US: Washington State decriminalises HIV exposure and removes stigmatising language in state law

Failing to share HIV status downgraded from felony to misdemeanor in Washington

The Washington State Board of Health this week adopted new rules to decriminalize HIV exposure, remove stigmatizing language in state law and end legal discrimination against people living with HIV.

Previously, state law criminalized HIV exposure; a person living with HIV could be prosecuted for not disclosing their status to a sexual partner and could serve jail time. HIV is no longer in the criminal code in Washington state, and nondisclosure could result in a misdemeanor instead of a felony.

The board was tasked with rewriting the rules after legislation passed in 2020 directing them to work in consultation with state agencies and community stakeholders.

Dr. Bob Lutz, who serves on the State Board of Health, said the process involved consulting with local health jurisdictions, the Department of Corrections and the Department of Labor & Industries. Last October, the proposed revisions were opened for formal public comment, and after hearings and more meetings in late 2021, the board held a final hearing and vote Wednesday to adopt changes .

The updated state law will also include new language to reflect that it’s possible for a person to employ “practical means to prevent transmission,” such as modern HIV treatment that can eliminate the virus to the point of being undetectable, and prevention methods for not transmitting sexually transmitted infections, like condoms.

Dale Briese, an HIV advocate in Spokane and peer navigator, said the new rules are a step forward.

Briese, along with other advocates and community leaders, met with Board of Health staff several times in the past two years to get to the language in the rule presented to the board on Wednesday.

“I am comforted that these rules initiate for the first time the public health model for citizens that are in medical care, and are acting out of ‘good faith’ that they will have less potential legal ramifications,” Briese wrote in his prepared testimony.

Advocates who commented on the legislation also noted that there is still work to be done, especially to clarify how the law impacts community members living with HIV who have reached the point in their treatment where the virus is undetectable. It’s not clear in the new language whether these people would need to disclose their HIV status, despite the fact that they would be incapable of spreading it.

Even still, all three people who commented on the specific rule change applauded the efforts of the board and the state.

There were many more public comments during the hearing on the new rule, but they were primarily from people who thought the state was amending state law that pertains to quarantine orders, as well as people who wanted to comment on vaccine mandates for children.

Before the Board’s Wednesday meeting, misinformation spreading on social media led some people to believe that the board was considering mandatory quarantine “camps.” Board members clarified early during the hearing that their scope of work applied to the HIV-related language in the state’s public health law.

Since 2003, Washington state law has allowed public health officers to enforce quarantine orders if they are not voluntarily followed, and a superior court can be involved in this process. The board’s rulemaking on Wednesday did not change or alter the health officer’s ability to enforce quarantines, however. The board followed specific guidance from the Legislature, making changes only pertaining to how people living with HIV are treated by public health officials and other entities.

“Most counties have developed voluntary (quarantine centers), so people don’t infect their roommates or family,” Board Chairman Keith Grellner said on Wednesday.

“There are certainly lots of examples of those, but I am not aware of any mandatory quarantine or isolation center.”

Dr. Tao Sheng Kwan-Gett, the chief science officer at the Department of Health, said it was ironic that the intent of the rule and legislation were to remove stigma and initiate the healing process after past inequities in the HIV community brought on by this law, but that many people had used the meeting as an opportunity to spread division instead.

“I feel bad that the misinformation distracted from the intent of this,” he said.

He added that he was proud of the department and board for working closely with the community impacted to bring about the changes.

By Arielle Dreher

Russia: Laws that restrict migrants with HIV and deny them medical care increases the burden on the health care system

Legal barriers to migrants with HIV are not working

Automated translation via Deepl.com. For original article in Russian, please scroll down.

Laws that restrict the stay of foreign nationals with HIV, as well as the denial of free medical care, may be one of the causes of a hidden epidemic, writes the EECA Regional Platform.

The Regional Expert Group on Migrant Health conducted research in two EECA countries, Armenia and Uzbekistan. The aim was to identify the legal barriers to HIV faced by citizens of the countries who have returned from migration.

Challenges for migrants with HIV

Social isolation and stigmatization, lack of permanent relationships, language barriers, unstable material resources, and limited access to health care services are the main challenges faced by labour migrants with HIV.

Inability to obtain a legal patent because of HIV infection leads to administrative offences:

  • Among migrants: illegal labour activities, commercial sex services
    Among the citizens of host countries: illegal sale of patents and HIV certificates etc.

The problem with getting ARV treatment leads to resistance and a general deterioration of the health of migrants living with HIV. This ultimately increases the burden on the health care system: patients’ opportunistic infections need to be intensified, ART regimens need to be changed, etc. Moreover, returning migrants contribute to the spread of HIV in their home countries.

Currently, the Russian Federation, which receives the largest number of migrants from the EECA region, is one of 19 countries that restrict the stay of foreign nationals with HIV. People living with HIV entering Russia specify visiting relatives, tourism/travel or medical treatment as the purpose, rather than employment.

At the end of 2021, a law came into force in the Russian Federation which requires foreign nationals to be tested for HIV, banned substances and dangerous infectious diseases every 3 months. But foreign business associations, as well as the media, have reacted quite sharply to the Russian law. The business community sent a letter to the Russian Government asking it to simplify the rules and not to subject highly qualified specialists to testing.


Законодательные барьеры для мигрантов с ВИЧ не работают

Законы, которые ограничивают пребывание в стране иностранных граждан с ВИЧ, а также отказ в бесплатной медицинской помощи, могут быть одной из причин скрытой эпидемии, пишет Региональная Платформа ВЕЦА.

Региональная экспертная группа по здоровью мигрантов провела исследование в двух странах ВЕЦА — Армении и Узбекистане. Целью было определить правовые барьеры в связи с ВИЧ, с которыми сталкиваются граждане стран, вернувшиеся из миграции.

Проблемы мигрантов с ВИЧ

Социальная изоляция и стигматизация, отсутствие постоянных отношений, языковой барьер, нестабильный материальный уровень, ограниченный доступ к медицинским услугам — основные проблемы, с которыми сталкиваются трудовые мигранты с ВИЧ.

Невозможность получения легального патента из-за наличия ВИЧ-инфекции ведет к административным правонарушениям:

  • среди мигрантов: незаконная трудовая деятельность, коммерческие секс-услуги;
    среди граждан принимающей страны: нелегальная продажа патентов и сертификатов об отсутствии ВИЧ-инфекции и т.д.

Проблема с получением АРВ-терапии приводит к резистентности и общему ухудшению здоровья мигрантов, живущих с ВИЧ. Это в конечном итоге повышает нагрузку на систему здравоохранения: необходимо усиливать лечение оппортунистических инфекций пациентов, менять схему АРВТ и т.д. Более того, вернувшиеся домой мигранты способствуют распространению ВИЧ в своих странах.

В настоящее время Российская Федерация, принимающая наибольшее количество мигрантов из региона ВЕЦА, является одной из 19 стран, которые ограничивают пребывание иностранных граждан с ВИЧ. Люди, живущие с ВИЧ, въезжая в Россию, указывают в качестве цели не трудоустройство, а посещение родственников, туризм/путешествие или лечение.

В конце 2021 года в РФ вступил в силу закон, согласно которому иностранные граждане обязаны каждые 3 месяца сдавать анализ на ВИЧ, запрещенные вещества и опасные инфекционные заболевания. Но зарубежные бизнес-ассоциации, а также СМИ достаточно остро отреагировали на российский закон. Бизнес-сообщество направило письмо в Правительство РФ с просьбой упростить правила и не подвергать проверке высококвалифицированных специалистов.

