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Posted on Categories Featured, News 70 Comments on Is Criminalization of HIV Transmission Effective? Swedish Case Reveals Why the Answer Is No

Is Criminalization of HIV Transmission Effective? Swedish Case Reveals Why the Answer Is No

By Marianne Mollmann

Earlier this month, a 31-year-old woman in Sweden was sentenced to one and a half years in prison for having unprotected sex without disclosing to her partner beforehand that she is living with HIV.

Even a perfunctory news search reveals that this is not the first time the Swedish justice system has applied criminal sanctions to potential HIV-transmission. In January, a 20-year-old man was sentenced to eight months in prison for having unprotected sex without disclosing his status. In December 2006, a 34-year-old woman got two months, and in January 2003, a 32-year-old woman one year. All of these sentences also required the person living with HIV to pay monetary damages to their former sex-partners.

For anyone who cares about human rights from a health and discrimination angle, these cases raise multiple red flags.

For starters, consensual sex between consenting adults should, in principle, never be subject to government control or regulation. Moreover, the criminalization of HIV transmission has multiple negative outcomes. It leads to distrust in the health and justice systems; it can discourage people from seeking to know their HIV status; it adds to the stigmatization of those living with HIV; and it is ineffective in bringing down HIV transmission.

In fact, UNAIDS (the Joint UN Programme on HIV/AIDS) recommends that governments limit criminal sanctions for HIV transmission to cases where all of three conditions are met: the person charged 1) knows he or she is living with HIV; 2) acts with the intention of transmitting the virus; and 3) actually transmits it. UNAIDS also recommends that cases of such intentional HIV-transmission should be tried under generic criminal provisions for bodily harm or assault, and not under HIV-specific provisions.

Public health and human rights activists are clear on this. That is why the Swedish Embassy in France was defiled with paint-filled condoms in protest against the 2003 ruling. And that is also why my own reaction to the ruling was to declare it “bad” over twitter, a statement that was re-tweeted several times.

A closer read of the cases highlighted in the Swedish media, however, leads me to reconsider, at least in part.

If the media-accounts are accurate, the Swedish government has, in fact, partially followed UNAIDS recommendations. The convicted individuals all knew their HIV status and the cases were brought under general criminal law provisions on grave assault, physical abuse and attempt to cause physical harm. So far so good.

The two remaining questions — intent and actual transmission — are more difficult to gauge.

Consider this.

In most of the cases, the convicted person either has multiple convictions over several years for the same thing, or the conviction is based on multiple unprotected sexual interactions with different partners without disclosure. It is perhaps valid for prosecutors to ask if, absent proof of intent which is hard to produce, the fact that an individual living with HIV repeatedly and knowingly exposes someone else to a deadly virus shouldn’t count for something.

Further, actual HIV transmission may not be the only harm caused. The 20-year-old convicted man was charged with having unprotected sex with eight women, none of whom ultimately ended up HIV-positive, though they all claimed to have suffered severe emotional trauma as a result of the experience. In cases of domestic violence we often ask prosecutors to consider emotional distress as real harm, so why require actual transmission in order to prove harm in this case?

Then again, consider this.

The 20-year-old man was born HIV-positive and is being charged as an adult also for those unprotected sexual encounters that occurred when he was a teenager. He was initially placed in solitary confinement, seemingly because of his HIV status.

Also, one of the convicted women alleged she had been raped. The male partner produced evidence to the contrary and she later withdrew the allegation. Nevertheless, coercion and fear are highly relevant when it comes to decisions about how and when to disclose HIV status. Research indicates that many women, in fact, are reluctant to disclose their HIV status because they quite legitimately fear abuse.

And with regard to actual harm caused, it is at least possible that the ramped-up attention to the cases have contributed in some part to the severity of the emotional distress of the sex partners.

