SciELO - Scientific Electronic Library Online

 
vol.11 issue1Beyond paper-based affiliate status: National human rights institutions and the African Commission on Human and Peoples' RightsMarriage under African customary law in the face of the Bill of Rights and international human rights standards in Malawi author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand

Article

Indicators

Related links

  • On index processCited by Google
  • On index processSimilars in Google

Share


African Human Rights Law Journal

On-line version ISSN 1996-2096
Print version ISSN 1609-073X

Afr. hum. rights law j. vol.11 n.1 Pretoria Jan. 2011

 

Disentangling illness, crime and morality: Towards a rights-based approach to HIV prevention in Africa

 

 

Marius Pieterse

Professor of Law, University of the Witwatersrand, South Africa

 

 


SUMMARY

An increasing number of African states criminalise HIV transmission. In addition, several states criminalise private conduct traditionally associated with the risk for such transmission, such as homosexuality, sex work and drug use. However, there is increasing evidence that punitive responses to the HIV epidemic are inappropriate and counterproductive. They also fuel stigma and violate individual rights, especially those of members of marginalised groups. Relying on literature canvassing the content and effects of stigma pertaining to HIV, sex, perceived moral deviance and criminality and on studies questioning the effectiveness of criminal law in this context, this article disputes the appropriateness of employing the criminal law in relation to the transmission of HIV, as well as in relation to vulnerable or marginalised groups. Rather, the article argues for a human rights-infused, public health approach to HIV that upholds the rule of law, procedural justice and the principle of proportionality. Ultimately, the article asserts that, given the systemic causes of the African HIV and AIDS pandemic, solutions thereto should be similarly systemic in nature, rather than focused on individual instances of transmission.


 

 

“Full text available only in PDF format”

 

 

 

