US: Women living with HIV at the forefront of the fight against HIV criminalisation

Ending HIV Criminalization Starts With Me

Tiffany Moore had a panic attack at a Tennessee playground. That’s how her 2021 ended.

All she’d wanted was to give her 8-year-old daughter the gentle childhood she’d never had. By age 10, Moore had for years been strapped down repeatedly in mental health wards and “pumped full of drugs” in different hospitals. That was in addition to the abuse she’d experienced at home. Half a decade later, she would be on the streets, surviving through work with sex traffickers and pimps. At age 10, she says, she didn’t expect to see adulthood. Now, as a mother, she was determined her daughter would grow up enjoying her childhood experiences, including afternoons on swings and slides with her mommy.

But until December 2021, when a change in Tennessee law that she fought for went into effect, Moore was legally forbidden from visiting a playground. That’s because at 21, she was convicted of aggravated prostitution—the aggravation being that she’d acquired HIV during a rape. And even though she did not transmit HIV to anyone, Moore spent 20 years on Tennessee’s sex offender registry as a result of her status.

Within weeks of her removal from the registry, Moore was at a playground surrounded by children, and every fiber in her body told her to flee, that she was one call to the police away from being separated from her daughter.

“They’ve instilled for 20 years that you’re a danger to children and your child. You can’t go here; you can’t go there. You can’t be here; you can’t be there,” she says. “I just know—I know I have a lot of pieces to pick up.”

She’s not alone. Though the public face of HIV criminalization laws has been primarily gay men—particularly gay Black men—recent data show that such legislation also targets Black women.

In particular, research conducted by the Williams Institute at the University of California at Los Angeles has found that in California, for instance, Black women make up 3% of the population and 4% of people living with HIV but 22% of people prosecuted under that state’s old HIV criminalization law.

In Georgia, Black women make up 17% of the population and 18% of those living with HIV but fully half of people prosecuted under that state’s HIV criminalization laws. In Kentucky, which has a law similar to Tennessee’s, 32 people have been arrested on HIV criminalization charges. All but one of those charges was associated with sex work. In that state, those arrested have mostly been white women. According to an article in a Tennessee newspaper, by 2009, 38 people besides Moore had been arrested under the aggravated prostitution charge.

“The image we have around HIV criminalization laws maybe is of a gay cisgender man who doesn’t disclose his status to a sex partner,” says Nathan Cisneros, MS, the Williams Institute’s HIV criminalization analyst and the coauthor of the Kentucky study as well as a forthcoming report on Tennessee’s laws.

“What we find in states that have prostitution-specific HIV laws, though, is that sex work ends up taking on a substantial minority, sometimes a majority and sometimes the overwhelming majority of enforcement actions. And those primarily affect women,” he says.

Because arrest records reflect someone’s assigned gender at birth and not their preferred gender, it’s unclear how many of those arrested are women of transgender experience living with HIV, but other data suggest that this group is overrepresented among sex workers nationwide.

Yet women with HIV aren’t just the target of these laws—they are also fighting them, forming coalitions, writing legislation and, like Moore, testifying about the science and impact of the laws to effect change.

Today, 30 states have statutes specifically prosecuting people living with HIV for real or imagined crimes related to HIV transmission or exposure, according to The Center for HIV Law and Policy.

The list of potential crimes reads like an HIV stigma fever dream. In some instances, people with HIV can be arrested for allegedly not telling a partner they are living with the virus—even if they are taking HIV medications and are undetectable, which eliminates the risk of transmitting it to a partner.

They can be prosecuted even if they did tell the partner they were living with HIV but their partner tells the police that they didn’t. In other instances, people living with HIV can be arrested for exposing others to bodily fluids, including via spitting and biting, acts that don’t transmit HIV. Yet other laws prosecute syringe sharing among people living with HIV who inject drugs, and still more criminalize even semen donation by those who are HIV positive and want to become parents.

In addition, nine states have so-called sentence enhancements that can take a preexisting charge unrelated to HIV and increase prison time and penalties for people living with the virus. Six states may require people living with HIV who are found guilty to register as sex offenders.

The states that specifically increase the severity of penalties for people involved in sex work primarily impact women living with HIV. In Tennessee, where Moore lives and served time, a sex work charge alone is a misdemeanor, punishable by a fine. But add in the HIV charge and suddenly a woman is facing a felony, punishable by years in prison. That conviction also requires registration as a sex offender, with the heightened punishment of being classified as a violent offender.

“It makes it difficult to get housing and stable employment, to receive certain benefits, to vote in elections,” Cisneros says. “And of course, if you have children, it creates all these other terrible complications. You can’t pick your child up from school. You can’t visit them at the playground. You can’t have your children’s friends over for a sleepover.”

From the beginning, Moore’s experience of living with hiv was intertwined with incarceration. When she was arrested for sex work in March 2002, the state of Tennessee also required her to get an HIV test. That’s when she found out she was living with the virus.

But she wasn’t allowed a private moment to process it. Instead, when court staff read out the charges at her arraignment, “my status was read out loud in court,” she remembers. For her, she says, that was the “initial attack” in a yearslong journey through the court system.

She wasn’t offered care or services. She simply left jail and went back to her former life. She evaded the public health workers who were circulating her name and photo among the traffickers who could use it to hurt her. She was 20, not even legally able to drink. To cope, she’d been cutting herself for years. When that failed to stop the terror and flashbacks, she turned to crack.

“That was my Prozac,” she says. “My entire left wrist is cut up from my coping skills. [Using drugs] was the way to not cut myself. That was the only way I knew to keep myself safe.”

Now that she knew her HIV status, future arrests carried with them the extra weight of the criminalization statute. By August 2002, she’d been arrested again and could either stand trial, which could result in a 15-year prison term, or she could plead guilty to the charges and accept a four-year sentence with no possibility of parole and be added to the sex offender registry as a violent offender. No one had acquired HIV from her. She hadn’t even been engaged in sex work when the arrest happened. She’d just been loitering in a prostitution zone while living with HIV.

That began what would eventually total eight and a half years behind bars, off and on—always being released between 11 p.m. and 2 a.m., always finding johns waiting for her and always finding that drug treatment centers couldn’t take her because of her HIV diagnosis or her status as a registered sex offender. Halfway houses were out of the question—the sex offender registry again. It was maddening, Moore says now. She wanted to get off the streets, but the criminal code kept her stuck.

One thing did change during this time. She started on HIV meds in prison, at first on drugs that made her sick every day. About three years into her first term, she had an undetectable viral load, which means she couldn’t transmit the virus. But that didn’t stop the arrests from coming.

“I was always arrested before the medication ran out,” she says, so her treatment wasn’t interrupted.

In the Kentucky report from the Williams Institute, Cisneros and colleagues found that most of the arrests were made on the streets or in parking garages. At least 15% of arrests were “almost certainly for conduct that did not involve sex work. Indeed, arrests for allegations of sex work do not need to include actual sex acts.”

In 2011, Moore left prison for the last time. She finally found a treatment center that would accept her despite her status on the sex offender registry. She quit drugs. She started working with an HIV service organization and for the first time began addressing her posttraumatic stress disorder. Importantly, she finally connected with others living with HIV through the Sero Project, a group of people with the virus who are working to change criminalization laws.

And, almost as quickly, she started working to modernize Tennessee’s HIV laws. By 2015, she was also a new mom. What’s more, for the first time, she had her own apartment, a car and a job.

“I started to realize,” Moore says, “that what was done to me wasn’t right.”

Again, moore wasn’t alone. women and nonbinary people living with HIV have been working along with gay men to guide the decades-long effort to reform HIV criminalization laws.

Whether it’s Tami Haught, who was key to getting Iowa to remove people living with HIV from the sex offender registry in 2014, or Barb Cardell, who advocated successfully in Colorado for the elimination of mandatory HIV testing for people arrested for sex work and the removal of felony charges from someone living with HIV convicted of sex work, or Naina Khanna and other members of Positive Women’s Network–USA, who worked to reduce sex work charges for women with HIV from felonies to misdemeanors, women living with HIV have been guiding the movement against HIV criminalization for years.

