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TEDxSummit

Shereen El-Feki: HIV -- how to fight an epidemic of bad laws

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There is an epidemic of HIV, and with it an epidemic of bad laws -- laws that effectively criminalize being HIV positive. At the TEDxSummit in Doha, TED Fellow Shereen El-Feki gives a forceful argument that these laws, based in stigma, are actually helping the disease spread.

- Arab sexuality expert
Shereen El Feki works and writes on sexuality and social change in the Arab world. Full bio

Let's begin with a story.
00:16
Once upon a time --
00:20
well actually less than two years ago --
00:22
in a kingdom not so very far away,
00:25
there was a man
00:28
who traveled many miles
00:30
to come to work at the jewel in the kingdom's crown --
00:31
an internationally famous company.
00:35
Let's call it Island Networks.
00:38
Now this kingdom had many resources
00:41
and mighty ambitions,
00:44
but the one thing it lacked was people.
00:46
And so it invited workers from around the world
00:48
to come and help it build the nation.
00:52
But in order to enter and to stay
00:54
these migrants had to pass a few tests.
00:57
And so it was, our man presented himself
01:01
to authorities in the kingdom,
01:03
looking forward to settling into his new life.
01:05
But then something unexpected happened.
01:08
The medical personnel who took blood samples from the man
01:12
never actually told him what they were testing for.
01:15
He wasn't offered counseling before or after the test,
01:19
which is best medical practice.
01:23
He was never informed of the results of the test.
01:25
And yet, a couple of weeks later,
01:28
he was picked up and taken to prison
01:31
where he was subjected to a medical exam,
01:34
including a full-body search
01:36
in full view of the others in the cell.
01:39
He was released, but then a day or two later,
01:43
he was taken to the airport and he was deported.
01:46
What on earth did this man do
01:51
to merit this treatment?
01:55
What was his terrible crime?
01:57
He was infected with HIV.
01:59
Now the kingdom is one of about 50 countries
02:03
that imposes restrictions on the entry or stay
02:06
of people living with HIV.
02:10
The kingdom argues
02:13
that its laws allow it to detain or deport foreigners
02:15
who pose a risk to the economy
02:20
or the security or the public health
02:22
or the morals of the state.
02:26
But these laws, when applied to people living with HIV,
02:28
are a violation of international human rights agreements
02:32
to which these countries are signatories.
02:35
But you know what?
02:38
Matters of principle aside,
02:40
practically speaking, these laws drive HIV underground.
02:41
People are less likely to come forth
02:46
to be tested or treated or to disclose their condition,
02:49
none of which helps these individuals
02:53
or the communities these laws purport to protect.
02:56
Today we can prevent the transmission of HIV.
03:00
And with treatment, it is a manageable condition.
03:04
We are very far from the days
03:07
when the only practical response to dread disease
03:10
was to have banished the afflicted --
03:13
like this, "The Exile of the Leper."
03:16
So you tell me why, in our age of science,
03:19
we still have laws and policies
03:22
which come from an age of superstition.
03:25
Time for a quick show of hands.
03:28
Who here has been touched by HIV --
03:31
either because you yourself have the virus
03:34
or you have a family member or a friend or a colleague
03:37
who is living with HIV?
03:41
Hands up.
03:43
Wow. Wow.
03:44
That's a significant number of us.
03:46
You know better than anyone
03:49
that HIV brings out
03:52
the best and the worst in humanity.
03:54
And the laws reflect these attitudes.
03:57
I'm not just talking about laws on the books,
04:00
but laws as they are enforced on the streets
04:03
and laws as they are decided in the courts.
04:06
And I'm not just talking about laws
04:09
as they relate to people living with HIV,
04:12
but people who are at greatest risk of infection --
04:14
people such as those who inject drugs or sex workers
04:17
or men who have sex with men
04:21
or transgendered persons
04:23
or migrants or prisoners.
04:25
And in many parts of the world that includes women and children
04:28
who are especially vulnerable.
04:31
Now there are laws in many parts of the world
04:33
which reflect the best of human nature.
04:36
These laws treat people touched by HIV
04:39
with compassion and acceptance.
04:43
These laws respect universal human rights
04:46
and they are grounded in evidence.
04:49
These laws ensure that people living with HIV
04:52
and those at greatest risk
04:55
are protected from violence and discrimination
04:57
and that they get access to prevention and to treatment.
05:00
Unfortunately, these good laws
05:05
are counter-balanced by a mass
05:07
of really bad law --
05:10
law which is grounded in moral judgement
05:13
and in fear and in misinformation,
05:17
laws which specifically punish people living with HIV
05:20
or those at greatest risk.
05:24
These laws fly in the face of science,
05:26
and they are grounded in prejudice
05:28
