TOPEKA, Kansas – A promise from Kansas’ health department Thursday to continue protecting AIDS and HIV patients from being quarantined has resolved a dispute over a legislative proposal for helping medical personnel and emergency workers who may have been exposed to infectious diseases.
Botswana’s draconian Public Health Bill approved by Parliament, BONELA will challenge it as unconstitutional once President signs into law (Update 3)
Update: April 5th 2013
Very disappointing news from Botswana. The Public Health Bill – including all of its draconian provisions on HIV – has been approved by Parliament.
BONELA issued this press release last week just prior to the vote.
MEMBERS OF PARLIAMENT (MPs) ARE THE ONLY ONES WHO CAN SAVE US FROM THE PROPOSED PUBLIC HEALTH BILL…..IT IS IN THEIR HANDS
We knew that the Public Health Bill will be back in Parliament for further debate. However, we had anticipated that the Ministry of Health would heed calls made by stakeholders such as BONELA, UNAIDS, WHO, SALC, AIDS Alliance, ARASA, Ditshwanelo and other concerned Batswana and make amendments to the bill, particularly on the controversial, offensive and invasive provisions.
To our utter shock, the Ministry of Health intends to make no changes to the bill at all; even with the benefit of information on best practices availed to them. This to us; is a clear case of indifference and a deliberate plan to violate people’s rights.
BONELA and its stakeholders have done all that is possible to raise awareness, especially to the general public who would be affected by this law. It is now up to MPs to propose and vote on the amendments.
If MPs fail or decide not to discharge that constitutional mandate, as concerned stakeholders, we would know that our MPs are happy to see people’s rights being violated-that they are happy to see Batswana being tested for HIV without their consent, happy to give doctors sole mandates on deciding when and what to do with patients without consultations.
We would also know that MPs by failing to do their duty are happy to see litigants in court pleading not to be tested for HIV because their government want them to. Moreover, we would know that our MPs are happy to place responsibilities of sexual matters ONLY on those who are HIV positive by agreeing with forceful disclosure to all potential sexual partners by people living with HIV even if they are using protection.
Lastly, our MPs will be happy to see that whoever seeks dental services is required to do an HIV test before such services are meted.
It is therefore, in the hands of MPs to exercise their power to propose and vote for a sound Public Health bill. It is in your hands……
According to this APA piece, published on Wednesday, the Bill was approved by parliament. BONELA is now waiting for Botswana President, Ian Khama, to sign the Bill into law before it can approach the High Court to challenge the offending clauses as unconstitutional.
Botswana’s Health Minister, Dr John Seakgosing on Tuesday said the Public Health Bill, which seeks among other things, to isolate people who infect others with sexually-transmitted diseases such as HIV/AIDS, while knowing their status, will apply to Members of Parliament, cabinet ministers and even the president.
He explained to APA in an interview that the Bill that was passed last week, will not apply only to ordinary citizens.
According to Seakgosing, if the president, ministers and legislators are found to be infecting others carelessly, they will be brought before the courts where the magistrate will take a decision to isolate them from the public.
While he explained that the Bill does not seek to empower medical practitioners to force clients to undergo tests, but Clause 104 (3) (b) provides that “the director or a person authorised by him may where necessary and reasonable, require a person or a category of persons to undergo an HIV test”. Clause 104 (4) then provides that “where a person required to undergo a test under Clause 104 (3) refuses to do so, the director may apply to a magistrate for an order requiring that person to undergo the test.”
But some HIV/AIDS activists are up in arms saying the Bill will reverse the gains achieved in fighting the HIV scourge as it encourages discrimination.
AIDS advocacy group Botswana Network on Ethics Law and HIV/AIDS (BONELA) says it intends to take the government to court over the Public Health Bill that has been approved by parliament.
BONELA director, Uyapo Ndadi, said in an interview that his organisation is only waiting for President Ian Khama to sign the Bill into law before it can approach the high court to challenge certain clauses in it as they are unconstitutional.
