Sweden: Majority of MPs want to reform HIV disclosure obligation and 'HIV exposure' criminal liability

Two articles commemorating 30 years of HIV in Sweden in Svenska Dagbladet by journalist Tobias Brandel suggest that public – and political – opinion is being positively impacted by a two-year campaign by RFSU (the Swedish Association for Sexuality Education), HIV-Sweden, and RFSL (the Swedish Federation for Lesbian, Gay, Bisexual and Transgender Rights) to raise awareness and advocate against overly-broad HIV criminalisation.

The first article, with the headline, 'HIV-positive convicted harsher in Sweden' focuses on the fact that although HIV has been transformed from a fatal to a chronic disease, more people with HIV have been jailed in Sweden in the 2000s than in the 1980s and '90s combined.

The second, with the headline, 'HIV-law divides Government' highlights the fact that a majority of MPs want to revise both the Communicable Diseases Act (with its 'information obligation') and the criminal law that currently allows prosecutions for people with HIV for potential or perceived HIV exposure as well as transmission. However, there are divisions within both the coalition Government and the leading opposition parties.

Since these articles are the most up to date descriptions of the current moves towards law and policy reform in Sweden, I am including (in English via Google translate, with slight amendments for clarity) the full text of both articles below.

This is the Google-translated version, read the original article here

When Joakim Berlin received his diagnosis, HIV was a death sentence.

"The big question my relatives asked was when I was going to die. Of course, I thought it would go pretty quickly," he says.

It was 1991, five years before the arrival of antiretroviral drugs. Today he leads a "totally normal" life.

"Sometimes I get side effects such as cramps and fatigue. But HIV's biggest impact has been on my social life. Human ignorance is problematic. The fear is still there." Neither legislation nor case law has followed the progress of medicine. Although HIV has been transformed from a fatal to a chronic disease more people with HIV have been jailed in Sweden in the 2000s than in the 1980s and '90s combined. Anyone who has HIV - and knows it - and has unprotected sex with another person is at risk of prosecution for 'aggravated assault', 'attempted aggravated assault' or 'creating danger'.

The last year has seen four such convictions in Sweden,  according to a review by Svenska Dagbladet. All have resulted in prison sentences - even though they were not convicted of infecting their sexual partners. Only in one case was found to be HIV-positive plaintiff, but failed to clarify whether it was the offender who infected him.

A total of 44 people have convicted of crimes related to HIV since the late 1980s. This makes Sweden one of the countries in the world with the largest number of prosecutions in relation to the number of HIV-positive people, according to the Global Criminalisation Scan.

Sweden was also singled out as a bad example of how the law is used against people with HIV at the International AIDS Conference in Washington last summer. Even UNAIDS, the UN organisation for HIV / AIDS, criticises Sweden.

Ake Örtqvist, an infectious disease physician for Stockholm County Council, is critical of the Swedish court's reasoning over risk and intent.

"The courts judge very differently which is very unfortunate. Courts and prosecutors should have an increased knowledge about the disease and the concept of risk," he says.

Last year Denmark abolished a law that criminalises people with HIV referencing the current effective HIV drugs.

"The impact that treatment has in lowering viral load and infectiousness is very real, even if it is scientifically always hard to say zero. I think the courts reasoning is odd and they should embrace the fact that infection risk today is extremely small. One must ask whether it is reasonable to judge according to the Penal Code when the infection is well controlled and transmission has not occurred," said Jan Albert, Professor of Infectious Disease at the Karolinska Institute. In other words, the virus is spread very rarely by "HIV-men" as the condemned is usually called in the media. The real vectors are people who do not know they have HIV and therefore do not receive treatment.

According to the Communicable Diseases Act HIV-positive individuals must inform their sex partners of their status before having sex. Although it is not possible to judge according to the Infectious Diseases Act so courts often refer to information obligations.

Both RFSL and RFSU argue that the law is actually counter-productive.

"Of course you should tell if you have HIV before sex, but you should not risk punishment if you fail to do so. Criminalisation can also lead to a false sense of security, to believe that the person who is not saying anything does not have HIV," says RFSU President Kristina Ljungros.

She also believes that the prosecutions may deter people from testing. Even the UN-backed Global Commission on HIV and the Law concludes in a new report that criminalisation contributes to fewer people knowing their HIV status.

Preliminary data from a new U.S. study, received by Svenska Dagbladet, supports these ideas. The Sero Project, in collaboration with Eastern Michigan University interviewed more than 2000 HIV-positive individuals in the United States. Half of the respondents believe that it is reasonable to avoid HIV testing for fear of prosecution, and one in four say they know one or more individuals who chose not to test for fear of being prosecuted.

Joakim Berlin has lived with the virus for over 20 years and works at Positive Group West [part of HIV Sweden] as well as being a member of RFSL's board.

"It is the responsibility of both parties to protect themselves, so you cannot have laws that criminalise only one party," he said.

Is it not reasonable to tell your sexual partner so that he can make an informed decision?

"I have the responsibility to ensure that you do not get HIV, and you have the responsibility to ensure that you are not putting yourself at risk," he says. "The law places full responsibility on the HIV-positive person while everyone else thinks that they can do whatever they want without consequences. Most people get HIV from someone who does not know their HIV-positive status."

This is the Google-translated version, view the original here

Legislation and case law surrounding HIV has not kept pace with developments in medicine, as Svenska Dagbladet showed yesterday. Although modern HIV treatment reduces infectiousness dramatically, the law is the same as in the 1980s. There is now a majority in parliament who want a review of the Communicable Diseases Act, which forces people with HIV to disclose their status before having sex.

"We think that the issue should be revisited. Our knowledge about HIV is changing rapidly. We can not have laws that are outdated," says Barbro Westerholm, Liberal Party social policy spokesperson.

As previously reported to Svenska Dagbladet both infectious disease doctors and scientists are critical of Swedish courts that sentence HIV-positive people to prison for unprotected sex, despite there being no alleged transmission. As well as revisiting the Communicable Diseases Act, the Liberal Party would  like there to be a review of judicial practice.

The position of the Moderate Party is that there is no need for such a review, but the Party is now in discussion.

"We have not changed our minds, but we're talking about it. It is clear that we must keep up with new facts and analyses. There is a debate," says Mats Gerdau, a member of the social committee [which would recommend such a review to the Government].

The Centre Party is open to an amendment of the Penal Code in respect of how the courts reason about intentional and negligent [states of mind] - but they are clearly against removing the Communicable Diseases Act's notification requirement.

"There is an information obligation for all diseases that are generally hazardous. It is completely illogical to say that it should be removed only for HIV," says Anders W Jonsson, chairman of the social committee.

The Christian Democrats see no need for any kind of review. All four Alliance parties must agree before the law can be reviewed. The [opposition] Social Democrats, The Green Party and the Left are all clear that they want the information requirements to be removed for HIV.

"The law is counterproductive. It places responsibility solely on the person with HIV. It is a repressive law which, at worst, means people do not get tested," says Eva Olofsson (Left), also a member of the social committee.

Agneta Luttropp (Greens), another member of the social committee, believes that the law creates a false sense of security.

"The responsibility to protect is on both sides, on both the person who may have HIV and the person who does not. We hope and believe that a change in the law could lead to people being more invested in having protected sex," she says.

However, the Social Democrats want to keep the information obligation and do not believe that judicial practice needs to be reviewed.

