Public Health Watch

posted: 29/10/2010

Updating of public health rules means public authorities in England and Wales have powers they can use against individuals with HIV to protect the public health from 'infection or contamination'. Magistrates can make compulsory public health orders (known as Part 2A orders) on people. Similar powers were used in Manchester against a man with HIV in 1985.

Late in 1985, just after Manchester AIDS-Line (later George House Trust) was set up with the help of a small grant from Manchester City Council, the same council used its public health powers backed by a magistrate. It compulsorily detained a man with HIV at Monsall Hospital. Major protests followed and, after a court case, he was freed to leave hospital a few days later.

This was the first and only time public health powers have been used against someone with HIV in this country. You can read more about this here.

New Health Protection Regulations

These old public health powers have now been updated in new Health Protection Regulations. Helpful guidance has been produced by the Department of Health on how to use (and not use) these powers.

This makes clear that in almost all cases using these powers to manage the risk of HIV or STI transmission would be inappropriate and should only be considered, if at all, in the most exceptional of circumstances.

HIV community and clinical organisations like BHIVA and BASHH oppose the use of these powers against people with HIV. They would cause more harm than good, damaging trust in STI and HIV clinic confidentiality, increasing HIV hate and discrimination, and would only ever be a short-term fix for someone with a life-long health condition.

More information

More information on the new public health powers and HIV can be found at the NAT website.
 

The official guidance makes clear that Part 2A orders 'are not a tool for managing long-term problems' and that the orders:

• are not meant in any way to change the current system and culture of confidentiality within sexual health services
• are not to be a routine part of managing those with HIV who present with evidence of ongoing unsafe sex (for example by presenting with repeated STI infection)
• are not generally appropriate for contact tracing
• could have harmful consequences for wider trust in sexual health services
• and that in the very exceptional circumstances where a Part 2A order might be considered, advice should be sought from the treating clinician and clinic director as to the possible consequences of such an order, and confidentiality must be respected at all times.

Even with this guidance, these powers could be misapplied to people with HIV or another sexually transmitted infection.

We, and NAT, are keen to hear about any attempts to coerce someone with HIV, through the use or threatened use of these powers. We do not expect the powers to be used, because the old powers were only used once against someone with HIV, 25 years ago, and have not been used again since. But it could happen. 

Department of Health: Health Protection legislation guidance 2010, laws and regulations

Hospital Detention for HIV

posted: 07/09/2009

How many people now remember that 24 years ago a Manchester gay man with HIV was locked up for 10 days in the  hospital by order of the city's Magistrates, just because he had AIDS?

It has never happened since in this country, but HIV lock-ups often happen in Sweden, and might even happen once again in this country, if Parliament allows the Department of Health and the Health Protection Agency to get their way.

The government is consulting on changing the infectious diseases regulations which could allow it to force people into hospital isolation wards and more, if they have infectious diseases. The deadline for comments on the proposed rules is at the end of this month.

We are campaigning to make sure people living with HIV cannot be touched by any updated public health law and regulations.

What happened almost 25 years ago in Manchester?
There is a very brief mention in our history page for 1985,  but it was an event that rocketed Manchester and HIV onto the front page of the papers locally and nationally. Manchester AIDS-line, which became George House Trust, was closely involved and (now Councillor) Paul Fairweather, a gay rights worker at the former Gay Centre in Bloom Street, was in the thick of the campaigning. There were pickets outside the Town Hall and the old Monsall Isolation Hospital, and a national demonstration was held here. We’ve never forgotten it, and at Secrets and Lives, Cllr Paul Fairweather reminded our audience about it.

Old files and papers

We've dusted off old files and the papers to find out exactly what happened and tell the story again here. We’ll be reminding the government that they didn’t get away with discriminating against people with HIV in 1985, and shouldn’t even be thinking of making laws and regulations that would allow this again today.

What was it like in 1985?
It’s a bygone age in UK HIV history. For a start no-one talked about HIV - if people ever talked about the virus, they called it HTLV3. There were no tests available at clinics for it in Manchester, only in London.

There were only two people known to have AIDS in the city, and both gay men were ill in Monsall Hospital. In the whole of the UK there were only 100 people, gay men and haemophiliacs, with AIDS at the start of 1985. Now there are over 70,000 with HIV.

We knew the virus was sexually transmitted but not how exactly - so oral sex was thought to be high risk, as well as anal and vaginal sex. The connection between the virus and AIDS wasn’t properly understood. Gay men were struggling to get to grips with the idea of using condoms.

Hysteria and Panic

It was at the height of AIDS hysteria, but the first public campaign - the tombstone and leaflet campaign warning Don’t Die of AIDS - didn’t start until the following year, 1986.

In the UK press, AIDS was in the headlines and caused alarm. In most newspapers such as the Sun and Manchester Evening News, and on radio stations (Piccadilly Radio - now Key 103 and Magic), the prejudice was obvious.

Haemophiliacs were "innocent victims," whereas gay men and injecting drug-users brought it upon themselves. Firemen banned the kiss of life, and holiday makers cut short cruises on the QE2 for fear of getting AIDS from a passenger. A 9-year old haemophiliac was allowed to go to school, but some parents kept kids away. Actor Rock Hudson died of AIDS in the first days of October. He was the first major public figure known to die of AIDS. Almost as much of a shock to most people was to discover such a butch film star was gay.

