Within a week of being at the Canadian HIV/AIDS Network (the Network), I was given the opportunity to meet mayor John Tory and Queer Ontario New Democrat MPP Rev. Dr. Cheri DiNovo at a City Hall Proclamation declaring May 17th, International Day Against Homophobia, Transphobia and Biphobia. Notably, DiNovo introduced Bill 77, the “Affirming Sexual Orientation and Gender Identity Act” and is urging Kathleen Wynne to pass it by Pride in the upcoming weeks. The Act would prohibit conversion therapy for LGBTQ children, and prohibit doctors from billing Ontario Health Insurance for conversion therapy conducted on any patient. That said, Ontario isn’t the only province with groundbreaking trans* developments. Only a few days later in Quebec, amazing activists such as Gabrielle Bouchard, Samuel Singer and Jean-Sébastien Sauvé were speaking to the Committee on Institutions which included the Minister of Justice at the National Assembly at special consultations and public hearings on the draft regulation concerning the Regulation respecting change of name and of other particulars of civil status for transsexual and transgender persons. An issue of great concern for volunteering at the Clinique Juridique Trans* Legal Clinic and many trans* people living in Quebec.
The first two weeks of my internship revolved around preparing a proposal for UN Women and working along with the CONGEH team for the organisation of an advocacy workshop aimed at raising awareness amidst institutional actors. CONGEH is a conglomerate of smaller NGOs that work under the platform of gender – habitat – HIV/AIDS. Its specific goals makes CONGEH not only a network of NGOs with an interesting view but also endows it with the daunting, yet successfully accomplished task of answering all the questions with a high degree of hands-on knowledge, specificity and accuracy.
The workshop was focused not only on raising awareness, but also on obtaining a clear set of answers, recommendations and solutions with regards to the stigmatisation of women and the violation of their rights. Undoubtedly, the presence of representatives of different ministries was more than a prerequisite, while the presence of members of CONGEH and other NGOs was the trigger.
Regardless of the research I conducted and the statistics that I familiarized myself with during the preparation period, it was during the workshop where I quietly, mindfully and critically learned more than simple numbers or a list of well-known causes. The clash of customary and state law seems to favour the traditional views and practices of the Cameroonian communities. Chiefs of different under-developed areas of Yaoundé presented the reality of these customs: women are discriminated, widows can be accused of their husbands’ death and words such as property and succession are rarely, or almost never, associated with women. Yet, the favouring does not necessarily spur out of a preference for customary law. It is the lack of knowledge of their rights and, thus, their non-claiming that put women in such a precarious situation.
Now, of course, the conversation also took the direction of religion, as Cameroon is a country with a fear of God, regardless whether the God is catholic, orthodox, Muslim, etc. English and French are the official languages for the purpose of standardizing, but there are other 250 languages spoken in Cameroon. Cameroon is called Africa in Miniature not only for its landscape but also for its mix of cultures. We usually say there are as many opinions as there are men. This is true.
The law is meant to help bring about these changes in a uniform, healthy and non-violent way. The government is expected to successfully develop tools in order to encourage these changes. Everybody agreed that the law has been drafted in such a way as to encourage the promotion of equal rights of men and women. Yet, the participants strongly disagreed on what the government through its ministries and projects has done up until now and what tools they offer for these women. Lack of knowledge is prevalent in Cameroon. While I have not had the chance of leaving the heart of Yaoundé, members of other NGOs insisted on the lack of resources offered to these women. Women suffering of HIV/AIDS do not acknowledge and have no means of reaching the places where the government put in place special areas to help. Nonetheless, while these tools are thoughtful and meant to only do well, their application in real life situations has not been done effectively. Their translation into practice causes most of the problems and the dissatisfaction of the people is immense.
CONGEH has conducted its own study on 2000 women suffering of HIV/AIDS in the communities of Yaoundé and has observed that stigmatisation, lack of knowledge of their rights, violation of their rights to property, succession and housing, all lead to unsanitary life conditions as these women are abandoned, kicked out of their homes or left in unimaginable living conditions that do nothing but worsen their already weak situation. While infected men choose to abandon their homes, women are removed from the households and find themselves homeless or turn into squatters. Living a normal life while suffering of HIV/AIDS is no longer a dream, but it demands access to treatment, clean water and decent living conditions: the lack thereof leading to a fast deterioration of both their physical and mental health. The stigmatisation of those suffering of HIV/AIDS knows no gender discrimination, but the acute predisposition of women to being discriminated with regards to their rights to ownership leads to a casting aside with repercussions unbeknownst to our imagination.
Education of the society, modernisation and dismissal of the discriminating practices were in the minds and on the lips every workshop participant. If modernisation is the goal, and the removal of discriminating practices is the beginning, how will that work? What does modernisation actually entail? What effect will it have on all the Cameroonian customs? As newer generations are born changes are brought. Yet, each community wants to maintain its culture, while some even refuse compromises. Of course, the removal of discriminating practices is ideal and it is suggested, but how fast will it be done? And, do fast solutions necessarily mean realistic measures?