US: Legislation to modernise criminalisation law passed by New Jersey Senate

Senate Passes Vitale-Ruiz Bill to Modernize NJ Statutes Related to HIV/AIDS Transmission

Trenton – In an effort to modernize New Jersey’s statutes related to the transmission of HIV/AIDS and reduce the stigma suffered by individuals living with HIV/AIDS and other sexually transmitted infections (STI), legislation sponsored by Senators Joe Vitale and M. Teresa Ruiz that would eliminate crimes that are solely applicable to individuals living with HIV/AIDS and STIs was passed by the Senate.

The bill, S-3707, would repeal current statutes that make it a crime for a person to commit an act of sexual penetration under certain circumstances while knowing that he or she is infected with a venereal disease, HIV, or AIDS. The bill maintains and updates the provisions of the statute that criminalizes endangering another person, therefore maintaining an avenue for prosecution in appropriate cases involving the transmission of non-airborne infectious or communicable diseases, without specifically targeting individuals living with HIV/AIDs and sexually transmitted infections.

“While working with advocates to identify areas to improve our harm reduction system of care, they identified updating these statutes to reflect what we now know about the transmission of certain diseases, especially in light in the advances in treatment, as a huge priority,” said Senator Joe Vitale (D- Middlesex). “The current law serves only to criminalize some of our most vulnerable populations, primarily those with HIV, dismissing what we know about the treatment of HIV and how it is and can be transmitted. I am thankful to the advocates who brought this issue to our attention, not only for leading the way on solid public health policy, but also in serving those in need in New Jersey.”

The current laws in place target individuals based on their HIV/AIDS status, rather than their actions. They disproportionately impact certain communities that are more likely to be living with the virus including members of the LGBTQ+ community, Black and Latinx people and transgender women. The new legislation will work to remove the negative stigma and criminalization that these communities and others currently face.

“This legislation is a step in the right direction of inclusivity and removing the stigmatization that surrounds individuals living with HIV. Over the years, there has been criminalization targeting HIV-positive individuals, rather than those who are intentionally harming others,” said Senator Ruiz (D-Essex). “The criminal code is meant to punish actions that harm others, not discriminate against people living with a chronic health condition.”

The bill passed the Senate by a vote of (25-11).

US: Women account for 62 percent of HIV-related arrests despite making up just 17 percent of Kentucky’s HIV-positive population

Two-thirds of HIV-related arrests in Kentucky are women, study finds

Women account for 62 percent of HIV-related arrests despite making up just 17 percent of the state’s HIV-positive population, according to a report by the Williams Institute.

Story at a glance

  • At least 32 people have been arrested since 2006 under Kentucky laws that criminalize people living with HIV.
  • All but one of those arrests were related to sex work, and, in 44 percent of arrests, the HIV-related offense was the only reason for contact with law enforcement.
  • People living with HIV in Kentucky may face felony charges which carry a prison sentence of up to five years for engaging in sex work or donating blood, tissues, or organs.

Women account for nearly two-thirds of HIV-related arrests in Kentucky, new research has found, even though less than a quarter of the state’s population of people living with HIV are women.

At least 32 people have been arrested since 2006 under Kentucky laws that criminalize people living with HIV, according to a report by the Williams Institute, a public policy think tank studying issues related to sexual orientation and gender identity.

Women account for 62 percent of those arrests despite making up just 17 percent of the state’s HIV positive population, according to the report, which uses Uniform Crime Reporting data collected by Kentucky State Police.

All but one of the arrests were related to sex work, and, in 44 percent of HIV-related arrests, the HIV-related offense was the sole reason for contact with law enforcement.In Kentucky, people living with HIV, which lives in the blood and other bodily fluids, who engage in sex work or donate blood, tissues, or organs may face Class D felony charges, which carry a prison sentence of one to five years.

More than 15 percent of HIV-related arrests were “almost certainly for conduct that did not involve sex acts,” according to the report, which noted that arrests for allegations of sex work do not need to include actual sex acts.

“A person can be arrested for sex work in the state without engaging in actual sex acts,” the study’s lead author, Nathan Cisneros, said in a statement. “That means Kentucky law can apply a felony charge — which carries a prison term of up to five years — to people living with HIV without requiring actual transmission or even the possibility of transmission.”

More than two-thirds of U.S. states and territories have enacted HIV criminal laws, according to the Centers for Disease Control and Prevention.

US: Arrests for HIV crimes fell disproportionately on Black men in Virginia

Black people account for 68% of HIV-related arrests in Virginia

Incarcerating people for HIV-related offenses has cost Virginia at least $3.2 million.

LOS ANGELES – Since 2001, at least 97 people have been arrested under Virginia laws that criminalize people living with HIV, hepatitis B, and syphilis, according to a new report by the Williams Institute at UCLA School of Law. HIV-related crimes are disproportionately enforced on the basis of race and sex, with Black men being the most likely to be arrested and convicted.

Using data obtained from the Criminal Justice Information Services Division of the Virginia Department of State, researchers found that charges were filed in over 70% of HIV-related arrests in Virginia and more than half of them resulted in a guilty outcome, resulting in sentences averaging 2.1 years.

HIV criminalization is a term used to describe laws that either criminalize otherwise legal conduct or increase the penalties for illegal conduct based upon a person’s HIV-positive status. More than two-thirds of U.S. states and territories have enacted HIV criminal laws.

Until this year, Virginia’s HIV criminalization statute contained a felony provision—which prohibited people living with HIV, Hepatitis B, or syphilis from engaging in sexual activity of any kind with the intent to transmit the infection—and a misdemeanor charge for engaging in sexual activity without disclosing a positive status.

“In reality, people have been charged with felony crimes under Virginia’s HIV criminal laws simply for not disclosing their status,” said lead author Nathan Cisneros, HIV Criminalization Analyst at the Williams Institute. “For two decades, Virginia law has singled out people living with HIV for criminal prosecution without requiring actual transmission or even the possibility of transmission. Moreover, the law ignored whether the person living with HIV is in treatment and virally suppressed, and therefore cannot transmit HIV.”

KEY FINDINGS

  • At least 97 people in Virginia have been arrested for HIV-related criminal offenses since 2001.
  • Black people account for 20% of Virginia’s population, but 58% of the state’s people living with HIV, and 68% of all those arrested for HIV-related offenses.
  • Men comprise 75% of people living with HIV in Virginia, but 87% of people arrested for HIV-related offenses.
    • Black men are 40% of people living with HIV in Virginia, but 59% of all people arrested for HIV-related offenses.
  • Nearly one-fifth (18%) of those arrested for HIV-related crimes had no other criminal history.
  • Charges were filed in over 70% of HIV-related arrests in Virginia. And over half (54%) of all charges filed resulted in a guilty outcome.
  • Guilty outcomes resulted in an average sentence of 2.1 years.
  • Incarcerating people for HIV-related offenses has cost Virginia at least $3.2 million.

Virginia is one of four states, including Missouri, Illinois, and Nevada, to modernize its HIV criminal laws in 2021. Virginia’s new law only criminalises actual, intentional transmission, which remains a felony, and it removes HIV-specific language. Virginia also revised its donation law to align with the federal HIV Organ Policy Equity Act.

Read the report

Belarus: 34 prosecutions for HIV infection in 2021

Translated with Deepl.com – For original article in Russian, please scroll down.

34 criminal cases related to the human immunodeficiency virus were opened in 2021. This was reported by the Investigative Committee.

December 1 is the International AIDS Day. The day was established to raise awareness about the acquired immunodeficiency syndrome. This date annually urges the entire world community not only to remember this as yet incurable disease, but also to be tolerant to those who are already carriers of the disease.

“Deliberately transmitting the disease is punishable under criminal law,” the agency said.


СК: в 2021 году возбуждено 34 уголовных дела по факту заражения ВИЧ

1 декабря, Минск /Корр. БЕЛТА/. В 2021 году возбуждено 34 уголовных дела по факту заражения вирусом иммунодефицита человека. Об этом БЕЛТА сообщили в Следственном комитете.