Swirling in a cesspit of our own making - Manchester Chief Constable

And the Chief Constable of Greater Manchester Police, James Anderton, preached that gay men were "swirling about in a human cesspit of their own making". Gay papers, like Capital Gay and Mancunian Gay, provided the most accurate news and information.
 

Can I go home please, just for the weekend?

One of the two men in Monsall Hospital decided in the middle of September 1985 that he wanted a weekend break from hospital, to go to his home in South Manchester, where he would be looked after by his friends and family, and then he’d go back in the hospital. He asked his doctor if he could do this one Saturday morning. The doctor refused. In fact the doctor couldn’t stop him leaving the hospital and knew this, but didn’t tell the man.

Whirlwind of events that Saturday

A whirlwind of events followed that Saturday. We don’t know why, but the doctor panicked. He called the Council’s medical officer and asked her to stop him leaving the hospital. She called the Chair of the Environmental Services Committee, who authorised the making of an emergency application to the Magistrates Court.

The City Solicitor was called in and a special sitting of the Magistrates was held. The Magistrates, in open court, granted an Order for 3 weeks detention in the hospital, named him and said it was to protect the public from AIDS.

The hostile local press and independent radio were tipped off and his name and the details were broadcast and published - including in the national press.

The man has no idea any of this is going on behind his back, until he was presented with the Court Order.

10 days detained by Court Order

He spent the next 10 days in compulsory detention at hospital before he and his friends could get a solicitor and the Crown Court could review the decision. No doubt the stress added to his health problems.

Outrage and Uproar

Meanwhile absolute uproar broke out in the city’s gay community. The Council had already promised to do what it could to dampen down AIDS hysteria. But here was the council using the courts in a way which just poured petrol on the flames of that hysteria. The Public Health (infectious Diseases) Act had been rushed through Parliament only in the summer of the year before (1984) and in February of 1985, AIDS was quickly added to the official list of infectious diseases. Now the Council was using that panic list and law to detain a gay man who posed no health threat to anyone.

There were demonstrations and pickets outside the hospital and Town Hall.

Crown Court frees man

The Crown Court decided to approve the application by the man's solicitor for the order to be withdrawn 'by consent.' The man was spared the rest of the 11 days of forcible detention.

Withdrawal ‘by consent’ means the Council didn't attempt to defend its application, and it could not have produced a shred of evidence to justify the man's continued detention, because legally it was indefensible - he was no health risk to anyone.

A city behaving badly - but then it promises: never again
The city’s gay men’s consultative committee demanded the city council promise never to use the law again, and to campaign for its repeal. The vote was tight, but it agreed not to use the law again.

All involved - hospital doctor, city health officer, chair of social services, city solicitor, magistrates clerk, magistrates, the radio and press, all behaved badly. They had no legal power to act as they did in the circumstances and all were swept up in the panic and power-rush of taking emergency action. Nobody stopped to think and ask questions. No-one told the man in Monsall. He had no solicitor to say the law doesn’t allow you to do this to me.

Why are we concerned now?
In Sweden a man with HIV was ordered to be detained and isolated under their public health laws for an incredible seven years. Detention and isolation happens to quite a number of people with HIV in Sweden. Fortunately the European Court of Human Rights said in 2005 that this is illegal and breaches people's human rights under Article 5.

They ruled that detention for HIV always has to be a last resort, after everything else has been tried and has failed to prevent the person from passing it on. We don't think that judgement goes far enough - after all the criminal law can be used against reckless sexual transmission of HIV and that's more than enough protection for public health. But at least the European Court has drawn a useful line in the sand to protect people with HIV from unreasonable detention on health grounds.

There are some infectious diseases that are passed on easily by day to day contact. If they are serious - for example multiple drug-resistant TB - then there is a case for using the law to prevent its spread and protect the public, but only if the person doesn’t agree to temporary isolation for treatment, until they are no longer a risk to others.

Why are Sexually Transmitted Infections even on the list of infectious diseases?

Sexually Transmitted Infections (STIs) are not public health hazards like drug-resistant TB. HIV and other sexually transmitted infections aren’t passed on by touching, sneezing and the like. People need to have sex with the person and even then the risk of HIV transmission is pretty low. We think there is no case at all for any STI to be included in public health powers in the 21st century in the UK.

HIV - we take action and we fight back

The government seems not to have learnt anything from Manchester's shameful behaviour in 1985 - you mess with people with HIV at your peril. We won’t stand for it again. We take action and we fight back. And we hope Manchester City Council will now do as it was asked 24 years ago and campaign to remove any possibility of this happening again under public health laws and regulations. 

Here’s a full transcript of the 1985 reports in Mancunian Gay - written by the campaigners in the thick of the action. You can see this for yourself, along with other papers in the local history collection, in Manchester central library, St Peter’s Square.

The European Court of Human Rights judgment Enhorn v Sweden 2005

A useful article on the Enhorn v Sweden and its application to UK Public Health law and the detention of people living with HIV 

[Medical Law Review 2006 14(1):132-143; doi:10.1093/medlaw/fwi038
© The Author [2005]. Published by Oxford University Press; all rights reserved.
The online version of this article is published under open access. Users are entitled to disseminate etc. this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given.]