Sweden: Latest HIV non-disclosure prosecution highlights why Sweden's "nanny state" is getting it so wrong

Last week a 31-year-old woman, previously found guilty of attempted aggravated assault for having unprotected sex with her male partner without disclosing her HIV-positive status, was sentenced by the Falun District Court to 18 months in prison.  The man has not tested HIV-positive.

An editorial by the ubiquitous Professor Matthew Weait in today's Newsmill ('Rädsla för det orena bakom Sveriges hårda hiv-lagar' / 'Fear of the unclean behind Sweden's harsh HIV laws') critiques such prosecutions as symptomatic of Sweden's "nanny state" approach to the lives of its citizens.

So far, of the eleven comments, only one appears to agree with Matthew's brilliant but challenging assessment. Fortunately, it is not necessarily the general public in Sweden that needs to be persuaded to change course, but Sweden's politicians.  In this regard, the editorial may be helpful to the two year campaign by RFSU (the Swedish Association for Sexuality Education), HIV-Sweden, and RFSL (the Swedish Federation for Lesbian, Gay, Bisexual and Transgender Rights) to raise awareness and advocate against overly draconian HIV criminalisation in Sweden.

Here's the original English version adapted from Matthew's blog.

There is a horror film from 1992 called “The Hand that Rocks the Cradle”. The plot centres on the efforts of a vengeful nanny to destroy the life of a woman who the nanny blames for her own husband’s suicide and the miscarriage she subsequently suffers. The title is a good one for the film because it suggests security and safety when the opposite is in fact the case. There is nothing more disturbing than discovering that the person in whom you have put your trust is in fact the source of danger and harm to the thing you hold most dear.

Sweden has rocked its children in a cradle handed down through the generations for over a century, carved from the warm, soft wood of social democracy. And, for most of the children, the cradle is a very safe place. Indeed, many have fallen asleep as she rocks them and find the constant motion so comforting that there is little desire to wake up (which suits nanny just fine). For some other children though, the story is very different. Beware those who refuse to believe all of the stories nanny tells them, or the children behaving in such a way that she thinks will set a bad example. It’s not that she wants to be cruel, but she knows what’s in their best interests. She has little, if any, tolerance for those who jeopardise all the work she has done in raising the good, obedient, children, and she will take almost any action necessary to show the bad ones the error of their ways and bring them into line. Tough love: that’s nanny’s motto.

Some readers may find this extended metaphor shocking. It is meant to be. I, like many of my contemporaries in countries with less welfare-oriented, and stronger liberal-conservative, political traditions have always thought of Sweden and its neighbours as some kind of Nirvana – a promised land in which no-one will ever be too rich, and no-one too poor; where the contract between state and citizen assures security and support for all, irrespective of the personal misfortunes and disadvantages people may experience.

My recent research into Sweden’s response to people living with HIV has demonstrated how this image – accurate in many respects – is only part of the story. Not only has Sweden detained more than 100 people under its communicable disease legislation since the epidemic began (and been held, in one case, to have violated the European Convention on Human Rights as a result), it criminalises more people per 1000 living with HIV (PLHIV) than any other country in Europe. It criminalises them not only for deliberate transmission, but for non-deliberate transmission and for exposure (where HIV is not in fact transmitted). It criminalises only those who know their HIV status, despite the fact that the source of most new infections is people who are undiagnosed, and ignores the fact that PLHIV on effective treatment and with an undetectable viral load present practically no risk of onward transmission to a partner during sex. It criminalises these people despite the fact that HIV is a public health issue, despite the fact that there exists no evidence that criminalisation has any public health benefits, and despite the fact that the sensationalist headlines which accompany stories about HIV cases contribute to and reinforce the stigmatisation of all PLHIV.

It is my strong belief is that Sweden’s coercive and punitive response to HIV has its source precisely – and paradoxically – in values that have become so embedded in the psyche of the general population over the past century that anything, or anyone, that threatens them is treated as a dangerous contaminant to be dealt with accordingly. Just as with its approach to sex work (even this term is disliked), which treats all workers as victims and all men as deviant criminals, and drug use (where harm reduction – despite its efficacy – is distrusted because it suggests tolerance of something essentially dirty and dangerous), HIV is criminalised because it threatens, at a very fundamental level, what being Swedish means. HIV is not clean. HIV is not healthy. HIV is not normal. For as long as HIV can be contained among men who have sex with men, drug users and migrants – and (critically) be seen to be contained there by everyone who is not a member of these groups – the Swedish self-image of a country committed to enlightened, progressive values can be sustained. And because this is so important, any measures - however repressive, illogical or misguided – are acceptable.

Since March 2012, Sweden has a new Ambassador to the Kingdom of Swaziland, Ulla Andrén. On presenting her letters of credence to the King, Ambassador Andrén emphasised “the importance of a continued effort to work against the HIV/AIDS pandemic” in that country. Swaziland has the highest HIV prevalence in the world, with more than one in four people living with virus (some 200,000 people). Given the passionate commitment it has demonstrated to punishing PLHIV domestically, and its belief in the value of a punitive response, it would seem only sensible that Sweden should suggest that Swaziland adopts its. Except of course it shouldn’t do this, and nor would it. But it’s a serious point though. If it would be wrong to recommend the criminalisation of HIV in Swaziland, where HIV remains, for many, a dangerous and deadly disease, then why is it OK to criminalise it at home, where people who are diagnosed can lead long and otherwise healthy lives?

We all understand why the children like sleeping in nanny Sweden’s cradle. But it might be interesting, and liberating, for them to wake up and test her patience a little …

Sweden: Gay doctor convicted of HIV exposure has sentenced reduced (update)

Update: 10th April 2012
An HIV-positive doctor who was previously convicted for 'reckless endangerment' for having had unprotected sex (see below) has had his sentence reduced by the Stockholm Court of Appeal, according to a brief report at DN.se.

Originally convicted to ten months imprisonment by the District Court, the Court of Appeal dropped one of the charges and reduced the man's remaining prison sentence to four months primarily because there was no evidence of when the physician's partners were infected.

Original post: 22nd June 2010
A gay man in Stockholm who works as a doctor has been sentenced to ten months in prison for 'reckless endangerment' and must pay 26,900 kronor (€2825) compensation for having unprotected sex without disclosure with another man.

However, the more serious charge of aggravated assault brought by a second man who alleged that he became HIV-positive as a result of unprotected sex with the defendant was dismissed by the court because "it can not be ruled out that he was infected by someone else."

The case, reported in the English language at The Local.se, is at least a partial victory: the court appeared to understand that phylogenetic analysis can only be useful as 'proof' of transmission if all previous sexual partners prior to an HIV-positive test are also tested and those who are positive included in the analysis.

Lawyer Elisabeth Massi Fritz, representing the two men, told news agency TT that the ruling will be appealed. "The prosecutor and I agreed that we would appeal if any of the charges were to be dismissed."

The man was facing a further charge of aggravated assault, with an alternative charge relating to causing the HIV infection. These charges were dismissed by the court as it could not be concluded that the doctor was responsible for the infection. Elisabeth Massi Fritz says she is not surprised at the verdict but expressed disappointment that one of the charges was dismissed.

"There can be no other person that has infected my client. But we have to obtain a supplementary investigation to prove this," said Massi Fritz.

During sentencing the judge said that since the man worked as a doctor, he ought to have known better.

The district court concluded in its ruling that the doctor's actions had threatened the lives of the men and that his offence should be considered especially serious, given that in his professional capacity he should be aware of the Swedish Institute for Infectious Disease Control (SMI) rules of conduct.

