 Hi, everyone, we're going to give it a couple of seconds for people to trickle in and then we're going to get started. Okay, so we're going to get started with the introductions while people are still trickling in. Good afternoon, everyone. My name is Adelina if then I am the associate director of the health law institute at the housey. And it is my pleasure to host today's event, which is also the last seminar of the 2020 2021 series. It's been a crazy year, but we had amazing speakers so we are going to conclude once again with an amazing speaker and an amazing talk. Thank you for joining us throughout the year and thank you for joining us today. Before I introduce our speaker for today. I just have a couple of housekeeping info that as always so we have live closed captioning at the bottom of your screen you're going to see a closed captioning button. If the captioning is not turned on, just make sure that you push on subtitles on and you're going to be able to see the captioning. Secondly, we do not have a chat box but we do have a Q&A box. So I encourage you as Eli is going to be speaking today to type your questions in the Q&A box. And after Eli's talk I am going to come back and filter the questions for her. Now you can also see the questions that other people are posing so we can avoid repetition and you can vote them if those are questions that you would like answered with priority, make sure that you vote on them and I'll ask those ones first. Okay, so with that said, I am going to introduce our speaker for today which is Dr. Eli Menning. She is an assistant professor at the Halsey University School of Social Work. She is also a research associate with the Health Law Institute. Her HIV work began as an advocate for and with people living with HIV, trans people and queers. As an interdisciplinary academic, her HIV work is an extension of her social work career. Her forthcoming book, The New War on AIDS, HIV Treatment Adherence and the Treatment as Prevention Empire from UBC Press, disrupts the seemingly neutral language of treatment as prevention by showing how adherence perpetuates colonialism, racism and sexism. Her current research examines racism, colonialism and white supremacy in Canadian HIV criminalization. We are thrilled to have you here, Eli, and I'm going to turn to you now. Great. Thank you so much, Adelina. I'm going to share my screen now, just make sure that works. Adelina, can you just confirm that you can see it? I can see it. Everything is good. Super. Thank you so much for attending the last Health Law Institute seminar this year, or today. And I also want to thank Adelina and Matthew for inviting me to present my work. I want to acknowledge that I'm here in Shabuk Duk, which is in Migmagi, the unceded and ancestral territory of the Migmaw people. My colleague, Stel Raven, an Indigenous Two-Spirit trans-social worker and scholar, talks about how these territorial acknowledgements can be analogous to someone grabbing your belongings and saying, hey, I acknowledge I have your stuff. So they, along with many other Indigenous people and scholars, challenge us to think about what these territorial acknowledgements mean when we're settlers on Indigenous lands, and we've done little to disrupt these colonial relations. In the context of this presentation, it's important for me to recognize how Canadian laws pretend that they are the only laws of the land. Part of how colonization continues is by attempting to eradicate Indigenous sovereignty in multiple ways. One of these ways is to negate Indigenous laws that continue to govern Indigenous communities and nations. I see part of my work as a settler to disrupt the idea that Canadian laws are the supreme laws of the land. I hope that this presentation encourages you to think differently about the purpose of Canadian law and challenges you to answer the call to decolonize. I encourage you to read and commit to both the Truth and Reconciliation Commission's calls to action and the national inquiry into missing murdered women and girls and Two-Spirit people's calls for justice. These are two places to start. As you know, my topic today asks if AIDS quarantine is a metaphor or reality in British Columbia. Before we dive into these juicy bits, I want to say a word about metaphor. Argumentatively, I think metaphors are weak. But to say something is like something is one thing, but to say something is something else is a much stronger thing. So that said, where do you think this presentation is going? AIDS quarantine is not a figurative analogy or metaphor, but is a literal experience. It's not like quarantine, it is quarantine. First, I define AIDS quarantine not only as the physical confinement of people living with infectious diseases, but this practice also embodies AIDS hysteria that looks to separate out people living with HIV from those who are HIV negative. It privileges the lives of those who are negative over the lives of those who are positive. It also does this at the expense of those who are positive. I'm going to examine how AIDS quarantine came into BC legislation in 1987 and trace it through to present day public health legislation. So this legislative analysis comes out of a broader piece of my research regarding treatment as prevention. Treatment as prevention or task is a preventative approach that uses HIV medication to reduce transmission with the ultimate goal of eradicating HIV. Task targets people living with HIV, while prep or pre or pre exposure pro pro post pre exposure prophylaxis is targets HIV negative folks. It's also the provincial HIV prevention approach in British Columbia. Folks, it asks people living with HIV to maintain lifelong adherence to HIV treatment. But it also implements universal HIV testing, while also removing informed consent from the process. It requires a monitoring of individual