Building persuasive evidence

How can the social sciences support global anti-criminalisation advocacy?

Working paper prepared for HIV Prevention and the Criminal Law workshop,
Toronto April 26-28, 2013, by
Edwin J Bernard, Co-ordinator, HIV Justice Network

Introduction
Overthepastdecade,numerousnationalandinternationalagencieshave
undertakenmeasurestoincreaseunderstandingofandaddresstheapplication
ofthecriminallawtoindividualcasesofallegedHIVnondisclosure,potentialor
perceivedHIVexposureortransmissionHIVcriminalisationthroughthe
commissioningofresearch,coordinationofmeetings,developmentofpolicy
guidance,andpublicationofreportsandotherwebbasedresources. 1

MorerecentlyimportantglobalsummariesofthestateofHIVcriminalisation
havebeenpublished,includingthosebytheGlobalNetworkofPeopleLiving
withHIV(GNP+)in2010 2 andthoseproducedfortheGlobalCommissiononHIV
andtheLaw 3 andUNAIDS 4 in2011.

Thepast18monthsinparticularhasseensignificantinternationalactivities
focusedonevidenceandconsensusbuilding,andadvocacy,againstHIV
criminalisation,including:theGlobalCommissiononHIVandtheLawprocess
andreport(20102012) 5 ;amajorprojectledbyUNAIDS(20112013) 6 ;the
launchofIPPF's'CriminalizeHate,NotHIV'website(December2011) 7 ;theOslo
DeclarationonHIVCriminalisation(February2012) 8 ;andtheupdateandre
launchofbothGNP+'sGlobalCriminalisationScanwebsite(September2012) 9
andtheHIVJusticeNetwork'swebsiteandnewsletter(November2012) 10 .

1ImportantpublishedworktodateincludesUNAIDSCriminalLaw,PublicHealthandHIV

Transmission:APolicyOptionsPaper(2002)andtheUNAIDS/UNDPCriminalizationofHIV
transmissionPolicyBrief(2008);GlobalCriminalisationScansin2005,2008and2010bythe
GlobalNetworkofPeopleLivingwithHIV(GNP+);VerdictonaVirus(2008)bytheInternational
PlannedParenthoodFederation,InternationalCommunityofWomenLivingwithHIV/AIDS,and
GNP+;TenReasonstoOpposetheCriminalizationofHIVExposureorTransmissionbytheOpen
SocietyFoundations(2008);10ReasonsWhyCriminalisationofHIVExposureorTransmission
HarmsWomenbytheATHENANetwork(2009);andthe2010ReporttotheHumanRights
CounciloftheSpecialRapporteurontherightofeveryonetotheenjoymentofthehighest
attainablestandardofphysicalandmentalhealth.
2CameronS&ReynoldsL.TheGlobalCriminalisationScanReport2010:Documentingtrends,
presentingevidence,GNP+,2010.
3WeaitM.TheCriminalisationofHIVExposureandTransmission:AGlobalReview.and
WorkingPaperpreparedfortheThirdMeetingoftheTechnicalAdvisoryGroup,Global
CommissiononHIVandtheLaw,79July,2011.
4UNAIDS.CriminalisationofHIVNonDisclosure,ExposureandTransmission:Backgroundand
CurrentLandscape,Geneva,2011
5Availableat:http://www.hivlawcommission.org/
6Thisprojectincludedtheproductionofresearchmaterialsandtheholdingoftwointernational
consultationsinGeneva(31August2September2011)andinOslo(1415February2012).
7Availableat:http://www.hivandthelaw.com
8Available:http://www.hivjustice.net/oslo/
9Availableat:http://www.gnpplus.net/criminalisation/
10Availableat:http://www.hivjustice.net/

Building persuasive evidence

However,despitetheseactivities,inappropriateandoverlybroadnewlaws
aimedatpunishingandcontrollingpeoplelivingwithHIVcontinuetobe
proposedand/orenactedinBotswana,11 DominicanRepublic 12 ,Germany
(SaxonyAnhalt 13 ),Uganda 14 andtheUnitedStates(Arizona 15 andKansas 16 ).

Inaddition,twoimportantprocessesgreatlyanticipatedbyadvocatesworking
toendinappropriateHIVcriminalisationproduceddisappointingresults.In
October2012,theSupremeCourtofCanadaruledthatindividualswhoknow
theyareHIVpositiveareliabletocriminalprosecutionforaggravatedsexual
assaultiftheydonotdisclosethisfactpriortosexthatmayriska"realistic
possibilityoftransmissionofHIV",statingthatthedutyforanHIVpositive
individualtodisclosecanbeexempted,butonlywhenacondomisusedandthe
individualalsohasalowviralload. 17 Therulingwasseverelycriticisedasa
majorstepbackwardsforpublichealthandhumanrightsbyacoalitionofcivil
societyintervenersinthetwocasesunderappeal. 18

Ofnote,theSupremeCourtwasnotconvincedbyargumentshighlightinga
potentialnegativepublichealthimpactpresentedtheinterveners 19 :
SomeintervenerschallengetheuseofthecriminallawinthecaseofHIVonthe
groundthatitmaydeterpeoplefromseekingtreatmentordisclosingtheir
condition,therebyincreasingthehealthrisktothecarrierandthosehehassex
with.Ontherecordbeforeus,Icannotacceptthisargument.Theonlyevidence
wasstudiespresentedbyintervenerssuggestingthatcriminalizationprobably
actsasadeterrenttoHIVtesting:see,e.g.,M.A.Wainberg,CriminalizingHIV
transmissionmaybeamistake(2009),180C.M.A.J.688.Otherstudiessuggest
littledifferenceinreportingratesinstatesthatcriminalizedanddidnot
criminalizebehaviour:S.Burris,etal.,DoCriminalLawsInfluenceHIVRisk
Behavior?AnEmpiricalTrial(2007),39Ariz.St.L.J.467,atp.501.The
conclusionsinthesestudiesaretentative,andthestudieswerenotplacedin
evidenceandnottestedbycrossexamination.Theyfailtoprovideanadequate