And that doesn’t even include advocates living in states that have yet to reform their laws, like Indiana, Georgia and Ohio.

So in 2015, when Moore testified before the Tennessee Statehouse to advocate for people placed on the sex offender registry to be able to have themselves removed if they had been sex trafficked, raped or abused, she was part of a bigger sisterhood. But it came at a price. She went back to her old coping mechanism. She relapsed. It was the first time, she says, that she knew what it was like to lose everything because “before, I had nothing.”

In the last seven years, though, Moore has held on to her recovery with both hands.

“I grew up,” she says. “It was like, literally, wisdom overnight.”

Now, she’s stepping into advocacy again. She is part of a complaint filed by The Center for HIV Law and Policy asking the Department of Justice to investigate HIV criminal statutes in Tennessee and Ohio. And it looks like the tide is turning.

In 2016, the Association of Nurses in AIDS Care released the first clinical guidelines on addressing HIV criminalization, and the American Psychological Association officially came out against HIV criminalization laws. This was followed by a consensus statement issued in 2018 by the world’s premier HIV scientists and clinicians arguing that laws should be revised to reflect the actual science of HIV transmission.

The following year, the American Medical Association came out against the laws. Now, the Centers for Disease Control and Prevention’s website has a page dedicated to how HIV criminalization laws are inconsistent with the national effort to reduce new HIV transmissions by 90% by 2030.

For Moore, being removed from the sex offender registry at the end of 2021 was bittersweet. The aftereffects linger, she says, and she still thinks about how Tennessee’s law might be different had she been able to tolerate “the uncomfortable second” that comes with the overwhelming urge to hide in just one more inhalation on a crack pipe.

As written, the law requires people seeking removal from the list to prove that they were abused, raped or otherwise sex trafficked in order to gain their freedom. Courts can require trials that force women to come up with proof of the abuse.

Now, Moore says she’s on a new healing journey, with the registry behind her. She will continue to pick through the traumatic effects of surviving her childhood and living with the stigma of the registry. Still, when she sees her daughter playing in her own room, surrounded by all the things she didn’t have growing up, in an apartment Moore pays for with a job she selected, with a car she owns parked outside, she says a sense of peace and happiness comes over her.

“I just want her to be a kid,” she says. “There’s so much time for her heart to be broken by the world we live in right now. I just want her to play with slime and dolls.”

Russia: Court overturns decision of the Ministry of Justice to include NGO in “foreign agents” register for commenting on HIV criminalisation law

Court orders Ministry of Justice to remove “Humanitarian Action” charitable foundation from registry of “foreign agents”

St Petersburg City Court has ordered the Russian Ministry of Justice to remove the charitable foundation “Humanitarian Action” from the register of “foreign agents” NGOs. This was reported on the foundation’s Telegram channel.

“This is the first time in Russia that an NPO has been removed from the register under a court ruling without rejecting foreign funding,” the report said.

For now, the foundation remains on the register of “foreign agents” NGOs.

The St. Petersburg-based charity foundation Humanitarian Action works with drug users and people living with HIV. The organisation was declared a foreign agent in December 2020.

The Russian authorities decided that Humanitarian Action was engaged in “political activities”. Comments on amendments to the law “On the prevention of the spread of HIV infection in Russia” sent to the Ministry of Justice as part of an open public debate were cited as such.

According to OVDInfo, 220 non-profit organisations and unregistered public associations have been included in the register of “foreign agents” since 2012. Of these, 99 were removed from the list due to cessation of activities (liquidation or reorganisation), 40 due to cessation of foreign funding or political activities, five after a complaint about the unreasonableness or illegality of their inclusion in the register was satisfied, and one after property was returned to a foreign source.

Суд обязал Минюст исключить благотворительный фонд «Гуманитарное действие» из реестра «иноагентов»

Санкт-Петербургский городской суд обязал Минюст России исключить благотворительный фонд «Гуманитарное действие» из реестра НКО — «иностранных агентов». Об этом сообщили в телеграм-канале фонда.

«Это первое в России исключение НКО из реестра по судебному решению без отказа от иностранного финансирования», — говорится в сообщении.

Пока фонд остается в реестре НКО-«иноагентов».

Петербургский благотворительный фонд «Гуманитарное действие» работает с наркопотребителями и людьми с ВИЧ. Организацию объявили иностранным агентом в декабре 2020 года.

Российские власти решили, что «Гуманитарное действие» занимается «политической деятельностью». В качестве примера таковой, в частности, приводились комментарии о поправках в закон «О предупреждении распространения ВИЧ-инфекции в России», направленные в адрес Минюста в рамках открытых общественных обсуждений.

По данным «ОВД-Инфо», с 2012 года в реестр НКО-«иностранных агентов» включили 220 некоммерческих организаций и незарегистрированных общественных объединений. Из них 99 были исключены из списка в связи с прекращением деятельности (ликвидация или реорганизация), 40 — из-за прекращения иностранного финансирования или политической деятельности, пять — после удовлетворения жалобы на необоснованность или незаконность включения в реестр, одна — после возврата имущества иностранному источнику.

Canada: New study examines the production of Canadian media stories about HIV criminalisation

Writing for digital news about HIV criminalization in Canada

For years, HIV activists in Canada have expressed serious concerns about the stigmatizing and sensational way that HIV criminalization is portrayed in the mainstream press. Discourse analyses of the content of news stories about HIV criminalization confirm that news reports of HIV criminal cases rely on sensational language and reproduce negative stereotypes of people living with HIV. This paper contributes to social justice scholarship in the area by building upon studies of news content to uncover how news reports of HIV criminalization are produced in the first place. Through institutional ethnographic interviews with journalists who produce news stories about HIV criminalization, this study brings into view that conditions of convergence journalism make it exceedingly difficult for reporters to disrupt the genre of crime stories about HIV criminalization in which stigmatizing discourses proliferate.

The full study can be accessed here.

2021 in review: more successes, more challenges, much more to do

This past year we’ve been challenged yet again due to the COVID-19 pandemic. As well as the impact on each of us, personally, the legal and policy decisions relating to its control – and their enforcement – have significantly impacted people living with HIV who are already criminalised or otherwise marginalised, which we have been continuing to highlight in our HIV Justice Weekly newsletter.

And as COVID-19 continues to dominate not only policymaking and law enforcement activities, but also media headlines, it seems very likely that relying primarily on media reports to document unjust cases of HIV criminalisation underestimates how many people are affected.

This past year we documented 54 media reports of unjust HIV criminalisation cases in 20 countries. This compares to 91 cases in 25 countries last year, which was still fewer than reported in previous years.

Although this could be seen as a cause for celebration, I fear that the reason we are seeing fewer media reports is not because of fewer cases, but because the media is distracted by COVID-19 and just isn’t reporting on them. For example, we only recorded one media report of a horribly unjust case in Belarus in January 2021 but on World AIDS Day 2021 the official Telegram account of Investigative Committee of Belarus reported that there had actually been 34 HIV-related criminal cases in 2021.

After Belarus, the highest number of case reports came from Russia, where it was also reported that over the past five years, Russian courts have acquitted only one defendant under its problematic HIV-specific criminal law. The United States, Canada and France make up the rest of the top five. Alarmingly, women living with HIV were accused in 33% of all reported cases in 2021, up from 25% last year.

We will be providing a much more detailed analysis of laws and cases – and the remarkable advocacy successes and achievements – in the next edition of our Advancing HIV Justice progress report, covering January 2019 – December 2021, which we plan to publish by the end of the first quarter of next year.

Despite the impact of COVID-19 on our ability to organise – and a growing acceptance of punitive approaches to a public health issue – this year we’ve also seen some remarkable advocacy in the global movement to end HIV criminalisation, none more so than across the United States.

In March, both Georgia and Virginia modernised their HIV criminalisation laws and in June and July Nevada and Missouri did the same. And in July Illinois completely repealed its outdated and unjust HIV-specific criminal law, becoming only the second US state ever to do so. In October, New Jersey’s Acting Attorney General issued science-informed prosecutorial guidance to limit the overly broad application of its HIV criminalisation law, and in December, on World AIDS Day, President Biden became the first-ever government leader to speak out against HIV criminalisation laws whilst in office. The year ended on a high with proposals to modernise HIV criminalisation laws in Florida and on a federal level.