Update: December 14th 2012
The Public Health Hill has been shelved until next February thanks to the advocacy against the “outrageous” HIV-related provisions (see below) spearheaded by the Botswana Network on Ethics, Law and HIV/AIDS (BONELA). That’s the good news this morning, according to Uyapo Ndadi, BONELA’s Executive Director:
I am happy to inform you that the outrageous Public Health Bill has been shelved, at least until next year February when parliament resumes business. Our collective advocacy has helped to thwart cabinet’s plans to have the bill passed into law during this sitting.
I am happy to further inform you that UNAIDS has also written to our government to remove the draconian provisions from the bill.
It is now hoped that in the intervening months, BONELA and other human rights advocates will add to the pressure created by UNAIDS to make the Government see that in order to save face internationally, they must either substantially rewrite the Bill or drop it completely.
Update: December 11th
Disappointing and worrying news today from BONELA:
Parliament yesterday voted in favour of passing the Bill from the 2nd reading stage to the Committee stage. Amendments to the Bill may be made at the Committee stage. It means that our efforts to get the Minister to withdraw the bill for lack of consultation have failed. Our hope now is that Parliament will remove from the bill the draconian parts of it.
A report in BOPA daily news highlights the debate yesterday
The Member of Parliament for Lobatse, Mr Nehemiah Modubule says he does not support the Public Health Bill in its current state. Debating the bill in parliament on Thursday, Mr Modubule said it should first be put into perspective, as some of the clauses are contradictory. He argued that they would have a hard time trying to amend such clauses if the bill passes to the committee stage. He noted that consultations with some stakeholders such as Botswana Network on Law and AIDS (BONELA) were not done. Furthermore, he said, the minister of health should have done justice to the bill by deferring it for further consultations, as some clauses touch on customs and practices of Batswana.
In his contribution, the MP for Moshupa, Mr Mokgweetsi Masisi supported the bill, arguing that prevention and control of diseases is not peculiar to Botswana, more so that new communicable diseases continue to emerge. Mr Masisi said the bill conforms to international practices in terms of public health, adding that consultations had been done and they should not delay the bill.
Original post: December 10th
On Friday, Botswana’s Parliament debated the proposed Public Health Bill which contains some shocking and regressive HIV-related provisions that, according to a strongly-worded press release from the Botswana Network on Ethics, Law and HIV/AIDS (BONELA) “have no place in a democratic and modern day Botswana..that are counter-productive, discriminatory, unconstitutional and barbaric.”
The relevant passages of the Bill are available to download here (Botswana Public Health Bill 2012.pdf, 1.4MB)
Some of the most problematic provisions as highlighted by BONELA, are below.
Clause 104 (3) b – empowering medical practitioners to force their patients to undergo HIV tests without their consent.
The Director, or any person authorised by him or her, may, where necessary and reasonable require a person or a category of persons to undergo an HIV test.
Clause 105 (2) b – empowering doctors to test patients without their knowledge.
A medical practitioner responsible for the treatment of a person may conduct an HIV test without the consent of that person where — (b) the medical practitioner believes that such a test is clinically necessary or desirable in the interests of that person.
Clause 109 (3) – allowing surgeons or dentists to test a patient for HIV before deciding on whether to carry out a non-urgent procedure.
Where, in the opinion of a medical practitioner, nurse or dental practitioner, the surgical or dental procedure is not urgently required in respect of a person, the medical practitioner, nurse or dental practitioner may require the person to undergo an HIV test before carrying out that procedure.
Clause 116 (1) – mandating HIV disclosure to all potential sexual partners or care giver and allowing prosecution for placing another at risk.
A person who is aware of being infected with HIV or is carrying and is aware of carrying HIV antibodies shall — (a) take all reasonable measures and precautions to prevent the transmission of HIV to others; (b) inform, in advance, any sexual contact or care giver or person with whom sharp instruments are shared, of that fact; and (c) not place another person at risk of becoming infected with HIV.
Clause 116 (7) empowering doctors to disclose their patient’s HIV status to their sexual partner without their consent.
A medical practitioner who is responsible for the treatment of a person and who becomes aware that the person has not, after a reasonable opportunity [disclosed their HIV status] may, after consultation with an approved specialist medical practitioner, inform any sexual contact or care giver of that person of the HIV or HIV antibody status of that person.
Clause 116 (9-12) – limiting the right to freedom of movement for people with HIV without sufficient legal checks and balances.
