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Category Archives: HIV Stigmatization

SIGNIFICANCE OF THE UNDETECTABLE EQUALS UNTRANSMITTIBLE (U = U) CONCEPT/CAMPAIGN ON THE LIVES OF PEOPLE LIVING WITH HIV

 by: VICTOR EBOH ESQ                                                                                            (LEGAL/REPRODUCTIVE RIGHT OFFICER) LAWYERS ALERT

LAWYERS ALERT

1st day of December of every year is designated as WORLD AIDS DAY, an international day dedicated to raising awareness of the Aids pandemic caused by the spread of HIV infection and mourning those who have died of the disease.

 

There is no known cure for HIV/AIDS in the world today. However, treatment for

HIV, offers hope for people living with the virus. According to the UNAIDS Fact Sheet (2019), there are 37.9 million people living with HIV, globally.

Out of this number, 24.5 million people are accessing HIV treatment.

 

In Nigeria, UNAIDS (2018) estimated that 1.9 million people in Nigeria were living with HIV, however, in 2019 statistics indicate a 1.4% HIV prevalence rate among adults aged 15-49 years in Nigeria. Consistent and effective HIV treatment leads to improved health outcomes for people living with HIV.

Scientific evidence holds that people living with HIV who have an undetectable viral load cannot transmit HIV via unprotected sex to their partners. This is the basis for the undetectable equals untransmittable (U=U) concept.

 

CONCEPT OF UNTRANSMITTABLE (U = U)

 

The U=U Campaign was started by PREVENTION ACCESS, an organization in

the United States which seeks to raise awareness and ensure universal access to

treatment for people living with HIV. It is beneficial for people who are diagnosed

with HIV to start treatment early and adhere, by remaining on treatment. This

reduces the amount of HIV in the blood stream to an undetectable level. In simpler

terms, an undetectable HIV viral load means that the amount of HIV in the blood is

negligible.

 

The Centre for Disease Control, CDC (2019) holds that most people on

HIV treatment achieve an undetectable viral load within six (6) months of initiating

HIV treatment. This occurs as long as they consistently take the medication as

prescribed. After, the initial six (6) month period, adherence to HIV treatment is

advised to ensure that the HIV viral load stays undetectable. While the CDC (2019)

defines an undetectable viral load as having less than 200 copies of HIV per mililitre

of blood, the Canada AIDS Treatment Information Exchange, CATIE (2018) notes

that, HIV viral load is undetectable when it is less than 40 to 50 copies of HIV per

mililitre of blood.

 

The U=U concept is supported around the world by renowned organizations. The

World Health Organization, WHO (2019) cites an empirical study to the effect that,

the risk of HIV transmission through sex, where condoms are not used, in sero-discordant couples is effectively zero when HIV viral load is suppressed through

ART treatment. The WHO recommendation to initiate ART in all people living with HIV will contribute significantly to reducing HIV transmission.

 

From the foregoing, there is no risk of HIV transmission through unprotected sexual

intercourse from a person living with HIV to a negative partner as long as the former

is on HIV treatment and has achieved an undetectable viral load. This finding has far

reaching implications on the relationships and interactions between people living

with HIV and those who are HIV negative, especially surrounding stigma and

discrimination.

 

People living with HIV often suffer stigma from other members of the public when they know the HIV status of the former. Thus, scientific evidence such as U=U which supports the fact that people living with HIV who consistently adhere to HIV treatment, and become undetectable, cannot transmit HIV through unprotected sex, “strikes down” the reason for the stigma and discrimination against people living with HIV.

In addition, UNAIDS (2018) lends credence to the U=U concept with its submission

that, there is a strong scientific consensus that people living with HIV who are taking effective antiretroviral therapy and whose level of HIV is suppressed to undetectable levels, will not transmit HIV sexually.

 

This evidence from UNAIDS (2018) is borne from twenty (20) years of research

which demonstrates that effective treatment of HIV reduces the risk of HIV

transmission. Due to this fact, the U=U concept validates previous concepts such as

Treatment as Prevention (TasP). The reasoning is logical. If HIV treatment reduces

the risk of HIV transmission, then it simply means that HIV treatment is an effective

strategy at preventing the transmission of HIV from one person to another. However,

it is important to reiterate the conditions necessary for which transmission of HIV

will not occur. The person living with HIV, has to adhere to HIV treatment and consistently maintain an undetectable HIV viral load.

In Nigeria, (and indeed most countries of the world) HIV treatment services are free and viral load tests are conducted once every six (6) months. There is a persistent need to ensure that user fees are not charged to encourage access and uptake of HIV treatment.

Strict adherence to HIV treatment is advised for people living with the virus. This is

necessary because consistent HIV treatment ensures that the virus remains

undetectable over a long period and reduces the risk of transmission via unprotected

sex to zero (0). Thus, people with effective HIV treatment cannot transmit the

virus  through unprotected sex. This has far reaching implications on public health

and should re-configure popular perception about HIV especially the way people

living with HIV are treated in society.

