More Advocacy Needed to Stop HIV Criminalisation

People living with HIV face increased criminalisation and prosecution based on their HIV status, finds a new report by the HIV Justice Network and the Global Network of People Living with HIV (GNP+).

HIV criminalisation is the application of the criminal law to people living with HIV based solely on their HIV status. This happens through HIV-specific criminal statutes, or by applying general criminal laws that allow for prosecution of unintentional HIV transmission, potential or perceived exposure to HIV without transmission, and/or non-disclosure of known HIV-positive status.

The use of criminal laws against people with HIV impacts entire communities. It perpetuates stigma, discrimination and feelings of fear, shame and anger towards people living with HIV.

“These laws and prosecutions do not only impact the people investigated, prosecuted, or incarcerated. These laws undermine core sexual rights and public health principles. Their existence and application exacerbate racial and gender inequalities and jeopardize critical HIV prevention and service delivery efforts” says Julian Hows of GNP+.

The report, Advancing HIV Justice 2: building momentum in global advocacy against HIV finds a total of 72 countries have adopted laws that specifically allow for HIV criminalisation. In these countries laws are either HIV-specific, or name HIV as one (or more) of the diseases covered by the law. Prosecutions for HIV non-disclosure, potential or perceived exposure and/or unintentional transmission have now been reported in 61 countries.

Of particular concern is the fact that 30 sub-Saharan African countries have now enacted overly broad and/or vague HIV specific statues enabling legal repercussions against people living with HIV. The report shows the highest number of prosecutions are being reported in Russia, the United States, Belarus and Canada.

The trend is in contrast with the latest science which shows that people with HIV who adhere to HIV treatment and have an undetectable viral load are not infectious. In addition this approach of the criminal law violates key legal and human rights principles.

HIV criminalisation does not exist in vacuum. It is often linked to punitive laws and policies that impact sexual and reproductive health and rights, especially those aimed at sex workers, current and former drug users (particularly people living with hepatitis C), transgender people and/or men who have sex with men and other sexual minorities.

Click here to read the new report and visit the HIV Justice Network for more information on how you can get involved in the movement to eliminate HIV – or modernise – HIV criminalisation laws.

New report shows HIV criminalisation is a growing, global concern but advocates are fighting back

A new report released today shows that HIV criminalisation is a growing, global phenomenon. However, advocates around the world are working hard to ensure that the criminal law’s approach to people living with HIV fits with up-to-date science, as well as key legal and human rights principles.

Click on this link to read or download Advancing HIV Justice 2: Building momentum in global advocacy against HIV criminalisation.

What do we mean by ‘HIV criminalisation’?

HIV criminalisation describes the unjust application of the criminal law to people living with HIV based solely on their HIV status – either via HIV-specific criminal statutes, or by applying general criminal laws that allow for prosecution of unintentional HIV transmission, potential or perceived exposure to HIV where HIV was not transmitted, and/or non-disclosure of known HIV-positive status.

Such unjust application of the criminal law in relation to HIV is (i) not guided by the best available scientific and medical evidence relating to HIV, (ii) fails to uphold the principles of legal and judicial fairness (including key criminal law principles of legality, foreseeability, intent, causality, proportionality and proof), and (iii) infringes upon the human rights of those involved in criminal law cases.

What is the impact of HIV criminalisation?

Understanding the potential negative impact of HIV criminalisation on public health is critical to making informed policy decisions.

The last few years have seen increasing interest among researchers in the area of HIV criminalisation and a push into new areas of enquiry to examine the impacts of the unjust application of criminal law.

The report summarises a body of research which shows that instead of delivering a public health benefit, HIV criminalisation is a poor public health strategy, exacerbating racial and gender inequalities and negatively impacting a number of key areas including: testing; disclosure; sexual behaviour; and healthcare practice.

How many countries around the world have HIV criminalisation laws?

Since our last report, we found an increase in the number of countries that specifically allow for HIV criminalisation: these could be stand-alone HIV-specific criminal laws, part of omnibus HIV laws, or criminal and/or public health laws that specifically mention HIV.

Some of this increase is due to laws enacted since 2013 in Botswana, Cote d’lvoire, Nigeria, Uganda and Veracruz state (Mexico), and some is due to improved reporting and research methodology.

Our analysis shows that a total of 72 countries have adopted laws that specifically allow for HIV criminalisation, either because the law is HIV-specific, or because it names HIV as one (or more) of the diseases covered by the law. This total increases to 101 jurisdictions when the HIV criminalisation laws in 30 of the states that make up the United States are counted individually.

AHJ2-Where HIV criminalisation laws exist (as of April 2016)_6

How many countries have prosecuted people living with HIV?

Prosecutions for HIV non-disclosure, potential or perceived exposure and/or unintentional transmission have now been reported in 61 countries. This total increases to 105 jurisdictions when individual US states and Australian states / territories are counted separately.

Of the 61 countries, 26 applied HIV criminalisation laws, 32 applied general criminal or public health laws, and three (Australia, Denmark and United States) applied both HIV criminalisation and general laws.

AHJ2-Where HIV criminalisation laws exist (as of April 2016)_7

Where have prosecutions recently taken place?

We found reports of at least 313 arrests, prosecutions and/or convictions in 28 countries during the report period, covering 1 April 2013 to 30 September 2015.

Of note, we are now able to include data on reported prosecutions in Belarus and Russia, which are likely to have been taking place at least since the enactment of a Belarusian public health law in 1993 and a Russian HIV criminalisation law in 1995.

The highest number of cases during this period were reported in:

• Russia (at least 115) • United States (at least 104) • Belarus (at least 20) • Canada (at least 17) • France (at least 7) • United Kingdom (at least 6) • Italy (at least 6) • Australia (at least 5) • Germany (at least 5).

AHJ2-Where HIV criminalisation laws exist (as of April 2016)_8

HIV criminalisation in sub-Sarahan Africa of increasing concern

Where there was no HIV criminalisation at the start of the 21st century, 30 sub-Saharan African countries have now enacted overly broad and/or vague HIV-specific criminal statutes.

