Keeping confidence: HIV and the criminal law from HIV service providers' perspectives

Life and love under criminalization: The experiences of people living with HIV in Canada

Based upon qualitative interviews with 54 women and men living with HIV across Ontario, Canada, this paper examines the impact of HIV criminalization on the sexual and romantic relationships of people living with HIV. This research highlights the navigation strategies people living with HIV create and employ to both navigate and protect themselves from the law. Through a thematic and intersectional analysis, this study shows how adoption of these strategies is unequal, with access to navigation strategies varying along lines of gender, race, and sexual orientation. As a result, women and racialized people living with HIV face more difficulties navigating the impact of the law. HIV criminalization in Canada fuels and validates HIV stigma and produces vulnerability both within and outside of the relationships of people living with HIV. This paper seeks to understand HIV criminalization from the perspective of those governed by the law, in hopes of producing knowledge which will contribute to legal reform, inform policy, and support the development of efficacious secondary prevention initiatives.

Alternatives to sharing COVID-19 data with law enforcement: Recommendations for stakeholders

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In jurisdictions around the world, police have been enforcing COVID-19-related measures.

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Researchers and civil society agree: criminalizing illnesses does more harm than good.

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We describe two North American jurisdictions that share coronavirus data with police.

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COVID-19 data policies will likely have broad ramifications for health data policy.

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We present seven concrete alternatives to sharing health data with law enforcement.

During the COVID-19 pandemic, in some jurisdictions, police have become involved in enforcing coronavirus-related measures. Relatedly, several North American jurisdictions have established COVID-19 data sharing protocols with law enforcement. Research across a range of fields has demonstrated that involving police in matters of public health disproportionately impacts the most vulnerable and does more harm than good. This is reflected in the consensus against COVID-19 criminalization that has emerged among civil society organizations focused on HIV, human rights, and harm reduction. The European Data Protection Board has also released guidelines against re-uses of COVID-19 data for law enforcement purposes. This article offers an overview of the harms of criminalizing illnesses and strategies for health stakeholders to seek alternatives to sharing COVID-19 data with police agencies while facilitating interoperability with healthcare first responders. It also presents case studies from two North American jurisdictions – Ontario and Minnesota – that have established routine COVID-19 data sharing with police. We recommended seven alternatives, including designating COVID-19 data as sensitive and implementing segmented interoperability with first responder agencies. These guidelines can help ensure that health information technology platforms do not become vehicles for the criminalization of COVID-19, and that health data stay within the health system.

Genetic Transmission of Disease: A Legal Harm?

This paper considers whether existing law could potentially be used to criminalize the transmission of genetic disease. The paper argues that even if an offence could be made out, the criminal law should not be involved in this context for many reasons, including the need to protect reproductive liberty and pregnant women's rights. The paper also examines whether there might be scope for civil claims between reproductive partners for a 'failure to warn' of potential genetic harm and argues there are strong policy grounds for resisting such claims. If such a duty were to exist, there might, in the future, be scope for a child to bring a claim under the Congenital Disabilities (Civil Liability Act) 1976. Such a claim could be for the failure by the child's father to warn her mother, which in turn led to the loss of opportunity to have treatment in utero which could have prevented the disability. It is suggested that the same arguments which supported granting maternal immunity under the Act would also support paternal immunity and that, therefore the issue of the lack of paternal immunity under the Act should be revisited.

Anti-homosexual legislation and HIV-related stigma in African nations: what has been the role of PEPFAR?

BACKGROUND

Gay men and other men who have sex with men are disproportionately burdened by HIV infection. Laws that penalize same-sex intercourse contribute to a cycle of stigma, homonegativity and discrimination. In many African nations, laws criminalizing homosexuality may be fueling the epidemic, as they dissuade key populations from seeking treatment and health care providers from offering it.

OBJECTIVES

We analyzed the ways in which policies and practices of the US President's Emergency Plan for AIDS Relief (PEPFAR) program addressed pervasively harsh anti-homosexuality laws across Africa. Given the aim of the US PEPFAR program to reduce stigma surrounding HIV, we explored how PEPFAR may have used its influence to reduce the criminalization of homosexuality in the countries where it operated.

METHODS

We assessed homosexuality laws in 21 African countries where PEPFAR funding sought to reduce the HIV epidemic. We examined PEPFAR Policy Framework agreements associated with those countries, and other PEPFAR documents, for evidence of attempts to reduce stigma by decriminalizing homosexuality.

RESULTS

We found 16 of Africa's 21 PEPFAR-funded countries had laws characterized as harsh in relation to homosexuality. Among the top eight PEPFAR-funded countries in Africa, seven had harsh anti-homosexuality laws. Most (14) of the 16 African 'Partnership Framework' (PEPFAR) policy agreements between African governments and the US State Department call for stigma reduction; however, none call for reducing penalties on individuals who engage in homosexual behavior.

CONCLUSIONS

We conclude that while PEPFAR has acknowledged the negative role of stigma in fueling the HIV epidemic, it has, so far, missed opportunities to explicitly address the role of the criminalization of homosexuality in feeding stigmatizing attitudes. Our analysis suggests mechanisms like PEPFAR Partnership Framework agreements could be ideal vehicles to call for removal of anti-homosexuality legislation.

Voluntary medical male circumcision for HIV prevention in fishing communities in Uganda: the influence of local beliefs and practice

Local beliefs and practices about voluntary medical male circumcision (VMMC) may influence uptake and effectiveness. Data were gathered through interviews with 40 people from four ethnically mixed fishing communities in Uganda. Some men believed that wound healing could be promoted by contact with vaginal fluids while sex with non-regular partners could chase away spirits - practices which encouraged unsafe sexual practices. Information given by providers stressed that VMMC did not afford complete protection from sexually-transmitted infections, however, a number of male community members held the view that they were fully protected once circumcised. Both men and women said that VMMC was good not just for HIV prevention but also as a way of maintaining hygiene among the men. The implementation of VMMC in high-HIV prevalence settings needs to take account of local beliefs about circumcision, working with local religious/social group leaders, women and peers in the roll-out of the intervention.