Canada: Review undertaken as part of government’s examination of HIV nondisclosure laws confirms risk of sexual transmission when viral load is suppressed is virtually zero

Risk of sexual transmission of human immunodeficiency virus with antiretroviral therapy, suppressed viral load and condom use: a systematic review

Abstract

Background: The Public Health Agency of Canada reviewed sexual transmission of HIV between serodiscordant partners to support examination of the criminal justice system response to HIV nondisclosure by the Department of Justice of Canada. We sought to determine HIV transmission risk when an HIV-positive partner takes antiretroviral therapy, has a suppressed viral load or uses condoms.

Methods: We conducted an overview and systematic review update by searching MEDLINE and other databases (Jan. 1, 2007, to Mar. 13, 2017; and Nov. 1, 2012, to Apr. 27, 2017, respectively). We considered reviews and studies about absolute risk of sexual transmission of HIV between serodiscordant partners to be eligible for inclusion. We used A Measurement Tool to Assess Systematic Reviews (AMSTAR) for review quality, Quality in Prognosis Studies (QUIPS) instrument for study risk of bias and then the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence across studies. We calculated HIV incidence per 100 person-years with 95% confidence intervals (CIs). We assigned risk categories according to potential for and evidence of HIV transmission.

Results: We identified 12 reviews. We selected 1 review to estimate risk of HIV transmission for condom use without antiretroviral therapy (1.14 transmissions/100 person-years, 95% CI 0.56–2.04; low risk). We identified 11 studies with 23 transmissions over 10 511 person-years with antiretroviral therapy (0.22 transmissions/ 100 person-years, 95% CI 0.14–0.33; low risk). We found no transmissions with antiretroviral therapy and a viral load of less than 200 copies/mL across consecutive measurements 4 to 6 months apart (0.00 transmissions/100 person-years, 95% CI 0.00–0.28; negligible risk regardless of condom use).

For full study see: http://www.cmaj.ca/content/190/46/E1350

Australia: Community advocates call for decriminalisation of HIV and an implementation of U=U education campaign to remove stigma

Calls for review of Western Australia’s HIV Laws

Community advocates are calling for a review of Western Australian legislation relating to HIV, and criminalisation.

Grassroots organisation HIV Institute of WA have issued an open letter to Attorney General John Quigley, highlighting the relationship between HIV criminalisation and stigma faced by people living with HIV and the importance of the U=U (Undetectable = Untransmissible) campaign.

The letter, signed by spokesperson Neil Buckley, also notes the recent fake email sent to voters of Wentworth, suggesting candidate Dr Kerryn Phelps had withdrawn from the race after having been diagnosed with HIV. 

“The stigma in our own backyard needs addressing, implementing the U=U education campaign in the wider community would be a start to decriminalizing HIV and removing stigma which is a barrier to testing treatments.”

The group also raise concerns about the ambiguity in the phrasing of the current Western Australian Health Act. Currently the Act states that “a person who has a notifiable infection disease must take all reasonable precautions to ensure that others are not unknowingly placed at risk of contracting the disease.”

“What exactly constitutes reasonable practices is unclear and currently left up to the courts to decide,” the letter reads.

“Today, those with an undetectable viral load are believed to be un-infectious yet no court in Australia has ruled that this satisfies the reasonable precautions test. This ambiguity is concerning and can leave many unclear on whether they could face criminal charges.”

“While no criminal laws in Western Australia target HIV specifically, it can be prosecuted under assault-based offenses, which carry multi-year prison sentences.”

“While usually only applied to individuals that intentionally transmit HIV, it can be used against those that are only deemed negligent in their exposure.” the group highlight.

OIP Staff

Published in Out in Perth on November 12, 2018

US: PJP update – November 2018

The November 2018 edition of the Positive Justice Project newsletter is available here.

Update of global database on HIV specific travel and residence restrictions shows 49 countries restrict long-term stays and 13 have punitive laws

The Global Database on HIV-specific Travel & Residence Restrictions, a useful online tool regarding the cross-border mobility of people living with HIV/AIDS, was recently updated.

This is a joint collaboration between the International AIDS Society (IAS), the European AIDS Treatment Group (EATG), the German AIDS Federation (DAH) and Positive Council Switzerland.

Below you can find an update by the International AIDS Society, as it was shared with its members:

The global database was updated in July 2018 and shared at the 22nd International AIDS Conference, Amsterdam, The Netherlands.

