This report is a direct follow-up to Global Commission on HIV and the Law: Risks, Rights and Health (July 2012) and the Asia-Pacific Regional Dialogue of the Global Commission on HIV and the Law convened in Bangkok in February 2011.
AIDS laws in Asia and the Pacific are failing to protect those most vulnerable | ReliefWeb
New UNDP study highlights gaps in human rights protections for people living with HIV in Asia and the Pacific Bangkok – Legal protections are unevenly enforced and human rights violations persist for people living with HIV in Asia and the Pacific.
US: REPEAL ACT to modernise HIV criminalisation laws reintroduced with bipartisan support
Yesterday, California Congresswoman Barbara Lee (Democrat) was joined by Florida Congresswoman Ileana Ros-Lehtinen (Republican) to introduce a new version of the ‘Repeal Existing Policies that Encourage and Allow Legal HIV Discrimination Act’ (the ‘REPEAL HIV Discrimination Act’, or the ‘REPEAL Act’) first introduced by Congresswoman Lee in September 2011.
The REPEAL Act was the first to take on the issue of HIV criminalisation in the United States. The first time around it achieved 41 co-sponsors, all of whom were Democrats.
It is notable this this time, the REPEAL Act (known formally as H.R. 1843) has intially been co-sponsored by a Republican, suggesting the Act may go further this time and make it out of committee and on to the floor for consideration.
A press release issued yesterday by Congresswoman Lee’s office summarises the proposed legislation (which can be read in full and downloaded below):
“These laws are based on bias, not science. We need to make sure that our federal and state laws don’t discriminate against people who are living with HIV. These laws breed fear, discrimination, distrust, and hatred, and we’ve got to modernize them. That’s exactly what this legislation would do,” said Congresswoman Barbara Lee.
Today, 32 states and 2 U.S. territories have criminal statutes based on outdated information regarding HIV/AIDS. This bipartisan legislation would allow federal and state officials and community stakeholders to work together to review the efficacy of laws that target people living with HIV/AIDS. The REPEAL HIV Discrimination Act would authorize the Attorney General, the Secretary of Health and Human Services, and the Secretary of Defense to monitor new and existing laws imposing criminal liability against people with HIV/AIDS and to establish a set of best practices for legislatures to consider when proposing such legislation.
Congresswoman Ros-Lehtinen added, “I’m pleased to co-sponsor this bipartisan bill that will help end the serious problem of discrimination in criminal and civil cases against those who are HIV positive. Singling out and discriminating against those living with HIV is not in line with our American values and we must do better. The legislation seeks to modernize our current outdated laws and bring them into the 21st century. I urge my Republican and Democrat colleagues to join Barbara and me in helping those persons living with HIV live as healthy and normal a life as possible.”
If passed, the act will be a key step towards ending unfair and unjust HIV criminalization laws in the United States by developing a set of best practices for the treatment of HIV in criminal and civil commitment cases, issuing guidance to states based on those best practices, and monitoring how states change policies consistent with that guidance.
Kan. health agency pledges to protect AIDS/HIV patients from quarantines, clearing bill's path
TOPEKA, Kansas – A promise from Kansas’ health department Thursday to continue protecting AIDS and HIV patients from being quarantined has resolved a dispute over a legislative proposal for helping medical personnel and emergency workers who may have been exposed to infectious diseases.
Nigeria: State Action Committee on AIDS to be transformed into an agency to ensure the passage of new anti-HIV stigmatisation bill into law
Home > State > Akwa-Ibom > Akwa Ibom to enact law against HIV/AIDS stigmatisation By Nkechi on April 3, 2013 Chairman, Akwa Ibom State Agency for the Control of HIV/AIDS, Dr Francis Udoikpong, has said that the government will soon enact a law against stigmatization of persons living with HIV/AIDS in Akwa Ibom state.
Ghana AIDS Commission proposes new supportive and enabling HIV law
GAC holds policy dialogue on human rights, HIV and law Ghana needs a roadmap for the proposal of an HIV/AIDS prevention and control law to consolidate gains made so far by the Ghana Aids Commission (GAC) and its partners.
Uganda: As second reading of controversial national HIV law awaits, activists hope regional HIV law – with no HIV criminal statute – will take precedence
Activists in Uganda are seeing an opportunity to shoot down the country’s controversial HIV Bill that criminalises transmission of the Aids virus and enforces mandatory testing, after President Yoweri Museveni signed a more liberal one proposed by the East African Community. They want Uganda’s parliament to incorporate into law the EAC HIV and Aids Prevention Bill (EAC HIV Bill) that President Museveni signed last week. More than 30 NGOs in Uganda find the national law that is awaiting a second reading in parliament offensive, saying that it could exacerbate the spread of HIV. Laws passed by the East African Legislative Assembly take precedence over national laws. President Museveni can also prevail upon the Ugandan parliament to drop the bill.
As Kenya and Uganda assent to East African Community's Regional AIDS Law, the lack of an HIV criminalisation statute apparently holds back Tanzania and Burundi
Having a common regional approach to the HIV and Aids pandemic is an important step for the East African Community, as the five member states get ready for closer integration. The increased trade and labour migration that comes with closer economic ties will invariably create situations where large numbers of foreign nationals travel or relocate freely in their territories.
Nigeria: Advocates successfully argue for removal of HIV criminalisation clause from draft HIV and AIDS Anti-Discrimination Act
Advocates in Nigeria have successfullly argued to remove a clause criminalising the ‘willful or deliberate spead of HIV’ from the latest draft of the long-awaited HIV and AIDS Anti-Discrimination Act.