It is, of course, reckless to knowingly expose anyone to real danger, also through potential HIV-transmission, even if the danger ultimately does not materialize. This is a notion the UNAIDS recommendations to a large extent fail to acknowledge.

But the highly publicized use of the criminal law in Sweden to punish those living with HIV for being timid about their health status does not make it easier for anyone to disclose. So perhaps the real question with regard to any government’s approach to HIV transmission should not be whether it follows UNAIDS recommendations, but rather if it is effective.

An educated guess says not so much.

This article was first published on RHRealityCheck.

Source: http://www.huffingtonpost.com/marianne-mollmann/is-criminalization-of-hiv-effective_b_1445385.html

Posted on Categories Featured, News 58 Comments on Kenya: Access to Generic Drugs Prevails in High Court Ruling on Anti-Counterfeit Law

Kenya: Access to Generic Drugs Prevails in High Court Ruling on Anti-Counterfeit Law

In a landmark decision last Friday, Kenya’s High Court ruled that the country’s anti-counterfeiting legislation could potentially undermine access to life-saving generic medicines. Lawmakers will now have to reconsider the relevant sections of the bill to eliminate ambiguities between generic and counterfeit drugs.

The 2008 Anti-Counterfeit Act was approved by the Kenyan Parliament with the intent of prohibiting trade in counterfeit goods and establishing an Anti-Counterfeiting Agency. (See Bridges Review, June 2009) The legal challenge to the act began in 2009 with a lawsuit filed by three petitioners with HIV/AIDS.

High Court Judge Mumbi Ngugi found that the act fails to clearly distinguish between counterfeited drugs and generic medicines. The ruling affirms that this legislative misstep may lead to confusion, which in turn could hinder access to life-saving medicines, particularly for people living with HIV.

“The right to life, dignity, and health of people like the petitioners who are infected with the HIV virus cannot be secured by a vague provison in a situation where those charged with the responsibility of enforcement of the law may not have a clear understanding of the difference between generic and counterfeit medicine,” Judge Mumbi Ngugi stated in the ruling.

“The Anti-Counterfeit Act has, in my view, prioritised enforcement of intellectual property rights in dealing with the problem of counterfeit medicine. It has not taken an approach focused on quality and standards which would achieve … the protection of the petitioners in particular and the general public from substandard medicine,” Ngugi added.

Following doubts in July 2010 over the act’s consistency with the Kenyan Constitution on the right to life and the right to the highest standard of health, the High Court suspended implementation of the act’s provisions on counterfeited drugs until a decision on the case could be taken.

Last Friday’s ruling reaffirmed the suspension, underscoring that “there can be no room for ambiguity where the right to health and life of the petitioners and the many other Kenyans who are affected by HIV/AIDS are at stake.”
Health activists welcome decision

After the ruling, UNAIDS Executive Director Michel Sidibé declared that “the High Court of Kenya has upheld a fundamental element of the right to health.”

According to UNAIDS, 1.6 million people in Kenya live with HIV/AIDS; an estimated 743,000 Kenyans are eligible for antiretroviral treatment, of whom 539,000 are currently receiving it. Generic drugs are the most widely used medicines in Kenya.

“We must have both generic drugs and strong anti-counterfeit laws. Generic drugs give more people access to life-saving treatment – while anti-counterfeit laws keep people safe,” Sidibé added.

Several health advocacy groups similarly applauded the decision. AIDS Law Project Executive Director Jacinta Nyachae – in a joint statement issued by Médecins Sans Frontières, Health Action International Africa, and the Kenya Ethical and Legal Issues Network on HIV and AIDS – welcomed the High Court ruling and underlined the possible ripple effect the decision could have on Kenya’s neighbours.

“Kenya is leading the way in protecting access to medicines and public health and we are watching the actions of the East African Community member states to see if they follow suit,” Nyachae concluded.