The good news:

  • Taiwan and South Korea have abolished all existing restrictions
  • Singapore has eased its laws and is now allowing short-term stays
  • Canada is making it easier for people living with HIV to obtain a residence permit
  • No country has introduced new legislation or punitive laws affecting people living with HIV
  • New information from several countries indicates they are “free of restrictions” (Belarus, Bosnia Herzegovina, Germany, Hungary, Indonesia, Rwanda and Turkmenistan)

The bad news:

Entry bars, restrictions for short-term and long-term stays persist, and many countries continue to deport people living with HIV.

Countries with entry bars:

  • Brunei, Equatorial Guinea, Iran, Iraq, Jordan, Solomon Islands, United Arab Emirates, Yemen. Russia is listed because a factual entry bar applies to multiple entry visa

Countries deporting people living with HIV:

  • Bahrain, Brunei, China, Egypt, Equatorial Guinea, Iran, Iraq, Jordan, Kuwait, Lebanon, Malaysia, Oman, Russia, Saudi Arabia, Solomon Islands, United Arab Emirates, Yemen

Thirteen countries have punitive laws affecting stays below 90 days. Forty-nine countries restrict long-term stays of more than 90 days. Laws and practices are unclear in 24 countries, while 143 countries have no restrictions. An overview on all restriction categories is available here.

Published on EATG website on October 9,2018

US: New report by the Williams Institute shows clear disparities in enforcement of HIV criminalization laws in Florida

Study shows impact of HIV criminalization laws 

Los Angeles – Florida laws that criminalize people living with HIV directly affected 614 people from 1986 to 2017, according to a new report by the Williams Institute at the UCLA School of Law. Researchers found that women were disproportionately affected by HIV criminalization. White women were disproportionately arrested for HIV offenses in Florida, and black women were most likely to be convicted for HIV offenses related to sex work. HIV criminalization is a term used to describe laws that either criminalize otherwise legal conduct or increase the penalties for illegal conduct based upon a person’s HIV-positive status. More than two-thirds of US states and territories have enacted HIV criminal laws.

“Our study shows that certain communities, whether defined by gender, race/ethnicity, or sex-worker status, are bearing more of the weight of these laws,” said lead author Amira Hasenbush. “What’s more, these HIV criminal laws, which were originally intended to control the spread of HIV by prosecuting individuals who expose others, don’t require proof of transmission or even exposure in most cases. So the laws are not doing what they set out to do.”

Key findings: Individuals were arrested under HIV-related statutes in 47 out of the 67 counties in Florida. The highest prevalence of HIV in the state is found in Miami-Dade (24%) and Broward Counties (18%), but those counties represent only 4% and 3%, respectively, of the HIV-related arrests. On the other hand, Duval County is home to only 6% of the people living with HIV in Florida but 23% of all HIV-related arrests in the state. Over half (56%) of all individuals arrested under an HIV-related offense were women. More than four in ten people arrested under an HIV-related offense were black (43%) and white women were more likely to be arrested for an HIV-criminal offense than other groups. Black men were more likely to be convicted of an HIV-related offense than white men and white women. Convictions for HIV arrests were twice as likely when there was a concurrent sex work arrest than when the HIV offense occurred outside of the context of sex work. Read the report Williamsinstitute.law.ucla.edu/wp-content/uploads/HIV-Criminalization-Florida-Oct-2018.pdf

Published in Baltimore Outloud on October 13, 2018

The fight for justice in HIV must join the fight to decriminalise abortion to ease the burdens on the sexual and reproductive lives of women and girls

Criminalizing the right to health: The shared struggle of the HIV and safe abortion movements

Edwin Cameron, Anand Grover

This month, India’s Supreme Court struck down Section 377 – a colonial-era law that banned same-sex activity and led to the systemic discrimination and persecution of LGBTQ Indians. This was a huge victory for India and – as two lawyers who have spent decades fighting for the rights of LGBTQ individuals – a very personal one.

Yet, while we celebrate this incredible achievement, we must remember that criminalization remains a potent threat for the health and lives of many people around the world. And those that often bear the largest burden are people living with HIV and AIDS and women and girls seeking abortion services.

While accessing legal and safe abortion services may seem very different from preventing or treating HIV, profound linkages bind the two struggles. Both HIV and AIDS and unsafe abortion endanger life and health, with a disproportionate impact on people living in developing countries. Both impose vast burdens on the sexual and reproductive lives of women and girls and imperil their equal citizenship. And both have the harsh, often cruel and blunt methods of criminal law imposed upon them.

