Africa: HIV Laws Do More Harm Than Good by Miriam Mannak (IPS)

I received an email last week from Miriam Mannak, a freelance writer based in Cape Town, South Africa who keeps on blog on AIDS in Africa. She recently contributed this excellent piece on the spectre of criminalisation on her continent to the Inter Press Service News Agency, whose mission is to give voices to the voiceless.

AFRICA: HIV Laws Do More Harm Than Good by Miriam Mannak (IPS)

CAPE TOWN, Jul 30 (IPS) - In Sierra Leone, a mother who transmits HIV to her child can be fined, jailed for up to seven years, or both. Human Rights Watch reports that in 2008, several men were arrested in Egypt simply for being HIV positive. New legislation is currently being discussed in Angola that could lead to a three to ten year jail sentence for those who knowingly pass on HIV.

The legislation is inspired by a September 2004 workshop organised by the influential reproductive health organisation Family Health International developed an "African Model Law" intended to protect those who are infected and exposed to HIV.

But various civil society organisations fear that these legislative measures will hurt more than help the fight against HIV/AIDS.

Discourages testing, delays treatment

"If being HIV positive is being regarded as a crime, people will be less likely to get themselves tested," said Johanna Kehler, director of the Aids Legal Network (ALN) - a South African non-governmental organisation that aims to protect the human rights of people living with and affected by HIV/AIDS.

"This means that they are more likely to spread the disease unknowingly, and will not have access to antiretrovirals that may help to prolong their lives."

Jennifer Gatsi Mallet - coordinator of the Namibian branch of the International Community of Women Living with HIV/AIDS (ICW), a global network run for and by HIV positive women - agrees with Kehler’s statements.

"The criminalisation of HIV will be yet another reason why people will stay away from testing facilities and clinics," she said.

The International Planned Parenthood Federation, a global organisation that advocates sexual and reproductive health and rights, counts 58 countries around the world with laws in place to prosecute HIV transmission and 33 others that are considering passing such legislation. Of these, twenty are in Africa.

Women lose more

"Women will be the first ones in line to be prosecuted, as they are more likely to know their status compared to men, simply because they visit clinics more often, for instance during and after their pregnancy," Kehler explained.

Gatsi Mallet added that in "many parts of Africa, clinics and men are like water in fire. While some accuse health facilities of being unfriendly to men because most of the health care workers are female, others consider visiting as unmanly, especially when it comes to HIV and other sexual related transmitted diseases," she added.

"They therefore rather prefer to go to traditional healers, whom are in general more male orientated."

Because women are more likely to discover they are HIV positive, their male partners often blame them for bringing the virus home - regardless of the fact that the infection may well have travelled the other way.

"Women across the world, including in Africa, experience difficulties negotiating safe sex," Kehler said. "If a man does not want to use a condom, they often are left with no choice."

Angela from Cape Town, who requested anonymity - contracted the virus a few years ago. "I never had sex with anyone else but my husband, but I suspected that he was sleeping around. I just knew. So sometimes I asked him to use a condom, but he always blatantly refused," she explained.

"He said that a wife is supposed to trust her husband. When I went for prenatal care two years ago, I was told I was HIV-positive. After confronting my husband, he accused me of sleeping around and of infecting him. He threw me out of the house."

In countries like Egypt, such an accusation could lead to prosecution. The same is true in Togo, where HIV-positive people are prohibited by law from having unprotected sex, regardless of whether they have disclosed their status to their partner.

"In case of prosecution, women are left in a terribly vulnerable position, as many do not have the resources to, for instance, prove that they were HIV negative before intercourse," Kehler noted. "Neither can they prove if they did not do it deliberately."

Laws against mother to child transmission (MTCT) should also be banned, the ALN argues.

An HIV-positive mother can pass the virus to her child during pregnancy, whilst giving birth, or through breast feeding. Of the 370,000 cases of MTCT each year, about 90 percent occur in Africa, according to UNAIDS.

In countries like Guinea, Guinea-Bissau, Mali and Niger, a mother can be criminally charged if she does not take steps to prevent HIV transmission to baby, including taking antiretrovirals during the pregnancy.

MTCT is almost entirely preventable, by taking antiretrovirals and giving birth in a sterile environment. Breast feeding poses certain risks: WHO studies indicate that a mother who is HIV positive risks passing the virus on to her child. But in certain situations - for example where a mother does not have access to clean water to mix formula and sterilise bottles, but is on antiretrovirals - exclusive breastfeeding is recommended.

