The International Planned Parenthood Federation (IPPF) launched on 13 November 2008 a new report Verdict on a Virus: Public Health, Human Rights and Criminal Law.

The International Planned Parenthood Federation (IPPF) launched on 13 November 2008 a new report Verdict on a Virus: Public Health, Human Rights and Criminal Law. The aim of the publication is to provide information about the criminalization of HIV transmission or exposure and its related health, human rights and legal implications.

The report brings together opinions from legal experts, human rights groups, medical and health professionals and HIV activists. Ten questions around the criminalization of HIV transmission are explored as chapters which also provide answers followed by explanatory text and illustrated with case studies.

Verdict on a virus is also a call to action to advocate for “good strategies and laws” that promote HIV prevention, while working with governments to discourage and prevent new laws criminalizing transmission of HIV from being passed.

“The law can be a powerful tool in addressing HIV if it is used to empower those vulnerable to HIV infection and to its impact, by guaranteeing access to services and protecting people from discrimination and the sexual violence that can drive HIV vulnerability,” said Susan Timberlake UNAIDS Senior Advisor, Human Rights and Law. “We need to make scarce legal resources work for the HIV response, not against it,” she added.

As Justice Cameron explained at a lecture at Peking University Law School, from his perspective, the law serves two important functions. Credit: UNAIDS/Zhou Dao

During his recent trip to Beijing as a guest of UNAIDS, Justice Edwin Cameron of South Africa’s Supreme Court of Appeals used every opportunity to raise the question, “What role can the law play in China in response to HIV?”

As Justice Cameron explained at a lecture at Peking University Law School, from his perspective, the law serves two important functions. First, it is an embodiment of public morality. Second, the law constrains the exercise of government power. In both these capacities, the law can have a profound impact on the lives of people living with HIV.

For example, in South Africa, the 1995 Labor Relations Act prohibits pre-employment testing for HIV. Justice Cameron applauds the law because it guides social conduct to be consistent with the moral stance underlying the law. “There are very few legitimate reasons to deny someone work because of HIV status,” said Justice Cameron.

The most important Chinese law embodying public morality about HIV is State Council Decree 457 of 2006, which prohibits discrimination against people living with HIV. Although this law sets a vital standard for Chinese society, public awareness of the law is low. As former Minister of Health Wang Longde explained at a joint press conference with Justice Cameron, even medical professionals often don’t know that they are not permitted to discriminate against HIV positive individuals. Professor Wang called for an educational campaign for medical professionals.

While Decree 457 is a good law that faces some implementation challenges, other laws are less positive. At a round table discussion held at UNAIDS China offices during Justice Cameron’s visit, he described the disturbing trend in African countries of laws criminalizing HIV transmission. Some of these laws require HIV positive individuals to disclose their status prior to engaging in sexual contact, but without clarifying when a person must disclose, or what constitutes “sexual contact.”

In Justice Cameron’s analysis, while these laws are intended to protect people — a laudable motivation — they can have devastating public health consequences. First, the laws are not effective as a means of stopping transmission; no law can accomplish that. As Justice Cameron explained, most acts of transmission occur between individuals who do not know they are HIV positive.

Second, the laws increase stigma and discourage people, especially women, from getting tested. Under some of these laws, women can incur legal liability for exposing their unborn child to HIV, even if transmission doesn’t occur. Many women and men find remaining ignorant about their HIV status preferable to risking criminal prosecution. Ultimately, by discouraging people from getting tested and seeking treatment for HIV, these laws lead to more people dying needlessly.

Justice Cameron pointed out that, ironically, these laws are unnecessary. In the event that anyone deliberately transmits HIV to another person, existing laws of assault or murder would apply.

China doesn’t have any laws that specifically criminalize transmission of HIV. But one article of the Chinese law does criminalize the intentional transmission of a sexually-transmitted disease (STD) by sex workers, and another law criminalizes intentionally causing harm to another person. Some critics have pointed out that the STD law has caused some sex workers to stop getting health check-ups. Justice Cameron commented that, although China’s criminal laws appear to have some negative ramifications for public health, the laws were general, and were not targeted to HIV specifically.

