US: Closing session of CDC's national HIV Prevention conference highlights stigma and HIV-specific criminalisation laws as barriers to improving outcomes in prevention and care

HIV Stigma in Focus at Closing Session of CDC’s National HIV Prevention Conference

HIV-related stigma and its impact on HIV-related health disparities were the topic of the final plenary session at CDC’s National HIV Prevention Conference. The March 21 session examined social and cultural factors that have contributed to stigma as well as efforts to combat the effects of HIV-related stigma on specific populations. Moderator Johanne Morne, director of the New York State Department of Health AIDS Institute, reminded the conference participants that stigma is an historic and continuing theme that must be addressed to improve outcomes along both the HIV prevention and care continuums.

HIV Stigma and What Can Be Done to Combat It

Greg Millett, vice president and director of public policy at amfAR, delivered the keynote address, “Progress: Same or Different? HIV Stigma at 37.” He noted that while many of the most extreme forms of stigma from the early days of the HIV epidemic have dissipated over time, inaccurate beliefs about the HIV risk of casual social contact persist.

Such stigmatizing beliefs are supported by societal factors such as HIV criminalization laws, Mr. Millett said. He pointed to the fact that 29 states still have HIV-specific criminalization laws on the books and while over 800 people have been prosecuted using these laws, none of the prosecutions were for any actual HIV transmission. He highlighted a CDC assessment that found that HIV criminalization laws have no detectable HIV prevention effect given there was no association with HIV diagnosis rates or AIDS diagnoses in states with such laws.

Further, he observed that not only are people with or at risk for HIV too often stigmatized, but the effective tools to prevent HIV such as PrEP are also stigmatized. A recent study found that individuals who experienced a high degree of stigma around their choice to use PrEP were 50% less likely to be on PrEP at their next clinical visit. Additionally, he pointed to syringe services programs (SSPs) that are known to reduce the risk of HIV transmission among people who inject drugs. Yet, stigma related to both HIV and people who use drugs limits public support for SSPs, limiting their expansion in many communities that could benefit from them, he said.

One factor that may enable this enduring stigma, Mr. Millett posited, is Americans’ lack of personal knowledge of people living with HIV. A Kaiser Family Foundation study found that only 45% of Americans say they know someone with HIV. To counter that, he encouraged more people living with HIV to be open about their status since that would contribute to stigma reduction. He also applauded creative efforts from the HIV community to combat stigma. These included public announcements by people living with HIV of their status on social media, anti-stigma campaigns, and even a series of social media videos about living with HIV.

Combatting HIV-related Stigma and Improving Outcomes for Specific Populations

A series of presentations followed, each discussing unique approaches to combating HIV stigma and offering recommendations on how to help reduce it to improve HIV prevention and care outcomes.

  • Daniel Driffin, co-founder of THRIVE SS, discussed building innovative, community-driven solutions to address HIV disparities among African American men living with HIV. Originally founded as a support group in Atlanta, the program has grown to an online platform that engages and offers support to more than 3,500 people across the southeast United States. Among THRIVE SS’s innovations are programs to re-engage and retain men in HIV care, a mental health group, and a photo campaign. Mr. Driffin shared results of a 2018 program participant survey that revealed that 92% of the men surveyed self-reported being virally suppressed. “Black men living with HIV are achieving viral suppression,” Mr. Driffin declared. “I challenge you to no longer say these men are ‘hard to reach.’” His advice for others seeking similar outcomes included: using the lived experiences of people living with HIV to inform HIV care and prevention, re-imagining everything, and supporting community-created approaches.
  • Omar Martinez, assistant professor at Temple University’s School of Social Work, examined HIV-related stigma among sexual and gender minority Latinx individuals. He observed that members of this community often experience stigma related to many aspects of their lives including culture, language, and immigration status, all of which impact their HIV risk. Dr. Martinez profiled several programs that have demonstrated success, including a number that engage non-traditional partners or that address legal and other needs. He advised stakeholders to focus on affirming models of care; to examine immigration status as a social determinant of health; and to continue to invest in the development and replication of “locally-grown” HIV prevention, treatment, and anti-stigma interventions that have proven effective.
  • Gail Wyatt, PhD, professor and director of the UCLA Sexual Health Program, discussed HIV stigma and disparities among African American women, reminding the audience of the importance of the inclusion of women’s perspectives in HIV prevention, care and treatment, and research. She discussed the impact of trauma on women’s health-seeking behaviors and treatment retention. She emphasized that an effective HIV response requires attention to holistic health, including mental health, to improve outcomes for women living with HIV. She also argued that some health care providers need to be re-educated about African American women given that many have biases about Black women that may hinder their delivery of effective health care services.
  • Cecilia Chung, co-director of programs and policy at the Transgender Law Center, shared her personal story as an Asian transgender woman living with HIV and discussed the power of personal storytelling to change hearts. She remarked, “Storytelling can help us get past differences, stigmas, and biases, and humanize individuals.” Being able to confidently tell one’s story affects the listener and also empowers the storyteller as they move forward on their path as a person living with HIV.

Dr. Eugene McCray, Director of CDC’s Division of HIV/AIDS Prevention, closed the session, thanking the participants from across the nation and the more than 500 of them who had shared results of their work with others in sessions, poster presentations, and exhibits during the conference. He noted that CDC was pleased to have been able to share more details of the Ending the HIV Epidemic Plan through several plenary session addresses and in a community engagement session. Implementing that Plan, he observed, will require ongoing dialogue and collaboration. With the powerful tools now available, the insights that data offer, leadership from all sectors, and community-driven and -developed plans, Dr. McCray indicated that he was confident that the nation could achieve the goal of reducing new HIV infections by 90% in ten years.