(9) The Director or any officer representing the Director may, in writing, apply to a magistrate for an order where the Director reasonably believes that a person infected with HIV — (a) is not complying with this Part; b) knowingly or recklessly places another person at risk of becoming infected with HIV without the knowledge of that person of the infected person’s HIV status; or (c) is likely to continue the behaviour referred to in paragraph (b). (10) For the purpose of subsection (9), a magistrate may make any or all of the following orders — (a) an order that the person infected with HIV undergo such medical and psychological assessment as the Minister determines; (b) an order imposing restrictions on the person for a period not exceeding 28 days; or (c) an order requiring that the person be isolated and detained by a person, at a place and in the manner specified in the order for a period not exceeding 28 days. (11) In making an order in respect of a person under subsection (10), a magistrate shall take into account the following matters — (a) whether, arid by what method, the person transmitted HIV; (b) the seriousness of the risk of the person infecting other persons; (c) the past behaviour and likely future behaviour of the person; and (d) any other matter the magistrate considers relevant. (12) The Director may, in writing, apply to a magistrate to renew an order made under subsection (10) for a further period or periods not exceeding 28 days.
According to BONELA, the Bill appeared from out of the blue without any public consultation.
We are concerned by government attitude and tendency of introducing Bills in Parliament and debating them before engaging all stakeholders, including the civil society and Batswana as a whole. We know that the Botswana Health Professions Council is not aware of this Bill for they have not been consulted on it. As custodians of health we expect them to be intimately involved as this Bill is going to affect the way they work. This bill is significant in the lives of all of us and we therefore call upon [Minister of Health] Reverend Dr. John G.N. Seakgosing [contactable via phone on +267313632521] to withdraw it and if he refuses to, we urge MPs to reject it.
Although the Bill was discussed last Friday – and a copy of the Bill obtained only then – Parliament adjourned before voting, but will continue this week. Action, therefore, is urgently required.
US: How well-meaning ideals of constitutional 'equality' are leading to a law that may be used to harass and control people with HIV in Kansas
A bill that a leading gay rights advocate says will lead to the harassment of people with AIDS appears headed toward approval. House Bill 2183 would repeal a 25-year-old law that prohibits state and local health officials from quarantining people with AIDS or HIV, the virus that causes AIDS.
US: Todd Heywood's analytical history of how the US developed HIV-specific criminal statutes and why there's now a movement to modernise or repeal these laws
In the late fall of 1988, state lawmakers and representatives from major insurance and pharmaceutical companies were hard at work addressing the looming AIDS crisis for the American Legislative Exchange Council, a conservative-leaning think tank that produces state-based business-friendly model legislation.
Uganda: As second reading of controversial national HIV law awaits, activists hope regional HIV law – with no HIV criminal statute – will take precedence
Activists in Uganda are seeing an opportunity to shoot down the country’s controversial HIV Bill that criminalises transmission of the Aids virus and enforces mandatory testing, after President Yoweri Museveni signed a more liberal one proposed by the East African Community. They want Uganda’s parliament to incorporate into law the EAC HIV and Aids Prevention Bill (EAC HIV Bill) that President Museveni signed last week. More than 30 NGOs in Uganda find the national law that is awaiting a second reading in parliament offensive, saying that it could exacerbate the spread of HIV. Laws passed by the East African Legislative Assembly take precedence over national laws. President Museveni can also prevail upon the Ugandan parliament to drop the bill.
US: Kansas Senate rejects amendment to remove possibility of quarantining people with HIV, headline suggests otherwise
State health officials in Kansas worked Friday to tamp down speculation about a House bill interpreted as a vehicle to authorize the quarantine of people with HIV or AIDS.Charles Hunt, an epidemiologist in the Kansas Department of Health and Environment, said House Bill 2183 wouldn’t allow state-sanctioned isolation of people exposed to the human immunodeficiency virus, which causes acquired immune deficiency syndrome.
