Canada: Criminalisation of people with HIV is based on and perpetuates misinformation

Health Economist, Assistant Professor at the University of Toronto

HIV Stigma Can Be More Dangerous Than The Disease Itself

In the past 20 years the medical implications of an HIV diagnosis have changed completely, almost miraculously. Antiretroviral drugs allow people living with HIV to have unprotected sex without passing the virus to their partners, to have HIV-negative children and to live healthy lives well into old age.

In fact, in 2016 the stigma surrounding HIV is probably more life-threatening than HIV itself. The fear of being “outed” as HIV positive stops a lot of people from seeking treatment. A delay in treatment allows the virus to spread, and in many cases, leads to death.

Stigma has many causes, one of which is a genuine fear of contagion. Despite the fact that HIV is now a treatable condition, “educational” messages on HIV prevention are still based on fear, and almost universally exaggerate the risks of HIV infection and its consequences.

Many of us still seem to view HIV as a life-threatening disease rather than a relatively mild condition.

Most people think that HIV is transmitted easily through unprotected sex, though the transmission rate is less than one per cent per act. When a person is taking antiretroviral drugs, the virus is suppressed and transmission is nearly impossible. Many of us still seem to view HIV as a life-threatening disease rather than a relatively mild condition.

In Canada, a person who is diagnosed with HIV and has unprotected sex can be sent to jail for aggravated sexual assault, even if they are taking medication and are virally suppressed. Such criminal convictions are based on and perpetuate misinformation. When it comes to HIV prevention, proper adherence to antiretroviral drugs is actually more effective than condoms.

What’s more, Canadian policy specifically discourages testing and treatment, because a diagnosis makes you criminally responsible. Treatment prevents the spread of HIV, so a policy that criminalizes HIV transmission could actually increase the spread of the virus. Even worse — high-risk individuals (those who frequently engage in unprotected sex) are the most susceptible to a conviction and therefore the least likely to get tested and treated. In November, the United Nations urged Canada to limit criminalization to cases of intentional transmission.

I study barriers to HIV testing in Malawi, a small country in southern Africa with an HIV infection rate of around 15 per cent. I recently ran a large-scale information experiment to correct a common misconception: most participants didn’t know that an HIV-infected person who is taking antiretroviral drugs is not contagious. Providing this information reduced stigma at the community level which caused a significant increase in HIV testing.

While Canada is a long way from Malawi, the social issues surrounding HIV are in some ways similar. Approximately one in five people living with HIV are undiagnosed. Misinformation and an inflated fear of HIV infection are widespread.

In a 2012 survey of Canadians commissioned by the Public Health Agency of Canada, nearly half believed that AIDS was always fatal, and only one-third believed that antiretroviral drugs were very effective. Half of survey respondents were not comfortable drinking from a glass once used by an HIV-infected person.

I understand the instinct to overstate the risks of HIV in order to encourage prevention, but messages that stoke fear and stigmatize HIV come with serious unintended consequences. Antiretroviral drugs are our best hope of ending the HIV epidemic.

In fact, “treatment as prevention” was a strategy developed right here in Canada, at the B.C. Centre for Excellence in HIV/AIDS. It has now been embraced by both the UN and the WHO. Rather than pushing prevention through fear, we should mobilize to support people living with HIV.

Good policy should focus not on fear, but on providing accurate information, encouraging HIV testing and providing universal access to life-saving medication.

US: Four out of five LGBT people live in states with HIV criminalization laws.

A majority of LGBT Americans—about 81 percent—live in states with HIV criminalization laws, according to a new report from the Movement Advancement Project (MAP), a group that provides research and data related to LGBT equality.

Titled LGBT Policy Spotlight: HIV Criminalization Laws, the free report explores why these laws are problematic and how they harm public health and the justice system, according to MAP press release.

“Over the past 35 years, 38 states have passed laws that have not kept up with modern medical research and facts about the risks, likelihood, and modes of transmission of HIV,” states the press release. “These HIV criminalization laws therefore often criminalize a range of behaviors that are now known to carry no or a negligible risk of transmission. Most of these laws also not only criminalize the intentional transmission of HIV, but also criminalize behaviors that unintentionally or accidentally exposed others to the virus. Together, these laws perpetuate dangerous stigmas and misinformation about the disease and people living with HIV, create a strong disincentive for individuals to find out their HIV status, and disproportionately target—and add to higher rates of incarceration for—LGBT people.”