The remarkable successes in the United States didn’t happen overnight – the movement to end HIV criminalisation has been nurtured – and increasingly better funded – for more than a decade. This is why our focus has turned to other parts of the world – notably Eastern Europe and Central Asia, sub-Saharan Africa, Latin America and the Caribbean – where many challenges remain.

In May, a new parliamentary bill in Ukraine proposed expanding its already problematic HIV-specific criminal law with harsher sentences for transmitting all serious communicable diseases, and Uganda passed a new Sexual Offences Bill with horrendous implications for people living with HIV, gay men and sex workers. Fortunately, neither have been enacted into law, yet.

We also saw advocacy successes in these regions, too. In Uganda, after five years of waiting, the Constitutional Court of Uganda has finally begun to hear a landmark case challenging the overly broad and draconian provisions of its HIV and AIDS Prevention and Control Act. In Mexico, the ‘danger of contagion’ law used by many Mexican states to prosecute people living with HIV was found to be unconstitutional by a court in the federal district of Mexico City, with proposals for its full repeal presented in November. Also in November, the Committee on the Elimination of Discrimination against Women (CEDAW) recommended the removal of Kyrgyzstan’s HIV-specific criminal law, thanks to a powerful shadow report by our HIV JUSTICE WORLDWIDE partners, the Eurasian Women’s Network on AIDS.

There is still so much more to do, however. That’s why, for example, we produced a brand-new section of our HIV Justice Toolkit specifically to help defend people living with HIV who are prosecuted for breastfeeding, chest feeding or comfort nursing, and why HIV JUSTICE WORLDWIDE launched a briefing paper and video in October to help advocates understand the complexities – and consequences – of molecular HIV surveillance.

Despite these successes, as well as the many milestones the HIV JUSTICE WORLDWIDE movement has achieved since its launch in 2016, we will not rest until everyone living with HIV in all their diversity is treated equally, fairly, and justly by all actors of the criminal legal and public health systems.

Belarus: 34 prosecutions for HIV infection in 2021

Translated with Deepl.com – For original article in Russian, please scroll down.

34 criminal cases related to the human immunodeficiency virus were opened in 2021. This was reported by the Investigative Committee.

December 1 is the International AIDS Day. The day was established to raise awareness about the acquired immunodeficiency syndrome. This date annually urges the entire world community not only to remember this as yet incurable disease, but also to be tolerant to those who are already carriers of the disease.

“Deliberately transmitting the disease is punishable under criminal law,” the agency said.

СК: в 2021 году возбуждено 34 уголовных дела по факту заражения ВИЧ

1 декабря, Минск /Корр. БЕЛТА/. В 2021 году возбуждено 34 уголовных дела по факту заражения вирусом иммунодефицита человека. Об этом БЕЛТА сообщили в Следственном комитете.

1 декабря отмечается Международный день борьбы со СПИДом. День учрежден с целью повышения осведомленности о синдроме приобретенного иммунодефицита. Эта дата ежегодно призывает всю мировую общественность не просто помнить об этой пока неизлечимой болезни, но и быть терпимыми к тем, кто уже является переносчиком этого заболевания.

“Умышленное заражение этим заболеванием преследуется в уголовно-правовом порядке”, – отметили в ведомстве.-0-

Brazil: Litigation clinic and HIV organisation request leave to submit an amicus brief in discrimination case against the airforce

Armed Forces accused of discriminating against people with HIV

Automated translation via Deepl. For original article in Portuguese, please scroll down.

FGV Law Group and NGO want to act in a lawsuit against the Air Force

A group from FGV Direito and another that campaigns on behalf of people living with HIV requested on Tuesday (30) from the TRF (Federal Regional Court) of the 2nd region, in Rio de Janeiro, their permission to file an amicus curiae (friend of the court) in a lawsuit against the Armed Forces for discrimination against people living with HIV.

Although Brazilian law condemns any form of prejudice and discrimination against HIV-positive people, the Armed Forces require an HIV test and, if the result is positive, prevents the person from entering the military.

However, there is ample scientific evidence showing that people with HIV may not develop the disease if they are under treatment. Many even have undetectable viral loads for years, which means that they do not transmit the virus.

The lawsuit that motivated the action of the two entities is in progress since 2018 and is brought by a business administrator from Rio de Janeiro who was barred from entry-level competition in the Air Force for being a person living with HIV. “Unfit for purpose”, says the medical report of the Air Force.

Seropositive for 11 years, he has always worked in administrative activities, has proof of full physical and mental health and is being treated with antiretroviral drugs, in addition to clinical follow-up.

Through an injunction, Silva joined the Air Force, but six months later, in the first internal competition, he had his promotion to second lieutenant annulled and was excluded from the Armed Forces. He appealed the decision in the TRF, and the appeal has not yet been judged.

It was almost an ambush. It is evident that the same thing would happen [a positive result for HIV],” says lawyer Eloisa Machado, professor of the Strategic Litigation of Human Rights Clinic at FGV Law in São Paulo, who filed the amicus curiae request together with GIV (Life Incentive Group).

The friend of the court is a process in Brazilian law that guarantees the participation of public agencies and civil society entities in judicial proceedings. The action is based on manifestations on controversial issues or those requiring technical knowledge for analysis. The FGV students studied the suit for six months, according to Machado.

For the lawyer, competition edicts and internal military norms attribute to people living with HIV a definitive incapacity, preventing not only entry into the Armed Forces but also eventual promotions of people who contracted the virus after being admitted.

“Our attempt [as amicus curiae] is perhaps to reverse this latest area of formal discrimination against people living with HIV,” Machado says.

According to her, a revision of the statute in the Armed Forces is necessary, since a positive diagnosis of the HIV virus solely does not mean inability to exercise any functions.

The mathematics professor from USP Jorge Beloqui, from GIV, reinforces that, without this updating of the rules, more cases of discrimination, without any scientific basis, will continue to occur.

For him, the consequences of discrimination at work on a person living with HIV go beyond an isolated case and end up affecting all HIV-positive people.

Although criticised, this attitude from the Air Force is not illegal. In previous positions on the subject, the technical advisory of the Ministry of Defense reported that, by law, the Armed Forces have “autonomy to decide not to accept candidates who present some kind of debilitation that prevents them from exercising their positions”.

Private companies and other public institutions, on the other hand, are prohibited from asking for an HIV test for job applicants. Law No. 11,199/2002 considers that it is discrimination towards people with HIV and people with AIDS to require an HIV test in competition applications or selection to enter public and private service.

The Ministry of Defence’s press office had not replied regarding the publication of this text.

Forças Armadas são acusadas de discriminar pessoas com HIV

Grupo da FGV Direito e ONG querem atuar em processo contra a Aeronáutica

Um grupo da FGV Direito e outro que milita a favor das pessoas vivendo com HIV-Aids solicitaram nesta terça (30) ao TRF (Tribunal Regional Federal) da 2ª região, do Rio de Janeiro, sua permissão como amicus curiae (amigo da corte) em ação movida contra as Forças Armadas por discriminação de pessoas vivendo com HIV.

Embora a legislação brasileira condene qualquer forma de preconceito e discriminação aos portadores de HIV, as Forças Armadas exigem o exame que detecta o vírus e, diante de um resultado positivo, impede que a pessoa ingresse na carreira militar.

Ocorre que há fartas evidências científicas demonstrando que as pessoas com HIV podem não desenvolver a doença se estiverem sob tratamento. Muitas, inclusive, estão com cargas virais indetectáveis há anos, o que significa que também não transmitem o vírus.

O processo que motivou a atuação das duas entidades tramita desde 2018 e é movido por um administrador de empresas do Rio de Janeiro que foi barrado em concurso de ingresso na Aeronáutica por ser pessoa vivendo com HIV. “Incapaz para o fim que se destina”, diz o laudo médico da Aeronáutica.