1 декабря отмечается Международный день борьбы со СПИДом. День учрежден с целью повышения осведомленности о синдроме приобретенного иммунодефицита. Эта дата ежегодно призывает всю мировую общественность не просто помнить об этой пока неизлечимой болезни, но и быть терпимыми к тем, кто уже является переносчиком этого заболевания.

“Умышленное заражение этим заболеванием преследуется в уголовно-правовом порядке”, – отметили в ведомстве.-0-

 

US: Congressmember Barbara Lee files bill to initiate review of federal laws to end stigma and discrimination based on HIV status

Lee introduces bill to end bias based on HIV status

Oakland Congressmember Barbara Lee took the occasion of World AIDS Day to introduce a bill that, if passed, would facilitate a review of federal and state laws to determine whether they add “unique or additional burdens upon people living with HIV.”

“This is an important bill to end the stigma and the terrible punitive consequences of people being penalized by having a virus,” Lee said.

Lee, a Democrat, spoke to the Bay Area Reporter late November 30. She said that she has been introducing this legislation for a decade.

“The first time was in 2011,” Lee said. “I was appointed to the United Nations Commission on HIV and the law in 2008, maybe, and we went around the world to look at laws criminalizing HIV-positive people. We had four to five roundtable meetings, and it dawned on me that I was the only American on the committee and I said ‘wait a minute, why not look at the United States?'”

Upon research, Lee said she found out “we were one of the bad actors.” Indeed, as of 2021, 35 states criminalize the behavior of people with HIV through HIV-specific laws, according to the U.S. Centers for Disease Control and Prevention. These include 14 states that criminalize behavior at low risk of transmitting HIV, such as biting or oral sex, and 14 states that have a maximum sentence length of over 10 years (or even life) even if people with HIV took measures to prevent transmission.

“The bill didn’t pass,” Lee said, but some of it was repurposed for technical assistance to states provided by the U.S. Department of Justice during the Obama administration.

At the time, under California law HIV-positive persons could be prosecuted and imprisoned for up to eight years for engaging in unprotected sexual intercourse with the intent to transmit HIV, even if no actual viral transmission occurred.

Lee said she approached state lawmakers to ask for any takers who’d want to change the law but didn’t find any until the 2016 election of gay state Senator Scott Wiener (D-San Francisco).

“I went and talked to many of the California legislators and I was with the Elizabeth Taylor AIDS Foundation, and I found nobody in the Legislature who would take it up till I talked to Scott,” Lee said. “He was very brave and bold. … It was incredible it took Scott that long, because many members thought it wasn’t important.”

Wiener’s Senate Bill 239, which requires proof that transmission of HIV did occur in order for a person to be prosecuted for intentionally transmitting the virus to a sex partner, passed and was signed by then-Governor Jerry Brown in 2017. It went into effect the following year.

Wiener told the B.A.R. December 1 that he is supportive of Lee’s federal legislation.

“Barbara Lee is an extraordinary leader in the fight to end discrimination against and criminalization of people living with HIV. I fully support her legislation and applaud her for taking this on,” he said.

Lee’s Repeal HIV Discrimination Act of 2022 states, “Not later than 90 days after the enactment of this act, the attorney general, the secretary of health and human services, the secretary of defense, and the director of the White House Office of National AIDS Policy, acting jointly, shall initiate — a review of federal laws, policies, regulations, and judicial precedents and decisions regarding criminal and related civil commitment cases involving people living with HIV/AIDS, including in regard to the Uniform Code of Military Justice; and an updated national review of state laws, policies, regulations, and judicial precedents and decisions regarding criminal and related civil commitment cases involving people living with HIV/AIDS.”

No more than 180 days later, a report of the review is to be published. This report is to contain judgments of whether laws, policies, regulations, and judicial precedents and decisions create undue or additional burdens on people living with HIV, and determine whether these are “public health-oriented” and “evidence-based.”

Finally, the law states “the designated officials shall develop and transmit to the president and the Congress, and make publicly available, such proposals as may be necessary to implement adjustments to federal laws, policies, or regulations, including to the Uniform Code of Military Justice, that reflect the reports and guidance required under this Act either through executive order or through changes to statutory law.”

However, “nothing in this act shall be construed to prohibit the prosecution of individuals who act with the specific intent to do harm to another person by transmitting HIV through means likely to result in actual transmission, and who in fact transmit HIV.”

Lee said she is confident this bill will become law if it can get through the Senate, which is split 50-50 between Democrats and Republicans. Vice President Kamala Harris serves as a tie-breaker.

“You know the politics of the Senate,” Lee said. Nevertheless, “I’m certain if we got it to the president’s desk, he’d sign it.”

Lee said she’s “cautiously optimistic” about the bill’s prospects in both houses of Congress because there has been some bipartisan cooperation on it. Representative Jenniffer González-Colón (R-Puerto Rico), co-chair of the Congressional HIV/AIDS caucus, was the lead co-sponsor. (González-Colón is a non-voting member of Congress, since she represents a U.S. territory.)

González-Colón’s office did not respond to an immediate request for comment December 1.

Lee said “it took a while to get the White House on board,” but the Biden administration has been helpful with the parts of the legislation relating to the Uniform Code of Military Justice.

A senior Biden administration official, speaking on background during a press call early December 1, said in response to a question posed by USA Today about state laws that discriminate against HIV positive people, that the administration will be working with the U.S. Department of Health and Human Services and the Department of Justice to support efforts to reform and eliminate those laws, because they don’t reflect the most up-to-date science.

Also on World AIDS Day, the CDC released a report showing that Black and Latino gay and bisexual men are not seeing the same improvements as white men, as the B.A.R. also reported.

US: Identical bills filed in Florida Senate and House of Representatives to bring outdated criminal law in line with science

Florida Lawmakers Introduce Bills to Modernize HIV Criminal Law on World AIDS Day

Coinciding with World AIDS Day, Senator Jason Pizzo (D-Miami) and Representative Felicia Robinson (D-Miami Gardens) have introduced identical bills in the Senate (SB 1074) and House of Representatives (HB 813) to bring an outdated criminal law in line with the contemporary understanding of HIV. Florida’s laws written at the height of the HIV/AIDS epidemic makes it a felony punishable by up to 30 years in prison for a person living with HIV to have sexual contact without first disclosing the diagnosis to their potential sexual partner, regardless of whether the contact presents any risk of transmission. The bills limit criminal liability to situations in which the person living with HIV intends to cause harm and engages in conduct that can transmit HIV.

“This modernization of Florida’s HIV-focused criminal laws is long overdue,” said Rep. Robinson upon filing the bill in the House. “Today, people living with HIV who are receiving appropriate treatment live long, healthy lives—and those same treatments make it impossible to transmit HIV sexually. Given these advances, the criminal law should stop treating HIV differently from any other transmissible infection.”

Advocates view the prospects for these bills as good given how COVID-19 has changed public perceptions regarding transmissible disease and the appropriate role of the government in controlling choices about the risks that people take, particularly in the privacy of their own homes.

“Imposing criminal penalties to attempt to control a transmissible disease was never sound public policy—and COVID-19 has made that clear to more people,” said Sen. Pizzo. “We hope to see bipartisan support this session for fixing these laws that turn law-abiding citizens into criminals based on the fact that they are living with a manageable, transmissible disease and choose to live their lives like anyone else.”

Kamaria Laffrey, who leads the Florida HIV Justice Coalition, noted the benefits to public health and efforts to end the HIV epidemic in Florida: “We want people to get tested for HIV and to remain engaged in care and treatment if they test positive, but the threat of criminal prosecution under the current law is a barrier to these things,” said Laffrey. “By eliminating criminal penalties and reducing the intense stigma associated with HIV, we make it easier for people to seek the testing and care they need and for everyone to have frank conversations about the risks involved in any sexual encounter.”