While offering a national look at HIV criminalization, the report also looks at the degree of punishment for these laws—for example, whether a violation is considered a felony and whether offenses will result in registration as a sex offender. The report also examines how HIV laws disproportionately affect the LGBT population and people of color.

Published in Poz on Dec 7, 2016

Matthew Weait, from the University of Portsmouth, writes on how stigma and the law affect the lives of people with HIV

HIV Stigma and the Criminal Law

December 1st marks World AIDS Day, an opportunity for people worldwide to unite in the fight against HIV, show their support for people living with HIV and to commemorate people who have died. Matthew Weait, from the University of Portsmouth, writes here on how stigma and the law affect the lives of people with HIV.

Today, December 1st, is World AIDS Day.  According to the latest available data from UNAIDS, 1.1 million people died from AIDS-related causes in 2015, there are just over 2 million new HIV infections globally every year, and just under 40 million people are living with the virus.  These are depressing figures, particularly in light of the advances in our understanding of HIV, its prevention and treatment, the laudable rise in the number of people accessing antiretroviral therapy (ART) (up from 7.5 million to 18 million in the past five years), and the massive impact of ART on reducing the likelihood of onward transmission.

Despite the fact that the life expectancy of people on ART has improved significantly, especially for those who receive a timely diagnosis, and that there exist effective ways of avoiding infection, the stigma associated with HIV remains.  The impact of this stigma, and the associated discrimination which people living with HIV (PLHIV) and those in key populations are subjected to, is substantial and undermines the work being done to promote access to health and other services critical to curtailing the epidemic.

Stigma is not only correlated with adverse health outcomes for PLHIV (including depression and lower adherence to medication), but also with non-disclosure of status and with less safe sexual practices.  It is for these reasons that combating stigma, and the factors which contribute to it, has long been identified as a public health priority.

Among the most pernicious contributors to HIV stigma is the widespread and inappropriate use of criminal laws against PLHIV and those at heightened risk of infection.  For example, PLHIV or those suspected of being HIV-positive have been and are at risk of being investigated, prosecuted and imprisoned for exposure offences – where no transmission takes place – even where there is negligible risk (as when a PLHIV is on effective treatment and has an undetectable viral load), where there is no risk (e.g. through biting or spitting), and even where a partner has consented to the risk involved.

In some countries, such as Canada, the very fact of non-disclosure of status can, irrespective of risk, turn otherwise consensual sex into sexual assault.  And where transmission does in fact occur (which is more likely when someone does not know their status and is not on treatment than when they do know and are), PLHIV are at risk of extended custodial punishment, even if it is not their intention to cause harm.

These laws serve no public health purpose and, because it is typically only those that have a positive diagnosis who may be found criminally liable, do nothing to incentivise the testing which is a pre-requisite of treatment and care.

It is not only those already living with HIV who suffer from the enforcement of punitive laws.  The social opprobrium associated with and / or criminalization of transgender people, homosexuality, sex work, and injecting drug use in many countries of the world (including nations with high HIV prevalence) reinforces stigma, makes it harder to support those at heightened risk of acquiring the virus, and in fact makes infection more likely.

If the possession of condoms is treated as evidence of sex work, sex workers may not carry them; and if the possession of syringes is treated as evidence of drug use, the chance that these will be shared increases, as does the risk of transmitting blood-borne viruses (including HIV and hepatitis C).  Put simply, the policing of these communities, and the absence of harm reduction opportunities in the carceral settings they may find themselves in as a result of that policing, exacerbate risks which are already greater than for the general population.

The adverse impact of using criminal law in the fight against HIV, and on those directly and indirectly affected by it, has been extensively researched and documented.  The consensus among expert bodies such as UNAIDS and the Global Commission on HIV and the Law is that countries should review their punitive laws and significantly restrict their use, and there have been a number of progressive and welcome developments both in law reform and in policing, many of these led by coalitions of activists and clinicians.  At the same time, and despite the evidence of the harm that they cause, and the stigma which it feeds and sustains, countries continue to pass and enforce these laws.

Irrespective of any moral or ethical questions there may be about HIV transmission, exposure, or non-disclosure, it is incontrovertible that the criminal law makes the elimination of HIV harder.  If we are going to end the epidemic, this needs to be recognised and acted on as a priority. If not, more people will become infected, more people will get sick, more people will have a lower quality of life – even when virally suppressed – and more people will die.