Around the world, governments have used such criminal laws to police sexuality and reproduction, including for same-sex activity, HIV non-disclosure and exposure, and abortion services. These laws are often cloaked in the guise of keeping people safe or evoke morality as a justification.

But, as lawyers and advocates, we know that punitive provisions are not only ineffective, but have damaging and deadly consequences. They cause acute pain, suffering and even death. The fight to lift legal barriers to care is core to the fight for just healthcare for all.

We have both been part of the struggle for justice and rationality in the HIV epidemic and, more recently, in advocating safe abortion care. We know from personal experience how criminal laws, prosecutions and punishments grossly hamper human rights, particularly the right to health. Unjust laws also propagate stigma and discrimination, which, in turn, further impedes access to healthcare services, blocks dissemination of accurate and pertinent health information, and makes it difficult, if not impossible, to seek medical services, facilities and medicines. This severely impairs the dignity of women and girls.

We also recognize what science and the right to health has long told us: criminalization of health services almost invariably hits marginalized, vulnerable communities hardest and has a disastrous impact on health outcomes worldwide.

All of us, men and women, should have the freedom to decide if and when to reproduce and the right to access safe, effective, affordable and appropriate health care services, facilities and commodities. But, speaking as two males, we recognize the lamentable and grievous fact that this right is of particular urgency and concern to women and girls. And that its denial is harshest – indeed, too often fatal – for women and girls.

Every single year, more than 22,800 women and girls die due to complications from unsafe abortion – a stark reminder of the life and death consequences of criminalizing health care. In 68 countries, people living with HIV face laws that criminalize non-disclosure, exposure or transmission, which not only have a negative impact on prevention, but can discourage HIV testing and disclosure. The dream of “an AIDS-free world” will remain a dream if people are afraid to get tested or speak about their status for fear of arrest.

HIV is the leading cause of death among women of reproductive age in developing regions. The second biggest killer is maternal death, of which unsafe abortion accounts for a disquieting share. It is vital that women and girls remain at the center of these battles and their voices and experiences lead these movements. But we all lose if men shy away from the vital importance, to all, of life-saving care for women and girls.

We know that progress is possible. Beyond the recent victory to overturn Section 377, we’ve also seen the repeal of HIV criminalization laws in countries as diverse as Ghana, Tajikistan and Switzerland. Earlier this year, the Irish people overwhelmingly voted to overturn a constitutional ban on abortion.

As we learned in our decades of HIV/AIDS activism, the more people who fight for a just cause, the more change we can achieve. The fight for justice and plain sense in HIV must join the fight to decriminalize abortion. HIV and safe abortion activists around the world have already begun to make the connections – in thought and action – to come together and raise their voices against unjust laws, coercion and stigma, and demand accountability from governments.

Unison in understanding the issues and in tackling them brings fresh power to the fight for reproductive justice. Too many lives depend on it for any of us to be indifferent.

Justice Edwin Cameron is a judge on the Constitutional Court in South Africa and author of the prize-winning memoir “Witness to AIDS”, about his own experience of living with HIV.

Anand Grover is a designated Senior Advocate practicing in the Supreme Court of India, and the Director of the HIV/AIDS Unit of Lawyer’s Collective. He represented Naz Foundation, one of the petitioners in the Section 377 case.

 Published on Reuters on October 10, 2018
 
 
 
 

Beyond Blame 2018 Meeting Report and Evaluation Now Available

Beyond Blame 2018: Challenging HIV Criminalisation was a one-day meeting for activists, advocates, judges, lawyers, scientists, healthcare professionals and researchers working to end HIV criminalisation. Held at the historic De Balie in Amsterdam, immediately preceding the 22nd International AIDS Conference (AIDS 2018), the meeting was convened by HIV JUSTICE WORLDWIDE and supported by a grant from the Robert Carr Fund for Civil Society Networks.

The Meeting Report and Evaluation, written by the meeting’s lead rapporteur, Sally Cameron, Senior Policy Analyst for the HIV Justice Network, is now available for download here.

Screen Shot 2018-10-03 at 10.56.59The meeting discussed progress on the global effort to combat the unjust use of the criminal law against people living with HIV, including practical opportunities for advocates working in different jurisdictions to share knowledge, collaborate, and energise the global fight against HIV criminalisation. The programme included keynote presentations, interactive panels, and more intimate workshops focusing on critical issues in the fight against HIV criminalisation around the world.