and community viral load, and also engages in directly observed therapy for those reluctant people living with HIV. It is beneficial in the sense that it offers universal access to treatment, but it also uses problematic practices that I'll speak of today. Under task, those who don't know HIV status are considered the most dangerous as they are seen to cause the majority of serial conversions. Additionally, those who are non adherent to medication are also conceived of as a threat to public health. In order to prove that task works, massive amounts of data are needed to show an increase in adherence rates and a decrease in transmission rates and viral loads. Viral load is a key marker in tasks because what it shows if you have an undetectable viral load and that what that means is that you have so few viral replications in your blood that it's below the level of detection of existing tests. And it also effectively means that you won't transmit HIV. So the notion of undetectability in health promotion, such as you equals you or undetectability equals untransmitability promotes adherence to HIV medication as very few people can attain undetectability without it. Within this broader project, I examined several fields of knowledge regarding adherence, biomedical research, public health legislation regulations and policy and artwork produced by people living with HIV. AIDS quarantine was proposed in the BC legislature in July 1987, responding to the AIDS hysteria of the time. As an omnibus bill, it proposed changes related to other acts, but I will focus on the Health Act and its implications for people living with HIV. AIDS activists, the BC Civil Liberties Association, the Vancouver Gay and Lesbian Community Center, which I'll refer to as the center, and the ad hoc coalition for responsible health legislation, which I'll refer to as the coalition, shifted to reject AIDS quarantine and represent the needs of people living with HIV. I'm going to focus on three things that Bill 34 or the AIDS quarantine bill as it was more commonly known proposed. The first thing that it did was that it introduced the vague language of health hazards. And in the proposal it defines health hazards as a conditioner thing that does or is likely to endanger public health, or prevent or hinder prevention or suppression of disease. It includes prescribed conditions or thing or prescribed condition or thing that fails to meet the prescribed standard. So, a little bit vague in terms of its language. In response to the introduction of health hazards, the Vancouver Gay and Lesbian Community Center and the ad hoc coalition for responsible health legislation, objected to the variable definition that left the definition in the hands of select members of government. Specifically, the center and the coalition argued that this quote, sweeping legislation leaves the definition of words up to a small group of politicians who may respond to the paranoia and paranoia and hysteria of an ill informed public. In condemning the broadness of this proposed bill they further stated, quote, past experiences in this country and in this province does not leave us with any sense of security. One only has to reflect upon the treatment of Canadians of Japanese ancestry during the Second World War. The second thing that Bill 34 introduced was extending the powers of medical health officers to impose testing force treatment and allow for confinement. Bill 34's initial proposal of enhancing the role of medical health health officers. This is what actually led AIDS activists to push back against the proposed legislation that enabled AIDS quarantine. In its initial wording, it charged medical health officers with the power to isolate and quarantine any person with a reportable communicable illness. In short, this allowed medical health officers to impose testing treatment and or confinement any person living with HIV or AIDS. Boldly the center and the coalition stated that this amendment was quote, clearly designed for people testing positive for the antibodies to the AIDS virus. There is no other explanation, end quote. The Liberty's Association echoed concerns that this bill targeted people living with HIV, but suggested a particular amendment to the proposed legislation. Quote, if the legislation is designed to deal with those who are willfully or carelessly spreading AIDS, it should say so, end quote. Following this suggestion, the legislation passed with the BC civil liberties intent amendment and added an additional clause, which states the person who is likely willfully or carelessly or because of mental incompetence. The third thing that the bill introduced was the collection of patient information for government use. This is important because it predates HIV as a reportable infection, which didn't actually happen until May 2004 in British Columbia. The bill proposed amendments that permitted the government to obtain health information about people who participated in medical health research. Several groups were concerned about the proposed clause that would allow the government to access health and health information for undisclosed purposes. The previous amendment to empower a cabinet to define public health terms. The result could have been that the government accessing that government accessing people's health information disclosed for research purposes could use it as they saw fit. The center, the coalition and the civil liberties association raised objections to this proposed legislation. The center and the coalition made the same argument. In these times of pervasive government involvement in so many areas of potential for information regarding a person or class of persons, reaching many government departments is great. In this situation, we can place no reliance on government assurances of confidentiality. End quote. Part of bill 34 