Human rights are key to ending the epidemics

OPINION: End epidemics by breaking down human rights barriers to health

Access to healthcare is a right, not a luxury. We have an historic opportunity to rid the world of HIV, TB and malaria. Let’s seize that opportunity.

Peter Sands is the executive director of The Global Fund to Fight AIDS, Tuberculosis and Malaria and Antonio Zappulla is the chief executive of the Thomson Reuters Foundation.

Among the many challenges involved in improving health services, one is both pervasive and largely hidden. Human rights-related barriers to health, some explicit, others expressed in behaviours and norms, prevent millions of people from access to lifesaving prevention and treatment.

Think of a girl who is forced to get married at 15 and needs her husband’s permission to undergo an HIV test, or to get a bed net to protect herself and her children from malaria. Or a gay man who is beaten up by police and charged with sodomy when he secretly visits the home of a community health care worker to obtain condoms. Or a group of miners working 14 hours a day deep in a mine without ventilation and health insurance despite widespread tuberculosis.

Money alone cannot ensure and protect basic human rights for people most at risk from infectious diseases.

If the media stokes the appetite for a witch hunt against LGBT+ people or condones violence against women, how will society behave? If laws allow abuse and discrimination to be justified, how can social justice be achieved?

Stigma, ignorance, prejudice and lack of opportunities are some of the toughest road blocks to remove. But the combined power of the law and the media can make a difference.

Fair and balanced news coverage is critical in informing public opinion. Respect for human rights is essential to ensure access to health services. Combined, they become the key to unlocking systemic change.

In sub-Saharan Africa, women and girls are twice as likely to be HIV-positive compared to young men. Contributing factors include gender inequality, violence and limited access to education. Meanwhile, men who have sex with men, people who inject drugs, sex workers and transgender people often lack access to health programmes. The root cause? Social taboos, punitive laws and fear of arrest.

Framing health as a human right creates an obligation on states to ensure accessible, acceptable and affordable health care of appropriate quality. But this conception of health as a human right is not shared around the world. You have only to look, for example, at how HIV non-disclosure, exposure and transmission is still criminalized in 86 jurisdictions worldwide.

We will never end the epidemics of HIV, TB and malaria – which killed 3 million people in 2017 alone – unless we dismantle social and human rights barriers to health services.

Everyone has a right to healthcare, encompassing dignity and respect. Not only is this a basic human right, but it is critical to fostering social stability and boosting economic growth. It is predicted that drug-resistant TB will cost the global economy approximately US$17 trillion by 2050 if progress is not made fast enough.

The Global Fund and the Thomson Reuters Foundation are joining forces to combine the power of an international health financing organization with global media and legal expertise, to help break down barriers to health services.

Each year, the Global Fund mobilizes and invests more than US$4 billion to support health programs run by local experts in more than 100 countries. Through its “Breaking Down Barriers” Initiative, the Global Fund is working with countries to reduce human rights-related barriers to health services: to ensure that everybody, including the most marginalized, also have access to prevention, treatment and care services; to see that health care workers are trained not to discriminate against, turn away, or fear people living with HIV or TB; to ensure that police are sensitized to support LGBT people to access prevention and treatment, rather than subject them to extortion, arbitrary arrest and violence; and to inform women, girls and others most affected by disease and violence about their rights and access to legal support. In the last three years, over US$120 million have gone to these and other programs to reduce stigma and discrimination and increase access to justice, an unprecedented investment in human rights as a critical component of our efforts to end HIV, TB, and malaria.

But more needs to be done. In its new partnership with the Global Fund, the Thomson Reuters Foundation will facilitate legal services and support for civil society partners in key countries, including development of “know your rights” training, capacity-building for health practitioners, services providers and their clients, plus guidance for NGOs and civil society groups working in challenging social contexts. The Thomson Reuters Foundation will also train journalists on human rights and health issues, and support awareness-raising on human rights-related barriers to health. Our hope is that by combining forces, we can achieve real impact.

Access to healthcare is a right, not a luxury. We have an historic opportunity to rid the world of HIV, TB and malaria. Let’s seize that opportunity.

On Human Rights Day, please endorse the EECA Statement against HIV Criminalization

Today, December 10, 2019, Human Rights Day, National and Regional Networks and Civil Society Organizations on HIV Criminalization in the EECA Region are asking you to support the movement against HIV criminalization by endorsing the following Statement.

Download a pdf of the Statement in English or Russian.

Endorse the Statement in English here. EПодпишите заявление на русском языке здесь.

On November 25-26, 2019, the “Decriminalization of HIV transmission in the EECA region: the role of civil society and advocacy tools” meeting was held in Minsk, Belarus, by the Eurasian Women’s Network on AIDS (EWNA), the Global Network of People Living with HIV (GNP+) and CO “100 PERCENT LIFE”. Activists representing national, regional and international networks discussed the current situation with HIV criminalization in the EECA region and options available to strengthen the movement in order to counter that HIV criminalization in the EECA region.

HIV criminalization is a global issue that undermines human rights and impedes the development of public health and, as a result, weakens the efforts to eradicate the HIV epidemic. An analysis of recent HIV criminalization cases shows that they do not reflect the demographics of local epidemics, and the likelihood of persecution is compounded by discrimination against marginalized groups on the basic of drug use, ethnicity, gender identity, immigration status, sex work and sexuality.

The Global Commission on HIV and the Law, the United Nations Development Program (UNDP) and the Joint United Nations Program on AIDS (UNAIDS), among others, declare that any use of criminal law against people living with HIV should be strictly limited to exceptional cases of intentional and malicious HIV transmission to another person and only where real harm occurred. However, the law and law enforcement practice go beyond this limitation in many countries.

According to HIV Justice Worldwide, Europe and Central Asia is the region with the second highest number of laws criminalizing HIV exposure, non-disclosure and transmission. 18 of the 19 countries where such laws have been adopted are in the EECA region. Many of them allow criminal prosecution for actions that do not pose a risk of HIV or pose a low risk only. These laws do not recognize condom use or low viral load as a means of protection against prosecution. They criminalize oral sex, individual breastfeeding cases, as well as bites, scratches, bites, or spitting. Such laws were developed in the times when efficient ARV therapy was not yet available and the HIV diagnosis was equated with a death sentence. The implementation of such laws is most often informed by myths, misconceptions on HIV transmission ways, and stigma against people living with HIV and vulnerable communities.

The laws of the EECA countries criminalizing the HIV transmission vary in their severity and in specific sanctions. The Russian Federation and Belarus are global and regional leaders in terms of the number of criminal cases related to HIV6. In Uzbekistan, a person living with HIV can be prosecuted regardless of whether his/her partner wants to initiate a criminal case. In 2019, a punishment was introduced in the law in Tajikistan for those who refuse to receive HIV therapy7. In many EECA countries, the punishment for any crime involving an HIV-positive person is exacerbated by the positive HIV status.

Concerned by the fact that prosecutions are not always informed by the best available scientific and medical evidence, 20 of the world’s leading HIV scientists have presented the Expert consensus statement on the science of HIV in the context of criminal law.

The criminalization of HIV transmission is a growing human rights issue in Eastern Europe and Central Asia. This fact is also confirmed by the first regional report, prepared in 2017 using the data of the communities of women living with HIV. The study was organized and conducted by EWNA with the support of GNP+ and HIV Justice Worldwide.