Formula-fed babies in developing countries are six times more likely to die from diseases like diarrhoea and respiratory infections than breast-fed babies, according to WHO.

"The problem is that many African women do not have access to proper health care facilities and cannot afford formula," Kehler said. "These are things governments should provide. If they fail, they should be the ones that are to be held accountable for MTCT."

SIDEBAR: Who's responsible for MTCT?

Chantelle Heunis* from Overcome Heights - an informal settlement near Cape Town - was infected by her now ex-husband with the disease in 1999. At the time she was pregnant with her second daughter.

"I only found out after my baby was three months old, after I went for a check-up as she was ill due to lactose intolerance. The nurse offered to test me for HIV - which was not a routine procedure back in the days. The results came back positive."

The next step was to test the baby. "It was dreadful, but thank god she was found HIV negative," Heunis said. "She is ten years old now, and as healthy as can be."

According to Heunis, it should not be allowed for women to be punished for MTCT. "I was lucky because I was in good hands, but many women do not have this privilege. They transmit the virus through unhygienic birthing practices, for instance, or because they do not have access to ARVs to prevent MTCT."

She also rejects the notion that HIV positive women should not be allowed to have children. "It is within our rights to have children. Besides, if a mother is HIV positive, that does not mean the baby is also."

* not her real name.

Egypt: Appeals court upholds convictions of HIV-positive gay men

Egypt continues to criminalise people living with HIV, according to Human Rights Watch.

Police and guards beat several of the men in detention. A prosecutor told one of the men that he had tested positive for HIV by saying, "People like you should be burnt alive. You do not deserve to live."

Nine HIV-positive men have been sent to prison so far this year, simply because they were HIV-positive - apparent 'proof' that they were in the "habitual practice of debauchery" – or gay – which is against Egyptian law.

Full story from pinknews.co.uk.

Egypt accused of "indifference to justice and public health" as HIV convictions upheld
By Staff Writer, PinkNews.co.uk
May 30, 2008

A Cairo appeals court has upheld the sentences handed down to five men jailed as part of a 'crackdown' on men who are HIV positive or living with AIDS.

Nine men have been sent to prison so far.

"To send these men to prison because of their HIV status is inhuman and unjust," said Joe Amon, director of the HIV/AIDS programme at Human Rights Watch.

"Police, prosecutors, and doctors have already abused them and violated their most basic rights, and now fear has trumped justice in a court of law."

As in previous cases, authorities forced the detainees to undergo HIV tests without their consent.

Four of the five convicted last month tested positive.

They were charged with the "habitual practice of debauchery," a term which in Egyptian law includes consensual sexual acts between men.

These convictions occurred after police used information coerced from men already in detention, according to the Health and Human Rights Programme of the Cairo-based Egyptian Initiative for Personal Rights (EIPR).

A lawyer for the five men has claimed they were beaten by police who tried to get them to confess to homosexual acts.

More than 115 organisations that advocate human rights and the rights of people living with HIV/AIDS have protested to the government of Egypt.

The groups signing the letter represent 41 countries on six continents, among them Human Rights Watch and Amnesty.

In a letter to the Health Ministry and the Egyptian Doctors' Syndicate, the groups said that doctors who helped interrogate men jailed on suspicion of being HIV-positive violated their own medical ethics.

EIPR reportedly found a document from the Ministry of Health and Population titled Questionnaire for Patients with HIV/AIDS in one of the men's case files.

It includes 'yes' or 'no' questions that doctors from the ministry apparently use to interrogate people in the crackdown about whether they had sexual relations 'with the other sex' or 'with the same sex,' and 'with one person' or 'with more than one person.'

Prosecutors included the men's answers that they had relations with the same sex as evidence of their guilt.

Malcolm Smart, director of the Middle East and North Africa programme of Amnesty International, said:

"It is unacceptable for doctors to perform forcible HIV tests, or to examine people to 'prove' offences that should never be criminalised.

"Doctors who engage in or enable human rights abuses are violating their most elemental responsibilities."

The current wave of arrests began in October 2007, when police intervened between two men having an argument in the street in central Cairo.

When one of them told the officers that he was HIV-positive, police immediately took them both to the Morality Police office and opened an investigation against them for homosexual conduct.

Police demanded the names of their friends and sexual contacts during interrogations.

The two men told lawyers that officers slapped and beat them for refusing to sign statements the police wrote for them.

