US: Activists activists raise concerns over the links between public health & law enforcement surveillance

Questioning the Benefits of Molecular Surveillance

Can this HIV prevention strategy overcome mistrust and fear among marginalized communities?

In Texas, health officials recently used a new surveillance technology to identify a large HIV outbreak among gay and bisexual Latino men. In Massachusetts, officials used the same strategy to respond to an outbreak among injection drug users. And in California, researchers used the method to identify a transmission cluster among transgender women.

Led by initial proof-of-principle research at the Centers for Disease Control and Prevention (CDC), an HIV prevention strategy known as molecular surveillance is quickly expanding across the country. Since December 2015, according to an email from a CDC source who commented on background, the technique, based on sequencing and comparing individuals’ viral genetic blueprints, has identified more than 240 recent and rapidly growing HIV transmission clusters, the vast majority of which had not previously been recognized. Comparing these sequences allows researchers to determine whether individuals’ HIV is closely related, which offers clues about who transmitted the virus to whom. 

Traditional public health methods—now being used to trace the spread of COVID-19, the disease caused by the new SARS-CoV-2 coronavirus—largely rely on asking people about their contacts and getting in touch with them by phone or in person. The CDC source said molecular data analysis allows for more rapid and comprehensive cluster and outbreak detection and response. As such, molecular surveillance is seen by the agency as a key part of effective HIV prevention and a means to help hard-hit communities and the nation end the HIV epidemic.

Those idealized goals, however, are clashing with a far messier reality in which decades of mistrust and fear among marginalized communities, heightened in the current political climate, are coming to a head. The tech-aided HIV surveillance strategy, six activists told POZ, could open up new avenues for private data to be breached, exploited, subpoenaed or otherwise released through many of the HIV criminalization laws and statutes still on the books in 34 states.

Activists say the CDC-led molecular surveillance effort was launched with little or no consultation or buy-in from the communities most likely to be impacted. Several meetings ensued, including one convened in 2018 by the O’Neill Institute for National & Global Health Law at Georgetown Law School in Washington, DC, that allowed critics to air some of their concerns. Despite a subsequent round of CDC guidelines on how best to safeguard patient data, however, the controversy has only grown over the potential misuse and unintended consequences of the surveillance scheme.

Patients can’t opt out of providing their viral sequence data for the molecular tracking, critics point out. Nor does the strategy adequately consider the state-by-state patchwork of protections and penalties or the growing health implications of an erosion of immigrant, minority and LGBTQ rights, they say.

Sean Strub, POZ’s founder and the executive director of the nonprofit Sero Project, which focuses on reforming HIV criminalization laws, says he fears the CDC-led strategy will diminish trust and cooperation with public health agencies and drive more vulnerable people further from the health care system out of fear of surveillance. “I think the risk of unintended consequences is very great,” he says.

Strub and other activists see molecular surveillance as part of a broader trend in the “securitization of disease,” which is increasingly blurring the lines between the public health and criminal justice systems.

“We are potentially threatening people’s freedom just to get cleaner data, and I think it’s a clear ethical concern,” says Devin Hursey, a member of the Missouri HIV Justice Coalition and a board member of Blaq Out, a nonprofit advocacy group for Black queer and transgender people in the Kansas City region. “We can’t just look the other way or say we’re doing our best effort when we’re not really addressing that HIV criminalization still exists.”

The CDC source told POZ that the agency understands and has addressed many of the questions and concerns raised by community advocates. The CDC has strong data protections and security measures in place, the source said, and has worked for many years to provide guidance to states on reviewing and revising criminalization laws and ensuring data are well protected.

But Naina Khanna, executive director of Positive Women’s Network–USA, says the CDC hasn’t responded to specific questions about its data-sharing practices with other federal agencies, like the Department of Homeland Security and Immigration and Customs Enforcement (ICE). Khanna points out that the communities most impacted by HIV are also disproportionately affected by surveillance, policing and criminalization. “That’s extremely concerning when we think about how policing intersects with being a Black gay man or being a Latino gay man,” she says. In response, the CDC source told POZ that all HIV surveillance data are reported to the agency without names or any personal identifiers and are encrypted and protected by an Assurance of Confidentiality under Section 308(d) of the federal Public Health Service Act.

A New Surveillance Tool

When someone tests positive for HIV in the United States, a blood draw allows labs to sequence part of the viral genome, or its genetic blueprint, and use that to determine whether the virus contains mutations that might lead to drug resistance. This information can help doctors tailor the best HIV treatment regimen for each individual. But once the genetic sequencing is complete, health departments can access that data for molecular HIV surveillance. Specifically, they compare viral RNA sequences from multiple individuals to identify clusters of transmission. This is possible because HIV mutates over time; as a result, people with similar genetic sequences are more likely to have been infected around the same time as part of the same person-to-person chain of viral transmission.

Randy Mayer, MS, MPH, chief of the Bureau of HIV, STD and Hepatitis at the Iowa Department of Public Health, says the HIV resistance tests sent in by doctors around the state essentially provide his department with free surveillance data. “It’s something that we can use to try to improve our response that doesn’t really cost us anything,” Mayer says. “So from that point of view, it is cost effective.”