Soropositivo há 11 anos, ele sempre trabalhou em atividades administrativas, tem comprovação de plena saúde física e mental e está em tratamento com antirretrovirais, além de acompanhamento clínico.

Por meio de uma liminar, Silva chegou a ingressar na Aeronáutica, mas, seis meses depois, no primeiro concurso interno, ele teve sua promoção para segundo tenente anulada e foi excluído das Forças Armadas. Ele recorreu da decisão no TRF, e o recurso ainda não foi julgado.

Foi quase uma emboscada. É evidente que ia dar a mesma coisa [resultado positivo para o HIV]”, diz a advogada Eloísa Machado, professora da Clínica de Litigância Estratégica de Direitos Humanos da FGV Direito de São Paulo, que ingressou com o pedido de amicus curiae junto com o GIV (Grupo de Incentivo à Vida).

O amigo da corte é uma figura do direito brasileiro que garante a participação de órgãos públicos e entidades da sociedade civil em processos judiciais. A atuação se dá com base em manifestações sobre assuntos polêmicos ou que necessitem de conhecimento técnico para análise. Os alunos da FGV estudaram a ação durante seis meses, segundo Machado.

Para a advogada, os editais de concurso e as normas internas militares imputam às pessoas vivendo com HIV uma incapacidade definitiva, impedindo não só o ingresso nas Forças Armadas como eventuais promoções de pessoas que contraíram o vírus depois de serem admitidas.

“Nossa tentativa [como amicus curiae] é talvez reverter esse último espaço de discriminação formal contra pessoas convivendo com HIV”, afirma Machado.

Segundo ela, é necessária uma revisão no estatuto nas Forças Armadas, já que apenas o diagnóstico positivo do vírus HIV não significa incapacidade para exercício de quaisquer funções.

O professor de matemática da USP Jorge Beloqui, do GIV, reforça que, sem essa atualização das normas, mais casos de discriminação, sem nenhum embasamento científico, vão continuar ocorrendo.

Para ele, as consequências da discriminação no trabalho sobre uma pessoa vivendo com HIV vão além de um caso isolado e acabam atingindo todos os soropositivos.

Embora criticada, essa atitude da Aeronáutica não é proibida. Em posicionamentos anteriores sobre o assunto, a assessoria técnica do Ministério da Defesa informou que, por lei, as Forças Armadas têm “autonomia para decidir não aceitar candidatos que apresentarem algum tipo de debilitação que os impeça de exercer seus cargos”.

Já as empresas privadas e outras instituições públicas estão proibidas de pedir o exame de HIV aos aspirantes a vagas de trabalho. A lei nº 11.199/2002 considera discriminação aos portadores do HIV e das pessoas com Aids a exigência de exames de detecção do vírus em inscrições de concurso ou seleção para ingressar no serviço público e privado.

Procurada, a assessoria de imprensa do Ministério da Defesa não se manifestou até a publicação deste texto.

Austria: Austria’s AIDS Support organisations call for the destigmatisation of HIV positive people in criminal law

HIV-positive people are discriminated against in court

Translated with www.DeepL.com/Translator (free version) – For original article in German, please scroll down

AIDShilfen: HIV-positive people are discriminated against in court
Criminal law should follow scientific findings. HIV infections should no longer be prosecuted.

Vienna – Austria’s AIDS support organisations are protesting against discrimination in court and demand “the destigmatisation of HIV-positive people in criminal law”. People with HIV who regularly take their therapy and whose viral load is below the detectability limit “do not pose a threat”, it was stressed. “It is high time that criminal law follows the scientific findings,” warned Andrea Brunner, Executive Director of Aidshilfe Wien.

In the past, HIV-positive people have been held criminally responsible despite effective therapy and even though no transmission had taken place. The potential risk of infection was assumed, according to the AIDS support organisations. In 2020, the Higher Regional Court (OLG) of Graz overturned such a first-instance decision on the grounds that successful HIV therapy precluded criminal liability.

Adequate therapy as prevention
Sections 178 and 179 of the Criminal Code (Strafgesetzbuch, StGB) “or the previous case law on the subject”, however, continue to expose people with HIV to discrimination and stigmatisation. Since it has been proven that regular and effective therapy prevents the HIV virus from being passed on, those affected would not be committing a “dangerous act” during sexual intercourse, argues Aidshilfe. Since there is no risk of transmission, the facts of section 178 (“risk of spreading”) are not fulfilled. However, the fear of criminal consequences could contribute to a decrease in the willingness to test among those affected.

The Austrian Aids Support Services demand that an HIV infection should no longer be covered by the punishability of section 178f. As long as this remains the case, “the current state of medical research must be taken into account in the decision by a court. This means that both safe sex and the consistent pursuit of drug therapy must be grounds for exclusion from a trial.”

Broad support from parties
The demands meet with broad support among the parties represented in the National Council. The health spokespersons of the SPÖ, FPÖ do so unreservedly. NEOS (Neues Österreich) health spokesperson Fiona Fiedler is “basically in favour of reducing discrimination and promoting education”, but courts already take the state of science into account – “this demand is therefore obsolete”.

The press office of the ÖVP parliamentary club refers to the Ministry of Justice. There, the demands of the Aids organisations are currently being examined, it says on request. According to the press office of his club, the Green health spokesman Ralph Schallmeiner has already made an appointment with Andrea Brunner, managing director of Aids Hilfe Wien, to discuss possible improvements. (APA, red, 25.10.2021)

HIV-Positive werden vor Gericht diskriminiert
Das Strafrecht solle wissenschaftlichen Erkenntnissen folgen. HIV-Infektionen sollen nicht mehr strafrechtlich verfolgt werden.

Wien – Die Aidshilfen Österreichs protestieren gegen Diskriminierung vor Gericht und fordern “die Entstigmatisierung von HIV-Positiven im Strafrecht”. Menschen mit HIV, die regelmäßig ihre Therapie einnehmen und deren Virenlast unter der Nachweisbarkeitsgrenze liegt, “stellen keine Gefährdung dar”, wurde betont. “Es ist höchst an der Zeit, dass das Strafrecht den wissenschaftlichen Erkenntnissen folgt”, mahnte Andrea Brunner, Geschäftsführerin der Aidshilfe Wien.

In der Vergangenheit seien HIV-positive Menschen trotz wirksamer Therapie und obwohl gar keine Übertragung stattgefunden habe, strafrechtlich zur Verantwortung gezogen worden. Es sei das Gefährdungspotenzial für eine Ansteckung unterstellt worden, so die Aidshilfen. 2020 hob das Oberlandesgericht (OLG) Graz eine solche erstinstanzliche Entscheidung mit der Begründung auf, dass eine erfolgreiche HIV-Therapie eine Strafbarkeit ausschließe.

Adäquate Therapie als Prävention
Die Paragrafen 178 und 179 im Strafgesetzbuch (StGB) “beziehungsweise die bisherige Rechtsprechung dazu” setze Menschen mit HIV aber weiterhin Diskriminierung und Stigmatisierung aus. Da erwiesen ist, dass eine regelmäßige und wirksame Therapie eine Weitergabe des HI-Virus unterbindet, würden Betroffene beim Geschlechtsverkehr jedoch keine “gefährdende Handlung” setzen, argumentiert die Aidshilfe. Da kein Risiko für eine Übertragung besteht, sei der Tatbestand des Paragrafen 178 (“Gefahr der Verbreitung”) nicht erfüllt. Die Angst vor strafrechtlichen Konsequenzen könne jedoch dazu beitragen, dass die Testbereitschaft bei Betroffenen sinkt.

Die Aidshilfen Österreichs fordern, dass eine HIV-Infektion nicht mehr von der Strafbarkeit von Paragraf 178f erfasst sein soll. Solange dies der Fall bleibt, “muss bei der Entscheidung durch ein Gericht der aktuelle Stand der medizinischen Forschung beachtet werden. Das bedeutet, dass sowohl Safer Sex als auch das konsequente Verfolgen einer medikamentösen Therapie als Ausschlussgrund für ein Verfahren gelten müssen.”

