Switzerland: New Law on Epidemics only criminalising intentional transmission passed in lower house

In a remarkable turns of events in the Swiss Federal Assembly's National Council (lower house) yesterday, the new, revised Law on Epidemics was passed with a last minute amendment by Green MP Alec von Graffenried that only criminalises the intentional spread of a communicable disease.

The history of the revision of the Swiss Law on Epidemics has been a long and rocky one. The redrafting of revisions to Article 231 of the Swiss Penal Code – one of the most draconian and discriminatory laws on HIV exposure in the world – began in 2010.

The first draft of the proposed new article removed much of the most draconian provisions (i.e. allowing for prosecutions of an HIV-positive partner despite an HIV-negative partner's full, knowing consent to unprotected sex) leaving only intentional exposure or transmission a criminal offence.  Broad stakeholder consultation agreed with this draft.

However, in December 2010, a new draft presented by the Swiss Parliament's Executive Branch (Federal Council) ignored the consultation and added lesser states of mind – simple intention and negligence – as well as malicious intent, despite the broad acceptance that the previous version had achieved amongst all stakeholders. Furthermore, the bill introduced a new paragraph creating an HIV disclosure defence.

At a mid-2011 hearing, the National Council's Committee on Social Security and Public Health (tasked with the re-drafting of the Law on Epidemics) appeared to be open to moving back towards the original draft. The Committee explicitly recognised that the present criminalisation of consensual unprotected sex between a person with HIV and one without undermines prevention efforts and the principle of shared responsibility of both sexual partners.

However, at the end of 2011 the Committee produced further amendments that discarded the disclosure defence but which added "lack of scruples" and "self-serving motives" as alternative elements of intent. The Committee remained split on the question of negligence with the majority opting to retain the section and the minority recommending it be stricken.

So it came as a very welcome surprise that, when the bill finally reached the National Council for debate and final vote yesterday, an amendment by Green MP Alec von Graffenried was proposed at the last minute and almost immediately and overwhelmingly passed by 116 votes to 40.

A transcript of the entire proceedings (in a combination of French and German) are available here, but below I quote the full (unofficial) English translation of von Graffenried's speech (courtesy of Nick Feustel) explaining his amendment.

In short, he says that the Law on Epidemics needs to deal only with public health issues, such as bioterrorism, and not address harm to individuals.  He notes that general assault laws already exist to punish egregious cases of HIV transmission and that much of the proposed bill is not only redundant, but confusing.  "You can't be 'negligent', 'malicious' and 'unscrupulous' at the same time, that's just not logical," he argued, quite convicingly.

Advocates in Switzerland were overjoyed at this unexpected turn of events, but one government insider warns that we should not celebrate too early. The bill must now go through the Health Commission of the Council of States (upper house), before it goes to a final vote, and this could take some time (June is mooted, but not definite) and so there may still be further amendments.

For now, however, the clear logic and rationality of von Graffenried is to be celebrated.

Hopefully these developments will have an impact on other countries, too, notably Norway where a similar commission is debating changes to laws that are eerily similar in purpose and outcome to Switzerland's notorious and outdated Article 231.

Von Graffenried's Speech

"I speak for the parliamentary group of the Green Party, but of course also in part for my proposition as an individual. This is about punitive laws, we are talking about the amendment of Article 231 in the Penal Code. Reading the draft doesn't really make you understand what the Commission was about. So I stopped short and then tried to make it clearer in my proposition. As Mrs Schenker explained earlier, there were still some unanswered questions after the Commission's consultation.

"The problem is that when it comes to transmission of diseases there are always two levels. On the one hand, there is the individual level, the individual health of the aggrieved party. Their health and physical integrity are protected by Articles 111 and the following on those offenses at the beginning of the Special Section of the Penal Code. On the other hand, there is the disease-control part of it. This is the part that article 231 is meant to deal with. That was – how I learned from conversations with the Commission's members – the Commission's concern. Article 231 in its present form confuses these two levels. That is how, until now, for example an HIV positive person becomes guilty of bodily harm according to article 123 as well as the spreading of human diseases according to article 231.

"In their draft, the Federal Council completely revised article 231. They included a 'basic offense', a 'qualified offense', a 'privileged offense' and a 'negligent offense'. But they still adhered to article 231 protecting individual health as well as being effective for disease-control. This was obviously not what the Commission wanted, and so they slashed the article.

