US: "Punishment is the wrong approach to infectious disease control"

Should we punish the sick?

Would you consider calling the police if a coworker showed up at work one day with the flu? As absurd as that may sound, recent developments suggest that the notion of punishing people who are ill is becoming more entrenched and pervasive in American society.

Although new laws have cropped up in several states targeting diseases as diverse as meningitis and hepatitis, no disease is more widely criminalized than HIV. This year, on World AIDS Day (observed annually on Dec. 1), many advocates and public health organizations will be celebrating the dramatic advances in decreasing the number of new infections made possible by successful treatment and prevention.

In major urban cities around the globe — including London, Sydney and San Francisco — health departments are implementing powerful new tools to stop HIV transmission that are working. These include pre-exposure prophylaxis, or PrEP, which can greatly reduce the risk of infection when taken daily. In addition, it has come to light that treating HIV with antiretroviral medications help prevent its spread by rendering people living with HIV virtually noninfectious.

But while these advances are certainly promising, they do not tell the whole story.

The problem is that laws written in response to the AIDS epidemic remain stuck in 1985. HIV-specific criminal laws passed in the 1980s and 1990s at the height of America’s AIDS scare remain on the books. Law enforcement and prosecutors continue to vigorously enforce them, despite their lack of medical knowledge and sometimes without any legal justification. These moves are simply reactionary, based on stigmatizing views of HIV that unfairly punish innocent individuals.

Many HIV-related statutes make it a crime for people living with HIV to engage in a wide range of behaviors without first disclosing their HIV status—regardless of whether HIV could have been plausibly transmitted through their actions. Sometimes mistakenly referred to as “HIV transmission laws,” they make no mention of transmitting the disease or even putting a partner at risk of infection. For example, in Michigan, the law criminalizes any “sexual penetration” without disclosing one’s status—an overly broad formulation that includes many behaviors that cannot transmit HIV. Most HIV-specific state laws are felonies with harsh penalties, ranging from several years to life in prison.

Some states have laws so broadly written that they can be also used to punish a range of harmless nonsexual behaviors. In Tennessee, for example prosecutors regularly charge people living with HIV who spit at or bite police officers.

To that point, a recent report coauthored by the Centers for Disease Control (CDC) and the Department of Justice found that 25 states criminalize one or more behaviors that pose a low or negligible risk for HIV transmission, such as biting or spitting.

Michigan’s law is so badly written that one creative prosecutor used it to convict a woman for giving a lap dance in 2009. A detective explained the incident to the court with a graphic depiction of the woman’s genitals touching the man’s nose. That no one has ever contracted HIV via nasal contact mattered little under Michigan’s questionable (to say the least) law.

In a dozen cases reviewed during research for my book, “Punishing Disease,” accusers falsely claimed that it would take many years to know if a defendant had infected them. But most conventional HIV tests have only a three-to-six month “window” after exposure before patients can receive definitive test results. Court testimony in many cases almost invariably came long after that time period had elapsed.

These inaccurate suppositions directly impact sentencing. In a 2004 case in Davidson County, Tenn., the accuser claimed she wouldn’t know whether the defendant infected her for 10 years. The judge accepted her ignorant claim, ordering the defendant to serve 10 years’ probation and to pay for the woman to be tested for HIV for the next 10 years.

While HIV was originally the singular target of such laws, legislators seeking to “modernize” these laws have begun broadening their scope to include additional diseases such as meningitis and hepatitis – suggesting that the criminalization of sickness is contagious.

Punishment is the wrong approach to infectious disease control. The war on drug’s failure to contain drug addiction should warn us to the pitfalls of punitive approaches to controlling medical problems. Blame and shame are not the tools to protect us from disease; they are instead the fuel that drives epidemics.

Trevor Hoppe, Ph.D. is the author of ‘Punishing Disease: HIV and the Criminalization of Sickness’ and co-editor of ‘The War on Sex.’ He is currently assistant professor of sociology at University at Albany (SUNY).

Published in the Washington Blade on Nov 20, 2017

UK: Police accused of fear mongering by playing up the risks of HIV and hepatitis C transmission through spitting

Police accused of exaggerating risks of HIV to introduce spit guards

Force plans to issue guards to officers from January, saying people infected with blood-borne viruses use spitting as a weapon

A police force has been accused of fear mongering and stigmatising sufferers of hepatitis C and HIV by playing up the risks of transmission of blood-borne viruses as a reason to introduce spit guards.

Avon and Somerset police announced their plan to issue spit guards to all operational officers from January next year. “Each day we face being spat at, putting us at risk of HIV, hepatitis and tuberculosis and the degrading assault can have a lasting psychological impact,” said Assistant Chief Constable Stephen Cullen.

Spit guards are tight mesh hoods that officers can pull over the heads of suspects resisting detention to stop them from spitting or biting. They are used by 25 forces but have been criticised by human rights groups.

Avon and Somerset’s announcement came with an account by an officer, named John, who said people infected with blood-borne viruses use spitting as a “weapon”. He described an incident in which he arrested a drunk woman who had hepatitis C after she attacked a paramedic.

“She was continually spitting, spit that was bloody. It was disgusting; she was trying to infect us,” he said, recounting how officers donned riot gear to protect themselves as they stripped the detainee for her safety. “After the shift we all went home to our kids wondering what we were taking home.”

Rachel Halford, the deputy chief executive of the Hepatitis C Trust, said she agreed that police should be protected from health risks, but rejected the force’s implication that the virus could be transmitted through spitting.

“Hepatitis C is a blood-borne virus and is therefore only transmitted through blood-to-blood contact. The virus cannot be transmitted via spit,” she said.

“Stigma and misinformation about hepatitis C and other blood-borne viruses is a key challenge faced by patients, who are already disproportionately from the most marginalised and disadvantaged groups in society. Many patients report feeling ‘dirty’ and experiencing social exclusion due to misinformation about transmission risks.”

Kat Smithson, the director of policy and campaigns at NAT (National Aids Trust), said Avon and Somerset’s claims about HIV and hepatitis C were wrong and stigmatised people with the conditions.

“HIV is irrelevant to the debate about spit hoods because spitting simply is not an HIV transmission route,” she said. “In the history of the epidemic, there has never been a case of HIV being passed on through spitting, even when the spit contains blood.”

According to Avon and Somerset police, the restraints will be used only when a person threatens to spit, has attempted to spit or has already spat, and only when officers’ body-worn cameras are switched on.