In recent years, there has been an apparent increase in the number of people prosecuted for transmitting HIV, particularly in Europe and North America, with cases now numbering in the hundreds in the English-speaking world alone. There is also an increase in laws that criminalize HIV transmission and exposure to the virus, as reported in sub-Saharan Africa, Asia, and Latin America and the Caribbean.

As early as 1996, UNAIDS and the Office of the UN High Commissioner for Human Rights expressed concern over the inappropriate and overly broad application of criminal law to HIV transmission and provided guidance on it in the International Guidelines on HIV/AIDS and Human Rights. In 2002, UNAIDS issued a more detailed policy options paper on the subject. However, in light of growing concern over the spread of such laws, UNAIDS and UNDP felt it necessary to recently publish a policy brief entitled “Criminalization of HIV transmission”.

Intentional transmission of HIV

The policy brief makes specific recommendations for governments, civil society and international partners, urging that criminalization be limited to cases of intentional transmission of HIV. While UNAIDS and UNDP acknowledge that use of the criminal law may be justified in these limited circumstances – i.e. where a person knows his or her HIV positive status, acts with the intention to transmit HIV, and does in fact transmit it – they are concerned that going beyond such cases risks applying criminal sanctions to people who are not actually blameworthy, further stigmatizes people living with HIV, and creates disincentives for mutual responsibility for sexual health and to finding out one’s HIV.

The policy brief highlights concerns about possible negative impacts on effective prevention of HIV transmission, problematic disclosure and partner notification provisions, miscarriage of justice, as well as the possible negative impact on women and girls.

International Consultation on the Criminalization of HIV Transmission

In November 2007, the UNAIDS Secretariat and UNDP hosted an “International Consultation on the Criminalization of HIV Transmission” in order to consider recent developments in the area. The meeting brought together diverse points of view but also a shared concern over the apparent trend of criminalizing HIV transmission. An in-depth report from the three-day meeting has been released, giving an overview of the discussions, summary of the main issues and conclusions by the participants who included parliamentarians, members of the judiciary, criminal law experts, civil society representatives and people living with HIV, alongside representatives of WHO, ILO and the Office of the UN High Commissioner for Human Rights.

The report also includes the summary provided by Justice Edwin Cameron, judge of the Supreme Court of Appeal, South Africa.

“What meeting participants underlined was the fact that laws criminalizing HIV exposure and transmission are a dangerous and ineffective ‘sideshow’ in the response to AIDS,” said Susan Timberlake, Senior Human Rights and Law Adviser, UNAIDS Secretariat.

“Criminal law will never do the work of comprehensive and evidence-informed HIV prevention programmes. In fact, widespread criminalization may set back prevention efforts by deterring people from learning their HIV status, disclosing it to partners, and accessing treatment.”

No evidence that the use of criminal law reduces transmission of HIV

The main reasons advanced for applying criminal law are either punishment for someone who has caused harm or to deter risky behaviours that lead to HIV transmission.

However, there is no evidence that the use of criminal law is an effective measure for reducing transmission of HIV, and experts are concerned that criminalization is likely to have a negative impact on the overall response to HIV, including HIV prevention.

Potential negative impacts of use of criminal law

For fear of prosecution, people may be more reluctant to get tested and find out about their HIV status, as a perceived “legal defense”. Such laws and the reporting of individual cases in the media risk undermining the public health message that it is best to take responsibility for your own protection, rather than rely on a legal obligation of HIV positive people to disclose their status.

Criminalization may also create distrust in relationships with health service providers as courts might subpoena medical records in court cases. Finally, though many of these laws appear to have been passed as a “measure to protect women”, many experts fear that these laws will actually be disproportionately applied to women living with HIV. Women are often the first to find out their status and cannot tell their partners for fear of violence or abandonment. They also are less likely to have access to legal counsel than men.

For these and other reasons, many experts are concerned that the potential adverse consequences for both public health and human rights far outweigh any perceived benefits that could arise from an increased and overly broad application of criminal law to HIV transmission.