The more than 150 attendees at the meeting came from 30 countries covering most regions of the world including Africa, Asia and the Pacific, Eastern Europe and Central Asia, Latin and North America and Western Europe. Participation was extended to a global audience through livestreaming of the meeting on the HIV JUSTICE WORLDWIDE YouTube Channel, with interaction facilitated through the use of Twitter (using the hashtag #BeyondBlame2018) to ask questions of panellists and other speakers. See our Twitter Moments story here.

Following the meeting, participants were surveyed to gauge the event’s success. All participants rated Beyond Blame 2018 as good (6%), very good (37%), or excellent (57%), with 100% of participants saying that Beyond Blame 2018 had provided useful information and evidence they could use to advocate against HIV criminalisation. 

A video recording of the entire meeting is available on HIV JUSTICE WORLDWIDE’s YouTube Chanel.  

Key points

  • The experience of HIV criminalisation was a poor fit for individual’s actions and the consequences of those actions, particularly where actions included little or no possibility of transmission or where courts did not address scientific evidence
  • The consequences of prosecution for alleged HIV non-disclosure prior to sex are enormous and may include being ostracised, dealing with trauma and ongoing mental health issues, loss of social standing, financial instability, multiple barriers to participation in society, and sex offender registration
  • Survivors of the experience shared a sense of solidarity with others who had been through the system, and were determined to use their voices to create change so that others do not have to go through similar experiences
  • Becoming an advocate against HIV criminalisation is empowering and helps to make sense of individuals’ experiences
  • The movement against HIV criminalisation has grown significantly over the last decade but as the movement has grown, so has understanding of the breadth of the issue, with new cases and laws frequently uncovered in different parts of the world.
  • As well as stigma, there are multiple structural barriers in place enabling HIV criminalisation, including lags in getting modern science into courtrooms and incentives for police to bring cases for prosecution.
  • Community mobilisation is vital to successful advocacy. That work requires funding, education, and dialogue among those most affected to develop local agendas for change.
  • Criminalisation is complex and more work is required to build legal literacy of local communities.
  • Regional and global organisations play a vital role supporting local organisations to network and increase understanding and capacity for advocacy.
  • There have already been many advocacy successes, frequently the result of interagency collaboration and effective community mobilisation.
  • It is critical to frame advocacy against HIV criminalisation around justice, effective public health strategy and science rather than relying on science alone, as this more comprehensive framing is both more strategic and will help prevent injustices that may result from a reliance on science alone.
  • There have been lengthy delays between scientific and medical understanding of HIV being substantiated in large scale, authoritative trials, and that knowledge being accepted by courts.
  • Improving courts’ understanding that effective treatment radically reduces HIV transmission risk (galvanised in the grassroots ‘U=U’ movement) has the potential to dramatically decrease the number of prosecutions and convictions associated with HIV criminalisation and could lead to a modernisation of HIV-related laws.
  • Great care must be exercised when advocating a ‘U=U’ position at policy/law reform level, as doing so has the potential to deflect attention from issues of justice, particularly the need to repeal HIV-specific laws, stop the overly broad application of laws, and ensure that people who are not on treatment, cannot access viral load testing and/or who have a detectable viral load are not left behind.
  • Courts’ poor understanding of the effectiveness of modern antiretroviral therapies contributes to laws being inappropriately applied and people being convicted and sentenced to lengthy jail terms because of an exaggerated perception of ‘the harms’ caused by HIV.
  • HIV-related stigma remains a major impediment to the application of modern science into the courtroom, and a major issue undermining justice for people living with HIV throughout all legal systems.
  • HIV prevention, including individuals living with HIV accessing and remaining on treatment, is as much the responsibility of governments as individuals, and governments should ensure accessible, affordable and supportive health systems to enable everyone to access HIV prevention and treatment.
  • New education campaigns are required, bringing modern scientific understanding into community health education.
  • Continuing to work in silos is slowing our response to the HIV epidemic.
  • HIV criminalisation plays out in social contexts, with patriarchal social structures and gender discrimination intersecting with race, class, sexuality and other factors to exacerbate existing social inequalities.
  • Women’s efforts to seek protections from the criminal justice system are not always feminist; they often further the carceral state and promote criminalisation.
  • Interventions by some purporting to speak on behalf of women’s safety or HIV prevention efforts have delivered limited successes because social power, the structuring of laws and the ways laws are administered remain rooted in patriarchal power and structural violence.
  • Feminist approaches must recognise that women’s experiences differ according to a range of factors including race, class, types of work, immigration status, the experience of colonisation, and others.
  • For many women, HIV disclosure is not a safe option.
  • More work is needed to increase legal literacy and support for local women to develop and lead HIV criminalisation advocacy based on their local context.
  • When women affected by HIV have had the opportunity to consider the way that ‘protective’ HIV laws are likely to be applied, they have often concluded that those laws will be used against them and have taken action to advocate against the use of those laws.