and in ignorance and in a rewriting of tradition
05:32
and a selective reading of religion.
05:35
But you know what? You don't have to take my word for it.
05:39
We're going to hear from two people
05:41
who are on the sharp end of the law.
05:43
The first is Nick Rhoades. He's an American.
05:46
And he was convicted under the U.S. State of Iowa's law
05:48
on HIV transmission and exposure --
05:52
neither of which offense he actually committed.
05:55
(Video) Nick Rhoades: If something is against the law
05:58
then that is telling society
06:02
that is unacceptable, that's bad behavior.
06:03
And I think the severity of that punishment
06:05
tells you how bad you are as a person.
06:08
You're a class B felon,
06:12
lifetime sex offender.
06:14
You are a very, very, very bad person.
06:17
And you did a very, very, very bad thing.
06:21
And so that's just programmed into you.
06:24
And you go through the correctional system
06:27
and everyone's telling you the same thing.
06:30
And you're just like, I'm a very bad person.
06:32
Shereen El-Feki: It's not just a question
06:37
of unfair or ineffective laws.
06:39
Some countries have good laws,
06:42
laws which could stem the tide of HIV.
06:44
The problem is that these laws are flouted.
06:47
Because stigma gives unofficial license
06:50
to treat people living with HIV
06:53
or those at greatest risk
06:55
unlike other citizens.
06:56
And this is exactly what happened
06:59
to Helma and Dongo from Namibia.
07:00
(Video) Hilma: I found out
07:04
when I went to the hospital for a pregnancy check-up.
07:05
The nurse announced that every pregnant woman
07:08
must also be tested for HIV that day.
07:12
I took the test and the result showed I was positive.
07:14
That's the day I found out.
07:17
The nurse said to me, "Why should you people bcome pregnant
07:20
when you know you are HIV positive?
07:22
Why are you pregnant when you are living positive?"
07:24
I am sure now that is the reason they sterilized me.
07:26
Because I am HIV positive.
07:29
They didn't give the forms to me
07:34
or explain what was in the form.
07:37
The nurse just came with it
07:41
already marked where I had to sign.
07:43
And with the labor pain,
07:46
I didn't have the strength to ask them to read it to me.
07:47
I just signed.
07:55
SE: Hilma and Nick and our man in the kingdom
07:57
are among the 34 million people living with HIV
08:00
according to recent estimates.
08:05
They're the lucky ones
08:07
because they're still alive.
08:09
According to those same estimates,
08:10
in 2010 1.8 million people died
08:12
of AIDS related causes.
08:16
These are terrible and tragic figures.
08:19
But if we look a little more broadly into the statistics,
08:22
we actually see some reason for hope.
08:26
Looking globally, the number of new infections of HIV is declining.
08:30
And looking globally as well,
08:35
deaths are also starting to fall.
08:38
There are many reasons for these positive developments,
08:41
but one of the most remarkable
08:43
is in the increase in the number of people around the world
08:45
on anti-retroviral therapy,
08:48
the medicines they need to keep their HIV in check.
08:50
Now there are still many problems.
08:55
Only about half of the people who need treatment
08:57
are currently receiving it.
09:00
In some parts of the world --
09:02
like here in the Middle East and North Africa --
09:04
new infections are rising and so are deaths.
09:06
And the money, the money we need
09:10
for the global response to HIV,
09:13
that is shrinking.
09:15
But for the first time
09:18
in three decades into this epidemic
09:20
we have a real chance to come to grips with HIV.
09:23
But in order to do that
09:27
we need to tackle an epidemic of really bad law.
09:29
It's for this reason
09:33
that the Global Commission on HIV and the Law,
09:35
of which I'm a member,
09:37
was established by the agencies of the United Nations --
09:38
to look at the ways that legal environments
09:41
are affecting people living with HIV
09:44
and those at greatest risk,
09:46
and to recommend what should be done
09:48
to make the law an ally, not an enemy,
09:50
of the global response to HIV.
09:53
Let me give you just one example
09:56
of the way a legal environment
09:58
can make a positive difference.
10:01
People who inject drugs
10:03
are one of those groups I mentioned.
10:06
They're at high risk of HIV
10:08
through contaminated injection equipment
10:10
and other risk-related behaviors.
10:12
In fact, one in every 10 new infections of HIV
10:15
is among people who inject drugs.
10:18
Now drug use or possession
10:21
is illegal in almost every country.
10:24
But some countries take a harder line on this than others.
10:26
In Thailand people who use drugs,
10:30
or are merely suspected of using drugs,
10:33
are placed in detention centers,
10:36
like the one you see here,
10:38
where they are supposed to clean up.
10:40
There is absolutely no evidence
10:42
to show that throwing people into detention
10:45
cures their drug dependence.
10:47
There is, however, ample evidence
10:50
to show that incarcerating people
10:52
increases their risk of HIV and other infections.
10:54
We know how to reduce HIV transmission and other risks
10:59
in people who inject drugs.