BBC World Service

According to a BBC report on 13 November 2008, "Doctors in Germany say a patient appears to have been cured of HIV by a bone marrow transplant from a donor who had a genetic resistance to the virus."

UNAIDS Chief Scientific Adviser Dr Catherine Hankins spoke to the BBC Radio’s Julian Keane on “The World Today”.

Dr Hankins discussed what can be learned from a case like this and why it may be one more piece in the puzzle to discover why it is that some people don't get infected and or some who do get infected don't progress and get sick.

This interview was first broadcast on Thursday 13 November 2008.

Cultural sensitivity is critical for the success of development strategies according to a new report produced by the United Nations Population Fund (UNFPA). Credit UNFPA

Cultural sensitivity is critical for the success of development strategies according to a new report produced by the United Nations Population Fund (UNFPA). Reaching Common Ground: Culture, Gender and Human Rights, launched 12 November 2008, reports that culture is a central component of successful development of countries, and must be integrated into development policy and programming.

The State of World Population 2008 report affirms that development strategies that are sensitive to cultural values can reduce harmful practices against women and promote human rights, including gender equality and women’s empowerment.

Despite many declarations and affirmations in support of women’s rights, the report argues, gender inequality is widespread and deep-rooted in many cultures. Coercive power relations underlie practices such as child marriage - a leading cause of obstetric fistula and maternal death—and female genital mutilation or cutting. These and other harmful practices continue in many countries despite laws against them.

Gender inequality and HIV

The effects of gender inequality leave women and girls more at risk of exposure to HIV. Less access to education and economic opportunities results in women being more dependent on men in their relationships, and many who have no means of support must resort to bartering or selling sex to support themselves and their children. Where women can’t own property and lack legal protections, their dependence within their families is even greater. Economic and social dependence on men often limits women's power to refuse sex or to negotiate the use of condoms.

The report, which coincides with this year’s 60th anniversary of the Universal Declaration of Human Rights, is based on the concept that the international human rights framework has universal validity. Human rights express values common to all cultures and protect groups as well as individuals. The report endorses culturally sensitive approaches to the promotion of human rights, in general, and women’s rights, in particular.

Culturally sensitive approaches call for familiarity with how cultures work, and how to work with them. The report suggests that partnerships - especially with community-based institutions and leaders - can create effective strategies to promote human rights and end their abuses, such as female genital mutilation or cutting, wife inheritance or rape within marriage.

“Communities have to look at their cultural values and practices and determine whether they impede or promote the realization of human rights. Then, they can build on the positive and change the negative,” said Thoraya Ahmed Obaid, Executive Director of UNFPA

Therefore, The State of World Population report cautions that cultural sensitivity and engagement do not mean acceptance of harmful traditional practices, or a free pass for human rights abuses. Values and practices that infringe human rights can be found in all cultures. Understanding cultural realities can reveal the most effective ways to challenge these harmful cultural practices and strengthen beneficial ones.

The report concludes that analysing people’s choices in their local conditions and cultural contexts is a precondition for better development policies.

UNAIDS Executive Director Dr Peter Piot is visiting India this week. Thanks to government leadership, enhanced cooperation between civil society and the police could make a difference in communities across India.

A group of police and paramilitary personnel and representatives from State AIDS Control Societies and civil societies make action plans for implementation at the State level and district level. Credit: UNAIDS

Although adult HIV prevalence rate in India is low at 0.3%, still an estimated 2.4 million people are living with HIV in this the second most populous country in the world. Those most at risk of contracting the virus are people who engage in certain behaviours including buying and selling sex, injecting drugs and men who have sex with men. A complex range of social issues means they can be the people hardest to reach in society.

As they may also be criminalized by the legal system, their paths often cross with the police. This contact presents a unique opportunity for the police to act as facilitators for the provision of HIV related services to people most-at-risk.

Safer sex and drug injecting

Safer sexual and injecting practices are vital for the successful control of the HIV epidemic in India. Most HIV outreach for marginalized people is led by non-governmental (NGOs) and community based organizations. Traditionally, the police force did not work formally with civil society in India, although there have been excellent examples of police men and women coordinating with NGOs but this was on an ad hoc and personal basis.

