 стран имеют законы, которые специально предусматривают уголовную ответственность за сокрытие информации о наличие ВИЧ-инфекции от своего партнера по сексу, поставление другого лица в опасность инфицирования ВИЧ или передачу ВИЧ. Лидерами по количеству уголовных дел, связанных с ВИЧ, в регионе Восточной Европы и Центральной Азии являются Беларусь и Россия.

В 2018 году, 20 ученых из разных стран мира разработали Заявление об экспертном консенсусе в отношении использования научных данных о ВИЧ в системе уголовного правосудия. В нем описан подробный анализ имеющихся данных научных и медицинских исследований о передаче ВИЧ, эффективности лечения и доказательства, позволяющие лучше понять эти данные в уголовно-правовом контексте.

Законодательные нормы в отношении передачи ВИЧ должны быть пересмотрены. На это указываю различные факты — лечение ВИЧ-инфекции доступно, антиретровирусная терапия (АРТ) эффективно снижает вирусную нагрузку до неопределяемой и снижает риски передачи ВИЧ при сексуальном контакте до нуля [1,2,3,4], криминализация изначально клеймит людей ВИЧ-положительных людей и нарушает их права человека.

Один из аргументов в пользу существования уголовной ответственности в отношении передачи ВИЧ — это якобы защита женщин, в тех ситуациях, когда их мужья или партнеры инфицируют их ВИЧ. Этот аргумент довольно часто используют в странах Центральной Азии. Давайте рассмотрим на реальных примерах и статистических данных, насколько женщины на самом деле защищены существующими законами.

В начале 2018 года, благодаря правозащитницам и правозащитникам, в СМИ появилась статья «Викино дело», о 17-ти летней воспитаннице детского дома, которую осудили по части 1 статьи 122 УК Российской Федерации за заведомое поставление другого лица в опасность заражения ВИЧ-инфекцией. В 2017 году Вика познакомилась в социальной сети с мужчиной Ф. (31 год). Когда у них была интимная связь, девушка предложила использовать презерватив, но Ф. отказался. Вика не сказала Ф., что у нее ВИЧ. Из показаний девушки, предоставленных в суде, было видно, что она не желала ставить потерпевшего в опасность заражения, и не сказала о диагнозе, потому что боялась. Она пыталась намекнуть ему, рассказывая о ВИЧ-инфицированной подруге. Ф. предложил вместе сдать анализы на ВИЧ. В результате у него — минус, у нее — плюс. Ф. подал на Вику заявление в полицию. Мужчина решил наказать девушку за недостаточную, на его взгляд, искренность. После вынесенного приговора адвокатом Вики была подана жалоба в Верховный Суд. По рекомендации Верховного Суда, учитывая, что на момент совершения «преступления» она была несовершеннолетней, применить к ней наказание в виде предупреждение. При этом вину с неё никто не снял. Ведущую роль в защите и поддержке Вики сыграло женское сообщество в лице Ассоциации “ЕВА”.

Ситуацию с делом Вики комментирует правозащитница Елена Титина, руководительница БФ «Вектор жизни», которая выступала общественой защитницей в суде: «Женщины подвергаются еще большей стигме, осуждению, поэтому не защищают себя. Дело Вики очень показательно в этом. Девочке пришлось в течение трех лет, пока длился весь судебный процесс, просто выслушивать оскорбления, унижения в свой адрес, реплики некорректные — и со стороны истца, этого 31-летнего мужчины, со стороны судей, прокуроров, даже адвокаты порой вели себя как слоны в посудной лавке. Она, на мой взгляд, героиня. Я не уверена, что взрослая женщина выдержала бы то, что выдержала Вика, и дойти до конца, защищая свои права. С нее сняли уголовную статью. Уникальное дело, я очень горжусь, что я в нем участововала. Это единственное на сегодняшний момент дело, которое так закончилось, потому что больше таких прецедентов, с условным хэппи-эндом я не знаю».

В Уголовном кодексе Российской Федерации, в которой только официально зарегистрировано почти полтора миллиона случаев ВИЧ-инфекции у граждан, существует статья 122 “Заражение ВИЧ-инфекцией”. Дезагрегация данных начата в 2017, с 01.01.2017 по 31.12.2019 всего в рамках 122 статьи вынесено 150 приговоров по основной квалификации по частям 1-4. 93 приговора вынесено в отношении мужчин (62%), 57 (38%) — в отношении женщин. Примечательно, что по части 1 “Заведомое поставление другого лица в опасность заражения ВИЧ-инфекцией” осуждается больше женщин: 56,4% против 43,6% мужчин.

По данным Министерства здравоохранения Республики Таджикистан за 2018 год, всего по стране насчитывалось 10,7 тысяч людей с ВИЧ, из них порядка 7 тысяч — мужчины. Отмечено, что в 54,6% вирус передался половым путем, а в некоторых регионах доля таких случаев достигает 70%.