11BotswanasdraconianPublicHealthBillapprovedbyParliament,BONELAwillchallengeitas

unconstitutionaloncePresidentsignsintolaw.HIVJusticeNetwork,5April2013.
12BellocqJHControversialAIDSlawpassedinDominicanRepublic.InternationalAIDSAlliance,
20June2012.
13StateconsidersforcedHIVandhepatitistests.TheLocal,30November2012.
14BassudeE.HIV/AIDSbillalmostready.NewVision,1December2012.
15PeickS.BillseeksfelonychargeforintentionallyexposingotherstoHIV,STDs.CronkiteNews,
24January2013.
16RothschildS.ProtectionfromquarantineforHIV,AIDSpatientsisdiscriminatory,statesenator
says.LawrenceJournalWorld,3April2013.
17BernardEJ.SupremeCourtofCanadarulesthatcondomsalonedonotpreventa'realistic
possibility'ofHIVtransmission.Aidsmap.com8October2012.
18CanadianHIV/AIDSLegalNetwork,HIV/AIDSLegalClinicOntario(HALCO),Coalitiondes
organismescommunautairesqubcoisdeluttecontrelesida(COCQSIDA),PositiveLiving
SocietyofBritishColumbia(PositiveLivingBC),CanadianAIDSSociety(CAS),TorontoPeople
withAIDSFoundation(PWA),BlackCoalitionforAIDSPrevention(BlackCap),andCanadian
AboriginalAIDSNetwork(CAAN)See:
http://www.aidslaw.ca/publications/interfaces/downloadFile.php?ref=2055
19
Rv.Mabior,Rv'DC',SupremeCourtFactum:Interveners
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Building persuasive evidence

basistojustifyjudicialreversaloftheacceptedplaceofthecriminallawinthis
domain. 20

Thesamemonth,afterspendingalmosttwoyearsexaminingeveryaspect
ethical,legal,medical,socialandscientificoftheuseofthecriminallawto
punishandregulatepeoplewithcommunicablediseases(withaspecificfocuson
HIV)theNorwegianLawCommissionrecommendedthatNorwaycontinuesto
essentiallycriminaliseallunprotectedsexbypeoplelivingwithHIVregardlessof
theactualriskandregardlessofwhetherornottherewasintenttoharm.The
onlydefencewrittenintothesuggesteddraftlawisfortheHIVnegativepartner
togivefullandinformedconsenttounprotectedsexthatiswitnessedbya
healthcareprofessional. 21

TheCommissionwasalsonotpersuadedbyoralandwrittentestimonyandany
existingresearchintotheunintendedpublichealthandhumanrightsimpactof
HIVcriminalisation.

TheCommissionhasfoundlittlescientificevidenceoftheeffectsofcriminal
regulationofinfectiontransmissionandexposure,andthusofthevalidityofsome
oftheconsiderationsandargumentsthatarementioned.Itishardtofindgood
researchmethodsforansweringsuchquestions.Thisappliesnotonlytothelegal
areainquestion,butalsotothegeneralintendedandunintendedeffectsoflaws.
Fewornostudieshaveconvincinglydocumenteddirectlinksbetweencriminal
regulationandinfectedpersonsbehaviourandperceptionofdiscriminationor
stigmatisation,orlinksbetweencriminalregulationandnoninfectedpersons
(possiblyundiagnosedpersons)choiceofprotectivestrategiesandwillingnessto
undergotesting.Thismeansthatitisdifficulttocarryoutathoroughassessment
ofthevalidityofthearguments,includingthequestionofwhetherpenalprovisions
ofthisnaturehavetheintendedgeneraldeterrenteffectand/oradeterrenteffect
onindividuals. 22
Persuasiveevidenceofthe(unintended)harmfuleffectsofHIVcriminalisationto
publichealthandhumanrightsiscentraltoadvocatingforchangesinlawsor
policiesrelatingtoHIVandthecriminallaw.

CommonlycitedunintendedpublichealthimpactsofHIVcriminalisationcanbe
summarisedas:
IncreasingHIVrelatedstigma
MisunderstandingandoverstatingHIVrelatedrisksandharms
CreatingafalsesensethatHIVissomeoneelsesproblem
Providingafurtherdisincentivetoknowone'sHIVstatus
ProvidingafurtherdisincentivetodiscloseknownHIVpositivestatusto
sexualpartners
ProvidingadisincentivetodiscloseHIVrelatedriskbehavioursto
healthcareprofessionals

20

SupremeCourtofCanada.R.v.Mabior,2012SCC47[2012]2S.C.R.584at[59]

21CairnsG.ViralloadwillbenodefenceagainstprosecutionforHIVexposureortransmissionin

Norway.Aidsmap.com,20October2012.
NorwegianLawCommission.Ofloveandcoolingtowers.NOU2012:17Vedlegg3,p.336

22

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Building persuasive evidence

CommonlycitedunintendedhumanrightsimpactsofHIVcriminalisationcanbe
summarisedasfollows:
IncreasingHIVrelatedstigma
SelectiveprosecutionofHIV
Arbitrary,adhocandinconsistentprosecutionofpeoplewithHIV
DisproportionateimpactonwomenwithHIV
Potentialforblackmail,controlorabuse
Inappropriateandinsensitivepoliceinvestigations
Inappropriateandinsensitivemediareporting

However,notallevidenceisequallypersuasiveandmaybejurisdictionor
populationdependant.Givenalackofresources,anyevidencegatheredneeds
tonotonlyshowthatHIVcriminalisationdoesmoreharmthangoodintermsof
itsimpactonpublichealthand/orhumanrights,butalsoberelevantforcaseor
jurisdictionspecificadvocacy.

Inotherwordsforsuchevidencetobefitforpurposewemustensurethatany
researchintotheimpactsofHIVcriminalisationisframedtoprovidemaximum
impactanddeliveredbytherightpeopletotherightpeople.

Surveydesign
Inordertobetterunderstandhowadvocateshaveusedevidencetopersuade
policymakersand/orcriminaljusticesystemactorstorepeal,reformand/or
createimprovedoutcomesforpublichealthand/orhumanrights,leading
advocatesinfourjurisdictionswheresuchpositivechangesaretakingplace
and/orhavealreadyoccurred(Victoria,Australia;Denmark;England&Wales;
andIowa,UnitedStates)wereaskedtotakepartinasurveyhostedon
SurveyMonkey.comwhichaskedthefollowingeightquestions.

