Research and action on #HIVcriminalisation (#HIVcrim) and #HIVlaw were well represented at #AIDS2022: I've summarised some highlights in this #thread. 

[#HIVcrim = the use of the criminal law against people living with HIV (PLHIV), usually in allegations of transmission, exposure or nondisclosure, but also in relation to sex work, blood donation etc. As with criminalisation of gay sex, drug use etc, it's highly problematic]

1️⃣ GLOBAL: just before the conference, @HIVJusticeNet released 'Advancing #HIVJustice 4' (AHJ4), a global survey of the state of #HIVcrim. HJN tracked 275 cases in 39 countries over a three-year period, but estimates the true number to be over 700. https://www.hivjustice.net/publication/advancing4/

Certain countries (including Australia) have been identified as #HIVcrim 'hotspots' due to larger numbers of cases. While cases in some counties like Canada have declined recently, eastern Europe and Central Asia continues to be overrepresented. 

A poster by @edwinjbernard et al highlighted the findings from AHJ4. "We found that HIV-related arrests, prosecutions and convictions disproportionately impact marginalised populations and those in a position of vulnerability," they wrote. https://programme.aids2022.org/Abstract/Abstract/?abstractid=7925

2️⃣ THE HOST COUNTRY: Canada has a bad record for #HIVcrim. The Supreme Court here has held that people with HIV must disclose their status, even if there's a tiny risk of transmission, or face charges of aggravated sexual assault. At least 240 people have been criminalised.

That ignores the science that shows that people with undetectable viral load can't pass HIV on, regardless of whether a condom is used – that's the #UequalsU message, and it's globally accepted to be scientific fact: https://pubmed.ncbi.nlm.nih.gov/30044059/ 

The Canadian Coalition to Reform HIV Criminalization is working to change the law. With consultations on law reform due to start this year, the CCRHC launched a community consensus statement setting out their demands. You can read it here: http://www.hivcriminalization.ca/2022-consensus-statement/ 

At #AIDS2022, Richard Elliott of @HIVlegal spoke about the work being done and next steps. "The law is out of step," he said. "It causes any number of harms." The statement sets out four principles for legislative reform. 

Léa Pelletier-Marcotte of @COCQSIDA explained in a poster how engagement of people with lived experience of #HIVcrim has been essential in getting the Canadian government to open consultations. https://programme.aids2022.org/Abstract/Abstract/?abstractid=4507

I was lucky enough to attend the launch of the statement, hosted by @COCQSIDA and @gnpplus. By chance, the Canadian health minister @jyduclos was passing by and was asked to commit to action. The response was unedifying: 
https://twitter.com/paulkidd/status/1554197127835914240?s=21&t=WjN6FnANXdevGABh_ZBLfA

What's next? #AIDS2022 shone a light on the terrible way the #HIVcrim law has evolved there, but there's no guarantee things will improve. I met Senator @SenCormier at the conference: he seems engaged and supportive of reform: 

https://twitter.com/sencormier/status/1554473305855467520?s=21&t=WjN6FnANXdevGABh_ZBLfA

3️⃣ KERRY THOMAS. I think this will be my abiding memory from #AIDS2022. Kerry has been in prison since 2009 on #HIVcrim nondisclosure charges. He moderated one of the conference sessions with grace and aplomb – from inside his Idaho prison.

Stories like Kerry's are so important; we have to try to lift up the lived experience of people with HIV, not just in #HIVcrim advocacy but across so many sectors. In this session, his presence as moderator was a driver of that. Background from 2012: https://www.youtube.com/watch?v=z3JSP2dKvmc

4️⃣ HIV CRIMINALISATION IN AFRICA. A number of presentations showed what great work is being done across Africa, often in the face of considerable obstacles. @BoemoSekgoma of @sadcpf talked about the critical work of NGOs engaging with parliaments to drive change.

A key development has been the publication of the Model Law on HIV and AIDS in Southern Africa (https://www.sadcpf.org/index.php/en/component/k2/25-model-law-on-hiv-and-aids-in-southern-africa). While progress has been slow, the Model Law helped in repealing #Zimbabwe's HIV-specific criminal law (s79) recently.

Munya Mandipaza of @INERELA_SEC spoke about the role faith-based orgs have played in Africa, helping to drive reforms not only in Zimbabwe, but also making progress in Mozambique, Malawi and the DRC. FBOs have a long-term presence in Africa and can be key allies, she said.

Of course, faith-based orgs also have a history of homophobia and discrimination that has been a barrier to action on AIDS. Paul Ayamah of @ghanaids painted a chilling picture of the potential impact of a proposed anti-gay law on the HIV response in #Ghana. 

Gay sex is already illegal in Ghana, but the Ghanaian parliament is considering an atrociously anti-gay bill that would criminalise promotion of positive messages about LGBTIQ+ people, or even being allies. You can read about it here: https://www.theguardian.com/global-development/2022/aug/03/explainer-what-makes-ghana-draft-anti-gay-lgbtq-bill-so-extreme

#Ghana has only a small LGBTIQ+ population, Ayamah said, but MSM are massively overrepresented in HIV stats. The Bill is expected to have a devastating impact; they're already struggling to reach the 90-90-90 targets. Queer people and service providers are justifiably nervous.