Despite those safeguards, Deborah Coles, the director of Inquest, raised concerns over their introduction to another police force. “There should be no doubt spit hoods are a use of force and have the potential to cause acute trauma and injury,” she said.

“We know from our work that mental health concerns or other difficulties often sit behind agitated behaviour. Our fear is spit hoods will become the default response and used against vulnerable detainees.

“We had hoped that after the restraint death of James Herbert, Avon and Somerset police would have prioritised safer, more humane policing methods with a focus on de-escalation and detainee welfare.”

Avon and Somerset’s police federation backed the decision, which the force said was in support of the national federation’s proposed assault on emergency workers (offences) bill.

Vince Howard, the chairman of Avon and Somerset police federation, said: “This option affords those officers, who are increasingly subject to this abhorrent act, the opportunity to protect themselves from the risks of serious communicable diseases.”

Data for spitting incidents reported on the Welfare Information Form shows there have been 79 spitting incidents out of 487 recorded assaults since April, which a force spokesman said was a sharp increase on previous reports.

 

UK: Professor Matthew Weait reflects on the first convictions for intentional HIV transmission in England & Wales

Daryll Rowe guilty – but is criminal law the right way to stop the spread of HIV?

Daryll Rowe infected five male sexual partners with HIV, and tried unsuccessfully to infect a further five. Yesterday, he was convicted in the Crown Court at Lewes on ten counts of causing, and attempting to cause, grievous bodily harm. He will be sentenced in January.

This is the first case in the UK in which a person has been convicted of intentionally harming, or attempting to harm, others with HIV – prior to this, all UK convictions have been for reckless transmission. It is a uniquely harrowing and distressing case, and the impact of Rowe’s actions on the complainants cannot be underestimated.

Unsurprisingly, the trial has provoked much media comment, and his behaviour widespread condemnation – the details of Rowe’s actions, after all, are particularly shocking.

But whatever judgement we might pass on Rowe’s behaviour from a moral or ethical perspective, the criminalisation of HIV transmission and exposure more generally raises a number of important questions, not least regarding its impact on HIV-related stigma and efforts to reduce, and ultimately eradicate, the virus.

Ever since its discovery as the causative agent of AIDS in 1983, countries across the world have used the criminal law, both to censure those who have exposed others to the risk of infection or have in fact infected others, to control the spread of the virus.

The first of these rationales, a retributive one, reflected the fact that, until the mid-1990s, HIV was untreatable and almost inevitably led to death. It is therefore not surprising that states should have treated HIV as a weapon, and its effects as serious bodily harm.

The second rationale, a deterrent one, assumes that punishment will deter the accused – and others – from engaging in risky activity. It therefore has a supposed legitimacy from a public health perspective.

Both of these justifications are problematic.

The false path

Regarding retribution, criminal law requires that the defendant manifest a high degree of fault at the time – typically, that he acted intentionally, as Rowe did, or recklessly. As to intention, this can be established in English law and many other jurisdictions if (a) it is proven that it was the defendant’s purpose to infect, or (b) it may (but need not) be inferred if infection was virtually certain to occur, and the defendant foresaw that consequence as virtually certain.

Proving purposive intention is extremely difficult – a deliberate intention to engage in sexual activity which carries with it the risk of onward transmission is not the same as intending to transmit. It is also very difficult, in the case of HIV, to establish intention in the alternative way because, as has been confirmed in a number of clinical consensus statements, from Canada, Australia, and Sweden, the probability of transmission in any one incident of sexual intercourse is extremely low.

What’s more, where a deliberate (but unsuccessful) attempt to transmit HIV during sex is prosecuted, is it legitimate to punish someone for failing to achieve a consequence which is, statistically speaking, extremely unlikely to materialise? Critically, in the case of HIV, the accused is unable, as a matter of fact, to exercise agency over the outcome. (There is arguably a difference between swinging a bat at someone’s knee and missing, and having sex during which a virus may, but on any one occasion probably won’t, infect a partner.)

Recklessness (the conscious taking of an unjustifiable risk), however, is a lesser form of culpability. It is easier to prove, and a far more common basis for criminalisation. Until now, reckless transmission has been the basis for all UK convictions.

Rowe was found guilty of intentionally harming, or attempting to harm, others with HIV. But criminalising reckless transmission is particularly problematic. From a retributive perspective, this amounts to punishing people living with HIV who have sex during which HIV is transmitted, not because they had any desire that this should happen but because they were aware that it might. This places the entire burden of minimising the risk on them (even in cases where a partner is in fact aware of the risks), and is even more problematic where reckless exposure (as opposed to transmission) is criminalised.

This is not just because no physical harm has been caused, but because there is an absence of clarity as to what degree of risk is acceptable. In Canada, for example, there needs to be a “significant risk”, though what this means is contentious. It is now widely accepted that when a person diagnosed with HIV is on effective treatment and has an undetectable viral load, transmission is all but impossible. In the words of a current, high-profile, campaign to encourage testing and treatment, Undetectable = Untransmittable, or U=U.

A deterrent?

Criminalisation can also create obstacles to delivering beneficial public health outcomes.

First, because a person living with HIV can only be convicted for transmission, attempt, or exposure if he knew his HIV positive status at the relevant time, those who are in fact positive but don’t know can’t, by definition, be deterred by the prospect of punishment.

Second, and critically, criminalisation contributes to the stigma associated with HIV infection. Sensationalist press coverage, focusing on exceptional “newsworthy” cases, does little if anything to normalise HIV infection or to inform the general public about the fact that the vast majority of people living with HIV take every precaution against putting partners at risk. Instead, it fuels ignorance and misunderstanding.

Indeed, the print media in the UK and elsewhere has a long tradition of sensationalising HIV transmission and exposure cases, often at the expense of accurate reporting – whether about the trials themselves, or about the characteristics of those convicted.

This may make people wary of disclosing their status to partners, adhering to treatment, or getting tested in the first place.

Indeed, there is now near universal consensus among expert bodies, including UNAIDS and the Global Commission on HIV and the Law, that the use of the criminal law, where it is used at all, should be limited to the most egregious of cases and that exposure and reckless transmission should be decriminalised. Where states do use criminal law against those who deliberately and maliciously harm others, the highest standards of forensic evidence should be deployed.

Any moral judgement we pass on defendants in particular cases (who, it is worth remembering, were themselves infected by someone else) should not deflect attention from what must be our main priority: the total eradication of HIV.

We know definitively that regular testing and early treatment can significantly reduce the number of new infections, and we know that stigma, fuelled by criminalisation and press coverage, impedes this.