If a state-run computer program finds two or more individuals who share closely related viral sequences, it suggests that HIV might have passed between them or through a close intermediary. Spotting such clusters of transmission could help public health officials identify HIV-positive individuals and their close sexual or needle-sharing partners.

The surveillance approach has multiple potential benefits, researchers say. “This is just one more strategy in the toolbox of surveillance tools used to guide public practice,” says Nanette Benbow, MAS, research assistant professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine in Chicago. HIV transmission clusters identified through this method, she says, may represent only the “tip of the iceberg” of at-risk individuals, since the genetic information is available only for HIV-positive people who’ve been to a doctor and received drug resistance testing. Through contact tracing, though, public health officials can find other people associated with the cluster, contact them and offer them a range of care or prevention services, like pre-exposure prophylaxis (PrEP), if they’re not already receiving them.

Benbow says evidence suggests that the rate of HIV transmission within such clusters is much higher than that of transmissions overall, bolstering the case that public health agencies should focus on these clusters as significant sources of active viral transmission.

Some public health experts say the growth of surveillance is inevitable. “You’re not going to stop technology. All you can do is try to get it implemented in an ethical manner,” says Eve Mokotoff, MPH, managing director of HIV Counts, a consulting business based in Ann Arbor, Michigan, that assists with HIV surveillance.

Andrew Spieldenner, PhD, vice chair of the U.S. People Living with HIV Caucus and an assistant professor of communications at California State University San Marcos, rejects that argument. “Just because technology exists doesn’t mean we have to use it,” Spieldenner says. “We have to balance it with the harms it does to individuals.”

Newer technology that could extend molecular HIV surveillance is giving activists more pause. One method, called ultra-deep whole-genome next-generation sequencing, isn’t yet part of the CDC strategy. But emerging study data suggest that it could predict the directionality of linked HIV transmissions, potentially adding new evidence to suggest who infected whom. Researchers at Johns Hopkins University School of Medicine, in fact, recently described how they correctly predicted HIV transmission from an index case to a sexual partner in more than 90% of 105 sample pairs. The direction couldn’t be established in the remaining cases, but the method didn’t incorrectly predict any transmissions.

Other research the CDC is pursuing may help estimate the recency of an infection, meaning whether one person acquired HIV more recently than another. Together, the data could enable additional predictions about when and how HIV infections occurred within transmission clusters. Benbow says the data on their own don’t prove direct transmission, since another individual could have been an intermediary in the chain, but Khanna points out that judges and juries wouldn’t necessarily take these scientific caveats into account. “We see a lot of potential for opening the door to criminalization,” she says.

Despite privacy assurances, Strub maintains that data collected for one purpose is being unethically used for another without patient consent. “It’s not being used evenly across the society. Molecular surveillance focuses on the communities that are already highly marginalized, communities where there is the greatest risk of serious, harmful consequences,” he says. “People of privilege don’t see this.”

In a 2019 letter in the journal Lancet, researchers at the University of California, San Diego responded to criticism of their molecular surveillance study of an HIV transmission cluster involving transgender women by questioning whether informed consent is “imperative” for such analyses. “Surveillance for numerous infectious agents, including HIV, is done ethically and without consent. The public good of HIV surveillance justifies this approach,” they wrote. “Requiring consent for surveillance reporting would preclude a robust understanding of disease distribution and spread and the ensuing benefit to the health of individuals and communities.”

Alexander McClelland, PhD, a postdoctoral researcher in the Department of Criminology at the University of Ottawa, says such arguments reflect the logic that people living with HIV are an “object of risk” to be managed by public health. “We’re not considered to be people who have autonomy or rights to privacy or security of our own lives and our own bodies and our own data,” he says.

Many defenses of molecular surveillance, McClelland adds, also overlook other implications beyond the “broader public good” of repurposing patient data for public health surveillance. Among them, he says, are the criminalization, uncertainty and fear of people who are living with HIV and subject to continual privacy breaches. “People love to say, ‘We’re looking at molecules not people.’ But those molecules are connected to people, and those people are in the social world,” McClelland says, “and you can’t evacuate a virus from the social context that it’s in.”

A Climate of Fear

According to the Center for HIV Law & Policy in New York City, 34 states have enacted some form of HIV criminalization law or sentencing enhancement for other crimes allegedly committed by a person living with HIV. Although the language varies, 21 states have laws under which HIV-positive people who are aware of their status but don’t disclose it to sexual partners can be prosecuted (additional states have prosecuted nondisclosure under different laws); 12 states require the same disclosure among people who share needles. Some laws cover alleged HIV exposure while others cover actual transmission. Between 2009 and 2019, 24 states also prosecuted people living with HIV under other criminal statutes.

The interpretations and enforcement of laws can vary widely as well. In an April 2020 report, the Williams Institute at the UCLA School of Law documented 209 arrests and 107 convictions under Missouri’s HIV criminalization laws between 1990 and 2009. The report noted that the crimes appeared to be disproportionately enforced in St. Louis and adjacent St. Louis County. Although Black men account for 5.5% of Missouri’s population and 35% of people living with HIV, the report found, they accounted for more than half of HIV crime arrests and convictions over the 20-year period.

