November 28, 2019 — Sunday, December 1 is World AIDS Day, and the Canadian HIV/AIDS Legal Network is calling on the Government of Canada to respond to HIV with a renewed emphasis on human rights and a much-needed infusion of resources. The latest data shows HIV infections are continuing to rise, with a 17.1% increase from 2014 to 2017, demonstrating the critical need for restored resources.
Misguided policies, stigma, and discrimination continue to undermine Canada’s HIV prevention efforts. HIV funding has flat-lined. We’re jeopardizing health and human rights by continuing to criminalize people living with HIV and affected communities, including people who use drugs and sex workers. Thanks to more than three decades of scientific research, and frontline and lived experience, we know what programs and services are most needed and most effective.
Below are brief summaries of some of the most pressing issues for people living with or affected by HIV.
HIV criminalization: ending unjust prosecutions
People living with HIV currently face imprisonment for aggravated sexual assault and a lifetime designation as a sex offender for not disclosing their HIV status to sexual partners, even in cases where there is little or no risk of transmission.
The broad criminalization of HIV non-disclosure damages the rights and health of people living with HIV and is harmful to public health. On World AIDS Day 2018, the former Attorney General of Canada issued a directive to limit unjust prosecutions against people living with HIV. But the directive only applies to the three territories, so people living with HIV in Canada’s provinces remain in fear of prosecution. In June 2019, the House of Commons Standing Committee on Justice and Human Rights released a report on the criminalization of HIV non-disclosure in Canada. It contained important recommendations to limit the unjust use of the criminal law against people living with HIV, demonstrating Canadian policymakers’ recognition of the need for law reform.
But we still need a real commitment by way of actual law reform. We need to end the use of sexual assault laws to deal with HIV non-disclosure, and to limit any use of the law to cases of actual, intentional transmission.
HIV funding: the missing millions
Ending HIV as a public health threat is achievable with the right policies and interventions – accompanied by the commitment of adequate resources. Despite a previous federal government commitment to funding the HIV response at $85 million annually, in 2007 we saw this flat line at roughly $70 million a year – where it has remained for more than a decade. As a result, to date more than $117 million committed to the HIV response has simply never been delivered. Services and organizations have closed down or discontinued programs, despite the clear need.
A few months ago, the federal government released its new federal Five-Year Action Plan on Sexually Transmitted and Blood-Borne Infections (STBBIs), which is a welcome step. But the plan does not include firm targets and there is no commitment to funding.
In June 2019, the House of Commons Standing Committee on Health clearly and unanimously asserted that Canada needs an adequately funded federal HIV strategy — recommending an increase to $100 million annually in federal funding for the HIV response alone. Additional funding is needed for addressing hepatitis C virus (HCV) and other STBBIs. But a recommendation isn’t enough: if we are to meaningfully address the gaps in our HIV response, the Government of Canada needs to commit actual, adequate, ongoing funding, as recommended by the Standing Committee.
Harm reduction and drug law reform: saving lives in an ongoing overdose crisis
Canada continues to experience an unprecedented overdose crisis: more than 12,800 people have died in the past four years, reminiscent of the early years of the AIDS crisis. Canada’s current approach perpetuates stigma, discrimination, and violence against people who use drugs. As the overdose crisis continues to devastate our country, Canadians are calling on the federal government to provide real leadership on this issue and take immediate steps to protect the health and human rights of all people who use drugs.
Supervised consumption services (SCS) are evidence-based health interventions that provide a safe environment where people can use drugs under the supervision of trained staff or volunteers, and have proven to reduce the risks of HIV, hepatitis C (HCV), and fatal overdose. But service providers still face significant barriers. Canada must fund and scale up a diverse range of SCS across the country and needs to replace the burdensome case-by-case application process (to open new SCS) with a “class exemption” that automatically protects clients and staff from unjust prosecution. Canada must also take steps to make a safer supply of drugs available to replace the poisonous drugs that are killing our friends and family members.
We also need more profound change to our laws and policies on drugs. We must understand that criminalizing activities related to personal drug use does not stop or deter use, but instead reinforces stigma. It also puts people who use drugs at increased risk of harm, impeding their access to vital services and emergency care in the event of an overdose. Decriminalizing personal drug use is a critical first step to address these harms.
Harm reduction in prison: needle and syringe programs
For more than 27 years, needle and syringe programs have been available in prison systems in many countries and endorsed as an evidence-based public health measure to help prevent the spread of HIV and HCV and other harms that can arise from using and sharing non-sterile equipment to inject drugs. In 2018, the Correctional Service of Canada finally acknowledged that this health service is needed, and began implementing a prison needle exchange program (PNEP).
While this is a welcome development in principle, the current program is only available in a handful of prisons and is vulnerable to cancellation should a future government oppose this health service. Furthermore, details of Canada’s PNEP reveal serious deficiencies violating public health principles and professionally accepted standards for such programs. In fact, there is no working program in the world that uses the approach Canada has taken. Not surprisingly, uptake of the program to date has been low, meaning prisoners continue to be unnecessarily exposed to an increased risk of HIV, HCV and overdose.
The Government of Canada needs to make significant changes to the PNEP based on the extensive evidence of what is needed for its successful design and implementation. The program also needs to be available in all federal prisons.
Withholding essential health care is no justifiable part of a prison sentence — and that is why the Legal Network will be in court in early December to fight for federal prisoners’ right to an effective needle and syringe program. Effective harm reduction in prisons is good public health practice: prison health is public health.
Sex workers’ rights: respecting autonomy, promoting safe working conditions
Research has consistently demonstrated the negative effects of criminal law on the health and safety of sex workers — a fact that has led a growing number of human rights organizations and UN bodies to call for the repeal of sex work–specific criminal laws. However, Canada continues to criminalize virtually every element of the sex industry.
While the Supreme Court of Canada struck down criminal prohibitions on sex work in 2013 as unconstitutional violations of sex workers’ rights, the federal government passed the Protection of Communities and Exploited Persons Act (PCEPA) one year later, which reintroduced these prohibitions and continues to criminalize sex workers and force them into precarious situations without labour protections. Criminalizing sex work fuels violence towards and exploitation of sex workers, and hinders their access to health and social services and police protection.
The federal government must repeal the PCEPA (and other criminal laws singling out sex work) and must work with sex worker groups to develop legislation and other initiatives that respect and protect their autonomy and rights, including the right to work in safety. Sex workers can describe in compelling detail how laws that criminalize them, their clients, and their work settings are dangerous to their health and safety — we just need to listen to them.
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About the Canadian HIV/AIDS Legal Network
The Canadian HIV/AIDS Legal Network (www.aidslaw.ca) promotes the human rights of people living with, at risk of or affected by HIV or AIDS, through research and analysis, litigation and other advocacy, public education and community mobilization.
Emma Riach, Communications and Campaigns Officer
Canadian HIV/AIDS Legal Network
Telephone: +1 416 595-1666 ext. 236