20th International AIDS Conference - Melbourne, Australia

TUAD01 Sexier than You Think: HIV Policy, Regulation and Legislation
  Oral Abstract Session : Track D
Venue: Plenary 3
Time: 22.07.2014, 11:00 - 12:30
Co-Chairs: Michael Kirby, Australia
Mandeep Dhaliwal, UNDP

Laws, flaws and actions stalled: a review of laws and policies affecting young people´s access to HIV services in Asia-Pacific
J. Sass1, J. Godwin2
1UNESCO, HIV Prevention and Health Promotion (HP2) Unit, Bangkok, Thailand, 2Independent Consultant, Elizabeth Bay, Australia

When the 'evidence' ain't based on evidence: ensuring current scientific and medical evidence informs the application of criminal law to cases of HIV exposure or transmission
S. Cameron1, E. Bernard2, J. Hows3
1Australian Federation of AIDS Organisations, Sydney, Australia, 2HIV Justice Network, Brighton, United Kingdom, 3GNP+, Amsterdam, Netherlands

Effect of anti-stigma legislation on the level of stigma directed towards persons living with HIV in Nigeria
O. Fajemisin1,2, A. Oginni3, O. Idogho4, C. Ofoegbu5
1Enhancing Nigeria Response to HIV and AIDS (ENR), Strategic Knowledge and Monitoring Unit, Abuja, Nigeria, 2Population Services International, International Department, Washington DC, United States, 3Population Council, Abuja, Nigeria, 4Society for Family Health, ENR, Abuja, Nigeria, 5Society for Family Health, ENR Programme, Abuja, Nigeria

Using a feasibility study as an advocacy tool towards repealing an antiquated law that perpetuates HIV: a case of the deceased brother's widow's marriage act in Zambia
M.M. Chanda1, M. Chikuba-McLeod2, J. Sipho Chitengi2, J. Macmillan3, A. Miti3, G. Shauma2, C. Samanga3, T. Mambi Banda4, G. Mwanza3
1Support to the HIV/AIDS Response in Zambia, Policy and Legal, Lusaka, Zambia, 2SHARe II, Lusaka, Zambia, 3Zambia Law Development Commission, Lusaka, Zambia, 4SHARe II Project, Lusaka, Zambia

Eu´s evolving trade agenda in developing and least developed countries: a growing threat to universal access to affordable generic medicines for HIV and hepatitis C
K. Bhardwaj
Independent Lawyer (HIV, Health and Human Rights), New Delhi, India

Moderated discussion

Powerpoints presentations
Laws, flaws and actions stalled: a review of laws and policies affecting young people´s access to HIV services in Asia-Pacific - Justine Sass

Effect of anti-stigma legislation on the level of stigma directed towards persons living with HIV in Nigeria - Oluwole Fajemisin

Using a feasibility study as an advocacy tool towards repealing an antiquated law that perpetuates HIV: a case of the deceased brother's widow's marriage act in Zambia - Michael Mulimansenga Chanda

Rapporteur reports

Youth report by Jeffry Acaba

Note that this summary covers only one of the abstracts presented in this session – Laws, flaws and actions stalled: a review of laws and policies affecting young people´s access to HIV services in Asia-Pacific.

Note tNof

In 2013, UNESCO and partners carried out a systematic review of how laws and policies affect young people’s access to sexual and reproductive health (SRH) and HIV information and services in countries in the Asia Pacific region. The review highlighted that criminalisation of drug use, same-sex relations and selling/buying sex profoundly affects young people from these populations. In many settings, young people risk being charged with prostitution or soliciting for prostitution if they are found by the police to be carrying condoms, or being charged with drug offences if they are found carrying needles and syringes. The power imbalance young people face in interactions with police appears to increase their vulnerability to police abuse, harassment, and extortion.

Further, the review noted many contradictions between different laws within the same country when it comes to young people’s ability to make decisions about their own health. For example, while age of consent to sex in many countries is less than 18 (and as low as 12 in some countries), most do not allow young people under 18 to independently consent to medical interventions. The requirement for HIV testing and other SRH services is understandably a deterrent for young people who may not wish to disclose their behaviours in asking for parental consent.