States including Virginia, Nevada, Colorado, Iowa, and Michigan have recently revised similar HIV criminalization laws, recognizing the significant advances in science for treatment and prevention from the laws’ original enactments.

Since 1988, World AIDS Day has been observed on December 1, and is a time to raise awareness of the HIV/AIDS Epidemic and remember those lost to AIDS.

Equality Florida is the largest civil rights organization dedicated to securing full equality for Florida’s LGBTQ community. Through education, grassroots organizing, coalition building, and lobbying, we are changing Florida so that no one suffers harassment or discrimination on the basis of their sexual orientation or gender identity. www.equalityflorida.org 

El Salvador: Stigma Index reports that 23 women were sterilised without their knowledge or consent in the past year

El Salvador forced sterilisation of HIV-positive women

Translated via Deepl.com – For original article in Spanish, please scroll down –

Written by Fátima Escobar

When Lizz found out she was pregnant, she was also told she had HIV. When she gave birth to her only daughter, at the age of 17, she was forcibly sterilised by medical staff at one of El Salvador’s main public hospitals. The Constitutional Chamber of the Supreme Court of the Central American country only recognised that her right to reproductive health was violated. Eleven years later, she still wants to become a mother again. This text is part of the collaborative journalism project #ChangeTheStory, supported by the Deutsche Welle Akademie.

Months earlier, Lizz had received the news of her pregnancy and the positive test result for human immunodeficiency virus (HIV) at the same time. She says she was more concerned about the news of her pregnancy than the HIV diagnosis.

One morning in December 2010, Lizz* felt her baby kicking loudly in her belly and demanding to come into the world. Her pregnancy, marked by the despair of an unforeseen diagnosis, was nearing full term.

Upon her arrival at the National Women’s Hospital “Dr. María Isabel Rodríguez”, the most important women’s hospital in El Salvador, medical staff asked her if she wanted to be sterilised, but Lizz said no. Because of her HIV status, she had to be sterilised. Because of her HIV status, she had to have a caesarean section and was taken to the operating room that night.

Minutes before she was to be anaesthetised for the caesarean section, a nurse asked her again if she was going to be sterilised and handed her a form to authorise the procedure. Lizz signed without being fully informed of the consequences.

Eleven years later, she talks about that day via video call. She pauses, takes her eyes off the screen and says: “They were practically going to let me die, they told me that if I didn’t sign they wouldn’t treat me. I signed because I couldn’t stand the pain.

After giving birth to her only daughter, Lizz had part of her reproductive organ mutilated in surgery to prevent her from having children again when she was only 17.

Four years later, Lizz’s case was taken to the Constitutional Chamber of the Supreme Court of El Salvador, where it was found that she did not have full capacity to give informed consent to be sterilised because she was a minor.

I A pillar of support
When Lizz was just 16, she had a relationship with a man eight years her senior. A few months later, she began to feel sick and had severe headaches. She went to the doctor in the community of Cojutepeque, less than an hour from the capital, and after tests she was told that she was pregnant and that she was also HIV-positive.

“At that moment, what worried me most was that I was pregnant. I didn’t think about the HIV diagnosis,” she says.

When she told her partner the news, he was not surprised. He already knew he was HIV-positive and offered to live with her as a couple. Lizz moved out of her parents’ house and stopped her studies. Today she believes that she became pregnant as a result of rape because she was still a minor.

For the next few months, she had to go to the Women’s Hospital, the only one in the country for maternal care, where she received a course of retrovirals. At birth, her baby was born with a negative diagnosis. She was free of the virus.

The human immunodeficiency virus attacks the immune system and weakens defence systems against infections and certain cancers. It is transmitted through the exchange of body fluids from an infected person, such as blood, breast milk, semen or vaginal secretions.

State data show that the chances of a child being infected with HIV at birth are very low. According to the Ministry of Health of El Salvador (MINSAL), one in every 100 babies born to mothers with HIV are diagnosed with the virus. These figures are consistent with those reported by the Joint United Nations Programme on HIV/AIDS (UNAIDS), which states that the risk of a woman with HIV transmitting the virus to her child is reduced to 5% or less with effective treatment.

Lizz received the treatment stipulated by MINSAL. Indeed, the same report states that by 2010, 100% of known HIV-positive pregnant women in the country received antiretroviral drugs to reduce the risk of infant transmission. These figures reflect that Lizz could safely have more children.

In 2019, El Salvador’s Ministry of Health reported 26,893 people living with HIV in the country, 34% of whom were women.

Lizz followed her and her baby’s health status at her local hospital, some 18 km south of the country’s capital, and there she was connected to HIV support organisations when she went to her medical appointments.

“I used to go for check-ups at Cojutepeque Hospital, where I joined a support group and feminist non-governmental organisations. He (her ex-partner) was an alcoholic and beat me. I suffered a lot of physical abuse. But by joining these groups I became empowered. I became very empowered,” she says in an energetic tone. When her baby was three months old, she decided to separate and returned to her parents’ home.

At the hospital she met members of the Asociación Atlacatl Vivo Positivo, which works for the rights of people living with HIV. They provided her with a scholarship to finish high school. Psychological therapies and group sessions contributed to her education and empowerment. And she says that after a very difficult healing process, she can now talk more easily about it.

II More women with HIV sterilised

Lizz’s case is not unique. Other HIV-positive women and minors have been systematically sterilised in El Salvador.

In her amparo lawsuit, it was found that “in hospital practice, girls and adolescents are sterilised with the sole requirement that they sign an authorisation form to that effect”. In the ruling to which Alharaca had access, it is documented that one of the doctors questioned in the process said that “a minor under twelve years of age can be sterilised according to family planning regulations”.

The Technical Guide for Family Planning Care (GTAPF), mentioned in the amparo, does not stipulate that sterilisations of certain patients on the basis of age are allowed, but only requires the patient’s informed consent.

Lizz’s case was brought to the judiciary thanks to the Asociación Nacional de Personas Positivas Vida Nueva (ANP+VN), which focuses on reducing HIV disease in El Salvador.

Together with other civil society organisations and authorities, they participated in conducting the People Living with HIV Stigma Index (INDEX) 2019, interviewing patients in 19 hospitals of the public health system.

The report documented that 23 out of 514 people surveyed were sterilised without their knowledge or consent in the past year. All of those who said they had been sterilised were women. Most of them are poor and have little access to education, says Catherine Serpas, executive director of ANP+VN.

The same study found that 7.2 per cent of respondents were advised not to have children and 5.6 per cent said they were pressured, encouraged or induced to become permanently sterilised through tubal ligation or vasectomy.

Serpas added that the study also found three more cases of minors recounting their experience.

“It was alarming to come across cases of forced sterilisation. The first case we collected was from a woman who experienced this in 1998. Also, here we found cases of girls, minors,” says Serpas. She says that the association did not keep records of all of them, but after contacting some women, many decided not to participate in legal proceedings for fear of stigma.

One of those who did manage to follow up was Lizz, after conducting the INDEX 1.0 study. “The case happened in 2010, but she only spoke about it in 2014,” she explained.

III The legal battle
Organisations protecting the rights of people with HIV are often part of support groups like the one Lizz attended. There she met peers who had gone through the same thing and were persuaded by medical staff to be sterilised. This motivated her to speak out and start a legal process with the support of ANP+VN.

In 2014, they filed an injunction seeking recognition of the violation of Lizz’s reproductive health rights and HIV-related discrimination by medical staff at the National Women’s Hospital “Dr. María Isabel Rodríguez”.