ICTSD reporting; “Kenyan court ruling upholds access to generic drugs,” REUTERS AFRICA, 20 April 2012.

source: http://ictsd.org/i/news/bridgesweekly/131980/

Posted on Categories Featured 71 Comments on Sections of the Kenya Anti Counterfeiting Act Struck Down as a Threat to Fundamental Human Rights

Sections of the Kenya Anti Counterfeiting Act Struck Down as a Threat to Fundamental Human Rights

by Sisule F. Musungu 

In a landmark Judgement that has been hailed by many in the health community, including UNAIDS, the High Court of Kenya (Honourable Lady Justice Mumbi Ngugi – hereinafter “Justice Ngugi or “ the Judge”) held, in the case of Patricia Asero Ochieng and 2 Others v. the Attorney General & Another, that three sections of the Kenya Anti-Counterfeit Act, 2008 were unconstitutional being a threat to the right to life, dignity and health. Noting that: “There can be no room for ambiguity where the right to health and life of the petitioners and the many other Kenyans who are affected by HIV/AIDS are at stake”, the Judge specifically found that Section 2 (definition of counterfeiting), section 32 (offenses) and Section 34 (Powers of the Commissioner to seize suspected counterfeit Goods) could severely limit or threaten access to affordable and essential drugs including generic medicines for HIV/AIDS and therefore infringed the right to life, dignity and health of the three Petitioners (all people living with HIV/AIDS) under the Constitution of Kenya, 2010.

The 48 page Judgement addressed a range of critical issues, including issues that have animated international intellectual property (IP) discussions in recent years in the context of the World Trade Organization (WTO), the Anti Counterfeit Trade Agreement (ACTA), the World Health Organization (WHO) and the World Intellectual Property Organization (WIPO) Advisory Committee on Enforcement. The Judgement also comes at a time when the East Africa Community (EAC) has been considering an Anti-Counterfeit Bill largely inspired by the Kenya law. Among other issues, the Judge analysed: the real intentions of those behind the law; the role of TRIPS flexibilities in ensuring the fulfilment of fundamental rights; link between the rights of life, health and dignity; and the relationship between fundamental rights and IP rights. She then gave directions on what the Government needs to do.

Caught in a Lie – the Intentions of the Proponents of the Anti-Counterfeit Act

In debates about anti-counterfeiting it has often been argued that these laws are critical to ensure, among others, the health of the population against substandard or other falsified medicines. This was indeed one of the arguments made when the Kenyan law was being discussed in 2008. It is also one of the main arguments advanced by the Attorney General in opposition to the Petition. Justice Ngugi examined this claim and did not mince her words on what she found. At paragraph 82 and 83 she noted inter alia that:

“ Clearly… the tenor and object of the Act is to protect intellectual property rights of individuals… Had the primary intention been to safeguard consumers from counterfeit medicine, then the Act should have laid greater emphasis on standards and quality. The Anti-Counterfeit Act has, in my view, prioritised enforcement of intellectual property rights in dealing with the problem of counterfeit medicine. It has not taken an approach focused on quality and standards…Protection of consumers may have been a collateral issue in the minds of the drafters of the Act.”

She went on to hold that the right to life and health cannot be secured by a vague proviso in a situation where those charged with enforcement (customs officials, police etc.,) may not have a clear understanding of the difference between generic and counterfeit medicine.

Indeed, among others, I am on record to have raised this concern and others with the anti-counterfeiting efforts at the Sixth Session of the WIPO Advisory Committee on Enforcement in a paper titled “IP Infringements and Enforcement – Accounting for Socio-Economic, Technical and Development Variables”.

Credit to Parallel Importation

The Judge gave credit to the Kenya Industrial Property Act, 2001 which introduced parallel importation in Kenya for having enabled the widespread use of generic medicines not only for the treatment of HIV/AIDS but also for the treatment of other diseases as well. One of the questions to answer in the case was therefore the impact of the Anti-Counterfeit Act to the flexibility provided under Section 58(2) of the Industrial Property Act. By finding the Anti-Counterfeiting Act as a threat to generic medicines the Judge by implication accepted that the implementation of the Act could roll back the gains made through the implementation of parallel importation provisions in the Industrial Property Act.