Rowe’s behaviour was found to be criminal. But we should reflect on whether criminal law – in general – does more harm than good, and ensure wherever, and whenever, possible that HIV is understood and treated as a public health priority rather than as an opportunity for blame and punishment.

US: Scientific advances and determined advocates are forcing US states to re-evaluate HIV criminal laws

Science battles politics in growing state-by-state debate over HIV felony charges

  • California Gov. Jerry Brown signed a bill last month making California the fourth state to revise criminal laws regarding HIV exposure.
  • Medical studies say there is effectively no risk of transmitting HIV while taking current drug regimens.
  • Advocates are pushing states across the country to reevaluate HIV criminal laws.

In six U.S. states, individuals living with HIV who are found guilty of knowingly exposing a partner are required to be registered as a sex offender. They can face felony charges, or felony-level punishments, in 32 states.

But as breakthrough HIV drug treatments and medical studies show there is essentially no risk of sexually exposing someone to HIV while taking antiretroviral drug therapy (ART), states are being forced to play catch-up to the science, and stigma, of the AIDS virus.

There are 1.1 million people living with HIV in America, according to the Centers for Disease Control and Prevention. Between 2003 and 2013, ProPublica reported (in the most recent data available) 2,352 records of HIV-related charges, with at least 541 convictions or guilty pleas.

“It’s not easy to get people to agree with science,” said Bruce Richman, executive director at the Prevention Access Campaign, an organization that seeks to provide the public with accurate information about HIV exposure. “It conflicts with their long, deeply held beliefs about transmission risks.”

Last month Gov. Jerry Brown signed bill SB 239, making California the fourth state to rewrite HIV exposure laws that were enacted in the 1990s during the AIDS epidemic. Before the legislative reform, a person living with HIV who violated the California law could spend eight years in prison, with additional time if the person was a sex worker. The punishment resembled a typical sentence for voluntary manslaughter — three, six or 11 years in prison.

The bill reduced charges from a felony to a misdemeanor, with maximum sentencing in a county jail now set at six months, and is no longer HIV-specific but includes other communicable diseases, such as hepatitis. Anyone who intentionally attempts to transmit a disease without success will be charged with a misdemeanor with a maximum sentence of 90 days.

While the bill passed in the California Assembly 44-13, not all legislators agreed with the decision.

“I’m of the mind that if you purposefully inflict another with a disease that alters their lifestyle the rest of their life, puts them on a regimen of medications to maintain any kind of normalcy, it should be a felony. It’s absolutely crazy to me that we should go light on this,” Sen. Joel Anderson said as he debated the bill, according to a report in the Los Angeles Times.

“This isn’t about making people sick; it’s about people living with HIV being able to live their lives and not be subject to felonies that people with other communicable diseases are not subject to,” said Jo Michael, legislative manager at LGBT advocacy group Equality California. In fact, Michael said this legislation will lead to more individuals seeking treatment. “HIV was singled out, and that increases the stigma,” Michael said. “If you want to lower new infection rates and have fewer people living with it over time, addressing the disparity in discrimination is a way to do it.”

Two recent medical studies — the PARTNER study, which followed 900 heterosexual and gay couples for 16 months; and Opposites Attract study, which followed 358 gay couples — have determined that the risk of transmission while taking ART is effectively zero.

“We can achieve full suppression of viral replication, and we know from the data: If the medication is taken continuously and over the time of the infection, there is no breakthrough infection anymore,” said Hendrik Streeck, director of the Institute of HIV Research at the University Duisburg-Essen in Germany, which conducts research on therapy methods and vaccine development.

Without taking ART, condoms and PrEP (a medicine that lowers the risk of infection), reduce the risk of getting HIV by more than 90 percent.

Scientists from the National Institutes of Health and Paris-based pharmaceutical company Sanofi are also moving closer to developing a vaccine for AIDS.

According to research at the William Institute of Law at UCLA, the California law before its reform disproportionately affected women and people of color, and 95 percent of HIV-specific criminal incidents impacted sex workers or suspected sex workers.

Recent CDC statistics show that individuals living below the poverty line are two times more likely to be HIV-positive than those living above it.

States are still resistant to reforming HIV laws

Despite the latest science, many states remain hesitant to change laws adopted in the 1990s. In total, 29 states impose felonies on an individual who fails to disclose their HIV status before sex, and three states (Louisiana, Minnesota and New Jersey) impose punishments equivalent to that of a felony offense, with sentences of at least two years in prison.

In Tennessee a person living with HIV who knowingly exposes others can be quarantined by the state’s Department of Health “after exercising other appropriate measures” if he or she is determined to be a threat to the public. This health code does not require a conviction under the Tennessee HIV-exposure law.

State HIV criminal laws stem from a federal initiative in 1990 under the Ryan White Comprehensive AIDS Resources Emergency Act, which made funding for AIDS treatment and care contingent on states passing laws to prosecute individuals who knowingly exposed someone to HIV.

In 1995, AIDS was the leading cause of deaths for adults 25 to 44 years old. There were 51,414 deaths that year, the peak of the epidemic. Since new drugs to treat HIV became available between 1995 and 1996, the number of HIV-related deaths per year in the United States have sharply declined. In 2014 there were 6,721 deaths, according to the Centers for Disease Control and Prevention.

Iowa was among the first states to take small steps in reforming HIV laws, along with Colorado. In 2014, Iowa eliminated a requirement for convicted individuals to register as sex offenders, and it created a tiered penalty system, which now looks at whether transmission of HIV occurred and whether or not exposure was intentional. Additionally, other diseases were elevated to be included under the law, such as hepatitis or tuberculosis. However, someone who exposes a partner to HIV can still face up to five years in prison — up to 25 years in prison if the virus is transmitted.

In 2016, Colorado eliminated felony penalty enhancements involving sex workers living with HIV and modernized language having to do with HIV and other sexually transmitted infections in its public health code. It also reduced the sentence enhancement for sexual assault if a person is HIV-positive to twice the original sentence and requires proof of transmission.

Catherine Hanssens, executive director of The Center for HIV Law & Policy, says these state measures still don’t reflect the latest science regarding HIV.

“The rest of the country does not understand that it is not easily transmittable and easily manageable,” Hanssens said. “[HIV] is serious, but it can be managed.”

Advocates are pushing against many state legislatures that show little inclination to reform their laws.

“There are efforts to change the laws under way across the country from Florida to Ohio to Washington state,” said Kate Boulton, staff attorney at the HIV Center for Law & Policy. She says it is a highly complex process, depending on the political climate of the states.