"Obviously, the Commission didn't want to adopt this concept. They only wanted to adopt the 'qualified offense', i.e. a highly criminal, if not even terroristic offense. This is about public health, i.e. the spreading of epidemics. This is what I adopted for my proposition. Possible intentional or negligent bodily harm or even manslaughter are covered by the regulations in Article 111 and the following of the Penal Code. Those are about individual health. Thus, criminal liability is only carried out under these regulations, but not anymore under Article 231 of the Penal Code on the spreading of human diseases.

"However, the Commission adopted the 'negligent offense'. I'll have to expatiate on this.

"The negligent perpetration is already regulated under the Administrative Criminal Law. Having an article in the Penal Code on this is unnecessary, because this regulation is already included in Articles 82 and the following of the Epidemics Law, which you have just enacted without discussion. Negligent perpetration is already included there.

"The Commission's version is not possible, because the Commission eliminated the 'basic offense'. You can't be 'negligent', 'malicious' and 'unscrupulous' at the same time, that's just not logical. Paragraph 2 would become ineffective, but at the same time it would also prevent the application of the Administrative Criminal Law, because Article 82, paragraph 1 excludes applying the Administrative Criminal Law, because the Penal Code does have this regulation.

"Therefore, I ask you in the name of the parliamentary group of the Green Party to accept my proposition as an individual, in order to clarify the punitive laws."

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.

Switzerland: Government ignores expert recommendation to decriminalise non-intentional HIV exposure and transmission

The Swiss Government has ignored expert recommendations to decriminalise everything but intentional HIV exposure or transmission following a consultation on changing Article 231 of the Swiss Penal Code, according to a strongly worded press release from Groupe sida Genève issued yesterday.

At the International AIDS Conference in Vienna earlier this year, the Swiss Federal Commission for AIDS-related issues – the Swiss statement people – described 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. (Download the pdf here)

The law has only ever been used to prosecute people with HIV. 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.

The Swiss Federal Commission for AIDS-related issues issued a statement in September 2010 (available in English here) that stated:

[Current Swiss] legal practice is in blatant contradiction to the tried and tested Swiss Aids policy held by broad social consensus. Accordingly, the FCAI calls for the following requirements from the lawmakers and the practitioners of criminal law (public prosecution and judicial authorities):

1. Public prosecution and judicial authorities have to take into account the scientific findings on the infectiousness of HIV-positive persons under successful therapy (FCAI statement 2008). Persons, who are not considered to be infectious according to the FCAI criteria, shall not be punished. Any processes are to be stopped and previous sentences, when needed, are to be revised.

2. Also for HIV-positive persons, whose virus count is not yet under the detection limit, the risk of transmission is very low. The courts are therefore advised not to undertake hastily a possible deliberate action. The highest court of law of the Netherlands, in a leading decision in 2005, made an exemplary judgement in this regard.

3. The legislative body has to amend Art. 231 SPC such that amicable unprotected sexual contact may no longer be subsumed under this code. An opportunity for this is offered by the current (2010) revision of the epidemic law.

 The draft of the proposed new Law on Epidemics removed much of the draconian provisions of  Article 231, leaving only intentional exposure or transmission a criminal offence.

However, according to Groupe sida Genève

The present version put before the assembly maintains simple intention and negligence as well as malicious intent despite the broad acceptance that the consultation’s version found amongst all stakeholders.

Furthermore, the bill introduces a new paragraph creating an absolute defence in favour of the accused only in the event he made a full disclosure of the risk the HIV negative partner was exposing him or herself to.

The consequence is that Switzerland will move from having one of the most draconian and discriminatory laws on HIV exposure in the world to one that is similar to Canada's - making disclosure of HIV-positive status a defence to alleged exposure or transmission, in effect mandating disclosure before any kind of unprotected sex by someone aware they are living with HIV.  This is a lost opportunity for Switzerland to lead the world in decriminalisation of non-disclosure, alleged exposure and non-intentional transmission (following the lead of The Netherlands in 2005).

Although a previous Geneva Court of Justice aquittal (and the upholding of the subsequent Federal Court appeal) now suggests that someone with an undetectable viral load would not be found guilty of HIV exposure (with or without disclosure), this is not the case in Switzerland's 25 other cantons.