To view all or part of this plenary session, view CDC’s National Prevention Information Network video of Wednesday’s plenary session on their Facebook page .

[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.  

“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.” 

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. 

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.”   

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.”

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

Tajikistan: Criminal cases against people with HIV are on the rise, T. Khaidarova, Head of the network of women with HIV in Tajikistan, explains why

Source: Asia Plus on March 14, 2019

Google translation, for Russian article, please scroll down.

Why has the number of criminal cases for knowingly acquiring HIV infection suddenly increased in Tajikistan?

In Sughd Oblast, seven criminal cases against people living with HIV have been initiated since the beginning of 2019 alone.

Only seven per cent of HIV-positive women in Tajikistan are commercial sex workers, while the rest are ordinary women, wives of migrants and housewives. But against the backdrop of criminal cases related to deliberate HIV infection, which have noticeably increased, society only sees them as commercial sex workers.

And this is not the most important problem that people with HIV are facing,” said Takhmina Khaidarova, head of the network of women with HIV in Tajikistan.

– Takhmina, tell us how “deliberate infection” really happens, why do people go there?

– In practice, we meet with different people: some have three classes of education, others have graduated, and everyone needs a different approach. After a diagnosis is made, a person needs a detailed consultation in a language that is accessible to them. Unfortunately, we don’t have any specialized specialists who will do it.

People will find out that they are HIV-positive, and it is not a fact that they understand the seriousness of the situation. Or so – a person starts taking ARV therapy, and it often has very negative side effects, including hallucinations, and in order for the body to adapt, you need at least caloric food, which not everyone can afford, and people just quit taking medication.

Because they think, “I felt good, now I feel bad, so I’m better off not taking these drugs. Yes, after a person learns about his or her diagnosis, he or she is registered with the Republican Center for AIDS Prevention and Control, he or she signs a receipt stating that he or she has been warned about criminal responsibility, but who will guarantee that he or she understands the seriousness of what he or she is signing?

By the way, if a person who is HIV-positive and warns his or her sexual partner about the presence of an infection, and the latter agrees to have relations with him or her, then no criminal responsibility comes into play. However, it is impossible to prove it in court later on. Because partners do not give their consent in writing.

– Have such cases occurred in practice?

– Sometimes the partners are aware of it, but they refuse to be warned about it during the trial. In fact, all discordant couples (in which one partner is HIV-positive and the other is HIV-negative) can also fall under Article 125 Part 1 of the Criminal Code of Tajikistan. This part states: “Knowingly exposing another person to the risk of HIV infection”, i.e. it is not an actual infection, but a risk of infection. And all people with HIV-positive status who have a sexual partner, in fact, put them at risk of infection. But in reality this is not the case: if a person takes ARV therapy, their viral load is reduced, and even in the case of unprotected sex, their partner will not catch HIV.

Many high-profile criminal cases in Tajikistan have recently been initiated under the first part of Article 125 of the Criminal Code. This is very important to understand.

– So none of the victims were infected with HIV?

– The last sentences under this article were handed down in Khujand, and two women were sentenced to one year’s imprisonment: this is Article 125, Part 1 – it punishes by restriction of liberty for up to three years or imprisonment for up to two years. The second part of this article, “Infection of another person with HIV”, is punishable by two to five years’ imprisonment.

– How many women with HIV are commercial sex workers?

– According to statistics, only seven per cent of women work in the commercial sex industry, all other women are regular housewives, and more often they are wives of migrants who have contracted HIV from their husbands or contracted HIV through various medical procedures. But for some reason it still seems to everyone that a woman with HIV status is necessarily a commercial sex worker. And this leads to the fact that people are afraid to come to AIDS centers for help.

People with HIV cannot keep their confidentiality

– Why do you think the number of cases under Article 125 of the Criminal Code has increased recently?

– When the head of state visited the Tajik Medical University last September and raised the problems of infectious diseases, including HIV infection, which are important for the modern world, we were very grateful, because we believed that now they will be paid even more attention to. However, things have turned out a little differently. Previously, HIV infection issues were dealt with by the Republican Center for AIDS Prevention and Control, specialized NGOs, as well as other competent and informed structures, and now many other specialists are involved in this issue, who, unfortunately, do not always understand what HIV infection is.

In addition, after the introduction of mandatory testing for young couples before marriage, it has become much more difficult for people with HIV to maintain their confidentiality.

Here is how it happens: during testing it becomes clear that a person is HIV-positive, this is known to the administration at the polyclinic in their area of residence, which issues a marriage license, and then the civil register office, which will register the marriage, learn of the status. In the regions of the country, where the functions of the registry office are performed by jamoat departments, jamoats will also be recognized. Given the fact that in Tajikistan, it is the parents who decide everything for the young people, if they are HIV-positive, the entire family of the groom or bride will also learn about their HIV-positive status. While the confidentiality of a person who is HIV-positive is guaranteed by law, he or she should only tell his or her sexual partner about his or her status.

The law does not prohibit HIV-positive people from having a family. But when a civil register office receives information that a person is HIV-positive, what should they do? No one has the right to prohibit marriage of a person with HIV, and no one has the right to disclose information about the presence of infection, then why is this testing? In general, enforcement mechanisms have not been designed.

Fortunately, at the end of January this year, the Ministry of Health and Social Protection of Tajikistan together with international organizations, in accordance with the WHO recommendation, adopted methodological recommendations for the introduction of pre-exposure prophylaxis for HIV infection, which sets out all the mechanisms of action. I hope that something will change now.

“We already know about a third case of HIV cure..– How does information about cases of deliberate HIV infection affect people who are positive?