Breite Unterstützung von Parteien
Bei den im Nationalrat vertretenen Parteien stoßen die Forderungen großteils auf Unterstützung. Die Gesundheitssprecher von SPÖ, FPÖ tun dies vorbehaltlos. Neos-Gesundheitssprecherin Fiona Fiedler ist “grundsätzlich dafür, Diskriminierung abzubauen und Aufklärung voranzutreiben”, Gerichte würden den Stand der Wissenschaft aber schon jetzt berücksichtigen – “diese Forderung ist daher obsolet.”

Die Pressestelle des ÖVP-Parlamentsklubs verweist auf das Justizministerium. Dort werden die Forderungen der Aidshilfen aktuell geprüft, heißt es auf Nachfrage. Der grüne Gesundheitssprecher Ralph Schallmeiner hat, laut Pressestelle seines Klubs, bereits einen Termin mit Andrea Brunner, Geschäftsführerin der Aids Hilfe Wien, vereinbart, um etwaige Verbesserungen zu diskutieren. (APA, red, 25.10.2021)

Brazil: Instead of criminalising people living with HIV, strengthening health services would promote prevention and care

Living with HIV is not a crime. People living with the AIDS virus should have peace of mind like everyone else.

Google translation – For the original article in Portuguese, please scroll down.

By Esper Kallás

A few years ago, I was consulted about the case of a person who was allegedly trying to transmit HIV sexually. This happened because it was discovered that he was living with the virus after medical prescriptions were found in his drawer, which contained the medications for the treatment cocktail. The delegate responsible for investigating the complaint, until then, tended to accept the opening of the process.

Criminalizing someone for being infected with HIV is still a serious problem in several countries around the world, including Brazil. At least 92 countries have specific or sufficiently vague laws that allow a person living with the virus to be held liable for having sex. The situation becomes even more serious as the majority of people living with HIV belong to more socially vulnerable population groups.

In consensual sex, does a person living with HIV necessarily need to disclose their HIV status to their partner? The answer is “no”. In support of this position, here are some considerations.

Regarding the prevention of sexually transmitted infections, having a consensual sexual relationship brings responsibilities to everyone who takes part in it.

Treatment with the antiretroviral cocktail is highly effective in controlling the spread of HIV, allowing people to keep HIV undetectable in their blood. As a result, they stop transmitting HIV sexually. In several, extensive and repeated studies, the results are striking: persons who are part of couples with a sexual partner who lives with HIV and has an undetectable virus did not become infected, even with sexual relations without protection of a male or female condom. As a result, a person who is living with HIV and is undetectable is a safer sexual partner in unprotected sex than someone who does not know if they have the virus. Hence the concept of “undetectable = untransmissible”.

The recommendation is shared by the Joint United Nations Program on HIV/AIDS (UNAIDS), which also suggests that countries respect the confidentiality of people living with the virus, helping to combat prejudice and favoring access to health services. Continuing to criminalize people just because they are living with HIV takes the opposite path.

Comparing HIV to other agents of sexually transmitted infections, it is noted that these can also lead to potentially serious consequences. For example, syphilis, in its tertiary form, can compromise organs and systems, including neurological functions. Gonorrhea can lead to infertility. HPV can lead to genital cancer, especially in women. In these circumstances, there is not the same movement of attribution of guilt for having occurred by sexual transmission.

After a few days, the case presented at the beginning of the text was clarified by the delegate: the accused was undergoing treatment regularly and had an undetectable viral load, while the accuser, in bad faith, sought an opportunity for extortion.

Instead of criminalizing people living with HIV, it is necessary to strengthen health services to promote the prevention of sexually transmitted infections, facilitate access to tests for sexually transmitted agents and ensure treatment with antiretroviral cocktail drugs for those living with HIV. It is worth discussing here a campaign that better clarifies the concept “undetectable = non-transmitter” to society.

The time has passed already to resolve this public health and, also, human rights problem.

Viver com HIV não é crime. Pessoas que vivem com vírus da Aids devem ter tranquilidade como todos.

Por Esper Kallás

Há alguns anos, fui consultado sobre um caso de uma pessoa que, supostamente, tentava transmitir sexualmente o HIV. Isso aconteceu pois descobriu-se que vivia com o vírus, depois de terem sido encontradas receitas médicas em sua gaveta, nas quais constavam os remédios do coquetel de tratamento. O delegado responsável por investigar a denúncia, até então, tendia a aceitar a abertura do processo.

Criminalizar alguém por estar infectado pelo HIV ainda é um grave problema em vários países do mundo, incluindo o Brasil. Ao menos 92 países têm leis específicas ou suficientemente vagas que permitem responsabilizar judicialmente uma pessoa que vive com o vírus por manter relações sexuais. A situação torna-se ainda mais grave pois a maioria das pessoas vivendo com HIV pertence a grupos populacionais socialmente mais vulneráveis.

Em relações sexuais consensuais, uma pessoa que vive com HIV precisa, obrigatoriamente, revelar seu status sorológico para o parceiro? A resposta é “não”. Sustentando esta posição, seguem algumas ponderações.

Em relação à prevenção de infecções sexualmente transmissíveis, ter uma relação sexual consensual traz responsabilidades para todos que dela tomam parte.

O tratamento com o coquetel de antirretrovirais é altamente eficaz no controle da multiplicação do HIV, permitindo que as pessoas consigam manter o HIV indetectável no sangue. Como consequência, deixam de transmitir o HIV por via sexual. Em diversos, extensos e repetidos estudos, os resultados são contundentes: pessoas que compõem casais cujo parceiro sexual vive com HIV e tem vírus indetectável não se infectaram, mesmo com relações sexuais sem proteção por camisinha masculina ou feminina. Como resultado, uma pessoa que vive com o HIV e está indetectável é um parceiro sexual mais seguro em uma relação sexual desprotegida do que alguém que não sabe se tem o vírus. Daí o conceito de “indetectável = não transmissor”.

A recomendação é partilhada pelo Programa Conjunto das Nações Unidas para HIV/Aids (UNAIDS), que também sugere aos países respeito à confidencialidade das pessoas que vivem com o vírus, auxiliando no combate ao preconceito e favorecendo o acesso aos serviços de saúde. Continuar criminalizando pessoas somente porque vivem com o HIV trilha o caminho inverso.

Comparando HIV aos demais agentes de infecções sexualmente transmissíveis, nota-se que estes também podem levar a consequências potencialmente graves. Por exemplo, a sífilis, na forma terciária, pode comprometer órgãos e sistemas, inclusive as funções neurológicas. A gonorréia pode levar à infertilidade. O HPV pode levar a câncer genital, especialmente em mulheres. Não há, nestas circunstâncias, o mesmo movimento de imputação de culpa por ter ocorrido transmissão por sexo.

Passados alguns dias, o caso apresentado no começo do texto foi esclarecido pelo delegado: o acusado fazia seu tratamento regularmente e tinha carga viral indetectável, enquanto quem acusou, por má fé, buscava uma oportunidade de extorsão.

Ao contrário de criminalizar as pessoas que vivem com HIV, é preciso fortalecer os serviços de saúde para promoção da prevenção de infecções sexualmente transmissíveis, facilitar acesso a testes para agentes transmissíveis por via sexual e assegurar tratamento com remédios do coquetel antirretroviral aos que vivem com o HIV. Cabe, aqui, discutir uma campanha que esclareça melhor à sociedade o conceito “indetectável = não transmissor”.

Já passou a hora de resolver esse problema de saúde pública e, também, de direitos humanos.

Singapore: Do HIV Non-Disclosure Laws in Singapore Still Make Sense Today?

by Daniel Ho, Rayner Tan and Daryl Yang

It has been almost forty years since the human immunodeficiency virus (HIV) was first discovered in 1983. HIV is the virus that leads to acquired immune deficiency syndrome (AIDS), which is also commonly known as late-stage HIV.

While HIV was viewed as a death sentence at the beginning of the pandemic decades ago, the picture today is a far cry from that. Thanks to medical advances, HIV is now understood and treated as a chronic disease. Individuals living with HIV who receive treatment enjoy the same life expectancies compared to people without HIV.

