Who is really affected by laws criminalizing HIV transmission?

August 6, 2008, Mexico City—Laws that criminalize HIV transmission and exposure tend to be posited as protective devices to achieve justice, but often women experience more violence than protection as a result of criminalization, a panel this morning asserted. The panel entitled, "To Transmit of Not to Transmit: Is that really the question?" emphasized that criminalization has no preventative effects and instead serves to further stigmatize people living with HIV and discourage people from disclosing their status.

The panel offered several similar perspectives. Michaela Clayton of the AIDS and Rights Alliance of Southern Africa relayed testimony of women who had experienced beatings by their partner after their status became known. Julian Hows of the Terrance Higgins Trust commented that "laws are being made more putative without any evidence", and commented on a few "absurdities" that have appeared in various laws, for example, when prosecution is pursued only if the newly infected person dies, or statutes that allow children to file complaints against mothers who passed along the infection at birth.

When asked what an ideal law to deal with HIV transmission would be, Clayton said that there that there is no need for specific laws for HIV because there are other laws to address the instances where prosecution should occur, for example in cases of rape.

"The law is a very blunt tool," Mike Kennedy of Victorian AIDS Council/Gay Men's Health Centre added, agreeing that criminalization of HIV transmission laws do not prevent transmission as is often intended; instead they create more danger for people living with and at risk of contracting HIV.

In a 2006 report, "Life Doesn't Wait: Romania's Failure to Protect and Support Children and Youth Living with HIV," Human Rights Watch discussed the human rights implications of criminalization laws:

The criminalization of transmission of HIV as a discrete criminal offence creates both practical barriers to combating the transmission of HIV and obstacles for those living with HIV in accessing and enjoying basic rights such as health services. First, there are practical limitations to the application of the law, because a significant percentage of those living with HIV are unaware of their HIV status. There is also the difficulty - if not impossibility - of proving HIV transmission due to a specific, or series, of potential exposures. Furthermore, the existence of HIV transmission criminalization laws may impede efforts to promote disclosure to children and youth of their HIV-positive status or voluntary HIV testing, to reduce stigma and prevent discrimination, and to provide broader legal protection for individuals living with HIV. Finally, the law is likely to have a greater impact on girls and female youth than on boys and males.

Beyond Barriers: Disability and HIV/AIDS

August 6, 2008, Mexico City--Over the past 25 years of the HIV/AIDS epidemic, there has been a lot of attention paid to the development of sexuality education and services for people living with AIDS, as well on the factors that put certain groups at higher risk of contracting the virus. But what happens when a group of people is excluded from such programs, or experience compounded discrimination that puts them at even higher risk?

This was the subject of a panel discussion this afternoon called “Beyond Barriers: Disability and HIV/AIDS”. The panel featured studies from across the world – Brazil, South Africa, Cameroon, and Canada – and found that people with disabilities consistently experience higher vulnerability of infection. A study from Brazil – the first national study of its kind – found that mentally disabled people are often exposed to riskier situations; women in particular experience more unprotected sex than the general population, often as a result of sexual violence. A researcher in Kwa Zulu-Natal, where there is no disability-specific sex education, encountered a “let sleeping dogs lie” attitude in schools. As a result, she found that children with disabilities had little access to education or legal protection and were more vulnerable to abuse and infection. In Cameroon, a study focused on a young deaf population, found that sexual debut was on the whole earlier and riskier than in the general population.

The parallels between the studies were striking; however, a second researcher from Brazil who focused specifically on adolescents reminded the audience that people with disabilities also deal with all the factors of the general population: coming of age, culture, and gender. The communities examined by the disability rights movement must also consider the heterogeneity within the population and consider the diversity of challenges they face.

Background

The United Nations Convention on the Rights of Persons with Disabilities (“CRPD”) entered into force on May 3, 2008. One of only seven international human rights treaties to enter into force in the 60 years since the Universal Declaration of Human Rights, the CRPD did not create a new set of rights; rather, it acknowledges and clarifies the existing rights of persons with disabilities. The CRPD states that disability is an “evolving concept” that “results from the interaction between persons with impairments and attitudinal and environmental barriers that hinders their full and effective participation in society on an equal basis with others.” The CRPD acknowledges the special discrimination connected with disability but also explains that discrimination on the basis of disability interacts with and magnifies other forms of discrimination. The interaction of disability and HIV/AIDS will be only one of these focuses.