Для справки: с июля 2015 года для регистрации брака в Таджикистане необходимо пройти медицинское обследование, которое включает тест на ВИЧ.

Таджикистан стал одной из немногих стран (и единственной в регионе ВЕЦА), которой КЛДЖ дал рекомендацию от 09 ноября 2018 года: “Декриминализировать передачу ВИЧ/СПИДа (статья 125 Уголовного кодекса), и отменить постановления правительства от 25 сентября 2018 года и 1 октября 2004 года, запрещающие ВИЧ-положительным женщинам получать медицинскую степень, усыновлять ребенка или быть законным опекуном”.

Вместо этого, 02 января 2019 года президент страны Эмомали Рахмон подписал ряд законов, в том числе направленных на «усиление ответственности врачей, работников салонов красоты, парикмахерских и предприятий по обслуживанию, которые из-за несоблюдения санитарно-гигиенических, санитарно-противоэпидемических правил и норм стали причиной заражения вирусом ВИЧ/СПИД». С этого момента в СМИ появилось множество публикаций, иллюстрирующих не только широкое информирование граждан Таджикистана о выполняемых предписаниях, но и увеличение количества публикаций об уголовных наказаниях в связи с ВИЧ.

По результатам медиа-мониторинга, который проводит Евразийская Женская сеть по СПИДу, в 2019 году в электронных СМИ Таджикистана зарегистрировано 23 публикации по теме ВИЧ. Среди них поровну разделили места две темы — это общая информация относительно ответственности за передачу ВИЧ и статистика, а также публикации, в которых обвиняются женщины, как, например:

“27-летняя женщина подозревается в преднамеренном заражении ВИЧ/СПИД”,

“Двух женщин на севере Таджикистана осудили за заражение ВИЧ-инфекцией”,

“В Таджикистане вынесли приговор женщине, обвиняемой в «умышленном заражении ВИЧ» 23 мужчин”,

“Жительница Куляба Таджикистана подозревается в преднамеренном заражении ВИЧ”,

“Две женщины в Хатлоне заразили десятки мужчин”.

Среди этих публикаций нет ни одной, описывающей частные случаи в отношении мужчин. Об уязвимости женщины мы уже писали в августе прошлого года в нашем интервью с адвокатессой Зебо Касимовой.

Статистические данные о количестве дел, возбужденных по статье 125 УК Республики Таджикистан, “Заражение ВИЧ-инфекцией”, нам получить не удалось. Особенно важной была бы информация с разбивкой по полу — то есть дезагрегированные данные, сбор которых имеет особый смысл, ввиду аргументации государства о защите женщин. О важности дезагрегированной статистики говорится в Целях устойчивого развития — Резолюции, принятой Генеральной Ассамблеей ООН в 2015 году: только точные, достоверные, всесторонние тематические данные позволят понять проблемы, стоящие перед нами, и найти для них самые подходящие решения.

Елена Стрижак, одна из основательниц Евразийской Женской Сети по СПИДу и руководительница БО “Позитивные женщины”, активно продвигает тему декриминализации ВИЧ в Украине: “Я уже второй год состою в комитете по валидации элиминации передачи ВИЧ и сифилиса от матери к ребенку при Министерстве здравоохранение Украины, и активно принимаю участие не только в деятельности комитета в нашей стране, но и посещаю международные заседания Комитета в ВОЗ, общаюсь со многими людьми, работающими в этой сфере.

Одним из препятствий к тому, чтобы женщины вовремя обращались за медицинской помощью и за лечением, служит страх обвинения, страх перед возможной криминальной ответственностью. У нас в Украине я смогла получить статистические данные о количестве уголовных дел по статье 130 УК Украины, с разбивкой по полу. Была удивлена статистикой, потому что, начиная с 2015 года, по этой статье были осуждены исключительно женщины. Это негативно отражается не только на самих женщинах, но и на эффективности реализации государственных программ, в том числе на процессе валидации элиминации передачи ВИЧ от матери к ребенку”.

Из последнего кейса по Украине, за 2018 год: «…Так как подсудимая отказалась, специалист службы по делам детей протянула руки к ребенку с целью забрать ее, но подсудимая укусила ее за левую руку». Из обвинительного приговора: «Суд принял решение квалифицировать действия подсудимой … ч. 4 ст. 130 УК Украины как оконченное покушение на умышленное заражение другого лица вирусом иммунодефицита человека».

