By Ashraf Grimwood (Kheth'Impilo, South Africa)
“I can't even complete a full course of antibiotics, how am I going to remember to take my ART?”
Adherence is usually understood to mean ‘the taking of medication as prescribed’ at the correct time and with the correct association with meals. But managing HIV infection is more than just about taking pills – adherence is about sticking to positive lifestyle choices.
The impact of HIV starts from the time of infection and earlier treatment will go a long way in avoiding complications. But before starting treatment it is important to be mentally ready and prepared. I always recommend to my patients that soon after diagnosis, regardless of how they feel, counselling is vital. The usual response is, “What would I talk about? I know how I got infected and I know what I need to do!” I say, “Just go. Talk about anything, give time to connect with the why and the how, understand your feelings and see if you can use this positively.”
The best way of managing an HIV infection is about making the right lifestyle choices and, critically, adhering to these. Adherence is about following lifestyle choices - irrespective of what they may be - that ensure the best health outcomes. Regular monitoring, CD4 counting, STI testing, exercise and a good dietary plan are crucial for good health maintenance before even starting to take pills.
Combination antiretroviral treatment is the best known way of controlling the virus. Pills need to be taken as directed by a clinician. It is important that personal lifestyle is discussed with a health care worker to ensure there is no clash. “How do I take my pills when… I work shift work? I travel often? I take recreational drugs? I am addicted to heroin? I am on methadone? I am pregnant? My partner does not yet know I am HIV positive?” These all need to be discussed with a health care practitioner. It is important to talk through any life issues that might impact on treatment adherence. Open honest communication is always the best option to ensure better health outcomes.
When starting treatment it is important to know what is being prescribed – learn the names, understand what they do, how they work, what their side effects are and when to seek professional advice. Ensure treatment is taken at the times prescribed and know how much leeway is acceptable with regards to the timing so the margin of safety is known when travelling across time zones or working shifts.
Any day forgotten gives the virus an opportunity to rebound and any resistant strain to dominate. This can lead to multi-drug resistance and treatment failure. Treatment failure means new drugs need to be prescribed. All these treatments have different side effect profiles which need different management. It is best to remain on the initial prescribed regimen if there are no adverse effects.
There are many tools that can be used to act as reminders for taking pills on time. Using a daily treatment tick-sheet or diary, pill boxes, and cell phone reminders are a few techniques that people have found work for them. Some take their daily ART at night after brushing their teeth, so they are often kept where this is done. Some have spare pills at their workplace. Packing pill boxes once a week or getting blister pre-packs for the month are other strategies that have worked for some.
All people living with HIV today have the opportunity to lead as normal lives as possible with this infection – and adhering to medication and selected lifestyle choices is often the starting point. No doubt it’s hard to stick to these. But being honest with ourselves and with our clients is always a great start.
Article from IPPF HIV Update newsletter - Issue 24: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+24.htm
By Reuben Granich, Marco Vitoria, and Craig McClure (HIV/AIDS Department, WHO, Geneva)
Despite considerable progress, the global HIV situation remains serious. By the end of 2009, 5.2 million people were on antiretroviral treatment (ART); approximately 36 per cent of those estimated to be in need as per the new WHO recommendations. This, combined with the international fiscal crisis, has led to a growing concern regarding a weakening of the international commitment to universal access and to reaching the related Millennium Development Goals (MDG) by 2015. However, there are a number of reasons to be optimistic about our future efforts to confront HIV.
The 5.2 million people on treatment are a remarkable testament to the many outstanding examples of programmes that are doing great work on a large scale. However, our current response to HIV is often fragmented and unnecessarily complicated. This complexity often means late initiation of treatment, lack of continuum of care and increased costs for both programmes and patients. Retention of patients on antiretroviral therapy, which can mean the difference between life and death, is often hindered by our current approach to delivering treatment. Patients, where there is access to treatment, are often asked to travel great distances, wait in long queues, join lengthy waiting lists and return frequently to evaluate eligibility for treatment.
When placed on treatment, patients are often asked to adhere to difficult regimens with little hope of second line treatment in the case of toxicity or a failure to respond. Drug stock outs are also a stumbling block for adhering to ART programmes. Prevention, treatment, care and social support programmes are often in different locations and could be better integrated in order to effectively use scarce resources. There is a need to re-examine our approach to delivering prevention and treatment services to ensure easier access for people living with HIV.
