Verdict on a Virus

[JR Gabbard]

Hello everyone--

International Planned Parenthood has published a new brochure ( http://www.ippf.org/NR/rdonlyres/D858DFB2-19CD-4483-AEC9-1B1C5EBAF48A/0/VerdictOnAVirus.pdf/ ) that has a very thorough explanation of the issues involved in the Criminalization of HIV transmission/exposure.  It was written by a number of legal experts, including Justice Edwin Cameron of the South African Supreme Ct, who spoke at the 2008 conference, and who is himself openly HIV+ (I confess, I'm in awe).

This brochure contains the information you need if you want to advocate for a change in these laws.  Changing laws means speaking to power, so it is important to be well versed in the issues.  To get versed in the issues, you must first read about them, and discuss them with others.  That's how law school works (mostly--law school also involves arcane medieval torture devices  ).  Not that I'm trying to turn anyone into a lawyer against his/her will, but at times it does help to know how to talk like one.

We can use this thread to discuss any issue related to the Criminalization of HIV transmission/exposure, ie how do these laws discriminate against poz people, what can we do to change them, or anything else that comes up for you. 

We can also use this thread to discuss specific laws in specific countries, and devise ways to address them.  More heads working on an issue necessarily means more ideas will come up, which is a very good thing for working on such complex issues.

So, here's a question to start off the discussion (in 2 parts with extra credit):  If we accept the proposition that having an undetectable viral load makes an HIV+ person non-infectious, then universal testing and treatment availability is the best human rights oriented response to HIV.  What effect would the criminalization approach have on UTT (easy) and what is the best way to use the law to effect UTT in those countries that resist change (more subtle)?  Extra credit if you work "stigma" into the discussion.

Read the brochure first!!  It is an eye opener!!!

edit:  BIG file  1.6M loads slow, be patient!

[mecch]

"What effect would the criminalization approach have on UTT (easy) and what is the best way to use the law to effect UTT in those countries that resist change (more subtle)?"

I'd like to answer your questions but what is UTT??

[Ann]

UTT is shorthand for "universal testing and treatment".

[JR Gabbard]

There's a hearty helping of alphabet soup going on in the law.  GBH (not the party drug), UTT (see above), GIPA (greater involvement of people with AIDS), I could go on.

Fortunately for us all, there is a legend on about page 2 or 3 of the brochure that spells them all out.

For the sake of the question, I mean voluntary, universally available testing and treatment.  If anyone wants to argue for involuntary testing, have at it, and good luck!

"What effect would the criminalization approach have on UTT (easy) and what is the best way to use the law to effect UTT in those countries that resist change (more subtle)?"

I'd like to answer your questions but what is UTT??

[mecch]

Ok here's an experiment - first I'll answer on my uninformed opinion, then I'll read the brochure and see if it changes my mind.
Uninformed opinion:

1) If we accept the proposition that having an undetectable viral load makes an HIV+ person noninfectious, then universal testing and treatment availability is the best human rights oriented response to HIV.  What effect would the criminalization approach have on UTT (easy)

It depends on the details of the law.  A)  If it is a crime if the defendant transmits without knowing that he has the virus.  UTT would seem to help decrease this means of transmission. The law would argue there is no reason for the defendant not to have known.  Especially if stigma has declined due to UTT.  B) If it is a crime to transmit when one knows one has the virus.  UTT would seem to have no impact on the prosecution.  But UTT would seem to have an impact, still, on decreasing this route of transmission, if stigma has lowered so that HIV is discussed openly between sex partners...

But this is not exactly what you asked. You asked how criminalization would effect UTT.  I guess you mean the success or failure of UTT, do you want to know if criminalization would prevent the adoption of UTT by a country?   In my opinion, it is apples and oranges.  I think it UTT is a good thing, and I think criminalisation is a transitory thing in the timing of the epidemic.  It has good points and bad points.  The question is too technical. I have to read the brochure.

2) and what is the best way to use the law to effect UTT in those countries that resist change (more subtle)?  The best way to use the law is to protect citizen rights to UTT.  Using the law to criminalise transmission of HIV is tangential and possibly detrimental to an adequate national health policy designed to STOP or at least radically slow down this epidemic, and save lives of people who have HIV.  The law would therefore make UTT a "human right" and then the health care system would have to figure out a way to provide UTT, and protect those who are on treatment - finding ways to improve their lives if necessary.  That said, why should UTT be "human right" for HIV, and not for other diseases??? In a perverse way, it still means that HIV is special and stigmatized.  UTT as human right for diabetes?? UTT as human right for testicular/uterine/breast/skin cancers? Etc etc...


