HIV -- how to fight an epidemic of bad laws

There is an epidemic of HIV, and with it an epidemic of bad laws -- laws that effectively criminalize being HIV positive. At the TEDxSummit in Doha, TED Fellow Shereen El-Feki gives a forceful argument that these laws are not only based in stigma, but are helping the disease spread.

Let's begin with a story.

Once upon a time --

well actually less than two years ago --

in a kingdom not so very far away,

there was a man

who traveled many miles

to come to work at the jewel in the kingdom's crown --

an internationally famous company.

Let's call it Island Networks.

Now this kingdom had many resources

and mighty ambitions,

but the one thing it lacked was people.

And so it invited workers from around the world

to come and help it build the nation.

But in order to enter and to stay

these migrants had to pass a few tests.

And so it was, our man presented himself

to authorities in the kingdom,

looking forward to settling into his new life.

But then something unexpected happened.

The medical personnel who took blood samples from the man

never actually told him what they were testing for.

He wasn't offered counseling before or after the test,

which is best medical practice.

He was never informed of the results of the test.

And yet, a couple of weeks later,

he was picked up and taken to prison

where he was subjected to a medical exam,

including a full-body search

in full view of the others in the cell.

He was released, but then a day or two later,

he was taken to the airport and he was deported.

What on earth did this man do

to merit this treatment?

What was his terrible crime?

He was infected with HIV.

Now the kingdom is one of about 50 countries

that imposes restrictions on the entry or stay

of people living with HIV.

The kingdom argues

that its laws allow it to detain or deport foreigners

who pose a risk to the economy

or the security or the public health

or the morals of the state.

But these laws, when applied to people living with HIV,

are a violation of international human rights agreements

to which these countries are signatories.

But you know what?

Matters of principle aside,

practically speaking, these laws drive HIV underground.

People are less likely to come forth

to be tested or treated or to disclose their condition,

none of which helps these individuals

or the communities these laws purport to protect.

Today we can prevent the transmission of HIV.

And with treatment, it is a manageable condition.

We are very far from the days

when the only practical response to dread disease

was to have banished the afflicted --

like this, "The Exile of the Leper."

So you tell me why, in our age of science,

we still have laws and policies

which come from an age of superstition.

Time for a quick show of hands.

Who here has been touched by HIV --

either because you yourself have the virus

or you have a family member or a friend or a colleague

who is living with HIV?

Hands up.

Wow. Wow.

That's a significant number of us.

You know better than anyone

that HIV brings out

the best and the worst in humanity.

And the laws reflect these attitudes.

I'm not just talking about laws on the books,

but laws as they are enforced on the streets

and laws as they are decided in the courts.

And I'm not just talking about laws

as they relate to people living with HIV,

but people who are at greatest risk of infection --

people such as those who inject drugs or sex workers

or men who have sex with men

or transgendered persons

or migrants or prisoners.

And in many parts of the world that includes women and children

who are especially vulnerable.

Now there are laws in many parts of the world

which reflect the best of human nature.

These laws treat people touched by HIV

with compassion and acceptance.

These laws respect universal human rights

and they are grounded in evidence.

These laws ensure that people living with HIV

and those at greatest risk

are protected from violence and discrimination

and that they get access to prevention and to treatment.

Unfortunately, these good laws

are counter-balanced by a mass

of really bad law --

law which is grounded in moral judgement

and in fear and in misinformation,

laws which specifically punish people living with HIV

or those at greatest risk.

These laws fly in the face of science,

and they are grounded in prejudice

and in ignorance and in a rewriting of tradition

and a selective reading of religion.

But you know what? You don't have to take my word for it.

We're going to hear from two people

who are on the sharp end of the law.

The first is Nick Rhoades. He's an American.

And he was convicted under the U.S. State of Iowa's law

on HIV transmission and exposure --

neither of which offense he actually committed.

(Video) Nick Rhoades: If something is against the law

then that is telling society

that is unacceptable, that's bad behavior.

And I think the severity of that punishment

tells you how bad you are as a person.

You're a class B felon,

lifetime sex offender.

You are a very, very, very bad person.

And you did a very, very, very bad thing.

And so that's just programmed into you.

And you go through the correctional system

and everyone's telling you the same thing.

And you're just like, I'm a very bad person.

Shereen El-Feki: It's not just a question

of unfair or ineffective laws.

Some countries have good laws,

laws which could stem the tide of HIV.

The problem is that these laws are flouted.

Because stigma gives unofficial license

to treat people living with HIV

or those at greatest risk

unlike other citizens.

And this is exactly what happened

to Helma and Dongo from Namibia.

(Video) Hilma: I found out

when I went to the hospital for a pregnancy check-up.

The nurse announced that every pregnant woman

must also be tested for HIV that day.

I took the test and the result showed I was positive.

That's the day I found out.

The nurse said to me, "Why should you people bcome pregnant

when you know you are HIV positive?

Why are you pregnant when you are living positive?"

I am sure now that is the reason they sterilized me.

Because I am HIV positive.