Two key opportunities have the potential to hasten and expand the twin goals of saving lives and preventing new HIV infections. Firstly, the ongoing efforts to develop drug regimens and treatment strategies that will render HIV treatment easier to administer, more efficient to manage, and have a longer lasting impact for individuals and public health programmes. Secondly, it is also increasingly clear that universal access to ART can have a significant impact on HIV transmission. The potential individual and public health prevention benefits of treatment enhance the value of the universal access pledge from a life-saving initiative to a strategic investment aimed at ending the HIV epidemic.
‘Treatment 2.0’ was recently launched by UNAIDS and WHO to accelerate the simplification of ART in order to achieve and sustain universal access to treatment for all who need it and realize the significant potential for HIV and TB preventive benefits. The agenda of Treatment 2.0 involves radically simplifying drug regimens and diagnostics and monitoring, decentralizing service delivery, reducing costs and mobilizing communities.
When combined, expanding access to ART using simpler, more effective approaches and the use of ART as part of combination prevention will be critical in reaching the goals of universal access and will, most likely, result in cost savings over the medium and long term. Patient-friendly regimens should allow for improved adherence and increased access and retention to treatment. Our challenge is to understand how best to use new information regarding the role of ART for a reinvigorated, more effective and sustainable global response to AIDS. A simplified, public health approach to treatment is nothing new. WHO advanced this approach in 2003 to kick-start ART access in developing countries. Since then, the number of people on treatment has increased from 50,000 to over 5 million. What is potentially new is a renewed and intensified focus on simplification with accelerated expansion and full integration of treatment as a key aspect of HIV prevention efforts.
Article from IPPF HIV Update newsletter - Issue 24: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+24.htm
By Kevin Osborne (IPPF)
Taking any routine medication on a regular basis is challenging for us all. More so if the regimen is life-saving and adhering to it requires a life-long commitment. With antiretroviral treatment (ART) reaching more people than ever, many more are now facing this challenge. As the world recognizes both World AIDS Day (1 December) and International Human Rights Day (10 December), it is important to ensure that our programmes are improving and maintaining the health and well-being of people living with HIV, including support for treatment adherence.
As treatment reduces a person’s viral load, it also reduces the risk of onward HIV transmission. This evidence shows that treatment should be part of a combination prevention strategy or ‘treatment as prevention’ approach. Starting treatment earlier means that viral load can be reduced earlier and this, in turn, can help to avert a significant number of new HIV infections. This is one aspect of the new ‘Treatment 2.0’ platform introduced by WHO and UNAIDS.
In 2010, WHO introduced updated guidelines promoting the earlier initiation of treatment, adding an estimated five million people who are now eligible for treatment. With more people receiving treatment, there is growing emphasis on issues such as treatment retention and resistance. Once treatment is no longer effective, it may be necessary to move to second- or third-lines of treatment – a luxury still not widely available in many low- and middle-income countries.
However, reflections by Dr. Ashraf Grimwood – CEO of Kheth'Impilo and a leading HIV clinician in South Africa for many years – indicates that adherence is more than just about taking pills. While scientists develop new treatment options to improve the effectiveness and ease of use, IPPF needs to provide further support to people living with HIV – in ways big and small – to help increase overall treatment adherence rates. From supplying pill boxes and promoting individual adherence, to scaling-up community-based support services and providing adherence counselling and peer support – a variety of interventions will help to realize the promise of treatment and treatment-centred HIV prevention.
Article from IPPF HIV Update newsletter - Issue 24: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+24.htm
“I suffered stigma and discrimination both from my relatives and at my place of work. I was afraid of disclosing my status to my employer. I thought it may cost me my job.
People living with HIV need to have their rights like any other person; they need the right to privacy, for their status to be kept confidential.”
Alice Mwangi, beauty therapist from Yamumbi, Kenya.
In August 2006 Alice Mwangi filed a case. She had gone for a routine appointment at an antenatal clinic when she was tested for HIV without her consent. The test was followed by the unauthorized disclosure of her positive HIV status to her family members.
“I suffered stigma and discrimination both from my relatives and at my place of work. I was afraid of disclosing my status to my employer and their reaction to the news. I thought it may cost me my job and this would make my life more miserable.