Означает ли, что если осужденными оказались только женщины, тот факт, что только женщины являются источниками инфицирования? Из альтернативного теневого доклада Таджикистанской сети женщин, живущих с ВИЧ, представленного на 71-й сессии Комитета ООН по ликвидации всех форм дискриминации в отношении женщин в ноябре 2018 года: “При нарушении их прав, как правило, женщины никуда не обращаются. В ходе изучения ситуации при написании данного отчета выявлены нарушения прав женщин, живущих с ВИЧ, и женщин из затронутых групп, только единицы решились защищать свои права и то, потому что им был предоставлен адвокат за счет проекта. Причины такого поведения различны. Одна из основных причин, это отсутствие финансовых средств на оплату услуг адвоката. Во-вторых, многие женщины, живущие с ВИЧ, и женщины из затронутых ВИЧ групп имеют низкую правовую грамотность, у них нет информации о том, к кому обратиться по тому или иному вопросу. В-третьих, самостигматизация и боязнь разглашения конфиденциальности также мешает женщинам, живущим с ВИЧ, и женщинам из затронутых ВИЧ групп защищать свои права.”

Из доклада ясно, что женщины не защищают свои права, особенно по таким чувствительным вопросам, из-за страха почувствовать еще больше осуждения и стать еще более уязвимыми. Кроме того, в странах Центральной Азии, в семьях есть традиции, когда невестка должна сказать мужу или свекрови, куда она идет, и на что она собирается тратить или потратила деньги (к слову об оплате адвоката). Женщины зависят от других членов семьи, и часто не имеют своих собственных денег.

Насилие в отношении женщин увеличивает для них риск инфицирования ВИЧ, в то же время само наличие ВИЧ-инфекции у женщины также увеличивает опасность насилия, в том числе и со стороны родственников, из-за ее уязвимости и заниженной самооценки.

Криминализация ВИЧ, ни как превентивная мера, ни как способ защиты женщин от инфицирования не работает, как это пытаются представить люди, принимающие решения. Наоборот, на конкретных примерах мы наблюдаем, что женщины оказываются более уязвимыми.

Источники:

[1] — Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011 Aug 11; 365:493-505.

[2] — Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, van Lunzen J, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA. 2016; 316:171-81.

[3] — Grulich A, Bavinton B, Jin F, Prestage G, Zablotska, Grinsztejn B, et al. HIV transmission in male serodiscordant couples in Australia, Thailand and Brazil. Abstract for 2015 Conference on Retroviruses and Opportunistic Infections, Seattle, USA, 2015.

[4] — Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour M, Kumarasamy N, et al. Antiretroviral Therapy for the Prevention of HIV-1 Transmission. N Engl J Med. 2016 Sep 1; 375(9):830-9. 

Uzbekistan: Careless and distorted headline highlights why HIV criminalisation law must be reformed

Why HIV is no longer a sentence for medicine, but still a scourge for society

Automatic Deepl translation. For article in Russian, scroll down. 

Attitudes towards people with the immunodeficiency virus in Uzbekistan remain difficult, if not discriminatory. The problem lies not only in public intolerance and the negligence of the media, but also in the imperfection of legislation in this area.

TASHKENT, June 8 – Sputnik. In early June, an article on the problem of the spread of HIV infection among young people was published on the website of the Tashkent police department. It focused on the fact that the threat of infection is considered a criminal offence, and a case from 2019 was cited for clarity.

The aim of the publication is to draw the attention of parents and young people themselves to this topic so that they are responsible for their health and are not frivolous in sexual relations. However, a good cause has turned out to be a scandal. A local publication published an article titled “In Tashkent, a schoolchild infected his girlfriend with HIV”. As a result, the participants in last year’s story suffered twice because of the notorious positive status of one of the partners: first the young man was given a suspended sentence for an act that had no serious consequences, and then journalists with an easy hand “gave” his girlfriend an unconfirmed diagnosis of HIV.

Love against HIV
The trial of the young man took place in 2019, but it has only now become known. The young man was charged with a crime under Part 4 of Article 113 of the Uzbek Criminal Code – “Knowingly putting a person at risk of HIV infection”. The young people (he is 17 years old, she is 16) have known each other since childhood, and started dating as teenagers. The defendant fully confessed and explained that he knew about his diagnosis and since 2009 (from the age of seven) has been registered with the AIDS Centre and has been regularly examined.
The couple did not plan a family relationship, but, as usual, everything happened spontaneously, without using contraception. According to the young man, he warned his girlfriend about possible danger. It wasn’t until the fifth month that she was pregnant. As a result, neither the mother nor the child born later was diagnosed with HIV. The couple, of course, registered their marriage, but the husband got a suspended sentence for doing it.
An already unpleasant story, though with a happy ending, could have ended there, but the careless mentioning and distorted headline in the media, which is called, added oil to the fire. This example revealed a long overdue problem of the imperfection of the judicial system with regard to HIV-positive people, who are almost discriminated against twice.

A new perspective on the disease
According to experts, the law as it stands only contributes to the stigma and harassment of HIV-positive people in society, in particular adolescents. The legislation on HIV/AIDS is morally outdated. When it was drafted, it was indeed a fatal disease and there was no antiretroviral therapy. A few years ago, WHO officially declared HIV to be a chronic and non-fatal disease.

