California Health Care Services said taxpayers are paying nearly $30,000 to treat one patient with HIV/AIDS every year. That’s $28,800 for medications and $655.44 for labs. “That cost doesn’t even include clinical staff, diagnostic studies, or other costs,” said Joyce Hayhoe, Director of Legislation and Communications for California Health Care Services.
US: Sero Project and Transgender Law Center highlight the threat to transgender health created by HIV criminalisation
People living with HIV (PLHIV) who identify as transgender or third sex are more likely than any other group to feel that it is reasonable to avoid HIV testing (58%), disclosure of one’s HIV positive status to sex partners (61%) or accessing HIV treatment (48%) because of fear of HIV criminalization and distrust of the U.S. criminal justice system. The new findings from the National HIV Criminalization Survey were presented at the National Transgender Health Summit on May 15, 2013.
“These findings don’t surprise us,” said Cecilia Chung, Senior Strategist at the Oakland, California-based Transgender Law Center. “The data speaks to the long-standing history of stigmatization and discrimination of trans people, especially trans people of color, by the criminal justice system, because of either their race or their gender identity.” Chung was the first trans woman elected to chair the San Francisco Human Rights Commission, and she is currently a board member of the Global Network of People Living with HIV (GNP+).
More than 3,000 people living with and affected by HIV participated in the National HIV Criminalization Survey from June to August 2012, conducted online by the Sero Project in conjunction with Eastern Michigan University. The principal investigator, Laurel Sprague, is the Sero Project’s Research Director, Regional Coordinator of GNP+ North America, and a PhD candidate at Wayne State University in Detroit, Michigan.
Sprague noted, “Laws that criminalize non-disclosure of HIV status raise key issues about community norms, expectations of fair treatment by authorities, privacy and the increased vulnerability of certain communities.”
While the results revealed that HIV criminalization can discourage HIV testing—nearly 25% of HIV-positive respondents said that they knew one or more people who did not get tested for fear of criminal prosecution—when researchers returned to the survey results to closely examine transgender and third sex responses, they found that these particular respondents faced increased levels of vulnerability in relation to the U.S. justice system.
The majority of transgender and third sex respondents living with HIV (57%) reported that they feared false accusations of non-disclosure either a few times or frequently—a figure higher than that of any other group surveyed. Only 14% of transgender and third sex respondents living with HIV felt that a U.S. person living with HIV could get a fair court hearing if accused of non-disclosure.
When transgender and third sex respondents were asked their opinions about HIV criminalization, two out of three respondents (67%) said that non-disclosure of HIV status should not be criminalized. When asked if a sex worker living with HIV should disclose to clients, most transgender and third sex respondents (41%) said it depends on the circumstances. In fact, transgender and third sex respondents were the most likely to focus on the context (“it depends on the circumstances”) when determining whether there should be criminal charges for non-disclosure related to sex, drug use or sex work.
The transgender community’s historically fraught relationship with public health authorities, law enforcement and the criminal justice system also likely affects transgender and third sex attitudes about HIV criminalization.
Sprague shared a range of quotes from the survey to illustrate various nuanced transgender and third sex experiences and opinions regarding HIV criminalization:
• One trans woman explained why she didn’t press charges for non-disclosure: “In order to file charges, I [would have] had to disclose my rape, my [HIV] status and I would have to give up my privacy and be subjected to public scrutiny.”
• A third sex respondent said, “I think in cases of rape, incest and other power- or force-related situations, prosecutions should go forward. Otherwise, NO!”
• Another trans woman said that she didn’t press charges for non-disclosure because of the “difficulty in proving in court that he had infected me—and also accepting that we took equal risk in being intimate without protection.”
For policy makers and public health workers, the transgender and third sex responses to Sero’s National HIV Criminalization Survey should raise concern, especially the survey results that show increased barriers to HIV testing and treatment, as well as deep feelings of legal vulnerability due to HIV criminalization.
The responses highlight a critical need for access to legal education and legal services, safe and confidential locations for accessing health care, and support for spaces where transgender people living with HIV can share their experiences, provide mutual support, and work together to identify resilience strategies and advocacy priorities.
Canada: New guide offers practical advice to HIV nurses and clarifies professional obligations regarding HIV and the criminal law
A new guide which aims to address some of the realities and complexities faced by nurses and others who provide care to people living with HIV in Canada, is now available.