As Groupe sida Genève point out this latest development "not only maintains the criminalisation of HIV-positive persons, but also spells out rules of disclosure that will only lead to more stigma and discrimination."

I'll be posting more on this once I've digested all of the documents linked to in the press release below, and spoken with some insiders in Switzerland.  But I join Groupe sida Genève in condemning "the backwards attitude" of the Swiss authorities. 

Full press release below:

Groupe sida Genève denounces the proposed changes to art. 231 of the Swiss Penal Code. Exposure and transmission of HIV will remain a criminal offense despite best evidence that criminalisation is incompatible with the aims of successful general prevention programmes.

The executive branch of the Swiss government, the Federal Council, has introduced a bill in the federal assembly to revise the Federal Law on fighting infectious human diseases. (See the Federal Department of the Interior’s press release of Friday December the 3rd)

Included in the new provisions was one, article 86 (80 in the consultation version), to amend article 231 of the Swiss Penal Code incriminating the propagation of an infectious human disease.

The bill as it came out of the consultation process proposed to abrogate the paragraphs dealing with intentional and negligent exposure and transmission of HIV. Only the qualified form of malicious intent would have been indictable, the others would not have been considered offenses.

However, the bill, in the present version put before the assembly, maintains simple intention and negligence as well as malicious intent despite the broad acceptance that the consultation’s version found amongst all stakeholders.

Furthermore, the bill introduces a new paragraph creating an absolute defence in favour of the accused only in the event he made a full disclosure of the risk the HIV negative partner was exposing him or herself to.

Groupe sida Genève is convinced this amendment represents the complete opposite of the position taken by the Swiss Federal Commission for AIDS-related issues (FCAI) in its most recent Declaration on the criminality of HIV transmission. It not only maintains the criminalisation of HIV positive persons, but also spells out rules of disclosure that will only lead to more stigma and discrimination.

Groupe sida Genève is dismayed by this proposal and would like to encourage all to join in our condemnation of the backwards attitude of the Swiss Authorities. Please give this information the widest possible distribution in your networks.

Background

All Swiss federal legislation goes through a consultation procedure where all concerned stakeholders can give their views on proposed legislation. Bills traditionally include the results of the consultation procedure as this ensures the bill achieves the greatest possible consensus.

Article 231, incriminating propagation of a human disease, is one of two provisions in the Penal Code under which persons accused of transmission and exposure to HIV are customarily indicted, the other being article 122 concerning grievous bodily harm.

Under article 231 the intentional transmission of a human disease is punished by a custodial sentence of not more than 5 years whilst the negligent transmission or exposure by a sentence of not more than 3 years. In both cases the minimum sentence is 30 day-fines (jour-amende).

Approximately 39 HIV positive persons have been sentenced under one or the other or a combination of both provisions. In 2009, the criminal chamber of the Geneva Cantonal Court dismissed a case of exposure based on the 2008 declaration by the Swiss Federal Commission for AIDS-related issues (FCAI) on infectiousness of HIV under effective ART and the expert testimony of Professor Bernard Hirschel. To date it remains unclear whether the decision will be make jurisprudence.

References and further reading

Federal department of the Interior press release on the Revision of the Federal law on the fight against Epidemics. 03.12.2010 (link)

Declaration by the Swiss Federal Commission for AIDS-related issues (FCAI) on the criminality of HIV transmission. 18.11.2010 (PDF)

Summary of the declaration by the Swiss Federal Commission for AIDS-related issues (FCAI) on the infectiousness of HIV on effective ART treatment (Swiss statement). 30.01.2008 (PDF in French) (Canadian HIV/AIDS Legal Network's English translation  PDF)  The full text of the declaration was published in: Schweizerische Ärztezeitung / Bulletin des médecins suisses / Bollettino dei medici svizzeri / 2008; 89:5)

Bill tabled in the federal assembly as PDF: (in French)(in German)(in Italian), 03.12.201

Message on the bill tabled in the federal assembly as PDF: (in French)(in German)(in Italian), 03.12.2010

Consultation draft of the bill as PDF: (in French)(in German)(in Italian), 08.01.2008

Report on the results of the consultation as PDF: (in French)(in German)(in Italian), 20.10.2008

“S” v. Procureur Général, Judgement, February 23rd 2009, Chambre pénale, Geneva. (PDF in French with an English translation by the Canadian HIV/AIDS Legal Network from the resources for lawyers and advocates webpage.)