At the end of the meeting, participants were asked to make some closing observations. These included:

  • Recognising that the event had allowed a variety of voices to be heard. In particular, autobiographical voices were the most authentic and most powerful: people speaking about their own experiences. This model which deferred to those communicating personal experiences, should be use when speaking to those in power.
  • Appreciating that there was enormous value in hearing concrete examples of how people are working to address HIV criminalisation, particularly when working intersectionally. It is important to capture these practical examples and make them available (noting practical examples will form the focus of the pending Advancing HIV Justice 3 report).
  • Understanding that U=U is based on a degree of privilege that is not shared by all people living with HIV. It is vital that accurate science informs HIV criminalisation as a means to reduce the number of people being prosecuted, however, people who are not on treatment are likely to become the new ‘scapegoats’. It is important that we take all opportunities to build bridges between U=U and anti-HIV criminalisation advocates, to create strong pathways to work together and support shared work.
  • Noting the importance of calling out racism and colonialism and their effects.
  • Observing that more effort is required to better understand and improve the role of police, health care providers and peer educators to limit HIV criminalisation.
  • Exploring innovative ways to advocate against HIV criminalisation, including community education work through the use of art, theatre, dance and other mechanisms.
  • Concluding that we must challenge ourselves going forward. That we must make the circle bigger. That next time we meet, we should challenge ourselves to bring someone who doesn’t agree with us. That we each find five people who aren’t on our side or don’t believe HIV criminalisation is a problem and we find ways and means (including funding) to bring them to the next Beyond Blame.

US: PJP Update – September 2018

The September 2018 edition of the Positive Justice Project newsletter is available here.

Eurasian Women's Network on AIDS launches awareness campaign to draw attention to HIV criminalisation in EECA region

Eurasian Women’s Network on AIDS is launching the “HIV Is Not a Crime” information campaign

By 

 

The Eurasian Women’s Network on AIDS is launching the “HIV Is Not a Crime” awareness campaign, which aims to draw attention to the situation with the criminalization of HIV transmission in the Eastern Europe and Central Asia region. Within the campaign, we expect to hold discussions with activists and human rights defenders who will enhance their professional level, moreover, we will take efforts to change public opinion on the topic of criminalization.

We will focus on the following issues:

– Why does the criminalization of HIV transmission not solve the problem of the HIV spread?

– Why criminalization violates human rights?

– How are criminalization and gender related?

– How a person who is charged with transmitting HIV can defend themselves?

– … And many more questions, that you can write to us in the comments and send by letters and messengers.

The campaign “HIV Is Not a Crime” is one of the components of the “Chase Virus, Not People” campaign of EECA region community networks, which reflects the criminalization of HIV as one of the key barriers to access to treatment and support, conducive to an increase in new HIV/AIDS cases and mortality, and also being a violation of human rights.

The information campaign “HIV Is Not a Crime” is held within the framework of the project “HIV Criminalization Scan”, supported by the Global Network of People Living with HIV (GNP+). The project was launched in 2017 and produced an analytical report on the situation with the criminalization of HIV transmission in 9 countries of the EECA region, published in January 2018, as a preliminary result. You can read the report and cases in the “Criminalization” section on page “Our projects” page of www.ewna.org website.

The campaign is supported by the East Europe and Central Asia Union of People Living with HIV (ECUO) and the Minusvirus.org online platform

 

US: Coalition of US organisations and networks issue Call to Action for HIV Criminal Law Reform grounded in racial justice

Call to Action for Racial Justice in HIV Criminal Law Reform

A coalition of racial justice, HIV, and criminal justice organizations and networks have come together to issue this Call to Action in support of an HIV criminal law reform movement that is grounded in racial justice and leaves no one behind.

The collaboratively drafted Consensus Statement on HIV “Treatment as Prevention” in Criminal Law Reform was launched in July 2017[1] in response to uncertainty about the most effective way to incorporate modern HIV treatment advances, reflected in the Undetectable=Untransmittable campaign, into efforts to reform HIV criminal laws.