The study has shown that HIV criminalization is a gender issue10. The stories and cases documented in the report and other recently conducted studies illustrate that women are more likely to be persecuted, as they are often the first to become aware of their status through regular HIV testing during pregnancy, but they are less likely to safely disclose their HIV positive status to their partner due to gender inequality in the family, economic dependence and high levels of violence. In addition, women living with HIV are less likely to receive adequate legal assistance and to have competent representation in court. In their stories, women talk about violence, threats, and blackmail associated with their HIV-positive status. The laws adopted were designed to protect women from HIV. Unfortunately, this is not the case in the reality as HIV criminalization makes women more vulnerable to violence and structural disparities. HIV criminalization increases the vulnerability of women to deprivation of parental rights, property loss, and poverty.

EECA activists make essential efforts to advocate for the decriminalization of HIV infection. Thus, the active advocacy work conducted by the community of people living with HIV pushed Belarus to adopt an important legislative amendment: the HIV-positive partner should be exempt from criminal liability if he or she has timely warned the HIV-negative partner about HIV and the latter has voluntarily agreed to take actions, which created a risk of infection. However this step alone is not sufficient to solve the issue of HIV criminalization.

We call attention of the EECA countries to the fact that in a society with low stigma and discrimination, people are more likely to be voluntarily tested for HIV and, learning about their status, begin ARV treatment.

We urge communities of people living with HIV and other criminalized and marginalized communities, in particular sex workers, LGBT people, people who use drugs, to unite and take a consolidated position to counter HIV criminalization, presenting a united front against HIV stigma and discrimination embedded in the law.

We urge governments and parliamentarians to use general law to prevent HIV transmission in the harm to health context and, instead of applying criminal law in any cases other than actual infection transmission by malicious intent, take steps to encourage people to be tested, take ARV treatment, communicate their HIV status and have safe sex without fear of stigma, discrimination and violence. This can be achieved by adopting and applying anti-discrimination laws and organizing public information campaigns to dispel myths about HIV, as such campaigns are evidence-based and are led by people living with HIV.

We urge prosecution agencies and prosecutors, to use scientific evidence and evidence-based medicine, in particular the evidence included in the Expert consensus statement on the science of HIV in the context of criminal law, in pre-trial and trial proceedings, in order to limit or prevent abuse of criminal prosecution in cases of allegations of HIV transmission or exposure or in cases of non-disclosure of HIV status.

We urge the media to stop demonizing people living with HIV, presenting us as criminals and as sources of infection. We request the media to consider HIV related issues from the perspective of human rights and use facts and evidence-based medicine while covering such issues.

We encourage donors to invest in communities and advocates opposing HIV criminalization, which undermines human rights and public health.

US: Growing number of Ohio public health experts and advocates call for reform of HIV criminalisation law

Experts: Ohio law on HIV status disclosure hurts public health

COLUMBUS, Ohio — A growing number of Ohio public health experts and advocates are now working to stop what they call the criminalization of HIV.

Daphne Kackloudis, Chief Public Policy Officer at Equitas Health, told News 5 Ohio’s current law charging someone who fails to disclose their HIV status with a felony in all cases is hurting public health.

Kackloudis said the threat of up to eight years in prison is causing too many people to avoid getting tested, because according the current law if someone doesn’t get tested, and isn’t aware of their status they can’t be prosecuted.

“It is a disincentive for someone to get tested, and that’s not good for an individuals health and the public health,” Kackloudis said.

“We want them to get on antiretroviral therapy to get as healthy as possible, and be virally suppressed so they can not transmit HIV.”

Kackloudis believes the potential penalty should be moved back to a misdemeanor in cases where those charged are on HIV medication and are a far less infection risk.

She said the current law allows someone to file charges against an HIV-positive partner, even if they didn’t get the virus from that partner.

Kackloudis is a member of the Ohio Health Modernization Movement , which is also making an effort to change Ohio law.

She also made it clear she fully understands why the law was created, and said the proposed change in the law would still allow for full prosecution of those who willingly give others HIV.

Graig Cote of Columbus, who has been HIV positive for 33 years, told News 5 changes in the law are needed because it’s too difficult to prove if someone made proper disclosure of their status or not, unless there was a witness or if it was in writing or recorded.

“If we don’t change the laws, people don’t get tested, if they don’t get tested they don’t know if they’re HIV positive,” Cote said.

“We’re not asking for a free ride, we’re just asking that the laws catch up with the science.”

Cote said he hopes the proposed change in Ohio law is ready to present at the statehouse in the first quarter of 2020, and again made it clear the effort would not keep those who willingly spread HIV from facing full prosecution.

“People who want to infect somebody need to be stopped, there’s no dispute about that,” Cote said.

Ukraine: Svetlana Moroz, chair of the Eurasian Women’s AIDS Network, talks about the campaign to decriminalise HIV

HIV criminalisation creates an atmosphere of false effectiveness of the State

Google translation – Scroll down for article in Russian

Global changes in Ukrainian politics in the spring and summer of 2019 generated a new wave of “high expectations” of civil society in relation to changes in the field of legislation. As a result, along with calls to immediately punish all corrupt officials and restructure the domestic economy, the concept of “decriminalization” has come into use in the media over the past half year.

The most famous today are public campaigns to decriminalize medical cannabis and sex work. Both topics are considered “hot” from the point of view of journalists and there is no doubt that a serious public discussion in this area awaits us in the coming months.

Unfortunately, the topic of decriminalization of HIV today is far from the focus of media attention. The draft amendments to the Legislation in this area was submitted for discussion to state bodies by human rights defenders at the beginning of 2017, but either because of the catastrophic stigmatization of the topic, or because of the total disinterest of officials in solving the problem, it is still “under the cloth” .

About why article 130 part 1 of the Criminal Code of Ukraine is so bad, how much the idea of HIV transmission has changed over the past 30 years, and what do we need to do to remove the label “Potential Criminal” from tens of thousands of Ukrainians, we are talking with the chairman of the board of the Eurasian Women’s AIDS Network Svetlana Moroz.

Svetlana, I know that you have a lot of experience in protecting the rights of people living with HIV and you often represent Ukraine at international conferences on this topic. Is it true that the criminalization of HIV is a common place in the Criminal Codes of countries with different ideologies?

According to the HIV Justice Network and the Global Commission on HIV and Legislation, as of July 2018, 68 countries criminalize not reporting an HIV diagnosis, putting people at risk of transmission and transmitting HIV, and HIV-positive status can be considered aggravating and punishment of circumstance.

There is also information about prosecutions for HIV-positive status in 69 countries. The leaders in the number of criminal cases related to HIV are Belarus, Canada, Russia and the USA. Yes, in that order.

But, on the other hand, for the period 2012-2018. In several countries, such as Venezuela, Ghana, Greece, Honduras, Zimbabwe, Kenya, Malawi, Mongolia, Tajikistan, Switzerland, and two US states, laws criminalizing HIV transmission have been repealed. And this is also a fact.

What damage does HIV criminalization do in real life?

The criminalization of HIV is the application of existing criminal or other laws to people living with HIV (PLHIV) who establish responsibility for putting them at risk of infection and becoming infected with HIV.

Excessive use of laws that criminalize PLHIV is a public health problem, as it discredits evidence-based strategies for HIV prevention, treatment, care and support for PLHIV, and ignores scientific advances related to the risk of HIV transmission. Criminalization reinforces the stigma associated with HIV status and identifies HIV-positive people as potential criminals, which in turn further increases discrimination.