– This has a very negative impact on people’s lives because they see all this negativity and can simply refuse ARV therapy so that they do not have to go to AIDS centres again. Or people who have doubts about their health may simply not take the test and lose valuable time. Medicine is now so advanced that a person who is taking ARV therapy correctly, becomes safe even for his sexual partner, for his future child. HIV infection is no longer a deadly disease, but a chronic one, which is regulated by therapy; just a few days ago a the third case of HIV cure became known.

In Tajikistan, there are no problems with ARV treatment, all medicines are provided free of charge, and people can take them and live just like everyone else. If you look at the world experience, thanks to new medicines, restrictions for people with HIV are being removed, but here, in our country, on the contrary, they become more common.

– In Denmark, seven years ago, the punishment for unprotected sex with an HIV-negative person was abolished, because the life expectancy of a person with HIV does not differ from that of a person who is negative when receiving therapy.

– In October 2018, the CEDAW Committee, which oversees the implementation of the Convention on the Elimination of All Forms of Discrimination against Women (Tajikistan is a signatory to the Convention – note: Autumn 2018), presented an alternative report in which the topic of women with HIV status was seriously discussed. The report recommended that part 1 of article 125 of the Criminal Code of Tajikistan be repealed.

In addition, a recommendation was made to repeal a government decree of 2004, according to which people with HIV could not be guardians and foster parents of a child. Comments were also made on the 2018 decree, which states that people with HIV status cannot study in medical universities. The Committee recommends that the Government remove these restrictions within five years.

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Почему в Таджикистане увеличилось число уголовных дел за осознанное заражение ВИЧ инфекцией?

В Согдийской области только с начала 2019 года было возбуждено уже семь уголовных дел в отношении людей с положительным статусом ВИЧ.

Только семь процентов ВИЧ положительных женщин в Таджикистане являются работницами коммерческого секса, все остальные – обычные женщины – жёны мигрантов, домохозяйки. Но на фоне уголовных дел, связанных с осознанным заражением ВИЧ, которых стало заметно больше, в обществе снова видят в них только работниц коммерческого секса.

И это не самая главная проблема, которая возникла у людей с положительным ВИЧ-статусом; о том, какие еще – нам рассказала Тахмина Хайдарова, руководитель сети женщин с ВИЧ в Таджикистане.

– Тахмина, расскажите, как на самом деле происходит «осознанное заражение», почему люди идут на это?

– На практике мы встречаемся с разными людьми: у кого-то образование – три класса, а кто-то окончил вуз, и к каждому нужен свой подход. После того, как ставят диагноз, человеку нужна подробная консультация на доступном именно для него языке. К сожалению, у нас нет профильных специалистов, которые этим будут заниматься.

Люди узнают, что у них ВИЧ-инфекция, и не факт что они понимают всю серьезность ситуации. Или бывает так – человек начинает принимать АРВ-терапию, (терапия, которая замедляет развитие вируса и заболевания – прим.авт.), а она часто имеет очень негативные побочные действия вплоть до галлюцинаций, и чтобы организм адаптировался, нужна, как минимум, калорийная пища, которую не каждый себе может позволить, и люди просто бросают принимать лекарства.

Потому что они думают так: «я чувствовал себя хорошо, теперь мне плохо, значит, мне лучше не пить эти лекарства». Да, после того, как человек узнает о своём диагнозе, его ставят на учет в «Республиканском центре по профилактике и борьбе со СПИД», он подписывает расписку о том, что предупрежден об уголовной ответственности, но кто даст гарантию, что он понимает всю серьезность того, что подписывает?

Кстати, в случае если человек с положительным статусом ВИЧ предупреждает своего полового партнера о наличии инфекции, и последний соглашается вступить с ним в контакт, то уголовной ответственности не наступает. Однако, потом в суде доказать это невозможно. Потому что партнеры не дают свое согласие письменно.

– Такие случаи встречались на практике?

– Иногда партнеры в курсе, но они отказываются от того, что их предупреждали об этом во время суда. По сути, под статью 125 часть 1 УК Таджикистана могут попасть и все дискордантные пары (в которых один партнер с положительным статусом ВИЧ, другой – с отрицательным – прим.авт.). В этой части прописано: «Заведомое  подставление  другого лица в опасность заражения ВИЧ‐инфекцией», то есть это не фактическое заражение, а риск заражения. И все люди с положительным ВИЧ статусом, у которых есть половой партнер, по сути, ставят его под угрозу риска заражения. Но по факту это не так: если человек принимает АРВ-терапию, его вирусная нагрузка снижена, и даже в случае незащищенного секса, его партнер не заразится ВИЧ.

Многие громкие уголовные дела в Таджикистане за последнее время были возбуждены именно по первой части статьи 125 УК. Это очень важно понимать.

– То есть никто из пострадавших не заразился ВИЧ-инфекцией?

– Последние приговоры по этой статье были вынесены в Худжанде, двух женщин приговорили к одному году тюремного срока – это статья 125, часть 1 – наказывается ограничением свободы на срок до трех лет либо лишением свободы на срок до двух лет. Тогда как вторая часть этой статьи «Заражение другого лица ВИЧ‐инфекцией» – наказывается лишением свободы на срок от  двух до пяти лет.

– Сколько женщин с положительным статусом ВИЧ являются работницами коммерческого секса?

– По статистике только семь процентов женщин работают в сфере коммерческого секса, все остальные женщины – это обычные домохозяйки, чаще – жёны мигрантов, которые заразились от своих мужей или получили ВИЧ во время различных медицинских манипуляций. Но почему-то всем до сих пор кажется, что женщина с положительным статусом ВИЧ – это обязательно работница коммерческого секса. И это приводит к тому, что люди боятся приходить в центры СПИД за помощью.

