This 90 minute webinar introduced attendees to some of the concepts and practices highlighted in the Making Media Work for HIV Justice media toolkit, and featured formidable activists, journalists, communications professionals, and human rights defenders working at the intersection of media and HIV criminalisation.
Canadian study finds that fear of prosecution deters some men from testing
Fear of Prosecution Over HIV Non-Disclosure Reduces HIV-Negative MSM Testing
According to a recently published study, fear of prosecution over HIV non-disclosure was reported to reduce HIV testing willingness by a minority of HIV-negative men who have sex with men (MSM).
Even though HIV transmission risk is low with effective antiretroviral therapy (ART), non-disclosure criminal prosecutions among gay, bisexual and other MSM are increasing. Because reduced testing may decrease the impact of HIV ‘test and treat’ strategies, researchers aimed to quantify the potential impact of non-disclosure prosecution on HIV testing and transmission among MSM.
Researchers recruited 150 HIV-negative MSM attending an HIV and primary care clinic in Toronto from September 2010–June 2012. Eligible participants included males 16 years or older, HIV-negative patients, and those that had sex with another man in the previous 12 months.
Participants completed an audio computer-assisted self-interview questionnaire that incorporated demographic and sexual behavior characteristics. HIV-negative participants were asked whether concern over non-disclosure prosecution altered the likelihood of HIV testing. Answers were based on a 5-point Likert scale that ranged from much less likely to much more likely to be tested.
Responses were characterized utilizing cross-tabulations and bivariate logistic regressions, while flowcharts modeled how changes in HIV testing behaviour impacted HIV transmission rates controlling for ART use, condom use and HIV status disclosure.
Findings concluded that 129 HIV-negative participants answered the question about concern of prosecution affecting HIV-testing decisions. Seven (5.4%) were much less likely to get tested, 2 (1.6%) were less likely to get tested, 90 (69.8%) reported no change, 11 (8.5%) were more likely to get tested and 14 (10.9%) were much more likely to get tested.
A total of 7% (9/124) were less or much less likely to be testing due to concern over future prosecution. There was no obvious socio/sexual demographic characteristics associated with decreased willingness of HIV testing to due concern.
Researchers estimated that this 7% reduction in testing could cause an 18.5% increase in community HIV transmission and that 73% is driven by unmet needs of HIV-positive undiagnosed MSM individuals.
“This reduction has the potential to significantly increase HIV transmission at the community level which has important public health implications,” study authors said in the study. “There are also great concerns surrounding how negative, crime-related framing of media reports and discourse surrounding HIV criminalization cases could deter HIV testing and increase HIV stigma and discrimination. Hence, HIV criminalization laws could also make disclosure and/or condom use conversations even harder.”
Study limitations include the fact that a clinic-based recruitment was used, which could lead to selection bias with respect to MSM seeking primary care. There was also not sufficient variability in the outcome in order to carry out a multivariable analysis.
Even though the full impact of non-disclosure laws are unclear, decreasing the population on ART through reduction in HIV testing will not reduce transmissions. Future studies are needed to determine the awareness and knowledge of HIV criminalization laws among HIV-positive and HIV-negative individuals. It’s also unclear if never having had a positive HIV test would be a legitimate argument against possible future prosecution.
The study, “Prosecution of non-disclosure of HIV status: Potential impact on HIV testing and transmission among HIV-negative men who have sex with men” was published February 2018 in PLOS One.
Published in MD Magazine on April 1, 2018
HIV Criminalization in Canada: Testimonials (Alexander McClelland / Canadian HIV/AIDS Legal Network, 2018)
http://www.hivcriminalization.ca/testimonials/
Australia: Interview with David Kernohan, CEO of the WA Aids Council, on U=U and law reform in Western Australia
How can we change the laws regarding HIV transmission & criminal offences in WA?
The conviction of one & charging of another HIV+ individual in Western Australia with recklessly causing grievously bodily harm by transmitting HIV to another individual has left many in the HIV+ communities concerned, what does this mean for them, their past and the way in which people perceive them?
Dean Arcuri continues his conversation with CEO of the WA Aids Council.