In Uzbekistan, free antiretroviral therapy has been available since 2006. There is scientific evidence that a person with a depressed (undefined) viral load (the amount of the virus in the blood), as a convicted young man, has a risk of transmitting the virus to zero. But practice shows that the law is sometimes not heeded to science.

Azizbek Boltayev, a psychotherapist from Bukhara, was one of the first to react to the publication of the GUVD and then reprint it in an Internet publication with an ignorant headline.

“Special attention should be paid to the age when the guy was registered – 7 years old, i.e. he was very likely to be infected in one of the medical institutions of the country. It turns out that the person was punished for the condition he had because of the lack of supervision of state controlling bodies. After all, if the guy had not been infected as a child, today’s problem simply would not have happened. Who would want to register with the AIDS Center after such news?” – noted the expert.
Today medicine allows HIV-positive people to really live a full life, have families without any risk for their partner and have absolutely healthy children. This is why amendments to the legislation are so necessary.

“According to international practice, having a separate article on HIV only reinforces stigma, so it is recommended to apply common articles on harm to health. In addition, only wilfully malicious infections or attempts to infect should be criminalized. If no infection has occurred, the act will usually be decriminalised,” said lawyer Timur Abdullayev.
Article 113 of the Uzbek Penal Code consists of five parts, with HIV being devoted to part of the Criminal Code. 4 и 5. And in one part, two notions are combined: “infection” and “knowingly put in danger.

“The latter refers to any action that involves any risk above zero. So, protected sexual intercourse with contraception does not exclude liability, because it does not protect 100%. Thus, all that is not equal to zero is in any case an article, and it does not matter whether there is a transmission or not, whether there is intent or not. In addition, the Code does not explain what “known” means and what intention it means – direct, indirect or no intention at all,” explains the lawyer.
Thus, the outcome of the trial depends on the interpretation of the law by the investigation bodies and the court.

“In Russia, Belarus and Kazakhstan, notes were added to the article that if the HIV-negative partner was warned and agreed to the risk and there is a receipt, then the liability is cancelled,” Abdullayev continues. – However, the Uzbek Criminal Code does not have such a note, which means that all HIV-positive partners in discordant couples (where only one of them is infected) are de jure criminals”.

A humane approach
Over the past few years, Uzbekistan has achieved impressive results in the fight against HIV infection. In addition, the most comfortable conditions for people with status are being created. For example, within the limits of the decision of the president of Uzbekistan “About measures on the further perfection of system of counteraction to distribution of the disease caused by a virus of immunodeficiency of the person, in the Republic of Uzbekistan” pre-contact prophylaxis by antiretroviral preparations for HIV-negative persons in discordant pairs is already practiced.

However, the judicial and legal system requires immediate reforms, dictated by international recommendations and human rights organizations. In the experts’ view, article 113 of the Convention on the Elimination of All Forms of Discrimination against Women. 4 of the Criminal Code contradicts several provisions of the Constitution – articles 18 and 27, as well as article 4 of the Family Code. Lawyers are convinced that amendments to the current legislation will contribute to a humane approach to the HIV response.
In the case of the described pair of infected girls did not occur, HIV activists have achieved the correction of the scandalous false title, but how to deal with its consequences now? One indiscreet word crosses out years of work by specialists in eliminating discrimination against HIV-positive people.

“We still find it shameful to stigmatize people already suffering from a serious chronic disease who face restrictions because of their status. Happening of such a situation among healthy teenagers is unlikely to cause public resonance,” believes Zulfiya Tairova, international expert on public health and HIV/AIDS programs.
Hardened stereotypes and a craving to denounce the culprit, to punish it and to make it public so that others would not be harmed, she said.

Imaginary phobias and real barriers
The prevailing opinion in society is still that HIV is a problem exclusively for risk groups (drug addicts, sex workers, prisoners, etc.). Did the convicted young person, who was infected at the age of 7, belong to any of these categories? Was it his or her fault for the infection? Why does he now have to live with the label of a person with a criminal record?

Another problem is related to the restriction of the rights of young people with HIV: the inability to study at a foreign university, a ban on entering foreign countries for a long period of time for work or study, where a certificate of absence of this diagnosis is required.
Even physicians avoid such patients once they are diagnosed with HIV status, sometimes refusing to provide services or transferring the patient to another doctor.

With regard to youth education, Tairova said it is time to stop covering up real problems and not ignore the physiology of adolescents.

“We need to talk to children in their language and teach them how to protect their health, and stop covering up sexual education with a veil of “comfort” (shame, shame). Teenagers should know how to use a condom and that this is the safest way to protect themselves from infection and unwanted pregnancy,” she said.
In 2019 Moldova hosted the first Regional Forum of Eastern European and Central Asian Judges on HIV. Unfortunately, representatives of Uzbekistan were not there. A second meeting is planned this year. Due to the coronavirus pandemic, the format of the meeting is still unknown. HIV activists hope that this time the republic will not be left out of discussion on a very important topic. The purpose of this forum is to raise awareness of judges and change their attitude towards HIV-positive defendants.