Furthermore, individuals who have achieved viral suppression as a result of medication cannot transmit HIV sexually. Three recent, large observational cohort studies produced zero cases of transmission in spite of approximately 125,000 unprotected sex acts between couples of differing HIV status, without the use of any HIV prevention methods like condoms or HIV pre-exposure prophylaxis.

Viral suppression is often also known as achieving an ‘undetectable’ viral load, and these two terms are used interchangeably. Viral loads are ‘undetectable’ because the equipment used to ‘count’ such viral loads does not detect the virus’s presence below specific thresholds.

The origins of HIV non-disclosure laws in Singapore

Like the ongoing COVID-19 pandemic, the early years of HIV were characterised by fear and panic due to a lack of information on how the virus would spread between individuals.

As a result, heavy-handed and sweeping legal reforms were undertaken to keep Singaporeans safe from the virus.

In 1992, the Infectious Diseases Act was amended to ban people living with HIV from engaging in sexual activity unless they have informed their sexual partner of the risk of contracting HIV/AIDS from them and that sexual partner has voluntarily agreed to accept that risk.

In 1998, non-Singaporeans living with HIV were prohibited from entering Singapore, regardless of their immigration status.

However, while the ban on foreigners with HIV was partially lifted in 2015 to allow short-term visitors, laws criminalizing HIV non-disclosure have not only remained in the books but were expanded in scope and severity.

In 2008, Parliament amended the law such that anyone who has “reason to believe” that he has or “has been exposed to a significant risk” of contracting HIV/AIDS must also disclose to his sexual partners the risk of contracting HIV/AIDS from him.

Alternatively, suppose he chooses not to disclose such risk. In that case, he must have either tested negative for HIV or take reasonable precautions to ensure that he does not expose his sexual partner to the risk of contracting HIV.

The punishment for failing to do so was also increased five-fold with a fine of up to S$50,000 or 10 years’ imprisonment.

HIV non-disclosure laws are counterproductive to public health

While these laws were passed to protect you from HIV, scientists working in the field of HIV would confidently tell you that they are more likely to exacerbate the spread of HIV today.

A global expert panel of more than 20 HIV scientists and experts was convened in 2018 to publish a consensus statement on the science of HIV in the context of criminal law and called for “legal and judicial systems to pay close attention to the significant advances in HIV science that have occurred over the last three decades to ensure current scientific knowledge informs application of the law in cases related to HIV”.

This is because such laws are ineffective and create a false sense of security and perpetuate stigma and discrimination, which can deter many from getting tested or seeking treatment for HIV.

When HIV non-disclosure was criminalised in 1992, then Minister for Health Yeo Cheow Tong said that this was meant to address the “irresponsible and dangerous behaviour” of HIV-positive individuals.

Subsequently, when expanding the offence to those at significant risk of contracting HIV, then Minister for Health Khaw Boon Wan explained that these laws are necessary because “for every known HIV case, there could be another one to two cases who are infected but remain undiagnosed until the symptoms appear”.

While Khaw is correct that a key problem with ending the HIV epidemic in Singapore is late diagnosis, these laws do not encourage people to get tested regularly. Instead, they create a climate of fear, stigma and shame around HIV.

The existence of these laws runs contrary to the Ministry of Health’s own strategy of “destigmatising HIV infection and getting more people at-risk to come forward to get tested”.

Living with HIV non-disclosure laws

“Yes I know who I got it from. After that I actually got tested and then I Informed some of my friends, who then agreed to go to Bangkok with me, because I didn’t want to get registered in Singapore. But after a year or so I decided to come back to Singapore to seek treatment because it was… Very troublesome for me to go back and forth.”

Apart from disincentivising linkage to the healthcare system, as explained by a participant above from a past study on living with HIV, such laws possibly maintain stigma and discrimination of already vulnerable communities of people living with HIV.

Because of this legal obligation to disclose the risk of contracting HIV to sexual partners, people living with HIV live in fear of having their HIV-positive statuses “outed” to others who may know them in various capacities, be it their employers, friends, family, or other loved ones.

The pain of rejection is very real. The fear of alienation from others may also implicate not just people living with HIV but also those who might avoid going for sexual health testing for fear of finding out that they may be HIV-positive.

This is also exacerbated by the fact that there is no legal protection for people living with HIV from discrimination, nor is there any law prohibiting their sexual partners from disclosing their HIV status to third parties.

Beyond its direct impact on the fear of having their statuses disclosed, what we know about stigma, and in particular concealed stigma (not visible or immediately obvious, such as hidden disabilities, being a sexual minority or having a mental illness) is that it places considerable psychological stress on the individual.

Living with concealed stigma

Given the ever-looming threat of discovery and possible alienation, people living with HIV may report a sense of shame and demoralisation, particularly in instances where the threat of discovery is higher or more salient, such as during job interviews or health screenings.

“For example, during Chinese New Year when we are having a steamboat. You know right, after my first round of helpings, I will not use the same utensils. Or even, even during meals, I wouldn’t use… unless they are scraps… or there are tongs or whatever. If not, then I usually will not help myself to a second round of food.”

As shared by another participant above, people living with concealed stigma may also find themselves being on a near-constant vigilance toward their interactions with others and even those who already know about their status, as a result of shame and self-stigma.

Other implications may also involve the preoccupation of having to ‘keep a secret’ due to the risks of disclosure, adding to the cognitive burden that these individuals face in their daily interactions with others.

Coupled with feelings of shame and demoralisation, the fear that people they know may shun them because of their HIV status may affect their overall behaviour. It can also lead to increased social isolation, impaired relational functioning, and excessive impression management.

These challenges stemming from stigma and discrimination may further heighten the sense of despair and exclusion that people living with HIV experience as vulnerable members of society.

What will happen without HIV non-disclosure laws?

We now know that removing HIV non-disclosure laws will help us reduce stigma and get more people to access the care they need. But what happens without such laws? Are we at greater risk of contracting HIV from someone who is living with HIV?

No, we are not, and here are three reasons why.

First, there is no evidence that such laws actually reduce HIV transmission (in fact, the opposite is more likely to be true). Furthermore, the burden of sexual health should not fall only on one party in sexual partnerships.

The removal of this law also ensures that we do not remain complacent around one’s risk of acquiring sexually transmitted infections in general and will create opportunities for more equitable, comprehensive sexual health education.

Second, it is a fact that a majority of people in Singapore who are living with HIV cannot transmit HIV sexually. The Ministry of Health has estimated that in 2018, 80% of individuals living with HIV in Singapore knew about their own status, of whom 91% had initiated treatment, and 91% of those who initiated treatment had achieved viral suppression or an undetectable viral load.

This means that based on the science of viral suppression, an estimated 66% of all people living with HIV in Singapore cannot transmit HIV through sex. While the risk will always remain at the individual level, removing such laws will get more people tested for HIV, lead to an increase in the proportion of people who start treatment, get virally suppressed, and therefore cannot transmit HIV through sex at a population level.

Third, even if someone had intentionally or recklessly put you at risk of HIV, HIV non-disclosure laws are unnecessary because existing criminal legislation already addresses this.

For example, Section 376H of the Penal Code criminalizes deception or false representation in the context of being a carrier of a sexually transmitted disease, which includes HIV. Still, it does not single out HIV as uniquely or more dangerous than other diseases.

Law enforcement may also arguably prosecute the intentional transmission of HIV as a form of grievous hurt by “means of any substance which it is harmful to the human body to… receive into the blood” under Section 326 of the Penal Code.

Ending AIDS and onward transmission of HIV by 2030

The Joint Declaration of the United Nations on HIV/AIDS (UNAIDS) adopts the ‘90-90-90’ goal, also known as the ‘HIV treatment cascade’, to track countries’ progress in the fight against HIV and AIDS.

The first 90 refers to having 90% of people living with HIV know their status, the second 90 refers to having 90% of those who know their status initiating medication, and the third 90 refers to having 90% of those on medication who have achieved viral suppression.

Earlier, we shared that Singapore’s cascade in 2018 was estimated to be 80-91-91.