“We’re oftentimes targeted by not just HIV laws but by a lot of other different laws. We’re more likely to experience surveillance by law enforcement,” Hursey says of Black men. Layering on the element of molecular surveillance, he adds, only compounds the fear and lack of trust in public health and discourages the honest answers and cooperation necessary for HIV peer educators like him to do their jobs effectively. That mistrust is heightened by the legal requirement that Missouri’s health department must turn over all surveillance data to prosecutors pursuing an HIV criminalization case, he says.

“We have an epidemic of criminalization of people living with HIV, and you can only be prosecuted or convicted if you know your HIV status,” Khanna says. If people already feel marginalized and stigmatized, she and Hursey say, the added threat of criminalization based on knowing their HIV status can deter them from ever seeking out testing or care—the very opposite of stated public health goals.

Marco Castro-Bojorquez, cochair of the HIV Racial Justice Now project, says molecular HIV surveillance could likewise put undocumented immigrants at risk, especially since their existence in the United States is already criminalized. “It’s problematic, and it breaks my heart because a lot of people that could be very affected are those that are so fearful of the government and don’t really know that it’s happening,” he says.

Across the border from Missouri, Mayer says public health data are “well protected” in Iowa. They weren’t always, but in 2014, Iowa reformed its HIV criminalization law. The updated statute, Mayer says, requires proof that an HIV-positive person was negligent in exposing a partner to the virus and prohibits molecular surveillance data gathered by the state health department from being used to prosecute anyone. “I had some upset prosecutors who have tried to come to me, with subpoenas, to get information, which we don’t allow,” he says. Prosecutors can gather the data from other sources, but the health department has largely cut its tether to law enforcement.

Even so, prosecutors have found other mechanisms to gather data and enforce Iowa’s HIV criminalization law. In May, a 33-year-old Black man was sentenced to 26 years for “knowingly” exposing three women and a minor to HIV and transmitting the virus to three of them.

Activists say public health agencies also cannot divorce their molecular surveillance plans, however well intentioned, from the current rollback of LGBTQ, immigrant and minority rights. Castro-Bojorquez says the Trump administration’s anti-immigrant rhetoric and policies have not only eroded the Latino community’s trust in public officials but also worsened health outcomes. “Those attacks,” he says, “and the promotion of hatred, rolling back the few rights that we had and we fought so hard for, they have an impact, and people die.”

Numerous undocumented immigrants held in crowded detention centers have contracted COVID-19, and some deported immigrants have brought the coronavirus back to Guatemala, Mexico and other countries. Fear of HIV criminalization or deportation, Castro-Bojorquez says, has led other immigrants to avoid or delay “official” activities, including HIV testing and treatment. “Late diagnosis is a major issue in our communities,” he says, adding that it’s a big contributor to higher mortality rates among Latino men.

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Finding Common Ground

Amid the ongoing controversy, HIV activists and public health officials may be finding common ground on the need for more community engagement and on the importance of decoupling public health and law enforcement. In a 2019 commentary in the American Journal of Public Health, Benbow joined other AIDS researchers, bioethicists and a representative of the National Alliance of State and Territorial AIDS Directors (NASTAD) in explaining how multiple aspects of existing HIV criminalization laws could confound public health goals around molecular surveillance.

Benbow and her coauthors cautioned that using identified surveillance data against the interest of patients, especially without informing them, “could jeopardize community confidence in public health agencies.” The authors also noted the CDC’s requirement that funded health departments create plans to address gaps in data protection and consider eliminating or modifying potentially counterproductive laws. “In light of the considerations we have addressed, health department leaders should consider supporting statutes that expressly limit, or even prohibit entirely, release of surveillance data for law enforcement purposes,” they wrote.

Mokotoff cautions that a health department can’t always change its state law. “But the health department can work with the community to help them understand what needs to be done and what kind of wording might be helpful,” she says. “We have to stop allowing surveillance data to be used for prosecution of people who are sick or infected.” Protecting that data from being used in law enforcement, she adds, “would change the entire discussion” with stakeholders in the HIV-positive community.

The CDC itself has avoided criticizing specific state laws, though the agency source told POZ that the CDC has worked with partners like NASTAD to review the range of legal protections, policies and procedures that can help protect HIV data. The source noted that in 2014, the Department of Justice recommended that states either reform their laws to eliminate HIV-specific criminal penalties or modernize their laws to reflect current scientific evidence. The source also pointed out that the Department of Health and Human Services 2019 initiative, “Ending the HIV Epidemic: A Plan for America,” encourages states to take similar steps to help reduce stigma.

Benbow conceded that addressing the intense mistrust of underserved individuals who may need HIV prevention or treatment services the most, including people who inject drugs and undocumented immigrants, remains a steep challenge. But identifying clusters, she says, could help health officials make the case for targeted services that benefit underserved people, like the legalization of needle exchange programs.

“A lot of what we do in public health infringes on privacy, and what we’re trying to do is balance a person’s individual freedoms and liberties and privacy with trying to improve public health and work for the common good,” Mayer says. “You really have to think very carefully about that because if you push that too far, then you’re likely to get a lot of public health interventions rolled back, and people don’t want to work with you. They don’t trust you.” And as the history of HIV shows, regaining lost trust can take decades.

US: Interdisciplinary working group issues recommendations to better inform research while serving the interests of individuals affected by HIV

Addressing ethical challenges in US-based HIV phylogenetic research

Abstract

In recent years, phylogenetic analysis of HIV sequence data has been used in research studies to investigate transmission patterns between individuals and groups, including analysis of data from HIV prevention clinical trials; in molecular epidemiology; and in public health surveillance programs.