* BLC LLB LLM (Pretoria), PhD (Witwatersrand);Marius.Pieterse@wits.ac.za. The research in this article was enabled by a grant from the NRF. An earlier version of the article was presented at the African Network of Constitutional Lawyers' Annual Conference held in Rabat, Morocco, 2-5 February 2011.
1 E Cameron 'Legal and human rights responses to the HIV/AIDS epidemic' (2006) 17 Stellenbosch Law Review 47 52-53.         [ Links ]
2 M Kirby 'The never-ending paradoxes of HIV/AIDS and human rights' (2004) 4 African Human Rights Law Journal 163 167-68;         [ Links ] M Heneke 'An analysis of HIV-related law in South Africa: Progressive in text, unproductive in practice' (2009) 18 Transnational Law and Contemporary Problems 751 754;         [ Links ] R Johnson 'The Model Law on HIV in Southern Africa: Third World Approaches to International Law insights into a human rights-based approach' (2009) 9 African Human Rights Law Journal 129 141;         [ Links ] UNAIDS Criminal law, public health and HIV transmission: A policy options paper (2002) (UNAIDS Criminal law) 15; UNAIDS Policy brief on criminalisation of HIV transmission (2008) (UNAIDS Policy brief) 2.
3 SADC Model Law on HIV and AIDS in Southern Africa (2008) http://www.sadcpf.org (accessed 31 March 2011).
4 African Commission on Human and Peoples' Rights Resolution on the Establishment of a Committee on the Protection of the Rights of People Living with HIV and Those at Risk, Vulnerable to and Affected by HIV (2010).
5 Uganda published the much-maligned Anti-Homosexuality Bill 18 of 2009, whereas Malawi has been in the news for arresting and detaining a same-sex married couple under public indecency laws.
6 PM Eba Stigma[ta]: Aids Review2007 (2008) 12. See also 11.
7 See examples discussed by B Bergman 'AIDS, prostitution, and the use of historical stereotypes to legislate sexuality' (1998) 21 John Marshall Law Review 777 791-92; Eba (n 6 above) 11.
8 See Bergman (n 7 above) 778; Cameron (n 1 above) 88-89; Eba (n 6 above) 12 38; Kirby (n 2 above) 167; N Nongogo 'HIV testing and voluntary counselling in the context of stigma' in F Viljoen (ed) Righting stigma: Exploring a rights-based approach to addressing stigma (2005) 94 97-98; C Visser 'Floundering in the seas of human unconcern: AIDS, its metaphors and legal axiology' (1991) 108 South African Law Journal 619 629-630.
9 See Eba (n 6 above) 41-42; M Pieterse 'The interdependence of rights to health and autonomy in South Africa' (2008) 125 South African Law Journal 553 556 564 568; F Viljoen 'Stigmatising HIV/AIDS, stigmatising sex? A reply to Professor Van Wyk' (2000) 41 Codicillus 11 14 16; Visser (n 8 above) 625 628.
10 Eba (n 6 above) 12 17-18 24.
11 Visser (n 8 above) 630-631.
12 See Eba (n 6 above) 24 27-28; Visser (n 8 above) 625-626.
13 Bergman (n 7 above) 793; Eba (n 6 above) 38-40.
14 Eba (n 6 above) 38; Johnson (n 2 above) 156.
15 Eba (n 6 above) 38. See also Visser (n 8 above) 629-630.
16 See E Bonthuys 'Women's sexuality in the South African Constitutional Court' (2006) 14 Feminist Legal Studies 391 397 399 407; S Burris 'Disease stigma in US public health law' (2002) 30 Journal of Law, Medicine and Ethics 179 183; Eba (n 6 above) 12 27-28 38-39; Nongogo (n 8 above) 98; Visser (n 8 above) 629-630.
17 JK Strader 'Criminalisation as a policy response to a public health crisis' (1994) 27 john Marshall Law Review 435 445-446.
18 Eba (n 6 above) 48; PM Eba 'Pandora's box: The criminalisation of HIV transmission or exposure in SADC countries' in F Viljoen & S Precious (eds) Human rights under threat: Four perspectives on HIV, AIDS, and the law in Southern Africa (2007) 13 44-45 47-48 51; N Hunt & J Derricott 'Smackheads, crackheads and other junkies: Dimensions of the stigma of drug use' in T Mason et al (eds) Stigma and social exclusion in healthcare (2001) 190 191 202; Strader (n 17 above) 446; UNAIDS Criminal law (n 2 above) 23-24.
19 Strader (n 17 above) 441.
20 See, generally, Eba (n 6 above); Nongogo (n 8 above).
21 Eba (n 6 above) 45-47; Eba (n 18 above) 18; LO Gostin et al 'The law and the public's health: A study of infectious disease law in the United States' (1999) 99 Columbia Law Review 59 65 92-93; Heneke (n 2 above) 753; Kirby (n 2 above) 176; UNAIDS Criminal law (n 2 above) 17.
22 See Eba (n 6 above) 48; D Wikler 'Personal and social responsibility for health' in S Anand et al (eds) Public health, ethics, and equity (2004) 109 125.
23 Kirby (n 2 above) 167.
24 Quote from Strader (n 17 above) 435. See also Strader 436 447; E Cameron & E Swanson 'Public health and human rights: The AIDS crisis in South Africa' (1992) 8 South African Journal on Human Rights 200 232; Kirby (n 2 above) 167; Eba (n 18 above) 14-15; M Pieterse & A Hassim 'Placing human rights at the centre of public health: A critique of Minister of Health, Western Cape v Goliath' (2009) 126 South African Law Journal 231; Viljoen (n 9 above) 14; UNAIDS Criminal law (n 2 above) 13.