Later I went for a tooth extraction and my father shouted to the dentist that I ‘had AIDS’. The dentist then refused to provide dental services. It was difficult for me and I had to find an alternative dentist.
In Kenya HIV transmission is described as a criminal act in the HIV Act. If a person who knows his or her status infects another person willingly or intentionally, they can be charged in a court of law.
The impact of the criminalisation of HIV transmission has made me think about my own sexual behaviour and about protecting my partner and about discussing my partner’s own HIV status. It has made me develop a positive attitude towards people living with HIV. It has also made me think about confidentiality – after all, no one wants his or her status shared without her consent.
People living with HIV need to have their rights like any other person; they need the right to privacy, for their status to be kept confidential and rights to non discrimination, to liberty and freedom of movement in terms of being protected against imprisonment, segregation or isolation in a special hospital ward. They need their right education and information: their right to access to all HIV prevention education and information, especially sexual reproductive information.
Do I think people living with HIV should disclose their HIV status before every sexual encounter? That depends on the person whom they want to disclose to, and whether this person will give support. At the same time they should insist on protection.
We should all be responsible for preventing the transmission of HIV, not only the people who are infected. HIV prevention should be comprehensive, making use of all approaches known to be effective.
Laws addressing issues on HIV transmission should be reinforced to curb the rapidly increasing number of HIV infections but, at the same time, it should not be used to victimize the people who are already positive and doing something about it to protect themselves and others. Stigma has undermined the ability of individuals’ families and society at large to protect themselves and provide support and reassurance to those affected."
“It was an example of the state system falling apart. The established counselling service was misused for a purpose contrary to its basic principles: that of guaranteed voluntary consent and confidentiality.”
Milena Stevanovic from Skopje, Macedonia, was a member of a medical team that was on duty in November 2008 when the police issued a court warrant to test arrested street commercial sex workers for STIs.
"In November 2008, the Ministry of Interior began a campaign to eradicate the so-called ‘socio-pathological occurrence of male and female individuals giving sexual services for money.’
According to the Ministry the official grounds for the police intervention, arrest and detainment of sex workers was the existence ‘of certain indications that these persons might be carriers of different sexually transmitted diseases, and consciously transmit them to other persons, which is in violation with the existent laws in the Republic of Macedonia.’ Calling on the Criminal Code the Ministry provided a court order to perform medical examinations.
The process started early in morning when the police called us on the telephone asking if we provided HIV and STI testing. Then they announced their intentions. Immediately I had a meeting with the director who said that we couldn’t perform such a service. When this fact was presented to the police it took them less than two hours to issue us with a court order.
There followed a statement informing the public of the results of the compulsory testing of the sex workers. According to the analyses, ‘Seven of them were carriers of the virus HCV-Hepatitis C, an infectious disease transmitted by sexual and blood contact with an infected person.’ The ministry said that they instigated criminal charges because of reasonable suspicion that ‘they performed a criminal act of transmitting infectious disease.’ Given the resistance they showed during the implementation of the court order, it was argued, they were aware of the virus they carried, and therefore they were negligent. After one year’s legal process the sex workers were found guilty of transmitting STIs but were given probation.
It was an example of the state system falling apart. The established counselling service was misused for a purpose contrary to its basic principles: that of the guaranteed voluntary consent and confidentiality. So it was a paradox. As someone who helped develop that system - and its voluntary counselling and testing (VCT) protocols and services - I can’t understand why anyone would use that same system for that purpose, especially on a group of people, such as street sex workers, who were being counselled and tested on HIV and STIs. So if you ask me, that’s the greatest tragedy of this incident.
Or maybe the worst thing is that a health institution, which should have been protected by law, ended up exposing test results without the consent of its patients.
This leads me to the conclusion that someone had the aim of destroying everything we’ve achieved. You feel completely powerless. You feel as if the only thing you can do is to help lessen the consequences for those poor women.
Previously there had been no cases of HIV or other infectious disease being brought up in court. We can’t predict what would happen if criminalisation became an everyday reality. What I do know is that some people will suffer from double stigma: being HIV positive and coming from the different key populations.
There is absolutely no reason for criminalising HIV transmission.
Maybe we need a legal discussion on the pros and cons. Objectively, there is no reason why HIV should be treated as a criminal offence. The explanation is very simple: everyone is responsible for their own behaviour and risks - that’s the end of the story.