amend was amended to specify the maintenance of the BC cancer registry for the cancer control agency of British Columbia to ensure that's quote its ability to identify individuals whose medical problems are being studied as well as collect medical information about them. End quote. The civil liberties association acquiesce to not jeopardize this very worthwhile endeavor, but they were, but they were still specifically concerned about the potential instances for governments demanding identifying information about participants in age research. To this end, the civil liberties association recommended specifying legislation that would quote the needs of the cancer agency control cancer control agency of British Columbia, and to withdraw the general legislation regarding gathering the information research information, end quote. On December 17 1987, the bill passed into law incorporated into the health act, leaving unchanged health hazards, amending powers of the medical health officer to include intent, and specifying the collection of information for the cancer agency, but it did not retract the section that would allow government to access health information for undisclosed purposes. Now we're going to skip ahead two decades. Technological advancements that include mass production of computers, widespread use of the internet and the digitization of government files, including medical records, challenges, changes to pharmaceuticals that allowed for combined regimens into one pill reducing pill burden. Scientific studies that seek to prevent HIV transmission using medication, reluctance and doubts about long term side effects of safer sex education and practices. Scientific claims that shift medication side effects to discussions of disease progression, the renewal of HIV prevention biomedicalization collapsing the historical debate between treatment and prevention. And then the entrance of treatment is prevention. And intensification of adherence to HIV medication for the purposes of prevention. TASP advocates pushed for legislative reform in order to enact several public health practices to support this intervention. It coincides with the province taking on task as a provincial prevention approach, and the launch of other health legislations like the e health act. The province changed the health act to the public health act, which came within, which came with several changes to continue AIDS quarantine into the 21st century. In the new public health act, there are health hazards are simplified, and their applications are broadened. It's defined now as a condition thing or an activity that endangers or is likely to endanger public health. Additionally, new terms were added, including infected persons, which describes a person who is, or is likely infected with, or has been or has likely been exposed to an infection or hazardous material. The public health act defines additional terms like health impediment, infectious agent and preventative measures. These hazards get attached to numerous sections of the public health act, effectively broadening the reason for intervention to now include anyone who has, quote, likely been exposed to an infectious agent or hazardous material. Adding likelihood to the definition, while it may seem insignificant opens up the possibility for more expensive applications. The specification is to how broadly this could be applied. For example, the legislation doesn't require medical testing assessment to determine the likelihood of infection or exposure. These broad definitions effectively enact a wider scope for the application of public health legislation, then even originally proposed in bill 34. The broad application is a central feature that aids activists contested of bill 34, but the new public health map, the new public health act was met with no recorded objections in 2009. The second thing that the public health act introduces is an emphasis on by any means, any means necessary to protect public health. With this introduction of new terms, there's new applications. For example, preventative measures include one, preventing illness to promoting health, three, preventing transmission of infectious agent, or four, preventing contamination by hazardous agent. Further preventative measures include, quote, being treated or vaccinated or preventing or taking preventative medication, end quote. Under section 27 of the public health act, the health officer is charged with the powers to issue an order if they deem it reasonable and if that order is necessary to protect public health. So if the medical health officer believes a person needs the criteria and the medical health, the medical health officer can then quote, order a person to do anything that the medical health officer reasonably believes is necessary, end quote. It included also included also in any any means necessary was the introduction of police and for enforcement and compliance, which was not previously included in public health legislation in BC. The enactment of police for the purposes of public health was never proposed in bill 34. So in this way, it's a more extreme measure than the 1987 AIDS quarantine bill. The new public health act also removes intent. It removes willfully or carelessly as long as well as mental incompetence. You remember that the BC civil liberties association requested that the language be amended to include intent and the legislation indeed did pass with that amendment. But in the new public health act that specific wording is completely absent. It's reverted back to the excessively broad language originally proposed in bill 34. The judgment of the medical health officer is the measure used to enact a public health order. Given Vancouver Coastal's medical health officers enthusiasm for tasks and their reiteration that public health threats pose to and the and the reiteration of