Repealing laws that criminalize HIV non-disclosure will help end the present climate of fear and stigma around HIV and encourage more people to get tested for HIV and start treatment. The impact on HIV transmission would be immense.

For example, improving our estimates from 80-91-91 to 90-91-91 would mean 74.5% of people living with HIV not being able to transmit HIV sexually, up from 66%, as shared earlier. The reduced number of HIV cases would be beneficial for society without any adverse knock-on effects.

The impact on the quality of life among people living with HIV would also be significant. Reducing stigma associated with HIV will empower individuals to lead full, productive lives. HIV can finally be treated socially—as it has clinically—like any other chronic disease.

Community groups in Singapore, alongside UNAIDS, have called for the end of AIDS and onward transmission of HIV by the year 2030. We are getting close to that goal, but such laws remain a hurdle. Guided by medical advancements and public health research, it is time to repeal HIV non-disclosure laws so that they may no longer hinder Singapore’s efforts to end the HIV epidemic.

[Feature] It Takes More Than A Village to End HIV Criminalisation

The proverb says, “It takes a village to raise a child”. But what if a mother in the village is living with HIV, and some of the villagers stigmatise her? What if that stigma creates a situation where the mother living with HIV is unjustly criminalised because of her HIV status? Then it takes more than a village to get justice for that woman. It takes a global movement to end HIV criminalisation to sensitise and train lawyers and expert witnesses. It takes national communities of women living with HIV to support that woman following her release, and to educate the community in which she lives about HIV.

Introduction

In 2016, a Malawi court convicted a woman living with HIV of “negligently and recklessly doing an act likely to spread the infection of any disease which is dangerous to life” under section 192 of the Malawi Penal Code. She had attended a village meeting with her baby which she breastfed as usual before passing the child to her grandmother. Another woman then asked her to hold her baby. It was alleged that this child began breastfeeding briefly before the woman realised what was happening. The child’s mother then reported the incident to the police. The woman was arrested and without legal advice or representation, pleaded guilty, was convicted, and sentenced to nine months’ imprisonment with hard labour.

The circumstances of the case are all the more shocking because women living with HIV are encouraged to breastfeed in Malawi (and in other countries with high HIV prevalence and settings in which diarrhoea, pneumonia and undernutrition are common causes of infant and child deaths) and because HIV-related prosecutions involving breastfeeding are exceedingly rare. Unfortunately, we have seen an increase in the number of such cases since 2016. HJN is working to address this in a number of ways because we believe there should never be prosecutions of women living with HIV for breastfeeding.

In addition, the accused woman was taking antiretroviral therapy. The chances of HIV transmission through even long-term breastfeeding are very low (which is why WHO guidelines recommend it when access to infant formula and clean water are limited) and the chances of transmission during the brief period the baby allegedly fed were infinitesimally small. In fact, the accused woman’s own child, who was routinely breastfed, has not acquired HIV, calling into question any suggestion that she intended to cause harm to the other woman’s child. Perversely, for a system that unjustly condemned her for risking harm to the other woman’s child, her own baby was imprisoned with her, without any arrangements for appropriate feeding and care, negating any notion that the legal system’s purpose was to protect children.

Following media reports of her initial conviction, numerous individuals and organisations – including HJN and our HIV JUSTICE WORLDWIDE partners, ARASA and SALC – became involved in the case, ultimately changing the outcome for the woman and her family, and laying the groundwork for further anti-HIV stigma advocacy and education in the region. Her story demonstrates the vital role that education, training, strong networks, and community play in the pursuit of HIV justice.

Living with HIV-related stigma

When interviewed at her home in 2019, the woman referred to as “EL” talked about her life:^[1]

[1] The initials EL are used instead of her full name following a court order of anonymity to protect her privacy. The interview took place in 2019, during the village visit described later in this article.

“As kids, there were the two of us — me and my brother. My parents faced challenges raising us. Finding the basic necessities like soap and food was a tall order, let alone talking about going to school. It was difficult to get learning materials as well as proper clothes to wear at school. I worked hard in class but couldn’t get past Standard 5 at primary school. Eventually I dropped out, and my brother did the same, … My daily life was taken up doing house chores just like any other girl in the village, as well as helping my parents with farming. At 16, I got married.”

EL further described how she was diagnosed HIV-positive in 2015 after a de facto compulsory HIV test at an antenatal visit. She already had two children and was pregnant with her third. She had heard about HIV but did not know much about it. EL said that the healthcare workers provided a lot of assistance, giving her accurate information about HIV, including the importance of adhering to her antiretroviral treatment (ARVs).

EL and two of her children. Photo: Amos Gumulira/UNDP Malawi

EL said that she generally enjoyed life in her village, although at times she was subject to stigma and discrimination:

“When I went to fetch water at the community borehole, people would laugh at me, and whenever I wanted to participate in community work, you would find pockets of community members talking ill about me. Some people used to insult me, calling me names. But I persevered because my relatives, including the Village Headman himself, gave me support and always stood by my side.”

Members of EL’s family also faced discrimination. “Due to lack of information, a lot of people thought HIV was hereditary and because I was diagnosed HIV-positive, this meant that all my family members had HIV, and they were discriminated against,” EL said.

EL wonders if more could have been done to help her fight stigma. In particular, EL gained a lot of knowledge about HIV from the counselling she got when diagnosed, but perhaps she could have been better equipped with information to share with people in her community:

“A lot of people don’t know that if you adhere to ARVs, you reduce the risk of transmitting HIV to others. This information needs to be passed on to many people. There are also other issues to do with ARVs. A lot of people don’t have adequate information on the effects of ARVs and at the end of the day, they start pointing fingers at each other, giving people room to start speculating about issues to do with witchcraft.”

EL’s prosecution had repercussions for her whole village. One woman from the community explained:

“I was there and very close to where EL was sitting. Yes, she was carrying another woman’s child. This other woman had given the child to EL for safe keeping while she went to stand in a queue, but honestly speaking, I didn’t see EL breastfeed the child. I just heard some people who were sitting a distance from where we were sitting, as they started pointing accusing fingers at her.”

She said that things moved so fast that before they could think of anything to stop what she called “the rumour.” It had gotten out of hand and people started saying that EL had intentionally breastfed the child to transmit HIV.

After receiving a summons, EL voluntarily turned herself in at the police station. She was accompanied by the Village Headman (her grandfather) who wanted first-hand information about what crime she was alleged to have committed. That same day, police transferred EL to a larger town, where she was remanded for three days. At the age of 29, this was the first time that EL had ever left her village.

Days later, she appeared in court and the charge sheet was read out. EL recounted that she had not understood what was happening and could not make arguments because she had no legal representation. EL agreed with the summary of events as they were described, so she was found guilty and was imprisoned together with her youngest child.

She described life in prison as “hell”:

“After a week, my brother showed up to give me my ARVs. All this talk about a woman with HIV breastfeeding. I breastfed but I also found it tough to feed my baby while in prison because there was no provision of special food for babies. We were eating nandolo (pigeon peas) almost every day with Msima ya Mgaiwa (maize meal). And there was only one toilet for a cell of more than 50 people.”

After some time, relatives and other members of her community started visiting, giving her money she could use to buy soap and food for her baby. “When we heard from our Village Headman that she had been arrested, we were so devastated”, a woman from EL’s village explained. “We raised funds for some members to go and give her support only to learn that she had been transferred to one town, then another, but some of us did manage on several occasions to visit her and offer our support when she was in prison.”

Then, out of the blue, EL received a message that some people had come looking for her. She went to meet them: a lawyer, Wesley Mwafulirwa, and his paralegal. They explained why they were there and asked if she would like them to appeal on her behalf. She accepted enthusiastically. “I was excited but at the same time I was confused because I could not believe that I could be so lucky to have these people come to help me.”

Fighting the charges

Solicitor Wesley Mwafulirwa had volunteered to attend training to address legal barriers to prison health and human rights presented by the Southern African Litigation Centre (SALC). He travelled from Malawi to South Africa to attend the training which addressed useful regional and international mechanisms, and presented insights about legal practice and strategic litigation to support prison health and human rights, particularly for those facing heightened vulnerability to HIV and TB.