Here, the chance of someone not knowing their HIV status is very high. But if we are talking about something that is a criminal offence like rape, and if HIV is transmitted as consequence of a violent act, then that would be something else. But, again, the reason for prosecution should be the criminal act and not HIV.
The criminalisation of HIV transmission has had a completely demoralising effect on me. It means that whatever you agree upon within the community, to adopt a document, to establish a state service, it is worthless. There is always someone who has the political power to destroy for their own political promotion.
Human rights in our context are a mockery. The main reason is because there is no implementation in everyday life.
They are often misused by the institutions responsible for protection of human rights. There is no rule of law when human rights are concerned and sometimes patients in Macedonia are not well informed and refer to the human rights legislative for trivial issues.
Rights, but also the obligations, should be the same for everybody. What do I mean by obligations? Everyone is responsible for their own actions and the risks of those actions. So this is the basic philosophy when we are talking about HIV. Otherwise you can easily enter in to a labyrinth leading to millions of questions. Hypothetically all of my patients can start a court procedure against the person responsible for their HIV status. So I ask myself, what would be the consequence of all of these court processes?
Here is an example: I had a case where the husband wouldn’t disclose his status to his wife. We tried everything we could to motivate him to inform his wife about the possibility of HIV transmission. But he didn’t want to and continued to live a ‘normal’ married life. So the woman was left to discover that she had become HIV positive on her own, when she became really sick. I had to live with the knowledge that someone’s life is in danger. However my team followed the protocol and we didn’t disclose the status of the patient to his wife. In the end, although it took some time, the husband decided to tell his wife. This case illustrates why everyone should be responsible for their own actions and protection.
Although this example is an argument for obligatory disclosure, I would say that we can discuss this option only within marriage, but when we are talking about different sexual relationships, I can’t see the purpose of making the disclosure obligatory. To be more precise, you can’t solve all of the HIV problems with adopting legal instrument for prosecuting people living with HIV (PLHIV).
If we insist that PLHIV disclose their status in every sexual encounter than we are insisting on an ideal society, a utopia. I can’t find a good reason why we should ask PLHIV to be extremely responsible if the rest of society is not behaving in the same manner. In the same way, we can’t ask that from any patient living with any other kind of disease.
The things here in Macedonia are going to change. We needed 20 years to ‘grow up’ and to face HIV. There were no PLHIV in the past, simply because they were dying.
Today we have people living with HIV. So we are just starting to go through the HIV issues that other societies have already faced. Hopefully we will use their experience to find easier solutions."
This is one of the stories exposing the effect criminal laws on HIV transmission are having on people’s working and private lives in 'Behind bars: life stories of people affected by the criminalization of HIV'. For more information and to read the other stories: http://bit.ly/criminalization.
“I have a learnt a lot from my interactions with people who are HIV positive. At a personal level it has also enabled me and my wife to discuss these issues more, because we discuss some cases looking at what happened, and we realize and learn that being HIV positive is not strange – it is just part of life. Nothing really changes when people are positive.”
Chrispine Sibande, is a lawyer and Deputy Director for Legal Services of the Malawi Human Rights Commission.
"HIV is being criminalized right now in Malawi. This is through the Penal Code – Section 192. It states that ‘any person who unlawfully or negligently commits does any act which is, and which he knows or has reason to believe to be, likely to spread the infection of any disease dangerous to life, shall be guilty of a misdemeanor.’ So, we have seen cases in Malawi where the courts have charged people under this provision on issues of HIV. People have been prosecuted because of their HIV status.
One example from 2009 relates to sex workers who were charged with an act of negligence (contrary to section 192 of the penal code) in Mwanza district, for ‘unlawfully and knowingly committing an act likely to spread infection of the disease HIV and AIDS by practicing prostitution’. This happened in three different cases.
The women were arrested at a bar, and taken by the police, with some men. All the men were released – only the women remained in custody. They were ordered to board a police vehicle and taken to Mwanza District Hospital. At the hospital, there were two police officers in the corridor, they were taken into a room where they saw they saw two medical officers and additional two police officers, and were simply told ‘can we have your hand?’ So then blood was taken from them, but they didn’t know what for - until they were taken to court. They were charged with the offence of spreading a venereal disease, specifically HIV.