Thus, the fear of prosecution can deter many people living with HIV, in particular women and members of key groups (people who use drugs, sex workers, migrants, men who have sex with men and people from sex) from receiving the necessary treatment and support, prevents information disclosure and increases the vulnerability of people living with HIV to violence.

Much less commonly discussed is how these laws affect healthcare providers. When a criminal trial was conducted in the United States over an HIV-positive patient, his doctor was called as a witness. She told how she was in a situation where she was forced to violate professional ethics, confidentiality and trust of her patient. When the prosecutor congratulated her on the fact that she helped to put the “scum” behind bars, the doctor felt devastated, because she could not help her patient and even harmed him by violating the main oath – “do no harm”.

In Russia, it is enough for an HIV-positive person to bite or scratch a policeman to get a few months on top of the main sentence. In Belarus, people living with HIV, living in families with children for a long time, receive real terms, depending on who was first registered with the doctor.

How has the perception of HIV transmission changed over the past 30 years?

Science took a big step forward. We live in an era of highly active antiretroviral therapy (ART), which has made HIV infection a chronic disease. Three critical studies have shown that the risk of transmitting the virus to HIV-positive people with sufficiently suppressed ART viral load is zero.

At the same time, taking an HIV-negative person with pre-exposure prophylaxis (PCP) as prescribed by a doctor almost always protects against HIV infection. These facts helped lawyers defend themselves against criminal prosecution on charges of transmitting HIV and putting it at risk of being brought forward from misconceptions about HIV as a “deadly weapon”.

What is the main illusion of the criminalization of HIV?

Criminal prosecution of PLHIV places the responsibility for HIV solely on them, thus creating an atmosphere of false peace for the rest of society for their health. People think their partners will warn that they have HIV under pain of criminal liability. In reality, this rarely happens, because the very dynamics of intimate contact, especially random contacts, exclude such information. As a result, people do not practice safe sex because they believe that if the partner does not report having HIV, then he is healthy and you can’t protect yourself. In many cases, the additional burden of possible criminal responsibility for concealing HIV-positive status only exacerbates the problems, making it difficult to talk openly about HIV in building relationships, in the work community and in the family.

Criminalization creates an atmosphere of false state effectiveness: it is being eliminated from the implementation of effective HIV information and prevention programs.

When my organization began working in prisons in the Donetsk region in 2005, I listened with horror and indignation to the stories of social workers about how HIV + men who did not infect their wives and to whom their spouses had no complaints were serving their sentences. My colleague from Kharkov received a suspended sentence only because she was pregnant (a mitigating factor), otherwise, she would have been in prison for not informing the nurse about her HIV status.

What is the main goal of your advocacy campaign for decriminalizing HIV?

The maximum program is to remove HIV infection from criminal law and use general legislation, for example, causing harm to health where the intent of HIV infection has been proven. Otherwise, it is a stigma built into the laws.

We will also consider as a big advance the cancellation of Part 1 of Article 130 of the Civil Code of Ukraine (Intentionally putting another person in danger of contracting the human immunodeficiency virus or other incurable infectious disease that is dangerous to human life – is punishable by arrest for up to three months or restriction of liberty for up to five years , or imprisonment for up to three years), which human rights activists and activists have been talking about for many years, but the proposed laws were lost in bureaucratic corridors back in 2016. Our country has a very progressive AIDS Law, but the Criminal Code contradicts it.

And, of course, the minimum program – in our country, where laws are still in place that criminalize the transmission of HIV, the courts must, in accordance with the standards of the criminal process, require evidence of intent to transmit HIV. It is impossible to presume or justify the existence of intent by circumstances such as knowledge and / or non-reporting by the accused of their HIV-positive status, participation in unprotected sex, having a baby without taking measures to prevent mother-to-child transmission of HIV, or sharing injecting drug use equipment .

It should be noted that people living with HIV suffer from multiple criminalization, since many of them belong to marginalized groups – people who use drugs and have sex work. They are being persecuted for possession of drugs for personal use and for engaging in sex work. This, of course, is a separate big problem, worthy of increased attention of human rights defenders of Ukraine.

Interview conducted by: Sergey Myasoedov (Ukrainian Helsinki Human Rights Union)

Криминализация ВИЧ создает атмосферу ложной эффективности работы государства

Глобальные изменения в украинском политикуме весной-летом 2019 года породили новую волну «больших ожиданий» гражданского общества применительно к изменениям в сфере законодательства. В итоге, наряду с призывами немедленно наказать всех коррупционеров и реструктурировать отечественную экономику, в СМИ за последние пол-года в обиход вошло понятие «декриминализация».

Наиболее известными на сегодня являются общественные кампании по декриминализации медицинской конопли и секс-работы. Обе темы считаются «горячими» с точки зрения журналистов и несомненно, что в ближайшие месяцы нас ожидает серьезная общественная дискуссия в этой сфере.

К сожалению, тема декриминализации ВИЧ на сегодня далека от фокуса внимания СМИ. Проект изменений Законодательства в этой сфере был передан правозащитниками на обсуждение в гос органы еще в начале 2017 года, но, то ли в силу катастрофической стигматизированности темы, то ли в силу тотальной незаинтересованности чиновников в решении проблемы, он до сих пор находится «под сукном».

О том, почему статья 130 часть 1-я УК Украины так плоха, насколько изменились представления о передаче ВИЧ за последние 30 лет, и что же нам нужно сделать, чтобы убрать с десятков тысяч украинцев ярлык «Потенциальный преступник» беседуем с председательницей правления Евразийской Женской Сети по СПИДу Светланой Мороз.

Светлана я знаю, что у вас очень большой опыт работы по защите прав людей, живущих с ВИЧ и вы часто представляете Украину на международных конференциях по данной тематике. Правда ли, что криминализация ВИЧ является общим местом в Уголовных Кодексах стран с различной идеологией?

Согласно данным HIV Justice Network и Глобальной комиссии по ВИЧ и Законодательству по состоянию на июль 2018 года, в 68 странах предусмотрена уголовная ответственность за несообщение диагноза ВИЧ, поставление в опасность инфицирования и передачу ВИЧ, а ВИЧ-положительный статус может рассматриваться в качестве отягчающего ответственность и наказание обстоятельства.

Также имеется информация о случаях уголовного преследования в связи с ВИЧ-положительным статусом в 69 странах. Лидерами по количеству уголовных дел, связанных с ВИЧ, являются Беларусь, Канада, Россия и США. Да, в такой последовательности.

Но, с другой стороны, за период 2012-2018 гг. в ряде стран, например, в Венесуэле, Гане, Греции, Гондурасе, Зимбабве, Кении, Малави, Монголии, Таджикистане, Швейцарии и двух штатах США, были отменены законы, предусматривающие уголовную ответственность за передачу ВИЧ. И это тоже факт.

Какой ущерб наносит людям криминализация ВИЧ в реальной жизни?

Криминализация ВИЧ – это применение существующих уголовных или других законов в отношении людей, живущих с ВИЧ (ЛЖВ), устанавливающих ответственность за постановку в опасность заражения и заражение ВИЧ-инфекцией.

Чрезмерное использование законов, которые криминализуют ЛЖВ, является проблемой общественного здравоохранения, поскольку дискредитирует основанные на фактических данных стратегии в отношении профилактики ВИЧ-инфекции, а также лечения, ухода и поддержки ЛЖВ, и игнорирует научные достижения, связанные с риском передачи ВИЧ-инфекции. Криминализация усиливает стигму, связанную с ВИЧ-статусом, и идентифицирует ВИЧ-положительных людей, как потенциальных преступников, что, в свою очередь, еще больше повышает дискриминацию.