Published in BioMed Central on Dec 1, 2016

Canada: Canadian Report highlights a "clear pattern of racism" in media reporting of HIV-related offences

Media accused of racism in reporting HIV-related crime

Black males with HIV account for 20 per cent of the 181 people charged for no disclosing HIV status to sexual partners, but 62 per cent of newspaper articles focused on their cases.

Canadian mainstream media disproportionally focus on black immigrant men criminally charged for not disclosing HIV status to their sexual partners when the majority of offenders are white, says a new study.

To mark World AIDS Day on Wednesday, a team of Canadian researchers released the pioneering study last week identifying “a clear pattern of racism” toward black men in the reporting of HIV non-disclosure in Canadian newspapers.

“The most striking revelation of this report was the grand scale of stereotyping and stigmatizing by Canadian media outlets in their sensationalistic coverage of HIV non-disclosure cases,” said Eric Mykhalovskiy, a York University sociology professor, who leads the team.

“It’s upsetting to read myths masquerading as news and repeating the theme of how black men living with HIV are hypersexual dangerous ‘others.’ This approach not only demeans journalism, but it inflames racism and HIV stigmatization, undermining educational and treatment efforts.”

Based on the database of Factiva, an English-language Canadian newspaper articles from 1989 to 2015, researchers from York, University of Toronto and Lakehead University identified 1,680 reports of HIV non-disclosure cases. Of those reports 68 per cent, or 1,141 of the articles, focused on racialized defendants.

According to court records of HIV-related criminal cases in Canada, African, Caribbean and black men living with HIV, the virus that causes AIDS, account for 20 per cent or 36 of the 181 people charged for these offenses. However, 62 per cent or 1,049 of the 1,680 media reports focused on these 20 per cent of the cases.

Immigrants and refugees receive particularly higher amount of coverage. While only 32 of the 181 accused are known to be migrants to Canada, yet stories about their offences represented 62 per cent (1,046 of 1,680) of the media coverage.

“The report documents the media’s stigmatizing and unjust racial profiling of black heterosexual immigrant men in HIV non-disclosure cases that perpetuates systematic discrimination,” said Christian Hui, an HIV activist and co-founder of the Canadian Positive People Network.

“We know next to nothing about them other than their name, age, residence, occupation, the charges they face,” said the report. “What is distinct about the coverage of African, Caribbean and black male defendants is how (they) are linked with racializing forms of representation in ways that amplify connections between HIV, criminality, race and ‘foreignness.’”

Mykhalovskiy said the research team recognized that accused criminals often refuse to speak with the media at their counsel’s advice, but it does not change the fact black immigrant offenders are disproportionally represented in the coverage.

The study urges the Canadian media to treat HIV non-disclosure as a health issue and not simply a crime story; to stop using mug shots that further stigmatizing and discriminate people with HIV as criminals; and to reach out to AIDS service organizations when interviewing sources for these stories.

Published in The Star, on Dec 1, 2016

HIV Criminalization: Masking Fear and Discrimination (Sero, US, 2016)

A short documentary for the Sero Project produced by Mark S King, written by Christopher King, and edited by Andrew Seger.

Canada: New report explores mainstream Canadian newspaper coverage of HIV non-disclosure criminal cases, highlighting stigmatizing representations of African, Caribbean and Black men living with HIV

Abstract:

This report explores mainstream Canadian newspaper coverage of HIV non-disclosure criminal cases in Canada. It pays particular attention to how defendants’ race and immigration status figure into the newspaper representations of such cases. We empirically enquire into claims that African, Caribbean and Black (ACB) people living with HIV are negatively portrayed and overrepresented in Canadian newspaper stories about HIV non-disclosure cases. Our analysis is based on what, to our knowledge, is the largest data set of news coverage of the issue: a corpus of 1680 English-language Canadian newspaper articles about HIV non-disclosure criminal cases in Canada written between 1 January 1989 and 31 December 2015. Our quantitative and qualitative findings show that Canadian mainstream newspapers are a source of profoundly stigmatizing representations of ACB men living with HIV. For example, Black immigrant men living with HIV are dramatically overemphasized in Canadian mainstream newspaper stories about such cases. While these men account for only 15% of defendants charged they are the focus of 61% of newspaper coverage. Mainstream newspapers rely on forms of language that transfer a long history of exaggerated connections between criminality, race, sex, and otherness to the site of HIV. The result is that ACB men living with HIV are repeatedly represented as dangerous, hypersexual, foreigners who pose a threat to the health and safety of individuals (White women) and, more broadly, the imagined Canadian nation.
The report is available to download here