Most of these statutes are part of omnibus HIV-specific laws that also include protective provisions, such as those relating to non-discrimination in employment, health and housing. However, they also include a number of problematic provisions such as compulsory HIV testing and involuntary partner notification, as well as HIV criminalisation.

During the period covered by this report four countries in sub-Saharan Africa passed new HIV criminalisation laws: Botswana, Cote d’lvoire, Nigeria and Uganda.

Very few countries in Africa are now unaffected by problematic HIV criminalisation laws. The rise of reported prosecutions in Africa during this period (in Botswana, South Africa, Uganda, and especially Zimbabwe), along with the continuing, growing number of HIV criminalisation laws on this continent, is especially alarming.

AHJ2-Where HIV criminalisation laws exist (as of April 2016)_9

Where has advocacy improved legal environments?

Important and promising developments in case law, law reform and policy have taken place in many jurisdictions, most of which came about as a direct result of advocacy.

During the report period, although an additional 13 jurisdictions in nine countries proposed new HIV criminalisation laws, seven of these were not passed, primarily due to swift and effective advocacy against them at an early stage. Advocacy in another ten jurisdictions in seven countries challenged, improved or repealed HIV criminalisation laws.

The legal environment relating to HIV criminalisation has improved in a small number of countries in sub-Saharan Africa, most notably in Kenya. On 18 March 2015, Kenya’s High Court ruled that its HIV criminalisation provision – Section 24 of the HIV Prevention and Control Act 2006 – was unconstitutional because it was vague, overbroad and lacking in legal certainty, particularly in respect to the term ‘sexual contact’.

The Court also found it contravened Article 31 of the Kenyan Constitution which guarantees the right to privacy because the law created an obligation for people with HIV to disclose their status to their ‘sexual contacts’, with no corresponding obligation for recipients of such sensitive medical information to keep it confidential.

AHJ2-Where HIV criminalisation laws exist (as of April 2016)_10

Using science as an advocacy tool

Increased knowledge about reduced infectiousness due to antiretroviral therapy has led to advocacy that resulted in a number of jurisdictions revising or revisiting their criminal laws or prosecutorial policies relating to HIV criminalisation, although progress has been frustratingly slow.

Following the ‘Swiss statement’, published in January 2008, a growing number of courts, government ministries and prosecutorial authorities have accepted antiretroviral therapy’s impact on reducing the risk of both HIV exposure and transmission.

However, scientific advances alone will neither ‘end AIDS’ nor end HIV criminalisation. Although the impact of antiretroviral therapy on infectiousness is an important advocacy tool, it must be remembered that many people with HIV do not have access to treatment (or are unable to achieve an undetectable viral load when on treatment) and that everyone has a right to choose not to know their status and/or start treatment and should not be stigmatised nor considered ‘second class citizens’ should they wish to delay diagnosis or antiretroviral therapy.

More work required

Despite the many incremental successes of the past few years, much more work is required to strengthen advocacy capacity. This is why a coalition of seven organisations launched HIV Justice Worldwide in April 2016.

We also need to be aware that HIV criminalisation does not exist in vacuum, and is often linked to punitive laws and policies that impact sexual and reproductive health and rights, especially those aimed at sex workers and/or men who have sex with men and other sexual minorities.

And, bearing in mind the stigma faced by those with, for example, hepatitis C and concerns over the sexual transmission of the Ebola and Zika viruses, as we move forward to eliminate – or modernise – HIV criminalisation laws, we must ensure that our work does not inadvertently lead to the further criminalisation of other communicable and/or sexually transmitted infections.

Click on this link to read or download Advancing HIV Justice 2: Building momentum in global advocacy against HIV criminalisation.

A note about the limitations of the data

The data and case analyses in this report covers a 30-month period, 1 April 2013 to 30 September 2015. This begins where the original Advancing HIV Justice report – which covered the 18-month period, 1 September 2011 to 31 March 2013 – left off. Our data should be seen as an illustration of what may be a more widespread, but generally undocumented, use of the criminal law against people with HIV.

Justice Edwin Cameron: ‘Why HIV criminalisation is bad policy and why I’m proud that advocacy against it is being led by people living with HIV’

[This is the foreword to Advancing HIV Justice 2: Buiding momentum in global advocacy against HIV criminalisation, which will be published by the HIV Justice Network and GNP+ tomorrow, Tuesday May 10th.]

Since the beginning of the HIV epidemic, 35 long years ago, policymakers and politicians have been tempted to punish those of us with, and at risk of, HIV. Sometimes propelled by public opinion, sometimes themselves noxiously propelling public opinion, they have tried to find in punitive approaches a quick solution to the problem of HIV. One way has been to use HIV criminalisation – criminal laws against people living with HIV who don’t declare they have HIV, or to make potential or perceived exposure, or transmission that occurs when it is not deliberate (without “malice aforethought”), criminal offences.

Most of these laws are appallingly broad. And many of the prosecutions under them have been wickedly unjust. Sometimes scientific evidence about how HIV is transmitted, and how low the risk of transmitting the virus is, is ignored. And critical criminal legal and human rights principles are disregarded. These are enshrined in the International Guidelines on HIV and Human Rights. They are further developed by the UNAIDS guidance note, Ending overly-broad criminalisation of HIV non-disclosure, exposure and transmission: Critical scientific, medical and legal considerations. Important considerations, as these documents show, include foreseeability, intent, causality, proportionality, defence and proof.

The last 20 years have seen a massive shift in the management of HIV which is now a medically manageable disease. I know this myself: 19 years ago, when I was dying of AIDS, my life was given back to me when I was able to start taking antiretroviral medications. But despite the progress in HIV prevention, treatment and care, HIV continues to be treated exceptionally for one over-riding reason: stigma.

The enactment and enforcement of HIV-specific criminal laws – or even the threat of their enforcement – fuels the fires of stigma. It reinforces the idea that HIV is shameful, that it is a disgraceful contamination. And by reinforcing stigma, HIV criminalisation makes it more difficult for those at risk of HIV to access testing and prevention. It also makes it more difficult for those living with the virus to talk openly about it, and to be tested, treated and supported.

For those accused, gossiped about and maligned in the media, investigated, prosecuted and convicted, these laws can have catastrophic consequences. These include enforced disclosures, miscarriages of justice, and ruined lives.

