20th International AIDS Conference - Melbourne, Australia


TUAD02 Critical Justice: Human Rights, Legal Issues and HIV
  Oral Abstract Session : Track D
Venue: Plenary 2
Time: 22.07.2014, 14:30 - 16:00
Co-Chairs: Sofia Gruskin, United States
Urmila Bhoola, South Africa

14:30
TUAD0201
Abstract
Powerpoint
Webcast
Criminalization of same-sex behavior is harmful to public health: significant reductions in access to HIV prevention and care services associated with arrest and convictions for sex between men
G.-M. Santos1,2, K. Makofane3, S. Arreola3, J. Beck3, P. Wilson4, P. Hebert3, T. Do2, G. Ayala3
1San Francisco Department of Public Health, Center for Public Health Research, San Francisco, United States, 2University of California San Francisco, Epidemiology and Biostatistics, San Francisco, United States, 3Global Forum on MSM and HIV, Oakland, United States, 4Columbia University, New York, United States

14:45
TUAD0202
Abstract
Powerpoint
Webcast
Southern exposure: HIV and human rights in the southern United States
M. McLemore
Human Rights Watch, Health and Human Rights Division, New York, United States

15:00
TUAD0203
Abstract
Powerpoint
Webcast
Ending overly-broad criminalisation of HIV non-disclosure, exposure and transmission: critical scientific, medical and legal considerations
S. Timberlake, P. Eba
UNAIDS, Geneva, Switzerland

15:15
TUAD0204
Abstract
Powerpoint
Webcast
Assessing policy impact on HIV intervention targeting MSM in Abuja, Nigeria
I.K. Orazulike1, J. Adeniyi2, O. Stanley2, U. Ononaku3, D. Kalu2, A. Doroh4, C. Akolo5, S. Kennedy5, S. Baral6, M. Charurat5
1International Center for Advocacy on Rights to Health (ICARH), Executive Director, FCT, Nigeria, 2International Center for Advocacy on Rights to Health (ICARH), Human Rights and Advocacy Unit, FCT, Nigeria, 3Institute of Human Virology Nigeria (IHVN), Research, FCT, Nigeria, 4International Center for Advocacy on Rights to Health (ICARH), HIV Prevention Unit, FCT, Nigeria, 5Institute of Human Virology (IHV), Epidemiology and Prevention, Baltimore, United States, 6Johns Hopkins University Bloomberg School of Public Health, Epidemiology and Prevention, Baltimore, United States

15:30
TUAD0205
Abstract
Webcast
Seeking justice at the frontline of the AIDS crisis: the African grandmothers tribunal
L. Waldorf
The Stephen Lewis Foundation, Toronto, Canada

15:45
TUAD0206
Moderated discussion

Powerpoints presentations
Criminalization of same-sex behavior is harmful to public health: significant reductions in access to HIV prevention and care services associated with arrest and convictions for sex between men - Glenn-Milo Santos

Southern exposure: HIV and human rights in the southern United States - Megan McLemore

Ending overly-broad criminalisation of HIV non-disclosure, exposure and transmission: critical scientific, medical and legal considerations - Patrick Eba

Assessing policy impact on HIV intervention targeting MSM in Abuja, Nigeria - Ifeanyi Kelly Orazulike



Rapporteur reports

Track D report by Laura Ferguson


There is excessive criminalization and a backlash against HIV across many settings. The panelists in this session presented compelling evidence of the negative impact on public health and human rights of this backlash with a view to identifying some tools to promote the use of law to promote rather than undermine justice and human rights in the context of HIV.

Glenn-Milo Santos showed that in a global sample of 4020 MSM,  one in twelve reported having been arrested for same sex behavior with this increasing to almost one in four in sub-Saharan Africa. Those with a history of arrest reported significantly lower access to STI testing, STI treatment, HIV testing, condoms, mental health services, medical care and, among PLHIV, HIV treatment services. Santos concluded that these laws deprive MSM of their basic human rights and freedoms and called for decriminalization in order to ensure an effective HIV response for MSM.

Megan McLemore presented data to illustrate how HIV disproportionately affects the south of the United States and, within this region, African Americans. In many southern States African-Americans constitute 60-75% of PLHIV but only 30% of the population. McLemore attributed this to the ‘environment of risk’ and drew attention to the fact that ‘structural factors’, so often blamed for high HIV prevalence, are often underpinned by specific laws and policies that could be, and in some cases have been, improved.