However, since the maximum prison sentence is two years for this 'crime' he was still somewhat lenient - if you accept that a prison sentence for not disclosing your HIV status before sex that may risk HIV exposure (and we don't know about the doctor's viral load, or the sexual acts or sexual position which may have reduced the risk to almost zero, or better than using condoms) is ever warranted.

Important new research project on HIV criminalisation and law reform in Nordic countries by Prof. Matthew Weait

Following on from yesterday's post on advocacy efforts underway in Sweden, other Nordic countries and Switzerland,  my friend and colleague, Matthew Weait, Professor of Law and Policy
at Birkbeck College, University of London is about to undertake an important new research study in Denmark, Finland, Norway and Sweden next Spring.

With Matthew's permission, I'm replicating the note he sent me with all the details and further background. If you can help, please contact Matthew directly, or leave a comment on my blog.

The Decriminalization of HIV Transmission and Exposure: Advocacy, Activism and Law Reform in Denmark, Norway, Finland and Sweden

Dear Friends and Colleagues,

I am writing to ask if you would be willing to assist in a research project that I will be undertaking in Denmark, Finland, Norway and Sweden in March / April 2012.  The project is summarised and discussed in more detail below, but put at its simplest it will be exploring the ways in which HIV activists and others have sought to reform criminal law concerning HIV transmission and exposure in the region.  My aim is to improve our understanding of advocacy and activism in this field, and to gather evidence about what works and what doesn’t.  Although we have an increasing amount of data about the effects of criminalization, there is very little evidence about how civil society has responded to criminalization, and I am hoping this project will not only provide that evidence but assist people elsewhere in their reform efforts.

As explained below, the research will be conducted primarily through interviews with those who have been involved in reform efforts, and I would like to speak to as many people as possible during my time in your countries.

If you are willing and able to participate I would be very grateful if you could contact me and let me know where and when it would be convenient to meet.  I would also appreciate any advice about who else I should try to contact (including, if possible, politicians, lawyers etc who have been involved).  I will be in your cities between the following dates:
9/3 - 18/3
Copenhagen
18/3 - 23/3
Oslo
23/3 - 30/3
Helsinki
30/3 - 5/4
Stockholm

I am funding this research project myself (though I am hoping to get a travel grant from the Wellcome Trust).  It is not sponsored in any way.

I very much hope to hear from you soon.

All best wishes

Matthew

Summary of Project
The project will explore recent initiatives by Scandinavian civil society organizations and activists to the criminalization of reckless and negligent HIV transmission and exposure in the region.  Despite having levels of HIV prevalence which are among the lowest in Europe, survey data indicates that the Scandinavian countries have among the highest rates of criminalization (as measured by convictions per 1000 people living with HIV (PLHIV)).  This is not only counter-intuitive, when research shows that these are countries which have lower than average imprisonment rates and that their citizens are, in general, less punitive in their attitudes towards offending behaviour than those elsewhere in Europe, it ignores UNAIDS best practice guidance on the use of criminal law as a response to the epidemic. The principal goal of the project is to contribute to our understanding of the effectiveness or otherwise of law reform strategies in the field of HIV and public health.  If, as experts agree, the inappropriate use of criminal law impedes HIV prevention efforts and contributes to the stigmatization of PLHIV, it is important to understand the dynamics of, and barriers to, legal reform.

Background
The European region is suffering from an epidemic of criminalization.  Across the continent, people living with HIV are being investigated, prosecuted, convicted and imprisoned for non-deliberate HIV exposure and transmission, contrary to the best practice guidance of UNAIDS and other international organizations concerned with preventing the spread of HIV and promoting the health and human rights of PLHIV.   It is an epidemic that is impeding efforts to normalize HIV and reduce stigma and to affirm the importance of shared responsibility for sexual health.  It is an epidemic whose impact is felt especially by people who already experience particular social and economic exclusion and vulnerability.  It is an epidemic that, in theory at least, has created some 2.2 million potential criminals in Western and Central Europe.

Although all but a few countries in the region have laws which criminalize HIV transmission and exposure, the scale and intensity of their enforcement is not evenly distributed.  Based on available data relating to HIV prevalence and convictions per 1000 PLHIV, there is a marked difference between the Scandinavian countries (Denmark, Sweden, Norway and Sweden) and those further south.  The former, despite having significantly lower HIV prevalence than the European average, have a markedly higher rate of criminalization.  Sweden and Denmark, for example, have conviction rates of 6.12 and 4.66 per 1000, while the rates for France and Italy are 0.1 and 0.74 respectively.

There is a number of possible explanations for this increased resort to criminal law in Scandinavia compared with elsewhere (including higher levels of inter-personal trust, greater confidence in judicial institutions, and a tradition of robust public health laws), but whatever the causes are, it has resulted in concern among HIV activists and civil society organisations (CSOs) in the region, who have – over the past few years especially – mobilised in efforts to repeal and reform laws and / or constrain their enforcement.

Research Questions
This research project is concerned with the work of these activists and CSOs, and specifically with understanding:

1. what their motivations for legal reform have been;
2. how they have organised nationally and regionally to try and achieve that reform;
3. how they have developed their policy agendas
5. whether, and if so how, they have engaged and communicated with both (a) PLHIV and key groups especially vulnerable to HIV infection and (b) the wider population to achieve “buy in” and broader legitimacy for reform efforts;
6. how they have engaged with policy makers, politicians, and government;
7. the political, institutional and other barriers to reform; and
8. what the results and consequences of reform efforts have been to date, and what they anticipate for the future.

Aims
These questions all focus on an attempt to understand better the ways in which civil society responds to the impact of law on PLHIV.  By focusing on a region in which punitive law has been deployed disproportionately, and where there established and comparatively well-resourced organisations, the research will contribute to our understanding of how expert groups committed to HIV prevention and human rights protection mobilise in the face of what they perceive as a threat to the constituents whose interests they represent.  In so doing, the research will provide original data about the dynamics of health activism and the impact of activism on law and policy.  Two further aims are to provide a practical resource of value to HIV activists and organisations elsewhere in Europe and a record that will contribute to the oral history of the HIV epidemic in Europe.

Matthew Weait’s Background in the Area
I have worked and published in the field of law and HIV for more than a decade, specifically in the area of criminalization.  For the past five years I have been involved at an international level with work on this subject: as a consultant for the EU Agency for Fundamental Rights, HIV in Europe, WHO Europe and UNAIDS, and as an invited expert at their criminalization policy development meetings, and most recently as a member of the Technical Advisory Group for the UNDP-led Global Commission on HIV and the Law.  As a contributor to the policy development work of these organisations I have contributed to a number of important outputs, including a report on a rights-based approach to HIV in the EU (2010), the WHO Europe Technical Consultation on the Criminalization of HIV and other STIs (2007), and the UNAIDS Criminal Law and HIV Policy Brief (2008).  For the Global Commission I was commissioned to write the Report on Criminalization of HIV Transmission and Exposure across the world.  In October 2011 I was invited to give evidence to the Working Group of the Norwegian Law Commission that has been tasked to consider reform of its transmission and exposure laws, and in November 2011 I gave a plenary lecture on this subject at an international sexual health conference in Stockholm.  In addition to this policy work I have published widely in peer-reviewed journals, both alone and with colleagues in other disciplines, and have written a monograph on the subject.  All of this has impressed on me the importance both of understanding the dynamics of law reform in the field, and of developing a stronger, empirically grounded, evidence base.  I see this project as a small, but significant, attempt to do both these things.