This episode of The Informer aired on JOY 94.9 on 14th March 2018
https://joy.org.au/theinformer/?powerpress_pinw=3320-podcast
Published on JOY 94.9 on 14th March 2018
New Toolkit Supports Advocates in Using Media to Fight for HIV Justice
When it comes to the widely misunderstood, complex issue of HIV criminalisation, media can be a powerful tool–or a blunt-force weapon.
And so today, as people around the world living with HIV continue to be criminalised and convicted at alarming rates, HIV JUSTICE WORLDWIDE has released “Making Media Work for HIV Justice: An introduction to media engagement for advocates opposing HIV criminalisation.”
The new resource is the latest addition to the HIV JUSTICE Toolkit, which provides resources from all over the world to assist advocates in approaching a range of advocacy targets, including lawmakers, prosecutors and judges, police, and the media.
The purpose of this critical media toolkit is to inform and equip global grassroots advocates who are engaged in media response to HIV criminalisation–and to demystify the practice of working with, and through, media to change the conversation around criminalisation.
“As advocates work to build community coalitions and consensus about the importance of limiting and ending HIV criminalisation, we need to articulate our common positions to the public and to decision-makers; thus, working with the media is critically important,” says Richard Elliott, Executive Director of the Canadian HIV/AIDS Legal Network and a member of the HIV JUSTICE WORLDWIDE Steering Committee. “Also, particularly in settings where sexual assault laws are used to criminalise people living with HIV, it is important to communicate via the media why this misuse of the criminal law is harmful to women.”
The toolkit provides an introduction to the topic of HIV criminalisation and the importance of engagement with media to change narratives around this unjust practice. The toolkit also includes reporting tips for journalists, designed to educate writers and media makers around the nuances of HIV criminalisation, and the harms of inaccurate and stigmatising coverage.
Positive Women’s Network – USA (PWN-USA), the HIV JUSTICE WORLDWIDE Steering Committee member organisation that produced the toolkit, has been working on HIV criminalisation for many years, and was an instrumental part of the coalition that brought HIV criminal law reform to the US state of California.
“With HIV rarely making front page news anymore, the highly sensationalised reporting of criminalisation cases–which most often contains little in the way of facts or science–paints a dehumanising picture of people living with HIV,” says Jennie Smith-Camejo, Communications Director for PWN-USA. “This kind of coverage can and does destroy real lives of those affected by HIV criminalisation laws, while fueling and feeding misinformation and stigma.”
The toolkit also includes a number of case studies providing examples of how media played a significant role in the outcome, or the impetus, of HIV criminalisation advocacy.
“I have been monitoring media coverage of speculations, arrests, prosecutions, and convictions of people living with HIV, and also legal and policy proposals for new laws and/or reform, for more than a decade,” notes Edwin J Bernard, Global Co-ordinator of the HIV Justice Network and a member of the HIV JUSTICE WORLDWIDE coalition. “It’s time for the injustice to end. ‘Making Media Work for HIV Justice’ is a long-overdue welcome addition to the HIV JUSTICE Toolkit, and an important step towards realising a world where people living with HIV are not singled out by the criminal justice system simply for having a virus.“
“Making Media Work for HIV Justice: An introduction to media engagement for advocates opposing HIV criminalisation” was supported by a grant from the Robert Carr Fund for Civil Society Networks. It will also be translated into French, Spanish, and Russian later this year.
Webinar: Making Media Work for HIV Justice
This 90 minute webinar introduced attendees to some of the concepts and practices highlighted in the toolkit, and featured formidable activists, journalists, communications professionals, and human rights defenders working at the intersection of media and HIV criminalisation.
About HIV JUSTICE WORLDWIDE
HIV JUSTICE WORLDWIDE is an initiative made up of global, regional, and national civil society organisations–most of them led by people living with HIV–who are working together to build a worldwide movement to end HIV criminalisation. All of the founding partners have worked individually and collectively on HIV criminalisation for a number of years.
HIV JUSTICE WORLDWIDE is run by a 10-member Steering Committee: AIDS Action Europe / European HIV Legal Forum; AIDS-Free World; AIDS and Rights Alliance for Southern Africa (ARASA); Canadian HIV/AIDS Legal Network; Global Network of People Living with HIV (GNP+); HIV Justice Network; International Community of Women Living with HIV (ICW); Positive Women’s Network – USA (PWN-USA); Sero Project (SERO); and Southern Africa Litigation Centre (SALC).