1. Pleasebrieflysummarisethepositivechangeseffectedbyyouandother
advocatesinyourcountry/staterelatingtoHIVcriminalisation.
2. Howimportantwasevidencefromthesocialsciences(i.e.studiesthat
showedaneutralornegativeimpactonHIVcriminalisationonpublic
healthand/orhumanrights)inyourabilitytopersuadepolicymakers
and/orcriminaljusticesystemactorstomakethepositivechange?23
3. Howpersuasiveweregeneralisednegativepublichealtharguments(e.g.
addeddisincentivetoknowordiscloseHIVstatus,falsesenseofsecurity
regardingresponsibilityforHIVprevention)comparedwithmore
focusednegativepublichealtharguments(e.g.impactonhealthcare
workers'abilitytoeffectivelycounselpatients)?
4. Howpersuasiveweregeneralnegativehumanrightsarguments(e.g.
singlingoutpeoplewithHIVforunusuallyharshpunishment)compared
withmorefocusednegativehumanrightsarguments(e.g.policeormedia
notkeepingindividualcomplainant'sconfidentiality)?
5. Didyouusesocialscienceevidencefromoutsideofyourowncountryor

23

Thisrequiredaresponseonafourpointscale.1.Notatall.2.Somewhat3.Very4.Invaluable.

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Building persuasive evidence

state?Ifyes,pleaseexplainhowyouarguedthatitappliedinyour
context.Ifno,pleaseexplainwhyyoudidnot.
6. Weretheregapsintheevidenceforwhichyouwishedyouhaddata?If
so,whatwerethey?
7. Didanyevidence'backfire'and/orresultinunexpectedorunwanted
outcomes?(Forexample,didevidencethatHIVcriminalisationnegatively
affectedHIVtestingresultinpolicymakersfindingwaystopotentially
criminaliseuntestedindividuals.)
8. Isthereanythingelseyou'dliketoshareaboutyourexperienceofusing
socialscienceresearchinyourHIVcriminalisationadvocacy?

AdvocatingforLawReform
Lawreformisfrequentlyacumbersomeprocessinvolvingtheestablishmentof
relationships,thedevelopmentofpartnerships,andtheformulationofevidence
intoargumentsgoodenoughtoconvincedisparatepoliticianswithawatchful
eyeontheviewsoftheelectorate.

Severalagencieshavedevelopedstrategiestoargueforthereformoflaws
criminalisingHIVnondisclosure,exposureand/ortransmission.Theirwork
includedthedevelopmentofmediastrategiestobettereducatethegeneral
public;communityforumstoincreaseunderstandingamongkeystakeholders;
meetingswithpoliticiansandpublicservantstoensuretheywereinformedof
currentevidence;developmentofnetworkstobroadenthelobbybase(including
drawingcliniciansintothefold);andthecommissioningandpublishingof
evidence,includingtestimonyfromsomewhohadbeenprosecuted.Insome
locales,theiradvocacyhasproducedimpressiveresults.Inothers,theprocess
continues.

Denmark
InFebruary2011,DenmarksuspendedArticle252oftheCriminalCodepending
aninquirybyaGovernmentworkinggrouptoconsiderwhethertheonlyHIV
specificlawinWesternEuropeshouldberevisedorabolished. 24

Therehadpreviouslybeenatleast20prosecutionsandatleastfifteen
convictionsforeithersexualHIVexposureortransmissionunderArticle252,
includingtwoasrecentlyas2008. 25 InAugust2012,amanlivingwithHIVwho
hadpreviouslybeenfoundguiltyunderthestatutehadhiscaserevieweddueto
thelaw'ssuspensionandwassubsequentlyacquitted.Hisprisonsentencewas
reducedtosixmonthsbasedonlyhisconvictionforother,drugrelated,offences.
ThecourtsarenowintheprocessofreviewingallHIVrelatedcriminalcases
from2007theyearthatNationalBoardofHealthinformedtheMinistryof
JusticethatHIVwasnolongeralifethreateningillness. 26

24HIVJusticeNetwork.Denmark:JusticeMinistersuspendsHIVspecificcriminallaw,setsup

workinggroup.February17,2011.
25GlobalCriminalisationScan:Denmark.GNP+.October2012
26HIVJusticeNetwork.Denmark:Manconvictedin2007undernowsuspendedlawacquitted;
furthercasestobereviewed.August8,2012.
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Building persuasive evidence

ThelawwassuspendedbecausetheNationalBoardofHealthhadinformedthe
MinistryofJusticethatHIVwasnolonger,asthelawspecified,alifethreatening
andincurabledisease,citingdatafromaDanishcohortstudypublishedin2007
whichfoundthatforpeoplelivingwithHIVinDenmarkwhoareontreatment,
HIVhadbecomeamanageable,chronichealthcondition. 27

TheworkinggroupconfirmedinNovember2011thatthelegalbasisforthe
currentstatutenolongerexistedandrecommendeditsrepeal.Althoughthey
suggestedwordingforanewlawthatwouldcriminaliseHIVnondisclosure
unless"suitableprotection"wasusedandrecommendedthatthecurrent
maximumsentenceofeightyearsinprisonshouldbereducedtotwoyears,no
newlawhasbeenenactedtodate. 28

Ofnote,civilsocietyadvocacy,ledbyNGOAIDSFondetandtheDanishpeople
livingwithHIVorganisation,HIVDenmark,playedanimportantpartinthe
suspensionofArticle252.Followingthepublicationofthe2007dataonlife
expectancy,theydevelopedastrategytopersuadetheGovernmentthatscientific
advanceshadmadethelawobsolete.Oncethelawhadbeensuspendedthey
focusedtheiradvocacyonensuringthatnonewlawreplacedit.Theiradvocacy
campaigncoveredarangeofactivitiesincluding:

BuildingnetworksoffriendlymedicalHIVspecialistsand
parliamentarians;
Writingandplacingarticlesinnationalnewspapersincooperationwith
parliamentariansandHIVclinicians;
Meetingwith,andwritingto,ministers,parliamentariansandthe
NationalBoardofHealth;
Organisinganationalconferencewithapaneldebateondecriminalising
HIVwithparliamentariansinattendance;and
Connectingtointernationalnetworksworkingonthesameissuesand
collectingsignaturesfrom122organisationsfromallovertheworld,
endorsingalettertotheMinisterofJusticeandtheministerofHealth
congratulatingtheministersontheirdecisiontosuspendtheDanish
PenalCodeandaskingthemtoconsidernoreplacementfollowingits
repeal. 29

Surveyresponses(ExecutiveDirector,AIDSFondet)
1. Pleasebrieflysummarisethepositivechangeseffectedbyyouandother
advocatesinyourcountry/staterelatingtoHIVcriminalisation.
TheprovisiononHIVcriminalisationwassuspendedFeb.2011
2. Howimportantwasevidencefromthesocialsciences(i.e.studiesthat
showedaneutralornegativeimpactonHIVcriminalisationonpublic

27LohseNetal.SurvivalofpersonswithandwithoutHIVinfectioninDenmark,19952005.

AnnalsofInternalMedicine:146:8795,2007.

28HIVJusticeNetwork.Denmark:HIVtoberemovedfromArticle252,butnewstatutewording

mayrecriminalisenondisclosurewithoutsuitableprotection.November10,2011.
29AIDSFondet.SubmissiontoGlobalCommissiononHIVandtheLawHighIncomeCountry
Dialogue.Oakland,September2011.

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Building persuasive evidence

3.

4.

5.

6.

7.

8.

healthand/orhumanrights)inyourabilitytopersuadepolicymakers
and/orcriminaljusticesystemactorstomakethepositivechange?
2.Somewhat
Howpersuasiveweregeneralisednegativepublichealtharguments(e.g.
addeddisincentivetoknowordiscloseHIVstatus,falsesenseofsecurity
regardingresponsibilityforHIVprevention)comparedwithmore
focusednegativepublichealtharguments(e.g.impactonhealthcare
workers'abilitytoeffectivelycounselpatients)?
MostpersuasivewastheargumentondisincentivetoknowyourHIV
status.
Howpersuasiveweregeneralnegativehumanrightsarguments(e.g.
singlingoutpeoplewithHIVforunusuallyharshpunishment)compared
withmorefocusednegativehumanrightsarguments(e.g.policeormedia
notkeepingindividualcomplainant'sconfidentiality)?
SinglingoutpeoplewithHIVwasthemorepersuasiveargument.
Didyouusesocialscienceevidencefromoutsideofyourowncountryor
state?Ifyes,pleaseexplainhowyouarguedthatitappliedinyour
context.Ifno,pleaseexplainwhyyoudidnot.
InrecentdiscussionswithpoliticiansonthefutureofHIV
criminalisationinDenmarkIincludedsocialsciencefromCanada
andtheUS.Especiallysocialscienceshowingthatcriminalisation
deterspeoplefromtestingnotleasttheoneshavingthemostrisky
sexualbehaviourandthereforeexactlytheoneswewanttotestthe
most.ItwasneverquestionedifthisalsoappliedinaDanishcontext.
Weretheregapsintheevidenceforwhichyouwishedyouhaddata?If
so,whatwerethey?
Ohyes.WeneedmuchmoreevidenceonhowHIVcriminalisation
hinderspreventionefforts,makepeoplewithHIVnotwantto
discloseandhowitleadstostigmaofpeoplewithHIV.
Didanyevidence'backfire'and/orresultinunexpectedorunwanted
outcomes?(Forexample,didevidencethatHIVcriminalisationnegatively
affectedHIVtestingresultinpolicymakersfindingwaystopotentially
criminaliseuntestedindividuals.)
[Notanswered]
Isthereanythingelseyou'dliketoshareaboutyourexperienceofusing
socialscienceresearchinyourHIVcriminalisationadvocacy?
Noteonquestion2:Socialsciencescouldhavebeeninvaluable,but
notmuchavailableatthetimeofsuspension.

Iowa,UnitedStates
Iowarecentlybecamethefirststatetointroducelegislationthatwouldchange
its1998HIVspecificstatute,whichcurrentlyallowsfor25yearprison
sentencesandlifetimesexoffenderregistrationtoanyoneconvictedofHIVnon
disclosure,regardlessofactualrisk,intentoractualtransmission.Therehave
beenatleast25prosecutionsand15convictionsunderthislaw 30 ,includingthat

30GlobalCriminalisationScan:Iowa.GNP+.April2012

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Building persuasive evidence

ofNickRhoades,whoseappealwillbeheardatIowaSupremeCourtlaterin
2013. 31

LobbyingbyabroadcoalitionofactivistsspearheadedbyCommunity
HIV/HepatitisAdvocatesofIowa(CHAIN)andNASTADChair,RandyMayer,
chiefoftheBureauofHIV,STD,andHepatitisfortheIowaDepartmentofPublic
HealthledtotheFebruary2013introductionofSenateFile215bySenatorSteve
SoddersandSenatorMattMcCoywhichproposesmodernisingthestatute. 32

TheproposedlegislationtakesactualHIVrisk,riskreductionmethods,and
whetherornottransmissionoccurredintoaccount,andincludestwostatesof
mindmaliciousintentandrecklessdisregard.Themaximumsentencefor
transmissionwithintentwouldbe10years.Exposurewithintentwouldbe
subjecttoamaximumoffiveyearsinprison.Theproposalshavesupportfrom
healthcareprofessionals,HIV/AIDSadvocacygroups,lawenforcementandthe
Iowaattorneygeneral'sofficeaswellasfromlocalmedia. 33

InMarch2013,thelegislationpassedtheStateSenate'sJudiciaryCommittee,11
to2,pickingupallsevenDemocratsandfourofthesixRepublicans,
demonstratingthefeasibilityofbipartisansupportfortheseefforts. 34