August 5, 2008

Mexico City – The relationship between AIDS and migration has been a focus of this AIDS conference, particularly along the border of Mexico and the United States, and especially in Tijuana.

The largest city on the border, Tijuana is situated on a major migration and drug trafficking route. It has the highest number of drug users per capita in Mexico, and there is a large population of sex workers as well.

This afternoon, a presentation entitled, “No Man’s Land: Deportation and Migration as Risk Factors versus Protective Factors for HIV Infection Among Male and Female Injection Drug Users in Tijuana, Mexico” looked at the heightened risk factors among the mobile populations on the US-Mexico border. The researchers found, through working with drug users in Tijuana with varying backgrounds, that injection drug users who were deported to Tijuana from the United States are four times more likely to become infected with HIV than those in Tijuana who hadn’t been deported.

Causal connections are unclear, but this research suggests that deportation might be indicative of higher risk-taking. In an earlier news release, Remedios Lozada, one of the researchers, explained that "with disintegrating family support networks, sudden changes in a person's cultural environment, homelessness and poverty, we're more apt to see risk behaviors such as unprotected sex with sex workers, other men or sharing injection needles among male migrants. However, an alternate explanation could be that deportation from the United States leads to social upheaval, loss of social ties and income factors which lead to engaging in high-risk behaviors." The presentation recommended cross-border cooperation to address the vulnerable group of injecting drug users.

The study also found that almost half of men having sex with men in Tijuana and 75 percent of those in San Diego reported having partners across the border. In addition, of the 1,000 prostitutes who were interviewed in Tijuana, 69 percent had been in contact with people who crossed the border.

Amidst this combination of foreboding statistics, it was reassuring that Dr Jorge Saavedra, the head of the Mexico AIDS Program, was a speaker at today’s plenary session. Dr Saavedra has worked to put condoms and needle-exchange programs at the forefront of Mexico’s public health strategy.

This morning, in light of the statistic that over a quarter of HIV infections in the Latin American region are related to men who have sex with men, Dr. Saavedra commented on the specific need to involve gay and bisexual men in planning outreach strategies. Same sex relationships have been a social taboo here, which has inhibited discussion and efforts to promote safer sexual relations. A leader like Dr. Saavedra, who is openly gay and HIV-positive, is likely to push conversations and efforts forward, particularly after taking a prominent role here this week.

August 4, 2008

MEXICO CITY – After just two days of the 2008 AIDS Conference, the sheer number of topics covered by the various sessions emphasizes the far reach of this epidemic into society, how much has been discovered in the past 25 years, and how much remains to discover.

A panel entitled “Vaccines and Microbicides: Where do we go from here?” throbbed with the excitement and urgency of discovery: “We need to move forward with big investments. We have to be unafraid to fail,” said Tachi Yamada of the Gates Foundation. He announced the foundation’s new initiative, the Grand Challenges Exploration, which will aggressively fund new research and collaborations, and noted that vaccine research is more of an art than a science, with little predictive ability. Allan Bernstein of the Global Vaccine Enterprise emphasized the need to move away from product-science and instead attract young minds to research: “Unquestionably, the best way to stop HIV is a vaccine.”

Lack of knowledge was not the theme just a few hours later, but the lack of action. At a news conference on AIDS and Black America, Sheryl Lee Ralph, an actress and activists, shouted into the microphone, “When will the national emergency take place?”

Black Americans make up 70 percent of new HIV diagnoses among teenagers; black women in the United States are 23 times more likely than white women to be diagnosed with AIDS. A new report put out by the Black AIDS Institute (BAI) called “Left Behind” outlines the severity of the epidemic among black Americans and calls for a US version of the PEPFAR bill. Phill Wilson, the director of BAI simultaneously praised the US government for its aid abroad and demanded that it do the same for its own citizens.