Почему ВИЧ – уже не приговор для медицины, но все еще бич для общества

Отношение к лицам с вирусом иммунодефицита в Узбекистане остается сложным, если не сказать дискриминационным. Проблема кроется не только в нетерпимости общества и неосторожности СМИ, но и в несовершенстве законодательства в этой сфере.

ТАШКЕНТ, 8 июн — Sputnik. В начале июня на сайте ГУВД Ташкента была опубликована статья, посвященная проблеме распространения ВИЧ-инфекции среди молодежи. В ней был сделан упор на то, что угроза заражения считается уголовно наказуемым преступлением, а для наглядности приведено дело 2019 года.

Цель публикации – обратить внимание родителей и самих молодых людей к этой теме, чтобы они ответственно относились к своему здоровью и не были легкомысленны в половых отношениях. Однако благое начинание обернулось скандалом. Одно из местных изданий опубликовало статью с заголовком “В Ташкенте школьник заразил свою девушку ВИЧ-инфекцией”. В результате участники прошлогодней истории дважды пострадали из-за пресловутого положительного статуса одного из партнеров: сначала молодой человек получил условный срок за не имевшее тяжелых последствий деяние, а затем еще и журналисты с легкой руки “поставили” его девушке неподтвержденный диагноз ВИЧ.

Любовь против ВИЧ

Судебное разбирательство в отношении молодого человека проходило в 2019 году, однако известно о нем стало только сейчас. Юноше инкриминировалось преступление по части 4 статьи 113 УК Узбекистана — “Заведомое поставление человека в опасность заражения ВИЧ-инфекцией”. Молодые люди (ему 17 лет, ей – 16) знакомы с детства, еще подростками начали встречаться. Обвиняемый полностью сознался в содеянном и пояснил, что о своем диагнозе знает и с 2009 года (с семилетнего возраста) состоит на учете в Центре по борьбе со СПИДом, а также регулярно проходил обследование.

Семейных отношений пара не планировала, но, как водится, все произошло спонтанно, без использования контрацептивов. По признанию молодого человека, он предупредил свою девушку о возможной опасности. Беременность выявили лишь на пятом месяце. В итоге ни у матери, ни у родившегося позже ребенка не был обнаружен ВИЧ. Пара, конечно, зарегистрировала свой брак, но супруг получил за содеянное условный срок.

И без того неприятная история, хоть и со счастливым финалом, на этом могла бы закончиться, но неосторожное упоминание и искаженный заголовок в СМИ, что называется, подлили масла в огонь. Этот пример выявил давно назревшую проблему несовершенства судебной системы в отношении ВИЧ-инфицированных, которые подвергаются чуть ли не двойной дискриминации.

Новый взгляд на заболевание

По мнению экспертов, закон в нынешнем виде только способствует укреплению в обществе стигмы и притеснениям по отношению к ВИЧ-положительным, в частности, подросткам. Законодательство по ВИЧ/СПИДу морально устарело. Когда оно составлялось, это действительно было смертельным заболеванием, отсутствовала антиретровирусная терапия. Несколько лет назад ВОЗ официально объявила ВИЧ хронической и несмертельной болезнью.

В Узбекистане бесплатная АРВ-терапия доступна с 2006 года. Есть научные данные, что у человека с подавленной (неопределяемой) вирусной нагрузкой (количество вируса в крови), как у осужденного молодого человека, риск передачи вируса равен нулю. Но практика показывает, что закон порой к науке не прислушивается.

Одним из первых на публикацию ГУВД, а затем ее перепечатку в интернет-издании с невежественным заголовком отреагировал Азизбек Болтаев, психотерапевт из Бухары.

“Особое внимание общественности должен привлечь возраст, когда парень встал на учет – 7 лет, т. е. с большой вероятностью его заразили в одном из медучреждений страны. Получается, что человека наказали за состояние, которое возникло у него по причине недосмотра государственных контролирующих органов. Ведь если бы парня не заразили в детстве, сегодняшней проблемы попросту бы не было. Кто после подобных новостей захочет вставать на учет в Центр по борьбе со СПИДом?” — заметил эксперт.

Сегодня медицина позволяет ВИЧ-положительным людям действительно жить полноценной жизнью, заводить семьи без какого-либо риска для своего партнера и иметь абсолютно здоровых детей. Вот почему поправки в законодательстве так необходимы.

“В соответствии с международной практикой, наличие отдельной статьи о ВИЧ лишь усиливает стигму, поэтому рекомендуется применять общие статьи о причинении вреда здоровью. Кроме того, уголовная ответственность должна быть предусмотрена только за случаи предумышленного злонамеренного инфицирования либо попытки инфицировать. Если инфицирования не произошло, деяние, как правило, декриминализируют”, — отметил юрист Тимур Абдуллаев.