Люди с положительным статусом ВИЧ не могут сохранить конфиденциальность

– Как вы думаете, почему именно в последнее время увеличилось количество дел по 125 статье УК?

– Когда в сентябре прошлого года глава государства посетил таджикский медуниверситет и поднял там проблемы инфекционных заболеваний, в том числе и проблемы ВИЧ-инфекции, которые являются актуальными для современного мира, мы были очень благодарны, так как верили, что теперь на них будут обращать еще большее внимание. Однако все получилось несколько по-другому. Раньше вопросами ВИЧ-инфекции занимались «Республиканский центр по профилактике и борьбе со СПИД», профильные НПО, а также другие компетентные и информированные структуры, теперь в этом вопросе принимают участие и многие другие специалисты, которые, к сожалению, не всегда понимают, что такое ВИЧ-инфекция.

Кроме того, после введения обязательного тестирования молодых пар перед заключением брака, людям с положительным статусом ВИЧ стало намного сложнее сохранить свою конфиденциальность.

Вот как это происходит: при тестировании выясняется, что у человека положительный статус ВИЧ, об этом узнает орган при поликлинике по месту жительства, который выдает разрешение на брак, затем о его статусе узнает ЗАГС, который будет регистрировать брак. В регионах страны, где функции ЗАГСа выполняют отделы при джамотах, узнают и джамоаты. Учитывая то, что в Таджикистане за молодых все решают родители, чаще всего, о положительном статусе ВИЧ узнает и вся родня жениха или невесты. Тогда как конфиденциальность человеку с положительным статусом ВИЧ гарантируется Законом,  он должен сказать о статусе только своему половому партнеру.

Закон не запрещает ВИЧ положительным людям иметь семью. Но, когда ЗАГС получает информацию о том, что у человека положительный статус ВИЧ, что он должен делать? Никто не имеет права запретить вступить в брак человеку с ВИЧ, и никто не имеет права раскрывать информацию о наличии инфекции, тогда зачем это тестирование? В общем, механизмы исполнения законов не продуманы.  

К счастью, в конце января этого года министерство здравоохранения и социальной защиты населения Таджикистана совместно с международными организациями согласно рекомендации ВОЗ приняли методические рекомендации по внедрению доконтактной профилактики ВИЧ-инфекции, в котором прописаны все механизмы действия. Надеюсь, теперь что-то изменится.  

«Уже известно о третьем случае излечения от ВИЧ»

– Как информация о делах, связанных с осознанным заражением ВИЧ, отражается на людях, у которых положительный статус?

– Это очень негативно влияет на жизнь людей, потому что они видят весь этот негатив, и могут просто отказаться от АРВ-терапии, чтобы лишний раз не ходить в центры СПИД. Или люди, которые сомневаются в своем здоровье, они просто могут не пойти сдавать тест и потеряют драгоценное время. Медицина сейчас настолько продвинулась, что человек, который правильно и во время принимает АВР-терапию, становится безопасным даже для своего полового партнера, для своего будущего ребёнка. ВИЧ-инфекция уже давно не смертельное заболевание, а хроническое, которое регулируется с помощью терапии; буквально на днях стало известно о третьем случае излечения от ВИЧ.

 

У нас в Таджикистане нет проблем с получением АРВ-терапии, все медикаменты предоставляются бесплатно, люди могут их принимать и жить точно так же, как и все остальные. Если посмотреть на мировой опыт, то благодаря развитой медицине, ограничения для людей с положительным статусом ВИЧ снимаются, а у нас их наоборот станвоитяс больше.

– В Дании семь лет назад отменили наказание для человека с ВИЧ за незащищенный секс с ВИЧ-отрицательным человеком, потому что при приеме терапии, продолжительность жизни человека с положительным статусом ВИЧ не отличается от того, у кого он отрицательный.

– В октябре 2018 года комитет СИДО (CEDAW), который курирует исполнение конвенции о ликвидации всех форм дискриминации в отношении женщин (Таджикистан является подписантом конвенции – прим.авт.) представил альтернативный отчет, в котором тема женщин с положительным статусом ВИЧ серьезно обсуждалась. В отчете была высказана рекомендация об отмене части 1 статьи 125 УК Таджикистана.

Кроме того, была высказана рекомендация отменить постановление правительства от 2004 года, в соответствии с которым люди с положительным статусом ВИЧ не могут быть опекунами и приёмными родителями ребенка. Также были высказаны замечания относительно постановления от 2018 года, в котором указано, что люди с положительным статусом ВИЧ не могут учиться в медицинских вузах. Комитет рекомендует правительству устранить эти ограничения в течение пяти лет.

 

Kazakhstan: Women living with HIV submit report to CEDAW, recommending repeal of HIV criminalisation provision in Kazakhstan penal code

Source: EWNA, published on March 11, 2019

For the first time, HIV+ women in Kazakhstan submitted a shadow report to CEDAW 

Today in Geneva, at the pre-sessional working group of the 74th meeting of the UN Committee on the Elimination of All Forms of Discrimination against Women (CEDAW) , representatives of the community of women living with HIV, women who use drugs and sex workers from Kazakhstan presented for the first time a shadow report from civil society on rights situations for women from key groups.

In July 2018, civil society organizations submitted the Shadow Civil Society Report on Discrimination and Violence against Women Living with HIV, Women Using Drugs, Sex Workers and Women from Prisons, to the UN Committee on the Elimination of All Forms of Discrimination against women. The report is based on studies of cases of violation of rights registered by non-governmental organizations in 2015-2017. The full report is available on the EZSS website, in Russian and English .