They didn't give the forms to me

or explain what was in the form.

The nurse just came with it

already marked where I had to sign.

And with the labor pain,

I didn't have the strength to ask them to read it to me.

I just signed.

SE: Hilma and Nick and our man in the kingdom

are among the 34 million people living with HIV

according to recent estimates.

They're the lucky ones

because they're still alive.

According to those same estimates,

in 2010 1.8 million people died

of AIDS related causes.

These are terrible and tragic figures.

But if we look a little more broadly into the statistics,

we actually see some reason for hope.

Looking globally, the number of new infections of HIV is declining.

And looking globally as well,

deaths are also starting to fall.

There are many reasons for these positive developments,

but one of the most remarkable

is in the increase in the number of people around the world

on anti-retroviral therapy,

the medicines they need to keep their HIV in check.

Now there are still many problems.

Only about half of the people who need treatment

are currently receiving it.

In some parts of the world --

like here in the Middle East and North Africa --

new infections are rising and so are deaths.

And the money, the money we need

for the global response to HIV,

that is shrinking.

But for the first time

in three decades into this epidemic

we have a real chance to come to grips with HIV.

But in order to do that

we need to tackle an epidemic of really bad law.

It's for this reason

that the Global Commission on HIV and the Law,

of which I'm a member,

was established by the agencies of the United Nations --

to look at the ways that legal environments

are affecting people living with HIV

and those at greatest risk,

and to recommend what should be done

to make the law an ally, not an enemy,

of the global response to HIV.

Let me give you just one example

of the way a legal environment

can make a positive difference.

People who inject drugs

are one of those groups I mentioned.

They're at high risk of HIV

through contaminated injection equipment

and other risk-related behaviors.

In fact, one in every 10 new infections of HIV

is among people who inject drugs.

Now drug use or possession

is illegal in almost every country.

But some countries take a harder line on this than others.

In Thailand people who use drugs,

or are merely suspected of using drugs,

are placed in detention centers,

like the one you see here,

where they are supposed to clean up.

There is absolutely no evidence

to show that throwing people into detention

cures their drug dependence.

There is, however, ample evidence

to show that incarcerating people

increases their risk of HIV and other infections.

We know how to reduce HIV transmission and other risks

in people who inject drugs.

It's called harm reduction,

and it involves, among other things,

providing clean needles and syringes,

offering opioid substitution therapy

and other evidence-based treatments

to reduce drug dependence.

It involves providing information

and education and condoms

to reduce HIV transmission,

and also providing HIV testing

and counseling and treatment

should people become infected.

Where the legal environment allows for harm reduction

the results are striking.

Australia and Switzerland

were two countries which introduced harm reduction

very early on in their HIV epidemics,

and they have a very low rate of HIV

among injecting drug users.

The U.S. and Malaysia

came to harm reduction a little later,

and they have higher rates of HIV in these populations.

Thailand and Russia, however,

have resisted harm reduction

and have stringent laws

which punish drug use.

And hey, surprise,

very high rates of HIV among people who are injecting drugs.

At the Global Commission we have studied the evidence,

and we've heard the experiences

of over 700 people from 140 countries.

And the trend? Well the trend is clear.

Where you criminalize people living with HIV

or those at greatest risk,

you fuel the epidemic.

Now coming up with a vaccine for HIV

or a cure for AIDS --

now that's rocket science.

But changing the law isn't.

And in fact, a number of countries are starting to make progress

on a number of points.

To begin, countries need to review their legislation

as it touches HIV and vulnerable groups.

On the back of those reviews,

governments should repeal laws

that punish or discriminate against people living with HIV

or those at greatest risk.

Repealing a law isn't easy,

and it's particularly difficult

when it relates to touchy subjects like drugs and sex.

But there's plenty you can do while that process is underway.

One of the key points is to reform the police

so that they have better practices on the ground.

So for example, outreach workers

who are distributing condoms to vulnerable populations

are not themselves subject to police harassment

or abuse or arbitrary arrest.

We can also train judges

so that they find flexibilities in the law

and so that they rule on the side of tolerance

rather than prejudice.

We can retool prisons

so that HIV prevention and harm reduction

is available to prisoners.

The key to all this is reinforcing civil society.

Because civil society is key

to raising awareness among vulnerable groups

of their legal rights.

But awareness needs action.

And so we need to ensure

that these people who are living with HIV

or at greatest risk of HIV

have access to legal services

and they have equal access to the courts.

And also important is talking to communities

so that we change interpretations

of religious or customary law,

which is too often used

to justify punishment and fuel stigma.

For many of us here

HIV is not an abstract threat.

It hits very close to home.

The law, on the other hand,

can seem remote, arcane, the stuff of specialists,

but it isn't.

Because for those of us who live in democracies,

or in aspiring democracies,

the law begins with us.

Laws that treat people living with HIV

or those at greatest risk with respect

start with the way that we treat them ourselves: as equals.

If we are going to stop the spread of HIV in our lifetime,

then that is the change we need to spread.

Thank you.

(Applause)