Статья 113 УК РУз состоит из пяти частей, ВИЧ посвящены ч. 4 и 5. Причем в одной части объединены два понятия: и “заражение”, и “заведомое поставление в опасность”.

“Последнее обозначает всякое действие, предполагающее любой риск выше нуля. Получается, защищенный половой контакт с использованием контрацептива не исключает ответственность, потому что он не защищает на 100%. Таким образом, все, что не равно нулю, – это в любом случае статья, и не важно, есть факт передачи или нет, есть умысел или нет. Кроме этого, Кодекс не объясняет, что значит “заведомое” и какой умысел оно означает – прямой, косвенный или вообще его отсутствие”, — объясняет юрист.

Таким образом исход судебного разбирательства зависит от трактовки закона органами следствия и судом.

“В России, Беларуси, Казахстане были добавлены примечания к статье, что в случае если ВИЧ-отрицательный партнер был предупрежден и согласился с риском и об этом имеется расписка, то ответственность отменяется, — продолжает Абдуллаев. — Однако в УК Узбекистана нет и такого примечания, а значит, все ВИЧ-положительные партнеры в дискордантных парах (где лишь один из них инфицирован) – де-юре преступники”.

Гуманный подход

За последние несколько лет Узбекистан достиг внушительных результатов в борьбе с ВИЧ-инфекцией. Кроме этого, создаются максимально комфортные условия для людей со статусом. Например, в рамках постановления президента Узбекистана “О мерах по дальнейшему совершенствованию системы противодействия распространению заболевания, вызываемого вирусом иммунодефицита человека, в Республике Узбекистан” уже практикуется доконтактная профилактика антиретровирусными препаратами для ВИЧ-отрицательных лиц в дискордантных парах.

Однако судебно-правовая система требует незамедлительных реформ, продиктованных международными рекомендациями и правозащитными организациями. По мнению экспертов, статья 113 ч. 4 УК РУз противоречит ряду положений Конституции – статье 18 и 27, а также статье 4 Семейного кодекса. Юристы убеждены, что поправки в текущее законодательство поспособствуют гуманному подходу в противодействии ВИЧ.

В случае с описанной парой заражения девушки не произошло, ВИЧ-активисты добились исправления скандального неправдивого заголовка, но как теперь быть с его последствиями? Одним неосторожным словом перечеркивается многолетняя работа специалистов по искоренению дискриминации ВИЧ-положительных.

“До сих пор мы констатируем факты позорного клеймения и без того страдающих тяжелым хроническим заболеванием людей, которые сталкиваются с ограничениями из-за статуса. Случись подобная ситуация среди здоровых подростков, вряд ли это вызвало бы общественный резонанс”, — убеждена Зульфия Таирова, международный эксперт по вопросам общественного здравоохранения и программ по борьбе с ВИЧ/СПИДом. 

По ее словам, в обществе еще сильны закостенелые стереотипы и жажда обличить виновника, наказать, предать огласке, чтобы другим не повадно было.

Мнимые фобии и реальные барьеры

В социуме все еще доминирует мнение о том, что ВИЧ – это проблема исключительно групп риска (наркозависимых, лиц, оказывающих платные секс-услуги, заключенных и т. д.). Относился ли осужденный молодой человек, зараженный в 7-летнем возрасте, к какой-то из этих категорий? Есть ли его вина в заражении? Почему теперь он вынужден жить с ярлыком человека с уголовным прошлым?

Другая проблема связанна с ограничением прав молодых людей с ВИЧ: невозможность учиться в иностранном вузе, запрет на въезд в иностранные государства на длительный срок по работе или учебе, где требуется сертификат об отсутствии этого диагноза.Даже медики сторонятся таких пациентов после выявления у них ВИЧ-статуса, порой отказывая в предоставлении услуг или передавая больного другому врачу.

Что касается воспитания молодежи, то, по словам Таировой, пора перестать прикрывать реальные проблемы и не игнорировать физиологию подростков.

“Нужно говорить с детьми на их языке и учить их способам защиты своего здоровья, прекратить прикрывать сексуальное воспитание завесой “уят” (стыд, позор). Подростки должны знать, как пользоваться презервативом и что это самый надежный способ защиты от инфекций и нежелательной беременности”, — уверена она.

В 2019-м в Молдове впервые прошел Региональный форум судей Восточной Европы и Центральной Азии по ВИЧ. К сожалению, представителей Узбекистана там не было. В этом году планируется второе заседание. В связи с пандемией коронавируса формат его проведения пока неизвестен. ВИЧ-активисты надеются, что на этот раз республика не останется в стороне от обсуждения очень важной темы. Цель этого форума – повысить информированность судей и изменить их отношение к ВИЧ-положительным подсудимым.

US: A decade after his expected release date, Nushawn Williams remains in state custody

Nushawn Williams Served Out His HIV-Related Sentence in 2010. Why Is He Still Not Free?