 

Czech Republic: Police drop charges against all 30 gay men living with HIV following Prague Public Health Authority ‘witch hunt’

All criminal charges have been dropped against the 30 gay men living with HIV who were reported to the police by the Prague Public Health Authority earlier this year after they were diagnosed with an STI, Czech media report today.

The draconian behaviour of Prague Public Health led to widespread condemnation by human rights defenders.

A change.org petition initated by the European AIDS Treament Group (EATG) was signed by more than 1000 supporters, including the HIV Justice Network.

Today’s media report in Aktuálně.cz notes that three of the 30 men had been indicted for potential HIV transmission (under a law criminalising ‘the spread of infectious human diseases‘) but prosecutorial authorities withdrew the charges due to lack of evidence.

Police spokesman, Jan Danek, told the paper that following an investigation there was no case to prove against any of the 30 men and all charges had been dropped.

India: Sex workers organisations oppose Human Trafficking Bill which would make rehabilitation mandatory and HIV transmission a criminal offence

The most pressing concern is that the bill seems to be making rehabilitation mandatory

A consortium of rights bodies, especially of those working for sex workers, have come forward to speak out against the Human Trafficking Bill, which was sent to the Cabinet last month for approval. Associations of sex workers said that they fear that the bill will make it difficult for them to function. The most pressing concern, said Kusum, President of the All India Network of Sex Workers, is that the bill seems to be making rehabilitation mandatory. “Rehabilitation is needed for thousands of women who face trafficking around the country. But scores of practicing sex workers might not want it. Why not make it voluntary,” she says.

Dr Smarajit Jana, a health practitioner and the founder of Durbar Mahila Samanwaya Samiti, the first sex workers collective, agrees. Dr Jana was on a Supreme Court panel on the rights of sex workers, which submitted a report last month. He says that not a single state has statistics on rehabilitation. “Among the secretaries of the women and child development department of over 20 states we interacted with, 15 did not have any number for their own states,” says Dr Jana.

 The definition of a trafficking victim, both Dr Jana and Kusum said, was vague enough to include practicing sex workers. As per the Bill, a sex worker who gets married and has settled down will also come under the ambit of the definition. “There is also a clause that states that if a sex worker is found drinking and smoking with her friends, they can be booked for plying substances to her and punishable for over 10 years,” says Kusum.

Tripti Tandon of the Lawyer’s Collective says that the biggest lacunae in the bill is its failure to distinguish those in need of rescue from those who do not. “Since The Immoral Traffic (Prevention) Act will continue to function, the government is simply creating layer after layer of law, without really taking into account the problems of livelihood, sanitation, health which sex workers face routinely, like every working-class women,” says Tandon.

Another crucial loophole is that the bill states that if a person transmits HIV to another, then they will be punishable for a period of 10 years. “The problem is that many victims do not know if they are HIV positive. Globally, the debate is on decriminalising HIV patients,” says Dr Jana.

Published in DNA India on Nov 5, 2016

Mexico: Civil association in San Luis Potosi State urges parliament to rethink proposition to criminalise HIV transmission

English translation (Para artículo en español, desplácese hacia abajo)

Civil association urges a rethink of the criminalisation of HIV transmission as such an amendment to the penal code would promote higher levels of stigma and discrimination.

San Luis Potosi, SLP.- With regard to the initiative presented during the Ordinary Session No. 44, on October 27, 2016 in the State Congress by the State Governor Juan Manuel Carreras Lopez and Erika Velasquez Gutiérrez, the president of the Women Institute in San Luis Potosi, the civil association Amigos Potosinosen Lucha Contra el Sida condemned the initiative which they say, stigmatize people living with the Human Immunodeficiency Virus (HIV), and have therefore called for reconsideration of the initiative put forward, conveying the following position:

1. It is important to promote actions that recognise the human rights of women through the varied international tools signed and ratified in this matter by the Mexican State,  and which have been become mandatories following the constitutional reform of 2011 in the field of Human Rights.