.@tabengm spoke about the work of the African Regional Judges' Forum. They've developed training resources to help improve understanding of issues facing PLHIV and key populations. Those resources helped reverse a guilty verdict in this breastfeeding case: https://malawilii.org/mw/judgment/high-court-general-division/2016/656

5️⃣ HIV CRIMINALISATION IN EASTERN EUROPE. Svitlana Moroz of Eurasian Women's Network on AIDS, Ukraine spoke about the experience of women and other key populations of #HIVcrim in EECA countries, arguing it increases the risk of violence and exacerbates gender inequality.

A poster from Natalia Sidorenko of EWNA provided a chilling insight into how prevalent violence against women living with HIV is in Eastern Europe. The threat of #HIVcriminalisation is used to trap women in abusive relationships. 

6️⃣ HIV CRIMINALISATION IN AUSTRALIA. A trio of posters from my Aussie colleagues showed that we still have work to do to combat #HIVcrim here. 

Vikas Parwani of @halcNSW presented a case-study of a client who, while ultimately not convicted, was the first known prosecution under NSW's new mandatory precautions law (s79). 'I followed the law and it still ruined my life," the client says. https://programme.aids2022.org/Abstract/Abstract/?abstractid=4252

(S 79 was amended in 2018 to remove a mandatory disclosure requirement. Unfortunately it was replaced with a requirement that PLHIV take 'reasonable precautions' to prevent HIV, or face criminal sanctions. @nicheholas and I argued at #AIDS2018 that this was a backward step.)

Alex Stratigos @halcNSW and Aaron Cogle @napwha had a poster about the proliferation in Australia of anti-scientific mandatory testing laws for people who spit at police officers. They are based on 'misplaced fear', they argue. https://programme.aids2022.org/Abstract/Abstract/?abstractid=5789

A poster from @FelixDelhomme and colleagues also looked at the campaign against the introduction of these laws, conceding ruefully, 'we failed'. Their 'lessons learned' section shows the importance of remaining vigilant and acting in solidarity. https://programme.aids2022.org/Abstract/Abstract/?abstractid=7444

7️⃣ CRIMINALISATION OF BLOOD DONORS. An aspect of #HIVcrim that gets too little attention was the subject of an audit of laws conducted by @HIVJusticeNet. I did a whole thread about that work: https://twitter.com/paulkidd/status/1554478071222513666?s=21&t=WjN6FnANXdevGABh_ZBLfA 

8️⃣ THE WRAP-UP. #HIVcrim research and advocacy was very visible at #AIDS2022, perhaps more so than ever before. Progress is painfully slow, but great work is being done. Kudos to @MatthewWeait63 whose leadership no doubt helped to highlight that work.

You can read the unrolled version of this thread here: https://typefully.com/paulkidd/x1Kt274

HIV Criminalisation at AIDS 2022

Important new guidance on treatment of #MPXV (#monkeypox) in people living with #HIV: https://www.cdc.gov/mmwr/volumes/71/wr/mm7132e4.htm. Some key points summarised below.

🦠 we don't know if having HIV (by itself) makes you more likely to get MPXV, but we do know that people living with HIV are overrepresented among MPXV statistics in the current outbreak. Somewhere between 28% and 51% of MPXV cases are in people living with HIV (PLHIV).

🦠 people living with HIV (PLHIV) do tend to have higher rates of sexually-transmissible infections (STIs), so the MPXV stats might reflect the fact that MPXV is an STI (don't @ me) or there might be other biological factors at play. It's too soon to tell.

🦠 there are no known interactions between either the MPXV vaccine or the antiviral drug tecovirimat, so people taking HIV treatment, PrEP or PEP should continue to take that treatment as normal. 

🦠 for PLHIV with advanced HIV illness/who are immunocompromised, the CDC thinks it's likely that they will have more serious complications from MPXV and/or potential fatalities, but the data is limited. 

🦠 the CDC treatment recommendation is that PLHIV with MPXV should continue (or start) ARV treatment, and should be considered for tecovirimat if they have low CD4 counts or have more serious MPXV illness. 

🦠 on vaccination, the CDC guidance states that the MVA-BN vaccine (Jynneos) has been shown to be both safe and effective in PLHIV with CD4+ counts over 200. For people with low CD4+ counts, effectiveness is unknown. 

🦠 the older ACAM2000 vaccine is *not* recommended in people living with HIV.

🦠 importantly, while we have good data that shows that MVA-BN triggers a good immune response for MPXV in both HIV-positive and HIV-negative people, we still don't know for sure how well it protects against MPXV infection. No vaccine is 100% effective in real-world use. 

🦠 for people diagnosed with MPXV, the CDC states that both HIV-positive and -negative people should follow the same isolation guidance, including isolating from pets who may be infected and become reservoirs.