Methodology
The research will be qualitative, based primarily on semi-structured interviews and supplemented by policy and other documentation produced by respondents and their organisations.  The analysis will be undertaken using grounded theory (Glaser and Strauss, various dates), coding the data in order to generate concepts and categories so that a theory of law reform initiatives in this particular area may be developed.  It is also intended that the original interviews be made available (subject to participant consent) as a non-academic activist resource.

Relevance of the Project to Policy and Practice
As explained above, the project is highly relevant to policy and practice and will make an original and significant contribution to our understanding of the ways in which HIV activists feed into and influence (or fail to influence) law reform.  In using the data to develop a theory of law reform efforts in the particular area of HIV criminalisation it is hoped that the research will provide a resource of use to researchers interested in health policy making and activist participation more generally; in making available the raw interview material as audio, it is hoped that the research project will provide a resource for activists in other countries and regions who wish to learn about the experience of the Scandinavian peers.

Sweden: Campaign to change draconian, punitive policies for PLHIV aiming for Government review

In Sweden, the Communicable Diseases Act requires people with diagnosed HIV to disclose in any situation where someone might be placed at risk and to also practise safer sex (which, in Sweden, means using condoms - the impact of treatment on viral load and infectiousness is not yet considered to be part of the safer sex armamentarium.)

But in Sweden you're damned if you do (disclose) and damned if you don't because Sweden is one of several countries in western Europe – including Austria, Finland, Norway, and Switzerland – where people with HIV can be (and are) prosecuted for having consensual unprotected sex even when there was prior disclosure of HIV-positive status and agreement of the risk by the HIV-negative partner. Sweden uses the general criminal law for these prosecutions of which there have been at least 40 - out of an HIV population of around 5,000.

And if you think the Swedes aren't being overly harsh, then watch the harrowing documentary, 'How Could She?' about a young woman, Lillemore, who was in such denial that she did not tell anyone that she was HIV-positive (including the doctors who delivered her two children). Even though both children were born HIV-free, and no-one was harmed by her non-disclosure, following the break-up of her marriage, her ex-husband reported her to the authorities and she was sentenced to 2 1/2 years in prison.



Fortunately, most of these countries with overly-draconian policies towards people with HIV are well advanced in the process of examining (and hopefully, changing for the better) such laws and policies.

Norway has set up a special committee to examine whether its current law should be rewritten or abolished: its recommendations are due in May.

Switzerland is currently revising its Law on Epidemics, to be enacted later this year, and, according to my sources, the latest version appears to be mostly consistent with UNAIDS' recommendations.

In 2010, Austria's Ministry of Justice conceded that an undetectable viral load is considered a valid defence, even if they say individual judges can ignore their recommendation, although much more could still be done to remove the legal onus for HIV prevention on people with HIV.

And Finland has established an expert group on HIV/AIDS within the Finnish National Institute for Health and Welfare with the aim to ensure legislative reform, and address laws and polices that reinforce stigma and discrimination.

But Sweden - which has the most HIV-related prosecutions per capita of people with HIV in Europe (and probably the world) and that's not including the 100+ more people with HIV who have been forcibly detained and isolated under the Communicable Diseases Act – is lagging behind, and continues to enforce its 'human rights-unfriendly' policies.

Fortunately, civil society is fighting back. In 2010, HIV-Sweden, RFSU (the Swedish Association for Sexuality Education) and RFSL (the Swedish Federation for Lesbian, Gay, Bisexual and Transgender Rights) began a three-year campaign to raise awareness and advocate against Sweden's over-punitive HIV-related policies.

A recent conference held just before World AIDS Day put together by the campaign and attended by police, prosecutors and politicians highlighted the many human rights concerns over Sweden's current laws and policies. I was honoured to be one of only two non-Swedes to speak at the meeting (which was held mainly in Swedish - so a big thank you to Elizabeth, my personal "whisper" translator) - you can see the agenda and download a copy of my presentation here.

Download Google translated version of full article here

The meeting and associated campaign received a lot of press coverage, including the front page of the biggest circulation morning paper in Sweden on World AIDS Day.

Download 'HIV, Crime and Punishment'

At the meeting, HIV Sweden, RFSL and RFSU launched an important new manifesto, 'HIV, Crime and Punishment' that clearly explains what the problems are for people with HIV (and public health) in Sweden and asks for three actions from the Swedish Government:

• A review of Swedish law, including the Communicable Disease Act as well as the application of the criminal law to HIV non-disclosure, exposure and transmission.
• An endorsement by Sweden of the 2008 UNAIDS Policy Brief on the criminalisation of HIV transmission, which says that criminal prosecutions should be limited to unusually egregious cases where someone acted with malicious intent to transmit HIV, and succeeded in doing so.
• A renewed, clear focus of Sweden's National HIV Policy on a human rights-based approach to HIV prevention, care, support and treatment, and sex education. 

Let's hope that Sweden's policymakers take heed. After all, how can a country which supports UNAIDS' global efforts, and is perceived to be a global champion for human rights around the world treat people with HIV in its own country as second class citizens?

Don't think Sweden is that bad?  Check out the 2005 case of Enhorn v  Sweden at the European Court of Human Rights which found that Sweden had unlawfully isolated a man with HIV for a total of seven years, a violation of Article 5 § 1 of the Convention, 'right to liberty and security of person'.

Punitive Economies: The Criminalization of HIV Transmission and Exposure in Europe

Last week, Professor Matthew Weait presented this excellent paper at The Future of European Prevention Among MSM Conference (FEMP 2011) in Stockholm, Sweden.

I'll also quote from the introduction here, but the entire paper is a must-read, and can be dowloaded here.

The European region is suffering from an epidemic of criminalization. Across the continent, people living with HIV are being investigated, prosecuted, convicted and imprisoned for non-deliberate HIV exposure and transmission. It is an epidemic that is causing significant harm: not only directly – to the people who are being subjected to harsh and punitive responses – but indirectly, to efforts aimed at normalizing HIV and reducing stigma, to HIV prevention work, and to attempts to affirm the importance of shared responsibility for sexual health. It is an epidemic whose impact is felt especially by people who already experience particular social and economic exclusion and vulnerability. It is an epidemic that has created, based on UNAIDS HIV prevalence estimates for 2009, some 2.2 million potential criminals in Western and Central Europe. It is an epidemic that we have to respond to collectively, and which for we have to find a cure.

In this paper I will do three things. First, I will provide an overview of the scope, extent and distribution of criminalization in the region, and in doing so to emphasise the disparities that exist and the problematic consequences of these disparities for PLHIV. Second, I will discuss what I understand to be the reasons for criminalization, and its variation across countries. Third, and bearing in mind these reasons and variations, I will discuss some of the responses which civil society organisations and others have been making to criminalization, and at additional interventions we might consider exploring and developing.

The paper is especially timely given important developments in Switzerland and the Nordic countries, where law reform is ongoing in Denmark, Norway and Switzerland, and civil society advocacy moving towards law reform is taking place in Finland and Sweden.

One of the most interesting aspects of Prof. Weait's paper is that he finds a correlation between attitudes towards interpersonal trust and the high per capita conviction rates in the five countries mentioned above, which helps explain why the criminal law's approach to HIV in these countries focuses on public health rather than human rights.

These correlations between interpersonal trust and conviction rates in the region become even more interesting when we learn that, according to reliable empirical research, the Scandinavian countries have a lower fear of crime, are less punitive in their attitudes to those who commit crime, and – in general – have lower rates of imprisonment for convicted offenders than other countries. If this is the case, why would HIV transmission and exposure criminalization be so high?