Surveyresponses(CommunityOrganizer,CHAIN)
1. Pleasebrieflysummarisethepositivechangeseffectedbyyouandother
advocatesinyourcountry/staterelatingtoHIVcriminalisation.
InIowawehavehostedfoureducationalforumsforlegislatorsand
generalpublicthroughoutthestate.Wehavebeenabletobuildan
incrediblecoalitionofIowapartnerstohelpusadvocateforthis
change,including:IowaDept.ofPublicHealth,AttorneyGeneral's
office,ACLU,FamilyPlanningCouncil,NationalSocialWorkers
AssociationIAChapter,InterfaithAlliance,PharmacyStudent
Organization,andotherkeyhealthorganizations.SofarIowahas
gottenourbillthroughtheSenateJudiciarysubcommitteeand
Judiciarycommittee.ThebilliswaitingtobedebatedontheSenate
floor,butwehaveoneindividualwhohasintroducedanamendment
thatisnotacceptabletoadvocatesorfromapublichealthaspect.
2. Howimportantwasevidencefromthesocialsciences(i.e.studiesthat
showedaneutralornegativeimpactonHIVcriminalisationonpublic
healthand/orhumanrights)inyourabilitytopersuadepolicymakers
and/orcriminaljusticesystemactorstomakethepositivechange?
3.Very
3. Howpersuasiveweregeneralisednegativepublichealtharguments(e.g.
addeddisincentivetoknowordiscloseHIVstatus,falsesenseofsecurity
regardingresponsibilityforHIVprevention)comparedwithmore

31SeeLambdaLegal:Rhoadesv.Iowa

32SeeIowaLegislatureSenateFile215

33TheDesMoinesRegister.It'stimetorethinkIowa'sHIVsexlaw.Feb8,2013.

34PersonalcorrespondencebetweentheauthorandSeanStrub.Seealso:AP.Billreducing

penaltiesforHIVexposuremoveson.6March2013.

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Building persuasive evidence

4.

5.

6.

7.

8.

focusednegativepublichealtharguments(e.g.impactonhealthcare
workers'abilitytoeffectivelycounselpatients)?
IowawasuniqueinthattheIowaDept.ofPublicHealthwasableto
speakoutandattendthecommunityforums,notlobbyingforthe
bill,butprovidingreasoningforchangesnecessaryforpublichealth.
Thishasbeenveryimportanttous.
Howpersuasiveweregeneralnegativehumanrightsarguments(e.g.
singlingoutpeoplewithHIVforunusuallyharshpunishment)compared
withmorefocusednegativehumanrightsarguments(e.g.policeormedia
notkeepingindividualcomplainant'sconfidentiality)?
TheharshpunishmentargumenthasworkedinIowasinceoursis
theworstinthenation.Butconfidentialityhasnotbeenanargument
thathasgottenthroughtolegislatorsorpublic.
Didyouusesocialscienceevidencefromoutsideofyourowncountryor
state?Ifyes,pleaseexplainhowyouarguedthatitappliedinyour
context.Ifno,pleaseexplainwhyyoudidnot.
WeusedmostlyUSstatistics,butIleftthatuptotheIowaDept.of
PublicHealth.Thatwasreallytheirexpertise,soIcouldn'ttellyou
allsourcestheyused.
Weretheregapsintheevidenceforwhichyouwishedyouhaddata?If
so,whatwerethey?
Onethingthatwereallyneedishowsecondarydisclosurecanhurt
peoplewhoarepositivewhensomeonetakesthatinformationand
usesitasamanipulation,orjusttospreaditaroundthecommunity.
Didanyevidence'backfire'and/orresultinunexpectedorunwanted
outcomes?(Forexample,didevidencethatHIVcriminalisationnegatively
affectedHIVtestingresultinpolicymakersfindingwaystopotentially
criminaliseuntestedindividuals.)
No,notcriminalizeHIVnegativepeople,butoneamendmenthas
beentochargepeopleforlyingabouttheirstatus.
Isthereanythingelseyou'dliketoshareaboutyourexperienceofusing
socialscienceresearchinyourHIVcriminalisationadvocacy?
IhavehadadvicefromSERO,theIowaDept.ofPublicHealth,and
manyothergroups,.Iamalaypersonandreadinglongresearch
studiesisnotmycupoftea.Ifsomeonecouldwriteashortsummary
orhighlightsforthoseofuswhodonothavethetimeandtheability
tocompletelyunderstandtechnicalscienceresearch[thatwouldbe
veryuseful].Basically,dummydownreportsforthoseofuswho
wanttoreadthisinfo,butwillnotorcannotreadlengthyreports.

AddressingLegalProcesses&Enforcement
Policingpolicies,proceduresandworkforceculturesinfluencethelikelihoodof
casesinvolvingHIVnondisclosure,exposureortransmissionproceedingto
courtaswellastheexperiencesofaccusedandwitnesses.Prosecutorsinfluence
notonlywhethercasesproceedbutalsohowtheyarerun.Theexpertiseof
lawyers,judgesandmagistratesdirectlyimpactsthecourseandoutcomeof
casesaffectingscrutinyandanalysisofevidence,instructionstojuries,

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Building persuasive evidence

sentencing,andfuturetrialsthroughtheuseofprecedents.Whileprosecutions
mustbeinthepublicinterest,thepublicinterestisnotalwaysclearlydefined. 35

Innumeroussettings,advocateshaveendeavouredtoinfluenceandimprove
legalprocessesinanumberofdifferentways.Theirworkhasincluded:lobbying
forthedevelopmentofstrongprosecutorialguidelineslimitingtheapplicationof
criminallawtocasesofHIVnondisclosure,exposureortransmission;
undertakingcommunitybasedresearchontheimpactsofHIVcriminalisation;
creatingpolicystatementsandothermaterialstohelpeducatethecriminal
justicesystemonHIVrelatedrisk,harmandproof,aswellasthepotential
negativepublichealthimpactsofinappropriateprosecutions;andproviding
expertevidencetoinfluencetheoutcomeofindividualcases(andanyprecedents
theyset).