Covering everything from record keeping, confidentiality, viral load and safer sex to search warrants, subpoenas and testifying in court, it offers practical advice to HIV nurses and helps clarify their professional obligations regarding isues around HIV (non)disclosure and the criminal law.
Developed by the Canadian Association of Nurses in AIDS Care (CANAC) in partnership with CATIE (Canadian AIDS Treatment Information Exchange), it was written in February 2013, four months after the release of the Supreme Court of Canada decisions in the cases of R. v. Mabior and R. v. D.C.
The guide is an extremely important resource at a very difficult and confusing time in Canada – not only for people living with HIV, but also those who work with, or advocate for them. Although the guide covers legal and scientific complexities around (non)disclosure that are specific to the Canadian context, it may also be helpful for HIV service providers in other jurisdictions. At the very least, this is a ‘best practice’ model for others to emulate.
This excerpt from the introduction provides a good overview of the content and tone of the guide, which can be ordered and/or downloaded from the CATIE website.
In the current Canadian legal context, it is important for nurses to maintain trust and therapeutic relationships with clients, to preserve a safe space for clients to talk about HIV disclosure issues, and to recognize that real-life experiences of HIV disclosure are far more complex than the idealized representation of disclosure expressed in the criminal law.† Furthermore, it is important for nurses to continue providing excellent nursing care across the HIV healthcare continuum from prevention through diagnosis and treatment to care and support.
Research papers, reports and grey literature all point to the challenges of providing nursing care given the current legal context. In these circumstances, it seems particularly prudent for nurses to clarify their role and responsibilities as members of the healthcare team and to have a clear understanding of their own obligations with respect to HIV non/disclosure.
It would certainly be helpful for nurses to use this guide as a tool to engage other members of the healthcare team and identify their respective roles and responsibilities.
This guide was primarily developed to support nurses who provide care to people living with HIV in Canada and offer some guidance on how to meet professional standards when dealing with non/disclosure in nursing practice. Guidance may not provide a definitive answer or indicate a correct course of action in a given circumstance. However, nurses should be aware that existing legal, ethical and professional frameworks can be relied upon to respond in a professionally sound manner to key questions and concerns.
There are areas of nursing practice that will remain uncertain, so it is important for nurses to work on a case-by-case basis in collaboration with the other members of the healthcare team, seek guidance when necessary, initiate referrals to legal services when required, engage in reflective practice, and be mindful of their professional obligations. Laws, professional standards and policies can change at any time. It is important for nurses to remain aware of any new developments because these will inform their own professional obligations.
What the REPEAL HIV Discrimination Act Means to Public Health | NASTAD Blog
By Oscar Mairena, Manager, Policy & Legislative Affairs and Viral Hepatitis This month, Congresswomen Barbara Lee (D-CA) and Ileana Ros-Lehtinen (R-FL) introduced bipartisan legislation, , the Repeal Existing Policies that Encourage or Allow Legal (REPEAL) HIV Discrimination Act.