25 Z Lazzarini et al 'Evaluating the impact of criminal laws on HIV risk behaviour' (2002) 30 Journal of Law, Medicine and Ethics 239.
26 States with such legislation include Benin, Botswana, Guinea, Guinea Bissau, Lesotho, Malawi, Mali, Niger, Sierra Leone, Tanzania, Togo, Zambia and Zimbabwe. For a discussion of specific statutes and provisions, see Eba (n 18 above) 29-34; Johnson (n 2 above) 146-147.
27 In terms of sec 51(1) read with sec 51(3) and part 1 of Schedule 2 to the Criminal Law Amendment Act 105 of 1997. See S v Snoti 2007 1 SACR 660 (E) and other reported and unreported decisions discussed by Cameron (n 1 above) 71-72 76-77; C van Wyk 'The impact of HIV/AIDS on bail, sentencing and medical parole in South Africa' (2008) 23 SA Public Law 50 52-53.
28 See S v Nyalungu [2005] JOL 13 254 (T) as well as unreported cases discussed by Cameron (n 1 above) 77; Eba (n 18 above) 24 n 62.
29 See Venter v Nel 1997 4 SA 1014 (D) and discussion by Cameron (n 1 above) 79.
30 See Eba (n 15 above) 40 and authorities cited there.
31 See Cameron & Swanson (n 24 above) 202 204.
32 See S v Jordan 2002 6 SA 642 (CC) para 86.
33 See secs 2-3 of the Anti-Homosexuality Bill 18 of 2009.
34 See C van Wyk 'The need for a new statutory offence aimed at harmful HIV-related behaviour: The general public interest perspective' (2000) 41 Codicillus 2 4-7 10; Van Wyk (n 28 above) 63.
35 See M Brazier & J Harris 'Public health and private lives' (1996) 4 Medical Law Review 171 179 188-191; Cameron & Swanson (n 24 above) 220; Eba (n 18 above) 23; F Viljoen 'Verligting of verlustiging: Regshervorming in 'n tyd van VIGS' (1993) 110 South African Law Journal 100 110; Viljoen (n 9 above) 13 16; UNAIDS Policy brief (n 2 above) 1.
36 Eba (n 18 above) 38; Lazzarini et al (n 25 above) 247; Strader (n 17 above) 443.
37 See Eba (n 18 above) 26-27; Strader (n 17 above) 443; UNAIDS Criminal law (n 2 above) 22-23.
38 For examples, see Eba (n 18 above) 34-37.
39 Brazier & Harris (n 35 above) 184; Lazzarini et al (n 25 above) 251.
40 See BD Adam et al 'Effects of the criminalisation of HIV transmission in Cuerrier in men reporting unprotected sex with men' (2008) 23 Canadian Journal of Law and Society 143 157; Cameron & Swanson (n 24 above) 204 207; Eba (n 18 above) 38-39; Eba (n 6 above) 58; LO Gostin & Z Lazzarini Human rights and public health in the AIDS pandemic (1997) 106; Strader (n 17 above) 442 445; UNAIDS Policy brief (n 2 above) 1 4; UNAIDS Criminal law (n 2 above) 21.
41 Bergman (n 7 above) 816-817; Viljoen (n 9 above) 14.
42 Brazier & Harris (n 35 above) 184; Lazzarini et al (n 25 above) 252.
43 Adam et al (n 40 above) 143-144; Cameron & Swanson (n 24 above) 220; Heneke (n 2 above) 764; UNAIDS Policy brief (n 2 above) 5; Viljoen (n 35 above) 111-112; Viljoen (n 9 above) 14.
44 Bergman (n 7 above) 818; Bonthuys (n 16 above) 397; Brazier & Harris (n 35 above) 184; Eba (n 6 above) 46 48; Eba (n 18 above) 44; Heneke (n 2 above) 762; Lazzarini et al (n 25 above) 247; Viljoen (n 9 above) 13; Viljoen (n 35 above) 113; UNAIDS Policy brief (n 2 above) 5.
45 Bergman (n 7 above) 816; Cameron & Swanson (n 24 above) 221; Eba (n 6 above) 48; Eba (n 18 above) 40 47; Gostin & Lazzarini (n 40 above) 106; Viljoen (n 35 above) 113; UNAIDS Criminal law (n 2 above) 26; UNAIDS Policy brief (n 2 above) 4.
46 Cameron & Swanson (n 24 above) 207 209.
47 Brazier & Harris (n 35 above) 184; Cameron & Swanson (n 24 above) 207-209 220-221; Eba (n 18 above) 42-44 51; Gostin & Lazzarini (n 40 above) 106; Heneke (n 2 above) 763; R Jurgens et al 'People who use drugs, HIV and human rights' (July 2010) The Lancet 97 101; Viljoen (n 35 above) 111; Viljoen (n 9 above) 15; LE Wolf & R Vezina 'Crime and punishment: Is there a role for criminal law in HIV prevention policy?' (2004) 25 Whittier Law Review 821 869; UNAIDS Policy brief (n 2 above) 4-5; UNAIDS Criminal law (n 2 above) 24-25.
48 UNAIDS Criminal law (n 2 above) 27 32 39. See also Johnson (n 2 above) 147.
49 See Eba (n 18 above) 51; UNAIDS Criminal law (n 2 above) 28.
50 See, eg, arguments advanced in favour of a public health approach to HIV prevention in the context of intravenous drug use by D Wolfe & K Malinowska-Sempruch 'Seeing double: Mapping contradictions in HIV prevention and illicit drug policy worldwide' in C Beyrer & HF Pizer (eds) Public health and human rights: Evidence-based approaches (2007) 330 335-336 345-346.
51 See, in a different context, L London 'Confinement in the management of drug-resistant TB: The unsavoury prospect of balancing individual human rights and the public good' (June 2008) 1 SA Journal of Bioethics and Law 11 12.