Nushawn Williams was four days from freedom when he received a letter in April 2010 informing him New York State officials were effectively reneging on the deal he had reached with the state 12 years earlier. Instead of walking out of Wende Correctional Facility upon satisfying the maximum time permitted by his plea agreement and re-starting his life at the age of 33, Williams remains in state custody more than 10 years after he expected to be released.

“I haven’t been home one day after age 19, not one time,” Williams, now 43, told TheBody in a telephone interview from Central New York Psychiatric Center, where he has been confined since 2014 under a rarely invoked New York law that allows extended detention after an inmate has completed their prison sentence.

There was no Article 10 of New York’s Mental Hygiene Law in 1999, when Williams accepted a prison sentence ranging from four to 12 years after having sex with dozens of women without disclosing he was HIV positive. One encounter was with a girl under the state’s legal age of consent, which marked Williams as a violent sexual offender. Article 10 permits the involuntary “civil confinement” of inmates deemed extraordinarily predatory. It was enacted in 2007, about a year after Williams became eligible for supervised release and began focusing on his life after prison.

“It wasn’t looking good for parole, so I started angling for my max [end of the maximum length of a prison sentence]: what kind of job I was going to do. I wanted to go to school for cybersecurity, go to ITT Tech, learn about computers,” said Williams, who would strategize with his wife during weekend visits every 45 days.

“We got to talk and actually plan,” Williams recalled of their private time together. “Her whole thing was me getting back my name in a positive manner, to show the world that people can change, people can go through a setback, bounce back, and change. And when I didn’t get to max out, that shattered everything.”

Patients or Prisoners?

Article 10 requires New York prison officials to notify the state attorney general’s Office of Mental Health (OMH) any time someone convicted of a sexual offense is nearing his or her release date. OHM staff preform a cursory review of each inmate’s history that clears most for release, but some cases are forwarded to a three-person review team that recommends whether a more extensive psychiatric analysis should take place.

It was such a panel that sent Williams a letter less than a week before his prison sentence was to end in 2010, notifying him he would be evaluated to determine whether he had a mental abnormality warranting extended detention. According to the most recent annual report on the Article 10 system from the attorney general’s office, inmates are notified they may face a new form of custody an average of less than two weeks prior to their release date.

Then–attorney general Andrew Cuomo, now governor of New York, wound up filing a court petition to transfer Williams from criminal to civil confinement, and eventually Williams found himself in the legal proceeding he thought he had avoided by pleading guilty.

“If I went to trial [after my initial arrest], this is what would’ve happened, I felt this is what it would’ve looked like,” Williams said. It took a Chautauqua County jury just over an hour to determine Williams had a mental abnormality, and a judge ordered him moved from prison to the mental health hospital in central New York, where he remains indefinitely.

“The [New York] supreme court has held [Article 10] does not violate double jeopardy, because the goal here is not punishment, it’s treatment,” said Jessica Botticelli, principal attorney at Mental Hygiene Legal Service in New York, who works with Article 10 defendants but has no direct involvement with Williams’ case. “For the clients going through this, it feels like additional punishment, but the courts see it as treatment,” Botticelli said. “If you want my opinion, it’s a crock of shit.”

While individuals confined under Article 10 are supposed to be considered patients instead of inmates, New York’s mental health facilities offer fewer liberties than in traditional prisons, said Catherine Hanssens, executive director of The Center for HIV Law and Policy, who has worked with Williams for several years.

“The restrictions on them are very similar to what I used to see when I was representing death row inmates in New Jersey: no confidentiality, rooms constantly searched for contraband, [Williams’] particular religious items destroyed or removed and disrespected,” said Hanssens, who recalled being denied permission to send Williams a book about the unwritten rules of social relationships because the text was inconsistent with his therapeutic plan.

“There is a limitation on reading materials that would not have at all been a problem for him when he was an actual prisoner,” Hanssens said. “When he was actually serving time on these offenses, he had conjugal visits. When he was actually serving time, he was a trustee, which is a position you earn.”

Officials at Central New York Psychiatric Center have refused visitation to Williams’ mother and sister because his sister once had a relationship with someone who is currently detained at the facility, Williams said.

“Where do they do that, deny your mother to come see you because of the actions of my sister? This is the type of place this place is,” said Williams, who noted he also had more due-process and appeal rights if he was accused of wrongdoing while incarcerated at Wende, a maximum-security prison.

“Here, you’re guilty without even having a hearing or any of that stuff,” Williams said. “[Staff] writes notes just to make sure when the attorney general gets [the inmate file] there’s something in there to make you look like you haven’t changed, to make you look like you are still facing the same activities that you was facing when you was 19 years old.

“I haven’t had a misbehavior report in this facility in almost four years, but they don’t write none of that inside your report,” Williams said. “They don’t write about the positive adjustments you’ve made, the help that you constantly give to individuals that can’t control themselves—they don’t put any of that in it.”

The absence of any type of confidentiality for Article 10 detainees belies the presumption that treatment is being administered, Hanssens said.