As I am typing this blog entry at my desk, I realize it takes more than a workshop and an exchange of words to draw the real picture. These are numbers, opinions and well-known causes that have yet to been efficiently tackled. Modernisation is thrown around as a word that fills no gap, heals no wound and carries no weight. I look forward to the days where I will sit around the table facing the women we have been talking about. Their stories, their sorrows, their concerns will teach me even more than the intense debate did. And, hopefully, with time, madness or death will no longer exist as options.
by Jihyun Rosel Kim
When people hear the question “should non-disclosure of HIV status be a criminal offence?” their usual response is, “well of course! We shouldn’t hurt people.” When all we see and hear about HIV in the news is so sensationalized to the point that we equate HIV with death and people with HIV with predators, that response is understandable.
The landmark case involving HIV status disclosure was R. v. Cuerrier. In the case, the Supreme Court established that failure to disclose one’s HIV status could lead to a charge of aggravated sexual assault, which can lead to a maximum of a life sentence in prison. Justice Cory for the majority stated that non-disclosure of HIV status that would lead to a “significant risk of harm” would constitute an aggravated sexual assault. However, he never clarified what exactly would amount to “significant risk,” despite the differing levels of risk of transmission in diverse sexual activities. Justice Cory did, however, stated in an obiter that certain actions such as wearing a condom might be seen as mitigating the “significant risk.”
Since the Cuerrier decision in 1998, science has come a long way for HIV/AIDS. Moreover, research has shown that transmission risks for HIV are generally low, and differ significantly depending on the activity. Generally, the transmission rate of HIV during unprotected vaginal intercourse is 0.1% per act (with recent analysis suggesting a more accurate rate would be 0.08% per act). If a person has an undetectable viral load (below 50 copies of HIV virus per mililitre of blood), the risk of infection is about 1 in 10,000 for unprotected sex acts. Recent studies also suggest that antiretroviral therapy can reduce transmission up to 96% in heterosexual couples, where one partner is HIV-positive and the other is HIV-negative.
Yet, Canadian courts have not kept up with scientific evidence. Due to the unclear guidelines regarding what exactly constitutes “significant risk,” courts have continued to send mixed messages regarding legal duty to disclose one’s status. Some courts have held that a person who did not disclose to a partner but wore a condom is not criminally liable. Other courts have held the opposite view by charging a defendant with sexual assault for non-disclosure without considering the kind of sexual activities.
The conflicting messages from the courts seriously undermine and threaten the rights of people living with HIV/AIDS (PLHs). How can PLHs truly prove that they disclosed to a partner – should they require witnesses or signatures? Should activities such as oral sex and mutual masturbation, which bears almost zero risk of transmission, bear the possibility of a criminal charge, when almost no activity in our lives are truly risk-free? What about the issue of partners, who can blackmail and even abuse their HIV-positive partners by threatening to charge them?
My first two weeks at the Canadian HIV-AIDS Legal Network have felt like an intense and stimulating crash course. One of my first tasks was to gather information on access to HIV/AIDS treatment to help a policy analyst prepare for a guest lecture. The policy analyst also asked me to go beyond the numbers and find any factors that may complicate the numbers that I found. By the time I finished the research, I came out questioning the word “access” altogether. Here were my findings:
- At the end of 2009, 36% (about 5.2 million) of the 15 million people in need in low- and middle-income countries were receiving antiretroviral (ARV) therapy, which is used to suppress the HIV virus.
- Only 21 countries provide data on people with HIV who inject drugs. Out of the 21 countries, only 9 countries had a treatment rate of 10% for this demographic. 
- Some countries may have initiatives and programs that sound great and accessible, but the whole picture is always more complicated. For example, the National AIDS Control Organization (NACO) provides free first-line ARV treatment in India. However, accessing treatment for sex workers is still difficult due to the negative disposition of health workers. One sex worker recalled to the researchers: “If I am going to be in a condition to take tablets [ART], I will not go there because they denigrate us.”
- Migrants also face additional barriers to HIV/AIDS treatment, due to strict immigration policies. For example, EU’s Return Directive, established in 2008 and enforced in 2010, enables a member country to detain migrants up to six months. This may make public health interventions regarding HIV/AIDS to migrants more difficult.
If these facts sound a bit foreign and removed, there is also the issue of differing coverage of ARV drugs by province that can cause mobility issues. Some provincial health care systems don’t cover newer form of drugs. Quebec won’t reimburse claimants who buy medication out-of-province.
“Access” has become one of the buzzwords of human rights law. In many reports I read, there are often goals or objectives that have to do with improving or increasing access to certain services. In our efforts to improve access, we must not only focus on the numbers, but also focus on who gets to access services or programs as well, and how social structures and stigmas limit the effectiveness of certain programs.
 UNAIDS, Report on the Global AIDS Epidemic, 2010.
 V. Chakrapani et al. “Barriers to free antiretroviral treatment access for female sex workers in Chennai, India,” AIDS Patient Care and STDs 23 (11) (2009): pp. 973-980 at 976.
 Directive 2008/115/EC, European Union, art. 15.5. (http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2008:348:0098:0107:EN:PDF)
 Deborah Yoong, “Access and Coverage of HIV Medications across Canada”, published on Toronto General Hospital’s website: http://www.hivclinic.ca/main/drugs_reimbuse_files/Provincial%20Coverage%20of%20HIV%20medications.pdf)