July 1st, 2015
by Janet Madsen | @janet_madsen
Earlier this week the headlines announced that Cuba is the first country to eliminate mother to child transmission (MTCT) of HIV. Excellent, excellent . This is great news in two ways- it indicates that women are getting thorough prenatal care, and that also means care for the baby once they’re born.
Prenatal care includes testing all pregnant women for HIV and other STIs as a start. If a woman does test positive for HIV, care will include tracking viral load, getting her on pregnancy-friendly HIV treatment to minimize the possibility of transmission to the baby during pregnancy and during birth, and giving the newborn preventative HIV treatment in the early days of their life. Babies are tested for HIV and followed with medical care to ensure they are HIV free.
These are the simple aspects of prenatal HIV care in Canada too, where healthy babies are born to moms with HIV all the time. In BC, Oak Tree Clinic offers positive women prenatal counseling to make pregnancy as healthy as possible. For women who learn their status during pregnancy, their care at Oak Tree will be comprehensive to ensure the best outcomes for mom and babe.
If you read past the headline on Cuba’s success, you’ll see that it doesn’t mean MTCT is completely gone- how could it be? Some women will miss out on care if they miss a prenatal diagnosis, there’s lack of access to health care, or other factors. The later in pregnancy HIV is diagnosed, the more challenging it is to bring the viral load down to ideal levels to prevent transmission. Unfortunately, some babies will be infected with HIV.
Cuba worked to increase access to prenatal testing and diagnosis for HIV and syphilis and ensured women had treatment during pregnancy. To qualify for the World Health Organization criteria, Cuba had to show there were fewer than 50 cases per 100,000 live births for at least 1 year. This article notes that the US and Canada probably qualify too, but haven’t applied for the validation. Canada has significantly reduced rates of mom to child transmission over the years as diagnosis and treatment have improved.
June 25th, 2015
by Erin Seatter | @erinlynds
Guided by the principle that “harmonizing laws with human rights standards can foster the promotion of sexual health,” the World Health Organization’s recently released report Sexual Health, Human Rights and the Law combines research in these areas with a focus on public health.
It makes clear that repercussions follow from criminalizing HIV exposure and transmission, with no documented benefits. In fact, it says, “such laws may actually increase rather (than) decrease HIV transmission.”
“Contrary to the HIV-prevention rationale that such laws will act as a deterrent and provide retribution, there is no evidence to show that broad application of the criminal law to HIV transmission achieves either criminal justice or public health goals,” states the report. Instead, these laws contribute to stigma and fear, dissuade people from HIV testing, and weaken public health interventions.
HIV laws have gendered effects, as noted in the report.
Because women tend to use health care more than men, they often learn they have HIV before their male partners are tested. “For many women it is either difficult or impossible to negotiate safer sex or to disclose their status to a partner for fear of violence, abandonment or other negative consequences,” states the report, “and they may therefore face prosecution as a result of their failure to disclose their status.”
To guide law and policy makers in the area of HIV and the law, the report outlines a question of concern. “Does the state consider that establishing and applying specific criminal provisions on HIV transmission can be counter-productive for health and the respect, protection and fulfilment of human rights, and that general criminal law should be used strictly for intentional transmission of HIV?”
In other words, when you set law and policy, do you care that HIV criminalization is damaging for health and human rights?
For a number of countries, the current answer is no.
In Canada, a person with HIV can be prosecuted for not disclosing their HIV+ status prior to sex. The only exception provided by the law is when a person can prove they used a condom and had a low viral load (1,500 copies/mL or fewer) at the same time.
The current law arose from a Supreme Court of Canada ruling in 2012, prior to which the legal disclosure obligations of people living with HIV were less strict. The Canadian trend has been to harden the laws, contrary to medical advancements that reduce the likelihood of HIV transmission.
Echoing the recommendations of human rights organizations and United Nations agencies, the World Health Organization says that “governments should expand programmes that have been proven to reduce HIV transmission while protecting the human rights both of people living with HIV and those who are HIV-negative.”
Canadian courts, prosecutors, and governments would do well to add Sexual Health, Human Rights and the Law to their stack of reading.