HIV criminalisation is bad, bad policy. There is simply no evidence that it works. Instead, it sends out misleading and stigmatising messages. It undermines the remarkable scientific advances and proven public health strategies that open the path to vanquishing AIDS by 2030.

In 2008, on the final day of the International AIDS Conference in Mexico City, I called for a sustained and vocal campaign against HIV criminalisation. Along with many other activists, I hoped that the conference would result in a major international pushback against misguided criminal laws and prosecutions.

The Advancing HIV Justice 2 report shows how far we have come. It documents how the movement against these laws and prosecutions – burgeoning just a decade ago – is gaining strength. It is achieving some heartening outcomes. Laws have been repealed, modernised or struck down across the globe – from Australia to the United States, Kenya to Switzerland.

For someone like me, who has been living with HIV for over 30 years, it is especially fitting to note that much of the necessary advocacy has been undertaken by civil society led by individuals and networks of people living with HIV.

Advancing HIV Justice 2 highlights many of these courageous and pragmatic ventures by civil society. Not only have they monitored the cruelty of criminal law enforcement, acting as watchdogs, they have also played a key role in securing good sense where it has prevailed in the epidemic. This publication provides hope that lawmakers intending to enact laws propelled by populism and irrational fears can be stopped. Our hope is that outdated laws and rulings can be dispensed with altogether.

Yet this report also reminds us of the complexity of our struggle. Our ultimate goal – to end HIV criminalisation using reason and science – seems clear. But the pathways to attaining that goal are not always straightforward. We must be steadfast. We must be pragmatic. Our response to those who unjustly criminalise us must be evidence-rich and policy-sound. And we can draw strength from history. Other battles appeared “unwinnable” and quixotic. Think of slavery, racism, homophobia, women’s rights. Yet in each case justice and rationality have gained the edge.

That, we hope and believe, will be so, too, with laws targeting people with HIV for prosecution.

Edwin Cameron, Constitutional Court of South Africa, May 2016.

PA: Report analyses laws used in HIV criminalisation cases in Pennsylvania and makes recommendations for improvement

AIDS Law Project of Pennsylvania, SERO Project, PWN-USA-Philadelphia. All Pain, No Gain: HIV Criminalization in Pennsylvania. AIDS Law Project of Pennsylvania, April 2016.

Download here: ALL PAIN NO GAIN: HIV CRIMINALIZATION IN PA

US/Canada: Elton John AIDS Foundation on why they support civil society organisations working to end HIV criminalisation

France: National Aids Council President, Patrick Yeni, on why HIV criminalisation remains a problem for France

A year ago, in April 2015, the French National AIDS and Viral Hepatitis Council (Conseil national du sida et des hépatites virales, known simply as ‘CNS’) following extensive research into the law, nature of complaints and prosecutions, and their impact, issued a report, opinion and recommendations.

An English language version of the report, opinion and subsequent recommendations is still being prepared.

Earlier this year, Professor Patrick Yeni (pictured), chair of the CNS, was interviewed by Jean-François Laforgerie on the French language HIV website, seronet.info. His interview is eye-opening and powerful.

It highlights that although they had only found 23 convictions up to the end of 2014, surveys of people living with HIV suggest that up to 2000 complaints may have been made since the start of the epidemic.

The survey shows that slightly more than one person living with HIV in ten claims to have been tempted to complain against the person that they believed to be the source of infection. According to the same source, 1.4% of people living with HIV surveyed reported having actually complained. Based on these figures, we estimate an order of magnitude from 1 500 to 2 000 complaints that could be filed in total since the beginning of the epidemic.

He also notes that the law currently only recognises condom use as a way to show lack of a guilty mind, and he and his colleagues are concerned that up-to-date science is not reflected in the law. He also highlights that in France disclosure of known HIV-positive status – and subsequent consent to ‘risky’ sex – is not actually a defence, although in practice only cases where no disclosure took place and where no condoms were used have reached the court.

It seems unthinkable that what is obvious in terms of public health today on the promotion of biomedical preventions is lagging behind legally.

Given the importance of this body of work, we have decided to publish the interview and a summary of the main CNS recommendations beneath it, despite no official English translation.

It is interesting that the people who complain and go to trial are not part of the so-called risk groups where prevalence is high. For example, there is virtually no migrants among the complainants. Moreover, today there is a much greater legalisation of intimacy, including sexual facts than existed in the past. Perhaps this plays on the fact that people complain more now than twenty years ago.

Below is the English translation of the seronet.info interview, further improved from Google translate’s version by Sylvie Beaumont. Version anglaise via Google translate. Le texte français est après la traduction.

Q: In 2006, the National AIDS and viral hepatitis Council (CNS) published their review of the criminalisation of HIV transmission. What led you to work again on this issue and publish, in 2015, a second opinion?

Patrick Yeni [PY]: The media coverage of some trials in France and, secondly, the situation internationally. In other countries, there was an active debate on the criminalisation of HIV transmission, while in France this reflection seemed stalled. These are the two reasons that led us to revisit this issue, trying to understand and think about how things had changed since our first review.

Q: In your 2015 recommendations, you noted that the attention paid to legal, ethical and health issues relating to criminalisation of HIV transmission was low, both on the part of public authorities and civil society actors. How do you explain that?

PY: We have no clear answer to that. This is also why we wanted to restart the debate. If one takes the point of view of government and we take stock of court cases – 23 convictions for HIV transmission since the beginning of the epidemic throughout France – one can imagine that for the state this is not a national major problem at the criminal level, at least quantitatively. I guess the debate on criminal justice focuses primarily on other issues. For HIV organisations, it is probably more complicated because legal proceedings – as we attempt to analyse them in the recommendations – somewhat undermined the historical foundations on which the fight against HIV is based. By that I mean solidarity between people living with HIV and the refusal to distinguish between “patients as victims” allegedly infected and others who simply became infected. I imagine that this problem could have induced some inertia in advancing the debate. One recommendation from the CNS is to urge organisations to resume this discussion today, because it is a lever to act on issues of stigma, discrimination … and HIV prevention in general.