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.

Switzerland: New study examines every criminal prosecution; finds Swiss law discriminatory

A new and important study of criminal HIV exposure and transmission cases in Switzerland was published yesterday.

Update: An English-language version of the Swiss AIDS Federation's six page summary is now available. Download the pdf here.

With the support of Swiss National Science Foundation (see the press release in French and German) and the Swiss AIDS Federation (AIDS-Hilfe Schweiz/AIDS Suisse Contre Le SIDA), researchers Kurt Pärli and Peter Mösch Payot examined 39 individual cases dealt with in 51 separate cantonal (lower and higher) and federal court hearings between 1990 and 2009.



Of the 27 accused where country of origin was known, 11 were born in African countries; 9 were born in Switzerland; 4 were born elsewhere in Europe; 2 were born in Asia and the near East; and one was born in the US.

Three cases did not involve sex. One case involved a doctor who disclosed the HIV-positive status of one of his patients; another case involved the Red Cross and contaminated blood; and the third one involved biting.

The remaining 36 cases involved sex - 31 heterosexual sex, and five sex between men. All but three of these 36 sexual cases involved consensual sex (as opposed to rape or sexual assault).

[Note: the only English-language report so far gets this wrong, saying that all 36 cases took place with the informed consent of the victim. That's the problem with laws like these: in this case "consensual" means both parties agreed to have sex, and not that the HIV-positive partner had disclosed prior to sex.]

Admittedly, it is a bit complicated, since it is possible to be prosecuted for consensual, unprotected sex with disclosure under Article § 231 (spreading of dangerous diseases). In 21 cases, this law was used. Consequently, in more than half of the convictions there was no transmission of HIV, simply 'HIV exposure'. Most prison sentences ranged between 18 months and 4 years, plus a fine of up to CHF 80,000 (c. €53,000) as compensation to the 'victims'. The report authors point out that these sentences are longer than for other (non-HIV-related) 'crimes' charged under this statute.

Below is the table of cases (and scenarios discussed in court) adapted from the report.



Unfortunately, the impressive 149-page paper (complete with comparisons with other jurisdictions) is only available in German (this is the link to the complete pdf; 1.4MB ). A six-page fact sheet from the Swiss AIDS Federation summarising the findings is also available in German (and now English).

The authors conclude by recommending the repeal of Article § 231, because, they argue, the law is discriminatory by unfairly placing 100% responsibility on the HIV-positive partner which is in direct contradiction with public health policies.

[Many thanks to my native German-speaking partner, Nick, for helping me understand the paper.]

Switzerland: Federal Court confirms Geneva HIV exposure acquittal, but does not mention viral load (updated)

UPDATE July 8th 2009

The Federal Court has now confirmed the recent HIV exposure acquital in Geneva, but shied away from explicitly discussing the link between an undetectable viral load and risk of transmission. In effect: they lacked the courage to change HIV exposure law throughout Switzerland.

According to AIDS Geneva's Deborah Glejser, the Federal Court upheld the Geneva court's finding that HIV exposure charges were no longer possible because the two female complainants were not exposed to HIV, but they did not actually discuss why this was the case (i.e. because the defendent was on effective treatment).

A brief report (in French) on 20minutes online, notes that the Federal Court emphasized that the women were not infected with HIV during unprotected sex and accordingly are not considered by the criminal courts to be victims. They could have sued for psychological harm in the civil court, but didn't, and so "in the absence of such a request, their action can only be ruled inadmissible."

Deborah Glejser tells me that she is extremely disappointed in the Federal Court since this was "a great opportunity missed." Although HIV exposure remains no crime in Geneva, it will now be down to individual cases – and prosecutors as forward-thinking as Yves Bertossa – to change the law in Switzerland's 25 other cantons.

ORIGINAL POSTING July 1st 2009

Video and reports (in French) are now available following the May 18th meeting convened by Group SIDA Geneve (AIDS Geneva) featuring a discussion between Professor Pietro Vernazza, President of the Swiss Federal AIDS Commission (which produced the January 2008 'Swiss statement' on infectiousness) and Yves Bertossa, Geneva's deputy public prosecutor, (who pushed for the recent HIV exposure acquital in Geneva), moderated by AIDS Geneva's Deborah Glejser.