Here is the text of the oral statement presented by Lyubov Vorontsova, Kazakhstan Union of People Living with HIV (english text below):

“Thank you, Madam Chair.

I am a woman living with HIV from Kazakhstan and I represent the voices of women from my community.

We consider it extremely important to solve the problems of institutionalized discrimination that violates the rights of women and impedes access to health and social services, as well as contribute to social and economic vulnerability.

Women living with HIV have limited access to residential services in existing crisis centers designed to help women affected by violence. In the capital of Kazakhstan, a young girl with a child who was abused by her husband in winter is refused to be placed in an orphanage, since there is such a law and she has HIV. Article 118 of the Criminal Code of Kazakhstan provides for criminal penalties for putting people at risk of HIV infection, which has the opposite effect – this contributes to a higher risk of HIV infection, violence and gender inequality in the family, in the health care system, in society.

According to a study of the Stigma Index, 24.2% of women living with HIV, medical workers forced to terminate a pregnancy (abortion), 34% of women living with HIV never received advice on reproductive opportunities.

We recommend:

  • Revise Article 118. “Infection with Human Immunodeficiency Virus (HIV / AIDS)” of the Criminal Code of the Republic of Kazakhstan dated July 3, 2014 No. 226-V SA-RC to abolish the provision criminalizing the risk of acquiring HIV
  • To set up offices in crisis centers to work with drug addicts and HIV-positive women. Mobilize state efforts to expand the network of crisis centers and other emergency services for women who have experienced domestic violence, and to ensure adequate public funding for these institutions.
  • Introduce changes to the Order of the Minister of Health and Social Development of the Republic of Kazakhstan dated December 21, 2016 No. 1079 “On approval of the standard for providing special social services to victims of domestic violence”, limiting the possibility of women living with HIV in crisis centers.

Women who use drugs report the extreme prevalence of police brutality. Due to stigmatization, pregnant drug-addicted women cannot take advantage of necessary medical services, including drug treatment, antenatal care and post-natal care. Opioid substitution therapy is not available for women when they are hospitalized in any medical institution (including maternity hospitals, tuberculosis dispensaries, etc.).Immediately after childbirth, women are forced to travel independently to the substitution therapy program in order to receive drug support with methadone.

The rights of sex workers by medical personnel are violated, in particular, the humiliation of dignity, the infliction of physical and psychological violence, and the disclosure of HIV-positive status to third parties. For this reason, sex workers refuse timely diagnosis in medical institutions.

We recommend:

  • Develop and adopt a humanization policy for women who use drugs, laws and practices based on respect for human rights, which will protect and eliminate any discrimination and violence against women.
  • Include in the complex of preventive programs to combat HIV and AIDS at the local and national levels, training for police officers to reduce stigma and discrimination against women from vulnerable groups.
  • Actively investigate incidents of violence and any unlawful acts committed by law enforcement officers against sex workers, women who use drugs, and reported by public organizations.
  • Develop mechanisms for ensuring personal security and confidentiality that will allow women to report incidents of violence without fear for their safety.
  • Provide government funding for the provision of free family planning services, in particular contraception for marginalized and vulnerable women.
  • Provide training for medical personnel in providing quality sexual and reproductive health services for women living with HIV, sex workers and women who use drugs.
  • Include a substitution therapy program in the national health care system and drug practice, with further expansion and scaling in Kazakhstan, as well as develop mechanisms for access to treatment of opioid substitution therapy in hospitals (tub dispensary, maternity hospitals and others)

In Kazakhstan, there are no studies and disaggregated data in open sources regarding women prisoners. In the fifth periodic report, the state provides data on legislation that provides access to medical services for female prisoners. But this does not answer the question of whether it meets the needs of female prisoners.

We recommend:

  • Conduct research on the degree of satisfaction with women’s sexual and reproductive health services in places of detention, including data on women living with HIV and drug addicts, characterizing their access to antiretroviral treatment and drug treatment, including opioid substitution therapy. ”

ВПЕРВЫЕ ВИЧ+ ЖЕНЩИНЫ КАЗАХСТАНА ПРЕДСТАВИЛИ ТЕНЕВОЙ ОТЧЕТ В КЛДЖ

Сегодня в Женеве, на предсессионной рабочей группе 74 заседания Комитета ООН по ликвидации всех форм дискриминации в отношении женщин (CEDAW), представительницы сообщества женщин, живущих с ВИЧ, женщин употребляющих наркотики и секс-работниц из Казахстана, впервые представили теневой отчёт от гражданского общества о ситуации с нарушением прав в отношении женщин из ключевых групп.

В июле 2018 г. организациями гражданского общества был подан «Теневой отчет гражданского сообщества о дискриминации и насилии в отношении женщин, живущих с ВИЧ, женщин, употребляющих наркотики, секс — работниц и женщин из мест лишения свободы» в Комитет ООН по ликвидации всех форм дискриминации в отношении женщин. Отчет основан на исследованиях, случаях нарушения прав, зарегистрированных неправительственными организациями в 2015-2017 гг. С полным отчетом можно ознакомиться на сайте ЕЖСС, на русскоми английском языках.

Приводим текст устного заявления, которое представила Любовь Воронцова, Казахстанский Союз Людей, Живущих с ВИЧ (english text below):

«Спасибо, госпожа Председатель.

Я женщина, живущая с ВИЧ из Казахстана, и представляю голоса женщин из своего сообщества.

Мы считаем крайне важным решить проблемы институционализированной дискриминации, которая нарушает права женщин и препятствует доступу к медицинским и социальным услугам, а также способствуют социальной и экономической уязвимости.