Таким образом, страх перед судебным преследованием может удерживать многих людей, живущих с ВИЧ, в частности женщин и представителей ключевых групп (люди, употребляющие наркотики, секс работницы_ки, мигранты, мужчины, имеющие секс с мужчинами и транслюди) от получения необходимого лечения и поддержки, препятствует раскрытию информации и повышает уязвимость людей, живущих с ВИЧ, к насилию.

Намного реже обсуждается то, как эти законы влияют на медицинских работников. Когда в США шел уголовный процесс над ВИЧ-положительным пациентом, в качестве свидетеля была вызвана его врач. Она рассказала, как оказалась в ситуации, когда была вынуждена нарушить и профессиональную этику, конфиденциальность и доверие своего пациента. Когда прокурор поздравил ее с тем, что она помогла отправить за решетку «подонка», врач почувствовала себя опустошенной, поскольку она не смогла помочь своему пациенту и даже навредила ему, чем преступила главную клятву – «не навреди».

В России достаточно ВИЧ-положительному человеку укусить или поцарапать полицейского, чтобы получить несколько месяцев сверху к основному приговору. В Беларуси люди, живущие с ВИЧ, долгое время прожившие в семьях, имеющие детей, получают реальные сроки, в зависимости от того, кто первый был поставлен на учет к врачу.

Как изменилось представление о передаче ВИЧ за последние 30 лет?

Наука сильно шагнула вперед. Мы живем в эпоху высоко активной антиретровирусной терапии (АРТ), которая сделала ВИЧ-инфекцию хроническим заболеванием. Три важнейших исследования доказали, что риск передачи вируса ВИЧ-положительными людьми с достаточно подавленной АРТ вирусной нагрузкой равен нулю.

В то же время, прием ВИЧ-отрицательным человеком доконтактной профилактики (ДКП) в соответствии с предписаниями врача почти всегда защищает от инфицирования ВИЧ. Эти факты помогли юристам в защите от уголовного преследования по обвинениям в передаче ВИЧ и поставлении в опасность инфицирования, предъявленным из неверных представлений о ВИЧ как о «смертельном оружии».

В чем состоит главная иллюзия криминализации ВИЧ?

Уголовное преследование ЛЖВ перекладывает ответственность за ВИЧ исключительно на них, создавая таким образом атмосферу ложного спокойствия остальных членов общества за свое здоровье. Люди думают, что под страхом уголовной ответственности их партнеры предупредят, что у них ВИЧ. В реальности это происходит редко, потому что сама динамика интимного контакта, особенно случайных контактов, исключает подобное информирование. В итоге люди не практикуют защищенный секс, потому что считают, если партнер не сообщил о наличии у него ВИЧ, значит он здоров и можно не предохраняться. Во многих случаях дополнительное бремя возможной уголовной ответственности за сокрытие ВИЧ-положительного статуса только усиливает проблемы, мешая открыто говорить о ВИЧ при установлении отношений, в рабочем коллективе и семье. В результате общество не защищено существующим уголовным законодательством в отношении ЛЖВ от ВИЧ-инфекции, а даже наоборот.

Криминализация создает атмосферу ложной эффективности работы государства: оно устраняется от реализации эффективных программ информирования и профилактики ВИЧ.

Когда моя организация начинала работать в местах лишения свободы в Донецкой области в 2005 году, я с ужасом и негодованием слушала истории соцработников о том, как отбывают свои сроки ВИЧ+ мужчины, которые не инфицировали своих жен и к которым их супруги не имели никаких претензий. Моя коллега из Харькова получила условный срок, только потому что была беременная (смягчающий фактор), иначе, сидела бы в тюрьме за то, что не сообщила медсестре о своем ВИЧ-статусе.

Какова основная цель вашей правозащитной деятельности в связи с кампанией по декриминализации ВИЧ?

Программа максимум – убрать ВИЧ-инфекцию из криминального законодательства и использовать общее законодательство, например, причинение вреда здоровью там, где доказан умысел инфицирования ВИЧ. Иначе, это встроенная в законы стигма.

Большим продвижением мы также посчитаем отмену части 1 статьи 130 КК Украины (Заведомое поставление другого лица в опасность заражения вирусом иммунодефицита человека либо иной неизлечимой инфекционной болезни, опасной для жизни человека, – наказывается арестом на срок до трех месяцев или ограничением свободы на срок до пяти лет, или лишением свободы на срок до трех лет), о которой правозащитники и активисты говорят много лет, но предложенные законы потерялись в бюрократических коридорах еще в 2016 году. В нашей стране существует очень прогрессивный Закон о СПИДе, но Криминальный Кодекс ему противоречит.

И, конечно, программа минимум – в нашей стране, где все еще действуют законы, предусматривающие уголовную ответственность за передачу ВИЧ, суды должны в соответствии со стандартами уголовного процесса требовать доказательства о наличии умысла передачи ВИЧ. Нельзя предполагать или обосновывать наличие умысла такими обстоятельствами, как знание и/или несообщение обвиняемым своего ВИЧ-положительного статуса, участие в незащищенном половом контакте, рождение ребенка без принятия мер по профилактике передачи ВИЧ от матери к ребенку, либо совместное использование инструментария для инъекционного употребления наркотиков.

Тут нужно отметить, что люди, живущие с ВИЧ, страдают от множественной криминализации, поскольку многие из них принадлежат к маргинализированным группам – к людям, употребляющим наркотики и занимающимся секс-работой. Их преследуют за хранение наркотиков с целью личного употребления и за занятие секс-работой. Это конечно же отдельная большая проблема, достойная повышенного внимания правозащитников Украины.

Интервью вёл: Сергей Мясоедов (Украинский Хельсинкский союз по правам человека)

Mexico: Mexican Network of Organisations against HIV criminalisation calls on Veracruz State Congress to stop proposed criminalisation legislation

NGOs call local deputy to stop proposal that criminalizes people with HIV

Google translation, scroll down for Spanish article

On April 30, 2018, the Supreme Court of Justice of the Nation ruled in favour of the Unconstitutionality Action 139/2015 promoted by the National Human Rights Commission

The Mexican Network of Organizations Against HIV Criminalization, called upon the deputy chairwoman of the Administration and Budget Commission of the Veracruz State Congress, Jessica Ramírez Cisneros, to stop the legislative process of her proposal to reform articles 157 and 158 of the Criminal Code of the State , where it is intended to impose from six months to five years in prison and a fine of up to 50 Units of Measurement and Update (UMA) who, fraudulently, endangers of “contagion” of a serious illness to another person

In this, it is considered among these serious and communicable diseases to “syphilis, gonorrhea, hepatitis B and C, herpes, HIV, tuberculosis” , which contradicts the historical ruling of the SCJN that invalidates the modification of the annulment of article 158.

Through a letter addressed to the legislator to channel their efforts for human rights and encourage the repeal of article 158 of the Criminal Code for the Free and Sovereign State of Veracruz of Ignacio de la Llave.

Remember that on April 30, 2018, the Supreme Court of Justice of the Nation ruled in favor of the Unconstitutionality Action 139/2015 promoted by the National Human Rights Commission , at the request of the Multisectoral Group on HIV / AIDS and STIs of the State of Veracruz, against the amendment to article 158 of the Criminal Code for the Free and Sovereign State of Veracruz of Ignacio de la Llave, in whose content the penalty for the offense of alleged “contagion” (transmission should be said) was added to who has sexually transmitted infections, specifying HIV.