Q: What is prosecuted today? And what is a crime under the law?

PY: Primarily the fact that a person who knows s/he is HIV-positive, transmits HIV to a partner while s/he has not taken preventive measures to prevent this, i.e used a condom. In almost all trials in France, this is what has been prosecuted. We have had discussions on other issues as lawyers who supported us explained that the scope of what could be prosecuted or what could be an offence is probably wider than what is actually applied today.

Q: What are you referring to?

PY: One must think on several levels. The first criterion is that they are people who know they are HIV-positive. But it’s more complicated. Thus, from a legal point of view, we cannot know that a person, while not knowing officially that they are HIV-positive would consider themselves to be negative while they are engaged in repeated risky sexual behaviour. Justice may consider that even if they did not know their status officially, their sexual behaviour should have pushed them to consider themselves as potentially HIV-positive, and therefore to do a test and take preventive measures. In this case, the absence of screening does not guarantee the absence of criminal risk. The second criterion is that there must be proof that the person has transmitted HIV. Our analysis of judgments shows that exposing someone to HIV transmission, even without actual transmission can also be penalised. There have been convictions in France for exposure to the risk of transmission. This has occurred in the case of additional convictions to convictions for actual transmission, but it exists.

Q: So you think we could one day have a conviction on the sole ground of the risk of exposure to HIV transmission?

PY: Yes. The legal elements are there. That is, according to our analysis, another possibility of expanding the criminal field. The third criterion is that the ‘victim’ is not aware of the HIV status of their partner. In criminal law, whether or not the victim is informed does not exempt the defendant from liability. One cannot argue that the partner was informed and has agreed not to protect themselves and therefore would not be responsible. The information is not enough.

Fourth criterion. In all cases today, sexual prevention is understood as the use of condoms. It is the condom which is retained as the manifestation of concerns relating to the risk of transmission. We do not know what will happen when there will be proceedings for transmission or exposure by people who do not use condoms, but are treated effectively. Some lawyers have told us that if there was transmission despite condom use, it would be a case of force majeure which is exculpatory of responsibility. We can not guarantee the same thing about treatment. In other words, even with a good track treatment, a viral load of less than 20 copies, one cannot guarantee that there is not occasionally a little HIV in semen … and therefore transmission is possible even if treatment is adhered to, and viral load is undetectable … other lawyers tell us that we are, in this case, in a random situation, which does not exempt the person with HIV from responsibility. We must think about this. It seems unthinkable that what is obvious in terms of public health today on the promotion of biomedical preventions is lagging behind legally. This is a warning that we mention in the recommendation. But unfortunately we fear that this debate will only take place when a case of transmission from someone on effective treatment will come to court.

Q: How do you explain that the role of treatment as prevention is recognised in Switzerland with all the legal consequences that this entails, and yet the same argument does not hold legally with us?

PY: We wanted to alert on this point precisely so the conclusions of judges, when they have to decide, are identical to the public health conclusions we know today. We must not get to this contradiction where a person who is effectively treated is found guilty because s/he would not use a condom. With these examples, we can see the narrow scope of what is actually prosecuted and that it is imperative to have a debate on the possible expansion of what is a crime.

Q: The argument is often made that further criminalisation would deter people from testing?

PY: The review analysed the consequences of the criminalisation of HIV transmission on testing. All the studies to which we had access, mainly foreign, do not indicate that criminal risk linked to knowing one’s status would lead to decreased use of testing.

Q: You note the paradox that legal proceedings have developed in a context of “normalisation” of the disease. In other words, cases flourished in the 2000s, after the most acute phase of the epidemic. How do you explain it?

PY: We had discussions about it. Some of us were reluctant to say that there was an increase in the number of cases. One thing is certain, we are on a low figure: 23 convictions. Especially if we compare the data of the ANRS-Vespa 2 survey. The survey shows that slightly more than one person living with HIV in ten claims to have been tempted to complain against the person that they believed to be the source of infection. According to the same source, 1.4% of people living with HIV surveyed reported having actually complained. Based on these figures, we estimate an order of magnitude from 1,500 to 2,000 complaints that could be filed in total since the beginning of the epidemic. We do not know why some complaints were accepted and others not, why some were eventually classified and others have prospered. We have, unfortunately, no way to evaluate it. We just know that few cases reach a conviction.

To respond more specifically, one must take into account the fact that there is a significant delay, sometimes ten years from the time a complaint is filed to the time when an appeal judgment is pronounced. It might be possible to say that today there is an increase in the number of procedures, but it is not certain. We must be careful about this point. If this is true, how can we explain it? One hypothesis is that in the early days of the epidemic, when many people died of AIDS, a complaint against a person who was likely to die did not make much sense. Today the situation is different. For people, this may appear more “logical” to do so. We advance this hypothesis, but we don’t have the figures to confirm it. One can also look at who is complaining. It is interesting that the people who complain and go to trial are not part of the so-called risk groups where prevalence is high. For example, there is virtually no migrants among the complainants. Moreover, today there is a much greater legalisation of intimacy, including sexual facts than existed in the past. Perhaps this plays on the fact that people complain more now than twenty years ago.

Q: What goals did you set by publishing this new advice?

PY: Firstly: to inform people living with HIV about the conditions under which their criminal responsibility may be engaged. Our thinking has focused on being able to contribute to a fair justice. How? By raising awareness of the investigators in this matter through the National Schools of Police and Gendarmerie. By working with judges and lawyers. It is not possible for judges to have the technical knowledge about different diseases, we admit. Similarly, we can not consider today that under the pretext that people no longer die of AIDS, HIV is commonplace. This is not possible even today because there is a context of social representations that make it a special disease. However, the situation is not the same today, in particular medical progress has taken place. It is very important that judges and lawyers are aware of this. We propose that the National School of Magistrates opens this debate in its initial training as well as in continuing education. We asked the school director to include a discussion on HIV in its knowledge training. A problem that does not concern judges, is that of upgrading one’s knowledge to contribute to a fair trial. One of our wishes is also to allow a reflection on the position of criminal justice. Prison sentences predominate in cases of HIV transmission and issues of rehabilitation and prevention of relapses are not taken into account, even though the court must ensure both aspects in its approach.