The men spent four days in the Morality Police office handcuffed to an iron desk, and were left to sleep on the floor.

Police later subjected the two men to forensic anal examinations designed to "prove" that they had engaged in homosexual conduct.

Such forcible examinations to detect "evidence" of homosexuality are not only medically spurious, but also can amount to torture.

On January 14, 2008, a Cairo court sentenced four of those men to one-year prison terms on “debauchery” charges.

An appeals court upheld those sentences on February 2. The five defendants whose appeal was rejected this week were tried in March.

Authorities released three other men, who tested negative for HIV, without charge, after months in detention.

Police and guards beat several of the men in detention. A prosecutor told one of the men that he had tested positive for HIV by saying, "People like you should be burnt alive. You do not deserve to live."

The prisoners who tested positive were chained to their beds in hospitals for months. After a local and international outcry, the Ministry of Health ordered the men unchained on February 25.

“Putting these men in prison serves neither justice nor public health," Mr Amon said.

"The Egyptian government and the country’s medical profession must act to end this campaign of intolerance.”

Egypt: More HIV-positive men arrested

The BBC NEWS website is reporting that four more men suspected of being HIV-positive have been arrested in Egypt, bringing the total to twelve. For more on this appalling human rights violation, see this post.

"These cases show Egyptian police acting on the dangerous belief that HIV is not a condition to be treated but a crime to be punished."
Gasser Abdel-Razek
Human Rights Watch

Egypt police 'widen HIV arrests'
Published: 2008/02/15 16:28:10 GMT

Egyptian police have arrested four men suspected of being HIV positive, bringing the total detained in a recent crackdown to 12, rights groups say.

Human Rights Watch (HRW) said last week that HIV-positive Egyptian men had been chained to hospital beds and forced to undergo tests for the virus.

The latest arrests took place after police followed up information coerced from men already detained, HRW said.

The Egyptian interior ministry has not responded to the allegations.

In a joint press release, Amnesty International and HRW warned that Egypt's efforts to prevent the spread of the deadly virus could be seriously damaged by the arrests.

"This not only violates the most basic rights of people living with HIV. It also threatens public health, by making it dangerous for anyone to seek information about HIV prevention or treatment," said Rebecca Schleifer, who works on HIV/Aids issues at HRW.

Two of the newly-detained men tested positive for HIV, and are awaiting further hearings, HRW said.

Homosexuality 'tests'

The rights organisations say a wave of arrests began in October 2007, when two men were arrested after a scuffle in central Cairo.

When one said he was HIV-positive they were taken to the police branch which deals with issues of public morality, HRW said.

Both men said they had been beaten for refusing to sign statements written by the police and subjected to anal examinations to "prove" that they had engaged in homosexual conduct, the group said.

Two more men were arrested when police found their photographs and contact numbers in the wallets of those detained, HRW said.

All four men, who have not been identified, remain in custody pending a prosecutor's decision on possible charges.

Four further arrests were made in November when police raided the flat of one of those being held, which had been placed under surveillance, HRW reports.

Those four men were sentenced to one year in jail in January having been convicted of "habitual debauchery", which Human Rights Watch says is a euphemism used to penalise consensual homosexual acts.

Their lawyers claimed the prosecution had produced no evidence against the defendants, who pleaded not guilty.

All those who have tested positive have been held, chained to their beds, in Cairo hospitals, the rights groups said.

While not explicitly referred to in Egypt's legal code, homosexuality can be punished under several different laws covering obscenity, prostitution and debauchery.

Egypt has come under repeated criticism by both human rights groups and the international community for its treatment of homosexual people.

"These cases show Egyptian police acting on the dangerous belief that HIV is not a condition to be treated but a crime to be punished," Gasser Abdel-Razek, HRW's acting director of regional relations in the Middle East, told the BBC.

Egypt: Human Rights Watch highlights criminalisation of people with HIV

This blog is largely concerned with prosecutions for HIV exposure or transmission; often we refer to this in short-hand as 'the criminalisation of HIV'.

But, according to a devastating news report today from Human Rights Watch, Egypt has criminalised people with HIV, after testing them without their consent.

The full, harrowing, report is below.

Egypt: Stop Criminalizing HIV

HIV-Motivated Arrests and Convictions Threaten Justice and Public Health

(New York, February 5, 2008) – A series of arrests in Cairo sparked by one man’s admission to police that he was HIV-positive endangers public health as well as human rights, Human Rights Watch said today.