ONGs llaman a diputada local parar propuesta que criminaliza a personas con VIH

El 30 de abril de 2018, la Suprema Corte de Justicia de la Nación falló a favor de la Acción de Inconstitucionalidad 139/2015 promovida por la Comisión Nacional de los Derechos Humanos

La Red Mexicana de Organizaciones contra la Criminalización del VIH, hizo un exhorto a la diputada presidenta de la Comisión de Administración y Presupuesto del Congreso del Estado de Veracruz, Jessica Ramírez Cisneros, detener el proceso legislativo de su propuesta para reformar los artículos 157 y 158 del Código Penal del Estado, en donde se pretende imponer de seis meses a cinco años de prisión y multa de hasta 50 Unidades de Medida y Actualización (UMA) a quien, dolosamente, ponga en peligro de “contagio” de una enfermedad grave a otra persona.

En esta, se considera entre dichas enfermedades graves y transmisibles a la “sífilis, gonorrea, hepatitis B y C, herpes, VIH, tuberculosis”, misma que contradice el fallo histórico de la SCJN que invalida la modificación del anula el artículo 158.

A través de una carta dirigida a la legisladora canalizar sus esfuerzos en pro de los derechos humanos y fomente la derogación del artículo 158 del Código Penal para el Estado Libre y Soberano de Veracruz de Ignacio de la Llave.

Recuerdan que el 30 de abril de 2018, la Suprema Corte de Justicia de la Nación, falló a favor de la Acción de Inconstitucionalidad 139/2015 promovida por la Comisión Nacional de los Derechos Humanos, a solicitud del Grupo Multisectorial en VIH/sida e ITS del Estado de Veracruz, en contra de la reforma al artículo 158 del Código Penal para el Estado Libre y Soberano de Veracruz de Ignacio de la Llave, en cuyo contenido se agregó la sanción por delito de presunto “contagio” (debería decirse transmisión) a quien presente infecciones de transmisión sexual, especificando VIH.

UNAIDS and UNDP urge countries to lift all forms of HIV-related travel restrictions

UNAIDS and UNDP call on 48* countries and territories to remove all HIV-related travel restrictions

New data show that in 2019 around 48* countries and territories still have restrictions that include mandatory HIV testing and disclosure as part of requirements for entry, residence, work and/or study permits

GENEVA, 27 June 2019—UNAIDS and the United Nations Development Programme (UNDP) are urging countries to keep the promises made in the 2016 United Nations Political Declaration on Ending AIDS to remove all forms of HIV-related travel restrictions. Travel restrictions based on real or perceived HIV status are discriminatory, prevent people from accessing HIV services and propagate stigma and discrimination. Since 2015, four countries have taken steps to lift their HIV-related travel restrictions—Belarus, Lithuania, the Republic of Korea and Uzbekistan.

“Travel restrictions on the basis of HIV status violate human rights and are not effective in achieving the public health goal of preventing HIV transmission,” said Gunilla Carlsson, UNAIDS Executive Director, a.i. “UNAIDS calls on all countries that still have HIV-related travel restrictions to remove them.”

“HIV-related travel restrictions fuel exclusion and intolerance by fostering the dangerous and false idea that people on the move spread disease,” said Mandeep Dhaliwal, Director of UNDP’s HIV, Health and Development Group. “The 2018 Supplement of the Global Commission on HIV and the Law was unequivocal in its findings that these policies are counterproductive to effective AIDS responses.”

Out of the 48 countries and territories that maintain restrictions, at least 30 still impose bans on entry or stay and residence based on HIV status and 19 deport non-nationals on the grounds of their HIV status. Other countries and territories may require an HIV test or diagnosis as a requirement for a study, work or entry visa. The majority of countries that retain travel restrictions are in the Middle East and North Africa, but many countries in Asia and the Pacific and eastern Europe and central Asia also impose restrictions.

“HIV-related travel restrictions violate human rights and stimulate stigma and discrimination. They do not decrease the transmission of HIV and are based on moralistic notions of people living with HIV and key populations. It is truly incomprehensible that HIV-related entry and residency restrictions still exist,” said Rico Gustav, Executive Director of the Global Network of People Living with HIV.

The Human Rights Council, meeting in Geneva, Switzerland, this week for its 41st session, has consistently drawn the attention of the international community to, and raised awareness on, the importance of promoting human rights in the response to HIV, most recently in its 5 July 2018 resolution on human rights in the context of HIV.

“Policies requiring compulsory tests for HIV to impose travel restrictions are not based on scientific evidence, are harmful to the enjoyment of human rights and perpetuate discrimination and stigma,” said Dainius Pūras, Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of health. “They are a direct barrier to accessing health care and therefore ineffective in terms of public health. I call on states to abolish discriminatory policies that require mandatory testing and impose travel restrictions based on HIV status.”

The new data compiled by UNAIDS include for the first time an analysis of the kinds of travel restrictions imposed by countries and territories and include cases in which people are forced to take a test to renew a residency permit. The data were validated with Member States through their permanent missions to the United Nations.

UNAIDS and UNDP, as the convenor of the Joint Programme’s work on human rights, stigma and discrimination, are continuing to work with partners, governments and civil society organizations to change all laws that restrict travel based on HIV status as part of the Global Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination. This is a partnership of United Nations Member States, United Nations entities, civil society and the private and academic sectors for catalysing efforts in countries to implement and scale up programmes and improve shared responsibility and accountability for ending HIV-related stigma and discrimination.

*The 48 countries and territories that still have some form of HIV related travel restriction are: Angola, Aruba, Australia, Azerbaijan, Bahrain, Belize, Bosnia and Herzegovina, Brunei Darussalam, Cayman Islands, Cook Islands, Cuba, Dominican Republic, Egypt, Indonesia, Iraq, Israel, Jordan, Kazakhstan, Kuwait, Kyrgyzstan, Lebanon, Malaysia, Maldives, Marshall Islands, Mauritius, New Zealand, Oman, Palau, Papua New Guinea, Paraguay, Qatar, Russian Federation, Saint Kitts and Nevis, Samoa, Saudi Arabia, Saint Vincent and the Grenadines, Singapore, Solomon Islands, Sudan, Syrian Arab Republic, Tonga, Tunisia, Turkmenistan, Turks and Caicos, Tuvalu, Ukraine, United Arab Emirates and Yemen.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

HIV criminalization in Canada (Canadian HIV/AIDS Legal Network, 2019)

A short video summarising the situation as of Summer 2019 regarding HIV criminalisation in Canada. For more information, please visit hivcriminalization.ca.

[update]US: Bill aiming to modernise HIV legislation in Florida clears its second hurdle

Source: South Florida Gay News, Published on March 25, 2019

HIV Modernization Bill Continues to Make Progress in Florida House

An HIV modernization bill, the (HB 79), cleared its second hurdle this week passing the Florida House’s Appropriations Committee overwhelmingly 26-3.

This is the second committee to give the bill a favorable recommendation. It recently passed the House’s Criminal Justice Subcommittee, 10-3.

“We’re really excited by the bipartisan momentum that we’ve seen for this HIV modernization legislation,” said Jon Harris Maurer, Equality Florida’s Public Policy Director. “This is long overdue and it’s exciting to see this being addressed as a criminal justice reform issue and a public health issue.”