Wesley Mwafulirwa Photo: Amos Gumulira/UNDP Malawi

At the training, two lawyers spoke about their pro bono work. Wesley remembers one of them, Allan Maleche (Executive Director of KELIN), saying that each participant should take at least one case when they go back to their country. It was a turning point in Wesley’s career.

He had not been home long when he saw an article in the newspaper about an HIV-positive person convicted for trying to spread HIV. That person was EL.

Wesley, who lives in a small town in northern Malawi, drove for more than ten hours to get to the jail where EL was incarcerated. He explained his determination, saying “I was so fired up! I’d just come from SALC’s training … and I said, ‘I want to take up this case’.”

Wesley interviewed EL and offered to take her case pro bono. Wesley contacted SALC, who offered technical support. Their first step was to get an order for anonymity to protect EL’s identity and gain greater control over media reporting. Next, they faced an ethical question. They wanted to challenge the constitutionality of the law but that would take a long time. Because EL was in prison, they decided to undertake a criminal appeal instead. They applied for EL to be let out of custody on bail pending appeal. This is usually a difficult application to win, but they were successful and EL was released from prison.

In the appeal, the court was asked to consider whether the conviction could be justified, whether the penal provision was constitutional (arguing it was overly broad and vague), and whether the sentence was manifestly unjust. Wesley used his learnings from the SALC training to raise international principles and instruments relating to sentencing, which the court referenced and upheld. Michaela Clayton, then Executive Director of the AIDS and Rights Alliance for southern Africa (ARASA), and now a member of HJN’s Supervisory Board, provided expert testimony. Another expert witness, Dr Ruth Brand, identified through HJN’s global network, gave expert scientific evidence to show the risk of HIV transmission had been “infinitesimally small.”

The case was heard by Honourable Justice Zione Ntaba, who held that the proceedings in the trial court were irregular and “blatantly bias” against EL, compromising her right to a fair trial. Justice Ntaba found the charge sheet had been defective and therefore EL’s plea should not have been recorded as guilty. She noted the law must be sensitive to the accused’s knowledge or belief (or lack of) that HIV would be transmitted. Justice Ntaba decided the conviction could not be justified, acknowledging human rights principles against the overly broad criminalisation of HIV non-disclosure, exposure, or transmission. EL’s sentence was set aside. (The Constitutional challenge was referred to a full-member panel of the Constitutional Court although the case was not pursued.)

Notably, Justice Ntaba was a member of the African Regional Judges Forum to discuss HIV, TB and Human Rights (a process which is owned and planned by the judges and run with support from UNDP and funding from the Global Fund).

Fighting the stigma

Shortly after EL’s arrest, the Coalition of Women and Girls Living with HIV and AIDS in Malawi (COWLHA) and the Malawi branch of the International Community of Women Living with HIV/AIDS (ICW-Malawi) discussed the case at a roundtable meeting. At first, everyone was surprised and even laughed, questioning how she could have breastfed someone else’s child. They had never heard of a criminal case involving infant feeding and did not understand what they were dealing with.

During their discussions, COWLHA and ICW-Malawi agreed that the prosecution of EL was a manifestation of stigma and misinformation about HIV in the community. They learned more about the unjust measures that EL had experienced, like being imprisoned without being given a chance to be heard and not being given the chance to prepare and take her medication and things she needed to care for her child. COWLHA and ICW decided to get involved.

Representatives from COWLHA and ICW meet with members of EL’s village. Photo: COWLHA/ICW

Concerned that EL could face social and community hostility after her release, COWHLA and ICW planned a visit to the village to provide psychosocial support to EL and to work with traditional community leaders to provide community sensitisation on HIV, addressing issues of stigma and discrimination. Their efforts helped change some community members’ ideas about HIV.

The community formed two support groups— one for youth and another for adults (notably both were predominantly female groups). They have conducted numerous activities, including home visits, supporting children to go to school, helping the elderly with house chores, and they have a garden where they grow vegetables and rice. They hoped to access loans to become self-reliant. They also had a list of issues they wanted to learn more about, including preventing mother-to-child transmission, sexual and reproductive health, positive living, stigma and discrimination, and treatment literacy.

Visiting EL at home

In September 2019, a three-member team comprising Edna Tembo (Executive Director of COWLHA), Charity Mkona (ICW Board Chair), and Peter Gwazayani (media consultant), set out for EL’s village.

The team was welcomed by the Group Village Headman, who took them to EL’s house. EL recognised Edna from the work COWLHA and ICW-Malawi had done in the community previously. EL welcomed the team with a big smile.

EL and her husband looked cheerful as they laid a mat on the veranda of their house for the visitors. Her mother later joined the discussion.

EL was interested to learn that HJN wanted to write about her case and the type of interventions that had been helpful, to share the story with advocates for HIV justice around the world.

EL recounted that when she returned to the village, “most members of my community received me with happiness, particularly my relatives. The day I arrived, they were jubilant. They celebrated with songs that we normally sing during special occasions in the village.”

COWLHA ED Edna Tembo and Charity Mkona of ICW chat with EL, her husband and her mother (at far distance). Photo: COWLHA/ICW

EL lives with her husband, five children and her mother in a compound made up of three grass thatched houses. She introduced her children:

“The oldest is 13 and she goes to school, as do the second and third. The fourth, a little girl, is the child I was with in prison. She has not yet started school. And then there is this one, who I am breastfeeding. She is the fifth one. She has been tested for HIV on two occasions and will be going for the last test soon. The other two tests have come back HIV-negative.”

EL’s accuser and her family still lives in the same village which has presented some difficulties. EL said that on several occasions she had tried to greet them when they passed each other, but she had been ignored. “They don’t talk to me but from deep down in my heart, I have no grudges against them,” EL said. “I am just living my normal life,” EL says, although now she says that she would never agree to carry anybody else’s child, for any reason.

Moving beyond criminalisation

With respect to the community-level interventions, lawyer Annabel Raw, who worked at SALC during the time they supported the EL case said:

“As lawyers, we would never have thought to consider such an intervention had ICW-Malawi and COWLHA not shared their insights and been willing to support the client and her community. Their work has been so important to ensuring that meaningful justice was done to combat the actual root cause of the prosecution — stigma and discrimination — and to reconcile EL with her community.”

Engaging with the community also influenced ICW-Malawi and COWLHA’s thinking about HIV criminalisation. COWLHA’s Edna Tembo noted that:

Supporting people who have been prosecuted, particularly women, gives them power, … However, it is very important to stress that psychological support is absolutely vital for those who have been prosecuted. That includes family support, and a supportive community environment enabling acceptance of an individual accused.”

Tembo was also quick to emphasise that there is more work to be done. That work includes awareness raising and ongoing support to the community, especially to identify and train volunteers, empowering them to provide services at community level and to link them to health facilities and district offices for continued support and mentorship.

EL carries her youngest child home. Photo: Amos Gumulira/UNDP Malawi

EL described her dreams for the future:

“My wish now is to see my children progress in school so that they become productive citizens in this community and help it grow. That’s my dream. If they get educated, they will be able to stand on their own and support others. My husband is not employed and it is a challenge to get money for school fees for our children. We would love to get a loan or training to have greater knowledge of economic empowerment because we want to be self-reliant. We would then love to lease some land to grow rice to sell to pay back the loan.

“It’s also my wish to see the lives of all people in the community uplifted. We farm but on a small-scale. If we were to be supported with funds, I’d love to see the community establish big rice farms, working in groups, harvesting for consumption and for sale. In so doing, we would be able to uplift our lives for the better.”

Further Information

Learn more about Wesley’s experiences in EL’s case here and here.

Learn more about the African Regional Judges Forum here.

The full High Court judgement is available here, with a summary included here.

Read more about the successful HIV and AIDS Management Act community advocacy here.

This article is based on information provided by ICW-Malawi and COWLHA following their visits to EL’s village, and an interview with Wesley Mwafulirwa published by UNDP. HJN provided financial and logistical support for the village visits thanks to a grant provided to the HIV Justice Global Consortium from the Robert Carr Fund for civil society networks.