To learn more and to join the movement, visit: http://www.hivjusticeworldwide.org.
Download the media release as a pdf here: http://bit.ly/HIVJusticeToolkitMediaRelease
France: HIV criminalisation laws have a disproportionate impact on women
HIV: The share of women!
For the 8th of March, International Women’s Rights Day, Seronet takes stock of some figures on HIV related to women worldwide.
HIV in the world: women’s numbers
In 2015, globally, about 17.8 million women (aged 15 and over) were living with HIV, equivalent to 51% of the total population living with HIV. About 900,000 of the 1.9 million new HIV infections worldwide in 2015 – 47 percent – were women. It is young women and girls aged 15 to 24 who are particularly affected. Globally, about 2.3 million adolescent girls and young women were living with HIV in 2015, representing 60% of the entire population of young people (aged 15 to 24) living with HIV. 58% of new HIV infections among 15-24 year olds in 2015 were among adolescent girls and young women.
According to the same source, regional differences in new cases of HIV infection among young women and the proportion of women (aged 15 and over) living with HIV compared to men are considerable. They are even more important between young women (aged 15 to 24) and infected young men. In sub-Saharan Africa, 56% of new HIV infections occurred in women, and the rate was even higher among young women aged 15 to 24, accounting for 66% of new infections.
In the Caribbean, women accounted for 35% of newly infected adults, and 46% of new infections occurred among young women aged 15 to 24 years. In Eastern Europe and Central Asia, 31% of new cases of HIV infection have affected women; however, the rate of new infections among young women aged 15 to 24 reached 46%. In the Middle East and North Africa, women represent 38% of newly infected adults, while 48% of young women aged 15 to 24 are newly infected. In Western Europe, Central Europe and North America, 22% of new infections occurred in women, the highest rate among young women aged 15 to 24, with 29% of new infections (1).
Inequalities between women themselves
Some women are more exposed to HIV than others. This is a function of belonging to certain groups. The incidence of HIV in specific groups of women is disproportionate. According to an analysis of studies measuring the cumulative prevalence of HIV in 50 countries, it is estimated that sex workers around the world are about 14 times more likely to be infected with HIV than other women of childbearing age. (2). In addition, data from 30 countries indicate that the cumulative prevalence of HIV among women who inject drugs was 13%, compared to 9% among men who inject drugs (3).
A feminization of the HIV epidemic in France
Over the years, the HIV / AIDS epidemic has been strongly feminized in France too: the share of new diagnoses has increased in France from 13% in 1987 to 33% in 2009. Heterosexual contamination is the main vector of HIV transmission (54% of HIV-positive discoveries) and women make up the majority of these infections. Compared to men, they are infected younger.
In France, women account for about 30% of new HIV infections each year, a significant proportion of whom are born abroad and especially in sub-Saharan Africa. If we look at the 2016 data, we note that among heterosexuals, the majority of diagnostics relates to 2,300 people born abroad. 80% are born in sub-Saharan Africa and 63% are women. Late-stage discoveries are more specific to men than women.
Migrant women, in greater numbers than men in France, suffer more problems related to sexual health: complications specific to pregnancy and childbirth and sexual violence. These states are dependent on the conditions of the country of origin (sexual mutilation, forced marriages), and migration (rape, trafficking in human beings). They can be strengthened upon arrival in the host country, as the period of installation often corresponds to a period of health and social precariousness, which increases the risks of exposure to HIV and sexually transmitted infections.
What factors exacerbate the prevalence of HIV?
It’s obvious … but it’s worth remembering. Violence against women and girls increases their risk of HIV infection (4). A study in South Africa found that the link between intimate partner violence and HIV was more pronounced in the presence of domineering behaviour and high HIV prevalence.
In some settings, up to 45% of adolescent girls report that their first sexual experience was forced. Worldwide, more than 700 million women alive today were married before their eighteenth birthday. Often, they have limited access to prevention information and limited means to protect themselves from HIV infection. Worldwide, out of ten adolescent girls and young women aged 15 to 24, only three of them have complete and accurate knowledge of HIV (5). Lack of information on HIV prevention and the inability to use such information in the context of sexual relations, including in the context of marriage, undermine women’s ability to negotiate condom use and engage in safer sex, says UN Women.