US: Well-meaning bill to repeal Maryland's HIV-specific criminal law may do more harm than good, advocates warn
A Maryland lawmaker and a handful of local advocates have started the course to repeal the state’s HIV-specific criminal law, and if other states’ efforts are any indication, Maryland’s path will likely be a long and winding one. Maryland Del. Shirley Nathan-Pulliam (D-Baltimore County) decided last week to withdraw a short-lived bill that would have repealed a state law that makes it a misdemeanor crime – punishable by a fine of up to $2,500 and/or three years in prison – for a person who has HIV to “knowingly transfer or attempt to transfer” the virus to another person. Nathan-Pulliam said she withdrew the bill after hearing from HIV advocates who feared a straight repeal of the state law might do more harm than good.
Kan. health dept. proposal could allow for quarantine of individuals with HIV
TOPEKA, Kan. – A proposed bill in the Kansas state legislature could allow the quarantine of people with AIDS or HIV , according to an LGBT advocacy group in testimony before a Kansas state Senate panel on Thursday.
Canada: Police training and guidelines in criminal HIV non-disclosure cases urgently required
The Canadian HIV/AIDS Legal Network and HIV & AIDS Legal Clinic Ontario (HALCO) have submitted a paper to the Ontario Association of Chiefs of Police Diversity Committee, informed by their extensive experience in working on the issue.
The paper includes concrete recommendations for police that could be addressed in a general Best Practice Manual, and recommend the development of specific guidelines in relation to non-disclosure of HIV (and possibly other sexually transmitted infections), in consultation with people living with HIV and the Ontario Working Group on Criminal Law and HIV Exposure (CLHE), as well as other relevant stakeholders.
The submission states
The Ontario Association of Chiefs of Police should engage in a dialogue with representatives of the community, including the Ontario Working Group on Criminal Law and HIV Exposure(CLHE) in order to develop:
- training for police about HIV transmission and the realities of living with HIV today; and
- guidelines for police handling matters of alleged HIV (and possibly other sexually transmitted infection) non-disclosure.
Indeed, both training and guidance on HIV-related issues are urgently required in the aftermath of last November’s Supreme Court ruling which has created a great deal of confusion regarding the exact circumstances when alleged HIV non-disclosure may be a crime.
As the submission notes
Guidelines can help ensure that complaints are handled in a fair, non-discriminatory and consistent manner across the province; criminal investigations are informed by current medical and scientific knowledge about HIV and the social contexts of living with HIV; criminal investigations do not reinforce societal prejudices, preconceptions, and irrational fears regarding HIV, or undermine public health efforts to prevent the spread of HIV; unnecessary investigations are not pursued; and the rights of people living with HIV and complainants are fully respected and preserved.
Guidance around confidentiality issues are needed now more than ever. Last month, Toronto police issued a press release stating they were looking for a gay man “who failed to notify his partner that he is HIV positive.” The following day, they withdrew the alert “after police probed the case, [because] investigators found that no criminal offence was committed.” Unusually in this case, however, no name or photo was released.
Specific recommendations from HALCO and the Legal Network on this issue state:
Police should consider the negative impacts of publicly disclosing a person’s HIV-positive status given the high level of stigma experienced by people living with HIV. Police must ensure that the privacy of HIV status and other medical information is respected to the greatest extent possible (applies to accused and complainants). Media releases including the name, picture and/or health information of an accused are extremely prejudicial for people living with HIV and should only be published in exceptional circumstances and under strict conditions. Police should be mindful that even where HIV is not specified on a police and/or media release, members of the general public and/or people associated with the accused may easily understand that the accused is HIV-positive because of general awareness of HIV non-disclosure prosecutions in Canada. Detailed guidance should be developed to assist police in making decisions to publish a police and/or a media release, and to assist police with the content of such releases. Guidance should be developed to assist police in communicating to the media and the public about cases involving HIV non-disclosure.
The campaign for police training and guidelines in Ontario runs in parallel with a similar campaign for prosecutorial guidelines. A recent article in Lawyers Weekly highlights how advocates have been pushing for such guidelines for several years, and are hopeful that some movement may now take place
That hope springs from two sources. First, Canadian provinces would not be the first to put such guidelines in place. England, Wales and Scotland already have related prosecutorial requirements. Second, Ontario’s justice ministry had previously indicated a willingness to do this before the recent SCC decisions were handed down.
The full submission can be read below or downloaded here.
The criminalization of HIV non-disclosure: Recommendations for police
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.