Phylogenetic analysis can provide valuable information to inform HIV prevention efforts, but it also has risks, including stigma and marginalization of groups, or potential identification of HIV transmission between individuals. In response to these concerns, an interdisciplinary working group was assembled to address ethical challenges in United States-based HIV phylogenetic research. The working group developed recommendations regarding (1) study design; (2) data security, access, and sharing; (3) community engagement; (4) legal issues; and (5) communication and dissemination. The working group also identified areas for future research and scholarship to promote ethical conduct of HIV phylogenetic research.

The full analysis can be downloaded here

France: HIV organisations mobilise to halt sensationalism of news coverage in police violence case

Spit and HIV: the violence of words

Automatic translation via Deepl.com. For original article in French, please scroll down.

Spit and HIV: the violence of words

Following the release of an amateur video in which a police officer stopped and violently beat a demonstrator, a spokesperson for the police union Alliance, in defence of the officer involved, claimed that the person stopped spat blood in the officer’s face and said, “I have AIDS, you’re going to die. Since then, the victim has denied living with HIV and having threatened the police officers with “contamination” by spitting on them.

The case has swelled up in some media outlets, which have taken up the police unionist’s explanations without deflating the sensationalism surrounding the “danger” of spitting on an HIV-positive person.

Faced with this, many of his AIDS activists and associations of people living with HIV intervened to put the facts in their place, regardless of the position of responsibility that existed during the arrest. “The rapidity of news coverage regularly implies approximations or, worse, leaving room for false beliefs. This is particularly true with regard to HIV/AIDS. But to allow false ideas to be conveyed is to feed the serophobia that plays into the hands of the epidemic,” explains AIDES in its press release published in emergency on 20 January.

On Twitter, the president of Act Up-Paris, Marc-Antoine Bartoli, is moved and says that “aggression or “the attack on AIDS does not exist”. A few weeks ago Act Up New York had to deal with a similar case. It is important to remember that people who test positive for HIV have access to treatment that makes their viral load undetectable and cannot transmit HIV. First fact. The second is that, first and foremost, “the modes of contamination are sexual secretions, breast milk, blood. Saliva does not transmit HIV. Moreover, HIV has very low resistance to the open air. After five to ten seconds in the open air, a drop of blood no longer contains the virus,” AIDES recalls.

These simple indications would have deflated a Serophobic line of defence from the outset, continuing to play on irrational fears. “It is everyone’s responsibility to recall this information as soon as necessary. Without this, stigmatization and false beliefs will not be able to stop,” continues AIDES. And the media have their role to play in informing. This is what Fred Colby, a gay activist who is openly HIV-positive and committed to AIDES, is calling for: “People living with HIV are not walking viruses. People living with HIV are not walking viruses. The media needs to think before they publish this kind of thing or qualify it by talking about treatment and undetectable viral load. Without this prerequisite, this spitting case is likely to come back in the news, without any lessons being learned from the previous one. Again to the detriment of HIV-positive people.


Crachat et VIH : la violence des maux

À la suite de la diffusion d’une vidéo amateur, dans laquelle un policier interpelle et frappe violemment un manifestant, le porte-parole du syndicat de policiers Alliance affirmait, pour la défense de l’officier mis en cause, que la personne interpellée aurait craché du sang au visage du policier en disant : « J’ai le sida, tu vas crever ». Depuis, la victime réfute vivre avec le VIH et avoir menacé les policiers de « contamination » en leur crachant dessus. L’affaire a enflé dans certains médias, qui ont repris à leur compte les explications du syndicaliste de la police, sans pour autant dégonfler le sensationnalisme autour du « danger » d’un crachat d’une personne séropositive au VIH. Face à cela, de nombreux-ses militants-es de la lutte contre le sida et des associations de personnes vivant avec sont intervenus pour remettre les faits à leur place, peu importe la position sur les responsabilités en cours durant l’arrestation. « La rapidité de traitement de l’actualité implique régulièrement des approximations ou pire, de laisser la place à de fausses croyances. C’est particulièrement vrai concernant le VIH/sida. Or, laissez véhiculer de fausses idées, c’est nourrir la sérophobie qui fait le jeu de l’épidémie », explique AIDES dans son communiqué publié en urgence, le 20 janvier. Sur Twitter, le président d’Act Up-Paris, Marc-Antoine Bartoli, s’émeut et indique que « l’agression ou « l’attaque au sida n’existe pas ». Il y a quelques semaines Act up New-York a eu à faire à un cas similaire. Il est important de rappeler que les personnes dépistées séropositives ont accès à un traitement qui rend leur charge virale indétectable et ne peuvent pas transmette le VIH. Premier fait. Le second, c’est qu’avant toute chose, « les modes de contamination sont les sécrétions sexuelles, le lait maternel, le sang. La salive ne transmet pas le VIH. De plus, le VIH a une très faible résistance à l’air libre. Après cinq à dix secondes à l’air libre, une goutte de sang ne contient plus de virus », rappelle AIDES. Ces simples indications auraient permis de dégonfler d’emblée une ligne de défense sérophobe, continuant de jouer sur les peurs irrationnelles. « Il est de la responsabilité de toutes et tous de rappeler dès que nécessaires ces informations. Sans cela, les stigmatisations et fausses croyances ne pourront pas cesser », continue AIDES. Et les médias ont leur rôle d’information à jouer. C’est ce que réclame Fred Colby, activiste gay, ouvertement séropositif et engagé à AIDES: « Les personnes vivant avec le VIH ne sont pas des virus ambulants. Il faut que les médias réfléchissent avant de publier ce genre de choses ou nuancent en parlant du traitement et de la charge virale indétectable ». Sans ce préalable, cette affaire du crachat risque de revenir dans l’actualité, sans qu’aucune leçon ne soit tirée de la précédente. Au détriment, encore, des personnes séropositives.

