Scotland - Convictions for HIV Exposure

posted: 20/01/2010

UPDATED Friday 26 February : He was sentenced to 10 years jail.

The first ever conviction anywhere in the UK, just for exposing someone to HIV without passing on HIV, has happened at the High Court, Edinburgh, in Scotland. The law in England and Wales is different and does not allow prosecutions for exposing someone to HIV.

A 41 year-old man pleaded guilty to four charges of ‘culpable and reckless conduct’ after being accused of not disclosing his HIV status to four women between 2003 and 2008, only one of whom became HIV-positive. There have only been two earlier cases in Scotland, both for actual transmission of HIV.

The case has been widedly reported in both Scottish and English media. While reports on BBC Online, the Scotsman, and STV.tv were somewhat neutral, tabloid coverage has been typically stigmatising, including today's Scottish Sun : "HIV fiend is lowest of the low" ; Scottish Daily Record calls him a "callous predator"; and the UK-wide Daily Express: "HIV rat facing prison for infecting his lover'.

Most of the articles focus on the fact that the 28 year-old woman who became HIV-positive was diagnosed during routine prenatal screening. She subsequently chose to end her twin pregnancy. (With diagnosis and appropriate treatment and care, there is now only a very small chance of babies having HIV). Some reports also refer to a fifth woman who was diagnosed alongside Devereaux in 1994.

'Denial' defence mocked

All of the articles mock Mr Devereaux's defence that he was in denial, because the prosecution produced evidence that he was taking antiretrovirals. It is in fact quite common for people to have a serious illness such as HIV and yet have difficulty accepting the reality of diagnosis and its consequences.

HIV sector responses

BBC Online has a second report focusing on reaction in the HIV sector, concerned that this conviction will lead to more arrests for non-disclosure without transmission in Scotland.
 

Deborah Jack, chief executive of the National Aids Trust (NAT), said:

"It is totally unjust to single out people with an HIV diagnosis for punishment for unprotected sex - we all need to be wiser and safer, looking after ourselves and those we have sex with. Most HIV transmissions are from people who have never had an HIV test. We recommend that the Scottish Executive change the law so that people with HIV cannot be charged with culpable and reckless conduct if no transmission took place."
 

Roy Kilpatrick, chief executive of HIV Scotland, said:

"We are particularly worried about the fact that prosecutions were brought in this case in respect of three sexual partners of Mr Devereaux who had not contracted HIV. We recognise that the primary motivation for bringing this prosecution must have been the actual transmission of HIV and that the prosecution would have felt it necessary to put the full context before the court. However, it would be alarming if the charges brought in this case open the door for future prosecutions in cases where no harm has been caused."
He said that bringing prosecutions where no harm had been caused would stigmatise people living with HIV. He called for a clear statement of Scottish HIV prosecution policy.
 

Source

On sentencing and imprisonment

Image source 
 

HIV Prosecutions Focus

posted: 11/01/2010

HIV prosecutions and criminalisation in different countries is the focus of the latest issue of 'Reproductive Health Matters'.
 

One article looks at how gay men living with HIV in England and Wales have responded to prosecutions. This follows work by Sigma Research in its 2009 report ‘Relative Safety 2'. 
 

Does prosecution in an epidemic make public health better or worse?
 

42 HIV positive gay men, including some men using services at George House Trust, were asked what they knew about HIV prosecutions and how it may have changed their behaviour.
 

Only one in three are right about the law
There is considerable confusion among these gay men about the law and mistakes about whether their behaviour is legal or not. 1 in 3 of the men living with HIV were broadly right about how the law affects them. Most of the men were mistaken about the law.
 

Some of the men have changed their behaviour because of the law and reduced the risk of transmission, by telling partners their HIV status before sex, or in other ways.
 

Prosecutions have made HIV transmission more likely for most HIV positive men
But for most of the men, the law has made transmission more likely. Some of the men have felt pushed towards more anonymous sex, and are now less likely to tell partners they have HIV: HIV stigma is reinforced by prosecutions.
 

Other men felt that they were already being safe and so the law would not really matter because they wouldn’t pass on HIV anyway. But many of the men are making mistakes in their judgements about the risks so the likelihood of transmission rises.
 

A small number of other men are not able or willing to reduce their transmission risks despite the possibility of prosecution.
 

Public health harm outweighs the good
The aim of the criminal justice system is to provide justice, not to improve public health. But using the criminal law in an epidemic has few public health benefits and these are outweighed by the public health harms. Most of the men believe they are doing enough to prevent HIV transmission and that they are on the right side of the law. Most of them are mistaken about both.
 