Last week, the National Agency for the Control of AIDS (NACA) held a two-day stakeholders forum on the much delayed national anti-discrimination law. The meeting aimed to re-energize the passing of the bill into law, and to ensure that it incorporated international human rights conventions and standards as they relate to people living with HIV.
The national law also aims to harmonise state anti-discrimination laws. Currently, three states – Lagos, Enugu and Cross River State – include HIV criminalisation statutes in their their laws.
The vaguely-worded proposed HIV criminalisation statute of the draft national anti-discrimination bill read as follows:
Section 31 Willfull or Deliberate Spread of HIV Virus
Any person, having known his/her seropositive status, deliberately transmits the HIV directly or indirectly shall be guilty of an offence and, upon conviction be sentenced up to twelve months imprisonment or fine of up to N500,000 or both.
At the meeting, many stakeholders proposed to keep the HIV criminalisation statute in the bill, but civil society organisations, led by the Network of People Living with HIV and AIDS in Nigeria (NEPWHAN), successfully advocated against the statute.
Instead, the provisions of the anti-discrimination bill were expanded from covering workplace discrimination to be broadly applicable at the workplace, school, correctional institutions, religious institutions, and in society at large.
The draft harmonized bill as proposed with input from NEPWHAN and other civil society organisations is below. Note the absence of Section 31. Although this is unlikely to be the final wording of the law, it certaily shows how successful advocacy can remove problematic provisions in otherwise supportive and enabling HIV-related laws.
Draft Harmonized Nigerian HIV and AIDS Anti-Discriminational Act 2013
UK: Updated guidance on HIV transmission, the law and the work of the clinical team now published
The British HIV Association (BHIVA) and the British Association for Sexual Health and HIV (BASHH) have produced updated guidance on HIV Transmission, the Law and the Work of the Clinical Team.
This guidance is aimed at those working in the field of HIV medicine, especially clinicians, but will also be of use to general practitioners and people living with HIV who want to understand the legal and medical basis for some of their care decisions.
The guidance begins with a clear statement against HIV criminalisation:
BHIVA and BASHH believe that this use of the law is unhelpful and potentially harmful to public health and support UNAIDS recommendations to limit the use of criminal law and the Oslo declaration view that a “non-punitive, non-criminal HIV prevention approach” is preferable.
Covering the law in England & Wales as well as Scotland, the document aims to provide information and guidance on managing issues related to sexual transmission of HIV based on current scientific evidence. It applies generic ethical and professional principles but with a greater emphasis on providing a confidential environment in which extremely sensitive matters can be frankly and fully discussed. This enables appropriate care of people with HIV and benefits public health by encouraging individuals to access testing and treatment. Within this framework this document sets out the roles and responsibilities of health care professionals when caring for individuals living with HIV.
Consistent with the recent BHIVA and the Expert Advisory Group on AIDS (EAGA) position statement on the use of antiretroviral therapy to reduce HIV transmission, the guidance notes:
In most situations the appropriate use of antiretroviral treatment is at least as effective as condoms in preventing sexual transmission of HIV. This is accepted by the [Crown Prosecution Service of England and Wales] and [Scottish Crown Office and Procurator Fiscal Service] so it is likely that evidence showing that the defendant was taking effective antiretroviral treatment at the time of the alleged transmission may be used to demonstrate that they were not reckless.
The guidance also clearly states that healthcare professionals “must be mindful of their duty not to work beyond their expertise in legal matters. For people with HIV, advice must include the routes of HIV transmission and how to prevent transmission, with information about safer sexual practices, the use of condoms and suppression of viral load. Advice must be given in a non-judgmental way.”
It also discusses issues of confidentiality, noting that “it is important when considering breaching confidentiality to weigh up all potential harms as there may be situations where disclosure of HIV status to protect a sexual partner results in considerable harm to an individual e.g. domestic violence. In situations where a health care professional believes that an HIV positive individual continues to put sexual contacts at risk their duties and subsequent action depend upon the type of contact.” See Figure 1 below.
The guidance also clearly states that “no information should be released to the police unless patient consent has been verified or there is a court order in place, except in very limited circumstances defined by the [General Medical Council].”
Importantly, it also notes that only individuals can make complainants to the police “and health care workers should remain impartial during discussions with patients.”
Finally, it provides clear advice to both help prevent transmission of HIV to sexual partners and to avoid prosecution for ‘reckless’ HIV transmission. Accordingly, people with HIV should do at least one of the following:
- Use a male or female condom fitted correctly along with water-based lubricant. Individuals doing this are unlikely to be seen as reckless for legal purposes. In the event of a condom split, it is advisable to disclose HIV status in order to support the partner’s decision whether or not to obtain post-exposure prophylaxis (PEPSE), which should be taken within 72 hours. The need for PEPSE will depend upon the type of sexual activity and the HIV viral load. An assessment of the risk should be undertaken by a clinician according to the BASHH PEPSE guidelines. Disclosure in these situations would suggest that the person with HIV was not reckless.
- Adhere to effective (suppressed viral load) antiretroviral medication. There is growing evidence of extremely low/minimal risk of transmission when plasma HIV is fully suppressed with the use of antiretroviral medication. In some situations an undetectable viral load can afford protection equivalent to or greater than that of condoms. A person with HIV is unlikely to be seen as reckless when relying on a suppressed viral load instead of condom use if they have been counselled accordingly by an HIV clinician or similar medical authority. It is recommended that this discussion is documented in the patient’s medical records.
In addition people with HIV should be advised that disclosure of HIV positive status to a partner before sex is important to support informed agreement around risk and safer sex behaviours. To avoid successful prosecution an individual who is not taking effective antiretroviral medication and does not use a condom must disclose their HIV status to sexual partners before sex takes place.
The entire guidance is reproduced below.