Through successful advocacy, UNAIDS in India has proposed to the Ministry of Home Affairs to consider the value of enhancing cooperation and proactive support between the police and the agencies working with people at higher risk of HIV. With support from the police, the protection of community workers, their outreach and successful implementation of measures like condom distribution and needle exchange programmes are more assured.

In December 2007 the Ministry of Home Affairs issued an official order to all Directors General of Police to designate a Nodal officer for NGO Coordination at the state and district level. This officer is specifically tasked with engaging more closely with NGOs.

This has already been fully implemented across India in all twenty-eight states and seven Union Territories and is already seen as a major contribution to National HIV programming. By engaging with the issue of HIV and supporting prevention initiatives as part of their regular work, the police will automatically get sensitized for their own protection from the risk of HIV infection.

Nodal officers in charge of NGO coordination at the State and district level took part in a regional police conference on the role of police in HIV programming and formulated action plans. 7 August 2008 Credit: UNAIDS

“The Ministry of Home Affairs, Government of India has shown an extraordinary commitment to respond to HIV by introducing this unique intervention. At almost no cost, this ensures long term coordination between police and civil society in an institutionalized manner for supporting communities with prevention, treatment, care and support services and in achieving the targets of universal access,” said Mr Ranjan Dwivedi, Technical Advisor, Uniformed services and Civil Society partnerships, UNAIDS India.

This intervention by the Ministry removes the administrative cost of setting up initiatives by officers locally. As well as demonstrating the positive contribution of the police, community groups hope the measure will go a long way in assisting NGOs, not only in HIV prevention, but in other social programmes such as in the response to child abuse and violence against women.

Beyond law enforcement to proactive community support

Recently the Ministry of Home Affairs, in partnership with UNAIDS, organized four regional conferences for the newly identified nodal officers for NGO Coordination who would facilitate in rolling out of the strategy for HIV programming for uniformed services in all states. The events were an opportunity to sensitize the state police leadership as well as representatives from health departments and State AIDS control societies to plan HIV prevention initiatives in police departments together through new strategies evolved by the Ministry Of Home Affairs.

The role of the police to proactively support agencies working with most-at-risk populations was underlined, as well as their sensitive role in HIV prevention among people who buy and sell sex, inject drugs or men who have sex with other men.

Enhancing relations with the police

The community based organizations present emphasized the importance of police support in their local outreach efforts.

Kusum Jain from Gram Bharati Samiti (GBS), an NGO in Rajasthan, works closely with Rajput tribal community who by tradition practice sex work. When her organization first began to interact with the community they were chased with dogs as the people thought they had come to stop their business. With help from the local police, GBS workers over the years have built up the trust of the community who now see their only aim is to make them aware of HIV prevention that now they can work closely together.

Ms Jain believes that formalizing the role of the police in community support has enhanced their relations with the police, helping the police to be accessible and provide proactive support to agencies working on HIV prevention among most at risk populations.

A recent Asia Commission report concluded there is a vital need for political engagement and support to drive an effective AIDS response. Through this new initiative with the police, the Indian government is demonstrating such leadership.

UNAIDS/WHO plan to publish an AIDS Epidemic Update in 2009 that will report on 2008 estimates, incorporating the 2008 programme coverage data.

For more than a decade, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO), have produced a detailed report titled “AIDS Epidemic Update” prior to World AIDS Day that provided the most recent epidemiological figures and trends for the current year.

However the estimates of new HIV infections, deaths due to AIDS, and number of people living with HIV are now more and more affected by information coming from HIV services including HIV treatment coverage and prevention of mother to child transmission programmes. This information is usually made available after the year ends, meaning that it is no longer possible to provide credible estimates of a current year.

So this year it has been decided not to publish a new “AIDS Epidemic Update” in 2008. Instead UNAIDS/WHO plan to publish an AIDS Epidemic Update in 2009 that will report on 2008 estimates, incorporating the 2008 programme coverage data.