Seropositivity: a double sentence for women
Other data indicate that women living with HIV are at increased risk of violence (6), including violations of their sexual and reproductive rights (reproductive health). Cases of involuntary or forced sterilization and forced abortions among women living with HIV have been reported in at least fourteen countries. In addition, legal standards directly affect the level of risk for women to contract HIV, says the UN Women. In many countries where women are most at risk, the laws that are supposed to protect them are ineffective. The lack of legal rights reinforces women’s subordinate status, particularly with regard to women’s rights to divorce, to possess and inherit property, to enter into contracts, to prosecute and to testify in court, to consent to medical treatment and open a bank account. Discriminatory laws on the criminalization of HIV transmission can also have a disproportionate impact on women, as they are more vulnerable to being tested for HIV and to find out whether or not they are infected with HIV when they access healthcare for their pregnancy. HIV-positive mothers are considered criminals under HIV-related laws in several countries in West and Central Africa, which explicitly or implicitly prohibits them from being pregnant or breastfeeding. for fear that they might transmit the virus to the fetus or to the child (7).
The response to HIV for women
Globally, between 76% and 77% of pregnant women have had access to antiretroviral drugs to prevent mother-to-child transmission of HIV, says UN Women (data for 2015). Despite this encouraging rate, more than half of the 21 priority countries of the UNAIDS Global Plan were unable to meet the need for family planning services for at least 25% of all married women. Another element is that governments are increasingly recognizing the importance of gender equality in HIV interventions at the national level. However, only 57% (out of the 104 countries that submitted data) had a specific budget. For their part, Global Fund expenditures on women and girls have increased from 42 percent of its total portfolio in 2013 to about 60 percent in 2015.
(1): UNAIDS, 2015 estimates from the AIDSinfo online database. Additional disaggregated data correspond to unpublished estimates provided by UNAIDS for 2015, derived from country-specific AIDS epidemic models.
(2) : Stefan Baral and al. (15 mars 2012), “Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis”, The Lancet Infectious Diseases, vol. 12, no 7. p. 542.
(3) : UNAIDS (2014) The Gap Report, p. 175.
(4) : R. Jewkes and al. (2006) « Factors Associated with HIV Sero-Status in Young Rural South African Women: Connections between Intimate Partner Violence and HIV », International Journal of Epidemiology, 35, p. 1461-1468 ;
(5) : UNAIDS (2015) 2015 Report on World AIDS Day “On the Fast-Track to end AIDS by 2030: Focus on Location and Population“, p. 75.
(6) : WHO and UNAIDS (2010) “Addressing violence against women and HIV/AIDS: What works?“, p. 33.
(7) : Commission mondiale sur le VIH et le droit (2012) « Risques, droit et santé », p. 23.
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VIH : La part des femmes!
A l’occasion du 8 mars, Journée international des droits des femmes, Seronet fait le point sur quelques chiffres relatifs au VIH concernant les femmes dans le monde.
VIH dans le monde : la part des femmes
En 2015, à l’échelle mondiale, environ 17,8 millions de femmes (âgées de 15 ans et plus) vivaient avec le VIH, soit 51 % de toute la population vivant avec le VIH. Environ 900 000 des 1,9 million des nouveaux cas d’infection par le VIH constatés dans le monde en 2015 – soit 47 % – ont concerné des femmes. Ce sont les jeunes femmes et les adolescentes de 15 à 24 ans qui sont particulièrement touchées. A niveau mondial, environ 2,3 millions d’adolescentes et de jeunes femmes vivaient avec le VIH en 2015, représentant 60 % de toute la population de jeunes (de 15 à 24 ans) vivant avec le VIH. 58 % des nouveaux cas d’infection par le VIH chez les jeunes de 15 à 24 ans en 2015 touchaient des adolescentes et des jeunes femmes.
Selon la même source, les différences régionales concernant les nouveaux cas d’infection par le VIH chez les jeunes femmes et la proportion de femmes (âgées de 15 ans et plus) vivant avec le VIH par rapport aux hommes sont considérables. Elles sont encore plus importantes entre les jeunes femmes (âgées de 15 à 24 ans) et les jeunes hommes infectés. En Afrique subsaharienne, 56 % des nouveaux cas d’infection par le VIH ont touché des femmes, et ce taux a été encore plus élevé chez les jeunes femmes de 15 à 24 ans, représentant 66 % des nouveaux cas d’infection.