My answer to this is tentative, but it seems plausible to suggest that the sexual HIV cases that get as far as court and a conviction are ones which are paradigm examples of breach of trust. It is not inconsistent for a society to have a lower than average generalised fear of crime, or lower than average punitive attitudes, and at the same time to respond punitively to specific experiences of harm, especially when that arises from a belief that the person behaving harmfully could have behaved otherwise and chose not to. Indeed, it seems entirely plausible that where there are high expectations of trust, breaches of trust (for example, non-disclosure of HIV status) are treated as more significant than where value in trust is low. Combine this with countries (such as those in Scandinavia) which are committed to using law to ensure public health, and which consequently are prepared to using it to respond to the risk of harm (HIV exposure), as well as harm itself (HIV transmission), and we can see why the pattern of criminalization appears to be as it is.

Sweden: Underreported: The Link Between Julian Assange and Sweden’s Repressive HIV Law

"The arrest of Wikileaks founder Julian Assange has focused a spotlight on Sweden’s supposedly liberal, human rights-based sex conduct laws," writes Julie Turkewitz on the Housing Works blog. (Housing Works is an AIDS advocacy organisation in New York.)

Julie and I have been corresponding since December 9th, when she emailed me with a query about Swedish laws that criminalise sexual contact without a condom.  I also have been intrigued and perplexed by the Assange case and had been meaning to contact my esteemed colleague, Andreas Berglöf from HIV Sweden, who I thought may know about this arcane law.


Andreas confirmed what I already thought to be true: "There is no law in Sweden that prohibits unprotected sex. Unless you have an infection or disease that is included in The Swedish Communicable Disease Act, like HIV and other STI's. Then one also has a duty to inform about this."


I then suggested that Julie contact a smart Swedish journalist, Victor Bernhardtz, who had interviewed me in the summer.  He highlighted the more recent report that one of the complainants in the Assanage alleges he had sex with her whilst she was asleep (which is, therefore, non-consensual) rather than the allegations of non-condom use.

"What is illegal is to engage in sexual acticity without consent, which is the case when the other person is asleep," he said in a brief email.  "Everything points to that the charges against Assange are indeed quite valid."

Of note, my estimate in the article of the forced isolation of more than 100 people with HIV came via the Global Criminalisation Scan, which was informed by Andreas.  Following the 2005 European Court of Human Rights ruling (Enhorn vs. Sweden) Sweden changed its policy which is why Andreas now estimates that, on average, one person with HIV is now isolated per year.

With her permission, Julie's entire article on the Housing Works blog is below.

The arrest of Wikileaks founder Julian Assange has focused a spotlight on Sweden’s supposedly liberal, human rights-based sex conduct laws, which allow for a rape conviction even when a perpetrator uses a low level of coercion.

The extradition case against Assange began when two Swedish women contacted authorities to compel him to take an STD test. As reported by Reuters, Assange may have tried to have sex with the women without a condom.

What STD are the women worried about? That hasn’t been made public. But if, as part of an STD test, Assange were to test positive for HIV, the legal consequences could be dire. When it comes to the virus, Sweden’s policies are far from “liberal” or “rights-based.” The country is home to some scarily repressive HIV criminalization laws, which have allowed for the forced isolation of at least 100 HIV-positive people.

“Sweden and its Nordic neighbors are pretty draconian in the way they use their laws to control the lives of people living with HIV and AIDS,” said Edwin Bernard, editor of HIV and the Criminal Law, an extensive summary of laws, prosecutions and responses to criminalization of HIV. “Sweden is by far the worst, though.”

According to the National AIDS Manual, the Scandinavian nation has prosecuted more people living with HIV per capita for exposure or transmission than any other country in the world.

Punishment under the Communicable Disease Act
Despite recent arguments from UN Special Rapporteur Anand Grover that HIV criminalization fuels stigma, discourages testing and undermines public health goals, Sweden continues to persecute HIV-positive people under its Communicable Disease Act.

The law mandates the “obligation to inform sexual partners about infection carrier status.” In practice, those convicted of violating the act are often subject to extensive punishment.

Perhaps most strikingly, the act allows for the compulsory isolation of an HIV-positive person if officials decide that he or she is “not ready to undergo the measures to prevent” transmission. The law places no limits on how long such cumulative isolation may continue. Detentions happen about once a year, according to Andreas Berglöf, organization manager at HIV-Sweden, but “just having the legal possibility is awful, we think.”

The National AIDS Manual offers a higher estimate, saying that at least 100 people have been isolated under this measure.

HIV-Sweden, an umbrella organization that works to protect HIV-positive persons, has documented at least 50 prosecutions and 38 convictions for nondisclosure since 1992, a fairly high number, considering there are just over 5,000 people in Sweden living with HIV.

Incarceration for nondisclosure can last up two to years, and up to 10 years if transmission occurs. The average sentence is five to 10 years. Damages of around 700,000 krona—or about $100,000—are not unusual if transmission occurs, according to a 2009 report from HIV-Sweden. And not surprisingly, foreign nationals are disproportionately affected by the policies.

The European Court of Human Rights has lashed out against Sweden’s repressive policies, saying in 2005 that Sweden had violated the right to liberty and security of an HIV-positive man forcibly detained for up to seven years.

No word on when or if Assange will head to Sweden to answer questions about alleged sexual misconduct—or if he’ll take STD tests. But with these laws on the books, who would?

Global: Powerful personal testimony and video highlight criminalisation concerns

IPPF (the International Planned Parenthood Association) has been campaigning against the criminalisation of HIV non-disclosure, alleged exposure and non-intentional transmission for the past few years, and this World AIDS Day they are highlighting their 'Criminalise Hate Not HIV' Campaign.

They have produced a beautifully shot two minute video highlighting their ongoing campaign, which you can watch below.



IPPF has also just launched Behind Bars - a collection of interviews that highlights the effect criminal laws are having on people’s working and private lives. I was particularly struck by two testimonials from individuals with whom I have had some prior contact.

Jan Albert is a Professor of Infectious Diseases and has worked at the Swedish Institute for Infectious Disease Control (SMI). Currently he works as an HIV researcher at the Karolinska Institute. He has been an expert witness in several trials; served as the expert reviewer for the 'Proof' chapter of NAM's HIV and the criminal law; and contributed to my recent aidsmap.com news story on phylogenetic analysis. He was forced to do an about-turn in 2008 regarding the SMI helping police with their criminal investigations.

Here's an exerpts of what he says in Behind Bars

Since I’ve been an expert witness in court trials, my personal opinion regarding people living with HIV (PLHIV) has changed. In my experience the accused persons are seldom ‘raw criminals’.  Instead, they are people who have been careless or even reckless. There  are many reasons for neglecting to inform sexual partners about HIV status, including denial. None, or very few, have had the intent to transmit HIV which is how these acts often are described by the media....I’ve seen prejudice in the media reporting of these cases, but that’s  how the media works and I have learnt how to deal with it. They often  want the sensational and spectacular news, especially tabloids. I wished  there was place in the media for a more nuanced view; sometimes we see  it, but not very often...Do we want to turn a proportion of our population into potential criminals every time they have sex?

Marama Pala from New Zealand also tells her story on Behind Bars.  She had actually emailed me more than a year ago wanting to tell her story on my blog, and I was happy for her to do so.  I prepared a version of her email for her approval but never heard back (I had especially wanted to know how to credit her - using her real name or a psedunoym).  Now that IPPF have published her name and story, I'd like to post what she wrote for me, which is similar, but a little more detailed.