Michael Rajner, an HIV rights activist, attributes the newfound support to advocates, stakeholders and people living with HIV meeting with lawmakers to tell their stories.

Rajner said he’s been working toward a bill like this for at least 8 years.

This is the third year this bill has been introduced and there’s been a surge in support. This is also the furthest an HIV modernization has gotten in the Florida Legislature.

“Regardless of which side of the aisle you sit on people want better public safety and better health outcomes and that’s what this bill does,” said Justin Klecha, Deputy Director of SAVE and a member of the Florida HIV Justice Coalition. “This is a fantastic bill that takes a huge step forward reducing stigma around HIV.”

Klecha said most of the opposition comes from a lack of knowledge.

“Legislators don’t know the current science around HIV, or how far we’ve come with the treatments,” Klecha said.

HB 79 must now pass through the Judiciary Committee. While in the Senate, Jason Pizzo (D – Miami), has filed similar legislation (SB 846), but no hearings have been scheduled as of yet.

“This is the first year the legislature is actually taking any actions and votes. We have a tremendous bill sponsor this year, Nick Duran out of Miami, who is incredibly passionate about this,” Rajner said. “We also owe a great deal of thanks to Dr. Hansel Tookes and the medical students at the University of Miami who have been doing a tremendous job of advocating for needle syringe exchange programs statewide and in that process have been educating legislators on HIV.”

The current law does not take into account whether a person actually transmitted HIV. Nor does it matter if a condom was used, or if the person with HIV is on treatment and undetectable.

This new bill would revise the existing law such as defining “Substantial risk of transmission” as “a reasonable probability of disease transmission as proven by competent medical or epidemiological evidence.” The bill would also update outdated language such as changing “sexual intercourse” to “sexual conduct.”

“I think the most profound change is that there would have to be actual intent and transmission of HIV to another individual during sex,” Rajner said.

Other changes include allowing a person who has HIV to donate blood, plasma, organs, skin, or other human tissue as long as a medical professional deems it appropriate. Currently, there are no exceptions so if someone did make such a donation they would be committing a third-degree felony. HB 79 would downgrade the penalty to a first-degree misdemeanor.

“This bill would help modernize Florida’s HIV laws that were written in the mid-80s at the height of the HIV epidemic and haven’t been updated to align with current science on treatment and prevention for HIV,” Maurer said. “I think most strikingly is that the law currently doesn’t account for whether in fact there is any transmission of HIV. So under the current law, a person could be incarcerated for up to 30 years with a third-degree felony, even though there is no transmission of HIV, and scientifically there is no risk of transmission.”

Source: South Florida Gay News, published on March 7, 2019

HIV Modernization Bill Moves Forward In Florida House

An HIV modernization bill, the HIV Prevention Justice Act (HB 79), cleared its first hurdle passing 10-3 in the Florida House’s Criminal Justice Subcommittee.

Five Republicans and five Democrats voted for the bill.

The current law does not take into account whether a person actually transmitted HIV. Nor does it matter if a condom was used, or if the person with HIV is on treatment and undetectable.

The bill must also pass through the Appropriations Committee and Judiciary Committee.

Senator Jason Pizzo (D – Miami) has filed similar legislation (SB 846) in the Florida Senate.

Nicholas Duran bill aims to modernize HIV law

Equality Florida applauds legislation catching law up to modern science.

Count it a leftover of the AIDS scare in the 1980s: Florida law treats those who knowingly transmit HIV different than any other sexually transmitted disease.

But a bill advancing through the Florida House could de-stigmatize HIV without decriminalizing irresponsible transmission entirely.

“There’s a longstanding stigma with respect to this based on a years-ago understanding as opposed to current health and medical science on the disease,” state Rep. Nicholas Duran said.

He credits it to law written in a time when people worried spitting or sharing a toilet seat with an HIV-positive individual.

This year, the Miami Democrat filed the HIV Prevention Justice Act (HB 79) in hopes of reforming the law. The bill already has favorably passed through the House Criminal Justice Subcommittee.

If it becomes law, the legislation will reclassify a failure to notify a sexual partner of HIV-positive status as a misdemeanor, instead of a felony.

“This legislation will save lives and take care of the whole community,” said Alejandro Acosta, coordinator for Equality Florida’s HIV Advocacy Project. “It will help decrease HIV stigma, encourage people to get tested, and get into treatment.”

Acosta, who is HIV-positive, said Florida “has a responsibility to match our law with current science.”

That means acknowledging HIV, far from the death sentence it was in the 1980s, can be treated as a chronic condition more on par with asthma or diabetes.

While there are 115,000 people living with HIV in Florida, there were less than 900 deaths from HIV-related causes in the state in 2016.

But the spread of the virus remains a concern, particularly in Florida. The state saw 4,957 documented new transmissions in 2016, according to Equality Florida.

But the impact of the disease remains demographically uneven. Only 22 percent of new transmissions in Florida were for women. Meanwhile, 42 percent were for black individuals and 32 percent were Latino.

And date from the Centers for Disease Control shows the condition still impacts the LGBTQ more than the public as a whole. Gay and bisexual men make up 55 percent of Americans living with HIV.

At current rates, a quarter of all gay and bisexual Latino men will get HIV at some point in their life. Half of gay and bisexual black men will contract the virus.

All this may indicate an importance in being open with sexual partners about having the virus, and Duran doesn’t want failure to disclose information completely decriminalized.

But the severe legal consequence for failing to share information has led to a high number of individuals refusing to get tested for HIV. CDC data suggests 20,000 Floridians have contracted HIV but remain unaware of their status.

In an interview with HIV Plus Magazine in 2017, Acosta declined to say how long he’d had HIV, noting the current laws in Florida open individuals up to legal risk for years.

HIV-positive people can face up to 30 years in prison for failure to disclose their status with a consensual partner, and that risk comes whether the virus gets transmitted or not.

Further, current medical treatments can make HIV medically undetectable, and in turn can make the virus virtually non-transmittable.

It raises the question what obligation should exist for an individual employment safe sex practices has to a partner when there’s virtually no risk of catching HIV from an encounter.

Duran’s bill also addresses some specific issues, like acknowledging the low risk of ever transmitting HIV through oral sex.

States like California have already reduced the penalties for HIV-positive individuals withholding their status.

Efforts to change the law failed in Florida in the past. But Duran hopes a conversation based on current science can catch the law up with modern knowledge.

He notes Hepatitis C poses a greater risk and threat to public health today than HIV. Treating HIV patients as criminals at this point does more harm than good.

“We are going to create smart policy with HIV and STDs,” he said.

Published in FLAPOL on Feb 25, 2019

Belarus: Experience of serodiscordant couple in Belarus demonstrates how punitive legislation can harm HIV prevention efforts

Published in echo.msk.ru on March 1, 2019 – Google translation, for from Russian article please scroll down.

A prison awaits us: what are discordant couples in Belarus afraid of?

Ilya and Eugene – a gay couple from Belarus. They have been together for several years and call themselves an “interesting couple,” because they live in a discordant relationship. Recently, during sex, they broke a condom. They decided to start post-exposure prophylaxis (PEP). It would seem that everything was simple: within 72 hours after the risk of infection, you need to start taking pills. Moreover, the steps are known: go to the doctor, explain the situation, get the pills, drink a month’s course – and you can forget about the problem. But due to the peculiarities of local legislation, it is much more difficult to get help than it seems at first glance. AIDS.CENTER figured out what Belarusian discordant couples face and what are the ways out of the current situation in the republic.