public health threats that those who are unaware of their HIV status, as well as those who are in the treatment pose. It's not unreasonable to think that she may use her powers to enact orders against non adherent people living with HIV. What this legislation has potential to set in motion is the possibility of legally mandating HIV for treatment for treatment for prevention. There are a few limitations such as timeframe considerations or circumstances set out in the public health act to curb the possibility of mandatory HIV treatment. Thank you that the health act, the public health act actually reverts back to the 1987 AIDS quarantine hysteria or exceeds it and is in order to support treatment as prevention. So let's talk about the implications of these legislative changes. The blatant quarantine of people living with HIV was avoided under the implementation of bill 34. What exists is strengthened today by the broad based definitions that can be enacted across a wide range of situations. Health Hatter health hazards have a central role in broadening the reasons for public health interventions health hazards hazards have replaced the language proposed by the civil liberties Association regarding intent. The intent is not considered and in the new public health act, the discretion and quote reasonable belief of the medical health officer allows for significant latitude in enacting orders. Under the public health act, the medical health officer may order a person to undergo testing examination or preventative treatment. I want to emphasize preventative treatment here. If an individual fails to abide by an order of the medical health officer. The health officer may escalate their intervention using more forceful techniques, including seeking detainment or the services of police granted the medical health officer needs to support from the courts to enforce more extreme measures of public public health orders. But they are not obligated to notify the person against whom they seek the warrant or injunction, leaving challenges to the order to occur only after enforcement. The use of police to enforce public health orders blends the goals of public health with law enforcement, which reinforces the criminalization of people living with HIV. American legal scholar Lawrence Boston details three distinguishing factors related to civil and criminal applications used to confine people clarity objectivity and safeguards. This is that public health, often mobilized broad category such as dangerous or health hazards in our case, whereas criminal law focus focuses on specific behaviors or actions. With regards to the objective of the indicted person, civil confinement or quarantine can be based on future predictions of behavior, whereas criminal prosecutions must be based on acts that have already occurred. In terms of safeguards criminal convictions must be proven beyond a reasonable doubt, whereas civil interventions like the BC Public Health Act just needs to provide a convincing argument and evidence. Another safeguard that the criminal process offers that public health interventions do not is that the former has clear guidelines for the duration of sentence, whereas the latter does not in BC. There are numerous critiques of HIV criminalization, which use criminal justice to charge and prosecute people living with HIV, but the same is not true for public critique of public health interventions. To be clear, I'm not arguing for HIV criminalization, but rather demonstrating some of the problems with coercive public health measures. I want to caution against believing that public health is a more appropriate responsive or humane way to deal with non adherent people. Both the criminal justice system and the public health system are highly problematic. Persuasiveness of the BC Center for Excellence in HIV to have the province endorse and promote tasks as a provincial HIV prevention initiative. It's not unreasonable to be concerned about how present day public health legislation and regulations may be enacted to against those non adherent patients. As it stands, public health legislation would not require any significant changes in order to enact mandatory treatment. As the medical health officer believes it's reasonable and that public health is at risk. You may think I'm being hyperbolic, but in August 2018, the Public Health Act was used against a person living with HIV. The Vancouver Medical Health Officer, Rika Guffston charged an HIV positive man under the Public Health Act for not complying with treatment. The media reports state that the man failed, quote, to collect medication and failed to attend clinic appointments, end quote. His viral load had reached a certain level and which made him potentially infectious, but was he was supposed to attend daily medical appointments. In the CBC article, Guffston is quoted as saying, quote, the person would be required by the courts to take whatever preventative measures would be necessary to reduce the probability of transmission, end quote. So this legislation has actually been applied to people living with HIV under treatment as prevention. In addition, the Center for Excellence runs a number of directly observed therapy programs for non-adherent patients. These DOT programs, as they're more commonly known, are historically rooted in tuberculosis treatment where medical professionals watch people take their medication to ensure adherence. Similar approaches are used in the administration of methadone to prevent abuse. The underlying assumption with DOT programs is that people are not reliable, truthful, capable, or that they're downright resistant to taking medications as prescribed and therefore need medical supervision. These kinds of assumptions and medical practice promote the ideas of the malicious, reckless, recalcitrant HIV positive person. Well, the