Marama Pala was the key witness for the prosecution when Kenyan musician Peter Mwai was prosecuted for criminal HIV transmission in 1993.  Now an advocate for Māori living with HIV, she writes about her experiences and lessons learned exclusively for this blog.


KEY WITNESS FOR THE PROSECUTION

I was 22 years old when I had a sexual liaison with Peter Mwai that changed my life forever (23 July 1993). It was six weeks later that I saw a picture of his face on the front of a national newspaper with the caption, “Face of Fear”.  The article encouraged anyone that had contact with Peter Mwai to ring a detective in the New Zealand police. The detective asked, if I received a HIV-positive blood test would I help stop him from infecting other women? Not knowing what I was volunteering for, I said yes. The trial took over two years.

This was the first time that legislation written in 1963 was put to the test with charging someone with ‘wilfully infecting someone with a disease’ (maximum sentence 14 years). It was when the prosecution was unable to prove beyond a doubt that Peter Mwai was deliberately infecting people that charge was lessened to Grievous Bodily Harm (maximum sentence 7 years).

It was alleged that Peter Mwai infected an array of women before June 1993, and after six women – negative and positive – came forward and spoke to the police, they were able to charge him with reckless endangerment. I was the only one they could find who was infected after June – the date where the prosecution were able to provide evidence that he had knowledge of his HIV status. I’ve met 9 women infected by Peter Mwai.  It is presumed there are many more.

I had the condoms available, and during negotiating for safe sex, I was told that he was negative, he had a healthy child, he was healthy and why would he need to wear one and they hurt...  I trusted him. Bear in mind that 1993, negotiating for safe sex as a woman in New Zealand was almost non-existent, safe sex education was non-existent, and the only reason I had the condoms was because a friend had given them to me.

The court trial began. There was no doubt in my mind, should he be released back in to New Zealand society, that he would continue with his promiscuity, putting others at risk. He was found guilty.  He served five years in prison, was deported on release, and shortly after died in Uganda of TB.

RETHINKING CRIMINALISATION


I went in to hiding until 2005 due to unwanted and degrading media interference. It was when the situation within my ethnic community (Indigenous New Zealander Māori), was being threatened by HIV, that I became an advocate for Māori. We started a non-profit organisation called INA (Māori, Indigenous & South Pacific) HIV/AIDS Foundation.

On reflection, and spending time in the Pacific Islands reviewing the criminalisation of HIV in Papua New Guinea (my husband’s country) – first Pacific country to have HIV specific legislation – I began to recognise that the hyper-emotive ‘knee jerk’ reaction and subsequent dramas during the trial may have been a ‘tad’ heavy handed.

I started to become aware of how the criminalisation of HIV can cause stigma and discrimination for those living with HIV.  I then started to notice the differences that criminal law had on different cultural backgrounds, producing varied levels of severe to mild discrimination.  I also saw the agendas of all those who have a stake in this type of legislation. I’ve found the entire area to be a political minefield.  Whose rights are we wanting to protect? The rights of negative people wanting to be safe from infection? Or the rights of positive people to be protected from stigma and discrimination? It’s been said that the sway of the pendulum will always politically favour the majority. In Papua New Guinea’s HIV laws, they do have clauses for both sides: reckless infection of others, and discrimination of PLHWA.

INA has a philosophy that we are all responsible for HIV, and when all take responsibility, the fight will be won! Negative/Positive all have equal responsibility for HIV. HIV is an individual and public health concern.

In saying that, our women and men (Māori) have difficulty in negotiating safer sex and consensual sex. We have no programmes available to target either behavioural changes. Safer sex education is also lacking for all ages within cultural demographics. Sensitivity to cultural laws and beliefs on sex are not considered at all.

I’ve been quoted before saying that perhaps counselling and therapy would have been an option for Peter Mwai. Perhaps name, blame and shame, is not the best management of someone who puts others at risk.

I now believe that New Zealand’s criminal law is an ineffective and inappropriate tool used to address HIV risk behaviour. The psychological and mental state of a person who puts others at risk is not addressed in criminal law. Punishing them may have the opposite effect.  PLWHA are living longer with medication: would prison create a more calculating person that would be released eventually and continue to act with reckless disregard? There is no evidence to suggest that incarceration will offer any significant benefits in changing behaviours.

Criminal charges do little to stop the spread of HIV, within some cultures it dissuades people from being tested, having an attitude of ‘ignorance is bliss’, then they can’t be charged or fear of a positive test resulting in cultural violence, stigma and discrimination. Criminal charges do, however, divert resources and attention away from prevention initiatives already in place that are having an impact on reducing HIV transmission.

Most PLWHAs take responsibility for their bodies and their virus, practicing safer sex and disclosing to partners when necessary. I reiterate, it’s everybody’s responsibility to reduce exposure to any STI. Criminalising HIV puts the entire onus and responsibility on the PLWHA.

INFLUENCING NEW ZEALAND POLICY

My organisation, INA, would also like to acknowledge that ‘wilful’ or ‘reckless’ HIV infection continues to be an issue in New Zealand, with no criminal charges or spotlight placed on it in some communities. The cases mentioned above all involved women, with the most recent cases involving both men and women.  Sadly amongst our Men who have sex with men community, the prevention message targeting them the most as ‘High Risk’ has also created an acceptance of balancing the risk and life style. With many transmission of HIV being completely hidden with an acceptance attitude.

Mental illness, significant cognitive and/or psychological impairment, or a reasonable apprehension of harm adds to the compounding situation, with criminal charges doing nothing to respond to this reality or prevent further infection in such circumstances.

There has been no National Review of HIV in New Zealand, giving us a factual ‘picture’ of the situation in New Zealand. Even with recent criminal charges, there has been no directive on assessing the situation.  The complexities (homophobia, sexism, racism, stigma and discrimination) are being ignored and ‘panic’ is motivating decisions. That may be irreversible should these decisions become policy. All legal and policy responses would be best based on the best available evidence, HIV prevention, care, treatment, support and respect for human rights.

We support and advocate for a strong national policy response to HIV prevention and transmission.  We support a National Review of present criminal law in relation to HIV and review of support services available. And the exploration and development of alternatives to criminal charges and HIV, incorporating alternative responses addressing the individual, environment and social contexts involved.

Global: AIDS 2010 round-up part 2: Posters

This selection of posters presented in Vienna follows up from my previous AIDS 2010 posting on the sessions, meetings and media reporting that took place during last month's XVIII International AIDS Conference.  I'll be a highlighting a few others in later blog posts, but for now here's three posters that highlight how the law discriminates; why non-disclosure is problematic to criminalise; and how political advocacy can sometimes yield positive change.

 In Who gets prosecuted? A review of HIV transmission and exposure cases in Austria, England, Sweden and Switzerland, (THPE1012) Robert James examines which people and which communicable diseases came to the attention of the criminal justice system in four European countries, and concludes: "Men were more likely than women to be prosecuted for HIV exposure or transmission under criminal laws in Sweden, Switzerland and the UK. The majority of cases in Austria involved the prosecution of female sex workers. Migrants from southern and west African countries were the first people prosecuted in Sweden and England but home nationals have now become the largest group prosecuted in both countries. Even in countries without HIV specific criminal laws, people with HIV have been prosecuted more often than people with more common contagious diseases." Download the pdf here. 