 

Evidence for further validation of the U=U concept is provided by findings from

other empirical studies. Three (3) large studies (undertaken between 2007 and 2016)

were cited by Cohen, Chen, McCauley et al (2011), Roger, Cambiano, Bruun et al

(2016), and Grulich et al (2015). In each of these studies, the researchers investigated

sexual transmission of HIV among thousands of couples. With each of these couples,

one partner was living with HIV and the other was not, i.e. sero-discordant.

Findings from these studies show that there was not a single case of HIV transmission from the partner living with HIV (who had achieved undetectable levels of HIV) to their HIV negative partner. (Source: Rural Renewal & community Health Development Initiative)

 

Conversations as well as public enlightenment about the U=U concept are necessary

In the society to combat the stigma and discrimination which people living with HIV

face, especially regarding inter-personal relationships, family and even in the work

place. With the empirical evidence presented on U=U, people living with HIV

should not be barred from marriages and romantic relationships with others who are

HIV negative. They pose no risk because they cannot transmit the HIV virus through

unprotected sex. Sero-discordant couples have the potential of raising children

without the risk of transmitting HIV. Also, marital disharmony owing to HIV

diagnosis of one partner should not arise.

 

CONCLUSION

 

The concept of U=U offers hope to people living with HIV because HIV treatment

affords dignity, inclusion and acceptance in society. With effective public

enlightenment via relevant communication channels, notions of HIV/AIDS as a

deadly epidemic can be replaced with the U=U concept which demonstrates how

HIV transmission can be stopped. The hope and benefits from maintaining

undetectable levels of HIV will encourage people living with HIV to access HIV treatment services because it is a means to an end. Families, relatives and partners will be more accepting and supportive to persons living with HIV because they are no longer threatened by HIV transmission and treatment holds greater promise for better health outcomes.

Furthermore, countries and legal systems which impose travel bans as well as

criminalize people living with HIV on account of disclosure and so called “intended

HIV transmission,” need to revise these laws via necessary steps in the judicial

process. The scientific evidence from existing research is sufficient basis for judicial

reform in this respect. Also, the police, vigilante and other security agencies require

education and enlightenment on the U=U concept in order to guide the

administration of justice when complaints and disputes regarding HIV transmission

are brought before them.

References:

1. Three (3) large studies (undertaken between 2007 and 2016)

were cited by Cohen, Chen, McCauley et al (2011), Roger, Cambiano, Bruun et al

(2016), and Grulich et al (2015)

2. UNAIDS (2018) is borne from twenty (20) years of research

which demonstrates that effective treatment of HIV reduces the risk of HIV

transmission.

3. The World Health Organization, WHO (2019)

4. Canada AIDS Treatment Information Exchange, CATIE (2018)

5.  The Centre for Disease Control, CDC (2019)

CAVEAT

Lawyers Alert hereby puts our readers on notice that this article is based on the writers opinion and do not necessarily represent the views of the organization except otherwise stated.

 

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Successful completion of course on criminalization of HIV transmission, exposure and non – disclosure organized by AIDS & Rights Alliance for Southern Africa (ARASA).

Two of our Lawyers Alert staff participated in a course on criminalization of HIV transmission, exposure and non-disclosure organized by Aids & Rights Alliance for Southern Africa (ARASA) and upon successful completion of the course we are awarded certificates. pictures shows Roseline Oghenebrume, Director programs, Abuja office and Elvis Torkuma, project officer (youth) proudly displaying their certificates.

 

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HIV Criminalization Cases Recorded in 72 Countries, Including 49 in the Last Four Years.

By Arasa Network

hiv-aids pic

HIV criminalization continues: a global review has found that HIV-related arrests, investigations, prosecutions and convictions have ever occurred in at least 72 countries, with recent cases occurring in 49 countries, including 14 in which the law appeared to be applied for the first time.

The HIV Justice Network’s review concerns cases in which either the criminal or similar law is applied to people living with HIV based on HIV-positive status, either via HIV-specific criminal statutes (29 countries), general criminal or similar laws (37 countries), or both (6 countries). Such laws typically criminalize non-disclosure of HIV status to a sexual partner, potential or perceived exposure to HIV, or transmission of HIV.

HIV criminalization “is a pervasive illustration of how state-sponsored stigma and discrimination works against a marginalized group of people with immutable characteristics,” says HIV Justice Network. “As well as being a human rights issue of global concern, HIV criminalization is a barrier to universal access to HIV prevention, testing, treatment and care.”

Between October 2015 and December 2018, at least 913 people living with HIV were arrested, prosecuted, convicted or acquitted in 49 countries. The largest numbers of cases were reported in the Russian Federation (at least 314 cases), Belarus (249), United States (158), Ukraine (29), Canada (27), Zimbabwe (16), Czech Republic (15), United Kingdom (13), France (12) and Taiwan (11).

