Prosecutors Behaving Badly with Gonorrhoea

posted: 29/04/2009

In an odd set of circumstances, a man has been convicted for passing on gonnorrhoea to the two daughters of his partner. He was originally charged with child sex offences. Then with grievous bodily harm (GBH) at a retrial. The Court of Appeal became involved and has now issued a worrying judgement. We discuss what happened and what it may mean for people living with HIV.

The Crown Prosecution Service (CPS) has Guidelines and a Policy about prosecuting the sexual transmission of diseases. This says how it will deal with HIV prosecutions, and prosecutions for passing on almost every other sexually transmitted infection. Until recently, the CPS had only prosecuted HIV transmission.

Late last year it broke its own rules and was then able to get a conviction for hepatitis B transmission. Now it has broken its own rules again and so obtained a conviction for, supposedly non-sexual, transmission of gonorrhoea, the clap. And like the hepatitis case, this one also involves a migrant, and the use of deportation as part of the punishment.

Policy review time
The CPS promised to review how its policy and guidelines are working after one year. The evidence suggests that the CPS break their own policy and guidelines in both HIV and non-HIV cases. HIV and other organisations are now seeking to hold the CPS to account for its actions and to update policy and practice, by including for the first time, specific guidance about prosecuting young people with HIV. A recent conference concluded unanimously that young people with HIV are especially vulnerable and so should not be prosecuted for HIV transmission, in the public interest.

The bad law case of gonorrhoea
Dr Matthew Weait, a senior law lecturer and author of the leading law book on HIV transmission cases criticises the recent CPS prosecution of this male migrant for 'recklessly' transmitting gonorrhoea, through non-sexual means. You can read his full analysis on Edwin's fine criminalisation blog. We've summarised and explained it here.

Appealing about gonorrhoea

The Court of Appeal dealt with an appeal about the sentencing in a transmission of gonorrhoea case. As far as we know the man does not have HIV, but he did also claim to have severe thrush. Because it is a Court of Appeal decision, it is legally binding on lower courts in similar cases in future. That is why the implications are worrying.

However George House Trust's view is that for the moment nothing is likely to change in the way reckless HIV transmission is prosecuted.

Child sex offence charges
This man was charged with two offences of sexual activity with children, under the Sexual Offences Act 2003. It was said he had met the mother of the children (E and Z), started a relationship and moved in with her in September 2005. In November 2005 he was diagnosed with gonorrhoea, and was treated. A month later, in December 2005, the children were diagnosed with gonorrhoea. He was charged, prosecuted and tried in 2007, after child E complained of sexual abuse.

The jury could not agree on a verdict after he claimed he did not have gonorrhoea at the time alleged, but a severe form of thrush instead. A retrial was arranged for June 2007.

Pre-trial deal

Before the retrial, the defence told the CPS he would plead guilty to two counts of recklessly inflicting grievous bodily harm (GBH) on the basis that he had recklessly transmitted gonorrhoea to the children. GBH is the charge that is used in HIV transmission cases. He claimed it was his poor personal hygiene - he hadn't washed his hands before touching them "in an ordinary way," and that gave them gonorrhoea. He accepted he was reckless because he knew the risk of transmission and didn't take precautions.

Sentenced

He was sentenced at the retrial, to two years jail for each offence. He was also recommended for deportation, disqualified from working with children for life, and made subject of a Sexual Offences Prevention Order.

He appealed on a number of grounds, one of which was that he had pleaded guilty to offences that were not medically possible and another that, even if it were medically possible, he had not acted recklessly. The Court of Appeal agreed that the sentence was excessive and substituted a sentence of 12 months for each offence, both to be served at the same time. For legal reasons the order not to work with children was set aside, but the other orders were kept.

What's the problem?
This is a worrying decision for a number of reasons. He pleaded guilty to GBH on the basis that the gonorrhoea had been passed through casual touching. It was accepted that he provided care for E and Z which included touching. The Court of Appeal nonetheless confirmed the Sexual Offences Prevention Order, and worryingly went on to say that

" … he must have been accepting the possibility that in a domestic .... setting the disease could have been transferred. In such circumstances it would have been his duty to take the necessary protection to ensure there was no transference. We are not persuaded that there is anything in that ground of appeal." [George House Trust italics]

The first concern is that the Court is saying there is a duty to take the necessary precautions against any means of transmission of the disease. Matthew points out the principles behind the English law on recklessness don't require necessary precautions. Not taking precautions doesn't make you reckless in law; the essential point is you have to be aware of the risk of harming someone to be reckless. This might seem like being picky, but it is an important point. If the Court wanted to emphasise the duty all carers have towards children, then it should have said that clearly and not distorted the principles of recklessness to fit that duty of child care.