Dans les Caraïbes, les femmes ont représenté 35 % des adultes nouvellement infectés, et 46 % des nouveaux cas d’infections ont touché les jeunes femmes de 15 à 24 ans. En Europe de l’Est et en Asie centrale, 31 % des nouveaux cas d’infection par le VIH ont touché des femmes ; toutefois, le taux des nouveaux cas d’infection touchant les jeunes femmes de 15 à 24 ans a atteint 46 %. Au Moyen-Orient et en Afrique du Nord, les femmes représentent 38 % des adultes nouvellement infectés, alors que 48 % des jeunes femmes de 15 à 24 ans sont nouvellement infectées. En Europe occidentale, en Europe centrale et en Amérique du Nord, 22 % des nouveaux cas d’infection ont touché des femmes, ce taux étant plus élevé chez les jeunes femmes de 15 à 24 ans, avec 29 % de nouveaux cas d’infection (1).
Des inégalités entre les femmes elles-mêmes
Certaines femmes sont plus exposées au VIH que d’autres. C’est notamment fonction de l’appartenance à certaines groupes. L’incidence du VIH sur certains groupes spécifiques de femmes est disproportionnée. Selon une analyse d’études mesurant la prévalence cumulée du VIH dans 50 pays, on estime que, dans le monde, les travailleuses du sexe ont environ 14 fois plus de risques d’être infectées par le VIH que les autres femmes en âge de procréer (2). Par ailleurs, d’après des données émanant de 30 pays, la prévalence cumulée du VIH chez les femmes qui consomment des drogues injectables était de 13 %, contre 9 % chez les hommes qui consomment des drogues injectables (3).
Une féminisation de l’épidémie de VIH en France
Au fil des années, l’épidémie à VIH/sida s’est fortement féminisée en France aussi : la part de nouveaux diagnostics est passée, en France, de 13 % en 1987 à 33 % en 2009. La contamination hétérosexuelle est le principal vecteur de transmission du VIH (54 % des découvertes de séropositivité) et les femmes constituent la majorité de ces contaminations. Par rapport aux hommes, elles sont contaminées plus jeunes.
En France, les femmes représentent environ 30 % des nouvelles contaminations par le VIH chaque année, une part importante d’entre elles sont nées à l’étranger et en particulier en Afrique subsaharienne. Si on regarde les données de 2016, on note que les hétérosexuels, la majorité des découvertes de séropositivité est constituée par les 2 300 personnes nées à l’étranger. Il s’agit à 80 % de personnes nées en Afrique subsaharienne et à 63 % de femmes. Les découvertes à un stade avancé concernent plus particulièrement les hommes que les femmes.
Les femmes migrantes, en plus grand nombre que les hommes en France, subissent plus de problèmes liés à la santé sexuelle : complications propres à la grossesse et à l’accouchement, violences sexuelles. Ces états sont dépendants des conditions du pays d’origine (mutilations sexuelles, mariages forcés), et du parcours migratoire (viols, trafic d’êtres humains). Ils peuvent être renforcés à l’arrivée dans le pays d’accueil, la période d’installation correspondant souvent à une période de précarité sanitaire et sociale, qui accroît les risques d’exposition aux VIH et aux infections sexuellement transmissibles.
Quels facteurs exacerbent la prévalence du VIH ?
C’est une évidence… mais qu’il est bon de rappeler. La violence à l’égard des femmes et des filles augmente leurs risques d’infection par le VIH (4). Une étude menée en Afrique du Sud a démontré que le lien entre la violence infligée par un partenaire intime et le VIH était plus marqué en présence d’un comportement dominateur et d’une prévalence élevée du VIH.
Dans certains contextes, jusqu’à 45 % des adolescentes indiquent que leur première expérience sexuelle a été forcée. Dans le monde, plus de 700 millions de femmes en vie aujourd’hui ont été mariées avant leur dix-huitième anniversaire. Souvent, elles disposent d’un accès restreint aux informations de prévention, et de moyens limités pour se protéger contre une infection par le VIH. A l’échelle mondiale, sur dix adolescentes et jeunes femmes de 15 à 24 ans, seulement trois d’entre elles ont des connaissances complètes et exactes sur le VIH (5). Le manque d’informations sur la prévention du VIH et l’impossibilité d’utiliser de telles informations dans le cadre de relations sexuelles, y compris dans le contexte du mariage, compromettent la capacité des femmes à négocier le port d’un préservatif et à s’engager dans des pratiques sexuelles plus sûres, rappelle l’ONU Femmes.