“As soon as our condom broke, we consulted with friends and went to Minsk [to the infectious diseases hospital] on Kropotkin Street for a PCP,” recalls Ilya. The doctor listened to him and with a “very dissatisfied face” asked to disclose the name of the partner. Motivated by the fact that a young person must be registered, and in such cases, the medical officer “must report to the law enforcement authorities.”

The man asked if such a law had not been repealed, but they explained to him that it remains in force and that the partner would incur criminal liability. Of course, the man refused to tell him about Evgeny, but the doctor insisted: “How do I know? Maybe you are slandering someone? Suddenly you will now go to sell the medicines that I will give you? ” The pill was not given.

Indeed, in the Criminal Code of Belarus there is Art. 157 (Human immunodeficiency virus infection), according to which, if a person deliberately put another in danger of becoming infected with HIV, he can receive up to a prison term. It is noteworthy that the article provided for criminal liability, even if the injured party had no complaints against the defendant. And infectious disease doctors can initiate proceedings. Moreover, Belarus together with Russia are leaders in the criminal prosecution of people with HIV. For example, in 2017, 130 criminal cases were initiated under Art. 157 of the Criminal Code of the Republic of Belarus.

However, in the near future, legislation in the Republic may be relaxed, for example, on December 19, 2018, an amendment was made to decriminalize transmission of the disease. According to this, people with a diagnosis will no longer be prosecuted “for putting the threat of HIV transmission and HIV infection” on their partners if they have notified them in advance about their diagnosis. Now the bill has been submitted to the Council of the Republic and the president for approval.

“There are still a dozen of prohibitions for people with HIV-positive status in the legislation of Belarus ,” says Irina Statkevich, chairman of the local HIV-service organization “Positive Movement”. – In 2018, they made positive changes to the standard “Children living with HIV are prohibited from playing sports.” It is noteworthy that the children themselves living with HIV initiated the changes in the norm, namely, they went to the meeting at the Ministry of Health. ”

In addition, before people with HIV were forbidden to adopt children, now this article has been revised, but still there are some nuances in the application.

Who is responsible for health?

Ilya is convinced that he must bear responsibility for his own health. Once he himself worked as an HIV counselor and conducted rapid testing, so he knew that there was very little time for PEP after unprotected intercourse, only three days.

“In my opinion, the doctor was very unprofessional,” he complains. “The reason for concern was that at that time my young man and I didn’t know exactly his viral load.”

“In Belarus, as in many other countries, there is no document that would clearly define the indications for postexposure prophylaxis, and this is due to objective difficulties,” says infectious disease doctor Nikolai Golobrudko.

According to him, the PCP is provided in cases of occupational risks, for example, if a nurse injected with a syringe, which took blood from an HIV-positive patient. Or in some domestic situations (for example, the child found a syringe in the sandbox and injected with them) or at certain sexual contacts (for example, after rape).

Statkevich agrees with the lack of regulations for issuing such tablets. “Therefore, the requirement to name your partner in this regard is unlikely to exist,” she said, assuming that the doctor could ask the partner’s data for risk assessment. “The doctor could look at the viral load information in the partner’s registration card and thus understand how much the situation is really emergency.”

Ultimately, Ilya received postexposure prophylaxis, but not from doctors who were supposed to provide it, friends from Russia helped and promptly transferred it.

Soon he will go for tests, and if he is around, he wants to go to an appointment with the very same doctor: “Since it was she who jeopardized my health and my life. Requirements of this kind from a doctor, in my opinion, violate the law on medical confidentiality; disclosing a person’s HIV status can be a criminal offense. After all, there are people who will use this information far from for good purposes. ”

How to change the situation?

The case of Ilya is a good demonstration of how HIV prevention is related to legislative norms, in particular, with 157 articles, Statkevich believes. “Recently this topic has been actively discussed, there are real cases of imprisonment. And many people seek to keep secrets at all costs so as not to harm the HIV-positive partner, ”she adds.

A public organization advocates a reduction in the criminalization of HIV infection by offering several points. First, reclassify cases under article 157 from public to private accusation. Thus, they will be initiated not by representatives of the Ministry of Internal Affairs or the Prosecutor’s Office, but at the initiative of a person who has suffered from a crime. In addition, the case may be closed in case of reconciliation of the parties.

Secondly, the possibility of blackmail by an HIV-negative partner should be excluded. To do this, community activists offer either to issue an “informed consent to have sex with an HIV-positive partner,” suppose a infectious diseases doctor; or, which seems more realistic, to supplement the criminalizing article with the phrase “in the event of failure to take measures to prevent infection (refusal to take antiretroviral therapy or use a condom)”.

Thirdly, to define the terms of the Criminal Code article itself more clearly, for example, what is the “knowledge” and so on. Since the vagueness of the wording allows them to be interpreted unnecessarily broadly.

“Medical prophylaxis after cases of unprotected sex is sometimes needed, but it should not become a substitute for concern about the safety of one’s sexual behavior, the use of condoms,” says Goloborudko.

The doctor adds that there is another effective way of prevention for people with increased risk of infection, for example, for men who have sex with men, and for sex workers – pre-contact prophylaxis (PrEP or PrEP).

However, there is a problem with access to these pills, and both DCT and PEP. Antiretroviral drugs in Belarus are procured centrally for the state budget, and pharmacies simply do not arrive, that is, it is impossible to buy them yourself, at least legally. This means that due to stigma, fear to open up even to doctors and unwillingness to donate partners, the number of people with HIV may increase. The principle is simple: do not drink therapy – either you are infected yourself, or you transmit the virus to another. It remains to hope that a program on pre-and post-exposure prophylaxis may appear in Belarus (at least now such conversations are under way), which could be given out not only in state hospitals, but also in public organizations.

Нас ждет тюрьма: чего боятся дискордантные пары в Беларуси

Илья и Евгений — пара геев из Беларуси. Они уже несколько лет вместе и называют себя «интересной парочкой», поскольку живут в дискордантных отношениях. Недавно во время секса у них порвался презерватив. Они приняли решение начать постконтактную профилактику (ПКП). Казалось бы, все просто: в течение 72 часов после риска инфицирования нужно начать принимать таблетки. Тем более что шаги известны: прийти к врачу, объяснить ситуацию, получить таблетки, пропить месячный курс — и о проблеме можно забыть. Но из-за особенностей местного законодательства получить помощь гораздо сложнее, чем кажется на первый взгляд. СПИД.ЦЕНТР разбирался, с чем сталкиваются белорусские дискордантные пары и какие есть выходы из сложившейся в республике ситуации.

Не сдал — не получил

«Как только у нас порвался презерватив, мы посоветовались с друзьями и поехали в Минск [в инфекционную больницу] на улицу Кропоткина за ПКП», — вспоминает Илья. Врач его выслушал и с «очень недовольным лицом» попросил раскрыть имя партнера. Мотивировав тем, что молодого человека необходимо поставить на учет и в подобных случаях медицинский работник «должен докладывать правоохранительным органам».

Мужчина уточнил, не отменен ли еще такой закон, но ему пояснили, что он действует и партнер понесет уголовную ответственность. Само собой, мужчина отказался сдавать Евгения, но врач настаивала: «Откуда мне знать? Может быть, вы клевещете на кого-нибудь? Вдруг вы сейчас пойдете продавать лекарства, которые я вам выдам?». Таблетки так и не дали.