“It has a lot to do with how the individual legislation works and how connected to policymakers the advocates are,” Hanssens said.

An Ohio Supreme Court challenge fails

Ohio could have been the next state to reform their HIV criminalization laws, but the Ohio Supreme Court decided to uphold its current HIV codes in a ruling on Oct. 27. Orlando Batista appealed after being charged with a second-degree felony assault in 2016 for transmitting HIV to his girlfriend without disclosure and receiving a charge of eight years in prison.

The American Civil Liberties Union advised the court that his conviction violated the equal-protection clause by singling out people living with HIV, and it forced disclosure of personal medical diseases that violated his right to freedom of speech.

Elizabeth Bonham, staff attorney at ACLU, had been hopeful the law would be struck down in its entirety. “This was a disappointing decision and a setback for the rights of people living with HIV, but we will continue fighting against the stigma and against criminalization,” she said in an email the day the Supreme Court decision was released.

In Georgia, reform of HIV laws might take even longer, as advocates are still in the process of trying to update their legislators on the medical science of HIV transmission.

“I live in a state where legislators aren’t educated on HIV. The laws don’t protect me. … There is no room for defense for people like myself,” said Nina Martinez, who was diagnosed with transfusion-acquired HIV (passed along through blood) when she was 8 years old.

Martinez was present last week when Georgia State Legislator Betty Price — former Trump Department of Health and Human Services Secretary Tom Price’s wife — used the word “quarantine” in a suggestion for how to stop the spread of HIV in a meeting on improving health-care access.

“I feel like we’re back in the ’90s, but we’re in 2017,” Martinez said.

In Indiana the health codes are tied to HIV laws. Individuals given an HIV-positive diagnosis are asked to sign an acknowledgement that their health providers have a “duty to warn” — meaning doctors and health-care providers are permitted to break client/patient confidentiality agreements in cases having to do with HIV exposure. This could make people less likely to seek out a diagnosis or disclose information to their therapists or doctors.

“Health providers become an extension of the laws,” said Carrie Foote, chair of the HIV Modernization Movement in Indiana, which was formed last summer.

People living with HIV caught in the crosshairs

Aside from health providers, residents who seek diagnosis open themselves to potential criminal action merely by knowing their status. “If you don’t know your HIV status, it’s not a crime,” Foote said.

Travis Spoor was diagnosed with HIV in 2012, but he had never been linked to care when he was sentenced to three years in prison in Indiana for failing to disclose his HIV status to a sexual partner, even though he did not transmit HIV. Foote said it will be incredibly difficult for him to start getting treatment in the Indiana jails, since he had not been receiving care before his arrest.

“He should have been linked to care. Our system failed him, and it’s still failing him,” Foote said.

HIV is the only disease criminalized under Indiana laws. “It is not based on whether someone intended to harm or did harm. It’s based solely on their HIV status,” Foote said.

EQCA legislative manager Michael said, “Wherever laws like this exist, they are harming people.”

Nationally, California Congresswoman Barbara Lee reintroduced the REPEAL (Repeal Existing Policies that Encourage and Allow Legal) HIV Discrimination Act in the House for the third time in March 2017, requesting that the Department of Justice, Department of Health and Human Services and the Department of Defense review and modernize federal and state law regarding HIV-positive individuals. The same bill was introduced twice by Delaware Sen. Christopher Coons in the Senate and rejected both times.

“I don’t think this has particularly strong prospects in the current congressional climate,” said Boulton in an email.

Indiana HIV activist Foote remains determined.

“It shouldn’t matter how liberal or conservative your state is. It has to do with the fact that we have a health epidemic,” she said. “We have a public health issue. In this case, states are using the state law in an unwarranted way to treat a health issue, where there’s no evidence that works. … [HIV] criminalization has a unit effect, a family effect, and it has a ripple. It negatively affects all of us.”

— By Jessica Mathews, special to CNBC.com

Published on CNBC on Nov 7, 2017

Mexico: The Network against the Criminalisation of HIV report that 30 out of 32 states criminalise "exposure to infection" in Mexico

In Mexico 30 states criminalize HIV as “a crime of exposure to infection”  (Google translation. For article in Spanish, please scroll down)

The Network against the Criminalisation of HIV, a coalition formed by 29 associations in favour of human rights in Mexico, reported that 30 of the 32 states that make up the Mexican Republic include in their Penal Codes the category “Crime of exposure to infection”, which punishes people who transmit or can transmit a “non-curable disease” to another person.

“The aim of the network is not to start a witch hunt, because it was surprising that in the last two years this law has been discussed in three different state congresses,” he explained to Leonardo Bastida, member of the association, Letra S.

According to the organisations, this legal statute endangers people with HIV, as it criminalizes and undermines strategies aimed at combating the epidemic. Specifically, laws sanction the possibility of transmitting an illness, even if it happens involuntarily.

According to Bastida, since the year 200 have registered 39 criminal proceedings for this cause, of which 15 are located in Veracruz, nine in Sonora, five in Tamaulipas, five more in the State of Mexico, three in Chihuahua, one in Mexico City and one more in Nuevo León.

According to the activists, these criminalizing laws emerged in the first half of the 20th century and focused mainly on penalizing the “contagion” of syphilis, but over the years they were modified and included various diseases.

Only Aguascalientes and San Luis Potosí do not have this legalstatute in their penal codes, while in Sonora the law could be toughened, since there is currently a proposal that is being analyzed to establish sentences of up to 15 years in prison. Activists and the State Human Rights Commission seek to repeal Article 113 of the Criminal Code, which includes this criminal category.

The network detailed that in the case of Veracruz, legislators approved in 2015 an amendment to the local penal code to add to the “crime of contagion” the term “sexually transmitted infections. In addition, with the amendment of article 158, sentences of 6 months to 5 years in prison were established.

Faced with this situation, a group of social organizations presented an appeal of unconstitutionality to the Supreme Court of Justice of the Nation. The activists trust that the SCJN will rule in favor of the lawsuit.

Members of the Network against Criminalization warned that these types of laws do not help to combat the increase in HIV cases and only contribute to stigmatization and make it difficult for strategies focused on combating HIV transmission to meet their goals.

With information from EFE.

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En México 30 estados criminalizan el VIH como “delito de peligro de contagio”

La Red contra la Criminalización del VIH, una coalición conformada por 29 asociaciones a favor de los derechos humanos en México, informaron que 30 de los 32 estados que conforman la república mexicana contemplan en sus Códigos Penales la categoría “Delito de peligro de contagio”, la cual castiga a las personas que transmitan o puedan transmitir una “enfermedad no curable” a otra persona.