The law is complicated and it doesn't fit the complex reality of living with HIV - the strong force of HIV stigma, the difficulties of accurately judging transmission risks in different situations, the impossibility of providing plain and simple advice, and the complexities of some men's lives, all make HIV transmission more likely.
 

Involving the law has bad unintended public health consequences. George House Trust has always argued that prosecutions for HIV transmission do more public health harm than good. The evidence is here.

 

Source Responses to criminal prosecutions for HIV transmission among gay men with HIV in England and Wales Catherine Dodds, Adam Bourne, Matthew Weait

This is based on research for Relative Safety 2 - Sigma Research 2009
 

Reproductive Health Matters Volume 17, Issue 34, Pages 4-224 (November 2009) €21 / US$28 for the single issue

Articles on HIV criminalisation in this journal

• Criminalising HIV transmission: punishment without protection
• Protecting HIV-positive women's human rights: recommendations for the United States National HIV/AIDS Strategy
• Responses to criminal prosecutions for HIV transmission among gay men with HIV in England and Wales
• Advocating prevention over punishment: the risks of HIV criminalization in Burkina Faso
• Vertical HIV transmission should be excluded from criminal prosecution
• Ten reasons to oppose the criminalization of HIV exposure or transmission
• International consultation on the criminalization of HIV transmission: 31 October – 2 November 2007, Geneva, Switzerland Joint United Nations Programme on HIV/AIDS (UNAIDS),
• Round Up: HIV and AIDS

Campaign - Cut Late Diagnosis

posted: 03/12/2009

Late diagnosed HIV is bad news in NW England – we have England’s worst regional rate for late HIV diagnosis. Across the NW an average of 35.9% are diagnosed late, compared with the national average of 31%.
 

It matters because up to a third of people with HIV are diagnosed late, after the immune system has already been damaged by the virus. Late diagnosis makes

• treatment more complex 
• people more ill,
• life significantly shorter - and
• accidental HIV transmission more likely, because they don't know they have it.

e-mail your PCT

We're asking you to write to your PCT and encourage them to cut late diagnosis of HIV, so people stay healthy for longer.

Postcode to email easily
If you enter your details and postcode, the SHout-Loud website creates a custom letter about late diagnosed HIV in your own PCT. For Manchester, it tells the PCT that 38% are diagnosed late when the national average is only 31%, and that means a lot of people are diagnosed late here.

Click on the link below to take part, and remember to check the box to join ‘SHout Loud’ so you receive updates on other campaign actions.

Bit by bit, we can improve sexual health locally.

Click here to write to your local PCT

It may take a few moments for the e-mail letter to appear – please be patient!
 

Why bother?
More and more decisions about health services are now taken at a local level, and decision-makers have to take the views of local communities into account. The SHout Loud (Sexual Health out loud) aims to help you affect local decisions and improve sexual health in our community.
 

NW England – the late diagnosis hotspot
The late diagnosis rate varies dramatically between PCTs in NW England, and the figures are often distorted because the numbers diagnosed in some PCTs each year are very small, but North Lancashire has twice the national average rate (62% late diagnosed).

Late diagnosis figures for each Primary Care Trust in NW England

Worrying is Manchester ,because it has by far the largest number diagnosed late last year, 54 out of 142 people, 38% late. But this is next door to its twin city Salford, where just 23.9% were late (11 out of 46). It is difficult to understand how living on one side or the other of the River Irwell can make such a difference.
 

What Viral Load is Uninfectious?

posted: 23/11/2009

A new study has found more evidence that people with low viral loads are less infectious.
 

US researchers found that very few HIV transmissions come from people with a viral load below 1000 copies/ml. The rate of transmission more than doubles when the viral load reaches 10,000 copies/ml.
 

There’s been a lot of debate about HIV treatment, viral load and infectiousness. Evidence is mounting up to show that successful HIV treatment significantly reduces infectiousness.

'The Partners' study recruited 3408 people and monitored HIV sero-discordant (= mixed HIV status) couples every three months to look for new HIV infections and to measure viral load in the HIV-positive partner. If HIV infection was found in previously HIV-negative partners, viral sequencing of both partners was carried out to check that the partner was the source of HIV. This analysis revealed 108 linked infections, people who had infected their partners.