Keeping Confidence: HIV and the criminal law from service provider perspectives (HJN, 2013) (4 of 4)
The Keeping Confidence one day conference was a free event to discuss findings from a report that we produced in conjunction with Birkbeck College. For more detailed information on the project please follow this link to the project description page: sigmaresearch.org.uk/projects/policy/project55/
Feedback from afternoon workshops and closing whole group discussion
Prof Matthew weait, Birkbeck College
Dr Robert James, HIV Patient Representative, Lawson Unit, Brighton and Sussex University Hospitals NHS Trust
Dr Catherine Dodds, LSHTM
Video produced by georgetownmedia.de
Keeping Confidence: HIV and the criminal law from service provider perspectives (HJN, 2013) (3 of 4)
The Keeping Confidence one day conference was a free event to discuss findings from a report that we produced in conjunction with Birkbeck College. For more detailed information on the project please follow this link to the project description page: sigmaresearch.org.uk/projects/policy/project55/
Overview of updated 2013 BHIVA/BASHH position paper, ‘HIV transmission, the law and the work of the clinical team’
Dr Mary Poulton, Consultant and Clinical Head, Sexual Health and HIV, Kings College Hospital
Video produced by georgetownmedia.de
Keeping Confidence: HIV and the criminal law from service provider perspectives (HJN, 2013) (2 of 4)
The Keeping Confidence one day conference was a free event to discuss findings from a report that we produced in conjunction with Birkbeck College. For more detailed information on the project please follow this link to the project description page: sigmaresearch.org.uk/projects/policy/project55/
Response Panel
Chaired by Dr Adam Bourne, LSHTM
Ms Ceri Evans, Senior Health Adviser, West London Centre for Sexual Health, Chelsea and Westminster Hospital
Dr Robert James, HIV Patient Representative, Lawson Unit, Brighton and Sussex University Hospitals NHS Trust
Mrs Juliet Reid, Chief Executive, Centre for All Families Positive Health (CAFPH)
Video produced by georgetownmedia.de
Keeping Confidence: HIV and the criminal law from service provider perspectives (HJN, 2013) (1 of 4)
The Keeping Confidence one day conference was a free event to discuss findings from a report that we produced in conjunction with Birkbeck College. For more detailed information on the project please follow this link to the project description page: sigmaresearch.org.uk/projects/policy/project55/
Part 1: Overview of Keeping Confidence report and recommendations
Dr Catherine Dodds, LSHTM
Prof Matthew Weait, Birkbeck College
Introduction by Matt Williams, Monument Trust
Video produced by georgetownmedia.de
Mich. HIV data collection violates intent of statute, says lawmaker who helped create law
LANSING, MICH. – Michigan’s health department is violating the legislative intent of an HIV-related statute – and maybe the law itself – by indefinitely collecting information on people who test for HIV at federally funded clinics, says a former state lawmaker, who helped pass sweeping health reforms in the wake of the AIDS epidemic.
Germany: National AIDS Council releases powerful policy statement on HIV criminalisation
The German National AIDS Council – an independent advisory body of the Ministry of Health consisting of experts from the fields of research, medical care, public health services, ethics, law, social sciences, as well as people from the civil society – has produced a consensus statement on HIV criminalisation during consensual sex.
A press release issued yesterday by the Federal Ministry of Health states (unnofficial translation from German)
HIV infection has become a treatable chronic disease. In Germany, life expectancy with appropriate medical care is nearly normal. However, people with HIV still experience limitations, especially in everyday social life. They are often stigmatised and discriminated against in both the workplace and in the home environment. Criminal court judgments and their public perception play in a crucial role in this context.
- The National AIDS Council points out that the following medical factors should be assessed in criminal proceedings: HIV is difficult infection to transmit compared to other sexually transmitted diseases. The transmissibility of HIV is primarily related to viral load. In the first weeks after infection this is particularly high, and can amount to several million viral copies per milliliter of blood. After a few weeks or months, however, the immune system, usually controls the infection. Once viral load drops the body can keep viral load low for months or years before medication needs to be taken. During this time, the risk of infection is much lower than in the early phase of infection. Once the immune system weakens, generally antiretroviral therapy commences. With effective treatment, the viral load falls below the detection limit (viral load less than 50 viral copies / ml blood). If viral replication is permanently suppressed completely, according to current medical knowledge, HIV is not sexually transmitted. The risk reduction of successful antiretroviral therapy is at least comparable to the correct use of condoms. It is assumed that a large proportion of HIV transmission takes place during the early stages of HIV infection, i.e. at a time, when those who are infected are not aware of their infection, because an HIV antibody test can only show infection after a few weeks.
- Against this background, the National AIDS Council emphasises: A criminal examination of HIV exposure or transmission related to consensual sexual intercourse must be consistent with the medical facts. The decision whether or not the criminal liability of onward transmission can be assigned to the person with HIV cannot be made as a matter of routine. In fact, the determining factor are the circumstances of each individual case, especially the legitimate expectations of both sexual partners. In any case, in a short-term, consensual sexual encounter both partners are responsible for the application of protective measures, regardless of the knowledge or the acceptance of one’s own status and the status of the other person. Attributing either partner as perpetrator or victim is not appropriate.
Criminal proceedings regarding the transmission of HIV from consensual sexual intercourse do not contribute to HIV prevention. They can even be counterproductive in terms of the willingness of an individual to take an HIV test and in terms of open communication of sexual partners. In contrast, it is in the interest of the individual and society to increase willingness to take an HIV test.”
The full text of the statement (in German) can be found here.