“El objetivo de la red es que no empiece una cacería de brujas, porque fue sorprendente que en los últimos dos años se haya discutido en tres congresos estatales diferentes esta ley”, explicó a Leonardo Bastida, integrante de la asociación, Letra S.

De acuerdo con las organizaciones, dicha figura penal pone en peligro a las personas con VIH, ya que las criminaliza y resta fuerza a las estrategias enfocadas a combatir la epidemia. Específicamente, las leyes sancionan la posibilidad de transmitir alguna enfermedad, aunque suceda de forma involuntaria.

De acuerdo con Bastida, desde el año 200 se han registrado 39 procesos penales por esta causa, de los cuales 15 se ubican en Veracruz, nueve en Sonora, cinco en Tamaulipas, cinco más en el Estado de México, tres en Chihuahua, uno en la Ciudad de México y uno más en Nuevo León.

Según explicaron los activistas, estas leyes criminalizadoras surgieron en la primera mitad del siglo XX y se enfocaban principalmente a penalizar el “contagio” de la sífilis, pero con el pasar de los años se fueron modificando e incluyeron diversas enfermedades.

Sólo Aguascalientes y San Luis Potosí no cuentan con esta figura en sus códigos penales, mientras que en Sonora se podría endurecer la ley, ya que actualmente existe una propuesta que está siendo analizada para establecer penas con hasta 15 años de prisión. Los activistas y la Comisión de Derechos Humanos del Estado buscan derogar el artículo 113 del Código Penal, el cual incluye esta categoría penal.

La red detalló que en el caso de Veracruz, los legisladores aprobaron en 2015 modificar el código penal local para agregar al “delito del contagio” el término “infecciones de transmisión sexual. Además con la modificación del artículo 158 se establecieron penas de 6 meses a 5 años de cárcel.

Ante este panorama, un grupo de organizaciones sociales presentaron un recurso de inconstitucionalidad a la Suprema Corte de Justicia de la Nación. Los activistas confían en que la SCJN falle a favor de la demanda.

Los integrantes de la Red contra la Criminalización alertaron que este tipo de leyes no ayudan a combatir el aumento de casos de VIH y sólo contribuyen a la estigmatización y dificultan que las estrategias enfocadas a combatir la transmisión del VIH cumplan sus metas.

Con información de EFE.

Malawi: Human right groups condemn new HIV bill as discriminatory, paternalistic and harmful to the HIV response

Malawi rights bodies defy criminalising the transmission of HIV:  Bill deeply flawed

Stakeholders have described the new HIV and AIDS Bill as ‘a bad law’ and a disaster to happen as it is discriminatory and will impede the fight against AIDS.

The bill includes mandatory HIV testing for pregnant women and their partners, and allows medical providers to disclose a patient’s HIV status to others. The bill also criminalizes HIV transmission, attempted transmission, and behavior that might result in transmission by those who know their HIV status.

Human rights groups and activists who converged in Lilongwe recently for the media advocacy meeting on HIV and Aids Bill described the new bill on HIV and AIDS as a debauched law in the offing.

Centre for Human Rights Education, Advice and Assistance (CHREAA) organised the meeting.

Mandatory HIV testing and the disclosure of medical information without consent are contrary to international best practices and violate fundamental human rights, the rights activists said. The criminalization of HIV transmission, attempted transmission, and behavior that might result in transmission by those who know their HIV status is overly broad, and difficult to enforce.

Female Sex workers Association executive member, Zinenani Majawa, speaking on behalf of sex workers in in Malawi said: “This Bill targets us because men will always be saying this sex worker infected me with the disease.”

Majawa vehemently quashed the bill, saying it does not give any hope towards the HIV positive response.

The sex workers representative argued that Section 43 and 44 will also be difficult to apply with due adherence to fair trial rights including the right to be presumed innocent, adding that it is not correlating on the obligation for the state to prove criminal conduct beyond a reasonable doubt.

“This is because in most circumstances, there is no scientific means to prove the direction of HIV transmission beyond a reasonable doubt,” said Majawa.

During the meeting the stakeholders nudged holes on the new bill, saying, for example section 43 that targets deliberate transmission was seen to be similarly overboard.

“Phylogenetic analysis is expensive it requires the use of complex computational tools to estimate how closely related the samples of HIV taken from complainants and defendants are in comparison to other samples,” argued some stakeholders.

‘Vilification of women’

Making a presentation on the new Bill, Women Lawyers Association (WLA) President Sarai Chisala said, in its current format, despite the many admirable aspects of the HIV Bill, the provisions that create criminal measures to enforce various HIV management efforts have the effect of infantilizing, criminalizing, stigmatizing and potentially victimizing women – particularly women who are already living with HIV.

Said Chisala: “Rather than being protective and preventive, the law is paternalistic, positing women as both victims and vectors of HIV. Yet in reality women living with HIV rarely describe themselves as “victims” when relaying how they became infected, and the language of vectors is especially harmful for those most marginalised members of society such as female sex workers.”

Chisala further explained that the HIV Bill both demonizes and infantilizes women, they are painted as carriers of the disease but also as potentially careless and callous mothers; and women of loose morals.

“In a country where more than half of the women are married before the age of 18, and it is within these relationships – and oftentimes violent relationships, a product of harmful cultural practices – that they either become infected or learn of their infection, in this manner, lives that are already filled with violence are suddenly even more fraught with danger, Chisala said.

Sarai added that there are clear public health implications to a pandemic such as HIV and AIDS and the role that the government opts to play in the management of the pandemic has a severe impact on the course of the disease.

According to the WLA president: “legislation can be used to set out the manner in which issues such as voluntary counselling and testing; partner notification; medical care and treatment of AIDS related illnesses; and, epidemiological surveillance, amongst other things, are handled,” adding; “The UNAIDS Handbook for Legislators on HIV/AIDS, Law and Human Rights (the Handbook) suggests that laws should require specific informed consent before HIV testing is done for fear of risking violation of a person’s right to both privacy and personal liberty, the Handbook also goes on to stress that targeting specific groups for compulsory testing is in violation of the non-discrimination principle under international human rights law.”

The WLA leader also noted with consternation that the overly punitive crafting of many of the provisions in the HIV Bill, that were intended to prevent the spread of HIV and AIDS, are instead more likely to lead to disproportionate demonization and vilification of women living with HIV.