Center has named indigenous women living with living in the downtown East side as the most likely group of people to be non-adherent. Largely because of pharmaceutical changes in the biomedicalization of HIV prevention, we see more of what Danielle Elliott calls chemical incarceration than outright quarantine. She discusses how chemical incarceration. She discusses chemical incarceration as the viral containment of unruly non-adherent patients through supervised consumption of HIV medication. But also their spatial confinement as they are required to appear daily at a clinic. She points out and concludes that DOT programs speak to the tension between surveillance and containment. The complex practices of adherence carried out in the administration of DOT programs in the downtown East side highlight the multiple ways that people living with HIV are remade as non-adherent patients who require surveillance to ensure their viral infectiousness is contained within their bodies but who are also, but who also require physical containment to limit their contamination to the borders that divide classes and races. Indigenous people remain the key target of containment. We need to question how these approaches enact not only white supremacy, but also how they perpetuate colonialism in the 21st century. Components of AIDS quarantine continue to persist in BC's current public health legislation. So I leave you with these questions. I think critically about the implications of any form of forced actions or confinement, whether it be under public health or criminal law. Learn about the history of the legislation and regulations that you work with. What contestations have been made about them by whom and why. To what end and at whose expense do we prioritize public health. What protections exist for persons deemed health hazards or dangerous. What kinds of rights protected particularly the rights of those most vulnerable to the legislation. What other interventions could address harm both in the short and long term. How might the de-investment in carceral institutions enhance a solution. How do prison abolitionists suggest we address this problem. What might indigenous laws and legal processes offer to this problem. What about indigenous laws on the land that you live on and how might you build those relationships with indigenous nations to learn about them. If you're interested in this particular work I encourage you to read a chapter that a colleague and I wrote about AIDS quarantine in BC where he speaks to the lived experience of someone living with HV under TASP in BC. Thanks very much, and I welcome your comments and questions. Thank you very much, Eli for that absolutely insightful and moving presentation there are so many aspects of it that I normally. I think I've been very superficially thinking about this issue, more in the context of criminalization and less so in the context of public health and I know I've heard you talk before and I think. It's shocking how multi dimensional this problem is right and how many facets should be addressed is not just a matter of simply decriminalizing certain behavior related to HIV that has been is currently criminalized. So Sean has a question that sort of taps into something that I wanted to ask you, because I think that a lot of people potentially listening to you talk you know even when they are sympathetic to the issues that are raising maybe you know the regular public maybe very concerned about sure but we you know we sort of need protection from the virus for the spread of the virus, some people perhaps are not really respecting the requirements that that help sort of mitigate the risks of infection so. Sean is asking you under what conditions or in what circumstances if any do you think medical observation of adherence is defensible and how might such practices interact with or be shaped limited or expanded by individual duties towards community. Yeah, I think this is like one of those questions that opens up a lot, which is right where people go with this right. I think, you know, part of what treatment is prevention has shifted is the idea of who HIV positive people are. So, as I kind of said to in my talk, it really does assume that people who are HIV positive are out to infect other people. It also then assumes that HIV treatment is the only way to prevent HIV transmission. And so I think when those are the two premises that this approach is built on it really questions for me. Why, why, why do we have those preconceptions because that's absolutely what this kind of forced adherence is situated on. Right. And so to me it really is about questioning those sorts of preconceptions, because I don't think it's real. I think they're actually true. And I think that part of the danger with treatment is prevention is that it has been so successful in its medical arguments as to why HIV treatment is the best approach to HIV prevention that we've lost sight of any other forms of diseases like safer sex education and that sort of thing and so it and safer sex education also then puts the responsibility on all people involved in a situation rather than the responsibility solely on somebody living with HIV. I think in this situation, that's also an element that comes into play is that it places the sole responsibility for transmission on people who are HIV positive, which I think is an unfair balance of responsibility. So that's not really an answer to the Sean's question, but I think that what we really have to do is unpack why we think adherence and mandatory adherence is necessary or supervised adherence. People also have the right to choose for themselves whether or not they take medication, just because they take medication or take medication doesn't necessarily mean that they're going to be infectious or that they're going to willfully infect other