In Responsibilities, Significant Risks and Legal Repercussions: Interviews with gay men as complex knowledge-exchange sites for scientific and legal information about HIV (THPE1015), Daniel Grace and Josephine MacIntosh from Canada interviewed 55 gay men, some of whom were living with HIV, to explore issues related to the criminalisation of non-disclosure, notably responsibilities, significant risks and legal repercussions. Their findings highlight why gay men believe that disclosure is both important and highly problematic. Download the pdf here.

 

In Decriminalisation of HIV transmission in Switzerland (THPE1017), Luciano Ruggia and Kurt Pärli of the Swiss National AIDS Commission (EKAF) – the Swiss statement people – describe how they have been working behind the scenes to modify Article 231 of the Swiss Penal Code which allows for the prosecution by the police of anyone who allegedly spreads “intentionally or by neglect a dangerous transmissible human disease” without the need of a complainant. Disclosure of HIV-positive status and/or consent to unprotected sex does not preclude this being an offence, in effect criminalising all unprotected sex by people with HIV. Since 1989, there have been 39 prosecutions and 26 convictions under this law. A new Law on Epidemics removes Article 231, leaving only intentional transmission as a criminal offence, and will be deabted before the Swiss Parliament next year. Download the pdf here.

Global: 'Where HIV is a crime, not just a virus' - updated Top 20 table and video presentation now online

Where HIV Is a Crime, Not Just a Virus from HIV Action on Vimeo.

Here is my presentation providing a global overview of laws and prosecutions at the XVIII International AIDS Conference, Vienna, on 22 July 2010.

Abstract: Where HIV is a crime, not just a virus: a global ranking of prosecutions for HIV non-disclosure, exposure and transmission.

Issues: The global (mis)use of the criminal law to control and punish the behaviour of PLHIV was highlighted at AIDS 2008, where Justice Edwin Cameron called for "a campaign against criminalisation". However advocacy on this vitally important issue is in its infancy, hampered by lack of information on a local, national and international level.

Description: A global overview of prosecutions to December 2009, based on data from GNP+ Global Criminalisation Scan (http://criminalisation.gnpplus.net); media reports collated on criminalhivtransmission.blogspot.com and WHO Europe pilot human rights audit. Top 20 ranking is based on the ratio of rate per year/per HIV population.

Lessons learned: Prosecutions for non-intentional HIV exposure and transmission continue unabated. More than 60 countries have prosecuted HIV exposure or transmission and/or have HIV-specific laws that allow for prosecutions. At least eight countries enacted new HIV-specific laws in 2008/9; new laws are proposed in 15 countries or jurisdictions; 23 countries actively prosecuted PLHIV in 2008/9.

Next steps: PLHIV networks and civil society, in partnership with public sector, donor, multilateral and UN agencies, must invest in understanding the drivers and impact of criminalisation, and work pragmatically with criminal justice system/lawmakers to reduce its harm.

Video produced by www.georgetownmedia.de

This table reflects amended data for Sweden provided by Andreas Berglöf of HIV Sweden after the conference, relegating Sweden from 3rd to 4th. Its laws, including the forced disclosure of HIV-positive status, remain some of the most draconian in the world. Click here to download pdf.

Sweden: 20 year-old man gets another eight months for second HIV exposure conviction

The 20 year-old Linköping man previously sentenced to two years in prison in 2008 for having unprotected sex without disclosure with seven women aged 17-25 and arrested last month for having unprotected sex without disclosing his HIV-positive status to a 15 year-old girl has been sentenced to a further eight months in prison and must pay 40,000 SEK (about 4,000 Euro) damages.

According to the brief report on SvD.com (English translation here) since he was on conditional release after serving 16 months of his original sentence, he will serve the eight months months he had left in addition to this eight month sentence, meaning he will spend 16 months in prison in total. Since the sex only took place last month, the girl's HIV status is unclear.

Sweden: 20 year-old man previously convicted of HIV exposure arrested again

A 20 year-old Swedish man who was released from prison in January 2009 after serving 16 months of a two-year sentence for HIV exposure has been arrested again following allegations that he had unprotected sex without disclosure with a 15 year-old girl.

Although the case is briefly summarised in English in a report in The Local, much more detail is provided in the Swedish tabloid, Aftonbladet.

According to this report, the young man from Linköping was originally diagnosed in April 2007, at the age of 17, after having had unprotected sex with his HIV-positive girlfriend at the time, despite knowing her HIV status.

Following his diagnosis, he appeared to go on something of a bender, sleeping with seven young women without disclosing his status or wearing a condom. None became HIV-positive. He was arrested in September 2007 (previously reported on my blog here) and the case went to court in January 2008.

His defence was that he was in denial.

I rätten försvarade han sig med att han var chockad och inte kunde ta till sig informationen. (In court he defended himself that he was shocked and could not absorb the information.)

He was found guilty of attempted aggravated assault and sentenced to two years in prison. He was also ordered to pay 40,000 Swedish Krona (around €4000) in damages to each of the seven young women.

Released after 16 months' prison, in January 2009 he moved back to Linköping.

Last Friday, he was picked up for questioning by police following a complaint from a 15 year-old girl that he had had unprotected sex without disclosing his HIV status.

Prosecutor, Britt-Louise Viklund told Linköping District Court:

Han erkänner och skyller på att han var alkoholpåverkad. Han hade tillgång till kondom men använde den inte, säger Britt-Louise Viklund. ("He recognises and blames it on the fact that he was under the influence of alcohol. He had access to condoms but did not use them.")

His defence lawyer argued, unsuccessfully, that her client had changed.

Han är djupt ångerfull över det här, han har förändrat sitt beteende mycket den senaste tiden och han menade att det inte finns någon risk för fortsatt brottslighet, säger hans advokat Morgan Gerdin. (He is deeply remorseful over this: he has recently changed his behaviour and says that there is no risk of further crime," said his lawyer, Morgan Gerdin.)

However, the court decided that the risk was so great that he would expose more women to the risk of infection that he has been remanded in custody until his trial.

The case reveals much about the difficulties of a punitive approach to HIV non-disclosure and the Swedish system's inability to deal with a young man unable to come to terms with his diagnosis.

Surely prison is not working as a deterrent, nor has it rehabilitated him. Some of the comments from readers of The Local suggest far more draconian measures, including a tattoo on his forehead, castration and a slow a painful death. I have reported the latter suggestions (such as "Cover him in gasoline and BURN him!") as hate speech under The Local's 'report abuse' policy. Let's see if they remove such comments.

Issues such as inflammatory media coverage of HIV exposure/transmission cases, and how public health laws are also being used (and abused) in such cases were discussed in Stockholm in June 2009 at an excellent one-day symposium, HIV and Criminal Law, organised by HIV-Sweden.

You can download a pdf report of the meeting here or email HIV-Sweden to request a hard copy.

Sweden: Alleged rapist accuses HIV-positive woman of non-disclosure

An HIV-positive woman from Helsingborg, Sweden who was allegedly raped by a man last month has been accused of not disclosing her HIV status, according to a rather confusing report in the Helsingborgs Dagblad.

Two versions of events were presented to the police following the man's arrest. Both agree that the woman and the man, both aged 37, took a taxi together.

The woman claims he lured her up to his apartment to give her his share of the money for the taxi fare, and then forced her to have sex. She says that she asked him to use a condom during the assault, but he did not do so.

He claims that he was drunk and sexually excited and believed she was a sex worker. He says he paid her the 3000 Swedish krona (£250) for the sex and told the police that the reason she pressed charges against him was that she wanted to save her reputation.

Unfortunately Google translate doesn't do a great job of translating some of the detail of the piece: if anyone reads Swedish and can add to this story, please add a comment.