To estimate where the criminal law appears to be disproportionately applied, the researchers analyzed the number of known recent cases according to the estimated number of diagnosed people living with HIV in a country. They identified 15 criminalization hotspots: countries in which the number of cases was equal to or greater than 0.5 in 10,000 per capita of diagnosed individuals.

  • Belarus (139 in 10,000)
  • Czech Republic (55 in 10,000)
  • New Zealand (10 in 10,000)
  • Canada (4 in 10,000)
  • Sweden (4 in 10,000)
  • Russian Federation (3 in 10,000)
  • Taiwan (3 in 10,000)
  • Ukraine (2 in 10,000)
  • Australia (2 in 10,000)
  • Switzerland (2 in 10,000)
  • England and Wales (1 in 10,000)
  • Kazakhstan (1 in 10,000)
  • United States (1 in 10,000)
  • France (0.8 in 10,000)
  • Italy (0.5 in 10,000)

Their analysis suggests that recent HIV criminalization cases do not reflect the demographics of local epidemics, with the likelihood of prosecution exacerbated by discrimination against marginalized populations on the basis of drug use, ethnicity, gender, gender identity, immigration status, sex work and/or sexuality. Cases in the United States also appear to disproportionately impact people already in the purview of the criminal justice system, such as prisoners, and people living in poverty, including homeless people, with a high number of cases related to ‘HIV exposure’ via biting or spitting during arrest or whilst incarcerated.

Recent reports of increased numbers of cases in sub-Saharan Africa and in Eastern Europe and Central Asia illustrate what advocates have long-feared: that women are more likely to be prosecuted (and less likely to have adequate legal representation), since they are often the first in a relationship to know their status as a result of routine HIV testing during pregnancy, and are less likely to be able to safely disclose their HIV-positive status to their partner due to gendered power inequalities. Women with HIV also face the possibility of being prosecuted for passing HIV on to their child during pregnancy, birth or breastfeeding.

In addition, migrants from high HIV prevalence regions (such as sub-Saharan Africa and eastern Europe) appear to be disproportionately prosecuted in Canada, northern and western Europe and Australasia, and usually have limited access to adequate legal representation. Non-citizens are also likely to be deported to their country of origin after serving their sentence even if they have family ties in their adopted country.

HIV-specific laws continue to exist in at least 75 countries, including many countries in sub-Saharan Africa (29 countries) and eastern Europe and Central Asia (18).

Advocacy Success

Nonetheless, during the period covered by the report, promising developments in case law, law reform and policy have occurred, most often as a direct result of advocacy from individuals and organizations working to end the inappropriate use of the criminal law to regulate and punish people living with HIV.

HIV-specific laws have been repealed in Victoria, Australia and in the Democratic Republic of Congo. The latter decision followed eight years of effective civil society lobbying and nurturing of supportive parliamentarians.

There have been promising developments in case law, law reform and policy, most often as a direct result of advocacy.

Laws have been modernized in seven jurisdictions. For example, Belarus’ law previously made exposure of HIV a crime, regardless of disclosure of HIV status, condom use or whether the sexual partner wanted the prosecution to take place. As a result of advocacy by the community organization People PLUS, the government announced in December 2018 that a person with HIV will no longer be held criminally liable for HIV exposure or transmission if they disclose their HIV-positive status and their partner consents.

The US state of Colorado used to hand out longer sentences to individuals convicted of sex work, solicitation of a sex work or rape, if that person had been diagnosed with HIV at the time of the offence. Following several years of researching, consulting, organising, lobbying and negotiating by a coalition of campaigners, these laws were changed in 2016. The sex work provisions were removed, while the tougher sentences for HIV-positive individuals convicted of rape were somewhat lessened.

Other jurisdictions modernizing their laws in recent years are Switzerland, Norway, California, Michigan and North Carolina.

Several proposed laws have been withdrawn. In Malawi, a proposed law was initially welcomed by feminists, but perceptions of the law’s impact changed after consultations between legal activists and grassroots networks of women living with HIV, examining the legislation in detail. As it became clear to local women how the vague provisions on ‘willful transmission’ could play out in their lives, they decided to take up advocacy against it and the parliament withdrew that part of the law.

International activists facilitated the development of Mexican network of 44 civil society organizations (La Red Mexicana), which has had several successes, including the withdrawal of proposed laws in three Mexican states and the country’s supreme court declaring a law in Veracruz to be unconstitutional. A proposed law has also been withdrawn in Brazil and a Kenyan statute ruled to be unconstitutional.

In addition, precedent-setting cases in Finland, Germany, Greece, Italy, Sweden and Morocco have the potential to limit the overly broad application of the law through the recognition of up-to-date HIV-related science on the real risks of transmission.

Reference

Cameron S & Bernard EJ. Advancing HIV Justice 3: Growing the global movement against HIV criminalisation. HIV Justice Network, Amsterdam, May 2019. (Report).

 

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