people, right. And so it is a complicated question, but I really think it requires an examination of some of the assumptions that are underpin these kinds of approaches. Sean has a follow up question. Yeah. Given given the strength of autonomy as a guiding principle, and the demands of consent. How can these programs really get off the ground in the first place. I guess my question is like in terms of these programs like treatment is prevention. Um, I think he was referring to the alternatives that you were suggesting right. Okay. I think you can clarify but yeah. Yeah, I think, you know. Yeah, he was he said yes but I don't know if to yours or to mine. Okay, so I'm going to try to approach it around treatment is prevention around like, you know, um, so I think, again, we have to kind of think about what are the priorities in HIV prevention and who's at whose expense do we do we do this and I think, you know, if people in HIV were the center at the center of defining HIV prevention strategies that they would have probably really great suggestions. You know, and so, and we've seen that right I mean most AIDS prevention strategies have been designed by people who are HIV positive at least in the very early stages of the epidemic. And so, I think that there is attention in treatment is prevention around individual versus collective rights that's without a doubt certainly attention within this. But I think what happens in this more specifically is that there's a tension between protecting those who are not infected with HIV from those who are infected with HIV and really again kind of centrally situating people who are as positive as like infectious people who are deliberately going out to infect non positive folks. And so, it is a it's a flawed premise to begin an intervention on um okay Patrick has a question that has been voted up to the top. How do you counterbalance the precautionary principle lens that public health might be looking through with the potential harms of preventative treatment, particularly in the in a context where there are many unknowns for example, in the 1980s with HIV or in 2003 with SARS and now with COVID-19 very timely question. Yeah, and I think, you know, I think it's important to understand the differences between COVID and HIV. You know, I mean I think we can kind of we kind of know what they are right HIV is a blood borne pathogen. COVID is airborne, right and so the likelihood that you are going to contract an airborne disease is much higher than contracting HIV HIV is a very fickle frail virus it can't exist outside of the body, whereas it can't exist outside of the body for up to a number of days right and so there's different kinds of infectious diseases and I think each one requires a particular response so I think having public health legislation that is so Brad that it could cover any infectious disease, something like COVID to something like HIV which is much more harder to acquire. I think is is problematic like it, it, I know that the legislation is trying to kind of set up a blanket kind of statement but I think that it's to figure out how to do this, you know, I don't really have any solutions necessary for the preventative kind of measures, but I think, you know, having things within the public health act that look to protect people that are indicted under the public health act is a really necessary thing so how do we incorporate representation for people, how do we have an opportunity for people to contest public health orders. I think these are things that some ways that can can be done to kind of tinker with the concept of public health, but I think more broadly we need to think about what kinds of harms are being done under the public health act and how can that be mitigated, perhaps by the public health legislation. Thank you. Okay, so somebody has another question. They say, regarding learning more about the history of policies. I am curious as to your experience, the experiences of the persuasive impact that better knowledge of these histories can have. Is an increased focus on problematic policy histories persuasive to actors like government, health professionals, the public in encouraging them to reconsider the validity or necessity of policies. As a researcher and someone who likes the history of policies, I would like to think so. I think, for me when I was doing this work, and I, you know, I was doing work in the Vancouver gay and lesbian archives. And that's where I found meeting notes from from the, that both the center and the coalition and the civil liberties association. And so for me, it was much more eye opening as to what had happened at that particular time, and it gave us clues as to what are the problems that still exist, you know, and it was so fascinating to find all these sorts of challenges in 1987, but then nothing in like 2008 2009 when the, when the new public health that came into effect. And largely that has to do with, like, the, the reform of the public health act wasn't that well advertised I don't think necessarily and so I don't think people necessarily had the same kinds of opportunities to engage in debate around the specific changes to the public health act. I also think as one specific bill that was trying to go and change parts of the public of the health act in 1987. It was, in some ways, a vehicle that allowed for more dial like more public dialogue around that. I think changing over huge amounts of pieces of legislation all at one time like what happened in the, you know, late 2000s in BC really dissuaded the public from engaging in those settings. I think, you know, governments are in some cases really wanting to have consultation with public more. It depends on the government it depends on the particular province it depends it can so contextually specific, but I would like to think that it does shift or have an