The dearth of information was again key at a joint news conference given by Physicians for Human Rights and Human Rights Watch on the arrest of two HIV doctors in Iran.
We don’t know the whereabouts of Dr Arash Alaei and Dr Kamiar Alaei, and we can only speculate about why they were detained in June. . Their disappearance has many human rights implications, most immediately that they’ve been denied legal counsel and access to their families.

“To fight AIDS effectively, the government has realized that it must engage in global efforts to combat the disease, work with civil society, and confront taboo issues including sex and drugs,” said Joe Amon, director the Health and Human Rights program at Human Rights Watch “The detention without charges of the Alaei brothers has a joint effect on all of those efforts.”

HRW at the International AIDS Conference, Mexico City

Mexico City, August 3, 2008

The Global Village and the Centro Banamex hummed with excitement as the conference kicked off today. Plenty of momentum and energy had accumulated over the past few days, heightening the energy. The pre-conference satellite meetings, which included a gathering of youth coalitions, panel discussions on challenges faced by women, and a plenary focused on men who have sex with men, facilitated early conversations and focused the energy of the 22,000 people who have arrived in Mexico City over the past week.

Of particular notice was a magnificent march against stigma and discrimination that grew out of the Global Forum on Men Who Have Sex with Men on Saturday. The parade, bursting with inspiration, attracted thousands of individuals, both Mexico City dwellers and conference attendees. The parade progressed down Paseo de la Reforma to el Zocalo, the city center. Music and dancing created a lively and excited mood; the cheers from onlookers added to the general feeling of optimism.


Today, the official start of the conference, the Global Village was in full swing. There were booths of organizations from all regions of the world, with Mexican organizations comprising about one-fifth of them. The village filled with youth, harm reduction, human rights, and faith-based organizations; workshops, discussions, and trainings; dancers, singers, and costumed methadone-men. Behind the light-heartedness, a sense of determination reflected the various mottos of the constituencies: “Universal Access Now”; “Human Rights and HIV/AIDS: Now More Than Ever”; “Women Won’t Wait”.

The reasons behind this determination are clear: the numbers continue to climb and the factors affecting specific social groups persist. At the close of 2007, 33 million people were living with HIV. In just 12 months, 2.5 million people became infected with the virus, and 2 million people died of it. Antiretroviral therapy (ART) coverage was low—only 31% of people estimated to be in need of treatment in low- and middle-income countries were receiving it in 2007.

A report released here on Saturday by the US Center for Disease Control adds to the sense of urgency felt around the Global Village: the number of new infections in the US in 2006 was vastly underestimated by over 15,000; the numbers are now thought to be around 56,300, as compared to the previously thought 40,000. Homosexual and bisexual men and African-American men and women were the most affected groups.


At this AIDS Conference, Human Rights Watch will focus its efforts on advocacy around the research it conducted over the past few years on groups at particular risk of infection. HRW’s aim is to shed light on widespread human rights violations spurred by weak health systems and the enormous obstacles to universal access to prevention and treatment for HIV; such obstacles tend to disproportionately affect communities that are already marginalized and discriminated against. A rights-based approach to the epidemic restores the rights of people affected by HIV and AIDS, fights stigma and discrimination, and reduces vulnerability of the world's most marginalized individuals.

Recent HRW research that will be highlighted this week includes:

• Examining South Africa’s decision to treat Zimbabweans merely as voluntary economic migrants and its failure to respond effectively to stop the human rights abuses and economic deprivation in Zimbabwe that cause their flight and to address their needs in South Africa;
• Documenting how the Zambian government has fallen short of its international legal obligations to combat violence and discrimination against women and detailing abuses that obstruct women’s ability to start and adhere to HIV treatment regimens, including violence against women and insecure property rights that often force women into poverty and dependent, abusive relationships;
• Advocating for access to effective drug addiction treatment in Russia and for access to anti-retroviral drugs for injecting drug users in Thailand;
• Bringing attention to the lack of access to HIV prevention information and services for immigrants and prisoners living with HIV in US detention facilities;
• Demanding that the rights of people living with HIV and AIDS advocates in China, Saudi Arabia, Zambia and Burma are respected.
  