The meeting highlighted the importance of the Geneva court's ruling that an HIV-positive person on successful treatment, with an undetectable viral load, and no other STI, could not possibly be guilty of exposing another person to HIV if they had not disclosed their status before having unprotected sex.

The Geneva judgement has now been appealed by the complainant which means it will now be heard by the Federal Court, Switzerland's highest court. Mr Bertossa appeared confident that the Federal Court would confirm the acquittal, making the ruling relevant throughout Switzerland (and possibly providing more legal ammunition for other jurisdictions).

Highlights of the meeting are available to watch on the AIDS Geneva blog. The meeting also received mainstream coverage, including a report in L'Hebdo (Switzerland's answer to Time or Newsweek) and in the main Geneva broadsheet, L'evenement.

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).

Switzerland: Geneva Court of Justice accepts 'Swiss statement', quashes HIV exposure conviction

In the first ruling of its kind in the world, a court in Geneva, Switzerland, has quashed the 18 month prison sentence of a young HIV-positive man previously convicted of HIV exposure, after accepting that the risk of sexual HIV transmission on successful treatment is close to zero.

(Update: A more detailed version of this story now appears on aidsmap.com.)

The Geneva Court of Justice acquitted the young man on Monday, reports Le Temps. He had been found guilty last November after two female complainants testified that they had unprotected sex with him (which is against the law in Switzerland, whether or not there is disclosure, and even if the person with HIV is undiagnosed at the time), even though neither were infected.

Article 231 of the Swiss Criminal Code allows prosecution by the police – without the need for a complainant – of anyone who “deliberately spreads a dangerous transmissible human disease.” Informed consent to unprotected sex does not nullify the offence, and even the attempt to spread a dangerous transmissible human disease (i.e. HIV exposure without transmission) is also liable to prosecution.

During the original court case, reports The Geneva Tribune, an (unnamed) medical expert witness had testified that although treatment greatly reduces the risk of transmission, there remained a residual risk. Although the accused's lawyer, Nicole Riedle, had entered the Swiss Statement from the Swiss Federal AIDS Commision (EKAF) into evidence, and Geneva's deputy public prosecutor, Yves Bertossa, had wanted to suspend the hearing to interview an expert, the court declined to accept any further evidence.

Interestingly, it seems that it was Bertossa himself who appealed to the Court of Justice for Monday's hearing, where the expert testimony of Professor Bernard Hirschel, one of the co-authors of the Swiss statement, persuaded the Court that the man had not been infectious when he had unprotected sex.

This now suggests that in Switzerland effectively treated HIV-positive individuals should no longer be prosecuted for unprotected sex, and it is hoped that this ruling may well have consequences for other jurisdictions that have HIV exposure laws.

This is most urgently required in the US and Canada - however, until nationally recognised experts make statements of their own about the beneficial effect of treatment on transmission, neither legal systems are likely to accept it. Sadly, both the CDC and WHO/UNAIDS have so far summarily dismissed the Swiss statement, despite increasing numbers of experts agreeing with it.

Significantly, Yves Bertossa is quoted in Le Temps as saying that despite the fact that there is still debate regarding the residual risks of transmission in people on successful treatment this should not make a difference to the court: "One shoudn't convict people for hypothetical risks."

Ce débat, estime Yves Bertossa, ne devrait pas influencer la justice: «On ne condamne pas les gens pour des risques hypothétiques», fait-il valoir.

Switzerland: Federal Court rules that undiagnosed criminally liable for HIV transmission

Switzerland's highest court - the Federal Court in Lausanne - has ruled that a man who was unaware of his infection is still criminally liable for infecting a woman with HIV.

In effect, the court has ruled that anyone who has had unprotected sex in the past, and does not disclose it to their sexual partner before having unprotected sex with them, may be criminally liable should HIV transmission take place.

An unofficial translation of the article in the Neue Zürcher Zeitung (the original and the translation follow, below) reporting the case, says the following:

..you have to refrain from having unprotected intercourse, if there are concrete indications for a potential HIV infection. Indications can be, in principle, any perceived risky contact in the past, such as unprotected intimate contacts with a person whose sexual past one does not know. In principle the Safer Sex Guidelines of the Federal Health Office are authoritative for this. Irrelevant are the statistical risks of transmission or the fact that signs [of seroconversion] failed to appear.