impact at least in policy development. You know, as a social worker. It's also important for people, not only legislators and, and, you know, policy wants that work with them the government to understand these pieces of legislation, but also people who use them so be that doctors or nurses or social lawyers like anyone who is engaged in these kinds of pieces of legislation in any way within whatever their professions are. I think it's important for them to also understand that to understand historically what the content stations have been and how those still may be current and or how they may have shifted because of the contextual changes and the technological changes pharmaceutical changes, all these kinds of changes how those have shifted based on what the previous challenges were. And since we're talking about government I was I was curious if you know I know that's not was the bulk of your work but do you know how this has been dealt with in other provinces so in terms of in terms of public health rather where are there comparable legislation has are there any any provinces that have just let the matter be because I know that obviously the criminal law in this respect applies across the country. So I'm just curious as to what the situation is with with the public health regulation across the provinces. So, some of my colleagues in Ontario have done some examination of the public health legislation there. It's not my particular area but I do know that there has been work around the public health legislation particularly in Ontario so Eric New work is kind of looking towards public health legislation there. And so, you know, in some of you know in moving to Nova Scotia I've had to learn a little bit about the public health legislation here and I know that there is health hazards in BC or in Nova Scotia is public health legislation and so in some ways these ideas are transported from one area to another area. And so, you know, I think it's great to understand and kind of it would be an interesting study to kind of look across provinces and see how health hazards kind of come up when they come up how they've come up, you know, whether BC adopted it from another province or another country is, it's, I'm not really sure where it came from, but it certainly came out in 1987. So, to trace that across other provinces to see whether it showed up in public other public health legislation I suspect it has because I think when one province kind of has some success in doing something legislatively other provinces tend to borrow it so I would expect to see health hazards, potentially in other pieces of Canadian health, public health legislation but I'm not particularly clear on that other than for sure I do know that it has it does exist in Nova Scotia. Okay, I do have one more question but I would also like we have a bit more time so I would like to invite others to actually type their questions in the chat if there are any other questions. In the meanwhile, I'm going to ask you a bit of regarding if you have any knowledge and you might not but I know sometimes it can be very difficult to find any kind of stats on that. But I know, and you were talking about the very clear link between this legislation and the, you know, intersectional impact that is going to be having for obvious reasons right like they have even publicly said that indigenous sex workers are the most likely to not be adherent to treatment or whatnot. Do you have any sense of how these provisions have been applied when it comes to HIV non compliance and is there any data collected or information as to which are you know the kind of like the races that are have actually had these provisions imposed on, or you know, gender wise because I know that criminally. It's interesting because if the case is the case that led to essentially an increase in the criminalization of HIV. The accused was a white male right a very unsympathetic accused. What happened was that we saw that statistically this, it ended up applying to mostly queer individuals or people from the LGBTQ community or women and generally color so it had all of these unexpected consequences right so curious as to what this how this translates if it does with respect to the public health provisions. Yeah. I mean, we don't know a lot around the demographics in terms of how it's been applied. I think, you know, I haven't, I haven't requested that privacy information yet and I don't know if I would necessarily get it. I do know that the case that happened in BC, the race of the person was not disclosed it was disclosed that it was a man. We don't know what his sexuality was, or any of that so it's very hard. I mean, one of the challenges in doing research on the Center for excellence, because they are the main body that is using and promoting treatment is prevention they can they house the pharmacy that administers all HIV medication in the province. But they have essentially shut their doors to researchers who are looking to investigate them. Danielle Elliott who I spoke of in the in my presentation. For her PhD she looked to kind of examine the Center for excellence and kind of some of their practices with treatment is prevention. And after that they they pretty much closed their doors tightly after that so you can do research on people that they're interested in but to do research and find out kind of some of the inner workings of their own agency and how they work and who's kind of been included and that has been very challenging. I suspect that we will see if we get if we can get that information that it will fall down along particular lines of around race and class. And to some extent, possibly gender as well. I'm not sure if there are any other questions, but it doesn't seem right now that we have anything in the, in the box. I have one, Adelina, I just can't. Yeah, go ahead. I'm