A key element in bringing the case was to have the medical file, which they requested from the hospital through the Institute for Access to Public Information (IAIP), but were denied. Until they were taken to the amparo trial, the hospital authorities handed over the file, which had no evidence to justify the sterilisation.

Lizz’s defence had access to statements from some of the medical staff that it made “no sense” for people with HIV to continue having babies.

The hospital director denied before the Chamber any act of HIV discrimination or that the patient was forced to undergo sterilization.

The Constitutional Chamber declared in 2015 that there had been “violation of her fundamental rights to reproductive health, reproductive self-determination and personal integrity – in relation to the fact that, being a minor, and therefore not having full capacity to give her informed consent to be sterilised”.

“We did manage to prove that there was discrimination (on the grounds of HIV), but the Court did not admit it,” said Crissia Pérez, her lawyer and legal representative.

The Chamber’s ruling ordered the promotion of a process for material and moral damages and guaranteed adequate psychological treatment to overcome the consequences of the act of sterilisation.

IV Maternity. A right denied

Lizz suffered from recurrent bouts of depression. After the trial she wanted to regain her fertility.

Surgical sterilisation is a procedure in which the fallopian tubes, which carry the egg from the ovary to the uterus, are blocked. This can be by tying and cutting the tubes, by cauterisation, or closure with a ring or clamp.

About 20% of sterilised women regret their decision, but there are cases that cannot be reversed. One of them was Lizz’s.

“There are different ways of cutting the tubes, but the cut the doctor made was flush. There was no way to reconstruct the tubes. We interpret this as a practice of violence and an act against humanity,” says Catherine Serpas.

Between January 2013 and July 2021, 36 sterilisations were performed on women who verified delivery with a primary diagnosis of HIV out of a total of 280 deliveries in the country’s public hospitals, according to MINSAL data provided through the Institute for Access to Public Information (Instituto de Acceso a la Información Pública).

***

A gynaecologist working for the public health system, whose name she wishes to withhold for her own safety, warns that it is a moot point to recommend that a woman with HIV should not have children.

“If you go back to the 1980s, a diagnosis of HIV infection was practically a death foretold. Today we have the facility that there are various support programmes for these patients, including antiretroviral therapy, screening tests and social and psychological support groups,” she explains.

She says that if the patient is responsible for her health and her medication, she can become pregnant and have her pregnancy monitored regularly.

“Now, if the situation is different with a patient who has had poor adherence to her treatment or is irresponsible in her controls, who has uncontrolled secondary diseases or a poor prognosis,” she warns, “it becomes necessary to avoid pregnancy to prevent maternal or foetal complications.

Serpas explains that reproductive health issues are not seen as a problem. “This happens because we live in a world that is seen as totally masculine, especially on issues such as HIV,” she says.

ANP+VN often receives complaints about the lack of support in terms of family planning, she adds. “There is still a belief that the person is diagnosed and forgets about their sex life… We have found that when it comes to cytology (testing for the human papillomavirus, which causes cervical cancer) they have been mistreated by health staff, always with the interpretation ‘why are you still having sex’. The HIV response has evolved, but the thinking is still poor.

IV Migration
Lizz not only faced obstetric violence in her home country, during the trial she also received anonymous phone calls threatening her life. During her visits to the hospital for psychological treatment, medical staff tried to persuade her to drop her lawsuit.

The Head of the HIV and Human Rights Department of the Human Rights Ombudsman’s Office, Jaime Argueta, acknowledged that “there is no system of protection that can give guarantees to the person who has had the courage to file a complaint, to protect her against the state itself. She even began to be questioned when she received her treatment”.

Stigma is becoming less and less common in the health and workplace, she says, but “HIV testing is still required for employment as part of a battery of tests”.

At the community level, he warns that there is still a lot of discrimination and people’s diagnoses are disclosed in the places where they live.

“Maybe they work in a beauty salon and someone starts spreading the diagnosis and they lose their customers. Or they sell any kind of ready-made food for consumption and their livelihoods are also affected,” she said.

Lizz lived in an area declared to be at high risk of gang violence. This became another reason for her to migrate to the United States with her daughter and her current partner. There, more than 10,000 kilometres away from the country that expelled her, she is now trying to rebuild her life.

“I wanted a better life for my daughter. Fear also played a part in my decision to migrate,” she said.

V A new life
Despite her irregular migration status, Lizz has managed to access retroviral treatment through a protocol at a research centre in the United States, which she accessed through a hospital.

For now she is working, studying English and wants to go back to university to study law to help others: “My dream is to work in an organisation that helps with human rights or migration”.

According to the International Community of Women Living with HIV and AIDS (ICW Latina), in El Salvador the legal framework that establishes sanctions for health personnel in the case of forced sterilisation of women with HIV has a positive rating, that is, according to this organisation, doctors do receive penalties in these cases. However, those who attended Lizz’s case did not receive any penalty.

At the close of this investigation, an interview was requested with the head of the National STI/HIV/AIDS Programme, Dr Ana Isabel Nieto Gómez, to find out her position on Lizz’s case, but no response was received. Dr. Nieto was in the same position in 2010, when Lizz was forcibly sterilised.

Nieto is now an official in the government of President Nayib Bukele. His regime has been criticised for lacking accountability, giving little access to the press and declaring public information “confidential”.

ANP+VN currently works to provide legal support, training, psychological care, job reinsertion and alternative income generation for people living with HIV. It also has a close relationship with support groups for people with HIV in the national hospital network. Hundreds of people have benefited from its projects. Their lawyer shared that when the press covered Lizz’s case, they became aware of more cases that they could follow up and bring to justice if they had the funds.


El Salvador forzó la esterilización de mujeres con VIH

Cuando Lizz se enteró de que estaba embarazada, también le informaron que tenía VIH. Al momento de parir a su única hija, a la edad de 17 años, fue esterilizada de manera forzada por el personal médico de uno de los principales hospitales públicos de El Salvador. La Sala de lo Constitucional en la Corte Suprema del país centroamericano solo reconoció que se violó su derecho de salud reproductiva. A once años de lo ocurrido, mantiene el deseo de volver a ser madre.

Lizz había recibido meses antes de forma simultánea la noticia de su embarazo y el resultado positivo a la prueba del virus de inmunodeficiencia humana (VIH). Asegura que le preocupaba más la noticia de su embarazo que el diagnóstico del virus

Una mañana de diciembre de 2010, Lizz* sintió en su vientre que su bebé pateaba fuerte y con ello exigía su llegada al mundo. Su embarazo, marcado por la desesperanza de un diagnóstico imprevisto, estaba por llegar a término.

Desde su llegada al Hospital Nacional de la Mujer “Dra. María Isabel Rodríguez”, el más importante para la atención de la mujer en El Salvador, personal médico le preguntó si quería ser esterilizada, pero Lizz respondió que no. Por su condición de VIH le tenían que hacer una cesárea y en la noche fue llevada a la sala de operaciones.

Minutos antes de que se le aplicara la anestesia para practicarle la cesárea, una enfermera le preguntó de nuevo si se iba a esterilizar y le entregó un formulario para autorizar el procedimiento. Lizz firmó sin haber sido informada plenamente de las consecuencias.

A once años de lo ocurrido, habla sobre ese día a través de una videollamada. Hace una pausa, quita la mirada de la pantalla y dice: «prácticamente me iban a dejar morir, me dijeron que si no firmaba no me iban a atender. Yo firmé porque no soportaba el dolor».

Después de dar a luz a su única hija, a Lizz le fue mutilada una parte de su órgano reproductivo en una intervención quirúrgica para impedir que volviera a tener hijos cuando sólo tenía 17 años.