2. It is not advisable to seek to punish conducts that are perceived to be fraudulent with regard to HIV and other sexually transmitted infections, as the evidence tell us that HIV prevention is not achieved through punitive measures, but by public health policies which promote changes at the structural level, to facilitate equal access to services that guarantee the sexual and reproductive health of women, and also strengthen programmes and activities that promote equality between women and men.

3. Criminalisation promotes stigma and discrimination against people with HIV, including girls, children, adolescents and women, contradictorily promoting actions that violate the dignity of these vulnerable groups.

4. It is very difficult to determine causality, fraud and intention and other varied factors involved in HIV transmission such as: the possibility of transmission, the type of exposure, the use of condoms or not, at what stage of infection the person is, whether the person is on antiretroviral treatment, if their viral load is undetectable, if there is any concomitant infection, the health status of the receiving partner and the agreements between spouses or casual partners, among others.

5. It is important to emphasize that punitive measures such as those intended to legislate through this initiative, could hinder and affect various multisectoral actions in prevention, detection and HIV care in our state.

6. It might influence people who perceive themselves as having  risk factors for HIV, to not undergo testing in order not to know their status and avoid any potential criminal proceedings made possible by testing. Such legislation may affect the continuous detection, prevention and care of HIV in Mexico [1], which seeks to facilitate the early diagnosis of people who perceived themselves to at risk so they can receive timely treatment to improve their quality of life and also help to curb the transmission chain.

7. Scientific evidence indicates that to stop the chain of transmission of HIV from one person to another, it is essential to combine prevention strategies, which include biomedical, behavioural and structural change, the latter emphasizing the need for actions that contribute to the eradication of stigma and discrimination associated with HIV-AIDS, and a punitive law does not contribute to these strategies.

8. The specific content of this initiative “Risk of contagion” could result in the legal responsibility for HIV prevention to fall only on those living with HIV, and could conceal the public health message that sexual partners have shared responsibility for their sexual health. People may mistakenly assume that their partners are HIV-negative because they are unaware of their status or do not disclose it, and they would therefore stop taking preventive measures.

9. Such amendments to the penal code will promote higher levels of stigma and discrimination against diverse HIV populations and their families.

Amigos Potosinos en lucha contra el Sida urges the State governor Juan Manuel Carreras Lopez and Erika Velázquez Gutiérrez president of the Women Institute in San Luis Potosi (sic), to reconsider the criminalization of HIV, as to do so would place people with HIV under a status of being possible criminals, which is contrary to their dignity as persons, violating their human rights and stigmatising them for their health condition.

Better yet, we encourage you to promote the creation of the State Council for the control of HIV, AIDS and STIs in San Luis Potosi, and to increase resources to prevent, detect and address HIV in a timely manner; to improve the quality and comprehensiveness of care services in the State that are provided by CAPASITS and by hospitals in the health system; to generate and strengthen empowerment programs for women and actions that seek to promote equal opportunities between women and men; finally to reduce stigma and discrimination against key populations affected by HIV and other STIs incorporating the MIPA principle [3] which speaks of greater involvement of people living with HIV as part of the solution and response, thereby contributing to a democratic, inclusive and non-discriminatory Mexico.

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Asociación Civil pide reconsiderar tipificar como delito trasmisión del VIH. Este tipo de adecuaciones al código penal promoverán mayores niveles de estigma y discriminación.

San Luis Potosí, SLP.- En relación a la iniciativa presentada, en la Sesión Ordinaria No. 44, día 27 de octubre del 2016 al Congreso del Estado, por el gobernador del Estado Juan Manuel Carreras López y Erika Velázquez Gutiérrez presidenta del Instituto de las Mujeres en San Luis Potosí la asociación civil Amigos Potosinos en Lucha Contra el Sida condenaron la iniciativa que a decir de ellos, estigmatiza a las personas con contagiadas con el Virus de Inmunodeficiencia Humana (VIH), por lo que llaman a reconsiderar la iniciativa formulada, difundiendo el siguiente posicionamiento:

1.- Es importante impulsar acciones a favor del reconocimiento de los derechos humanos de las mujeres en el orden internacional de los diversos instrumentos que en esta materia ha suscrito y ratificado Estado Mexicano, lo cual se convierte en obligatorio a partir de la reforma Constitucional del año 2011 en materia de Derechos Humanos.