going to use the chat box I think because I'm in the HLI account so thanks Eli for a wonderful talk. So I wanted to come back to the treatment issue again that Sean raised earlier. And I wanted not to push too hard but I wonder if the problem, you know, I take the point that treatment eclipses all other approaches and that's a problem in itself but assuming there's some space for treatment. There's no problem in the treatment itself or how treat. And what I'm thinking of here is like medical abortion right that took they had originally when health Canada first proved it like you had to take it in front of the doctor. That was a huge barrier for obvious reasons. And also in the context of people use drugs are getting methadone and things and they do all these urine tests right it's it's this punitive disciplinary kind of approach to care that sometimes enter into enters into medical practice. That is the barrier, not the treatment itself or the substance itself so have you thought more about like, maybe this should be over the counter or so you know what what other ways to disrupt how it's delivered might be helpful. I mean, there's a whole bunch of kind of like soft ways at looking at how to address adherence so things like peer programs is one of those ways. I think those are complicated and above of themselves because then you have, you know, the peer mentor, essentially, encouraging the person to take their medication. And they're often kind of situated within some sort of health care system. Sometimes they're a peer navigator, you know, kind of whatever kind of peer program has been incorporated. And so, even though they may, they may also have then the weight of the clinic or the hospital supporting them based so it's still filtered down through the hospital right and so there's still that pressure, and that kind of medical surveillance that still continues. So, I mean, I don't have any easy answers to this essentially I think it's complicated. I think that, you know, the co-opting of like peer programs to kind of soften the hard edges of adherence can be problematic sometimes they can be better for people. But again, I think it really comes down to this idea of like what, why is this concept of adherence so important right like it takes it seems to take such precedence over the health of people living with HIV to an extreme. Right. And, and so, for me, it's like, I, I don't want to kind of tinker with how can we have better adherence practices. But look at, you know, how can people who are living with HIV have better lives is real. So to me, it's a shift in focus and it's a shift in, in action. Because I think the concept of adherence and how that continues to work through medicine is going to continually be problematic right like, if we look at the antecedents of adherence we know about compliance which you know the language shifted from compliance to adherence as a way to kind of like soften the medical professionalization and like authority. And so it's come software in, in different ways, but at the heart of it it's still that medical authority has the, the, is the most important and really should have the final say. And so I think rather what needs to happen is a focus on people living with HIV and what would make their lives better, because the healthier that they are the payoff is for everyone. Right. And so, yeah. Sheila had a question, and I mean she says, you know, you kind of partly answer it by what you're saying right now but I'm still going to ask you just in case you have any other thoughts on this. Do you have any starting ideas or examples of indigenous love relevance that may assist or make, or should be explored further. Yeah. So, um, there's a new. So, there's a new research project that's in Saskatchewan that's being led by Emily Snyder and Margaret case as PSAC, where they look at indigenous interventions, particularly into HIV criminalization so they're not necessarily looking at public health but they're addressing this issue of criminalization of people living with HIV. And so they are working with elders and within the Cree community in Saskatchewan to look very specifically at what Cree legal interventions could be used, or legal processes could be used to address that situation enough in a further way that actually addresses the harm that's being done, rather than these kind of punitive criminal or public health measures. So that's kind of like one example that I have I don't know what they've come up with. I think the project is kind of a long term project, and I think that that's what these sorts of things require is really a specific contextual response, not only geographically but also based on various indigenous nations right. Thank you. That's excellent. I'm really appreciate taking the time today to talk to us and to provide us with with your knowledge and your thoughts and give us an overview of your work and research has been very insightful, I'm sure for many of us watching. So I think there aren't any questions that we're going to conclude here. Oh, there is one more question actually. Oh, no, somebody's just saying thank you. And I want to thank everybody for joining us today. The recording is going to be made available on the YouTube channel of the Schulich School of Law, as well, together with all the others that are already up. If you have missed any of the of the talks in the series, make sure to check the YouTube channel the recordings are there. And thank you to thank you to everyone who took part in this thank you to the law school and to the Institute for putting the series together, and we're looking forward to seeing everyone next year. Hopefully for some of these in person. And Lina for running the series all year long. Great work at Lina. Thank you. Thanks Matt. And thank you guys. Again, Eli for your presentation today. Bye everyone.