Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

960 Abstracts 44108-44113

12th World AIDS Conference

State as an example, HIV Law Project Director will analyze effectiveness of this
approach.
Results: Mandatory HIV testing of pregnant women will not ensure women's
participation in treatment regimens to reduce perinatal transmission of HIV.
It is not proven that mandatory HIV testing of pregnant women is the most
effective approach for reducing perinatal transmission.
44108 1 Access to treatment a human rights: The case of Mexico
Silvia Panebianco Labbe1, L. Ortiz2. 1Ed. 29-802 V Olimpica, Mexico D.F;
2Conasida, Mexico City, Mexico
Issue: The right to health protection is guaranteed in the Mexican Constitution,
nevertheless the case of the HIV/AIDS pandemic shows the lack of health protection, for the majority of the population because there is no access to treatment.
Project: From 1992 to 1997, in the Social Support and Human Rights Department of the National Programme of AIDS in Mexico, we received social
support requests and complaints for human rights violations and discrimination.
The profile and characteristics of both changed through the years.
Results: In 1992, 37% were human rights violation complaints and 63% were
social support requests (N = 517). In 1997, only 5.8% were human rights complaints and 94.2% social support requests (N = 1772). Nevertheless the former
numbers had not diminished. The central change was the dramatic increase of
the second aspect.
Access to medication and treatment were the most outstanding requests in this
period.
Lessons Learned: The increasing of the poverty rates of PWA's, without social
security and basic services was the main reason in the changes described above.
The lack of guarantee of economical and social rights is the cause of these
serious social vulnerability.
44109 Bridging the gap: A southern governmental policy on
antiretroviral therapy
Pedro Chequer, V. Veloso, E. Sudo, E. Castilho. 'Brazilian AIDS Program MOH,
Brasilia DF, Brazil
Issue: Due to a Presidential Decree dated of November 1996, all people in Brazil
living with HIV/AIDS have the right to receive, free of charge, drugs for their
treatments, provided by the Brazilian Public Health System.
Project: Primary prevention is the main goal of the Brazilian AIDS Program. In
terms of secondary prevention, a nationwide therapy program was implemented.
Strategies include a national consensus on HIV antiretroviral therapy (ART) criteria based on T CD41 count and viral load, and the implementation of an on-line
electronic Drug Logistic Management System.
Results: In 1997, the introduction of protease inhibitors caused an increase
from US$ 40 million (1996) to US$ 280 million in the annual expenditure with ART
drugs, with an average increase of 2000 patients/month. By July 1997, the profile
of ART drugs distributed was: AZT = 81%; ddl = 38%; ddC = 14%; 3TC = 40%;
indinavir = 21%; saquinavir = 13%; and ritonavir = 9% among 40,000 patients.
Lessons Learned: After 6 months of availability of triple therapy, a reduction
in AIDS mortality was observed (20%-55%), and a reduction in the prevalence of
citomegalovirus diseases, among others. The inpatient occupancy rate strongly
decreased.
44110 1 Denial of migration on the basis of HIV status. Is the
situation getting better?
Andrew Doupe. c/o Yann Siegenthaler, Rue de Savoie, Geneva, Switzerland
Issues: The legislative response of States to the entry HIV infected persons into
their territory.
Project: A comparative analysis of the incremental increase/decrease in States'
laws, which exclude people on the basis of their HIV status from their territory
between 1991 and 1997. The focus being immigrants and applicants for long-tern
residence.
Results: In 1991 sone 40 States had introduced laws, which excluded HIV
infected people, while in 1997 this had risen to 88 States. In absolute terms this
represents an increase of 48 States. At present over 45% of the world's States
practice discrimination vis-a-vis the HIV infected at their borders.
States continue to maintain in absolute terms increase the number of laws
pertaining to the entry of HIV infected persons. Advocacy and documentation of
the human face of this denial are some of the basic measures needed to be taken
to get this issue on the agenda. Exclusion has consequences for the protection
of a host of human rights.
44111 Adolescent consent for HIV testing: Discrepancies
between policy on the books and policy in practice
Shelly Jackson1, T.L. Hafemeister1, S. Van Horn1. 'University of Nebraska 209