Cuatro años después, el caso de Lizz fue llevado a la Sala de lo Constitucional de la Corte Suprema de El Salvador, donde se comprobó que no tenía la capacidad plena para otorgar su consentimiento informado para ser esterilizada por el hecho de ser menor de edad.

I Un pilar de apoyo

Cuando Lizz tenía apenas 16 años, tuvo una relación con un hombre ocho años mayor que ella. A los pocos meses, comenzó a sentir malestar y dolores de cabeza intensos. Fue al médico en la comunidad de Cojutepeque, a menos de una hora de la capital, y después de hacer estudios le dijeron que estaba embarazada y que también era portadora de VIH.

“En ese momento lo que más me preocupó fue estar embarazada. No dimensioné el diagnóstico de VIH”, relata.

Cuando le dio la noticia a su pareja, él no se sorprendió. Ya sabía que era portador del virus y le ofreció vivir en pareja. Lizz salió de la casa de sus padres y suspendió sus estudios. Hoy considera que quedó embarazada por un acto de violación porque aún era menor de edad.

De su comunidad tuvo que ir los siguientes meses al Hospital de la Mujer, el único para atención materna en el país, donde recibió un tratamiento de retrovirales. Al nacer, su bebé nació con diagnóstico negativo. Estaba libre del virus.

El virus de la inmunodeficiencia humana ataca al sistema inmunitario y debilita los sistemas de defensa contra las infecciones y contra determinados tipos de cáncer. Se transmite a través del intercambio de líquidos corporales de la persona infectada, como la sangre, la leche materna, el semen o las secreciones vaginales.

Los datos del Estado reflejan que las probabilidades de que un menor se infecte de VIH al momento de su nacimiento son muy bajos. Según el Ministerio de Salud de El Salvador (MINSAL) uno de cada 100 bebés nacidos de madres con VIH son diagnosticados con el virus. Estos datos coinciden con los reflejados en el Programa Conjunto de las Naciones Unidas sobre el VIH/Sida ONUSIDA, donde se asegura que el riesgo de que una mujer con VIH le transmita el virus a su hijo se reduce a un 5 % o menos con un tratamiento eficaz.

Lizz recibió el tratamiento estipulado por el MINSAL. Incluso, el mismo informe asegura que para el año 2010 el 100 % de embarazadas con VIH conocidas en el país, recibieron medicamentos antirretrovirales para reducir el riesgo de transmisión infantil. Estas cifras reflejan que Lizz podía tener más hijos de forma segura.

En 2019, el Ministerio de Salud de El Salvador reportó 26,893 personas vivas con VIH en el país, de ellas el 34 % eran mujeres.

Lizz dio seguimiento a su estado de salud y el de su bebé en su hospital local, unos 18 km al sur de la capital del país, y ahí tuvo conexión con organizaciones de apoyo a personas con VIH cuando iba a sus citas médicas.

“Yo iba a controles al Hospital de Cojutepeque, ahí me uní a un grupo de apoyo y a organizaciones feministas no gubernamentales. Él (su expareja) era un hombre alcohólico y me golpeaba. Sufrí mucho abuso físico. Pero al unirme a estos grupos me empoderé. Me empoderé muchísimo”, dice en tono enérgico. Cuando su bebé cumplió tres meses, decidió separarse y volvió a casa de sus padres.

En el hospital conoció a integrantes de la Asociación Atlacatl Vivo Positivo, que trabaja a favor de los derechos de las personas con VIH. Ellos le brindaron una beca para terminar sus estudios de educación media. Las terapias psicológicas y las sesiones grupales contribuyeron a su formación y empoderamiento. Y asegura que después de un proceso de sanación muy difícil, ahora puede hablar con mayor facilidad sobre el tema.

II Más mujeres con VIH esterilizadas

El caso de Lizz no ha sido el único. Otras mujeres con VIH y menores de edad han sido esterilizadas de forma sistemática en El Salvador.

En su juicio de amparo, se comprobó que “en la práctica hospitalaria se esteriliza a niñas y adolescentes con el único requisito que estas suscriban un formulario de autorización para tal efecto”. En el fallo al que tuvo acceso Alharaca, se documenta que una de las doctoras interrogadas en el proceso dijo que «una menor de doce años de edad puede ser esterilizada según la normativa de planificación familiar».

La Guía Técnica de Atención en Planificación Familiar (GTAPF), mencionada en el amparo, no estipula que exista esterilizaciones a ciertos pacientes en razón de edad, únicamente exige que haya un consentimiento informado del paciente.

El caso de Lizz fue llevado al Poder Judicial gracias a la Asociación Nacional de Personas Positivas Vida Nueva (ANP+VN), enfocada en la reducción de la morbilidad del VIH en El Salvador.

Junto con otras organizaciones de la sociedad civil y autoridades, participaron en la realización del Índice de Estigma en Personas con VIH (INDEX) 2019, haciendo entrevistas a pacientes en 19 hospitales del sistema público de salud.

En el Informe se documentó que 23 de 514 personas encuestadas fueron esterilizadas sin su conocimiento o su consentimiento en el último año. Todas las que afirmaron este hecho eran mujeres. La mayoría de ellas son de escasos recursos económicos y tienen poco acceso a educación, señala Catherine Serpas, directora ejecutiva de ANP+VN.

El mismo estudio reflejó que a un 7.2 % de las personas encuestadas le aconsejaron no tener hijos y un 5.6 % menciona que fue presionado, motivado o inducido para esterilizarse de forma permanente por medio de ligadura de trompas o vasectomía.

Serpas añadió que en el estudio también encontraron tres casos más de menores de edad que contaban su experiencia.

“Fue alarmante encontrarnos con casos de esterilizaciones forzadas. El primer caso que recolectamos fue de una mujer que vivió esto en 1998. Además, aquí encontramos casos de niñas, menores de edad”, expresa Serpas. Ella dice que la asociación no guardó registro de todos, sin embargo, al realizar contacto con algunas mujeres, muchas decidieron no participar en procesos legales por miedo al estigma.

Una de las que sí lograron dar seguimiento fue Lizz, luego de realizar el estudio INDEX 1.0. “El caso ocurrió en 2010, pero ella habló de este hecho hasta 2014”, explicó.

III La batalla legal

Las organizaciones de protección de los derechos de personas con VIH suelen formar parte de los grupos de ayuda como a los que asistía Lizz. Ahí conoció a compañeras que pasaron por lo mismo y que fueron persuadidas por el personal médico para ser esterilizadas. Eso la motivó a hablar e iniciar un proceso legal con el acompañamiento de ANP+VN.

En 2014 promovieron un amparo para que se reconociera la violación de los derechos de salud reproductiva de Lizz y discriminación en razón del VIH por parte del personal médico del Hospital Nacional de la Mujer «Dra. María Isabel Rodríguez».

Un elemento clave para llevar el caso era tener el expediente médico, el cual solicitaron al hospital por medio del Instituto de Acceso a la Información Pública (IAIP), pero les fue negado. Hasta que fueron llevadas al juicio de amparo, las autoridades del hospital entregaron el expediente, el cual no tenía pruebas que justificaran la esterilización.

La defensa de Lizz tuvo acceso a declaraciones de parte del equipo médico que señalaban que “no tenía sentido” que las personas con VIH siguieran teniendo bebés.

El director del hospital negó ante la Sala cualquier acto de discriminación por VIH o que se haya forzado a la paciente para ser sometida a esterilización.

La Sala de lo Constitucional declaró en 2015 que sí hubo «vulneración de sus derechos fundamentales a la salud reproductiva, a la autodeterminación reproductiva y a la integridad personal —con relación al hecho de que, siendo menor de edad, y por lo tanto no teniendo la capacidad plena para otorgar su consentimiento informado para ser esterilizada».

“Sí logramos probar que hubo discriminación (en razón de VIH), pero la Sala no lo admitió”, lamentó su abogada y apoderada legal Crissia Pérez.