Victoria,Australia
Forsometime,theVictorianAIDSCouncil/GayMensHealthCentre
(VAC/GMHC)andLivingPositiveVictoriahaveworkedtodevelopgreater
understandingofthepredominanceofVictorianprosecutions.Theireffortshave
beenslowedbyarelativedisconnectbetweenthehealthsector(wheretheir
expertiselies)andthelegalsector(wheretrialsareinitiatedandprogressed).
Further,theVictorianhealthdepartmentfacedstrongpubliccriticismfortheir
handlingofa2009case,whereitwasarguedthecaseshouldhavebeenreferred
earlierforprosecution.Followingthreeindependentreviews,thatcriticismwas
generallyshowntobeunwarranted,withonlyminoramendmentsmadeto
elementsofthemanagementsystem.Still,thehandlingofcasesofindividuals
whoputotheratriskofHIVinfectioncontinuestobepoliticallysensitive.

Inlate2011,VAC/GMHCandLivingPositingVictoriasecuredameetingwith
staffoftheOfficeofPublicProsecutionsVictoria(OPP)tobeginadialogueabout
prosecutionsforHIVexposureandtransmission.In2012,VAC/GHMC
successfullysecuredfundingfromtheLegalServicesBoardtodevelopaproject
toinformlegalpracticeinthisarea.Theproject,toberolledoutduring2013,
willeducateprosecutorsoncurrentHIVepidemiologyandtherapidly
developingfieldofHIVscienceandmedicine.Itaimstoenhancethepublic
interestbyensuringcasesproceedonlyonthebasisofthestrongestavailable
evidence.

Theprojectwillconsultwithprosecutors,defencecounsel,andprovidersof
expertevidencetoidentifyknowledgegapseffectingHIVtrials.Itwillthen
commissionscholarlypeerreviewedarticlesontheapplicationofscience,
medicineandepidemiologyinHIVtrials.Trainingmaterialswillbedraftedand
trainingprovidedtoVictorianprosecutors.Theprojectalsoaimstodevelop
strongernetworksbetweentheOPPandtheHIVcommunitysectortoprovide
prosecutorswitharesourceandcontactpointwhenthecasesarise.

35CameronS.AustralianFederationofAIDSOrganisations.Sydney.2011.

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Building persuasive evidence

Surveyresponses(FormerPresident,LivingPositiveVictoria)

1. Pleasebrieflysummarisethepositivechangeseffectedbyyouandother
advocatesinyourcountry/staterelatingtoHIVcriminalisation.
Buildingawarenessoftheissue,developingdialoguewithjustice
agencies,monitoringcases,directadvocacy,educationof
prosecutors.
2. Howimportantwasevidencefromthesocialsciences(i.e.studiesthat
showedaneutralornegativeimpactonHIVcriminalisationonpublic
healthand/orhumanrights)inyourabilitytopersuadepolicymakers
and/orcriminaljusticesystemactorstomakethepositivechange?
4.Invaluable
3. Howpersuasiveweregeneralisednegativepublichealtharguments(e.g.
addeddisincentivetoknowordiscloseHIVstatus,falsesenseofsecurity
regardingresponsibilityforHIVprevention)comparedwithmore
focusednegativepublichealtharguments(e.g.impactonhealthcare
workers'abilitytoeffectivelycounselpatients)?
Wehavemadetheseargumentsandtheyhavebeenreceived
warmly,butthelackofstrongempiricalevidenceisaconstant
problem.Hardevidenceshowingadirectlinkbetween
criminalisationandnegativepublichealthoutcomesisveryhardto
comeby.
4. Howpersuasiveweregeneralnegativehumanrightsarguments(e.g.
singlingoutpeoplewithHIVforunusuallyharshpunishment)compared
withmorefocusednegativehumanrightsarguments(e.g.policeormedia
notkeepingindividualcomplainant'sconfidentiality)?
Notapplicableinourcase.
5. Didyouusesocialscienceevidencefromoutsideofyourowncountryor
state?Ifyes,pleaseexplainhowyouarguedthatitappliedinyour
context.Ifno,pleaseexplainwhyyoudidnot.
Wehaveto!Theresearchhasn'tbeendonelocally.Wearehopingto
getsomelocaldatasoon.
6. Weretheregapsintheevidenceforwhichyouwishedyouhaddata?If
so,whatwerethey?
ThewidespreadviewthatHIVcriminalisationreducestesting,
disclosureandincreasesstigmahaslimitedevidencetosupportit.
7. Didanyevidence'backfire'and/orresultinunexpectedorunwanted
outcomes?(Forexample,didevidencethatHIVcriminalisationnegatively
affectedHIVtestingresultinpolicymakersfindingwaystopotentially
criminaliseuntestedindividuals.)
Notyet.
8. Isthereanythingelseyou'dliketoshareaboutyourexperienceofusing
socialscienceresearchinyourHIVcriminalisationadvocacy?
[Notanswered]

UnitedKingdom
Almost25prosecutionshavetakenplaceintheUnitedKingdomunderexisting
assaultlawssince2001.ThesearesimilarforEngland,WalesandNorthern
Ireland;Scotlandhascompletelydifferentlaws.Thefirstprosecutiontookplace

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inScotlandin2001,followedbyEngland(2003)andWales(2005).Therehave
beennoprosecutionstodateinNorthernIreland.

HIVpolicyorganisationsintheUnitedKingdom(NATandTHT),lobbiedthe
CrownProsecutionService(CPS,withjurisdictionoverEnglandandWales)and
latertheAssociationofChiefPoliceOfficers(ACPO,withjurisdictionover
England,WalesandNorthernIreland)tocreatethefirsteversetsof
prosecutorialpolicy 36 andguidance 37 (firstpublishedin2008andupdatedin
2011)aswellaspoliceguidelines(publishedin2010) 38 relatingtoHIVandthe
criminallaw.