Some of the organizations which have openly challenged the newly introduced bill includes, female sex workers, Child Rights Information and Documentation Centre, Coalition of Women Living with HIV, AIDS Rights Alliance, Mango Network, Southern Africa Litigation Centre, Centre for Development of People, CHREAA, Youth Watch Society just to mention a few.

Published in the Nyasa Times on Nov 2, 2017

Mexico: Lawmakers and civil organisations commit to reform HIV criminalisation law in Quintana Roo

They will reform Penal Code to protect people with HIV

Lawmakers and civil organizations agree to push for changes to article 113

Saturday, October 21, 2017

Considering that article 113 of the Criminal Code of Quintana Roo may violate the human rights of people suffering from diseases such as HIV / AIDS, members of the 40th Legislature committed themselves to progress the analysis of a reform to modify it, or as the case may be, repeal it.

This Friday, Deputy Laura Esther Beristain Navarrete, president of the Commission on Health and Social Welfare and Deputy Alberto Vado Morales, president of the Culture Commission, met with civil organizations dedicated to issues such as HIV prevention and Human Rights of the LGBTQI Community, as well as representatives of the National Human Rights Commission and the Human Rights Commission of the State of Quintana Roo.

After looking at the drafting proposals with respect to the reform of article 113 of the Criminal Code of the State and listening to the arguments of the civil organizations and human rights organizations, it was agreed to push before the Justice Commission of the Congress this article that has been in force since 1991, they said.

It should be noted that Article 113 in its current wording, according to the organizations, criminalizes people living with HIV, implying that people suffering from this disease can be subject to a criminal trial solely because of their health condition, which is a matter of brevity, said the deputies.

During the meeting, topics such as the need to avoid legislative lag and to advance in the opinion of issues that have already been presented by the president of the Health Commission, Laura Beristain and the deputy Alberto Vado, such as reforms to the Civil Code for equal marriages and rights of affiliation of the LGBTTTI community; to the Criminal Code to deal with hate crimes against this sector of the population; the HIV Prevention and Treatment Act and reforms to promote gender identity of transgender people.

For his part, the president of the organization Círculo Social Igualitario, Edgar Mora Ucan, indicated that the repeal of article 113 of the Criminal Code is a watershed moment to legislate with a vision for human rights.

“This is a transcendental fact for the state, is creating the precedent of legislating with a vision for human rights. Only two states in the country do not have this legislation and in Quintana Roo it is being done. The door is being opened to legislate on other human rights issues, “he said.

Published in La Jornada Maya on October 21, 2017

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Reformarán Código Penal para proteger a personas con VIH

Acuerdan legisladores y organizaciones civiles impulsar cambios al artículo 113

La Jornada Maya

Sábado 21 de octubre, 2017Por considerar que el artículo 113 del Código Penal de Quintana Roo puede ser violatorio de los derechos humanos de las personas que padecen enfermedades como VIH Sida, diputados integrantes de la 40 Legislatura se comprometieron a avanzar en el análisis de una reforma para modificarlo y, en su caso, derogarlo.

Este viernes la diputada Laura Esther Beristain Navarrete, presidente de la Comisión de Salud y Asistencia Social y el diputado Alberto Vado Morales, presidente de la Comisión de Cultura, se reunieron con organizaciones civiles dedicadas a temas como la prevención del VIH y promotores de los derechos humanos de la Comunidad LGBTTTI, así como con representantes de la Comisión Nacional de Derechos Humanos y la Comisión de Derechos Humanos del Estado de Quintana Roo.

Luego de un análisis de las propuestas de redacción con respecto a la reforma del artículo 113 del Código Penal del Estado y con los argumentos de las organizaciones civiles y de los organismos de Derechos Humanos se acordó impulsar ante la Comisión de Justicia del Congreso, la derogación de dicho artículo que se encuentra vigente desde 1991, según señalaron.

Cabe destacar que el Artículo 113 en su redacción actual, de acuerdo con las organizaciones, criminaliza a las personas que viven con VIH, lo que implica que las personas que padecen esta enfermedad pueden estar sujetas a un juicio penal únicamente por su condición de salud, tema que es de atenderse a la brevedad, consideraron los diputados.

Durante el encuentro se abordaron temas como la necesidad de evitar el rezago legislativo y que se avance en el dictamen de temas que ya han sido presentados por la presidente la de la Comisión de Salud, Laura Beristain y el diputado Alberto Vado, tales como reformas al Código Civil para los matrimonios igualitarios y derechos de filiación de la comunidad LGBTTTI; al Código Penal para la atender los crímenes de odio hacia este sector de la población; la Ley de Prevención y Tratamiento del VIH y reformas para impulsar la identidad de género de las personas transgénero.

Por su parte el presidente de la organización Círculo Social Igualitario, Edgar Mora Ucan, indicó que la derogación del artículo 113 del Código Penal es parte-aguas para legislar con visión hacia los derechos humanos.

“Este es un hecho trascendental para el estado, está creando el precedente de legislar con visión hacia los derechos humanos. Solo dos estados en el país no cuentan con esta legislación y en Quintana Roo se está haciendo. Se está abriendo la puerta para que se legisle sobre otros temas en materia de derechos humanos” aseguró.

Belarus: More than 50 cases of criminal prosecution of HIV in Belarus in the first 6 months of 2017

Belarusian legislation discriminates against HIV-positive people (Google translation – Article in russian below)

In the six months of 2017, the number of cases of criminal prosecution of HIV-positive people in Article 53 of the Criminal Code of the Republic of Belarus (Infection with the Human Immunodeficiency Virus) has significantly increased in all regions of Belarus, especially in the Gomel region.

If in the period from 2012 to 2016, 38 cases were registered, then for 6 months in 2017 – more than 50 people were convicted, many of them are serving sentences in places of deprivation of liberty.

“The Belarusian community of PLWH” notes that at a time when calls for testing and self-testing for HIV are sounding throughout the country, campaigns are underway to create a tolerant attitude, people with identified HIV status are being prosecuted. The topic of HIV infection is actively discussed in the Belarusian press and abroad, thereby creating a negative, negative impression about people living with HIV, creating a new wave of enmity, stigma and discrimination in society.

Article 157 of the Criminal Code of the Republic of Belarus was approved in 1999, when HIV infection was considered an incurable disease. Since then, about 20 years have passed, mankind has stepped into a new age, medical approaches have changed, highly effective treatment has appeared, HIV is no longer a deadly disease, and has become chronic, well controlled by antiretroviral treatment. In HIV-positive people taking ARV therapy, with an undetectable viral load, the risk of HIV transmission during sexual intercourse is reduced to almost zero.