En el fallo de la Sala se ordenó la promoción de un proceso por los daños materiales y morales y garantizar un tratamiento psicológico adecuado para superar las secuelas por el acto de esterilización.

IV Maternidad. Un derecho negado

Lizz sufrió cuadros de depresión recurrentes. Después del juicio quiso recuperar su fertilidad.

La esterilización quirúrgica es un procedimiento en el que las trompas de Falopio, que transportan el óvulo desde el ovario hasta el útero, se bloquean. Esto puede ser por atadura y corte de los conductos, por cauterización, o cierre con un anillo o grapa.

Un 20 % de las mujeres esterilizadas se arrepiente de su decisión, pero hay casos que no se pueden revertir. Uno de ellos fue el de Lizz.

«Hay diferentes tipos de cortar las trompas, pero el corte que le hizo el médico era al ras. No había forma de reconstruir las trompas. Nosotros interpretamos esto como una práctica de violencia y un acto de lesa humanidad», señala Catherine Serpas.

Entre enero de 2013 hasta julio de 2021 se realizaron 36 esterilizaciones en mujeres que verificaron parto con un diagnóstico principal VIH de un total de 280 partos en los hospitales públicos del país, según datos del MINSAL brindados por medio del Instituto de Acceso a la Información Pública.

***

Una ginecóloga que trabaja para el sistema de salud público, cuyo nombre desea omitir para resguardar su seguridad, advierte que es una temática discutible el recomendar a una mujer con VIH no tener hijos.

“Si nos remontamos a los años ochenta, el diagnóstico de infección por VIH era prácticamente una muerte anunciada. Hoy tenemos la facilidad de que hay diversos programas de apoyo para estos pacientes, que incluyen la terapia antirretroviral, exámenes de control y grupos de apoyo social y psicológico”, explica.

La médica asegura que si la paciente es responsable de su salud y sus medicamentos, puede embarazarse y llevar el control periódico de su embarazo.

“Ahora, si el panorama es diferente con una paciente que ha tenido poca adherencia a su tratamiento o sea irresponsable en sus controles, que tenga enfermedades secundarias no controladas o de mal pronóstico», advierte, «se vuelve necesario evitar el embarazo para evitar complicaciones maternas o fetales”.

Serpas explica que los temas de salud reproductiva no son vistos como un problema. “Eso pasa porque vivimos en un mundo que se ve totalmente masculino, y más, en temas como el VIH”, dice.

ANP+VN recibe con frecuencia reclamos sobre la falta de apoyo en términos de planificación familiar, agrega. “Todavía se cree que la persona recibe el diagnóstico y se olvida de su vida sexual… Hemos detectado que a la hora que se les hace la citología (prueba de detección del virus del papiloma humano, que causa el cáncer de cérvix) han recibido maltrato por parte del personal de salud, siempre con la interpretación de ‘¿por qué sigue teniendo relaciones sexuales?’. La respuesta del VIH ha evolucionado, pero el pensamiento sigue siendo mediocre”.

IV Migración

Lizz no solo enfrentó la violencia obstétrica en su país, durante el juicio también recibió llamadas anónimas donde la amenazaban con atentar contra su vida. En sus visitas al hospital para recibir tratamiento psicológico, hubo personal médico que la intentó persuadir para que desistiera en su demanda.

El Jefe Departamento de VIH y Derechos Humanos de la Procuraduría General de Derechos Humanos, Jaime Argueta, reconoció que “no existe un sistema de protección que pueda dar garantías a la persona que ha tenido el valor de presentar la denuncia, para protegerla contra el mismo estado. Incluso, ella empezó a ser cuestionada al momento de recibir su tratamiento».

Cada vez es menos frecuente es el estigma en ámbito de salud o en el ámbito laboral, dice, pero aún se pide la “prueba de VIH para el ingreso a un empleo como parte de la batería de exámenes”.

En el ámbito comunitario, advierte que todavía hay mucha discriminación y se divulgan los diagnósticos de personas en los lugares donde ellos viven.

“Tal vez trabajan en una sala de belleza y alguien empieza a divulgar el diagnóstico y pierden sus clientes. O venden cualquier tipo de alimentos ya preparados para el consumo y también son afectadas en sus formas de vida”, expuso.

Lizz vivía en una zona declarada de alto riesgo de violencia por pandillas. Esto se convirtió en una razón más que la llevó a migrar a Estados Unidos junto con su hija y su actual pareja. Allá, a más de 10 mil kilómetros del país que la expulsó, ahora intenta rehacer su vida.

“Quería una vida mejor para mi hija. El miedo también tuvo que ver en mi decisión de migrar”, expresó.

V Una nueva vida

A pesar de su condición migratoria irregular, Lizz ha logrado tener acceso a un tratamiento de retrovirales a través de un protocolo en un Centro de Investigación en Estados Unidos, al cual accedió por medio de un hospital.

Por ahora trabaja, estudia inglés y desea regresar a la Universidad a estudiar leyes para ayudar a otras personas: “Mi sueño es trabajar en una organización que ayude en los derechos humanos o migración”.

Según la Comunidad Internacional de Mujeres viviendo con VIH Sida (ICW Latina), en El Salvador el marco legal que establece sanciones para el personal sanitario en el caso de la esterilización forzada a las mujeres con VIH tiene una calificación positiva, es decir, según esta organización los médicos sí reciben penalidad ante estos casos. Sin embargo, los que atendieron el caso de Lizz no recibieron ninguna penalidad.

Al cierre de esta investigación se solicitó una entrevista con la jefa del Programa Nacional de ITS/VIH/SIDA, Dra. Ana Isabel Nieto Gómez, para conocer su postura respecto al caso de Lizz, sin embargo no se recibió respuesta. La doctora Nieto fungía en ese mismo cargo en 2010, cuando Lizz fue esterilizada de forma forzosa.

En la actualidad Nieto es funcionaria del Gobierno del presidente Nayib Bukele. Su régimen ha sido señalado por nula rendición de cuentas, dar poco acceso a la prensa y por declarar “confidencial” información pública.

En la actualidad ANP+VN trabaja para brindar apoyo legal, capacitaciones, atención psicológica, reinserción laboral y generación de alternativas de ingresos para personas con VIH. Además, tiene estrecha relación con los grupos de apoyo de personas con VIH de la red hospitalaria nacional. Cientos de personas se han visto beneficiadas por sus proyectos. Su abogada compartió que cuando la prensa cubrió el caso de Lizz, tuvieron conocimiento de más casos a los que podrían dar más seguimiento y llevar a la justicia si contaran con los fondos.

 

Belgium: 26 organisations call for ending the criminalisation of HIV non-disclosure when people are undetectable or used protection

Call to protect people living with HIV from criminal prosecution

Article translated with www.DeepL.com/Translator. For original article in French please scroll down.  

“An HIV-positive person on treatment with an undetectable viral load does not transmit the virus,” said Sarah Schlitz (Ecolo), Federal Secretary of State for Equal Opportunities.

Ex Aequo, a non-profit organisation that promotes health and aims to reduce the number of new HIV/AIDS infections among men who have sex with men, is calling on Wednesday for an HIV-positive person whose viral load has been rendered undetectable by treatment, or who uses a means of protection, to no longer be exposed to criminal prosecution if he or she does not announce his or her serological status before having sex. The call is supported by the Federal Secretary of State for Equal Opportunities Sarah Schlitz (Ecolo) and 25 other associations.

“An HIV-positive person on treatment with an undetectable viral load does not transmit the virus”, says Sarah Schlitz. “The images and fears associated with the early years of the HIV epidemic are still very strong. This creates a climate of discrimination and prevents the 20,000 people living with HIV in our country from living their lives in peace.