Действительно, в Уголовном кодексе Беларуси есть ст. 157 (Заражение вирусом иммунодефицита человека), согласно которой, если человек заведомо поставил другого в опасность инфицирования ВИЧ, он может получить вплоть до тюремного срока. Примечательно, что статья предусматривала уголовную ответственность, даже если пострадавшая сторона не имела никаких претензий к ответчику. А инициировать возбуждение дела могут врачи-инфекционисты. Причем Беларусь вместе с Россией — лидеры по уголовному преследованию людей с ВИЧ. Например, в 2017 году было возбуждено 130 уголовных дел по ст. 157 УК Республики Беларусь.

Однако в ближайшее время законодательство в республике может быть смягчено, так, 19 декабря 2018 года внесена поправка о декриминализации передачи болезни. Согласно ей, люди с диагнозом больше не будут подвергаться уголовному преследованию «за постановку в угрозу передачи ВИЧ и заражение ВИЧ» своих партнеров, если они заранее уведомили их о своем диагнозе. Сейчас законопроект направлен для одобрения в Совет Республики и президенту.

«В законодательстве Беларуси все еще существует дюжина запретов для людей с ВИЧ-положительным статусом, — рассказывает председатель местной ВИЧ-сервисной организации «Позитивное движение» Ирина Статкевич. — В 2018 году внесли положительные изменения в норму «Детям, живущим с ВИЧ, запрещено заниматься спортом». Примечательно, что сами дети, живущие с ВИЧ, выступили инициаторами изменения нормы, а именно — ходили на встречу в Минздрав».

Кроме того, раньше людям с ВИЧ было запрещено усыновлять детей, сейчас эту статью пересмотрели, но все равно остались некоторые нюансы в применении.

Кто отвечает за здоровье?

Илья убежден, что ответственность за свое здоровье должен нести сам. Когда-то он сам работал консультантом по вопросам ВИЧ и проводил экспресс-тестирование, поэтому знал, что после незащищенного полового акта времени для ПКП очень мало, всего лишь трое суток.

«На мой взгляд, врач поступила очень непрофессионально, — сетует он. — Повод для беспокойства был — на тот момент мой молодой человек и я точно не знали его вирусную нагрузку».

«В Беларуси, как и во многих других странах, нет документа, который бы четко определял показания к проведению постконтактной профилактики, и это связано с объективными трудностями», — констатирует врач-инфекционист Николай Голоборудько.

По его словам, ПКП предоставляют в случаях профессиональных рисков, например, если медсестра укололась шприцем, которым забирала кровь у ВИЧ-положительного пациента. Или в некоторых бытовых ситуациях (например, ребенок нашел в песочнице шприц и укололся им) или при определенных половых контактах (например, после изнасилования).

Статкевич соглашается с отсутствием регламента выдачи таких таблеток. «Поэтому требование назвать своего партнера в данной связи вряд ли существует, — уточняет она, предполагая, что врач могла спрашивать данные партнера для оценки рисков. — Доктор мог посмотреть информацию о вирусной нагрузке в учетной карточке партнера и таким образом понять, насколько ситуация действительно экстренная».

В конечном счете постконтактную профилактику Илья все же получил, но не от врачей, которые должны ее предоставить, — помогли знакомые из России, оперативно передали ее.

Скоро он пойдет сдавать анализы, и если «плюсанет», то хочет попасть на прием к тому же самому врачу: «Так как это она поставила под угрозу мое здоровье и мою жизнь. Требования такого рода от врача, по моему мнению, нарушают закон о врачебной тайне, раскрытие ВИЧ-статуса человека может быть уголовно наказуемым. Ведь есть люди, которые данную информацию будут использовать далеко не для благих целей».

Как изменить ситуацию?

Случай Ильи — хорошая демонстрация того, как связана профилактика ВИЧ с законодательными нормами, в частности со 157 статьей, считает Статкевич. «В последнее время эта тема активно обсуждается, есть реальные случаи лишения свободы. А многие люди стремятся сохранить тайну любой ценой, чтобы не нанести вред ВИЧ-положительному партнеру», — добавляет она.

Общественная организация ратует за снижение криминализации инфицирования ВИЧ, предлагая несколько пунктов. Во-первых, переквалифицировать дела по статье 157 с публичного обвинения в частное. Таким образом, они будут возбуждаться не представителями МВД или прокуратуры, а по инициативе человека, пострадавшего от преступления. К тому же дела могут быть закрыты в случае примирения сторон.

Во-вторых, следует исключить возможность шантажа со стороны ВИЧ-отрицательного партнера. Для этого общественники предлагают либо оформлять «информированное согласие на вступление в половые контакты с ВИЧ-позитивным партнером», предположим, у врача-инфекциониста; или же, что кажется более реальным, дополнить криминализирующую статью фразой «в случае непринятия мер по профилактике заражения (отказ от приема антиретровирусной терапии либо от использования презерватива)».

В-третьих, более четко определить сами термины статьи УК, например, в чем заключается «заведомость» и так далее. Поскольку размытость формулировок позволяет трактовать их неоправданно широко.

«Медикаментозная профилактика после случаев незащищенного полового контакта иногда нужна, но она не должна становиться заменой заботы о безопасности своего полового поведения, использования презервативов», — говорит Голоборудько.

Врач добавляет, что есть другой эффективный способ профилактики для людей с повышенными рисками инфицирования, например, для мужчин, практикующих секс с мужчинами, и для секс-работниц — доконтактная профилактика (ДКП или PrEP).

Однако есть проблема с доступом к таким таблеткам, причем как ДКП, так и ПКП. Антиретровирусные препараты в Беларуси закупаются централизованно за госбюджет, а в аптеки просто не поступают, то есть купить их самостоятельно, по крайней мере легально, никак нельзя. А значит из-за стигмы, страха раскрыться даже врачам и нежелания сдавать партнеров количество людей с ВИЧ может увеличиваться. Принцип прост: не пьешь терапию — либо инфицируешься сам, либо передаешь вирус другому. Остается надеяться, что в Беларуси может появиться программа по до— и постконтактной профилактике (по крайней мере сейчас такие разговоры ведутся), которую могли бы выдавать не только в государственных больницах, но и в общественных организациях.

US: Indiana considers bill modernising laws related to HIV to reflect current science

HIV Modernization Legislation Considered By Lawmakers

A bill to modernize Indiana laws related to HIV, or human immunodeficiency virus, was heard by lawmakers Wednesday. The proposal would update laws to reflect current science and medicine.

Indiana laws related to the transmission of HIV were written in the ’90s. Rep. Ed Clere (R-New Albany), who authored the bill, says a lot has changed since then.

“When I was in high school HIV was a death sentence and it’s not today, thankfully,” says Clere. “Today it’s a chronic condition.”

IU School of Liberal Arts at IUPUI Associate Professor Dr. Carrie Foote leads Indiana’s HIV Modernization movement. She has lived with the virus for 30 years.

“Thanks to the advances in modern medicine, I am here with a very successful career and my husband and teenage son do not have HIV,” says Foote.

The bill removes stigmatized legal language, changes penalties and updates duty to warn laws. Dr. Bree Weaver, HIV expert at Indiana University’s School of Medicine, says people don’t get tested for fear of prosecution.

“Outdated and stigmatizing laws are negatively affecting our ability to bring people with HIV into care and thereby bring the HIV epidemic to an end,” says Weaver.

HIV modernization legislation can encourage testing, reduce stigma and eliminate barriers to effective treatment.

Amendments will be made to the bill before a committee vote.