Женщины, живущие с ВИЧ, имеют ограниченный доступ к услугам проживания в существующих кризисных центрах, предназначенных для помощи женщинам, пострадавшим от насилия. В столице Казахстана молодая девушка с ребенком, которая зимой подверглась насилию со стороны мужа, получает отказ быть помещенным в приют, поскольку существует такой закон и у нее ВИЧ. Cтатья 118 Уголовного Кодекса Казахстана предусматривает уголовное наказание за постановку в риск заражения ВИЧ, что имеет обратный эффект — это способствует более высокому риску заражения ВИЧ, насилия и гендерного неравенства в семье, в системе здравоохранения, в обществе.

По результатам исследования Индекс Стигмы 24,2% женщин, живущих с ВИЧ, медицинские работники принуждали к прерыванию беременности (аборту), 34% женщин, живущих с ВИЧ, никогда не получали консультацию по репродуктивным возможностям.

Мы рекомендуем:

  • Пересмотреть Статью 118. «Заражение вирусом иммунодефицита человека (ВИЧ/СПИД)» Уголовного кодекса РК от 3 июля 2014 года № 226-V ЗРК, чтобы отменить норму, устанавливающую уголовную ответственность за риск заражения ВИЧ.
  • Создать отделения в кризисных центрах для работы с наркозависимыми и ВИЧ-положительными женщинами. Мобилизовать усилия государства по расширению сети кризисных центров и других служб экстренной помощи женщинам, пережившим домашнее насилие, гарантировать адекватное государственное финансирование для этих учреждений.
  • Внести изменения в Приказ Министра здравоохранения и социального развития Республики Казахстан от 21 декабря 2016 года № 1079 «Об утверждении стандарта оказания специальных социальных услуг жертвам бытового насилия», ограничивающий возможность пребывания в кризисных центрах женщин, живущих с ВИЧ.

Женщины, употребляющие наркотики, сообщают о крайней распространенности жестокости полиции. Из-за стигматизации беременные наркозависимые женщины не могут воспользоваться необходимыми медицинскими услугами, в том числе наркологической, дородовой и послеродовой помощью. Опиоидная заместительная терапия не доступна для женщин при госпитализации в любые медицинские учреждения (включая родильные дома, противотуберкулезные диспансеры и т.д.). Сразу после родов женщины вынуждены самостоятельно добираться до программы заместительной терапии, чтобы получить лекарственную поддержку метадоном.

Нарушаются права секс-работниц со стороны медицинского персонала, в частности, унижение достоинства, причинение физического и психологического насилия, раскрытие ВИЧ-положительного статуса третьим лицам. По этой причине секс-работницы отказываются от своевременной диагностики в медицинских учреждениях

Мы рекомендуем:

  • Разработать и принять политику гуманизации в отношении женщин, употребляющих наркотики, законов и практик, основанных на уважении прав человека, которые обеспечат защиту и исключают любую дискриминацию и насилие в отношении женщин.
  • Включить в комплекс профилактических программ по противодействию ВИЧ и СПИД на местном и национальном уровнях обучающие мероприятия для полицейских о снижении стигмы и дискриминации по отношению к женщинам из уязвимых групп.
  • Активно расследовать случаи насилия и любых незаконных действий, совершенных сотрудниками правоохранительных органов против секс-работниц, женщин, употребляющих наркотики, зарегистрированных и сообщенных общественными организациями.
  • Разработать механизмы обеспечения личной безопасности и конфиденциальности, которые позволят женщинам сообщать о случаях насилия без страха за свою безопасность.
  • Обеспечить государственное финансирование на предоставление бесплатных услуг по планированию семьи, в частности контрацепции для маргинализированных и уязвимых женщин.
  • Обеспечить подготовку медицинского персонала по предоставлению качественных услуг по сексуальному и репродуктивному здоровью для женщин, живущих с ВИЧ, секс-работниц и женщин, употребляющих наркотики.
  • Включить программу заместительной терапии в национальную систему здравоохранения и наркологическую практику, с дальнейшим расширением и масштабированием в Казахстане, а так же разработать механизмы для доступа к лечению опиоидной заместительной терапии в условиях стационаров (тубдиспансер, родильные дома и другие)

В Казахстане отсутствуют исследования и дезагрегированные данные в открытых источниках в отношении женщин-заключенных. В пятом периодическом докладе государство приводит данные о законодательных актах, которые обеспечивают доступ к медицинским услугам для женщин-заключенных. Но, это не отвечает на вопрос о том, удовлетворяет ли это потребности женщин-заключенных.

Мы рекомендуем:

  • Провести исследования о степени удовлетворения услугами по сохранению сексуального и репродуктивного здоровья женщин в местах лишения свободы, включая данные о женщинах, живущих с ВИЧ и наркозависимых, характеризирующие их доступ к антиретровирусному лечению и наркологической помощи, включая опиоидную заместительную терапию.»

Mexico: Local congressman calls for the repeal of legislation criminalising people with HIV in Mexico City Federal District

Published in 20 minutos on March 12, 2019 (Google translation, for article in Spanish, please scroll down)

Local deputy calls for repeal of criminalization of HIV patients

Local Congressman Temístocles Villanueva Ramos considered that the authorities of Mexico City are obliged to provide adequate information, education and support, to guarantee access to means of prevention and treatment, as well as to eradicate the criminalization of those suffering from HIV and other sexually transmitted infections. 

Presenting an initiative that reforms Article 76 and repeals Article 159 of the Criminal Code of the Federal District, the legislator for Morena indicated that criminalizing diseases such as the Human Immunodeficiency Virus (HIV) hinders the duty of the authorities to guarantee public health while respecting human rights.