La séropositivité : une double peine pour les femmes
D’autres données indiquent que les femmes vivant avec le VIH sont davantage exposées à des actes de violence (6), y compris des violations de leurs droits sexuels et génésiques (la santé reproductive). Des cas de stérilisation involontaire ou forcée et d’avortements forcés chez les femmes vivant avec le VIH ont été signalés dans au moins quatorze pays. De plus, les normes juridiques affectent directement le niveau de risque pour les femmes de contracter le VIH, rappelle l’Onu Femmes. Dans bon nombre de pays où les femmes y sont le plus exposées, les lois qui sont censées les protéger sont inefficaces. Le manque de droits juridiques renforce le statut de subordination des femmes, en particulier au regard des droits des femmes de divorcer, de posséder et d’hériter de biens, de conclure des contrats, de lancer des poursuites et de témoigner devant un tribunal, de consentir à un traitement médical et d’ouvrir un compte bancaire. Par ailleurs, les lois discriminatoires sur la criminalisation de la transmission du VIH peuvent avoir des répercussions disproportionnées sur les femmes, car elles sont plus exposées à être soumises à des tests de dépistage et ainsi à savoir si elles sont ou non infectées lors de soins au cours de la grossesse. Les mères séropositives sont considérées comme des criminelles en vertu de toutes les lois relatives au VIH en vigueur dans plusieurs pays en Afrique de l’Ouest et en Afrique centrale, ce qui leur interdit, explicitement ou implicitement, d’être enceintes ou d’allaiter, de crainte qu’elles transmettent le virus au fœtus ou à l’enfant (7).
La réponse face au VIH pour les femmes
A l’échelle mondiale, entre 76 et 77 % des femmes enceintes ont eu accès à des médicaments antirétroviraux pour prévenir la transmission du VIH de la mère à l’enfant, indique l’Onu Femmes (données pour 2015). Malgré ce taux encourageant, plus de la moitié des 21 pays prioritaires du Plan mondial d’Onusida ne parvenaient pas à répondre aux besoins en services de planning familial d’au moins 25 % de l’ensemble des femmes mariées. Autre élément : les gouvernements reconnaissent de plus en plus l’importance de l’égalité des sexes dans les interventions face au VIH qui sont menées à l’échelle nationale. Cependant, seulement 57 % (sur les 104 pays qui ont soumis des données) d’entre eux disposaient d’un budget spécifique. De leur côté, les dépenses du Fonds mondial de lutte contre le sida consacrées aux femmes et aux filles ont augmenté, passant de 42 % de son portefeuille total en 2013 à environ 60 % en 2015.
(1) : Onusida, estimations de 2015 provenant de la base de données en ligne AIDSinfo. Les données désagrégées supplémentaires correspondent aux estimations non publiées fournies par l’Onusida pour 2015, obtenues à partir de modèles des épidémies de sida spécifiques aux pays.
(2) : Stefan Baral et al. (15 mars 2012), “Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis”, The Lancet Infectious Diseases, vol. 12, no 7. p. 542.
(3) : Onusida (2014) The Gap Report, p. 175.
(4) : R. Jewkes et al. (2006) « Factors Associated with HIV Sero-Status in Young Rural South African Women: Connections between Intimate Partner Violence and HIV », International Journal of Epidemiology, 35, p. 1461-1468 ;
(5) : Onusida (2015) Rapport 2015 sur la Journée mondiale de lutte contre le sida “On the Fast-Track to end AIDS by 2030: Focus on Location and Population“, p. 75.
(6) : L’OMS et ONUSIDA (2010) “Addressing violence against women and HIV/AIDS: What works?“, p. 33.
(7) : Commission mondiale sur le VIH et le droit (2012) « Risques, droit et santé », p. 23.
Published in Seronet on March 7, 2018
Sean Strub Harvard Lecture: HIV Criminalization: Creating a Viral Underclass in the Law (US, 2018)
HLS Lambda hosted this lecture on HIV stigma, criminalization, and activism.