Australia: Mandatory testing laws in Western Australia are not appropriate in cases of spitting and are based on misinformation

HIV experts fear ‘spitting laws’ being misused by police

About 100 people a year have been forced to be tested for HIV in Western Australia since so-called spitting laws were introduced four years ago.

HIV advocates have called for the reversal of so-called “spitting laws”, which they say are being misused in some states and increasing stigma.  

An audit, released on Thursday, showed Western Australia had the highest rates of mandatory testing of a person whose bodily fluids come into contact with police or emergency service workers, such as through biting or spitting.

In less than four years since the laws were introduced, 377 people in WA have been forced to get tested.

While in Victoria, where a medical specialist makes the decision, no mandatory tests have been ordered.

The audit, conducted by the National Association of People with HIV Australia, recommended the laws be repealed, describing their introduction in the first place was “perplexing and problematic”.

“Although violence against emergency services workers may be increasing, risk of HIV transmission is not,” the report stated.

“If anything, effective treatments mean that the majority of people living with HIV in Australia have a low or undetectable viral load, making transmission unlikely or impossible in the types of circumstances covered by these laws.”

HIV Justice Network senior policy adviser Sally Cameron said the audit’s WA findings were alarming.

“We think it is likely that the tests are being misused. It’s unclear whether there is any ill intent or not,” Ms Cameron told SBS News.

Ms Cameron stressed that they did not condone violence in any circumstance, particularly against emergency service personnel.

“For us, this isn’t an issue of us and them, our priority is that people are not unduly stressed by fear of HIV. That people do not go through stress and trauma when in fact there is no risk,” she said.

She called for better training of police officers and judicial oversight of decisions to force someone to be tested.

“This isn’t about saying they should be able to do whatever they want. The issue is whether it’s appropriate to do something as invasive as a blood test when in fact that there is no risk that anything’s concerned.”

Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine policy director Scott McGill said the so-called spitting laws were based on misinformation about the risk of transmission.

“Unfortunately our laws and policy are not only behind the curve in terms of that evidence, but also going in the wrong direction,” he told SBS News. 

“If we keep going down this path… we’re going to inadvertently fuel stigma, fuel fear which really means people won’t come forward for testing and treatment, will be fearful of what some of the consequences are and increases anxiety on both sides of the equation.”

At the time the laws were passed, then-police minister Liza Harvey told the ABC they were overdue and would help protect police officers.

She said the testing would assist in the diagnosis, clinical management and treatment of the exposed police officer. 

In April, the alleged violent assault of a police officer in Sydney, who was spat at and bitten, reignited debate about mandatory testing laws.  

NSW is one of only two jurisdictions in Australia that hasn’t introduced  in response to concerns about rising assaults on police and emergency service workers. 

President of the Police Association of NSW Tony King told 10 Daily the officer faced months of uncertainty as she waited for the results of an infectious diseases test.  

“This officer like many others will now have to change their lifestyle for fear of passing on possible infection. Can you imagine explaining to your own child why you can’t give them a kiss goodnight?” he said in April. 

But HIV experts said such claims were myths based on misinformation.  

“The likelihood of anything actually happening is extraordinarily low and we don’t have any recorded events of occupational exposure,” Mr McGill said. 

US: Charges of HIV exposure for spitting, despite absence of risks, prove that Georgia needs to modernise its HIV laws

HIV-positive man’s arrest for spitting called ‘plain and simple discrimination’

A 31-year-old man in Rome, Ga., was charged with exposing police officers to HIV after allegedly spitting on them, which HIV activists said highlights why the state needs to fix its HIV laws.

Authorities said JS was swearing at people and making obscene gestures near the intersection of Maple Road and Park Road on Aug. 25, according to the Marietta Daily Journal. S allegedly spat on officers after being apprehended by the Floyd County Police Department.

S was charged with criminal trespass, two misdemeanor counts of disorderly conduct, three misdemeanor counts of willful obstruction of police officers and three felony counts of assault on police officers by someone with HIV, according to the Floyd County Sheriff’s Office. He is being held without bond in the Floyd County Jail.

HIV cannot be transmitted by spitting, according to the Centers for Disease Control & Prevention. S’s arrest highlights why Georgia needs to modernize its HIV laws, according to Nina Martinez of the Georgia HIV Justice Coalition.

“In 2019, it’s not breaking news that saliva does not transmit HIV,” she told Project Q Atlanta. “And yet, the punishment for a person living with HIV who spits on a police officer is potentially 20 times greater than that for someone not living with HIV who commits the same offense. This is state-sanctioned discrimination, plain and simple.”