2.-No es recomendable buscar castigar las conductas que se perciben como dolosas en relación al VIH y otras infecciones sexuales, ya que la evidencia científica nos señala que la prevención del VIH no se logra con medidas punitivas, sino con políticas en salud pública que faciliten acciones que promuevan cambios a nivel estructural que faciliten la igualdad en el acceso a servicios que garanticen la salud sexual y reproductiva de las mujeres, así también fortalecer los programas y acciones que promuevan la igualdad entre mujeres y hombres

3.- La penalización favorece el estigma y la discriminación hacia personas con VIH, incluyendo a las niñas, niños, adolescentes y mujeres, por lo que resulta contradictorio impulsar acciones que contravienen a la dignidad de estos grupos vulnerables.

4.- Es muy difícil determinar la causalidad, el dolo, la intencionalidad ya que intervienen diversos factores en la trasmisión del VIH, como son: la posibilidad de la trasmisión, el tipo de exposición, el uso o no de condón, la etapa de la infección en la que se encuentra la persona, si lleva tratamiento antirretroviral, si tiene carga viral detectable o indetectable, si existen enfermedades concomitantes, el estado de salud de la pareja receptora y los acuerdos establecidos entre cónyuges o parejas ocasionales, entre otros.

5.- Es importante enfatizar que medidas punitivas como las que se pretende legislar a través de esta iniciativa, podrían obstaculizar y afectar las diversas acciones multisectoriales en materia de prevención, detección y atención del VIH en nuestro Estado.

6.- Podría influir a que las personas que se perciban con factores de riesgo ante el VIH, omitan realizarse una detección temprana a fin de no conocer su estado serológico en virtud de prevenir un posible proceso penal. Este tipo de legislaciones pueden afectar al Continuo de la detección, prevención y atención en VIH en México[1], el cual busca que las personas que se perciban en riesgo se realicen un diagnóstico temprano, puedan recibir un tratamiento oportuno que mejore su calidad de vida y además contribuya a frenar la cadena de transmisión.

7. La evidencia científica señala que para detener la cadena de trasmisión del VIH de una persona a otra es indispensable realizar estrategias de prevención combinada, entre las cuales, destacan las biomédicas, las comportamentales y las de cambio estructural, estas últimas enfatizan las acciones que contribuyen a erradicar el estigma y la discriminación asociado al VIH-sida, y una ley con acciones punitivas no contribuye con estas estrategias.

8.- El contenido en específico de esta iniciativa de “Peligro de contagio” podría provocar que la responsabilidad jurídica de la prevención del VIH recaiga solamente en quienes viven con VIH, y podría invisibilizar el mensaje de salud pública de que las parejas sexuales tienen responsabilidad compartida sobre su salud sexual. Las personas podrían suponer erróneamente que sus parejas son VIH-negativas porque desconocen o no revelan su estado serológico, por tal dejarían de incorporar medidas de prevención.

9.-Este tipo de adecuaciones al código penal promoverán mayores niveles de estigma y discriminación hacia las diversas poblaciones con VIH y sus familias.

Amigos Potosinos en lucha contra el Sida exhorta al gobernador del estado Juan Manuel Carreras López y a Erika Velázquez Gutiérrez presidenta del Instituto de las Mujeres en San Luis Potosí (sic), a reconsiderar la penalización del VIH, de hacerlo colocarían a las personas con VIH bajo un estatus de posibles criminales, contraviniendo a su dignidad como personas, atentando a sus derechos humanos y estigmatizándoles por su condición de salud.

Mejor aún, le exhortamos a impulsar la creación del Consejo Estatal Para el control del VIH, Sida e ITS en San Luis Potosí, además incrementar los recursos  para prevenir, detectar y atender oportunamente el VIH; mejorar la calidad e integralidad de los servicios de atención en el Estado que son otorgados desde los CAPASITS y hospitales del sector salud; generar y fortalecer programas de empoderamiento para las mujeres y acciones que busquen promover la igual de oportunidades entre mujeres y hombres; por último a disminuir el estigma y la discriminación hacia las poblaciones clave y personas afectadas por el VIH y otras ITS incorporando el principio MIPA[3] que habla del mayor involucramiento de las personas con VIH como parte de la solución y respuesta, con ello contribuir a un México democrático, incluyente y sin discriminación.