The physical presence of HRW will be in the Human Rights Networking Zone (section 421), where 24 human rights organizations have come together to drive home the role of human rights in addressing the epidemic. A guide to the zone has been published that highlights the human rights-themed events during the conference.

This daily blog will contain highlights, commentary, links, and resources throughout the conference, so please look for updates and feel free to leave comments on the entries.

Event Monday, August 4th:
Joint HRW-Physicians for Human Rights press conference, 4pm, conference room 2
Focus: detention of Iranian HIV doctors
For background information, please see HRW's recent press release

Letter to Peter Piot, Executive Director of the Joint United Nations Programme on HIV/AIDS

September 27, 2007

Dr. Peter Piot
Executive Director
UNAIDS Secretariat
20, Avenue Appia CH-1211
Geneva 27
Switzerland

Dear Mr. Piot,

As China is increasingly in the global spotlight in the lead-up to the 2008 Olympic Games in Beijing, the Chinese government has lost no opportunity to highlight its progressive achievements, including the scaling up of its national response to HIV and AIDS. Recent articles in major journals such as The Lancet and positive assessments on the part of United Nations officials have underscored that China is investing in “best practice” programs of HIV prevention, treatment, care and support much more than was the case only a few years ago. This progress is commendable.

But the scale-up of programs is only half the story of China’s response to HIV and AIDS. The other half is a story of repression of AIDS activists and organizations and violation of the rights of people living with and vulnerable to HIV. These actions are a violation of key principles on HIV and Human Rights which global leaders, including China, agreed to in the UN Political Declaration of June 2006.

We the undersigned appeal to the leaders of the UNAIDS secretariat and its co-sponsor United Nations agencies to join us in speaking publicly about the events and actions noted here, which undermine whatever positive steps there have been in China’s response to the epidemic. United Nations leadership is needed immediately to urge the Chinese government to cease its repression of members of civil society working to fight AIDS and to actively endorse and support a human rights based response to the AIDS epidemic.

A number of recent actions against the AIDS work of legitimate Chinese NGOs and advocates recall China’s early practices of detention and repression of pioneering civil society leaders earlier in China’s epidemic. Among the actions of greatest concern are the following:

• The NGOs Asia Catalyst and China Orchid AIDS Projects had planned an international conference on HIV/AIDS and the law in Guangzhou in early August. On July 26, the organizations were informed that the Guangzhou Public Security Bureau had instructed the managers of the hotel where the conference was to take place to cancel it. On the same day, national security agents detained Li Dan, director of China Orchid AIDS Project and winner of the 2005 Reebok Human Rights Award for 24 hours. The co-sponsors were informed that the combination of AIDS, law and foreigners was “too sensitive” in a time when the year-long countdown to the Olympics was about to begin.

• The China Network of People Living with HIV and AIDS (Beijing), in collaboration with an organization of people living with HIV/AIDS based in Henan, announced it would hold a meeting on August 19-20 with representatives of 30 organizations of people living with HIV from around the province. On August 14, the police in Kaifeng, where the meeting was to take place, told the group to postpone the meeting indefinitely.

• On August 15, after repeated “visits” to the Kaifeng and Ruanjia village offices of China Orchid AIDS Projects, police ordered both offices to be shut down. They said the offices were illegal, though the organization is legally registered with the government and has worked in Henan for many years. They said that if the office was not closed by noon on August 17, personal harm could come to Zhu Zhaohua, the office director. On the day of the closing, police oversaw the removal of the staff and their belongings and told staff to leave the city “for their own personal safety.” Police also shut down a branch office of China Orchid AIDS Projects in Ruanjia village (Henan), and detained and expelled five student volunteers and a professor from Henan. Both offices provided much-needed support and services to children affected by AIDS.

In addition to these actions, NGOs based in and near Beijing have reported that the mandatory detention period for people charged with drug crimes has been extended in Beijing, and HIV outreach activities aimed at sex workers and men who have sex with men in the Beijing metropolitan area face increasing police scrutiny and harassment.

These repressive actions come as international media have reported stepped-up detentions and harassment of civil society representatives identified with pro-democracy and human rights struggles, as well as tighter state controls to ensure that Chinese mass media portray the country in a positive light. All signs point to a period of repression leading up to the Olympic Games that risks undoing whatever progress may have been made in recent years in China’s response to HIV and AIDS.