Malcolm Reid, another member of the Georgia HIV Justice Coalition, agreed with Martinez.

“Although we don’t know much about this specific case, we do know that there is no chance of HIV transmission through spit,” he said. “This proves once again that the laws in Georgia need to catch up to science. HIV is not a crime.”

Georgia is one of some three-dozen states that criminalize a lack of HIV disclosure. Activists and lawmakers have tried for years to modernize state law by decriminalizing HIV. 

A Republican lawmaker introduced an HIV decriminalization bill on the final day of this year’s legislative session. It will be back in the 2020 session in January.

An Athens man was arrested in July after allegedly having sex with a woman without informing her he had HIV. He was charged with reckless conduct by a person with HIV. He remains in Athens-Clarke County Jail nearly two months later on a $3,000 bond, according to the Clarke County Sheriff’s Office.

A gay Atlanta man was arrested for HIV exposure in South Carolina in 2015. He claimed he disclosed his status before having sex with the alleged victim. The charges were later dropped.

The Global Network of People Living with HIV (GNP+) and the HIV Justice Network (HJN) condemn dismissal of appeal in Singapore HIV criminalisation case

The Global Network of People Living with HIV (GNP+) and the HIV Justice Network (HJN) condemn dismissal of appeal in Singapore HIV criminalisation case

The Global Network of People Living with HIV (GNP+) and the HIV Justice Network (HJN) condemn the dismissal of the appeal by a Singaporean man living with HIV who was convicted to two years’ imprisonment for not disclosing his status to his sexual partner and for not communicating the risk of HIV transmission to his sexual partner. We are particularly concerned that the judgement has emphasised the lack of explaining the risk of HIV transmission as the main reason for dismissing the appeal.

“HIV prevention is a shared responsibility and therefore not the sole responsibility of people living with HIV. If more people are sensitised to the rights of people living with HIV, including their sexual rights, and were aware of the mechanisms of HIV transmission there would be far less stigma and discrimination towards people living with HIV. Furthermore, HIV criminalisation creates a bad public health environment where people living with HIV have fears in disclosing their status, which lead to delay in engaging in care and treatment,” said Rico Gustav, Executive Director of GNP+.

According to the Infectious Diseases Act in 2016 of Singapore, Section 23 (1) a person who knows that he has HIV Infection shall not engage in any sexual activity with another person unless, before the sexual activity takes place — (a) he has informed that other person of the risk of contracting HIV Infection from him; and (b) that other person has voluntarily agreed to accept that risk.

“HIV is the only disease singled out as a transmittable disease in the Infectious Diseases Act,” said Edwin Bernard, Global Co-ordinator of the HIV Justice Network. “Not only does this perpetuate stigma, it also creates a false sense of security, suggesting that only people with diagnosed HIV can transmit HIV, when many new infections come from those who are undiagnosed. Ironically, a law such as this one that places such an onerous burden on people with diagnosed HIV, is only likely to make HIV testing, and open and honest discussions around HIV, less likely.”

Furthermore, the facts of the case reported in the judgement suggest that there was no effective HIV risk during any sexual activity, regardless of whether or not disclosure – and acceptance of risk – was established beyond reasonable doubt. Condoms were used early in the relationship, and subsequently when condoms were not used, the unjustly convicted man had a very low viral load.

As expressed in the Expert Consensus Statement on the Science of HIV in the context of criminal law, HIV criminalisation laws and prosecutions have not always been guided by the best available scientific and medical evidence, have not evolved to reflect advancements in knowledge of HIV and its treatment, and can be influenced by persistent societal stigma and fear associated with HIV. HIV continues to be singled out, with prosecutions occurring in cases where no harm was intended; where HIV transmission did not occur, was not possible or was extremely unlikely; and where transmission was neither alleged nor proven.

GNP+ and HJN not only strongly condemn this legislation and the dismissal of appeal of this case, but all kinds of HIV criminalisation, which often entails legislation that is applied in a manner inconsistent with contemporary medical and scientific evidence and includes overstating both the risk of HIV transmission and also the potential for harm to a person’s health and wellbeing. Such limited understanding of current HIV science reinforces stigma and may lead to human rights violation and undermines efforts to address the HIV epidemic.

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HJN Logo Rectangle

New report analyses the successes and challenges of the growing global movement against HIV criminalisation

A new report published today (May 29th 2019) by the HIV Justice Network on behalf of HIV JUSTICE WORLDWIDE provides clear evidence that the growing, global movement against HIV criminalisation has resulted in more advocacy successes than ever before. However, the number of unjust HIV criminalisation cases and HIV-related criminal laws across the world continue to increase, requiring more attention, co-ordinated advocacy, and funding.

Advancing HIV Justice 3: Growing the global movement against HIV criminalisation provides a progress report of achievements and challenges in global advocacy against HIV criminalisation from 1st October 2015 to 31st December 2018.

Although the full report is currently only available in English, a four-page executive summary is available now in English, French, Russian and Spanish.  The full report will be translated into these languages and made available later this summer.

The problem

HIV criminalisation describes the unjust application of criminal and similar laws to people living with HIV based on HIV-positive status, either via HIV-specific criminal statutes or general criminal or similar laws. It is a pervasive illustration of how state-sponsored stigma and discrimination works against a marginalised group of people with immutable characteristics. As well as being a human rights issue of global concern, HIV criminalisation is a barrier to universal access to HIV prevention, testing, treatment and care.

