反 LGBT 法律繼續阻礙愛滋病毒之應對

資料來源：http://www.thelancet.com/hiv/ Vol 9 October 2022 / 財團法人台灣紅絲帶基金會編譯

最近幾個月，一些國家取消或廢除了針對 LGBT 人群的法律，主要是將同性活動定為犯罪的法律。 7 月，安地卡及巴布達 (Antigua and Barbuda)  宣布該國 1995 年《性犯罪法》（將同性成年伴侶之間自願性行為定為犯罪）的部分內容違憲。 8 月，新加坡政府廢除了該國刑法中的一部分，該部分將男性之間自願發生的性關係定為犯罪；作為英國殖民統治的遺跡，起訴可判處最高 2 年的監禁。最近，另一個加勒比國家聖啟茨及尼維斯 (Saint Kitts and Nevis，亦稱聖克里斯多福及尼維斯聯邦) 的高等法院裁定，將同性行為定為犯罪的法律違憲，這意味著它們被從法律法規中刪除。近年來，其他國家在非刑事化方面也取得了進展，特別是安哥拉、不丹、波札那和加蓬。這都是好消息。在安地卡及巴布達，全面滿足情感和社會需求（Meeting Emotional and Social Needs Holistically, MESH；為 LGBT 社區服務）和婦女反對強姦組織提出了法律變革的理由——這些組織認為這些法律透過創造了一個違反保密和辱罵的敵對醫療環境來阻止人們尋求愛滋病毒檢測、治療和照護。聖啟茨和尼維斯平等聯盟在促成當地的法律變革方面發揮了重要作用。這兩個案例都得到了東加勒比多樣性與平等聯盟 (ECADE) 的支持。儘管取得了這些進展，但據估計，仍有 68 個國家制定了將從事同性關係的人群定為犯罪的法律。在這些國家中，有 21 個被認為將跨性別者定為刑事犯罪，11 個有法律規定可以對同性活動處以死刑，46 個處以最高 14 年的刑期，7 個處以 14 年至無期徒刑。撒哈拉以南非洲地區繼續在對 LGBT 人群制定懲罰性法律的國家中名列前茅。聯合國愛滋病規劃署報告說，非洲西部和中部的 13 個國家以及東部和南部非洲的 13 個國家制定了將同性活動定為犯罪的法律。其中一些國家的愛滋病毒負擔是世界上最高的。繼續將同性關係定為犯罪的國家高度集中的其他地區包括加勒比地區（7 個國家）、中東和北非（16 個國家）以及亞太地區（18 個國家）。將同性關係刑事定罪與男男性行為者 (MSM) 的 HIV 照護關聯的證據是引人注目的。 2019 年，MSM 感染 HIV 的風險是其他成年男性人口的 26 倍，而在將同性活動定為犯罪的國家相較於沒有刑事定罪的國家之人群中，其MSM 感染愛滋病毒的可能性是非刑事定罪國家之 2 到 5 倍，。 2019 年對非洲 MSM 中 HIV 檢測和照護參與的一項系統和薈萃分析發現，與立法最不嚴厲的國家相比，在反 LGBT 立法最嚴厲的國家，檢測水平和感染狀態之意識顯著降低（57%對比 72% 和 7% 對比 22%）。另一項研究 2014 年在奈及利亞引入了《禁止同性婚姻法》，該法進一步將該國的同性活動定為犯罪，報告稱，在引入《禁止同性婚姻法》後，MSM 對尋求 HIV 相關醫療保健的恐懼顯著增加。與以前相比（38% 對 25%），以及避免醫療保健（28% 對 20%）。一項對國家愛滋病應對相對成功的跨國生態分析表明，在同性活動被定為犯罪的國家，知道自己愛滋病毒狀況的愛滋病毒感染者比例相較於沒有刑事定罪國家的比例低 11%，病毒抑制比例則低 8%。法律將 LGBT 社區定為刑事犯罪的國家也更有可能會少報此類人口的規模，因此可能導改資源無法適當地被針對。將同性行為定為犯罪不僅侵犯了人權，而且會使受愛滋病毒影響的重點人群邊緣化，並對他們的健康和結束愛滋病毒流行的前景產生了嚴重後果。這些法律助長了社會上的同性戀恐懼症和跨性別恐懼症，加劇了對邊緣化人群的歧視、騷擾和暴力等行為。擁有此類法律的國家無法期待其終結愛滋病毒/愛滋病。立法機關和民間社會需要繼續解決這些法律造成的根深蒂固的污名化問題，其中大部分源於嚴峻的過去。廢除這些法律是消除污名和歧視並使各國在抗擊愛滋病毒/愛滋病方面取得進展的重要一步。 ■ 刺胳針愛滋病毒