“The criminalization of HIV generates more harm than benefits in public health and human rights, so this initiative aims to repeal the article and reform the other to eliminate sentencing and the type of transmission risks” said the legislator.

He explained that currently Article 159 of the Criminal Code treats sexually transmitted infections differently from any other diseases since it specifically penalizes the health condition of the active subject, which causes a discriminatory distinction between people who live with a disease acquired by sexual infection and those who have some other disease acquired by other means,

“The penalty for exposure to infection is based on the risk of harm, not on the harm itself, which overstates the responsibilities of people with HIV, limiting their adequate access to justice,” he lamented.

Villanueva Ramos said that in Mexico, as well as in other countries around the world, people with HIV are subject to criminal law when they expose other people to the virus. However, according to UNAIDS, there is no evidence that these measures generate justice or prevent the transmission of the virus. 

 

“If penalties for people with HIV and sexually transmitted infections (STIs) are eradicated, discrimination is reduced and cultural barriers to timely detection and prevention are eliminated,” he said. 

 

Villanueva Ramos warned that the main problem with the classification of “exposure to infection”, both in the Federal Criminal Code and in local codes, is the ambiguity of the definition of incriminating behaviours, so that the jurisdictional authority is the one who decides in most cases which diseases are considered serious or which behaviours are punishable.

 

This type of measures that end up violating the human rights of people with HIV without contributing to the eradication of the epidemic can also be observed in other countries,” he said.

Pide diputado local pide derogar criminalización de enfermos de VIH

El diputado local Temístocles Villanueva Ramos consideró que las autoridades de la Ciudad de México están obligadas a suministrar información, educación y apoyo adecuados, así como garantizar el acceso a los medios de prevención y tratamientos, así como erradicar la criminalización de quienes padecen VIH y otras infecciones de transmisión sexual.

Al presentar una iniciativa que reforma el Artículo 76 y se deroga el Artículo 159 del Código Penal del Distrito Federal, el legislador por Morena indicó que criminalizar las enfermedades como el Virus de la Inmunodeficiencia Humana (VIH) obstaculiza el deber de las autoridades para garantizar la salud pública respetando los derechos humanos.

“La criminalización del VIH genera más daños que beneficios en la salud pública y los derechos humanos, por lo que la presente iniciativa tiene como objeto derogar el artículo y reformar el que le hace referencia para eliminar la pena y el tipo de Peligro de Contagio”, dijo el legislador capitalino.

Explicó que actualmente el Artículo 159 del Código Penal da un trato distinto a las infecciones de transmisión sexual respecto a cualquier otra enfermedad, ya que se penaliza específicamente la condición de salud del sujeto activo, lo que provoca una distinción discriminatoria entre las personas que viven con una enfermedad adquirida por contagio sexual y quienes tienen alguna otra enfermedad adquirida por otros medios.

“La pena por Peligro de Contagio se basa en el riesgo de daño, no en el daño mismo, lo cual sobredimensiona las responsabilidades de las personas con VIH, limitando su acceso adecuado a la justicia”, lamentó.

Villanueva Ramos manifestó que en México, así como en otros países del mundo, a las personas con VIH se les aplica el derecho penal cuando exponen a otras personas, no obstante, de acuerdo con Onusida, no hay datos que comprueben que estas medidas generen justicia o que se prevenga la transmisión del virus.

“Si se erradican las penalizaciones a las personas con VIH e infecciones de transmisión sexual (ITS) se disminuye la discriminación y se eliminan las barreras culturales para la detección oportuna y la prevención”, aseguró.

Villanueva Ramos alertó que el principal problema de la tipificación de “Peligro de Contagio”, tanto en el Código Penal Federal como en los códigos locales es la ambigüedad de la definición de las conductas incriminatorias, por lo que la autoridad jurisdiccional es quien decide en la mayoría de las ocasiones qué enfermedades se consideran graves o qué conductas son las punibles.

“Este tipo de medidas que terminan violentando los derechos humanos de las personas con VIH sin aportar a la erradicación de la epidemia también se pueden observar en otros países”, refirió.

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: Five laws categorised as “bad” laws by the Human Rights Campaign in Missouri , including HIV/AIDS criminalisation laws

Missouri ranked in lowest category for LGBTQ protections, nondiscrimination

The Human Rights Campaign recently released their fifth annual State Equality Index — a state-by-state report detailing statewide laws and policies that affect LGBTQ people, assessing how well states are doing to protect LGBTQ individuals from discrimination.

This year, Missouri received the lowest rating, “High Priority to Achieve Basic Equality.” This rating is given to states that focus on raising suport for basic LGBTQ equality laws, such as non-discrimination laws, and for states focusing on municipal protections for LGBTQ people including opposing negative legislation.

Twenty-eight states earned this rating. Seventeen states earned the highest rating, “Working Toward Innovative Equality,” while the remaining five earned “Solidifying Equality” or “Building Equality.”

Karis Agnew, field director for PROMO, Missouri’s statewide LGBTQ advocacy organization, explained that they expected this rating for Missouri.

“It does not surprise me because there are basic protections that LGBTQ people lack in Missouri and those include protection of employment, housing and public accommodations,” Agnew said.

Missouri has a total of six laws that benefit LGBTQ people — hate crime laws, a college and universities non-discrimination law, a sexual orientation non-discrimination policy for state employees, an anti-bullying law specifically for cyberbullying, transgender inclusion in sports, and name and gender updates on identification documents for drivers licenses.

Missouri has five laws that the HRC categorizes as “bad” laws including HIV/AIDS criminalization laws, a state Religious Freedom Restoration Act, and transgender exclusions in state Medicaid coverage.