Indivisibility and Interdependence of Human Rights

The petitioners had gone to Court fearing the violation of their rights to life, dignity and health. In her analysis, the Judge found that “the right to health, life and human dignity are inextricably bound.” Though not specifically saying so the Judge by her decision affirmed the applicability of the well-recognised principle of indivisibility and interdependence of human rights under Kenyan law.

IP rights and Human Rights

A broader question that came up in this case was whether the enforcement of IP rights could constitute a legitimate limitation to fundamental rights. Accepting the reasoning of the UN Committee on Economic, Social and Cultural Rights inGeneral Comment 17, the Judge held that:

“While… intellectual property rights should be protected, where there is a likelihood, as in this case, that their protection will put in jeopardy fundamental rights such as the right to life of others… they [IP rights] must give way to the fundamental rights of citizens…” 

While the Judgement did not consider the implications of the Constitutional provisions relating to IP it is unlikely that she would have reached a different conclusion if she did.

What Next with Anti-Counterfeiting Law?

Having found that the Anti-Counterfeit Act was unconstitutional as far as generic medicines go the Judge left it to the government to reconsider and appropriately amend section 2 of the Anti-Counterfeit Act in a manner that ensures that the State fulfils its obligations to ensure that Kenyans have access to the highest attainable standard of health.

Importantly, however, the Judge left a more fundamental question open I suspect mainly because the issue was not canvassed before her. The question is whether in the context of Kenya’s existing legal framework as at 2008 the Anti-Counterfeit law was actually necessary? In other words, even with an amendment as foreseen by the Judgement should Kenyan taxpayers be paying for the implementation of this law including sustaining the Anti-Counterfeit Agency?

As the Judge noted (at paragraph 70) it appears that Anti-Counterfeit Act was intended to bolster the protection of IP rights by providing criminal sanctions for infringement. The truth is that, except for severity of penalties, Kenyan law already provided criminal sanctions for certain types of IP infringement as contemplated by the TRIPS Agreement. Some of the existing laws providing such sanctions included the Industrial Property Act, the Copyright Act, the Penal Code, the Standards Act and the Trade Descriptions Act. There is also an elaborate legal framework, backed by criminal sanctions, to ensure the safety of medicines in Kenya. Such laws include the Medical Practioners and Dentists Act, Narcotic Drugs and Psychotropic Substances Act, Pharmacy and Poisons Act, the Public Health Act and the Use of Poisonous Substances Act. Institutions to implement these laws also.

As the Kenyan government and Parliament considers the next steps to bring the Anti-Counterfeit Act in line with the Constitution there will be need to think hard and clearly as to what the objectives are, who is being served and why. The government will also be well advised to seek proper technical expertise. It is sad that both the Office of the Attorney General and the Anti-Counterfeit Agency seemed not to be abreast with critical legal developments in the IP world.

In the end one thing that this Judgement shows is that the Anti-Counterfeit Act, as drafted, is bad both the right to health and for IP rights holders. By conflating issues the Act has succeeded casting doubt on what may be the legitimate interests if IP rights holders.

 

Note: The Author is an Advocate of the High Court of Kenya and practices before the Court in the name and style of Sisule Munyi Kilonzo and Associates, Advocates

Posted on Categories Featured 91 Comments on Judgment on generic medicines – Kenya’s first victory on the right to health

Judgment on generic medicines – Kenya’s first victory on the right to health

Kenya is celebrating after a landmark judgment on Friday <20 April> ruled that sections of the Anti-Counterfeit Act 2008 will not apply to generic medicines – protecting access to affordable treatment.