Q: Specifically what do you recommend?

PY: For the Department of Justice to develop a form of observatory monitoring of judgments, to document the characteristics of procedures. The tool does not exist and we had to carry out considerable work to realise our new advice and to find all cases that resulted in convictions. We must create an interdepartmental committee to work on the development and provision of information tools tailored to professional (police, lawyers, judges) and other persons concerned, so that the procedures take account of available scientific and medical data, and for doctors to be better informed about the criminal risk of HIV transmission. It’s lobbying work which we pursue, including with HIV organisations. They must reclaim this question on which they were at a standby. We must recognise that the right to resort to justice is a right for all citizens, that our struggle is not against criminal law, but rather to ensure a fair process and prevent risks of criminalisation.

Summary of the CNS’s 2015 recommendations on HIV criminalisation

No.	Objectives	Recommendations	Competent authorities and/or recommendation targets
1	Contribute to better information of judges	Promote initial and continuing education of magistrates and future magistrates on HIV related issues	French National School for the Judiciary (école nationale de la magistrature)
2	Bolster the quality of police investigations	Promote training actions of police officers and future officers on HIV related issues	Ministry of the Interior
3	Prevent reoffending, enable the integration and reintegration of convicted people and improve their support	Apply alternatives to custodial sentences	Ministry of Justice
4	Promote the prevention of the prosecution risk	Contribute to a better understanding of legal issues by the people and communities concerned	HIV/AIDS associations
		Support actions aiming to provide information on the legal rights and responsibilities of people living with HIV.	Ministry of HealthFrench National Institute for Health Prevention and Education (INPES)
		Promote actions to fight PLHIV stigmatisation and discrimination and prevention actions towards the general population	Ministry of Health, Regional Health Agencies (ARS), French National Institute for Health Prevention and Education (INPES)Other competent ministriesHIV/AIDS associations
5	Provide access to up-to-date and high-quality legal and scientific information	Implement a reporting tool to follow-up the rulings issued in France and to document the characteristics of the related proceedings	Ministry of Justice
5		Initiate the creation of a working group in charge of designing and provisioning of information tools suitable for professionals and people involved	Health/Justice Interministerial Committee

Article original

PÉNALISATION DE LA TRANSMISSION DU VIH : GARANTIR UNE PROCÉDURE ÉQUITABLE

Où en est-on aujourd’hui en France sur la pénalisation de la transmission de VIH ? Le professeur Patrick Yéni, président du Conseil national du sida (CNS) fait le point. Interview.

In 2006, le Conseil national du sida et des hépatites virales (CNS) avait publié un premier avis sur la pénalisation de la transmission du VIH. Qu’est-ce qui vous a conduit à travailler de nouveau sur ce sujet et à publier, en 2015, un second avis ?

Patrick Yeni : Il y a la médiatisation de certains procès en France et, d’autre part, le constat sur le plan international, dans d’autres pays concernés, qu’il y avait une réflexion active sur la pénalisation de la transmission de l’infection par le VIH alors qu’en France cette réflexion semblait marquer le pas. Ce sont ces deux raisons qui nous ont conduits à retravailler sur cette question, en essayant de comprendre et de réfléchir à la façon dont les choses avaient évolué, depuis notre premier avis.

Dans l’avis de 2015, vous jugez que l’attention apportée aux enjeux juridiques, éthiques et sanitaires de la pénalisation de la transmission est faible, tant de la part des pouvoirs publics que des acteurs associatifs. Comment l’expliquez-vous ?

Nous n’avons pas de réponse claire à cela. C’est aussi pour cela que nous avons voulu reprendre cette réflexion. Si l’on se place du point de vue des pouvoirs publics et que l’on fait le bilan des affaires judiciaires — soit 23 condamnations pour transmission du VIH depuis le début de l’épidémie pour toute la France —, on peut imaginer que pour l’Etat il ne s’agit pas là d’un problème majeur national au niveau pénal, du moins sur le plan quantitatif. J’imagine que la réflexion sur la justice pénale porte prioritairement sur d’autres questions. Pour les associations de lutte contre le sida, c’est probablement plus compliqué parce que les procédures judiciaires — comme nous essayons de l’analyser dans l’avis — mettent quelque peu à mal les fondements historiques de la lutte contre le VIH. Je citerai la solidarité entre les personnes atteintes et le refus de distinguer entre des “malades victimes” qui auraient été contaminés et d’autres qui se seraient infectés. J’imagine que cette difficulté a pu introduire de l’inertie dans la progression de la réflexion. C’est justement une recommandation du CNS que d’exhorter les associations à reprendre aujourd’hui cette réflexion, parce qu’elle constitue un bras de levier pour agir sur les stigmatisations, les discriminations… et la prévention en général.

Qu’est-ce qui est condamné aujourd’hui ? Et qu’est-ce qui est condamnable sur le plan pénal ?

C’est avant tout le fait pour une personne qui se sait séropositive d’avoir transmis le VIH à un ou une partenaire alors qu’elle n’avait pas pris de mesure de prévention pour prévenir cette transmission, en l’occurrence l’utilisation de préservatif. Dans la quasi-totalité des procès en France, c’est cela qui est condamné. Nous avons eu des réflexions sur d’autres points car les juristes qui nous ont accompagnés ont expliqué que le champ de ce qui est condamnable, de ce qui pourrait représenter un délit, est sans doute plus large que celui qui est effectivement appliqué aujourd’hui.

A quoi faites-vous référence ?

Il faut raisonner sur plusieurs niveaux. Le premier critère retenu est que ce sont des personnes qui se savent séropositives. Mais c’est plus compliqué. Ainsi, d’un point de vue juridique, on ne peut assurer qu’une personne bien que ne se sachant pas formellement séropositive puisse se considérer comme séronégative alors qu’elle est engagée dans des comportements sexuels à risques, répétés. La justice peut considérer que même si elle ne sait pas de façon formelle quel est son statut, son comportement sexuel aurait du l’inciter à se considérer comme potentiellement séropositive, donc à se tester et à mettre en œuvre des moyens de prévention. Dans ce cas, l’absence de dépistage ne garantit pas l’absence de risque pénal. Le deuxième critère est qu’il faut la preuve que la personne ait transmis le VIH. Notre analyse des jugements montre que le fait d’exposer à la transmission du VIH, même sans transmission effective, peut également être pénalisé. Il y a eu des condamnations en France pour exposition au risque de transmission. Cela s’est produit dans des cas de condamnations additionnelles à des condamnations pour transmission effective, mais cela existe.