There are three articles below. First, my article on this published today on aidsmap.com. Then there is a short article in English from swissinfo.ch, and finally the Neue Zürcher Zeitung article (in English and then a jpg of the German original) which contains a lot more information.

I also have a copy of the full judgment in German, which helped inform my article for aidsmap.

I had delayed reporting on this very important case because I had asked the Swiss Federal AIDS Commission (EKAF) to provide an official comment, and to discuss its implications. However, I found out last night that this will not be available until they have their next meeting in September. Nevertheless, I know that some individuals working with EKAF are very concerned about this latest development.

(Thanks to Nick Feustel, of georgetownmedia.de, for providing German to English translations).

Swiss court rules all people with HIV can be criminally liable for transmission, even if untested

Edwin J. Bernard, aidsmap.com Friday, July 18, 2008

Switzerland's highest court - the Federal Court in Lausanne - has ruled that a man who was unaware of his infection when he had unprotected sex that transmitted HIV is still criminally liable. The ruling suggests that unprotected sex in Switzerland without first disclosing a sexual history may result in prosecution should HIV be transmitted.

In 2006, the California state Supreme Court ruled that ‘constructive knowledge’ – when it is reasonably foreseen by a reasonably intelligent person that their actions could lead to harm – of the possibility that HIV transmission may occur, is enough to allow for civil liability. However, this is the first ruling anywhere in the world to find that an undiagnosed individual may be criminally liable for HIV transmission.

The criminal case, reported in some detail in the July 1^st edition of the Neue Zürcher Zeitung, began with a trial in Zurich’s District Court in 2005. The complainant was a woman who had tested HIV-positive after having unprotected sex in 2002 with the defendant. Although the man had not been diagnosed HIV-positive before their sexual encounters, he did have a history of unprotected sex.

Notably, in 2000, he had been informed by a former sexual partner that she had been diagnosed HIV-positive. The man testified that he had not taken an HIV antibody test because he did not believe himself to have been infected during unprotected sex with this woman, based on a lack of seroconversion symptoms at the time. However, the District Court found him guilty under both public health and criminal law.

Swiss criminal HIV exposure and transmission laws
Liability for HIV exposure or transmission in Switzerland is based on two distinct sets of laws – those aimed at protecting the general public (public health law) and those protecting the individual (criminal law).

Article 231 of the Swiss Criminal Code allows prosecution by the police – without the need for a complainant – of anyone who “deliberately spreads a dangerous transmissible human disease.” Informed consent to unprotected sex does not nullify the offence, and even the attempt to spread a dangerous transmissible human disease (i.e. HIV exposure without transmission) is also liable to prosecution.

Article 122, also allows prosecution for grievous bodily harm if unprotected sex results in HIV transmission. However, informed consent is a defence in this case, and a prosecution requires a complainant in order to prove that informed consent (i.e. disclosure of HIV status before sex) was not obtained.

In effect, “any unprotected sex of an HIV-positive person is a crime, even if there is no transmission,” Professor Pietro Vernazza, of the Cantonal Hospital in St. Gallen, and President of the Swiss Federal Commission for HIV / AIDS, tells aidsmap.com. In part, it was these draconian laws that motivated the Swiss Federal AIDS Commission’s recent statement regarding antiretroviral therapy’s effect on HIV transmission.

Cantonal Court upholds appeal
The undiagnosed man convicted under these laws appealed to the Zurich Cantonal Court in 2007. The appeal had two parts: questioning whether an undiagnosed person has a legal requirement to test for HIV and to disclose their sexual history; and questioning the validity of the phylogenetic analysis evidence used in the original case.

The Cantonal Court ruled that not only was he not liable – because there is no law mandating HIV testing or disclosure after unprotected sex – but also that the scientific evidence was not conclusive enough to prove that he had infected the complainant.

Although phylogenetic analysis of the samples linked the man's rare HIV subtype to the complainant’s own HIV strain, his lawyers successfully argued that phylogenetic analysis cannot rule out that another individual may have infected the complainant. In addition, phylogenetic analysis ruled out a link between the defendant and the HIV-positive woman with whom he had ‘risky’ sex in 2000.