Anti-LGBT laws continue to hinder the HIV response

http://www.thelancet.com/hiv/ Vol 9 October 2022

In recent months, a number of countries struck out or repealed laws targeting LGBT populations, principally laws that criminalised same-sex activity. In July, Antigua and Barbuda declared that sections of the country’s 1995 Sexual Offences Act (which criminalised consensual sexual acts between same-sex, adult partners) were unconstitutional. In August, the Singaporean Government repealed a section of the country’s penal code, which criminalised consensual sexual relations between men. A vestige of British colonial rule, prosecution could bring a prison sentence of up to 2 years. And most recently, the high court of another Caribbean nation, Saint Kitts and Nevis, ruled that laws criminalising same-sex activity were unconstitutional, meaning that they were struck from the legal code. In recent years, other countries too have made progress with decriminalisation, notably Angola, Bhutan, Botswana, and Gabon. This is all good news. In Antigua and Barbuda, the case for legal change was made by the Meeting Emotional and Social Needs Holistically (MESH, which serves the LGBT community) and Women against Rape—the organisations argued that the law prevented people from seeking HIV testing, treatment, and care by creating a hostile health-care setting with breaches in confidentiality and verbal abuse. The Saint Kitts and Nevis Alliance for Equality was instrumental in effecting legal change there. Both cases were supported by Eastern Caribbean Alliance for Diversity and Equality (ECADE). Despite this progress, it is estimated that 68 countries still have laws that criminalise populations who engage in same-sex relations. Of these countries, 21 are believed to criminalise transgender people, 11 have legal provisions that can impose the death penalty for same-sex activity, 46 impose sentences of up to 14 years, and seven impose sentences of 14 years to life imprisonment. Regions in sub-Saharan Africa continue to top the list of countries that have punitive laws against LGBT populations. UNAIDS report that 13 countries in western and central Africa and 13 countries in eastern and southern Africa have laws that criminalise same-sex activity. Some of these countries have the highest burden of HIV in the world. Other regions with a high concentration of countries that continue to criminalise same-sex relations include the Caribbean (seven countries), the Middle East and north Africa (16 countries), and Asia and the Pacific (18 countries). Evidence linking criminalisation of same-sex relations with the HIV care of men who have sex with men (MSM) is compelling. In 2019, the risk of acquiring HIV was 26 times higher among MSM compared with the rest of the adult male population, and among those who live in countries that criminalise same-sex activity MSM are between two and five times more likely to be living with HIV than in countries without criminalisation. A 2019 systematic and meta-analysis of HIV testing and engagement with care among MSM in Africa found that levels of testing and status awareness were significantly lower in countries with the most severe anti-LGBT legislation compared with countries with the least severe legislation (57% vs 72% and 7% vs 22%). Another study examining the introduction of the Same-Sex Marriage Prohibition Act in Nigeria in 2014, a law that further criminalised same-sex activity in the country, reported that fear of seeking HIVrelated health care among MSM was significantly higher after the introduction of the law versus before (38% vs 25%), together with avoidance of health care (28% vs 20%). And a cross-national ecological analysis of the relative success of national AIDS responses, showed that in countries where same-sex activity was criminalised, the proportion of people with HIV who were aware of their HIV status was 11% lower and viral suppression 8% lower than in countries with no criminalisation. Countries with laws that criminalise LGBT communities are also more likely to under-report the size of such populations and thus, resources may not be targeted appropriately. Criminalisation of same-sex activity not only infringes human rights but also marginalises key populations affected by HIV, and has severe consequences for their health and the prospects for ending the HIV epidemic. These laws feed societal homophobia and transphobia, and exacerbate discrimination, harassment, and violence against marginalised populations. Countries with such laws cannot expect to end HIV/AIDS. Legislatures and civil society need to continue to tackle the deeply ingrained stigmatisation that these laws engender, most of which have their roots in a grim past. Repealing these laws is an essential step in unravelling stigma and discrimination and enabling countries to progress in their fights against HIV/AIDS. ■ The Lancet HIV

資料來源：http://www.thelancet.com/hiv/ Vol 9 October 2022 / 財團法人台灣紅絲帶基金會編譯