Sean Strub is a longtime HIV survivor, founder of POZ magazine, director of the Sero Project, and an advocate for people living with HIV. He is the author of Body Counts: A Memoir of Politics, AIDS, Sex, and Survival. His short film, HIV Is Not a Crime, introduced the problem of HIV criminalization to audiences worldwide. A longtime activist, Strub was the first openly HIV-positive person to run for the U.S. Congress. He has also produced the off-Broadway hit The Night Larry Kramer Kissed Me, and served as a member of the board of the Global Network of People Living with HIV.
For more information, visit our website at: petrieflom.law.harvard.edu/events/details/hiv-criminalization-lambda
Ukraine: HIV stigma, threats of violence and a culture of blame make women fearful of disclosing their status or seeking care
Women with HIV abused by partners, rejected by society
Shunned by relatives, doctors and the community, Ukrainian women struggle to survive and protect their children.
Kiev, Ukraine – In October 2012, 31-year-old Hanna Lilina, a Donetsk-native, was told she had HIV during a pre-natal check-up.
When she found out, she felt confused.
“I started to clean my apartment obsessively as if people could contract HIV just by touching a surface. I didn’t understand it, I was so afraid and paranoid,” she says.
Lilina became infected with HIV after having unprotected sex with her boyfriend, whom she suspects contracted the virus by sharing a needle with friends who injected opium.
He had been an abusive partner, and so by the time she discovered she had the virus, they had already parted ways.
“At first, it was just emotional abuse. Then he started to beat me, especially after he had been drinking. It was always worse then,” she says.
Lilina left her partner to rebuild her life in Kiev.
“Telling my family was difficult. My parents were shocked and upset at first but now they’re very supportive. However, my sister immediately assumed that I was a drug addict. She hates me and wants nothing to do with me.”
In Kiev, she started a new relationship.
But when her new boyfriend found out about the virus, “he started acting differently around me”, she says.
“When I was seven months pregnant, he tried to get me to have an abortion. By the time the baby was born, he had left me.”
Ukraine has one of the fastest growing HIV epidemics in Eastern Europe and Central Asia, with approximately 240,000 people living with the virus and a prevalence of 0.9 percent in the general adult population.
In Ukraine, 35 percent of women living with HIV have experienced violence from a partner or husband since the age of 15, compared to 19 percent of women who do not have HIV, according to a November 2016 survey by Positive Women, a Ukrainian NGO.
Approximately half of the 1,000 HIV-positive women surveyed across the country had no support after they suffered violence.
“There is an epidemic of gender-based violence in many regions of the world, disproportionately affecting women and girls, making them more vulnerable to becoming infected with HIV,” Vinay P. Saldanha, UNAIDS regional director for Eastern Europe and Central Asia, tells Al Jazeera.
‘A culture of blame’
According to UN Women, women living with HIV are more likely to experience violence, including violations of their sexual and reproductive rights.
“Involuntary and coerced sterilisation and forced abortion among women living with HIV has been reported in at least 14 countries worldwide,” UN Women reports.
“The relationship between violence and HIV is complicated, but a significant factor is the culture of blame that surrounds HIV.
“In Eastern Europe and Central Asia, as in many other regions, the blame for HIV tends to fall on women,” says Saldanha.
Women are also often the first in a couple to learn of HIV in the family as the coverage of HIV testing and treatment in Ukraine is higher among women.
Most women are tested for HIV at least once at gynaecology and obstetrics clinics.
“It can tragically unfold that her husband or sexual partner points the finger of blame at her, even if her male partner was the one to infect her with HIV.
“In such a situation, she is at potential risk of domestic and sexual violence.”
The consequences can be life-threatening.
“As a result, a woman’s de-facto response can be to refrain from telling her family or partner that she has HIV, and she might even be too afraid to seek out the life-saving health services available,” says Saldanha.
And even if a woman does want treatment, it is not always guaranteed.
In some cases, women are unable to access medical support because their partners refuse to pay for travel to the hospital.
“‘You can get treatment, just not with my money,’ is what they say. But when a woman is financially dependent, what can she do?,” says Sofia, an HIV-positive officer working for the All-Ukrainian Network of People Living with HIV/AIDS, the country’s largest patient organisation.