Does it mean use a condom?
Because the Court did not state clearly that there is no legal duty to take any precautions against the non-sexual transmission of gonorrhoea, the Court implies that a person living with HIV has a duty – meaning you could be taken to court if someone becomes infected – to prevent onward transmission to sexual partners. And, following the recent Hep B case, people with Hep B may also now have a duty to warn others not to share their razors, for example.

This ruling implies a duty to use a condom, or otherwise ensure HIV (or any other STI) is not transmitted.

This goes much further than the Appeal Court's rulings in the first and second HIV prosecution cases in England and Wales (Dica and Konzani) in which the Court set out the legal points that must be satisfied in cases of reckless HIV transmission.

Using condoms shows you are not being reckless
The CPS Guidelines on prosecuting cases of sexual transmission mean that a person who used condoms properly is not recklessness and should not be prosecuted, even if their partner became infected. These Guidelines do NOT (because the law on recklessness does not require it) say a person living with HIV must use a condom, nor does the law require a person to tell their partner. (Only if transmission happens is it reckless if you didn't get the person's informed consent first).

Wrong charge leads to errors all round

The retrial for a different offence - GBH - seems to have been a bad solution for a different problem. The defence suggested GBH and it seems the CPS agreed because it wanted to avoid making child E give evidence in court again. Instead of a retrial under the Sexual Offences Act, they twisted things to try to fit the circumstances to the Offences Against the Person Act. It led the Court of Appeal to some strained reasoning and misinterpretation of the legal principles of recklessness.

The knowledge and science gaps

Finally, although the Court of Appeal didn't discuss it, there's the thorny question of what he really knew about gonorrhoea transmission and whether there is scientific evidence to support gonorrhoea transmission by unwashed hands to children.
 

• He moved in with the 2 children and their mother in September 2005. He was diagnosed with gonorrhoea in November 2005 and the children in December 2005. When did he know or find out he could pass on gonorrhea by poor personal hygiene? Did the clinic tell him then, or was he led to say this by his solicitor at the time of the trial? Whatever the case, the dates mean it is possible he may have infected the children before he was diagnosed, or before he had any reason to believe he might have gonorrhoea. If so the case should have been thrown out. The Appeal Court, in the HIV cases of Dica and Knozani, ruled you have to know you have the STI to be reckless.
• Since the Court of Appeal accepted that gonorrhoea was transmitted because he didn't wash his hands before touching the children, the prosecution guidelines expect any other potential sources to be ruled out. No other sources were looked for, and none were considered.
• No scientific evidence was produced to back up the claim that the gonorrhoea was passed to the girls by his unwashed hands - a variation on the proverbial toilet seat excuse. It is certainly possible, but nonetheless international consensus guidelines state that gonorrhoea infection in pre-pubertal children is always, or nearly always, sexually transmitted. This man was originally charged with sexual offences against the two girls after one complained of abuse. He was not the girls' father. The Appeal Court confirmed the Sexual Offences Prevention Order.
   

One review of gonorrhea transmission tells us

"Spread of infection can occur via contaminated hands of infected caregivers. While all paediatric cases of gonorrhoea must be taken seriously, including contact tracking and testing, forensic medical examiners should keep an open mind about possible means of transmission. Doctors and lawyers need to be cognisant of the large body of literature demonstrating both sexual and non-sexual means of transmission of gonorrhoea in children." Goodyear-Smith, J. Journal of Forensic and Legal Medicine, 2007

Where's the 'compelling proof'?

The CPS Guidelines make it clear that there needs to be compelling proof that the defendant is the source of the infection – and (critically) that guilty pleas should not be accepted unless the prosecution believes that there is sufficient evidence to prosecute. Cases involving HIV transmission have fallen because of lack of scientific proof. The science for proving gonorrhoea transmission is probably as problematic as it is for HIV - and different because gonorrhoea is bacteria, not a virus. There is no indication that proof of transmission was even investigated in this gonorrhoea case.

This case is another example of the ways in which the CPS has failed to follow its guidelines and not thought its actions through properly, and this tripped up the Appeal Court. Trying to ensure that a man accused of child sex offences goes to jail for something, anything, may end up further restricting people with HIV or other STIs.

George House Trust comment - don't worry
Although Matthew argues that the Court of Appeal seems to have extended the law of HIV (and STI) transmission to mean that people living with HIV have an active duty to prevent transmission by some means - using a condom is the obvious solution - we don't think people with HIV need worry about this right now.