These women didn’t have legal representation so they pleaded guilty because the police intimidated them. The court read out their HIV status, and it was then that these women realized that the blood samples taken at the hospital were meant for an HIV test. It was the first time that the women had learned of their HIV status. The test results were announced to everybody in court– in front of so many people. Anyone who was in the court room at that time knew the HIV status of the accused persons.
So we partnered with another NGO and followed up the cases – I interviewed the women, reviewed the court files to find out exactly what happened, and we are now considering a Constitutional Challenge. This kind of action violates the Malawi Constitution and international human rights standards. In our Constitution we have Section 20, which guarantees the right to non-discrimination, and Section 21 that guarantees the right to Privacy and to Dignity. In one of the cases, the women were asked to leave Mwanza as part of the judgment, which is also strange because that is a clear violation of liberty and violation of the person’s right to live anywhere in Malawi.
We are trying to challenge the action from a human rights perspective based on our Constitution. In the Judicial Review we are asking the court to condemn the action of the police, the District Hospitaland the Magistrate and say it was unlawful, arbitrary and unreasonable. We are seeking declarations from the court on all three issues and that these women should be compensated. I have drafted the papers and I am ready to go to court.
Many of these women have now settled outside Mwanza, out of fear of being labeled ‘HIV positive’ and seen as ‘stupid ladies deliberately spreading HIV’. When I interviewed the Magistrate and also the police, they said ‘Oh why are you bothering about sex workers?’ I think the sex workers were deliberately targeted because they were seen to be ‘less human’. Of course evidence shows that almost every day these women are beaten or have money or cell phones confiscated from them, but there is that feeling that these women are ‘after all, prostitutes’. Nobody will listen to them. That is the spirit of the message that I got from the Magistrate and the police when I interviewed them.
So when you look at these particular cases it is very clear that people are already being criminalised for the transmission of HIV in Malawi. At the same time we have a draft HIV Bill that states that we intend to criminalise HIV and AIDS. In Malawi we have a constitution and we have ratified several human rights instruments, so the application of the criminal law is a very serious setback in Malawi.
When you look at the human rights standards it is clear that they don’t encourage criminalisation of HIV and AIDS. And we made that position known, but the problem was that we weren’t part of the Commission – the Malawi Human Rights Commission were simply asked to make a submission. We made it clear that we should never ever criminalise issues of HIV and AIDS.
The reasons are quite obvious. We need to address HIV as a health issue and there are obligations that the State has to meet to make sure that services are available and that people have treatment, and also that information is available. It is also very clear that there is a lot of stigma attached to HIV.
Now the moment you try and criminalise it, then people fear prosecution, and it won’t help with the provision of condoms, of ARVS, or for people to come forward and go for testing. If we look at criminalisation you can see how it targets people who know they are HIV positive and limits them having sex. The response to HIV should be a whole crusade where we need to get everybody involved.
The proposed HIV Bill introduces a number of positive things so to condemn the whole Bill would be unfair. When the Bill addresses issues of stigma and discrimination – for example that an employer will be prosecuted if they deny employment to someone on the basis of their HIV status – then it can be helpful. But imagine the consequences of criminalizing HIV particularly for women and for vulnerable groups such as sex workers? There are certain issues in the Bill that would be a setback for the fight against HIV.
Not only as a human rights lawyer but also from looking at the context of HIV in Malawi, honestly, criminalizing HIV does not make sense. For example witchcraft – it is an offence in Malawi to allege that someone is a witch. Now this is the criminal position – the question is what are people doing about it? Everyday people are accusing each other of witchcraft. Everyday people are calling on traditional doctors. Everyday, people are being arrested for witchcraft. So the issue is when you have a bad law it is more breached than honoured.
For HIV you need to make sure that people have information, and then that there is a provision to access condoms, and that people know their HIV status, and, if they are positive, the government provides health services like ARVs and counselling. The solution that ‘we will lock you up or arrest you because you are HIV positive’ will just force people underground, and as a result there will be more - not less - people who have HIV. We would just be perpetuating the problem.
My work has simply helped me to know that a person who is HIV positive is not different from any other person. I have also realized that there are serious challenges for people living with HIV – treatment remains a challenge in terms of access to ARVs, there is a lack of information, and other things at the national level.
My work has just helped me to understand more things from a legal perspective, a social perspective and a psychological perspective. I have a learnt a lot from my interactions with people who are HIV positive. At a personal level it has also enabled me and my wife to discuss these issues more, because we discuss some cases looking at what happened, and we realize and learn that being HIV positive is not strange – it is just part of life. Nothing really changes when people are positive."
