HIV/AIDS: Commonwealth Countries

Lord Black of Brentwood Excerpts

Wednesday 13th March 2013 Lords Chamber

Tabled By

[Lord Black of Brentwood]

To ask Her Majesty’s Government what assessment they have made of the impact of discrimination against gay men and women in Commonwealth countries on global efforts to halt the spread of HIV/AIDS, and what steps they are taking to tackle such discrimination.

[Lord Black of Brentwood]

My Lords, it is a privilege to lead this debate. I am indebted for the support of the organisations that work tirelessly in this area, including the Human Dignity Trust, the HIV/AIDS Alliance, the Kaleidoscope Trust and the Terrence Higgins Trust.

It is a while since this House debated the issue of HIV/AIDS, so let us first remind ourselves of the scale of the problem. While in the developed world, where HIV is now a chronic condition, not a death sentence, we sometimes become blasé about the subject, in much of the world HIV and AIDS remains a catastrophe. In three decades, AIDS has claimed 30 million souls. Last year, 1.8 million died. More than 34 million people are living with HIV and many of them will perish. Although new infections have declined by 21% in the past decade, still 7,400 people are infected each day.

HIV and AIDS remains a global health catastrophe—the worst pandemic in modern history. The good news is the enormous advance in treatment. Today, there is no reason why anyone receiving it should live any shorter a life than someone without HIV. Crucially, we also have the tools radically to slow new infections through education and prevention measures. However, that ability to prevent the spread of HIV is being seriously compromised. The Global Commission on HIV and the Law concluded that,

“punitive laws, discriminatory and brutal policing and denial of access to justice for people with and at risk of acquiring HIV are fuelling the epidemic”.

At the heart of international efforts to deal with this pandemic is a crisis of human rights law, not medicine. There is now overwhelming evidence of the link between criminalisation of homosexuality and the rate of HIV infection.

Why does criminalisation matter? What is the link between bad law and this public health disaster? The UN Development Programme’s Global Commission on HIV concluded that criminalisation of homosexuality “both causes and boosts” the rate of HIV among men who have sex with men, or MSM. Evidence is incontrovertible. In Caribbean countries where homosexuality is criminalised, almost one in four MSM are infected with HIV. In the absence of such laws, the prevalence is one in 15—a shocking disparity. A report in The Lancet in 2012 reaffirmed:

“The odds of HIV infection in black MSM relative to general populations were nearly two times higher in African … countries that criminalise homosexual activity than for those living in countries where [it] is legal”.

Why is that?

Criminalisation breeds stigma and marginalisation. Where this exists, homosexual behaviour is driven underground. Those at risk do not want to talk about their sexuality, receive information about prevention or, crucially, get tested, for to do so may mean prosecution and severe punishment. That has a terrible impact on homosexual behaviour. As The Lancet report I just mentioned concluded, where it is impossible for gay men to found lasting, loving relationships because the law prohibits it, they adopt non-monogamous, anonymous, unsafe sexual practices that fuel infection. There is nothing to warn them not to do so. It is after all almost impossible to mount HIV prevention campaigns where homosexuality is outlawed. A study in 2010 commissioned by the UNDP focusing on Asia and the Pacific found that such laws are regularly used by police to prohibit HIV prevention activities, confiscate condoms and censor educational material on HIV. Yet as studies in Cameroon, Senegal and Kenya have found, there is a strong correlation between the lack of these programmes and the likelihood of MSM having unprotected sex, simply out of ignorance of the basic facts.

Then there is the impact on the care of those infected. The threat of criminal sanction is an overwhelming disincentive to seeking access to HIV services—if, of course, they are available. In a recent case in Kenya where the penalty for,

“carnal knowledge of any person against the order of nature”,

is 21 years in prison, the Medical Research Institute had its HIV work disrupted after church leaders claimed that it was providing “counselling services to criminals”. There are similar horror stories from Uganda, Cameroon and Singapore, where health providers, who are key to preventing the spread of HIV, refuse to do so because of the threat of dreadful criminal sanctions.

The issue is not one that impacts just on gay men. HIV does not respect sexual orientation and statute in a neat and tidy manner. Because of these laws, many homosexuals inevitably maintain heterosexual relationships alongside a relationship with a man. The result is that innocent wives and children, often blissfully unaware of the fate that awaits them, also die as a result of criminalisation. So let us be very clear: criminalisation of homosexuality kills. It kills gay men. It kills women and children, and it kills them needlessly in their tens of thousands, with no end to this in sight. It begets a grotesque waste of human life on an unimaginable scale. Of course, criminalisation is an issue of fundamental human rights—one that I, as a gay man, feel profoundly. But it is also, overwhelmingly, an issue of public health. In the name of saving lives, it has to end.

To our shame, many Commonwealth countries stand in the dock. As we heard last October in a debate led by my noble friend Lord Lexden, their record on criminalising homosexual behaviour is shameful: 42 out of 54 Commonwealth countries criminalise same-sex relations. Punishments range from life in Sierra Leone to 20 years in prison, with flogging, in Malaysia. The record of the Commonwealth on HIV and AIDS is a pitch perfect underlining of my argument. While the Commonwealth represents 30% of the world’s population, it contains more than 60% of people living with HIV globally. That is a damning statistic. We will never be able to tackle the global AIDS epidemic until Commonwealth countries take action to dismantle cruel, degrading, outdated laws criminalising homosexuality.

That point was rightly recognised by the Commonwealth Eminent Persons Group, which in 2011 concluded that decriminalisation had been successful in reducing cases of HIV infection and recommended that steps be taken to procure repeal of these laws. But, in the interest of saving human lives, words need to be met with action. Let me suggest some. There are some things that this House can do. Our committees can play a vital role by providing oversight of Commonwealth institutions and scrutinising progress made by the UK in delivering its LGBT rights strategy. There are things that the Church of England, which has great sway in the Commonwealth, can do by condemning criminalisation specifically because of the way it squanders human life. I am delighted to see the right reverend Prelate here this evening.

There are challenges for the Government. I recognise that they have already done a great deal and I applaud the work of DfID and the leadership of the Prime Minister. I also recognise the enormous personal commitment of my noble friend Lady Northover, but there is more. The UK needs actively to support legal reform across the Commonwealth—an issue that should also be a high priority for CHOGM later this year. I ask my noble friend for an assurance that we will press to make this happen. I hope that the Government might also make decriminalisation and HIV prevention, which is crucial to it, a policy commitment for the FCO and DfID.

The Government should also press the Commonwealth Secretariat and the Commonwealth Foundation for action in this area. It is very worrying, given the sheer number of people at risk across the Commonwealth, that the secretariat has not included LGBT rights, legal reform or HIV in its new strategy. I would ask my noble friend to take this up with these institutions, which could play a vital role here. I also hope that the Government will look at introducing a specific funding mechanism for LGBT organisations working for legal or social reform within their own countries, or delivering services to LGBT people.

All these are important steps in beginning to tackle the tragedy—it is a tragedy—of criminalisation. It is an affront to human rights, an affront to human dignity and a legacy of 19th century colonialism that is killing tens of thousands of people in the 21st century. It is an extraordinary monument to man’s inhumanity to man. I shall listen with huge interest to our debate. We discuss many important issues in this House but it is not often that we get the chance to talk about a subject which, over time, could make the difference between life and death for many who are alive now but sick or at risk, and many yet to be born. This is one of those occasions and I am sure that we will rise to it.