Article 157 of the Criminal Code of the Republic of Belarus consists of three parts:

  1. Knowingly placing another person at risk of contracting the human immunodeficiency virus (HIV) – is punishable by a fine, or by arrest, or by imprisonment for up to three years.
  2. Infection of another person by frivolity or with the indirect intent of HIV by a person who knew about his having this disease is punishable by imprisonment for a term of two to seven years.
  3. The action provided for in paragraph 2 of this article, committed against two or more persons, either knowingly underage, or with direct intent, is punishable by imprisonment for a term of five to thirteen years.

In the first and second parts of this article, criminal cases are instituted against people who live in legal marriages or couples where one partner is HIV-positive even if he has informed his partner about HIV-carrier, even if the fact of one from family members is taken completely consciously and voluntarily.

In accordance with the requirements of Art. 157 of the Criminal Code of the Republic of Belarus, discordant marriages in general are under the ban and under penalty of criminal responsibility, as well as one-time voluntary sexual contacts between people of different HIV status.

In Belarus there are presumably more than 500 discordant couples. They live and work, multiplying the welfare of their country, are good taxpayers. Practically every family has children who risk being left in single-parent families, without parental care, because of the absurdity and inhumanity of law enforcement practice.

Russia also provides for criminal liability for posing a risk of contracting HIV infection under art. 122 of the Criminal Code. Thanks to the active efforts of the Russian community of PLHIV, an important note was added to the article in 2003, on the basis of which the person who put the partner at risk of infection or who infected him with HIV infection is released from criminal liability “if another person put at risk of infection, or was infected with HIV infection, was warned in a timely manner about the presence of the first of this disease and voluntarily agreed to perform actions that created the danger of infection. ” Such an addition in Article 122 of the Criminal Code released HIV-positive Russians with established HIV status from criminal prosecution.

“Belarusian community of PLWH” believes that Article 157 of the Criminal Code of the Republic of Belarus contradicts international and national legal norms. Under current legislation, an HIV-positive person can not feel a full-fledged citizen of their country. Such a practice with respect to people living with HIV is discriminatory and requires an early resolution at the legislative level of Belarus!

As of September 1, 2017, there were 18,438 HIV-positive people registered in Belarus.

Published in ECU on Oct 6, 2017

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Белорусское законодательство дискриминирует ВИЧ-позитивных людей

За шесть месяцев 2017 года во всех регионах  Беларуси,  особенно  в Гомельской области, значительно увеличилось количество случаев уголовного преследования ВИЧ-положительных людей по статье 157 Уголовного Кодекса Республики Беларусь (Заражение вирусом иммунодефицита человека).

Если в период с 2012 по 2016 годы было зарегистрировано 38 случаев, то за 6 месяцев 2017 года —  более 50-ти человек были  осуждены, многие из них отбывают срок наказания в местах лишения свободы.

«Белорусское сообщество ЛЖВ» отмечает, что в то время, когда по всей стране звучат призывы к тестированию и самотестированию на ВИЧ, проходят кампании по формированию толерантного отношения, люди с выявленным ВИЧ-статусом подвергаются уголовному преследованию. Тема о заражении ВИЧ активно муссируется в  белорусской прессе и за ее пределами, тем самым формируя отрицательное, негативное  впечатление о людях, живущих с ВИЧ, порождая новую волну вражды, стигмы и дискриминации в обществе.

Статья 157 Уголовного Кодекса Республики Беларусь  была утверждена  в 1999 году,  когда ВИЧ-инфекция считалась неизлечимым заболеванием. С тех пор прошло около 20 лет, человечество перешагнуло в новый век, поменялись медицинские подходы, появилось высокоэффективное лечение,  ВИЧ больше не является смертельно опасным заболеванием, и перешел в разряд хронических, хорошо контролируется антиретровирусным лечением. У ВИЧ-положительных людей, принимающих АРВ-терапию, при неопределяемой вирусной нагрузке риск передачи ВИЧ при половых контактах снижается практически до нуля.

Статья  157 УК РБ состоит из трех частей:

  1. Заведомое поставление другого лица в опасность заражения вирусом иммунодефицита человека (ВИЧ) – наказывается штрафом, или арестом, или лишением свободы на срок до трех лет.
  2. Заражение другого лица по легкомыслию или с косвенным умыслом ВИЧ лицом, знавшим о наличии у него этого заболевания  – наказывается лишением свободы на срок от двух до семи лет.
  3. Действие, предусмотренное частью 2 настоящей статьи, совершенное в отношении двух или более лиц, либо заведомо несовершеннолетнего, либо с прямым умыслом, – наказывается лишением свободы на срок от пяти до тринадцати лет.

По 1 и 2-ой  части данной статьи возбуждаются уголовные дела  по отношению к людям, которые живут в законных браках или парах, где один из партнеров является  ВИЧ-положительным,  даже  если  он проинформировал своего партнера о ВИЧ-носительстве, даже если факт заболевания одного из членов семьи принят совершенно осознанно и добровольно.

В соответствии с требованиями ст. 157 УК РБ дискордантные браки вообще находятся под запретом и  под страхом уголовной ответственности, равно как и разовые добровольные половые контакты между разными по ВИЧ-статусу  людьми.

В Беларуси предположительно насчитывается более 500 дискордантных пар. Они  живут и трудятся, преумножая благосостояние своей страны, являются добропорядочными налогоплательщиками. Практически в каждой семье есть дети, которые рискуют остаться в неполных семьях, без попечения родителей, по причине абсурдности и  антигуманности  правоприменительной практики.

В России также предусмотрена  уголовная ответственность за поставление в опасность заражения ВИЧ-инфекцией по ст. 122 УК РФ. Благодаря активным действиям российского сообщества ЛЖВ, в 2003 году в статью было внесено важное примечание, на основании которого человек, поставивший партнера в опасность заражения, либо заразивший его ВИЧ-инфекцией, освобождается от уголовной ответственности, «если другое лицо, поставленное в опасность заражения, либо зараженное ВИЧ-инфекцией, было своевременно предупреждено о наличии у первого этой болезни и добровольно согласилось совершить действия, создавшие опасность заражения». Такое дополнение в ст.122 УК РФ освободило ВИЧ-положительных россиян с установленным ВИЧ-статусом от уголовного преследования.