This change in reporting cycle was endorsed by leading epidemiologists during the International Consultation on Epidemiological Estimates organised by UNAIDS in November 2007.

For epidemiological information about the AIDS epidemic, please refer to UNAIDS’ Report on the global AIDS epidemic 2008.

Mohamed Alabbar, Chairman, Emaar Properties and co-chair of the Summit on the Global Agenda, speaking at the Introductory Session of the Summit on the Global Agenda, 07 November - 09 November 2008. Copyright World Economic Forum/Photo by Dana Smillie.

The World Economic Forum's first Summit of the Global Agenda Councils - a unique gathering of leaders from academia, business, government and civil society – is taking place in Dubai, United Arab Emirates from 7 to 9 November. UNAIDS Executive Director Dr. Peter Piot is in Dubai participating in this event.

The Summit aims to advance solutions to the world’s most critical challenges; the Forum’s new Global Agenda Council is being billed as the world’s foremost intelligence and knowledge network.

Over the coming days, Dr. Piot, in his role as Chairman of the Global Agenda Council for HIV/AIDS, will participate in several workshops and sessions where discussions will be held on how to improve the state of the world, highlighting specific issues including HIV, systemic financial risk, global governance, energy security, child welfare, climate change and food security. Further issues under discussion will be actions and actors in these areas; presentation of key insights from the Councils discussions; and decisions on next steps for the Councils.

The outcomes of this Summit will be presented for further discussion and action at the World Economic Forum’s upcoming Annual Meeting 2009 in Davos, Switzerland.

More than 30 representatives from 10 countries of the Commonwealth of Independent States (CIS), along with UNAIDS representatives, took part in the meeting of the CIS Coordination Council on HIV/AIDS on 30 October in Moscow

More than 30 representatives from 10 countries of the Commonwealth of Independent States (CIS), along with UNAIDS representatives, took part in the meeting of the CIS Coordination Council on HIV/AIDS on 30 October in Moscow. The meeting, hosted by the Russian Government, brought together government representatives, country and regional civil society leaders and members of the Eastern European and Central Asian Union of the Organizations of People Living with HIV to build on their experiences to scale up HIV prevention, treatment, care and support.

“It is a truly unique meeting not only for the country but the region as a whole”, said Dr Luiz Loures, Director of the UNAIDS Strategic Country Intelligence Office In his remarks opening the consultation. “The urgent need to provide universal access to HIV services emphasizes the importance of improved coordination and harmonization of our efforts. That is why the CIS as a regional platform for coordination is so essential for that to happen in this region.”

The number of people living with HIV in the CIS countries rose in 2007 to an estimated 1.6 million, with an estimated 150,000 new HIV infections. This represents a 150% increase since 2001.

The HIV epidemics in the CIS area are concentrated mainly among injecting drug users (IDU), sex workers, their respective sexual partners and, to a lesser extent, men who have sex with men (MSM). Of the new HIV cases reported in 2006, for which there was information on the mode of transmission, nearly two thirds (62%) were attributed to IDUs and more than one third (37%) to unprotected heterosexual intercourse.

In light of the regional data that identifies drug use as a major driver of the epidemic in the region, all participants agreed on the urgent need to remove stigmatizing and coercive measures, and training of health providers and law enforcement personnel to be able to work effectively with IDUs in reducing the spread of HIV. So far, the percentage of injecting drug users reached by prevention programmes such as needles/syringe exchange remains small, in spite of increased funding overall.

Less than 1% of new HIV diagnoses across the region were among men who have sex with men, although the real extent to which sex between men features in some of the region’s epidemics is unknown. Deep-rooted stigma and discrimination, growing xenophobia and homophobia are major barriers to the AIDS response. This is driving the epidemic underground as people are afraid to access HIV services

The reasons behind such trends noted at the meeting comprise not only resource and capacity deficits, but also the lack of broad leadership and partnership for AIDS, including at the highest levels of governments and communities. Such partnerships would link more closely decision makers with those who have first-hand experience of AIDS realities on the ground.

Therefore, countries recognized the importance of promoting information sharing between them on issues related to the protection of human rights, promotion of effective programmatic approaches and regionally relevant best practices.