“Nobody there, including Nushawn, gets actual therapy,” she said. “If you agree that effective therapy requires some assurances of confidentiality, it’s not there. There is nothing that they say to anybody on staff that can’t and won’t be put in their records.”

During the period between their supposed prison release date and the time of their Article 10 hearing, inmates can choose whether to remain in their correctional facility or be transferred to an OMH hospital. Botticelli, whose organization advocates for Article 10 defendants, said she advises clients to remain in prison unless they absolutely need to leave.

“Once they are transferred to an OMH facility, everything that they do or don’t do is recorded in some way, and can be used against them at their Article 10 trial,” Botticelli said. “It’s a no-win situation for them.”

Less than 1% of sexual offenders are civilly committed under Article 10 in New York, which is one of 20 states with a law permitting confinement beyond an individual’s prison sentence; however, 83% of those who are referred for an Article 10 trial are convicted. The New York attorney general’s office did not respond to interview requests, but its 2019 report on Article 10 noted, “It is obvious that civil management is making a difference in helping to protect communities from dangerous sex offenders.”

“It’s Not for Me to Make It out of Here”

Article 10 detainees are entitled to a review of their case each year to determine if they can be released, but even at those hearings, it’s difficult to see them as anything other than inmates.

“It has been determined that unless the client can provide a medical reason why they should not be shackled in this manner, then they will be: handcuffed, [put in] ankle shackles, [a] waist chain connecting to the ankle shackles, handcuffs connected to the waist chain with the black box, which is like a padlock which makes it so they can’t move their wrists,” Botticelli said. “I don’t think [the department of corrections] shackles [prisoners] that way.”

A backlog of cases means it’s not uncommon for a patient to be waiting for one annual review by the time another rolls around, Botticelli said. All Article 10 hearings have been postponed by COVID-19 restrictions, and while a handful of New York prisoners were released due to the pandemic, none were Article 10 detainees, Botticelli said.

Williams has not had a single annual review of his case in the five years he’s been at Central New York Psychiatric Center, and he remembers the promises made by politicians at the time of his arrest that he would spend the rest of his life behind bars.

“It’s not for me to make it out of here,” Williams said. “It’s for me to die in this facility.”

His story—that of a young Black man from the streets of New York City being allegedly promiscuous with mostly white women in Jamestown, New York—made his case the most high-profile in the county’s history, according to the local newspaper that runs annual reassurances such as, “Nushawn to Remain in Civil Confinement” and “Williams Remains in Civil Confinement.”

Following his arrest, Williams was labeled, “A One-Man HIV Epidemic,” by a New York Times headline, while Newsweek called him, “The AIDS Predator.” Residual prejudice toward HIV-related offenses has colored the treatment Williams receives at the psychiatric center, while his media-alleged background as a teenage drug dealer, stick-up boy, and convicted child molester has prevented HIV/AIDS and LGBT groups from rallying to his cause, Hanssens said.

“He doesn’t fit the profile that a lot of our community likes to support,” said Hanssens, who doesn’t consider Williams paranoid for believing he will die in state custody. Williams was taken off his HIV medication for the first two years he was confined at the mental health facility, and resumed treatment only after attorneys with the governor’s office intervened.

“Part of his cynicism is based on what he has come to know,” Hanssens said. “The officials that operate [his facility] engage in half-truths and outright lies on multiple occasions, and yet their characterizations of what’s going on is far more likely to be believed.”

No Way Out?

Graduating from one of New York’s mental health facilities is nearly impossible, which is why almost all patients are released by a judge’s order, Botticelli said.

“There was a court case in one of the prior iterations of the treatment program. It was a four-phase program, and one of the courts found Phase Four didn’t exist,” said Botticelli, who noted the replacement program has a similar shortcoming.

Judges look favorably upon Article 10 patients developing a relapse prevention plan, but Botticelli recalls a doctor from Williams’ facility testifying in a separate case that she and other staff were explicitly prohibited from helping detainees develop such a plan.

“That is not something they do, that is not something they can edit or advise on, so clients have to come up with it themselves without much input from the people who are treating them,” Botticelli said. “I don’t like to sound cynical, but I feel like the program is designed so that our clients cannot complete it, cannot succeed in it, and cannot be released without the intervention of the court.”

There are no HIV-specific interventions at the facility in which Williams is confined, but he has tried to piece together a relapse prevention program consisting of group therapy and countless drug rehabilitation courses for marijuana, which he considers a trigger for his youthful abandon.

“I was naive, I was young, I was idiotic. I lived a reckless life,” he said. “For me, a lot of the stuff they have here—understanding tactics, understanding the things I’ve done in my past, how to respect the laws, how to put an effective plan into motion that you plan to stick by once released, how to hold down a job, how to file taxes, how to budget your money—those are things I feel I can grab onto.

“I see things differently now,” Williams added. “I didn’t know any of these things before going to prison. I was a teenager.”