 Patrick Eba noted that in addition to its negative impact on the HIV response, the use of the criminal law around HIV often constitutes a disregard for the science of HIV (e.g. prosecutions for biting or spitting, prosecutions in spite of condom use or low viral load) and for legal and justice principles (e.g. lack of proof, disproportionate penalties). The voices of civil society networks and ‘criminalization survivors’ have been critical in challenging the use of the criminal law in prosecutions around HIV. UNAIDS created a new guidance note to reconcile the science and the law, which was published in 2013.

Orazulike presented striking data that showed the immediate detrimental impact of the law introduced in Nigeria in January that criminalizes ‘amorous’ relationships between men, organizations that provide intervention services to MSM, associations of MSM living with HIV, and anyone who supports these organisations. Following introduction of the law, the number of MSM accessing specific HIV services in Abuja fell from 60 to 15/month. In addition, 73% of MSM surveyed expressed declining interest in attending HIV-related services since enactment of the law. Orazulike concluded with an appeal to repeal discriminatory laws and to provide adequate alternative services for key populations.

 Lee Waldorf highlighted the huge responsibility for caring for orphans that grandmothers bear in many parts of sub-Saharan Africa. At a community tribunal organized by the Stephen Lewis Foundation, grandmothers testified about the challenges they faced – food insecurity, prohibitive school costs, violence from relatives, poor access to treatment and inadequate healthcare, and ‘an epidemic of property grabbing’. The people’s tribunal recommended financial and emotional support for grandmothers, participation in relevant decisions, policies and programmes, and avenues for remedy and redress in cases of rights violations. Waldorf ended by highlighting the need to look beyond the endpoint of zero new infections, noting the need to also focus on the health and well-being of everyone who has been affected by the epidemic.

A clear evidence base is emerging of the negative impact on public health and human rights of laws and policies that criminalize certain behaviours and populations. In the context of criminalization and human rights violations, health, well-being and the effectiveness of the HIV response are compromised. The populations most affected are typically those who are already marginalized and who have least voice to speak out against these injustices. It is critical that this evidence be used to repeal harmful laws and ensure a protective legal and policy environment.

The overarching recommendation to emerge is that laws criminalizing sex between men, needle exchange or HIV transmission (except perhaps in very specific circumstances of willful transmission) should be repealed. All laws and policies should be informed by the best available scientific evidence. In addition, panelists stressed that an effective HIV response must go beyond the endpoint of zero new infections to also include attention to the health and well-being of everyone affected by HIV.




Leadership and Accountability report by Craig Beyerinck


The overarching theme of this session was that decriminalization of HIV is needed to end AIDS as it negatively affects access to prevention and treatment services.

Homophobia and critical enablers result in the decreased impact of HIV prevention tools. Homophobia and the resulting enforcement of laws that criminalise same sex relations lead to decreased use of HIV services. After the passing of the Nigerian anti-gay law there was a large drop in the number of people who access HIV services as well as a decreased interest in HIV intervention programmes. Such punitive laws limit the optimum participation of MSM in public health programmes and should be repealed. The criminalization of HIV disregards the science behind HIV and principles of justice, each of which have negative impacts on the HIV responses. The UNAIDS Guidance Note recommends that laws should be restricted to truly blameworthy cases, uphold principles of justice and be driven by the best scientific and medical evidence.

HIV infection rates in the U.S. are highest in the South and disproportionately affect African Americans and other minorities such as Latinos. The South is most affected because of high poverty rates, lack of safety nets and investment in HIV/AIDS, high rates of uninsured persons, abstinence-based sex education, hostility towards LGBT people, high numbers of prisoners, criminalized HIV exposure and the lack of needle exchange programmes. Nontraditional actors in HIV prevention, such as grandmothers in African countries, should be further included in HIV prevention and treatment programmes. The overall goal of the HIV response must be the restored health and wellbeing of the people who live in countries hardest hit by HIV.

Several clarifying questions were asked but pertained mainly to the already presented data.

People who participate in such sessions can bring new ideas to their own countries and can help collect and disseminate information to help drive the global HIV response. 


   

    The organizers reserve the right to amend the programme.