11:05
It's called harm reduction,
11:07
and it involves, among other things,
11:09
providing clean needles and syringes,
11:10
offering opioid substitution therapy
11:14
and other evidence-based treatments
11:16
to reduce drug dependence.
11:19
It involves providing information
11:21
and education and condoms
11:23
to reduce HIV transmission,
11:25
and also providing HIV testing
11:29
and counseling and treatment
11:31
should people become infected.
11:33
Where the legal environment allows for harm reduction
11:35
the results are striking.
11:38
Australia and Switzerland
11:41
were two countries which introduced harm reduction
11:42
very early on in their HIV epidemics,
11:45
and they have a very low rate of HIV
11:48
among injecting drug users.
11:51
The U.S. and Malaysia
11:53
came to harm reduction a little later,
11:55
and they have higher rates of HIV in these populations.
11:58
Thailand and Russia, however,
12:02
have resisted harm reduction
12:03
and have stringent laws
12:05
which punish drug use.
12:07
And hey, surprise,
12:09
very high rates of HIV among people who are injecting drugs.
12:10
At the Global Commission we have studied the evidence,
12:15
and we've heard the experiences
12:18
of over 700 people from 140 countries.
12:20
And the trend? Well the trend is clear.
12:24
Where you criminalize people living with HIV
12:27
or those at greatest risk,
12:30
you fuel the epidemic.
12:31
Now coming up with a vaccine for HIV
12:34
or a cure for AIDS --
12:38
now that's rocket science.
12:40
But changing the law isn't.
12:42
And in fact, a number of countries are starting to make progress
12:44
on a number of points.
12:47
To begin, countries need to review their legislation
12:48
as it touches HIV and vulnerable groups.
12:52
On the back of those reviews,
12:56
governments should repeal laws
12:58
that punish or discriminate against people living with HIV
13:00
or those at greatest risk.
13:03
Repealing a law isn't easy,
13:05
and it's particularly difficult
13:08
when it relates to touchy subjects like drugs and sex.
13:09
But there's plenty you can do while that process is underway.
13:14
One of the key points is to reform the police
13:17
so that they have better practices on the ground.
13:22
So for example, outreach workers
13:24
who are distributing condoms to vulnerable populations
13:26
are not themselves subject to police harassment
13:29
or abuse or arbitrary arrest.
13:32
We can also train judges
13:35
so that they find flexibilities in the law
13:37
and so that they rule on the side of tolerance
13:40
rather than prejudice.
13:43
We can retool prisons
13:45
so that HIV prevention and harm reduction
13:47
is available to prisoners.
13:50
The key to all this is reinforcing civil society.
13:52
Because civil society is key
13:57
to raising awareness among vulnerable groups
13:58
of their legal rights.
14:01
But awareness needs action.
14:03
And so we need to ensure
14:05
that these people who are living with HIV
14:06
or at greatest risk of HIV
14:08
have access to legal services
14:10
and they have equal access to the courts.
14:13
And also important is talking to communities
14:16
so that we change interpretations
14:18
of religious or customary law,
14:21
which is too often used
14:23
to justify punishment and fuel stigma.
14:25
For many of us here
14:28
HIV is not an abstract threat.
14:30
It hits very close to home.
14:33
The law, on the other hand,
14:36
can seem remote, arcane, the stuff of specialists,
14:38
but it isn't.
14:43
Because for those of us who live in democracies,
14:45
or in aspiring democracies,
14:48
the law begins with us.
14:50
Laws that treat people living with HIV
14:53
or those at greatest risk with respect
14:56
start with the way that we treat them ourselves: as equals.
14:58
If we are going to stop the spread of HIV in our lifetime,
15:03
then that is the change we need to spread.
15:08
Thank you.
15:12
(Applause)
15:13
Translated by Timothy Covell
Reviewed by Jenny Zurawell

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About the Speaker:

Shereen El Feki - Arab sexuality expert
Shereen El Feki works and writes on sexuality and social change in the Arab world.

Why you should listen

Dividing her time between London and Cairo, TED Fellow Shereen El Feki works on issues related to health and social welfare in the Arab region -- including intimate attitudes toward sexual (and political) freedoms, as explored in her new book, Sex and the Citadel.

Half-Egyptian and half-Welsh, El Feki was brought up in Canada. She started her professional life in medical science, with a PhD in molecular immunology from the University of Cambridge, and later worked as healthcare correspondent at The Economist. She also is a former vice chair of the United Nations' Global Commission on HIV and Law. While she has worked in regional media as a presenter with the Al Jazeera Network, and continues to write on social issues in the Arab world, her passion lies in projects that aim to better understand, and surmount, the social challenges facing Arabs, particularly young people.

Read a Q&A with Sheeren El Feki on the TED Fellows site.

More profile about the speaker
Shereen El Feki | Speaker | TED.com