Theseguidelineshavenotonlyclarifiedtheexactcircumstancesunderwhich
prosecutionsmightbewarranted,therebyreducingthenumberofcases
reachingcourt,buttheirdevelopmentalsoledtocloserrelationshipsbeing
establishedbetweentheHIVsectorandthecriminaljusticesystemfostering
improvedadvocacyandmutualunderstanding. 39

InMay2012,followinglobbyingfromthesameHIVorganisations(withthe
additiononHIVScotland)CrownOfficeandProcuratorFiscalService(COPFS)
publishedtheirGuidanceforScotlandonIntentionalorRecklessSexual
Transmission,orExposureto,Infection. 40 Theguidancestatesthatprosecution
willbeunlikelywherethefollowingcircumstancesapply:
Theaccuseddidnotknowthathe/shewasHIVpositive.
TheaccuseddidnotunderstandhowHIVistransmitted.
TheaccuseddisclosedhisorherHIVpositivestatustothevictim.
Theaccusedtookreasonablestepstoreducetheriskoftransmission,for
example,byusingrecommendedprecautionsoravoidinghigherriskacts.
Theaccusedwasreceivingtreatmentandhadbeengivenmedicaladvice
thattherewasalowriskoftransmissionorthattherewasonlya
negligibleriskoftransmissioninsomesituationsorforcertainsexual
acts.

Itnotesthatprosecutionwillbelikelywherethefollowingcircumstancesapply:
Theaccuseddeliberatelymisledorconcealedinformationfromthe
victim.
Theaccuseddidnotattempttoreducetheriskoftransmission,for
examplebyfailingtotakeprescribedmedicationorbyfailingtofollow
particularmedicaladvice.

36See:http://www.cps.gov.uk/publications/prosecution/sti.html
37See:

http://www.cps.gov.uk/legal/h_to_k/intentional_or_reckless_sexual_transmission_of_infection_g
uidance/
38See:http://www.nat.org.uk/Ourthinking/Lawstigmaanddiscrimination/Police
investigations.aspx
39InJuly2012,theHIVJusticeNetworkproduceda30minuteeducationalandadvocacyvideo
documentary,'DoingHIVJustice:Clarifyingcriminallawandpolicythroughprosecutorial
guidance',whichdemystifiestheprocessofhowcivilsocietyworkedwiththeCrownProsecution
ServiceofEnglandandWalestocreatetheguidelines
40See:http://www.crownoffice.gov.uk/Publications/2012/05/SexualTransmissionor
ExposureInfectionProsecutionPolicy
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Building persuasive evidence

Thevictimwasparticularlyvulnerableinsomeway.
Thereisevidencethattheaccusedhadintentionallyembarkedona
courseofflagrantconduct.

AswellasbeinghelpfulinScotland,suchguidanceshouldalsobeauseful
educationalandadvocacytoolforthemanyotherjurisdictionsgloballythat
prosecutepotentialorperceivedHIVexposureaswellastransmission.

Surveyresponses(A.DirectorofPolicyandCampaigns,NAT;B.Policy
Director,THT;C.ProfessorofLawandPolicy,BirkbeckCollege,Universityof
London)
1. Pleasebrieflysummarisethepositivechangeseffectedbyyouandother
advocatesinyourcountry/staterelatingtoHIVcriminalisation.
A.Thereisbothprosecutionandinvestigationguidanceinplace
whichtakesaccountofevidentialissues,scienceandreasonable
expectationsaroundsafersexandtransmissionrisk.
B.Clarificationandcodificationofprosecutionguidelines;
clarificationandcodificationofpoliceproceduralguidelines;change
frommostpeoplepleadingguiltytomultiplenotguiltypleasand
verdictswhereevidencewasnotconclusive;andimproved
understandingoftheissuesbyPLHIV,communitiesatrisk,HIV
workers&cliniciansandtosomeextentlawmakers.
C.Consciousnessraisingaboutcriminalisationamongclinicaland
socialcareproviders,andpolicymakers,throughtalks/research
projects/events;productionofinformedprosecutionguidance;
policeawareness.
2. Howimportantwasevidencefromthesocialsciences(i.e.studiesthat
showedaneutralornegativeimpactonHIVcriminalisationonpublic
healthand/orhumanrights)inyourabilitytopersuadepolicymakers
and/orcriminaljusticesystemactorstomakethepositivechange?
A.2.Somewhat
B.2.Somewhat
C.2.Somewhat
3. Howpersuasiveweregeneralisednegativepublichealtharguments(e.g.
addeddisincentivetoknowordiscloseHIVstatus,falsesenseofsecurity
regardingresponsibilityforHIVprevention)comparedwithmore
focusednegativepublichealtharguments(e.g.impactonhealthcare
workers'abilitytoeffectivelycounselpatients)?
A.Thepublichealthargumentwasperhapseffectiveindeterringthe
CPSfromalsoprosecutingthosewho'shouldhaveknown'becauseof
theirdegreeofriskitwasmadeclearthiswouldcriminalisetensof
thousands.Theylimitedundiagnosedculpabilitytothosewhocan
bedeemedactuallytoknow.
B.Publichealthargumentshavenotbeenusefulatallbecause
criminaljusticedoesnottakeregardofpublichealth;whathasbeen
usefulisconcreteevidenceofpoorpracticeandmiscarriagesof
justice,alongwithdetailedchallengestothescientificreportsfor
theprosecution.Theonlyargumentthatinanywaysucceededwas
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Building persuasive evidence

4.

5.

6.

7.