52 See Brazier & Harris (n 35 above) 184-185; Eba (n 18 above) 54; UNAIDS Criminal law (n 2 above) 29-30.
53 See Cameron (n 1 above) 54-55; Cameron & Swanson (n 24 above) 202; Gostin & Lazzarini (n 40 above) 43; London (n 51 above) 12; Pieterse & Hassim (n 24 above) 232 245.
54 See London (n 51 above) 13-14; C Ngwena 'Responses to AIDS and constitutionalism in South Africa' (2003) 24 Obiter 299 300-301 305.
55 See Cameron & Swanson (n 24 above) 212-213; JF Childress & RG Bernheim 'Beyond the liberal and communitarian impasse: A framework and vision for public health' (2003) 55 Florida Law Review 1191 1202-1203; L Gostin & JM Mann 'Towards the development of a human rights impact assessment for the formulation and evaluation of public health policies' (1994) 1 Health and Human Rights 58-80; Gostin & Lazzarini (n 40 above) 57-57; London (n 51 above) 13; Pieterse & Hassim (n 24 above) 232-233. This mirrors the inquiry, under various constitutional systems, into the legitimacy of justifications offered in favour of restrictions of individual rights.See, eg, the limitation clause in sec 36 of the 1996 South African Constitution.
56 Cameron & Swanson (n 24 above) 212-217; Wolf & Vezina (n 47 above) 831; UNAIDS Criminal law (n 2 above) 17-18.
57 See Cameron (n 1 above) 52-55; Cameron & Swanson (n 24 above) 202 212-213; Childress & Bernheim (n 55 above) 1197 1207; CT Cook & K Kalu 'The political economy of health policy in sub-Saharan Africa' (2008) 27 Medicine and Law 29 36; Gostin & Mann (n 55 above) 75 77; Gostin & Lazzarini (n 40 above) 43 47; Kirby (n 2 above) 167-168; London (n 51 above) 12; Pieterse & Hassim (n 24 above) 232; Wolf & Vezina (n 47 above) 830-831.
58 Wolf & Vezina (n 47 above) 831.
59 UNAIDS Criminal law (n 2 above) 22.
60 As above. See also C Boudin & M Richter 'Adult, consensual sex work in South Africa: The cautionary message of criminal law and sexual morality' (2009) 25 South African Journal on Human Rights 179 192; Johnson (n 2 above) 141; Kirby (n 2 above) 169; Viljoen (n 35 above) 113.
61 See Bergman (n 7 above) 823; Boudin & Richter (n 60 above) 192 196-197; Eba (n 18 above) 53; Johnson (n 2 above) 156; J Stadler & S Delany 'The "healthy brothel": The context of clinical services for sex workers in Hillbrow, South Africa' (2006) 8 Culture, Health and Sexuality 451 452 458; Viljoen (n 35 above) 113.
62 National Coalition for Gay and Lesbian Equality v Minister of Justice 1999 1 SA 6 (CC). See specifically paras 23, 26-28 & 37.
63 S v Jordan (n 32 above). See specifically paras 10, 15-16 & 24.
64 See Bonthuys (n 16 above) 392 400 403 399; Boudin & Richter (n 60 above) 186 194; Pieterse (n 9 above) 568.
65 See Hunt & Derricott (n 18 above) 192; Jurgens et al (n 47 above) 98 101-102; Wolfe & Malinowska-Sempruch (n 50 above) 336.
66 Jurgens et al (n 47 above) 98; Wolfe & Malinowska-Sempruch (n 50 above) 335.
67 See J Chalmers Legal responses to HIV and AIDS (2008) 80-83 86; LO Gostin & Z Lazzarini 'Prevention of HIV/AIDS among injection drug users: The theory and science of public health and criminal justice approaches to disease prevention' (1997) 46 Emory Law Journal 587 644 648 677-682; Jurgens et al (n 47 above) 97.
68 Wolfe & Malinowska-Sempruch (n 50 above) 335.
69 UNAIDS Criminal law (n 2 above) 22.
70 Vienna Declaration (2010) http://www.viennadeclaration.com (accessed 31 March 2011). On the systemic advantages of a 'public health' rather than criminal justice approach to drug use, see further Gostin & Lazzarini (n 67 above) 590-592 642; RA Weisheit & JM Klofas 'The public health approach to illicit drugs' (1998) 23 Criminal Justice Review 197-207.
71 Preamble Model Law. See http://www.chr.up.ac.za/images/files/research/ahrru/news/ahrru_news_08_model_law_hiv_southern_africa.pdf (accessed 30 April 2011).
72 Sec 1 Model Law.
73 Secs 4-7 Model Law.
74 Secs 9-11 Model Law.
75 Secs 13-16 Model Law.
76 Secs 37-39 Model Law.
77 Secs 17-28 Model Law.
78 Secs 4(2)(f)-(g) Model Law.
79 Sec 11(1) Model Law.
80 Sec 29(1) Model Law. See further secs 29-35.
81 Sec 36(5) Model Law.
82 Sec 11(3) Model Law.
83 Sec 11(4) Model Law.
84 Minister of Health v Treatment Action Campaign (No 2) 2002 5 SA 721 (CC) para 123.
85 Hoffmann v South African Airways 2001 1 SA 1 (CC) para 36.
86 Cook & Kalu (n 57 above) 30 49; Johnson (n 2 above) 148; Kirby (n 2 above) 172 175; London (n 51 above) 12; Pieterse (n 9 above) 556 564 568 572; Pieterse & Hassim (n 24 above) 244-245; Strader (n 17 above) 447; Viljoen (n 9 above) 14.
87 UNAIDS Criminal law (n 2 above) 17.
88 Art 16 African Charter on Human and Peoples' Rights.
89 Cook & Kalu (n 57 above) 36; Kirby (n 2 above) 172 175.

Creative Commons License All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License