While discussing the 2009-2013 Joint CIS Programme on AIDS participants also made a strong case for mobilization of additional funds to sup¬plement the resources available through the extension of existing grants and loans provided by the Global Fund, the World Bank and other donors.

Finally, in order to guarantee the provision of universal access to HIV services in the region, participants identified the need for the development of a regional policy to en¬able proactive price negotiations for medical and laboratory commodities as well as to improve utilization of the existing regional training facilities to enhance technical capacity in the countries.

As Dr Sergei Furgal, Director, a.i., UNAIDS Regional Support Team for Eastern Europe and Central Asia, noted, “The Joint CIS Programme is based on the outcomes and recommendations of the UNAIDS-facilitated regional consultations on Universal Access as well as on the principles of hori¬zontal collaboration between the CIS countries. Regional team has been providing a substantial and solid support to the CIS as a key intergovernmental regional body in strengthening and consolidating response to AIDS.”

The next meeting of the CIS Coordination Council on HIV/AIDS is scheduled on February 2009. It will aim at reviewing regional progress and obstacles in scaling up HIV prevention, treatment, care and support towards the Universal Access targets and to develop a special regional pro¬gramme to tackle AIDS among labour migrants.

UNAIDS and KfW Entwicklungsbank (KfW) have entered into a new agreement to expand the reach of its cooperation

Four years after signing the first cooperation agreement to support the AIDS response in Central America and the Caribbean, UNAIDS and KfW Entwicklungsbank (KfW) have entered into a new agreement to expand the reach of its cooperation to include parts of Africa.

The first agreement between UNAIDS and KfW – which finances development programmes on behalf of the German Federal Ministry for Economic Cooperation and Development (BMZ) – was signed in July 2004 and focused on strengthening HIV prevention efforts in several Central American and Caribbean countries, such as Honduras, El Salvador, Guatemala, Dominican Republic, Haiti, and Guyana. Initiatives included the distribution of affordable condoms and social marketing campaigns to promote behaviour change.

Through the cooperation, in 2006 alone, more than 20 million subsidized condoms were distributed and sold in the region. In addition, condom social marketing programmes have reached an estimated 750,000 people, mainly groups most at risk of HIV infection.

The renewal, which runs from 2008 to 2011, will broaden efforts to address HIV prevention and reproductive health in West and Central Africa.

“Our first cooperation agreement enabled UNAIDS and KfW to provide access to quality, affordable condoms and to promote HIV awareness through various campaigns – prevention efforts that made a difference in the countries where we worked,” said UNAIDS Deputy Executive Director Michel Sidibe.

In the spirit of the previous framework, UNAIDS will continue to provide technical guidance for the initiatives and facilitate coordination among various stakeholders. KfW will further strengthen regional initiatives and enforce the regular information transfer between all parties. Jointly with UNAIDS, KfW will foster monitoring of the initiatives to improve transparency and detect opportunities and challenges.

“Enhancing the cooperation between UNAIDS and KfW Entwicklungsbank makes sense, as Africa is the continent that is by far the most affected by the epidemic,” said KfW’s Bruno Wenn, Senior Vice President Sub-Saharan Africa. “The activities by UNAIDS and KfW will increase the effectiveness of the AIDS response in Africa and elsewhere”.

About KfW
The German Development Bank finances development programmes in partner countries and regions on behalf of the German Federal Ministry for Economic Cooperation and Development. Between 2001 and 2007, a total of EUR 443 million has been committed to activities focused on sexual and reproductive health and HIV prevention.

About UNAIDS
UNAIDS is an innovative joint venture of the United Nations, bringing together the efforts and resources of the UNAIDS Secretariat and ten UN system organizations in the AIDS response. The Secretariat headquarters is in Geneva, Switzerland—with staff on the ground in more than 80 countries. Coherent action on AIDS by the UN system is coordinated in countries through UN theme groups, and joint programmes on AIDS.

UNAIDS’ Cosponsors include UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, ILO, UNESCO, WHO and the World Bank. Visit the UNAIDS Web site at www.unaids.org