This is one of the stories exposing the effect criminal laws on HIV transmission are having on people’s working and private lives in 'Behind bars: life stories of people affected by the criminalization of HIV'. For more information and to read the other stories: http://bit.ly/criminalization.
Marama Pala, an executive director from New Zealand, discovered that her former partner was HIV positive when she saw him on the front page of a newspaper article entitled 'Face of Fear'.
"The High Court Trial awful for me, he was found guilty by jury and sentenced to seven years imprisonment, on his release he was deported. During the trial he had large numbers of supporters trying to keep him in the country for his daughter. I was made the villain because I put him in jail and forced him out of the country.
I was infected on 23 July 1993 by an African Man in New Zealand – Peter Mwai. I found out that he had HIV from a newspaper article with his face on the front page saying 'FACE OF FEAR'.
The article below described how he had infected women with HIV and if anyone had had contact with this man to ring the police. I did, and then was asked that, if I should I test positive, would I help them stop this man from infecting any other women? I said yes, and then I was tested shortly after.
After a two week wait the test came back positive and charges were laid.
The police had evidence that he was told he had HIV in June by an infectious diseases clinician. I was infected in July, and fell within the time frame to charge him. Whereas the other women he infected didn’t, but five other women could charge him with reckless endangerment.
I had asked him to wear a condom, he refused. I did not insist, because I had very little knowledge about HIV, I thought he was too healthy-looking and he had already shown me a picture of his baby daughter who was healthy too.
HIV transmission is currently not the subject of a specific ‘law’ in New Zealand, but there is legislation from 1969 about intentionally infecting someone with a disease. Peter Mwai was originally charged with this, but the police could not prove ‘intent’ and the charge was lessened to Grievous Bodily Harm, as well as the reckless endangerment charges.
There was a High Court Trial - that was awful for me. He was found guilty by jury and sentenced to seven years imprisonment, on his release he was deported, and subsequently died of TB in Uganda. During the trial and his release time he had large numbers of supporters trying to keep him in the country for his daughter. I was made to feel like the villain because I put him in jail and forced him out of the country.
I think there is sufficient criminal law to stop the rare person who behaves irresponsibly. New laws would cause more stigma and discrimination for those already living with HIV.
Not all people living with HIV are reckless, 95 per cent of them would be deeply affected should they ever infect another person. It’s the people that don’t give a damn and intentionally or thoughtlessly expose people to the virus - that small five per cent is making it worse for the rest of us, and they need to be held accountable.
Age and wisdom have changed my mind about this issue. At the time the case was so hyped, and drama-filled. I believed I’d be supported afterwards, I wasn’t.
I was so young and easily influenced by the police. I had no idea of the consequences at the time.
This court case did no favours for dark-skinned men living with HIV in New Zealand. It created a stereotype that all ‘black’ men with HIV were intentionally infecting large numbers of women.
Yet the evidence shows there have only been a few cases. The few have made it worse for the rest of us. Now I’m married to a HIV positive man from Papua New Guinea, and he is dark skinned.
My husband and I have a great relationship, but he is very aware that, should it end, and if he was to live as a single man in New Zealnad, that the stereotype would follow him. The truth of this came home to me on one occasion when he was discriminated against, unfairly, by the police because of the colour of his skin and his HIV status.
I take the approach that no disclosure is necessary if safe sex is practiced, but if someone is having casual sex on more than one occasion, then that becomes a grey area.
I still support the idea that it is the decision of the person living with HIV, as long as they practice safe sex.
Apart from those two scenarios, I would still support the right of the person living with HIV to make that decision, either way; it’s a personal choice to trust someone with those details.
Personally, I have told every sexual partner since my infection, but because of my trial and the subsequent publicity, I was exposed and everybody knew of my case and my infection, therefore I had no choice but to disclose, in case they found out another way.
If someone has an unsafe sexual encounter, I would support the anonymous disclosure of the 'track and trace' system through a sexual health clinic. It isn’t only the responsibility of the person living with HIV to stay safe."
This is one of the stories exposing the effect criminal laws on HIV transmission are having on people’s working and private lives in 'Behind bars: life stories of people affected by the criminalization of HIV'. For more information and to read the other stories: http://bit.ly/criminalization.