Across the globe, laws used for HIV criminalisation are often written or applied based on myths and misconceptions about HIV and its modes of transmission, with a significant proportion of prosecutions for acts that constitute no or very little risk of HIV transmission, including: vaginal and anal sex when condoms had been used or the person with HIV had a low viral load; oral sex; and single acts of breastfeeding, biting, scratching or spitting.

Our global audit of HIV-related laws found that a total of 75 countries (103 jurisdictions) have laws that are HIV-specific or specify HIV as a disease covered by the law. As of 31st December 2018, 72 countries had reported cases: 29 countries had ever applied HIV-specific laws, 37 countries had ever applied general criminal or similar laws, and six countries had ever applied both types of laws.

Cases infographic During our audit period, there were at least 913 arrests, prosecutions, appeals and/or acquittals in 49 countries, 14 of which appear to have applied the criminal law for the first time. The highest number of cases were in Russia, Belarus and the United States. When cases were calculated according to the estimated number of diagnosed people living with HIV, the top three HIV criminalisation hotspots were Belarus, Czech Republic and New Zealand.

Screenshot 2019-05-29 at 10.27.51The pushback

Promising and exciting developments in case law, law reform and policy took place in many jurisdictions: two HIV criminalisation laws were repealed; two HIV criminalisation laws were found to be unconstitutional; seven laws were modernised; and at least four proposed laws were withdrawn. In addition, six countries saw precedent-setting cases limiting the overly broad application of the law through the use of up-to-date science.

Screenshot 2019-05-29 at 10.29.06The solution

Progress against HIV criminalisation is the result of sustained advocacy using a wide range of strategies. These include:

  • Building the evidence base Research-based evidence has proven vital to advocacy against HIV criminalisation. In particular, social science research has been used to challenge damaging myths and to identify who is being prosecuted, in order to help build local and regional advocacy movements.
  • Ensuring the voices of survivors are heard HIV criminalisation advocacy means ensuring that HIV criminalisation survivors are welcomed and supported as advocates and decision-makers at all stages of the movement to end HIV criminalisation.
  • Training to build capacity Successful strategies have focused on grassroots activists, recognising that training events must be community owned and provide opportunities for diverse community members to come together, hold discussions, set agendas, and build more inclusive coalitions and communities of action.
  • Using PLHIV-led research to build community engagement capacity Research led by people living with HIV (PLHIV) provides a mechanism to engage communities to develop in-depth understanding of issues and build relationships, mobilise and organise.

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  • Using science for justice HIV criminalisation is often based on outdated and/or inaccurate information exaggerating potential harms of HIV infection. In addition, HIV-related prosecutions frequently involve cases where no harm was intended; where HIV transmission did not occur, was not possible or was extremely unlikely; and where transmission was neither alleged nor proven beyond a reasonable doubt.
  • Engaging decision-makers through formal processes Activists have worked to bring about legal and policy changes not only by lobbying local decision-makers, but also by engaging in other formal processes including using international mechanisms to bring HIV criminalisation issues to the attention of state or national decision-makers.
  • Acting locally and growing capacity through networks Many community organisations working to limit HIV criminalisation are actively supporting grassroots community advocates’ participation at the decision-making table.
  • Getting the word out and engaging with media Activists have employed diverse strategies to extend the reach of advocacy against HIV criminalisation including pushing the issue onto conference agendas, presenting messaging through video, working through digital media forums, using public exhibitions to push campaign messaging, and holding public demonstrations. Sensationalist headlines and misreporting of HIV-related prosecutions remain a major issue, perpetuating HIV stigma while misrepresenting the facts. Activists are endeavouring to interrupt this pattern of salacious reporting, working to improve media by pushing alternative, factual narratives and asking journalists to accurately report HIV-related cases with care.

Acknowlegements

Advancing HIV Justice 3 was written on behalf of HIV JUSTICE WORLDWIDE by the HIV Justice Network’s Senior Policy Analyst, Sally Cameron, with the exception of the Global overview, which was written by HIV Justice Network’s Global Co-ordinator, Edwin J Bernard, who also edited the report.

We would especially like to acknowledge the courage and commitment of the growing number of advocates around the world who are challenging laws, policies and practices that inappropriately regulate and punish people living with HIV. Without them, this report would not have been possible.

rcnf 346x228We gratefully acknowledge the financial contribution of the Robert Carr Fund to this report.

A note about the limitations of the data

The data and case analyses in this report cover a 39-month period, 1 October 2015 to 31 December 2018. This begins where the second Advancing HIV Justice report – which covered a 30-month period, 1 April 2013 to 30 September 2015 – left off. Our data should be seen as an illustration of what may be a more widespread, but generally undocumented, use of the criminal law against people with HIV.

Similarly, despite the growing movement of advocates and organisations working on HIV criminalisation, it is not possible to document every piece of advocacy, some of which takes place behind the scenes and is therefore not publicly communicated.

Despite our growing global reach we may still not be connected with everyone who is working to end HIV criminalisation, and if we have missed you or your work, we apologise and hope that you will join the movement (visit: www.hivjusticeworldwide.org/en/join-the-movement) so we can be in touch and you can share information about your successes and challenges.