Viral load logs
Viral load figures are often given on a logarithmic scale, because viral load rises so very steeply. A ‘one log increase’ means that viral load has increased by ten times. A viral load of 10,000 copies/ml is therefore one log higher than a viral load of 1000 copies/ml. Similarly, a viral load of 1,000,000 copies/ml is one log higher than a viral load of 10,000 copies/ml, and so on.

Transmission halves as log falls
Researchers found that a fall in viral load of 0.74 log reduced the risk of HIV transmission by 50%.
It’s hoped that the findings of this study will assist further research into the use of HIV treatment in prevention.
 

Viral load is not the only thing which affects whether HIV is transmitted. If either partner has any sexually transmitted infection (often these show no symptoms), these STIs make HIV transmission far more likely, even with a low viral load. Recent Swiss, German and French statements have broadly confirmed that an undetectable viral load usually means HIV cannot be transmitted. But where there are STIs, HIV transmission becomes likely.  

Viral Load information

There is more information on viral load in NAM’s new patient information booklet CD4, viral load & other tests. You can download it here, or order it free from NAM's online bookshop. 

Source

image credit

Hepatitis C - Blood Blamed

posted: 13/11/2009

Contact with blood, not semen, is how hepatitis C is being passed on among some gay men living with with HIV. This is what is now being reported at the European HIV conference underway in Cologne, Germany.

Fisting, group sex, and snorting drugs emerged early on as significant risk factors for sexual transmission of hepatitis C. But unprotected anal sex on its own, without fisting, parties and snorting drugs, doesn't seem to transmit hepatitis C. 

The investigators believe we should refocusing hepatitis C prevention campaigns for HIV-infected gay men from warning about unprotected sex to warning about transmission, probably through tiny, usually invisible, droplets of blood.

Since 2000 outbreaks of sexually transmitted hepatitis C have been reported amongst HIV-positive gay men in a number of large northern European cities including London, Amsterdam and Berlin. Unprotected anal sex and fisting were quickly identified as risk factors.

Semen or Blood?

But is hepatitis C transmitted through the semen (like HIV), or through blood in these encounters?

Because men living with HIV have a higher hepatitis C viral load in semen than men without HIV, this could explain the higher rates of hepatitis C among HIV positive gay men. But HIV-negative partners (of gay men with both HIV and hepatitis C) almost never get heptaitis C, so it looks like it isn't transmitted through semen. HIV-positive heterosexual couples where one partner also have hepatitis C don't infect each other either. This points strongly to blood, not semen, as the means of hepatits C transmission among HIV+ gay men.

Positive gay men in Bonn

Investigators in Bonn did a case-controlled study involving 34 gay men with both HIV and hepatitis C, and 67 age-matched men who only had HIV. None of the men reported injecting drug use.

The men were recruited to the study between 2006 and 2008. They provided information on their sexual and drug use behaviour, and also stated if they had experienced rectal bleeding as a consequence of sex.

Unprotected anal sex was widely reported, and approximately 50% of men reported receptive fisting.

So how does the blood get transmitted?

The first set of statistical analysis showed that several risk factors were associated with infection with hepatitis C including

• use of sex toys
• rectal bleeding
• receptive fisting without gloves
• sharing and snorting stimulant drugs like cocaine and amphetamine during group sex.

Only these three things were clearly linked to heptatits C transmission when they did a more detailed multivariate analysis:

• receptive fisting 
• rectal bleeding 
• drug use during group sex.

So the researchers propose hepatitis C is being transmitted via blood rather than semen, and that even men without hepatatis C can be involved in a transmission chain, during group sex sessions.

Some disagreement

However, not all delegates at the conference were convinced. A questioner from the floor pointed out that many HIV-positive people with acute hepatitis C infection in London do not report fisting.

Moreover, Dr Sanjay Bhagani told aidsmap that it was his sense that the epidemiology of hepatitis C amongst HIV-positive gay men in London was changing and that many infections could probably be attributed to injecting drug use rather than sex.

In addition, HCV itself is sometimes found in semen, and men who have both HIV and HCV tend to have HCV in their semen more often than men who have HCV but not HIV, according to a report from Canadian AIDS Treatment Information Exchange.

Nevertheless, the investigators conclude that prevention messages should inform HIV-positive gay men of the risks of hepatitis C that arise from long-lasting, group-sex sessions where there is rectal trauma caused by activities such as fisting. The blood may not be visible - microscopic amounts are enough - hepatitis C is vastly easier to pass on than HIV.

Source with more details and reference