Federal Court reverses appeal
On June 30th 2008, Switzerland's highest court ruled that the man can be held responsible for HIV transmission under both public health and criminal law. They said the defendant could not ignore the fact that his own past behaviour was risky, particularly since one of his previous partners had told him she was HIV-positive after they had had unprotected sex.

It also ruled that the woman did not have joint responsibility for her HIV infection because she did not give informed consent to the risk of unprotected sex. If she had known the man’s sexual history, it was unlikely she would have had consented to unprotected sex, it said.

An unofficial translation of the German-language article in the Neue Zürcher Zeitung quotes the following: “...you have to refrain from having unprotected intercourse, if there are concrete indications for a potential HIV infection. Indications can be, in principle, any perceived risky contact in the past, such as unprotected intimate contacts with a person whose sexual past one does not know. In principle the Safer Sex Guidelines of the Federal Health Office are authoritative for this. Irrelevant are the statistical risks of transmission or the fact that signs [of seroconversion] failed to appear.”

The Federal Court also overturned the ruling on phylogenetic analysis, saying that since the defendant’s strain was so rare, it would have been highly unlikely that the complainant could have acquired it elsewhere.

In effect, Switzerland’s highest court had now ruled that anyone who has had unprotected sex in the past, and does not disclose it to their sexual partner before having unprotected sex with them, may be criminally liable should HIV transmission take place.

Court rules in HIV case
July 1, 2008
swissinfo.ch

Switzerland's highest court has ruled that a man who unknowingly infected a woman with HIV can be held responsible for his actions.

The Federal Court in Lausanne wrote that any person having occasional sex with another should use a condom to protect the other person. Otherwise they should expect to be accused of causing seriously bodily harm through negligence if the occasional partner is diagnosed with the Aids-causing virus.

The decision overturns an earlier one by Zurich's cantonal court after an appeal by a woman who was diagnosed with the virus. She had had unprotected sex with a man who did not know he was contaminated.

The man had previously had unprotected relations with other partners, and the country's highest court ruled that he had failed to apply the rules of safe sex.

Even if he did not know he was HIV positive, the judges said he could not ignore the fact that his own behaviour was risky, especially after one of his earlier partners had admitted being infected.

HIV Transmission After Risky Contacts: Conviction required
Neue Zürcher Zeitung
1 July 2008

If you ignore the possibility of being infected with HIV after previously having had risky contacts, and then infect a sexual partner by having unprotected intercourse, you can be prosecuted for reckless greivous bodily harm. The Federal court requires the Zurich cantonal courts to convict a man, who had unprotected intercourse with various women for years.

In 2000, one of his former sexual partners informed him she was HIV-positive. He abstained from having an HIV test done, because he relied on not having been infected due to the lack of signs, such as fever attacks. Two years later he had unprotected sex with another woman, who he didn't inform about that risk. Later she was diagnosed with having the same rare HIV strain as he did.

The Zurich cantonal court fully acquitted the man in March 2007 of the accusation of reckless greivous bodily harm and reckless spreading of human diseases, following an earlier convicion. The court had negated the recklessness of the act, claiming that there is no legal obligation to test for HIV after having had unprotected intercourse.

The Penal Department of the Federal court has now approved of the victim's remonstrance and sent the matter back to the Cantonal court for the conviction of the man. According to the adjudication from Lausanne, as for the question of recklessness, it is decisive that you have to refrain from having unprotected intercourse, if there are concrete indications for a potential HIV infection. Indications can be, in principle, any perceived risky contact in the past, such as unprotected intimate contacts with a person whose sexual past one does not know. In principle the Safer Sex Guidelines of the Federal Health Office are authoritative for this. Irrelevant are the statistical risks of transmission or the fact that signs [of seroconversion] failed to appear.

The Lausanne judges answered their Zurich colleagues back on another point. The Cantonal court's perception that the woman could have been infected indirectly via a chain of persons with the relevant virus type, is highly unlikely and therefore indefensible, according to the Lausanne judges.

Finally even a joint responsibility of the woman was negated. If she had known the preliminary history of her sexual partner, she would hardly have had consented to having unprotected intercourse, says the Federal court.