In addition to describing laws, policies and practices that impede access to services, the review highlights examples of those that are supportive of the rights of young people. These include (but are not limited to) those that recognise the evolving capacity of young people to make independent decisions regarding their own health, those that recognise privacy rights and those that protect against discrimination and stigma.


To supplement the literature review, focus group discussions (FGDs) were convened with young people aged 18 to 25 in Indonesia, Myanmar and the Philippines to explore their experiences, perspectives and opinions on barriers to accessing SRH and HIV services. This is a promising example of meaningfully involving young people, including young people from key populations in research relevant to their lives.

Track D report by Laura Ferguson

Mandeep Dhailwal, chair of the session, noted how exciting it is to have a wide range of speakers beyond lawyers talking about laws and human rights. The panellists noted that laws, policies and regulations can be used either to very good or to very negative effect in the context of HIV. Ongoing monitoring of and advocacy to improve laws and policies relevant to HIV is critical to an effective response.
Panellists drew attention to a range of laws and policies that lack any basis in public health evidence, the impacts of which include limiting access to HIV-related services, exacerbating HIV transmission and conviction of people living with HIV for transmission even in cases where no risk of HIV transmission existed. With regard to intellectual property, pressure from high-income country governments and the pharmaceutical industry is having an increasingly devastating effect on low-income countries’ ability to respond to HIV and other co-infections.
Justine Sass provided examples of some good legal and policy practices in the Asia Pacific region (e.g. mature minors, promotion of access to services for young people) but noted that laws and policies can also constitute obstacles to young people’s access to HIV services. By the age of 14 most countries consider young people old enough to stand trial for a criminal offence but many are not considered old enough to make decisions about their own health. Sass highlighted the lack of consistency across laws in many national settings about when young people can consent to sex, marry and access SRH services… which may all be disconnected from when young people actually start having sex. Young people’s evolving capacity to make decisions about their health care must be taken into account, and health workers need training to help them assess this capacity.

Sally Cameron focused her presentation on the yawning divide between the public health evidence around HIV and what happens within courts and the judicial system. She gave examples of the very wide range of existing laws and guidelines around criminalizing HIV exposure or transmission and the various strategies being employed around the world to increase the use of scientific evidence in criminalization cases and in efforts to repeal these laws.

Oluwole Fajemisin presented findings of a study in Nigeria on the impact of laws that prescribe discrimination based on HIV status. He suggested that although accepting attitudes are increasing throughout Nigeria, the increase is greater where such anti-discrimination laws exist. In response to a question from the audience, Fajemisin acknowledged the need to contextualize this work within the broader legal and policy environment that is evolving in Nigeria.

Highlighting the negative public health impact of widow inheritance, Michael Mulimnasenga Chanda reported that a feasibility study found that 97% of survey respondents support repealing the law that allows widow inheritance. Women reported that being inherited was degrading, humiliating, a violation of human rights and a way of exacerbating gender inequality. Chanda outlined plans to gather further evidence of this to inform advocacy for legal reform in this area as well as on 21 additional pieces of legislation relevant to HIV.

Kajal Bhardwaj warned that EU trade policy is likely to become an increasing impediment to medicines for HIV, Hepatitis C and other chronic diseases. Her historical overview highlighted how generic products transformed the accessibility of ARVs globally. But second and third line regimens are increasingly patent-protected and therefore much more expensive. Bhardwaj highlighted various strategies that impede low income countries’ use of flexibilities in trade-related intellectual property rights agreements, with emerging ‘free’ trade agreements that include restrictive clauses such as longer patent terms and restrictions on parallel imports the most damaging. She noted the need for further research on the impact of trade policies on access to drugs.

In his closing remarks, Michael Kirby drew attention to “the avalanche” that is about to hit us as more and more people move to 2nd or 3rd line therapies (or beyond) all of which are heavily patented. He noted that there is a crisis coming with regard to the 14 million people on ARVs when they need to shift regimens as we simply cannot afford to pay for this.

Recommendations are for broad legal and policy environment to be reviewed for its impact on HIV, that problematic laws and policies be repealed or amended, and that anti-discrimination laws and other evidence-informed provisions to promote public health and ensure human rights be enacted and implemented. Vigilance is required with regard to evolving trade agreements to ensure that the accessibility of antiretroviral drugs and other medications can be maximized.


    The organizers reserve the right to amend the programme.