Consequently, this report can only represent the tip of the iceberg: each piece of information a brief synopsis of the countless hours and many processes that individuals, organisations, networks, and agencies have dedicated to advocacy for HIV justice.


Suggested citation: Sally Cameron and Edwin J Bernard. Advancing HIV Justice 3: Growing the global movement against HIV criminalisation. HIV Justice Network, Amsterdam, May 2019.

France: Highest Court confirms that people living with HIV with an undetectable viral load can never be prosecuted as the risk of transmission is nul

Source TETU, Published 20/03/2019 – Google translation, for article in French please scroll down.

Can a person living with HIV be prosecuted if she is under treatment? The Court of Cassation (French Highest Court) delivers a landmark decision.

In a decision handed down on 5 March, the Court of Cassation ruled that it was impossible to prosecute an HIV-positive man on treatment who had sex without a condom and without informing his partner of his HIV status.

That’s a first. In a decision handed down on 5 March, the Court of Cassation recognised the preventive nature of HIV treatment. Thus, any person whose viral load is undetectable, who has sex without a condom with another person without the latter being aware of the HIV status of his or her partner, cannot be prosecuted.

In this case, a woman who had sex with a man who was HIV-positive and undergoing treatment sued the man on the grounds that he had not previously informed her of his HIV status. The partner was not infected. However, the man was prosecuted on the grounds of “administration of a harmful substance”, i.e. alleged exposure to the virus.

Non-harmful bodily fluids

The investigating judge did not give rise to prosecution. A decision from which the civil party has appealed. But the woman was once again dismissed. According to the Court of Appeal, it has been proven that the “HIV viral load” was “constantly undetectable since 3 September 2001”. The man was “strictly and permanently compliant with the treatment, so that his HIV status was only potential but not current”.

And the judges of the Court of Appeal ruled: “The carrier’s bodily fluids cannot be considered harmful on the date of the alleged acts”.

A significant reminder from the judges, who stated that it takes “a detectable viral load in an infected person for him/her to infect any partner”.

A purely mathematical margin of error

Moreover, the judges of the Court of Appeal acknowledged that there was indeed a margin of error, but that it was purely mathematical. Thus, they conceive of the idea of the “non-zero risk” of HIV transmission by a person undergoing treatment. A risk they call “very small” since it is about one in 10,000. And according to them, this margin of error does not make it possible to condemn the carrier of the virus.

The civil party has appealed to the Supreme Court. The High Court dismissed the appeal, aligning itself with the judges of first instance.


Peut-on poursuivre une personne séropositive sous traitement ? La Cour de cassation rend un arrêt historique

Dans un arrêt rendu le 5 mars dernier, la Cour de cassation a affirmé qu’il était impossible de poursuivre un homme séropositif sous traitement, ayant eu des relations sexuelles sans préservatif et sans informer sa partenaire de son statut sérologique.

C’est une première. La Cour de cassation a reconnu, dans un arrêt rendu le 5 mars dernier, le caractère préventif du traitement contre le VIH. Ainsi, ne saurait être poursuivie toute personne dont la charge virale est indétectable, qui aurait des relations sexuelles sans préservatif avec une autre personne sans que celle-ci ne soit au courant du statut sérologique de sa/son partenaire.

Dans cette affaire, une femme ayant eu des relations sexuelles avec un homme, porteur du VIH et sous traitement, a engagé des poursuites contre ce dernier au motif qu’il ne l’avait pas prévenue au préalable de son statut sérologique. Sa partenaire n’a pas été contaminée. Pourtant, l’homme était poursuivi au motif « d’administration d’une substance nuisible », c’est-à-dire à une prétendue exposition au virus.

Des fluides corporels non nuisibles

Le juge d’instruction n’a pas donné lieu aux poursuites. Une décision de laquelle la partie civile a fait appel. Mais la femme s’est fait une nouvelle fois débouter. Selon la Cour d’appel, il a été prouvé que « la charge virale de VIH » était « constamment indétectable depuis le 3 septembre 2001 ». L’homme a fait « compliance stricte et permanente au traitement, de sorte que la séropositivité n’était plus que potentielle mais non actuelle ».

Et les juges de la Cour d’appel de statuer : « Les fluides corporels du porteur ne sauraient être tenus pour nuisibles à la date des agissements qui lui sont reprochés ».

Un rappel non négligeable des juges, qui affirment qu’il faut « une charge virale détectable chez une personne infectée pour qu’elle puisse contaminer quelque partenaire ».

Une marge d’erreur purement mathématique

Par ailleurs, les juges de la Cour d’appel ont reconnu qu’il existait bel et bien une marge d’erreur, mais qu’elle était purement mathématique. Ainsi, ils conçoivent l’idée du « risque non nul » de la transmission du VIH par une personne sous traitement. Un risque qu’ils qualifient d’ »infime » puisqu’il est d’environ un sur 10.000. Et selon eux, cette marge d’erreur ne permet pas de condamner le porteur du virus.

La partie civile s’est pourvue en cassation. La haute juridiction a rejeté le pourvoi, s’alignant sur les juges de première instance.

 

Webinar: Molecular HIV Surveillance (PWN-USA, 2019)

PWN’s Barb Cardell’s webinar on Molecular HIV Surveillance and its implications for marginalized communities living with HIV, including intersections with HIV criminalization.