Vous estimez donc qu’on pourrait se trouver un jour avec une condamnation au seul motif du risque d’exposition à la transmission du VIH ?

Oui. Les éléments juridiques sont là. C’est, selon notre analyse, une autre possibilité d’élargissement du champ pénal. Le troisième critère est le fait que la victime ne soit pas informée de la séropositivité du ou de la partenaire. En droit pénal, le fait que la victime soit informée ou pas n’exonère pas le prévenu de sa responsabilité. On ne peut pas arguer que le partenaire était informé et qu’il a accepté de ne pas se protéger et donc qu’on ne serait pas responsable. L’information ne suffit pas.

Quatrième critère. Dans toutes les affaires aujourd’hui, la prévention des rapports sexuels est comprise comme l’usage du préservatif. C’est le préservatif qui est retenu comme la manifestation de la préoccupation face au risque de transmission. Nous ne savons pas ce qui se passera lorsqu’il y aura des procédures engagées pour transmission ou exposition concernant des personnes qui n’utilisent pas de préservatifs, mais qui sont traitées efficacement. Certains juristes nous ont expliqué que s’il y avait transmission malgré l’usage du préservatif, il s’agirait d’un cas de force majeure qui est exonératoire de la responsabilité. On ne peut pas garantir la même chose concernant le traitement. Autrement dit, avec un traitement bien suivi, une charge virale dans le sang inférieure à 20 copies, on ne peut pas garantir qu’il n’y ait pas de temps en temps un peu de VIH dans le sperme… et donc qu’une transmission soit possible même si le traitement est bien suivi, la charge virale indétectable… D’autres juristes nous disent que nous sommes, dans ce cas-là, dans une situation d’aléa, qui, elle, n’est pas exonératoire de la responsabilité. Nous devons réfléchir à cela. Il paraîtrait impensable que ce qui est une évidence en termes de santé publique aujourd’hui sur la promotion des préventions biomédicales, soit en décalage sur le plan juridique. C’est un motif d’alerte que nous mentionnons dans l’avis. Mais il est à craindre malheureusement que cette réflexion n’ait lieu que le jour où un cas de transmission concernant une personne sous traitement efficace vienne au tribunal.

Comment expliquer que le rôle du Tasp dans la protection du rapport soit reconnu en Suisse avec toutes les conséquences juridiques que cela implique et que ce même argument ne tienne pas juridiquement chez nous ?

Nous avons souhaité alerter sur ce point afin que justement les conclusions de la justice, lorsqu’elle aura à se prononcer, soient identiques aux conclusions de santé publique que nous connaissons aujourd’hui. Nous ne devons pas arriver à cette contradiction qu’une personne qui se traiterait efficacement soit condamnée parce qu’elle n’utiliserait pas le préservatif. Avec ces exemples, on voit bien l’espace assez restreint de ce qui est effectivement condamné aujourd’hui et le fait qu’il faut absolument avoir une réflexion sur le possible élargissement de ce qui est condamnable.

L’argument est souvent avancé qu’un engagement plus avant dans la pénalisation dissuaderait les personnes de faire le dépistage ?

L’avis a analysé les conséquences de la pénalisation de la transmission en matière de recours au dépistage. Toutes les études auxquelles nous avons eu accès, essentiellement étrangères, n’indiquent pas que le risque pénal lié à la connaissance de son statut sérologique conduirait à une diminution du recours au dépistage.

Vous notez le paradoxe que les recours en justice se sont développés dans un contexte de “normalisation” de la maladie. Autrement dit, les affaires ont prospéré dans les années 2000, postérieurement à la phase la plus aigüe de l’épidémie. Comment l’expliquez-vous ?

Nous avons eu des discussions à ce sujet. Certains d’entre nous étaient réticents à affirmer qu’il y avait une augmentation du nombre de cas. Une chose est sûre, nous sommes sur un chiffre bas : 23 condamnations. D’autant plus si on le rapporte aux données de l’enquête ANRS-Vespa 2. L’enquête montre qu’un peu plus d’une personne vivant avec le VIH sur dix déclare avoir été tentée de porter plainte contre la personne qu’elle estimait être à l’origine de sa contamination. Selon la même source, 1,4 % des personnes vivant avec le VIH interrogées déclaraient avoir effectivement porté plainte. Sur la base de ces chiffres, nous avons estimé un ordre de grandeur de 1 500 à 2 000 plaintes qui auraient pu être déposées au total depuis le début de l’épidémie. Nous ne savons pas pourquoi certaines plaintes ont été acceptées et d’autres pas, pourquoi certaines ont finalement été classées et d’autres ont prospéré. Nous n’avons, hélas, aucun moyen d’évaluer cela. Nous savons juste que peu d’affaires arrivent à une condamnation.

Pour répondre plus précisément, il faut prendre en compte le fait qu’il y a un délai important, parfois dix ans, entre le moment où une plainte est déposée et celui où un jugement en appel est prononcé. Dire qu’aujourd’hui nous sommes sur une augmentation du nombre de procédures, c’est possible, mais pas certain. Nous devons être prudents sur ce point. Si c’est vrai, comment l’expliquer ? Une des hypothèses, c’est qu’aux premiers temps de l’épidémie, lorsque beaucoup de monde décédait du sida, porter plainte contre une personne qui allait sans doute mourir n’avait pas grand sens. Aujourd’hui, la situation est différente. Pour des personnes, cela peut apparaître plus “logique” de le faire. Nous avançons cette hypothèse, mais aucun chiffre ne permet de la confirmer. On peut aussi regarder quels sont ceux qui portent plainte. C’est intéressant de voir que les personnes qui portent plainte et arrivent au procès ne font pas partie des groupes dits à risques où la prévalence est très forte. Par exemple, il n’y a quasiment pas de personnes migrantes parmi les plaignants. Par ailleurs, il existe aujourd’hui une judiciarisation bien plus importante de l’intime, notamment des faits sexuels, qu’elle n’existait dans le passé. Peut-être cela joue-t-il dans le fait de porter plainte plus aujourd’hui qu’il y a vingt ans.