Since then, the urgency of this question has only intensified: changes in North Carolina, Canada andSweden have all hinged on whether or not a person is virally undetectable. Many states continue to grapple with how or if U=U should be used as an essential element in advocacy for HIV criminal law reform. Some argue that eliminating criminal liability for those who can document regular health care engagement and consistently low viral load is an improvement that is better than no progress at all.

However, HIV justice in the criminal legal system cannot be achieved without racial justice. Particularly with the well-documented racism in the U.S. criminal legal system, justice demands interrogation of the harms inherent in relying on U=U as a vehicle for HIV criminal law reform.

Modern, consistent treatment and care has significantly improved the lives of people living with HIV, whose life expectancies are now similar to HIV-negative people. However, fewer than half of all PLHIV in the US have sustained viral suppression.[2] Any reform that uses viral detectability as a litmus test for criminal liability leaves a majority of PLHIV behind and creates a viral underclass of PLHIV whose increased risk of prosecution effectively gets a current-day seal of approval.

If we look at this general statistic more closely, disturbing patterns emerge. National data show unequivocally that there are significant racial disparities in treatment access and sustained viral suppression. The most recent comprehensive analysis showed that Black PLHIV had the lowest level of sustained viral suppression across the board — 40.8% as compared to 56.3% of whites and 50.1% of Hispanics.[3]

Racial and regional disparities are reflected in every study that examines the experiences and outcomes of Americans who pass through our criminal legal and healthcare systems. The South, which experiences the highest regional burden of HIV in the U.S., also has the greatest number of people who are uninsured. At the same time, nine of the ten states[4] with the highest rates of incarceration are also in the South. Across the country Black people are disproportionately targeted and harmed at every stage of the criminal legal system, from policing to incarceration and sentencing.[5]

Any HIV criminal law reform effort that relies on viral suppression will inevitably leave behind Black PLHIV who face the greatest harm from the intersecting injustices of the U.S. criminal legal system and inequitable treatment access. We must not only acknowledge these inequities in our efforts but also actively seek to challenge and dismantle them in our calls for change.

As the HIV criminal law reform movement continues to grow and more states mobilize for reform, we must hold ourselves accountable to our communities and to each other. In recent years, four states have passed measures amending their HIV criminal laws or health code,[6] and we know there are new legislative actions on the horizon — this past legislative session saw at least five HIV criminal law bills.

We issue this Call to Action with the understanding that state coalitions often face difficult decisions and options that may reduce harm or appear to reduce harm in the short-term, but can also have unintended negative consequences in the long-term, or for those who are most frequently targeted by law enforcement. Our hope is that advocates will continue to learn from one another and pursue the best possible outcomes in their states while maintaining a commitment to strategies for reform which advance racial, economic, and gender justice.

Take action:

  1. Endorse the Consensus Statement on HIV “Treatment as Prevention” in Criminal Law Reform.
  2. Share the Consensus Statement as a tool and resource to support conversations around treatment access, HIV criminal law reform, and racial justice.
  3. Educate on the personal empowerment and critical importance of U=U and other scientific advances in HIV as tools for reform rather than heart of reform.
  4. Advocate for an HIV criminal law reform strategy which is accountable to all of the communities it affects.

The following organizations join this Call to Action: 

The Black AIDS Institute

The Center for HIV Law and Policy

The Counter Narrative Project

Positive Women’s Network

Prevention Access Campaign/U=U

The SERO Project

NOTES:

[1] Original launching endorsers included the Center for HIV Law and Policy, Prevention Access Campaign/U=U, The Counter Narrative Project, Treatment Action Group, Women With a Vision, National Association of Criminal Defense Lawyers, National Center for Transgender Equality, The National LGBTQ Task Force, PFLAG, and Housing Works.

[2] This refers to PLHIV who have received a diagnosis.https://www.cdc.gov/mmwr/volumes/67/wr/mm6704a2.htm

[3] This CDC analysis included 38 reporting jurisdictions, accounting for a total of 651,811 PLHIV.  (2018)

[4] Florida, Georgia, Texas, Mississippi, Arkansas, Alabama, Louisiana, Missouri, Oklahoma. The other state is Arizona. https://www.usnews.com/news/best-states/slideshows/10-states-with-the-highest-incarceration-rates?slide=10 (2017)

[5] Georgia demonstrates the synergistic interaction of racial disparities across these different systems:

[6] IA, CO, CA, NC