«Белорусское сообщество ЛЖВ» считает, что  статья 157 УК РБ  противоречит  международным и национальным  правовым нормам. При существующем законодательстве ВИЧ-положительный человек не может чувствовать себя полноправным гражданином своей страны. Подобная практика по отношению к людям, живущим с ВИЧ является дискриминационной, и требует скорейшего разрешения на законодательном уровне Беларуси!

По состоянию на 1 сентября 2017 года в Беларуси зарегистрировано 18 438   ВИЧ-положительных людей.

New Zealand: Does the transmission of HIV still amount to grievous bodily harm? Interview with Jason Myers, AIDS Foundation Director, on the Court of Appeal current deliberation

Is deliberately spreading HIV grievous bodily harm?

A court’s being asked to determine whether spreading HIV still amounts to causing grievous bodily harm.

A man is appealing a grievous bodily harm conviction, after a jury found him guilty of knowingly infecting his partner with HIV.

He’s arguing the disease doesn’t amount to grievous bodily harm, because it can be easily treated.

Aids Foundation executive director Jason Myers said he isn’t surprised to see a case like this before the courts.

“Back in the eighties, early nineties it was a death sentence for many people. What you’ve essentially got in 2017 is a long-term manageable chronic disease.”

 

Canada: Legalities around disclosing HIV and other STIs in Canada

Have an STI? What you’re legally obligated to disclose

Jenelle Marie Pierce was 16 when she found out she had genital herpes.

“I was made to sleep on the floor at slumber parties because people thought they were going to contract my herpes from me,” the now 35-year-old from Caledonia, Mich., told Global News. “People can be cruel and really it’s just a product of a lack of information.”

Finding out you have a sexually transmitted infection (STI) may seem like the end of your love life, but according to experts, it’s not true. With the right amount of education, communication in disclosing your status and safe sex practices, you can foster a healthy intimate relationship.

In Canada, STI infections are on the rise. Between 1998 and 2015 (the most recent national data available), chlamydia — the most commonly reported STI in Canada — has risen from 39,372 to 116,499 annual cases among all ages and genders, and gonorrhea rates increased from 5,076 to 19,845 in the same time period. Infectious syphilis rates rose dramatically from 501 to 4,551 cases.

But aside from the obvious health implications these infections have, their emotional burden can be almost equally dangerous. A 2014 study published in the journalAIDS Patient Care and STDs found that STI-related stigma was associated with decreased odds of testing for STIs and decreased willingness to notify a partner of an STI among young African American men.

A similar study from 2009 that was published in Perspectives on Sexual and Reproductive Health also found that STI-related stigma was a barrier to adolescents’ screening behaviour.

“I’ve been called everything from a slut to a whore. People assume that you are a cheater, you are promiscuous … But it [affects] people from all walks of life, all backgrounds. It’s across the board. People from everywhere contract these infections.”

The key is to be open and ethical about your STI to prevent the spreading of any infections.

Legalities around disclosing

In Canada, it’s a crime not to disclose HIV or another STI before having sex that poses a “significant risk of serious bodily harm.” However, most prosecutions have been strictly related to HIV and hardly any have been related to herpes, syphilis, chlamydia or other STIs.

The legal obligation to disclose your status was established in the 1990s, but for people with HIV, the law became harsher in 2012. That’s when the Supreme Court of Canada decided that people living with HIV are obligated to tell their partner about their status before engaging in sex that poses a “realistic possibility of HIV transmission.”

In practice, what that means is if you’re going to engage in vaginal or anal sex and are HIV positive but don’t tell your partner ahead of time, you could face criminal prosecution if you don’t use a condom or if you use a condom but have a viral load higher than “low.”

According to advocates, this test has been applied inconsistently by the courts without proper regard to the science.

“The science is now established that there is effectively zero risk of transmission to a sexual partner if you have an undetectable viral load,” Richard Elliott, executive director of the Canadian HIV/AIDS Legal Network, told Global News.

There have been conflicting court decisions for people with HIV with an “undetectable” viral load. Some have been prosecuted and other’s haven’t.

At least 184 people have faced charges related to HIV non-disclosure after sex in Canada, one of the highest rates of HIV criminalization in the world, Elliott added. Only a few prosecutions have been related to herpes and syphilis. There haven’t been any prosecutions for non-disclosure of chlamydia, gonorrhea or HPV.

Public health

Besides the legal obligations laid out by the Canadian criminal code, some experts believe it’s important to be transparent about your STI in the name of public health.

“You want to be upfront, you want to tell the person, and you also want to reassure them that you will be performing safe and intimate contact,” Jason Tetro, a Canadian microbiologist, told Global News.

Tetro, who used to work in HIV research and policy, says STIs are becoming more and more resistant to antibiotics, which means they’ll be even more of a headache to treat — so, why not be open from the beginning, before any sexual contact?

“If you happen to be exposed you may be facing a very long and difficult antibiotic treatment before you’re clean, so the fact is, if we all work together to make sure we are not spreading these bugs, it’s going to improve public health overall.”

Having the awkward conversation

There are two approaches to talking to your partner, according to Pierce.

The first is being completely open about your STI status from the get-go. For those who are comfortable laying it out on the table, they can add their status to their dating profiles. The reason behind this approach, explained Pierce, is that you have a lower chance of getting your feelings hurt.

The second approach is more discreet. Just like any relationship that grows organically, some private matters like revealing your STI, are not discussed until trust is gained.

Of course, you need to disclose before there is any sexual contact.

“The idea behind that is that nobody actually puts everything out there on the table when they start dating. That’s kind of the whole dating process, it’s learning about somebody as you go,” Pierce said.

“Nobody says ‘I have horrible debt and my dad is an alcoholic and my brother is in prison’… [it’s a] myriad of things that might be a deal breaker for somebody.”

It really depends on who you are, there is no right or wrong way to do it, she added.

Once you’ve figured out the timing, you then need to figure out the method.

Avoid finding yourself in the heat of the moment. Find a private and quiet place to have the conversation, and approach it in a practical way, Pierce says. Lay out the facts in a neutral and non-emotional manner, because you don’t want to influence their response.

“It’s OK to acknowledge that it might be awkward or weird, but be as open and clear-cut as you can.”

Once you’ve disclosed your status and laid out the options for safe and protected sex, you have to let them decide if they want to take the relationship to the next level. Pierce’s biggest piece of advice? Don’t take the person’s response — positive or negative — personally.

Pierce, who has had a successful career and has had many healthy relationships, says you shouldn’t get discouraged. It’s better to be honest and straightforward, and foster a partnership with someone who will work with you to keep the STI contained to one person.

Published in Global News on October 16, 2017