Quels objectifs vous êtes-vous fixés en publiant ce nouvel avis ?

Tout d’abord : informer les personnes vivant avec le VIH sur les conditions dans lesquelles leur responsabilité pénale peut être engagée. Notre réflexion a surtout porté sur le fait de pouvoir contribuer à une justice équitable. Par quels moyens ? Par une sensibilisation des enquêteurs à cette question par les écoles nationales de police et de gendarmerie. Par un travail auprès des magistrats et des avocats. Il n’est pas possible que les juges aient des connaissances techniques sur les différentes maladies, nous l’admettons. De la même façon, on ne peut pas considérer aujourd’hui, au prétexte qu’on ne meure plus du sida, que l’infection par le VIH est banale. Ce n’est pas possible parce qu’il existe un contexte de représentations sociales qui en font une maladie particulière. Pour autant, la situation n’est plus la même aujourd’hui, des progrès notamment médicaux ont eu lieu. C’est très important que les magistrats et les avocats aient connaissance de cela. Nous proposons que l’Ecole nationale de la magistrature ouvre cette réflexion dans sa formation initiale, comme dans sa formation continue. Nous avons sollicité le directeur de cette école pour lui demander d’inclure une réflexion autour du VIH dans la formation des connaissances. Un problème, qui ne concerne pas que les juges, est celui de la mise à niveau des connaissances pour contribuer à une justice équitable. Un de nos souhaits est aussi de permettre de réfléchir à la position de la justice pénale. Les peines de prison ferme prédominent dans les affaires de transmission du VIH et les questions de réinsertion et de prévention de la récidive ne sont pas du tout prises en compte, alors même que la justice doit veiller à ces deux aspects dans sa démarche.

Concrètement que préconisez-vous ?

Pour le ministère de la Justice, de se doter d’une forme d’observatoire de suivi des jugements rendus, de documenter les caractéristiques des procédures. L’outil n’existe pas et nous avons dû effectuer un travail considérable pour réaliser notre nouvel avis et retrouver tous les cas ayant abouti à des condamnations. Il faut créer un comité interministériel pour qu’il travaille à la création et la mise à disposition d’outils d’information adaptés aux professionnels (policiers, avocats, magistrats) et aux personnes concernées, pour que les procédures tiennent compte des données scientifiques et médicales disponibles, pour que les médecins soient mieux informés sur le risque pénal de la transmission du VIH. C’est du travail de lobbying que nous menons, y compris auprès des associations de lutte contre le sida. Elles doivent se réapproprier cette question, sur laquelle elles étaient un peu en situation de veille. Nous devons admettre que le droit au recours à la justice est un droit des citoyens, que notre combat n’est pas contre la justice pénale, mais plutôt pour garantir une procédure équitable et prévenir le risque pénal.

Propos recueillis par Jean-François Laforgerie.

US: New York Public radio produces empathatic audio feature story on HIV criminalisation

Last summer, in a Missouri courtroom, a college wrestler named Michael Johnson was sentenced to 30 years in prison for “recklessly infecting a partner with HIV.”

Johnson, who also goes by “Tiger Mandingo”, was accused of knowingly infecting his partners with HIV, although at least one of them said Johnson called to tell him the diagnosis when Johnson tested positive for the virus.

The case shed light on the stigmas surrounding sexually transmitted infections, or STIs, and especially HIV/AIDS. In more than 30 states there is a legal requirement for HIV positive individuals to disclose their status to whomever they’re having sex with. And while most people agree that honest conversation is a good practice, the laws allow people with HIV to be imprisoned for even spitting, biting or oral sex.

“Every person with HIV in the country who knows they have HIV is one accusation away from finding themselves in a courtroom,” said Sean Strub, director of The Sero Project.

Strub was diagnosed with HIV in the 1980s. Since then, treatments for STIs like HIV/AIDS has made significant progress across the globe. But Strub argues that an HIV diagnosis has continued to carry a stigma, perhaps even worse than before. And Strub said forcing people to disclose their status can backfire, and alienate a population that needs support.

While Strub is working to change the policy, New York University sex researcher and educator, Zhana Vrangalova, is focused on challenging society’s perception of risky sex.

“People really fear that STIs are more prevalent than they are…and that once you catch it you may always keep it,” she said.

Vrangalova is on a mission to de-stigmatize safe sexual behavior. Her website, for example, is about casual sex and provides a forum for people to talk about the flings and one-night stands that are usually dismissed in traditional sex education. Students in her class learn how to balance health and protection with redefining normal sexual behavior.

Jake Hernandez, a 23-year-old nursing student taking her class, has had personal experience with the same situation that got Michael Johnson behind bars. His ex-boyfriend called him to tell him he was HIV positive after they had oral sex, and luckily, Hernandez tested negative.

While he felt betrayed by his boyfriend, Hernandez still believes society needs to challenge the stereotypes surrounded STIs and the people who have them, especially gay men. While visiting a sex shop for his class with Vrangalova, he said the assumption is, “that we just walk around having sex all the time.”

“I mean I would probably say I’ve had casual sex once in my life. If I was dating a girl would you be saying all these things?”

Listen here

Originally published at WNYC.com

US: American Psychological Association adopts resolution opposing HIV criminalisation

The American Psychological Association (APA) has adopted an evidence-informed resolution on HIV criminalisation in the United States.

It was developed with feedback from the APA Committee on Legal Issues and the HIV Medicine Association – who themselves issued a Policy Statement on HIV Criminalization in 2015 – along with the Sero Project and The Center for HIV Law and Policy.

According to the background document:

We believe an APA resolution will strongly encourage states with HIV criminalization laws to repeal such laws and provide psychologists practicing in relevant states with guidance on the impact that HIV-specific laws may have on their patients, clients, and the general public’s health.