Courageous civil society action has been crucial to the progress made on HIV and AIDS everywhere in the world. Senior Chinese officials have acknowledged the importance of civil society in fighting AIDS in the past, but the authorities’ fear of public embarrassment during the Olympics threatens to undo this commitment. Leaders and officials of UNAIDS and the co-sponsor agencies must use all available opportunities to ensure that the Beijing Olympic Games do not become the smokescreen behind which AIDS activists in China are attacked and silenced. Public support from the United Nations and others in the international sphere for the life-saving work of AIDS leaders in Chinese civil society is urgently needed. Praise for China’s important AIDS programs must be accompanied by public statements in favour of the human right of civil society representatives to assemble, express themselves freely and continue their life-saving work. In this regard we call on UNAIDS to support the convening of a civil society conference within China in early 2008 on HIV and human rights.

We, the undersigned, will monitor public statements from UNAIDS and its co-sponsors to Chinese authorities on HIV/AIDS and Chinese civil society in the expectation that UN leaders and officials will not let essential civil society voices be silenced in the struggle for human rights and an effective national response to HIV/AIDS.

Signed,

Accion Ciudadana Contra el SIDA (LACCASO – ACCSI), Venezuela
AIDS and Rights Alliance for Southern Africa (ARASA)
AIDS Law Project
American Anthropological Association, Committee for Human Rights
AP-Rainbow Advocates, Inc.
Asia Catalyst
Asia Pacific Network of people living with HIV/AIDS (APN+)
Asia Pacific Network of Sex Workers (APNSW)
Asian Harm Reduction Network (AHRN)
Association HIVLV, Latvia
Canadian HIV/AIDS Legal Network
Companions on a journey, Sri-lanka
Coordination of Action Research on AIDS & Mobility (CARAM Asia)
Delhi Network of Positive People (DNP+)
Empower India European AIDS Treatment Group (EATG)
FrontAIDS
Human Rights Watch
IGAT Hope, Papua New Guinea
International Network of People who Use Drugs (INPUD vzw)
International Treatment Preparedness coalition (ITPC)
International Treatment Preparedness coalition in Eastern Europe and Central Asia (ITPCru)
Lawyers Collective, India
Levi Strauss Foundation
Manipur Network of Positive People (MNP+), India
Physicians for Human Rights
Positive Malaysian Treatment Access & Advocacy group (MTAAG+)

Individuals
Zackie Achmat, Executive director, Treatment Action Campaign
Mark Heywood, Chair, UNAIDS Reference Group on HIV/AIDS and Human Rights
Stephen Lewis, Co-director, AIDS Free-World, and former UN Special Envoy for HIV/AIDS in Africa
Anastasia Agafonova
Snehansu Bhaduri, India
Deirdre Grant
Khartini Slamah
Sergey Kovalevsky
Marhalem Mansor, Kuala Lumpur, Malaysia
Aleksandrs Molokovskis
Luyanda Ngonyama
Vladimir Osin
Shona Schonning
Jamie Uhrig, Chiang Mai, Thailand
Gregory Vergus
Loretta Wong, Hong Kong

The Bush Policy on AIDS

By Joe Amon
Published in The Huffington Post

July 26, 2007 (New York) - Watching the Presidential candidates debate, the question I'd like to ask is "how many times per page would you make your Surgeon General refer to you in her speeches?" Two weeks ago former Surgeon General Richard Carmona told a Congressional panel that he was ordered to mention President Bush three times on every page of his speeches. I figure any candidate who pledges two or fewer references would be a positive step towards putting US health policy back on track.

And as the Surgeon General made clear, we can certainly use better policies when it comes to our failed response to fight AIDS.

In the US, despite half a million deaths and 1.5 million HIV infections over 26 years, there is still no strategic national plan to eliminate HIV/AIDS domestically. Although we are spending $16 billion per year, the money goes to an ad-hoc array of national, state and local programs with no consistent monitoring, benchmarks or review. This lack of coordination results in inconsistent access to prevention and treatment programs. For example, federal AIDS Drug Assistance Program (ADAP) funding and eligibility guidelines differ by states, so that the program that is the safety net for low income persons ineligible for any other coverage may or may not be available depending on where you live. And as of March of this year there were 571 people on waiting lists for drugs in 4 states. In 2006, 4 people died while on the South Carolina waiting list.

