A/HRC/41/34/Add.2 physicians’ conscientious objection does not impede women’s access to legal abortion services.38 96. Additional challenges concern the criminalization of sex work and the nondisclosure of HIV status, and access to HIV medication. The 2014 Protection of Communities and Exploited Persons Act follows the so-called “Nordic model”, which focuses on reducing demand by criminalizing the purchase of sexual services, prohibiting their advertising and profiting from others’ sexual services. It criminalizes the profiting from sex work by third parties. However, in Canada, individuals living with HIV who do not disclose their HIV status to their partner before sexual activity that poses “a realistic possibility of HIV transmission” may be prosecuted under the Criminal Code, regardless of whether or not there was an intention to transmit HIV and whether or not there was actual transmission. The Special Rapporteur stresses that criminalization of both sex work and HIV non-disclosure creates stigma, discrimination and barriers to gaining access to health care, including medical tests, treatment and support, due to fear of prosecution. He recommends that Canada decriminalize sex work, develop appropriate occupational health and safety regulations and establish a legal framework against abuse and exploitation. This can lead to sex workers’ improved health outcomes and reduce the incidence of violence. 97. Canada has one of the highest number of criminal prosecutions based on nondisclosure of HIV status. Persons living with HIV are generally charged with serious crimes, including sexual assault. Typically, convicted persons receive a prison sentence and are registered in the sex offenders registry. The Special Rapporteur highlights that criminal prosecution should only be initiated in very exceptional cases of intentional and actual transmission of HIV and that the recourse to criminal law should be avoided in all other circumstances. He also recommends that Canada develop specific training on HIV/AIDS for health-care personnel to avoid discrimination. He acknowledges the steps taken to address the over-criminalization of HIV non-disclosure, including the 2017 report that recommended that the application of the criminal law be limited to HIV non-disclosure cases as informed by the most recent medical science on sexual HIV transmission,39 and the 2018 announcement by the Attorney General of Canada of a prosecutorial directive to ensure an appropriate and evidence-based criminal justice system response to cases of HIV non-disclosure.40 98. The Special Rapporteur witnessed a good model at the Vancouver-based Dr. Peter Centre, which offers an HIV day health programme with 24-hour nursing care residence. The centre provides health care to individuals with multiple medical conditions and who face social barriers, through a multidisciplinary approach including improved adherence to medical treatment and a personalized programme reflecting the user’s preference. Services include specialized nursing care for complex mental health conditions; short-term stabilization; transition from hospital back into the community; a methadone maintenance programme, and harm reduction services. The centre provides housing and various therapeutic services and manages conflict in the community with no coercion. VI. Conclusions and recommendations 99. Canada is a highly developed country that has achieved a high standard of living; it has good economic and social indicators, and a large number of Canadians enjoy a good standard of health care. 100. Canada has a strong public health system that is firmly rooted in the principles of equity and fairness and the overall notion that access to health care should be based 38 39 40 See E/C.12/CAN/CO/6; Committee on Economic, Social and Cultural Rights general comment No. 22 (2016) on the right to sexual and reproductive health; and Committee on the Elimination of Discrimination against Women general recommendation No. 24 (1999) on women and health. Department of Justice Canada, Criminal Justice System’s Response to Non-Disclosure of HIV (December 2017). Available at www.justice.gc.ca/eng/rp-pr/other-autre/hivnd-vihnd/hivnd-vihnd.pdf. See www.canada.ca/en/department-justice/news/2018/12/attorney-general-of-canada-to-issuedirective-regarding-prosecutions-of-hiv-non-disclosure-cases.html. 19