thesomewhatspuriousclaim(withoutevidenceatthatpoint)that
needinganHIVtestbeforeaprosecutioncouldsucceedwouldlead
topeopleavoidingtestingwhichmadethemspecifythatyoudidn't
needtohavebeentestedtobeprosecuted;apotentiallyretrograde
step!
C.Notgenerallypersuasive.Risktakingandnondisclosureare
associatedwithmoralresponsibility.
Howpersuasiveweregeneralnegativehumanrightsarguments(e.g.
singlingoutpeoplewithHIVforunusuallyharshpunishment)compared
withmorefocusednegativehumanrightsarguments(e.g.policeormedia
notkeepingindividualcomplainant'sconfidentiality)?
A.Ithinktherewasabroadlyeffectivelinethattheequality,human
rightsanddiscriminationissueslinkedtoprosecutionswereso
seriousthatgreatcarehadtobetakeninidentifyinganappropriate
approachtotheseprosecutions.Theviewthatreasonable
approachestosafersexforHIVpositivepeoplewasnotdirectlya
matterfordeterminationbythecourtsbutratherforidentification
byprosecutingauthorities/courtsfromtheclinical
consensus/practicecanbeseenasaviewsensitivebothtohuman
rightsandpublichealth.
B.Notatallsofar,thoughwepersist.Thereisabasic
misunderstandingfromsocialscientistsabouthowmuchthe
criminaljusticesystem"must"beswayedbytheirgeneral
arguments.Politiciansmightbe,butlawmakersseldomare.They
respondmuchmoretoclearevidenceofmalpracticeorwastesof
timeandmoney.Theyrespondmostofalltolosingcasesbecause
theevidencewasinadequate.
C.Seeanswerto3.
Didyouusesocialscienceevidencefromoutsideofyourowncountryor
state?Ifyes,pleaseexplainhowyouarguedthatitappliedinyour
context.Ifno,pleaseexplainwhyyoudidnot.
A.No.
B.Seldom.
C.Notreally.Liabilityfornondisclosureandexposureraise
differentissues/questionsfromthoseassociatedwithtransmission.
Weretheregapsintheevidenceforwhichyouwishedyouhaddata?If
so,whatwerethey?
A.Notreally.
B.Hugegaps;thegenuinemeasurableimpact(asopposedto
anecdotalfocusgroupsofconcernedindividuals)ofprosecutions;
beingabletodirectlyexaminepolice/prosecutorialcasenotes.
C.Impactofcriminalisationontestingandaccesstoservices;impact
ofcriminalisationondisclosure.
Didanyevidence'backfire'and/orresultinunexpectedorunwanted
outcomes?(Forexample,didevidencethatHIVcriminalisationnegatively
affectedHIVtestingresultinpolicymakersfindingwaystopotentially
criminaliseuntestedindividuals.)
A.Yestherewasaconcerntoallowinexceptionalcasesof
prosecutionofanundiagnosedpersonasawaytoaddressthe

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Building persuasive evidence

disincentivetotestingargument.Morerecently,inrelationto
herpes,thechallengeastothedegreeofseriousnessinvolvedin
herpestransmission,hasmovedtheCPStoconsiderusinglesser
assaultchargestoaddressminorSTIs.
B.Seeaboveyouhaveitinone.Also,ensuringthatHIVwasnot
singledoutfromotherSTIs,whilecorrectinhumanrightsterms,has
ledtoarealtangleinprosecutionsforotherSTIs,particularly
herpes,withindividualmiscarriagesofjustice.
C.No.
8. Isthereanythingelseyou'dliketoshareaboutyourexperienceofusing
socialscienceresearchinyourHIVcriminalisationadvocacy?
A.Idon'tthinktheissuehasbeenoneofpublichealthbutoneof
justicesoargumentsaroundpublichealthimpacthavenotreally
beenthatrelevant.Particularlygiventhelackofevidenceof
seriouslyharmfulimpactsonpublichealth.
B.Hardevidenceofmiscarriagesofjusticeandhowmuchpoliceand
prosecutorialtimeisbeingwastedhasbeenmoreusefulinchanging
practicesofar.Socialsciencebasedargumentshavemostlybeen
usefulforgettingotherliberalsonboardwiththeagenda,whichin
itselfisuseful.However,toofewadvocatestrytoputthemselvesin
theshoesofthelawenforcementsideandthusfailtounderstand
whytheseargumentsseldomswaythem.
C.Thatthereisnotenough,thatwhatthereishastoonarrowabase,
thatitdoesnotengagesufficientlywith"hard"science.

Concludingthoughts
AdvocatesaroundtheworldcontinuetoaddressthecriminalisationofHIVnon
disclosure,exposureandtransmissioninmanydifferentwaysappropriateto
theirjurisdiction(s).Theirworkisnotonlyvariedintermsofthecomplex
intersectionoflaws,policiesandpracticesbutalsointermsoftheirunique
social,epidemiologicalandculturalcontexts.

Despitethemanyincrementalsuccessesofthepast18months,muchmorework
isrequiredtostrengthenadvocacycapacity.HIVcriminalisationisacomplex
issue.Itentailsadetailedunderstandingofdiverseaspectsofthecriminaljustice
system;collectionandanalysisofevidenceofthescopeandimpactof
prosecutionsacrosslocalandnationalboundaries;articulationandargument
aboutcomplexmoralandethicalissuesoftrust,blameandresponsibility;and
inclusionofHIVpreventionandhumanrightspriorities.

DevelopmentofstrategiesagainstHIVcriminalisationrelevanttoeachindividual
jurisdictionrequirestime,effortandtheinvolvementofmultidisciplinary
experts.Thisreportrepresentsonlythetipoftheiceberg:eachentryabrief
synopsisofthecountlesshoursandmanydecisionsindividualsandagencies
havededicatedtoadvocacyforgreaterjustice.Theirworkiscrucialtobuilding
aneffectiveHIVresponseandthepossibilityofaworldfreefromHIVrelated
stigmaanddiscrimination.

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Building persuasive evidence

MoreattentiontotheexperiencesofthosewhohavesurvivedHIV
criminalisationisalsorequired,aswellastheimpactofHIVcriminalisationon
theexperiencesofallpeoplelivingwithHIV.PeoplelivingwithHIVarecentral
toadvocacyagainstHIVcriminalisation.Theymustberesourcedtodevelop
sophisticatedunderstandingofHIVcriminalisationissuesandtolead
conversationswiththeirgovernmentsandwithothercivilsocietyorganisations
thatcontinuetoadvanceHIVjusticeforall.

Acknowledgments

Thispaperisbasedinpartontheforthcomingpublication,AdvancingHIVJustice:
AprogressreportofachievementsandchallengesinglobaladvocacyagainstHIV
criminalisation,writtenbyEdwinJBernardandSallyCamerononbehalfofthe
GlobalNetworkofPeopleLivingwithHIV(GNP+)andtheHIVJusticeNetwork.

Iwouldespeciallyliketothanktheadvocateswhorespondedsothoughtfullyto
thesurvey,withoutwhomthispaperwouldnothavebeenpossible.
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