The situation became so precarious that in May 2017, the Positive Women NGO filed a joint report to the United Nations on the violations of women’s rights, along with other civil society organisations representing drug-users, sex workers and members of the LGBT community.
“In small towns and the provinces, the situation is particularly difficult. It can be impossible for an HIV-positive woman to find a gynaecologist who will voluntarily examine or simply look at her,” says a member of Positive Women, who wished to remain anonymous.
“It’s only on the orders of high authorities that doctors will agree to an examination. And these are cases involving ‘safe’ women.”
If a woman is considered “unsafe” – an alcoholic, drug-user or sex worker – she cannot even enter a doctor’s office.
A community’s attitude to HIV can be so unsupportive that patients are often harassed or forced out.
“Doctor’s attitudes are not much better,” says the Positive Women member.
Sterilisation threats and protecting children
The group’s report to the UN detailed the case of Vera, a sex worker from the Kirovograd region who underwent a caesarean section to deliver her baby.
After the procedure, the 24-year-old was told that she had been sterilised because, in the words of her doctor, she had “no right to build a family and have children”.
“Over a year and a half later, Vera is still coming to terms with what happened to her,” said the Positive Women member.
Mothers are also challenged with having to protect their children from discrimination.
Olga Rudneva, head of the Elena Pinchuk ANTIAIDS Foundation (ANTIAIDS) in Kiev, tells Al Jazeera that mothers often hide their children’s HIV status.
“If, for example, a school director finds out that a student has HIV, the child could be kicked out.
“This leaves some women in extremely poor financial situations, unable to work because they must look after their child. Women prefer to just to pay for a clean medical record to avoid such problems – you can do that in Ukraine,” she says.
Lilina, the HIV patient and domestic abuse survivor, says her daughter’s paediatrician tried to inform her school of the child’s HIV status.
With the help of ANTIAIDS, she managed to block the doctor’s attempt.
“[He] was certainly not happy when he finally agreed to keep my status confidential,” says Lilina.
Government officials failed to respond to Al Jazeera’s repeated requests for comment.
But the Ukrainian government is taking this situation “very seriously”, says UNAIDS’ Saldanha.
In 2017, the National Coordination Council on preventing HIV/AIDS in Ukraine (NCC) accepted two representatives from Positive Women to help create an HIV/AIDS strategy over the next five years.
ANTIAIDS’ Rudneva says there is more to be done, however.
“If you have HIV, you deserve HIV. That’s the mentality in this country,” she says.
The foundation gave Lilina the support to start rebuilding her life in Kiev, helping her helping her find accommodation and providing her baby with a supply of nappies.
It also encouraged her to join Kyyanka, a support group.
At first, Lilina was sceptical and it took her a while to go to a meeting.
“But now the women are like my family,” she says. “It wasn’t until I joined Kyyanka that I understood how I’d been struggling with self-stigma and repressing negative feelings about myself.
“The self-stigma is still there, but at least I’m aware of it now. It’s only when you’re aware of the stigma, that you can start to fight against it.”
Published in Al Jazeera News on February 25, 2018
Lawyers for HIV and TB Justice 2018 Training (Johannesburg, 2018)
This playlist contains recordings of a training for lawyers on strategic litigation, legal defense and advocacy on HIV and TB justice from 20-23 February 2018 in Johannesburg, South Africa by the Southern Africa Litigation Centre (SALC), HIV Justice Worldwide, the Joint United Nations Programme on HIV/AIDS (UNAIDS), the Stop TB Partnership, the AIDS and Rights Alliance for Southern Africa (ARASA), and the Kenya Legal & Ethical Issues Network on HIV and AIDS (KELIN). The training was funded under the Africa Regional Grant on HIV: Removing Legal Barriers. Resources and more information on the training are available here: http://www.southernafricalitigationce… With thanks to Nicholas Feustel of Georgetown Media.
Webinar: PWN-USA HIV Criminalization First Responders Series: Combating Stigmatizing Reporting (PWN-USA, 2018)
The third and final webinar in the First Responder series focuses on working with the media. Hosted by Kamaria Laffrey (Sero) and featuring presentations from Carrie Foote (HIV Modernization Movement, Indiana) and Olivia G Ford (former PWN-USA Comms Dirctor).