The resolution, adopted by the Council of Representatives in February 2016 and published on March 15th, can be read in full on the APA website.

It includes the following key messages:

THEREFORE be it resolved that APA opposes HIV criminalization and recommends the repeal or reform of these laws to eliminate HIV-specific criminal penalties with the exceptions of 1) a person with known HIV committing a sex crime where there is risk of transmission, and 2) a person with known HIV who has the intent to transmit the virus and is engaged in a behavior with a high risk of transmission;

BE IT FURTHER RESOLVED that laws that are not in alignment with the current scientific evidence on HIV transmission should be repealed;

BE IT FURTHER RESOLVED that laws that criminalize behaviors posing low or negligible risk for HIV transmission should be repealed or reformed and better aligned with contemporary scientific evidence regarding HIV transmission probabilities for specific behaviors and the efficacy of risk-reduction activities (e.g., consistent condom use);

BE IT FURTHER RESOLVED that laws that target PLHIV and engender harsher sentencing should be repealed;

BE IT FURTHER RESOLVED that laws that increase likelihood of incarceration for PLHIV should be repealed;

BE IT FURTHER RESOLVED that laws that undermine national HIV prevention efforts should be repealed;

BE IT FURTHER RESOLVED that criminalization laws that increase the risk of and intimate partner violence to, and control of women and other vulnerable people with HIV should be repealed;

BE IT FURTHER RESOLVED that laws that specifically target and criminalize PLHIV should be repealed;

BE IT FURTHER RESOLVED that laws that discriminate and stigmatize against PLHIV should be repealed;

BE IT FURTHER RESOLVED that psychologists practicing in states with HIV-specific criminalization laws are encouraged to better understand the impact of these laws on their patients who have HIV or who may be at elevated risk for HIV infection.

US: Bernie Sanders “absolutely opposed” to HIV criminalisation

In the plan that Clinton articulated to achieve an “AIDS-free generation” the day after her gaffe, she came out against state HIV criminalization laws penalizing perceived transfer of the disease.

Although his plan doesn’t address them, a Sanders spokesperson said he’s “absolutely opposed” to those laws.

From Washington Blade.

US: Hillary Clinton: "We should call on states to reform outdated and stigmatizing HIV criminalization laws."

Yesterday, at Nancy Reagan’s funeral, I said something inaccurate when speaking about the Reagans’ record on HIV and AIDS. Since then, I’ve heard from countless people who were devastated by the loss of friends and loved ones, and hurt and disappointed by what I said. As someone who has also lost friends and loved ones to AIDS, I understand why. I made a mistake, plain and simple.

I want to use this opportunity to talk not only about where we’ve come from, but where we must go in the fight against HIV and AIDS.

To be clear, the Reagans did not start a national conversation about HIV and AIDS. That distinction belongs to generations of brave lesbian, gay, bisexual, and transgender people, along with straight allies, who started not just a conversation but a movement that continues to this day.

The AIDS crisis in America began as a quiet, deadly epidemic. Because of discrimination and disregard, it remained that way for far too long. When many in positions of power turned a blind eye, it was groups like ACT UP, Gay Men’s Health Crisis and others that came forward to shatter the silence — because as they reminded us again and again, Silence = Death. They organized and marched, held die-ins on the steps of city halls and vigils in the streets. They fought alongside a few courageous voices in Washington, like U.S. Representative Henry Waxman, who spoke out from the floor of Congress.

Then there were all the people whose names we don’t often hear today — the unsung heroes who fought on the front lines of the crisis, from hospital wards and bedsides, some with their last breath. Slowly, too slowly, ignorance was crowded out by information. People who had once closed their eyes opened their hearts.

If not for those advocates, activists, and ordinary, heroic people, we would not be where we are in preventing and treating HIV and AIDS. Their courage — and their refusal to accept silence as the status quo — saved lives.

We’ve come a long way. But we still have work to do to eradicate this disease for good and to erase the stigma that is an echo of a shameful and painful period in our country’s history.

This issue matters to me deeply. And I’ve always tried to do my part in the fight against this disease, and the stigma and pain that accompanies it. At the 1992 Democratic National Convention, when my husband accepted the nomination for president, we marked a break with the past by having two HIV-positive speakers — the first time that ever happened at a national convention. As First Lady, I brought together world leaders to strategize and coordinate efforts to take on HIV and AIDS around the world. In the Senate, I put forward legislation to expand global AIDS research and assistance and to increase prevention and education, and I proudly voted for the creation of PEPFAR and to defend and protect the Ryan White Act. And as secretary of state, I launched a campaign to usher in an AIDS-free generation through prevention and treatment, targeting the populations at greatest risk of contracting HIV.

The AIDS crisis looks very different today. There are more options for treatment and prevention than ever before. More people with HIV are leading full and happy lives. But HIV and AIDS are still with us. They continue to disproportionately impact communities of color, transgender people, young people and gay and bisexual men. There are still 1.2 million people living with HIV in the United States today, with about 50,000 people newly diagnosed each year. In Sub-Saharan Africa, almost 60 percent of people with HIV are women and girls. Even though the tools exist to end this epidemic once and for all, there are still far too many people dying today.

That is absolutely inexcusable.

I believe there’s even more we can — and must — do together. For starters, let’s continue to increase HIV and AIDS research and invest in the promising innovations that research is producing. Medications like PrEP are proving effective in preventing HIV infection; we should expand access to that drug for everyone, including at-risk populations. We should call on Republican governors to put people’s health and well-being ahead of politics and extend Medicaid, which would provide health care to those with HIV and AIDS.

We should call on states to reform outdated and stigmatizing HIV criminalization laws. We should increase global funding for HIV and AIDS prevention and treatment. And we should cap out-of-pocket expenses and drug costs—and hold companies like Turing and Valeant accountable when they attempt to gouge patients by jacking up the price of lifesaving medications.

We’re still surrounded by memories of loved ones lost and lives cut short. But we’re also surrounded by survivors who are fighting harder than ever. We owe it to them and to future generations to continue that fight together. For the first time, an AIDS-free generation is in sight. As president, I promise you that I will not let up until we reach that goal. We will not leave anyone behind.