There is no national plan to address the crisis in the African-American community, which accounts for one half of all new HIV infections, even though blacks are only 12 percent of the US population. Latinos have the second highest AIDS case rate in the nation and Latino adolescents have 3.5 times the case rate of adolescent whites. Yet, current US AIDS efforts regularly ignore the issues which make these groups vulnerable and affect their access to health care, such as housing, education and employment, and focus instead on simplistic strategies like "National HIV testing day" (June 27th).

Surgeon General Carmona testified that as "the nations doctor" he wanted to address sex education, and that scientific studies suggest that the most effective approach to sex education includes a discussion of contraceptives. Yet Dr Carmona stated that he was blocked from doing so by those who "wanted to preach abstinence only". This is not merely a scientific debate - the US spends well over $150 million annually for abstinence-only sex education programs in public schools and since President Bush took office the US has spent more than $2 billion worldwide.

Similarly, despite overwhelming evidence of their efficacy in reducing HIV transmission, federal policy prohibits funding of needle exchange programs. Like abstinence-only, the ban on funding of needle exchange programs has been a triumph of ideology over evidence. At the July 10th hearing, former Surgeon General David Satcher said that while the Clinton administration had discouraged him from issuing a report showing that needle-exchange programs were effective, he had released it anyway.

In Dr Satcher's report, he wrote: "After reviewing all of the research to date, the senior scientists of the Department and I have unanimously agreed that there is conclusive scientific evidence that syringe exchange programs . . . are an effective public health intervention that reduces the transmission of HIV and does not encourage the use of illegal drugs." However, under President Bush, the Office of National Drug Control Policy (ONDCP) has continued to misconstrue evidence in support of needle exchange as an effective strategy for HIV prevention. A recent interview with an ONDCP policy analyst entitled "What's Wrong with Needle Exchange Programs?" claimed that research about the programs' effectiveness in lowering HIV infection had been inconclusive, and that their effect on continued drug use is unknown.

For the fourth year in a row, the President's budget has proposed cutting funding for the Centers for Disease Control and Prevention (CDC). Adjusted for inflation, CDC spending on domestic HIV prevention in 2006 was the lowest since 1993. Not coincidentally the number of new HIV infections in the US is unchanged since 1990. And evidence of politics trumping public health science does not stop at the Office of the Surgeon General. The Department of Health and Human Services (HHS) has increasingly put the Atlanta-based CDC under greater restrictions and scrutiny from political appointees. Staff requests for overseas travel are required to be vetted by political appointees in Washington. A recent internal CDC memo leaked to the Atlanta Journal Constitution complained that such approvals were causing roughly half of CDC overseas posts to be unfilled. And HHS has also routinely gone around CDC to push its ideological agenda. For example, the department funds a website, www.4parents.gov, targeting adolescents which highlights contraceptive failure rates and gives such helpful tips as this: "Find non-sexual ways to show you care (give a card or a nice comment)."

Under President Bush, the CDC has capitulated to pressures from Washington to censor information about the effectiveness of condoms and to restrict funding to community AIDS organizations not preaching abstinence. At a national conference on sexually transmitted diseases sponsored by the CDC last year, officials bowed to pressure from Congressman Mark Souder and added two pro-abstinence speakers to a panel and removed a scientist whose presentation had been accepted via peer review. The title of the panel - proposed by public health scientists - was changed from "Are Abstinence-Only-Until-Marriage Programs a Threat to Public Health?" to "Public health strategies of Abstinence Programs for Youth".

Surgeon General Carmona was testifying to the House Oversight and Government Reform Committee as part of an effort by Congressman Henry Waxman to examine ways to strengthen the authority and autonomy of the Office of the Surgeon General. It is essential for the credibility of that office, and for the entire Department of Health and Human Services that such reforms take place. For the health of our nation, we should be confident in America's doctor being able to speak openly and honestly.