Missouri lacks all parenting laws such as parental presumption for same-sex couples, second parent adoption, and foster care non-discrimination. Missouri also lacks basic non-discrimination laws for employment, housing, public accommodation, education, adoption, foster care, insurance, credit, and jury selection.

The absence of youth laws in Missouri include anti-bullying laws, protection from conversion therapy, and laws to address LGBTQ youth homelessness. In the health and safety category, Missouri lacks laws including LGBTQ nondiscrimantion protections in Affordable Care Act exchanges, transgender healthcare coverage, and name and gender updates on identification documents for birth certificates.

Alex Padilla, co-president of Spectrum, an LGBTQ group at Missouri State Univerity, explained his fear regarding how few laws Missouri has protecting LGBTQ individuals like himself.

“Whenever I first came out, I was working at a fast food job and I was worried that I could be fired for who I was,” Padilla said.

He explained that he did a quick search online and found that there were no laws protecting him from being harassed or fired because of who he was.

Agnew, who prefers using gender-neutral pronouns, explained that although this rating is low, organizations like PROMO are working hard behind the scenes to make sure Missouri’s laws are progressing.

“When it comes to passing laws that are pro-equality, the thing that we really need the most to be able to do that is make sure that we don’t have bills that are anti-LGBTQ,” Agnew said.

Agnew explained that in 2018 five anti-LGBTQ laws were filed but PROMO worked to ensure zero made it to the governor’s desk to be signed.

“When those are filed, that is our priority, so it is really hard for us to file proactive legislation and pass proactive legislation when we have legislation that is harmful to LGBTQ people that we work so hard to prevent from passing,” Agnew said.

Agnew said a big reason why Missouri is far behind other states in passing pro-LGBTQ legislation is that Missouri legislators are not aware of what it is like to live as an LGBTQ individual.

“I think a lot of our legislators in Missouri honestly don’t know what it’s like to be LGBTQ — the majority of our legislators are not LGBTQ themselves,” Agnew said. “And because of that, I think a lot of them have a lot to learn from their constituents that are.”

Agnew said this year is the 21st year that PROMO has worked to file the Missouri Nondiscrimination Act, which would add protections for sexual orientation and gender identity in places of employment, housing and public accommodations.

“When their constituents aren’t bringing it up they assume it’s not important and not needed,” Agnew said. “The number one thing people can do is engage their elected officials and talk to them about why something like the Missouri Nondiscrimination Act is so important to them.”

Padilla explained how important it is for students to get involved.

“Help us lobby for equality, Padilla said. “Advocating for these things and showing that you are an ally is really helpful to all of Missouri and all of Missouri’s LGBTQ people.”

PROMO is hosting an “Equality Day,” a day of lobbying where people in the community come up to Jefferson City and talk to legislators about the Missouri Nondiscrimination Act on April 10.

Uganda: Mapping of the legal environment shows how the current criminal justice system discriminates against people living with HIV

Published in the Daily Monitor on Febraury 22, 2019

Report shows how laws discriminate against HIV positive people

KAMPALA- Various existing laws criminalise people living with HIV/ Aids, according to a new report released in Kampala on Thursday.

The report is titled: “Draft report on the assessment and mapping of the legal environment on provisions of HIV and TB services to let populations, persons living with HIV and tuberculosis”

“The existing legal framework is not favourable for some categories of the key, vulnerable and priority populations to freely access health services in Uganda. Specifically, the lifestyles sex workers, men who have sex with men, transgender persons and makes them most affected by the existing legal framework in Uganda,” read part of the report

It adds: “The laws criminalise sex work, same sex relationships and drug use. This results into violence, harassment, disappointment of sex workers and their legal recourse to address injustice against them.” “The other law, the HIV and Aids prevention and Control Act although not specifically targeting key vulnerable and priority populations, has implications for both the general affected by HIV in Uganda.”

The report indicates that the HIV and Aids Prevention and Control Act 2014 provides for voluntary HIV testing in Sub Section 9. However, the voluntarism is not considered if a person commits a sexual offense as part of the criminal proceedings and yet Section 8 provides for identity of a person tested with HIV not to be disclosed or released to any person except in accordance with the law and medical standards.

The report was carried out by civil society organisation Center for Health, Human Rights and Development (CEHURD) in conjunction with Aids and Rights Alliance for South Africa (ARASA).

The current criminal justice system is also discriminative as it hands down more deterrent jail terms to those suspects found to be living with HIV than their counterparts that are not.

Reacting to the aforementioned finding, a law professor at Makerere University, Prof. Ben Twinomugisha, explained that sometimes it’s prudent for the prosecution to take an HIV test of a suspect accused of committing a sexual offense for purposes of securing a conviction.

However, he was also quick to say that this compulsory HIV testing will lead to violation of their human rights and that this will drive those infected away instead of going to hospital to get medication.

“But a civil society organisation and I, have since petitioned court challenging Section 43 of the HIV Prevention and Control Act about criminalization of HIV,”  Prof. Twinomugisha said

“Why is it that a person suffering from Hepatitis B, which is more deadly than HIV are not subjected to a test when they commit a crime,” he wondered.

The study was carried out in three districts of Gulu, Mbarara and Tororo.

The study was mainly about the extent to which laws and policies protect and promote the rights of persons living with HIV/ Aids, let populations like sex workers, truck drivers and fishermen can access health care and services.

The HIV prevalence in Uganda stands at 6.2%. In 2016, approximately 1.4 million people were living with HIV and 28,000 Ugandans were estimated to have died of Aids-related illness.

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.

The PJP Update – February 2019

The February 2019 edition of the Positive Justice Project newsletter is available here.