Burnett Hall Lincoln Nebraska 68588-0338, USA
Purpose: The purpose of this study was to identify state statutes relevant to
adolescents' consent to HIV testing, and then to compare policies on the books
with policies that states actually practice.
Project: Scholars agree that one way to stem the spread of HIV/AIDS among
adolescents is for adolescents to be tested for HIV. However, not all adolescents

are opting to be tested. Some scholars assert that parental consent and notification policies should be abolished in the United States because such statutes
deter adolescents from testing for HIV. Indeed, all states allow adolescents to
be tested for sexually transmitted diseases without parental consent for public
health reasons. To determine which states statutorily allow minors to consent to
HIV testing, we first conducted a search of the relevant statutes in all 50 states
and comprised a list of states that either do or do not allow minors to consent
to HIV testing without parental consent (and the various restrictions), and the
separate issue of parental notification. This search "on the books" is currently
being followed-up by a telephone interview with AIDS Directors in each of the 50
states to determine states' practices regarding adolescents ability to consent to
HIV testing.
Results: There is tremendous statutory variation from state to state, with very
few states expressly addressing the issue of adolescent HIV testing, although
a few states do allow adolescents to consent to HIV testing without parental
consent. However, even some of these states apply age restrictions, give health
care providers discretion in notifying parents, or simply encourage adolescents
to notify their parents. Although AIDS Directors are still being interviewed, there
are great discrepancies in some states between the policies on the books and
the polies in practice. The principal explanation seems to be one of "Policy Interpretation." That is, Health Departments detour legislatures' particular restrictions
by interpreting the wording in the statutes in a way that allows all adolescents in
a particular state to consent to HIV testing.
Lessons Learned: Reading a state's statute alone does not in fact determine
whether or not adolescents are allowed to consent to an HIV test in a given
state. Although the statutes vary tremendously, in fact, the majority of states (we
have interviewed thus far) in practice allow adolescents to provide consent for an
HIV test. Whether or not adolescents, parents, and legislatures are aware of this
phenomenon remains unknown.
44112 Evaluating the legal impacts of and responses to AIDS
Shui Shan Lee1,2, Conrad Kui Shing Lam2, W.K. Tso2, T.M.Y. Choi2. 1AIDS Unit
5/F Yaumatei JCC 145 Battery Street, Yaumatei Kowloon; 2Advisory Council on
AIDS, Hong Kong
Issue: An understanding of the role of the law is crucial in an effective AIDS
programme.
Project: Laws in Hong Kong directly or indirectly linked with the prevention,
care and control of HIV/AIDS were reviewed. These were analysed in conjunction
with newspaper reports of related court cases in a six-year period between 1992
and 1997.
Results: The first case of AIDS in Hong Kong was reported in 1985. So far,
no laws have been specifically enacted in response to AIDS. As far as disease
control is concerned, the legal instrument is relatively inconspicuous. The legal
responses can however be clearly inferred from the enactment and amendments
of other laws. An obvious one was the amendment of the Crimes Ordinance to
decriminalise homosexuality, which has led to promotion of AIDS education in the
gay community. The same Ordinance has, in a complex way, also affected the
pattern of commercial sex and drug use. Condom standard, an important element
in safer sex promotion, received its legal backing through the enactment of the
Consumer Goods Safety Ordinance in 1995. In countering discrimination, the recently enacted Disability Discrimination Ordinance covers HIV/AIDS specifically.
No case has, however, been brought to court so far. Further, AIDS impacted
on the pattern of crimes in some unexpected ways. Among these were three
drug users who injured or threatened to injure others with blood-filled syringes.
There were instances in which the subject of AIDS was brought into courts: two
prisoners applied for their sentence to be reduced because of their HIV status;
on two other occasions, the judge ordered an HIV test on the defendant, which
ran contrary to the policy advocated in the community.
Lessons Learnt: In Hong Kong, AIDS has caused changes to existing laws
and affected the enactment of new ones. The impact should not be ignored
despite the low HIV prevalence. The potential impact of the judiciary's response
is an area of concern.
1 44113 | The crime of HIV transmission
Christopher Ward. PO. Box 876 Darlinghurst N.S.W. Australian Federation of
AIDS Organization, Australia
Issues: What is the role of laws which criminalise the spread of HIV? What is
their impact on other HIV/AIDS public health measures, and on the human rights
of people living with HIV/AIDS?
Project: The Australian Federation of AIDS Organisations' Legal Project has
contributed to policy and law reform on criminal laws against HIV transmission
since 1989. This project examines: the national policy context of laws which
criminalise the transmission of HIV in Australia; the rationale for, and content of,
criminal laws against HIV transmission in Australia; prosecutions under Australian
law; relevant international human rights instruments.
Results: Australia's experience with these laws suggests: 1) They conflict with

a human rights-based response to the AIDS pandemic. 2) Australian national
policy guidelines are not being followed. 3) In the second half of the 1990's,
the view that criminal laws against the transmission of HIV are necessary, has
gained currency. 4) the number of prosecutions under such laws has increased.
5) Prosecutions are generally the subject of intense media interest.
Policy developed at a national level quickly loses currency. Australia has enacted laws which contravene its national policy. Laws which criminalise the spread