In summary:  criminalisation can exist in a country without UTT, and it does not seem like fair play, or democratic.  (Would we say there is UTT in the USA, or not?  Many people seem to have a lot of financial difficulties, at least, getting on treatment (at the best time in their disease) and living as treated people.)

UTT can exist, I suppose, without criminalisation.

If a country is hesitant to be institute UTT it maybe, sadly, because of the cost!  And also because politicians don't want to treat a disease that has so much stigma (a vicious circle!!!).  I can only imagine that they would look to the law to add criminalisation to any UTT social/health/human rights bill. They might see criminalisation as a way to curtail costs (if criminalisation decreases transmission, as supposed), and criminalisation would also express the ruling government's prejudice about this disease.  I personally, am of mixed opinion.  In a perfect world, UTT would be available for all diseases and HIV would not be considered any different.  And in a perfect world, sorry people, criminalisation has a role, but prosecutions should be successful only in cases of "intentional" or "reckless" endangerment of another person via transmission of HIV.  Its communicable, preventable, and it kills people.

[mecch]

Dear Prince,
Thanks for sharing the info. And thanks for asking a question that made me think..
Regards!

[JR Gabbard]

Cost is quite a bit of the problem in providing health care services.  Politicians look at the short term costs, which are high ($724 annually per HIV+ person by one estimate), and discount the long term savings, measured in money not spent on new infections because there aren't as many, since everyone who is infected is no longer passing on the virus.

For my perspective that seems like a perfect world.  And it is acheivable today.

Except for the stigma factor, which often stops politicians from doing the right thing, because "What would the voters think?"  It is why activism is so important, especially activism by members of the affected community.  Goes miles towards dispelling the stigma myth.

Stigma is an interesting topic. 

Glad you liked the question, meech. 

[Snowangel]

How can we be certain that because UTT is available, that it would be used?  How would it be monitored?  Imagine that the cost/paperwork of making sure that everyone went to the doctor?  I can just imagine the schemes people would come up with to get around it.  How often would it have to be done?  Isn't that an awful lot of work not to disclose.

As far as stigma goes, there used to be stigma about cancer too.  No one would say the "c" word, it was whispered. Oh, they deserved it , they smoked, they didn't take care of themselves, etc.. These days people talk about it all the time.  The same thing needs to happen with HIV, it has been around this long and we still don't even whisper about it.  There would be no stigma if more people, positive and negative, talked about it.  Judging needs to be left to the people who get paid to wear the black robes.

I will be the first one to admit, I am guilty of not talking about it.  I need to stop caring about what other people think and bite the bullet but we all know that is easier than done.  Maybe that will be my New Year's resolution?

If there is criminalization, it needs to be uniform. Here in the U.S. a guy gets 30 yrs because he spit on a cop in Texas and nothing happens in Mass, if you knowingly transmit it to a whole bunch of people.  Speaking from experience, communication can only take you so far.  What if you don't word your questions right?  What if they take the condom off? 

I didn't finish the whole brochure yet, interesting though.

[mecch]

($724 annually per HIV+ person by one estimate)

Uh, what is that figure? Annual cost of treating an HIV+ person?? Seems low, is that a typo, or maybe the figure for patent-free countries such as India?  My drugs alone cost about 2000 a month. And then there are doctors and labs...

[JR Gabbard]

Snowangel:  You are correct.  Even if every man, woman and child on the planet had access to a free HIV test every year, with the promise that if they test positive they will receive free treatment for life, there is no guarantee that everyone would get tested.  There is no easy explanation as to why that is true.

Some won't get tested because they do not know/believe that they are at risk.  Others know they are at risk, but don't want to know for sure that if they are positive.  Call it plausible deniability.  Nothing on paper, it can't be true for them.  Others probably don't want to be reminded of their own mortality. 

I suspect that stigma has a lot to do with why people don't want to get tested in the first place.  And I agree with you about the importance of being more visible.

mecch:  $724 is testing and first line medication for one year.  It is probably an average, meaning it is the total cost of all testing and meds, divided by the number of tests.  It seems low because, presumably, not all tests will come back positive.  The negative test results do not incur medication costs, so it gets spread out more.  As for a source, it was an article I read within the past week, might have been from AIDSMeds, or Int'l Planned Parenthood, or GNP+.  There is a story in today's (12/01) New York Times, sans numbers.

Sorry, no links.  I'm composing this in WordPad, since I can't get the forum text editor to behave for me...