The case, which was filed by three people living with HIV and has been ongoing since 2009, challenged the aspects of the Anti-Counterfeit Act 2008 that confused counterfeiting with patent infringement, therefore threatening the importation of the generic medicines, including ARVs for people living with HIV.
In her judgment, Lady Justice Ngugi ruled that intellectual property should not override the right to life, right to health and right to human dignity outlined in the Constitution of Kenya 2010. Patent holders will therefore not be able to use the act to legitimately block the import of generic medicines, as was feared by the petitioners.

KELIN – the organisation promoting health and human rights – has been campaigning for access to affordable medicine to uphold the Right to Health and provided research support to the lead counsel of the petitioners Mr. Luseno of Majanja and Luseno Advocates. Speaking about the victory, KELIN`s Coordinator Allan Maleche said:

“This case was a matter of life or death for the thousands of people in Kenya who use generic medicine for treatment and we applaud the High Court for upholding the Right to Health.
“To make it clear, we are not supporting counterfeit and substandard medicines, but generics – legitimate exact copies of original brand name medicines. We hope this victory will have a positive effect on other East African countries considering law and policy around anti-counterfeiting.”

Maureen Murenga, a woman living with HIV in Kenya, who was one of the three petitioners in the case, said:
“It has been a long battle since we filed this case four years ago. Like thousands of people in Kenya, my son and I rely on generic antiretroviral medicine to stay healthy and its important that we fight to protect our access.

“I don’t think people understand what might happen to the health of East African nations if pharmaceutical companies are ever allowed to challenge the use of generic medicines here.”
The Attorney General will now ask the government to make amendments to the Anti-Counterfeit Act 2008 to reflect the ruling.
To view the full judgment follow this link http://kelinkenya.org/wp-content/uploads/2012/04/Judgment-Petition-No-409-of-20092.pdf

Posted on Categories Featured 279 Comments on Kenya set to repeal controversial anti-counterfeit law

Kenya set to repeal controversial anti-counterfeit law

23-Apr-2012
Kenya’s High Court has ordererd a review of a controversial anti-counterfeit law enacted in 2008 on the grounds that it could interfere with the supply of legitimate generic medicines to patients.

The 2008 Anti-Counterfeiting Act has been under fire since before it was passed with critics claiming that it was too much of a blunt instrument to handle the complexities of the counterfeit and substandard medicines trade, and set too much store by intellectual property rights.

The Act defined counterfeiting as an intellectual property breach of a protected good, which can include “the manufacture, production, packaging, re-packaging, labelling or making, whether in Kenya or elsewhere, of any goods whereby those protected goods are imitated in such manner and to such a degree that those other goods are identical or substantially similar copies of the protected goods.”

In theory, this could encompass legitimate generic copies of drugs that are on-patent anywhere overseas. Given that the vast majority of drug patents are not registered in developing countries like Kenya, there had been fears that enforcement of the ACT could reduce the range of generic medicines available to doctors and their patients.

That was acknowledged by the High Court, with Judge Mumbi Ngugi saying in her ruling that “the Act is vague and could undermine access to affordable generic medicines since [it] failed to clearly distinguish between counterfeit and generic medicines.”

The High Court has called on Kenya’s Parliament to review the Act and remove ambiguities that could result in arbitrary seizures of generic medicines under the pretext of fighting counterfeit drugs. The judgment also stated that IP rights should not override the right to life and health.

The judgment comes at a time when the World Health Organisation (WHO) is also struggling to contend with the controversy about the conflation of IP and public health issues in the area of what it refers to as substandard/spurious/falsely-labelled/falsified/counterfeit medical products (SSFFCs).

The High Court ruling has been immediately welcomed by UNAIDS, whose executive director Michel Sidibe said: “This decision will set an important precedent for ensuring access to life-saving drugs around the world.”

UNAIDS notes that at the end of 2011 about 1.6m people in Kenya were living with HIV, with more than half a million on antiretroviral therapy provided in large part by generic drugs from generic manufacturers in India and elsewhere.

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