Thank you.
Good morning. My name is Dr. Kristopher Wells and I'm an Associate Professor in the Faculty of Health and Community Studies at MacEwan University, which is located in Edmonton.
The focus of my research, teaching and scholarship centres on sexual and gender minority—or LGBTQ2—youth, education, health, sport and culture. Thank you for the opportunity to participate in this committee hearing this morning.
In his 2013 Massey Lecture series entitled “Blood: The Stuff of Life”, noted Canadian author Lawrence Hill asks, “How does blood unite us and how does it divide us?”
These are important questions, especially when we examine the history of HIV and AIDS and how it has forever changed the landscape of our world, nation and laws. When we ask whose blood matters, I would suggest that we are also asking whose lives matter. Our current Canadian laws and policies would imply that some blood is perceived to be more dangerous than others and, therefore, must be regulated and controlled.
It is shocking to know that Canada has one of the highest rates of prosecution in the world, including over 200 documented cases for alleged HIV non-disclosure. Canada's recent path to the criminalization of HIV has been described as “exceptionally punitive” and a potential violation of human rights for those living with HIV.
The question that should be asked is this: Why has HIV been singled out for such heavy-handed and disproportional treatment? For example, there have been very few prosecutions for other communicable diseases, such as HPV and hepatitis B or C. Perhaps what this differential treatment really indicates is the ongoing and pervasive misinformation and stigma that still surrounds HIV in our society, particularly within the criminal justice system.
It is well documented that the fear of unjust prosecution disproportionately impacts individuals from marginalized or vulnerable communities, such as those who are from racialized, indigenous, two-spirit or sexual and gender minorities. Criminalization also serves as a significant barrier in accessing HIV testing and treatment, as you've heard.
The ongoing criminalization of HIV non-disclosure is no longer in keeping with our evolving scientific knowledge, advances in medical treatment and the international consensus that “undetectable equals untransmittable”, which means that the risk of HIV transmission is effectively zero when a person living with HIV has an undetectable viral load. HIV is not an easily transmitted virus, and its specific roots or pathways are well documented.
The article “Expert consensus statement on the science of HIV in the context of criminal law”, which was published in June 2018, states that there are 68 countries that have laws that specifically criminalize HIV non-disclosure, exposure or transmission. Most prosecutions, including those in Canada, are related to perceived rather than actual risk of HIV acquisition.
Many of these laws and prosecutions have not been guided by the best scientific and medical evidence available, and are not reflective of advances in HIV treatment and care; however, they are greatly influenced by misinformation, societal stigma, fear and what some have described as an HIV panic. For example, we now know that HIV cannot be transmitted via contact from food or drink, or from inanimate objects such as chairs or toilet seats, nor from hugging, kissing, biting or spitting, yet at one time, these were all commonly held beliefs about modes of HIV transmission. In fact, until recently, many public and Catholic schools had policies banning HIV-positive students from attending class or sharing meals.
The Criminal Code is a blunt and often crude instrument, which should only be used in cases where there is intentional, actual or significant risk of harm. Instead, our primary attention should be on education, treatment and prevention. For example, our educational efforts should focus on science-based, non-judgmental and age-appropriate comprehensive sexual health education as a mandatory requirement in all K-12 schools across Canada.
We need to empower our young people to reduce stigma and increase their knowledge about sexual health. Research indicates that the vast majority of students want sexual health education provided by their teachers, whom they trust to share accurate and informed information, yet we need only read the news headlines across Canada to realize that inclusive and comprehensive sexual health is still not the norm and is frequently misunderstood and actively contested.
Canada has been a world leader in HIV research, with groundbreaking scientific discoveries that are now on the global front lines of HIV prevention and treatment efforts. Recently, several provinces have begun to provide free pre-exposure prophylaxis, or PrEP, to vulnerable populations.
PrEP is an anti-HIV medication that is scientifically proven to be more than 95% effective in preventing HIV acquisition. PrEP is one of the fastest growing and most promising and effective tools that we have in the fight against HIV. The Canadian government ought to work to make PrEP more readily available and publicly accessible across Canada as one of the most effective and cost-efficient prevention tools currently available.
There also needs to be enhanced funding to provide increased access to STI clinics and testing options, including rapid testing and other methods that empower individuals to look after their own sexual health.
First and foremost, HIV should be understood as an important public health issue, not a criminal one. Clearly, following the most recent medical science, criminal laws and codes should not apply to any person living with HIV who has engaged in sexual activity without disclosing their status if they have maintained a suppressed viral load.
The November 2018 prosecutorial guidelines issued by the Attorney General of Canada are an important first step forward; however, more needs to be done to reduce stigma, prejudice and the disproportional impact our laws have on indigenous, racialized and sexual and gender minority communities. We must finally end all unjust criminal prosecutions against those living with HIV if we are to meet Canada's commitment to eliminate HIV as a public health threat by 2030.
Currently, we are behind the 90-90-90 target for 2020, which requires that 90% of people living with HIV know their status, 90% of those diagnosed be receiving antiretroviral treatment and 90% of those on treatment achieve viral suppression. Removing the fear of unjust criminalization may help meet these important target goals. Many believe that the end of HIV is a realistic possibility if we focus concerted attention and scale up funding for accessible testing and treatment.
For these reasons, I urge this committee to closely examine the call to action contained within the “Community Consensus Statement: End Unjust HIV Criminalization”, which has been endorsed by over 170 Canadian civil society organizations. Clear evidence-based prosecutorial guidelines need to be developed, the Criminal Code of Canada should be reformed and all levels of government and public health agencies ought to work together to provide education and training to end the fear, misinformation and stigma that still surround HIV.
On November 29, 2017, I had the incredible privilege to be here in the House of Commons to witness the Prime Minister's historic apology to LGBTQ2 Canadians. It was an absolutely incredible day, a day that many of us thought we might never live to see. The Prime Minister's apology—indeed, Canada's apology—should not represent a one-time act but an ongoing commitment to end discrimination and unjust legislation, laws and practices that continue to target sexual and gender minorities.
Much work remains to be done, especially when it comes to current discriminatory policies on blood and organ donations and the increased backlash we are currently witnessing against LGBTQ2 equality in schools across our nation. For too long, the Criminal Code and the courts have been used as instruments of prejudice, violence and discrimination that have unjustly targeted those who are or who are perceived to be different in our society. The criminalization of HIV is only one very recent and tragic example.
Returning to Lawrence Hill's Massey Lectures, he eloquently reminds us:
Blood reveals and also protects us.... Blood...defines who we are: in our emotional states, in our social ranking, in our state of innocence or...guilt, and most important of all, in our relationships to each other.
Laws should not be used to unjustly prosecute people living with HIV. Rather, our laws should be used to protect us from discrimination and persecution, based on who we are and who we love and not on what is or isn't in our blood.
Thank you.