Human Rights Watch called on Egyptian authorities to overturn the convictions of four men for the “habitual practice of debauchery,” and to free four others who are held pending trial. The government should end arbitrary arrests based on HIV status and take steps to end prejudice and misinformation about HIV/AIDS.

“These shocking arrests and trials embody both ignorance and injustice,” said Scott Long, director of the Lesbian, Gay, Bisexual, and Transgender Rights Program at Human Rights Watch. “Egypt threatens not just its international reputation but its own population if it responds to the HIV/AIDS epidemic with prison terms instead of prevention and care.”

The arrests began in October 2007, when police stopped two men having an altercation on a street in central Cairo. When one of them told the officers that he was HIV-positive, police immediately took them both to the Morality Police office and opened an investigation against them for homosexual conduct. The two men told human rights defenders that they were slapped and beaten for refusing to sign statements the police wrote for them. They spent four days in the Morality Police office handcuffed to an iron desk, sleeping on the floor. Police later subjected the two men to forensic anal examinations designed to “prove” that they had engaged in homosexual conduct.

Human Rights Watch has documented that such examinations to detect “evidence” of homosexuality are not only medically spurious but constitute torture.

Police then arrested two more men because their photographs or telephone numbers were found on the first two detainees. Authorities subjected all to HIV tests without their consent. All four are still in detention, pending prosecutors’ decision on whether to bring charges of homosexual conduct. The first two arrestees, who reportedly tested HIV-positive, are being held in a Cairo hospital, handcuffed to their beds and only unchained for an hour each day.

Meanwhile, police apparently placed the apartment where one of the men had lived under surveillance. On November 20, two days after a new tenant had assumed the lease, police raided the apartment and detained four other men.

According to the arrest report, the men were fully dressed and were not engaging in any illegal acts at the time of the arrests. However, all were charged with homosexual conduct, apparently solely on the basis that they were found in a dwelling formerly occupied by one of the earlier detainees.

People who have spoken to the four men since their arrest told Human Rights Watch that a non-commissioned officer in the police station beat one detainee on the head several times. Police allegedly forced the four men to stand in a painful position for three hours with their arms lifted in the air. They were provided no food, drink, or blankets during their first four days of detention. Authorities also tested these men for HIV without their consent. One of the men reportedly said that the prosecutor, when informing him that he had tested positive for HIV, told him: “People like you should be burnt alive. You do not deserve to live.”

A Cairo court convicted these four men on January 13, 2008 under Article 9(c) of Law 10/1961, which criminalizes the “habitual practice of debauchery [fujur] – a term used to penalize consensual homosexual conduct in Egyptian law. According to defense attorneys, the prosecution based their case only on coerced and repudiated statements taken from the men, and neither called witnesses nor produced other evidence to counter the men’s pleas of not guilty. On February 2, 2008, a Cairo appeals court upheld their one-year prison sentence. One of them is held in a Cairo hospital, chained to his bed 23 hours a day.

“These cases show Egyptian police acting on the dangerous belief that HIV is not a condition to be treated but a crime to be punished,” said Long. “HIV tests forcibly taken without consent, ill-treatment in detention, trials driven by prejudice, and convictions without evidence all violate international law.”

In private letters sent to the Egyptian Public Prosecutor, Counselor Abdel Meguid Mahmoud Abdel Meguid, on November 29, 2007 and on January 8, 2008, Human Rights Watch expressed its grave concern about the arrests and their consequences for Egypt’s efforts against HIV/AIDS.

Human Rights Watch urged authorities to drop the charges, end the practice of chaining detainees in hospital, and ensure that the men receive the highest available standard of medical care for any serious health conditions. It also urged Egypt to undertake training for all criminal-justice officials on medical facts and international human rights standards in relation to HIV, and to halt immediately all testing of detainees without their consent.

Criminalizing consensual, adult homosexual conduct violates human rights protections to individual privacy and personal autonomy under international law. The apparent use of Article 9(c) in these cases to detain people on the basis of their declared HIV status, and to test them without their consent for HIV infection, also violates those international protections, and the right to bodily autonomy.

International human rights law clearly affirms that prisoners and detainees retain the absolute right to protection against torture and cruel, inhuman, or degrading treatment or punishment – and enjoy the right to the highest attainable standard of health, as guaranteed in Article 12 of the International Covenant on Economic, Social and Cultural Rights, to which Egypt has been party since 1982.