Widely followed treatments
The announcement in a Swiss journal in 2008 that people with an undetectable viral load had no risk of transmission was confirmed by a large study with HIV-positive couples initiated in 2010. “More than 90% of people living with HIV in Belgium take their treatment,” adds Mike Mayné, president of the association Ex Aequo. “There is no longer any reason to force these people to say they are HIV-positive before having sex, which is a vector of rejection… There is no risk of having sex with an HIV-positive person whose viral load is undetectable, which is not the case with a person who thinks he or she is negative until proven otherwise, and who may not have been tested to know his or her HIV status for several weeks, months or years. He pleads for the consideration of viral load to be anchored in jurisprudence.

“For a long time, there were debates about poisoning, but this did not lead to a decision on the grounds that, in this case, there must be an intention to kill,” recalls Charlotte Pezeril, director of the Observatoire du sida et des sexualités. “There was finally a first conviction in June 2011 which set a precedent.

Some convictions
The Huy criminal court ruled in favour of a newly infected woman and sentenced an HIV-positive man at an advanced stage to three years in prison (two of which were suspended) for “voluntarily administering, without the intention of killing, substances that can cause death or seriously alter health”, according to article 402 of the penal code.

In a case of paid homosexual intercourse, the Brussels correctional court then sentenced in October 2015 (decision confirmed on appeal in May 2017) to 18 months in prison the man paid for attempted administration, without taking into account his treatment and viral load in the proceedings.

There are only a few convictions in Belgium, according to a non-exhaustive data collection, which is also difficult. More broadly, “there was a wave of penalisations that emerged in the years 2000-2010, when we were at a time when effective antiviral treatments had been found”, observes Charlotte Pezeril. “At the beginning, HIV was a great cause for mobilisation, giving rise to solidarity with sufferers, and as long as there was no treatment, the messages called for partners to share responsibility and protect themselves with condoms. With the introduction of penalties, the focus of responsibility has shifted to those who have been diagnosed.

A perilous path
In Canada, where convictions have multiplied, the question of treatment has become central and since 2017 it has been necessary to prove that there is a real risk of transmission. Sarah Schlitz said that she and the Minister of Justice are examining the possibility of clarifying the text on the transmission of a virus when it is not intentional, in the context of the reform of the criminal code. Charlotte Pezeril drew attention to the proposal to insert “malicious dissemination of pathogens”, which is also under discussion.

While this virus is at the heart of a pandemic that has brought about major societal changes, this criminalisation could, in her opinion, open up a dangerous path: “We are now starting to see convictions in Australia for the transmission of syphilis. Now that HIV is treatable and we have case law, why not penalise the transmission of other sexually transmitted infections, or even other transmissible diseases… Penalisation does not seem to be a good public health policy and it has perverse effects in terms of prevention.


Appel pour prémunir les personnes vivant avec le VIH de poursuites au pénal

“Une personne séropositive au VIH sous traitement avec une charge virale indétectable ne transmet pas le virus” a appuyé la secrétaire d’État fédérale à l’Égalité des chances, Sarah Schlitz (Ecolo).

Ex Aequo, asbl de promotion de la santé visant une diminution des nouvelles infections au VIH/sida auprès des hommes qui ont des relations sexuelles avec d’autres hommes, plaide mercredi pour qu’une personne séropositive dont la charge virale est rendue indétectable par son traitement, ou utilisant un moyen de protection, ne soit plus exposée à des poursuites pénales si elle n’annonce pas son statut sérologique avant un rapport sexuel. Cet appel est soutenu par la secrétaire d’État fédérale à l’Égalité des chances Sarah Schlitz (Ecolo) et 25 autres associations.

« Une personne séropositive au VIH sous traitement avec une charge virale indétectable ne transmet pas le virus », met en exergue Sarah Schlitz. « Les images et les peurs liées aux premières années de l’épidémie du VIH restent très fortes. Cela crée un climat propice à la discrimination et empêche les 20.000 personnes vivant avec le VIH dans notre pays de vivre leur vie sereinement».

Traitements largement suivis
L’annonce dans une revue suisse de 2008 de l’annihilation du risque de transmission pour les personnes ayant une charge virale indétectable a été confirmée par une large étude avec des couples sérodifférents initiée en 2010. « Plus de 90% des personnes vivant avec le VIH en Belgique prennent leur traitement », ajoute Mike Mayné, président de l’association Ex Aequo. « Il n’y a donc plus de raison d’obliger ces gens à dire qu’ils sont porteurs avant un rapport sexuel, ce qui est vecteur de rejet… Il n’y a pas de risque d’avoir des rapports sexuels avec une personne séropositive dont la charge virale est indétectable, ce qui n’est pas le cas avec une personne qui pense être négative jusqu’à preuve du contraire, et qui n’a peut-être pas fait de test pour connaître son statut sérologique depuis plusieurs semaines, mois ou années ». Il plaide pour que la considération de la charge virale trouve ancrage dans la jurisprudence.

« Il y a eu pendant longtemps des débats autour de l’empoisonnement, mais cela n’a pas abouti au motif qu’il faut dans ce cas retenir une intention de tuer », rappelle Charlotte Pezeril, directrice de l’Observatoire du sida et des sexualités. « Il y a finalement eu une première condamnation en juin 2011 qui a fait jurisprudence ».

Quelques condamnations
Le tribunal correctionnel de Huy a donné raison à une femme nouvellement contaminée et a condamné un homme séropositif à un stade avancé à trois ans de prison (dont deux ans de sursis) pour avoir « administré volontairement, mais sans intention de tuer, des substances qui peuvent donner la mort ou altérer gravement la santé », selon l’article 402 du code pénal.

Dans une affaire de rapport homosexuel rémunéré, le tribunal correctionnel de Bruxelles a ensuite condamné en octobre 2015 (décision confirmée en appel en mai 2017) à 18 mois de prison l’homme payé pour tentative d’administration, sans prise en compte de son traitement et de sa charge virale dans les débats.

Il n’est question que de quelques condamnations en Belgique, selon une collecte des données non exhaustive, qui s’avère en outre difficile. Plus largement, « il y a eu une vague de pénalisations qui a émergé dans les années 2000-2010, alors qu’on était à une période où on avait trouvé des traitements antiviraux efficaces », observe Charlotte Pezeril. « Au début, le VIH était une grande cause de mobilisation suscitant solidarité avec les malades et tant qu’il n’y avait pas traitement, les messages appelaient à la coresponsabilité des partenaires, à se protéger avec des préservatifs. Avec les pénalisations, la responsabilisation ne s’est plus portée que sur les personnes diagnostiquées ».

Voie périlleuse
Au Canada où les condamnations se sont démultipliées, la question du traitement est devenue centrale et il faut depuis 2017 prouver qu’il y a un risque réel de transmission. Sarah Schlitz a indiqué examiner, avec le ministre de la Justice, la possibilité de clarifier le texte sur la transmission d’un virus lorsqu’elle n’est pas intentionnelle, dans le cadre de la réforme du code pénal. Charlotte Pezeril quant à elle attire l’attention sur la proposition d’insérer la « dissémination malveillante d’agents pathogènes », également en discussion.

Alors que ce virus est au coeur d’une pandémie qui a amené de grandes changements sociétaux, cette pénalisation pourrait selon elle ouvrir une voie périlleuse: « On commence aujourd’hui à avoir en Australie des condamnations pour transmission de syphilis. Maintenant que le VIH est traitable et qu’on a une jurisprudence, pourquoi ne pas aller pénaliser la transmission d’autres infections sexuellement transmissibles, voire d’autres pathologies transmissibles… La pénalisation ne semble pas être une bonne politique de santé publique et elle a des effets pervers au niveau de la prévention ».