Global prosecutions league table sees Sweden on top

I've just done a rather quick and dirty calculation of prosecutions for HIV non-disclosure, exposure or transmission per capita, based on GNP+'s Global Criminalisation Scan data, and produced this rather interesting league table.



Despite Canada, the US and Australia being disproportionately represented on my blog, due to the sheer number of prosecutions taking place, Sweden, Norway and New Zealand have actually prosecuted the highest proportion of people with HIV in their respective countries.

Having just returned from an excellent conference organised by HIV Sweden in Stockholm (on which I reported today in this aidsmap.com news story, highlights of which are below), it really comes as no surprise that Sweden and Norway head the league of shame.

And last Tuesday, Mr Justice Cameron addressed a meeting in Stockholm organised by HIV Sweden to discuss HIV and the criminal law in Sweden and other Nordic countries.

The meeting heard that Sweden's laws were often applied selectively and discriminatory, including the recent case of an African migrant woman who had gone to the police after being raped by two men.

However, rather than charge her assailants, the police charged the woman with HIV exposure. The case is still ongoing.

Peter Gröön, of Stockholm County Council, shared data showing that African migrants – ten of the 16 people prosecuted in the past five years – also received longer prison sentences than their Swedish counterparts. Mr Justice Cameron told the meeting that this kind of HIV exceptionalism, which is fuelled by stigma, must not be tolerated. "We want [HIV to be treated] neither better, nor worse than any other disease," he said.

The meeting also heard that a coalition of grass roots and civil society organisations in Norway might lead to an abolition of Norway's current HIV exposure and transmission law, Section 155, which has led to ten prosecutions the past five years.

The law, which does not allow HIV-negative people to consent to unprotected sex, and makes little distinction between HIV exposure and transmission, places the burden on HIV-positive individuals to both disclose HIV status and insist on condom use in order to be able to avoid potential prosecution.

Through a campaign that has included providing every MP in Norway with information about the inequities of the law, and a major newspaper article from Mr Justice Cameron, published in May, representatives of HIV Manifesto and HIV Norway were hopeful that the law will be repealed during the country's revision of the its Penal Code.

The meeting also heard that a similar opportunity might also be possible in Sweden later in the year, during the pubic debate that will follow a proposal to lengthen prison sentences for assault (the law under which criminal HIV exposure and transmission is prosecuted in Sweden).

Sweden: Health agency criticised for not co-operating with police

The Swedish Institute for Infectious Disease Control has revealed in an article in a medical journal that they have refused to co-operate with police in tracking down individuals who may have broken Sweden's draconian public health and criminal HIV exposure and transmission laws. Following a public furore, they have now backtracked somewhat.

Articles from the Associated Press and The Local.se below.

Swedish health agency blasted for HIV stance

By LOUISE NORDSTROM

Associated Press

22nd October

STOCKHOLM, Sweden (AP) — A Swedish health agency revealed in an article published Wednesday that it had refused to help police track down people who knowingly infect others with HIV.

The revelation triggered harsh criticism and the government agency, the Swedish Institute for Infectious Disease Control, agreed later in the day to resume helping police.

Officials for the agency were quoted in a medical newspaper as saying they had declined to cooperate with police because they disagreed with current legislation that criminalizes the willful spread of the AIDS virus.

The report in the Dagens Medicin weekly sparked anger among prosecutors, police and government officials, who accused the institute of placing itself above the law.

The institute backtracked and its officials also clarified their position, saying they had no problem with the law itself, but believed the penalties for spreading HIV were too severe. The willful transmission of the virus is punishable by a maximum 10 years in prison.

Jan Albert, an expert at the agency, said the threat of imprisonment harms prevention efforts because some people who suspect they may have the virus refrain from getting tested for fear of prosecution.

Albert said the agency had declined to help police on many occasions, "but we've come to the understanding that we'll resume work with the police."

'Decriminalize spread of HIV': agency
Published: 22 Oct 08 11:38 CET

A Swedish government agency is refusing to assist the police in an ongoing investigation concerning a person suspected of infecting a woman with HIV.

Under current legislation, a person with HIV risks spending one to ten years in jail on assault charges if he or she knowingly has unprotected sex with another person.

"The criminalization of HIV makes preventive work more difficult. Also, sentences are very tough," Ragnar Norrby, director-general of the Swedish Institute for Infectious Disease Control (SMI), told newspaper Dagens Medicin.

In a reversal of its previous policy, the disease control institute has recently refused to cooperate with prosecutors who requested information on a person suspected of spreading HIV.

"It is now our view that spreading HIV should not be classified as an offence," Jan Albert, SMI head physician and regional manager, told Dagens Medicin.

"It is at least as much the responsibility of the individual person to understand that unprotected sex involves risks," he added.

According to Ragnar Norrby, the threat of prosecution leads many people infected with HIV to remain anonymous, making it more difficult to trace the spread of the virus.

SMI also notes that the development of antiretroviral drugs has meant that HIV can no longer be equated to a death sentence.

Sweden: British man sentenced to 14 years for HIV transmission

The Associated Press reports that a British-born man who has lived in Sweden since chilhood has been jailed for 14 years on two counts of reckless HIV transmission, and 14 counts of HIV exposure.

Click here for a page refresh with all of this blog's previous stories on the case.

Briton jailed for HIV sex

2 hours ago
A British-born man has been jailed for 14 years in Sweden for infecting two young women with HIV and 14 other counts of HIV exposure.

Click here for a page refresh with all the previous posts on this blog about this case.

Christer Merrill Aggett, 32, who has lived in the country since childhood, was also sentenced for six offences of underage sex.

The Solna District Court in November had found Aggett guilty of the charges, but ordered that he undergo psychiatric examination before sentencing.

Aggett was charged in October with two counts of aggravated assault for allegedly infecting two girls with whom he had sex without telling them he was HIV-positive.

He was also charged with aggravated assault, or "exposing others to danger", by having unprotected sex with more than a dozen other women between 2001 and 2006. They were not infected with HIV.

Six of them, however, were under the age of 15, the legal age of consent in Sweden, when the sexual encounters took place.

He had confessed to most of the charges, but not to having had sex with underage girls, saying he was unaware they were so young.

Police suspect Aggett had been in contact with at least 130 women he met via internet chat rooms.

Sweden: British man guilty on two counts of HIV transmission

HIV Brit found guilty of infecting girls

Published: 15th November 2007 12:38 CET

A British citizen with HIV has been convicted of serious assault after having unprotected sex with 16 young girls, two of whom contracted the virus.

Merrill Christer Aggett, 32, was found guilty by Solna District Court on Thursday of two charges of serious assault, 13 charges of attempted assault, six charges of sexual exploitation of a minor, one minor narcotics offence and two charges of driving without a licence.

The trial is to be resumed next month after the court ruled that Aggett should now undergo a psychiatric analysis, which is scheduled for completion in mid-December.

If found to suffer from a psychiatric disorder, he will sentenced to secure psychiatric care rather than prison.

Aggett is believed to have contacted 130 girls between 2002 and 2006 via internet chat sites.

Two young girls were diagnosed as HIV positive after sleeping with Aggett. Prosecutors successfully argued that he should be convicted of serious assault for infecting the girls.

Aggett also faced charges of attempted assault for having unprotected sex with other young girls, none of whom were infected. Many of them were under 15 when they slept with him.

The British citizen, who has lived in Sweden since he was a child, was arrested in the early summer. Aggett himself was diagnosed as HIV positive in 1992.

TT/The Local (news@thelocal.se/08 656 6518)

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