• Prosecutions should continue to follow CPS policy and guidelines, and these haven't changed. They are under a review at the moment after their first year of operation, and we will keep you informed about this review. We will make sure the CPS notes that this is another case where it failed to follow its own policy and guidelines and this has caused further problems. We will oppose any attempt to toughen the guidelines following this Appeal Court ruling and we expect the rest of the HIV / STI sector will do the same.
  
• The basic legal principles followed in all types of cases involving recklessness are not changed by this judgement. If the CPS tried to prosecute based on this ruling and and a Crown Court followed this line in a HIV case, it is likely to go to appeal and be overturned.
  
• HIV cases in England are uncommon and now very hard for the CPS to prove, if they follow their own guidelines. Well-represented recent HIV cases in England have all left the CPS defeated.

Source Matthew Weait's comments on Edwin's criminalisation blog
The Appeal Court judgement [R v Peace Marangwanda [2009] EWCA Crim 60] should be published here  
 

Swiss Court Frees HIV+ Man

posted: 10/03/2009

In the first ruling of its kind in the world, the Geneva Court of Justice has freed a man given 18-months prison for exposing someone to HIV.The court ruled that the risk of HIV transmission while the man was on treatment was far too low to justify the conviction.

In Switzerland, public health law effectively made it a crime simply for people with HIV to have any  unprotected sex. However this court has now changed this. It accepted expert testimony from Professor Bernard Hirschel – one of the authors of the Swiss Federal Commission for HIV/AIDS consensus statement on the effect of treatment on transmission – that the risk of sexual HIV transmission during unprotected sex on successful treatment is 1 in 100,000. It ruled that this level of risk was far too low to keep unprotected sex a public health crime.

The case began in Lausanne in 2007, when a court sentenced the HIV-positive man, originally from the Democratic Republic of the Congo, to a suspended 28-month sentence for having unprotected sex, without telling his woman partner his HIV status.

Swiss HIV Law

Under the public health parts of the Swiss criminal law, Article 231 allows prosecutions against HIV-positive individuals for having unprotected sex, with or without disclosure. The UK doesn’t have a public health criminal law about disease exposure. Prosecuting and criminalising public health was dropped in the UK because it goes against the principle of encouraging people to come for testing and treatment. Criminalising public health drives people with health needs underground and protecting public health becomes far more difficult.

People with HIV in Switzerland can also be prosecuted under Article 122, for an attempt to engender grievous bodily harm. This makes it an attempted grievous bodily harm to have unprotected sex, even if there is no HIV transmission. People with HIV in Switzerland are jailed simply for having unprotected sex. This can't happen under English law. Here HIV transmission has to take place before the charge of "grievous bodily harm" can be made. There is no English crime of attempted grievous bodily harm.

Deborah Glejser of Swiss community HIV organisation, Groupe SIDA Genève, explains that although this public health law could be used even more harshly, to prosecute unprotected sex even when HIV status has been disclosed, in practice, the Swiss only prosecute HIV exposure without disclosure. Suspended sentences are normal so this man’s imprisonment was unusual.

Trial judge refused to consider Swiss statement

A second complaint last year led to the man standing trial again in Geneva in November 2008. According to a report in The Geneva Tribune, an expert medical witness had testified that although treatment greatly reduces the risk of transmission, there remained a residual risk. Although the man's lawyer had put forward the statement by the Swiss Federal Commission for HIV/AIDS as evidence, and Geneva's deputy public prosecutor wanted to suspend the hearing to consult with the Swiss HIV Commission, the lower Geneva court refused to allow this. This made it his second conviction so he was sent to jail for 18 months, in December 2008.

This clearly annoyed the deputy Public Prosecutor who felt justice was not being done or being seen to be done. The court refused to consider the evidence even the prosecutor thought was relevant. We are left with the suspicion that a white Swiss native would have not been jailed for 18 months like this black African migrant. The British pattern of a disproportionate numbers of migrants being jailed for HIV crimes is found across much of the globe

It's Super-Public-Prosecutor to the rescue

Late in February the deputy public prosecutor came to the rescue and told the Geneva Court of Justice that he was convinced by the Swiss Federal Commission for HIV/AIDS that the risk of transmission for an HIV-positive individual on successful treatment was less than 1 in 100,000. Under the circumstances he wanted to appeal so as to withdraw the charge and for the court to cancel the conviction.

On Monday, the Geneva Court of Justice acquitted the man, who was freed  after almost three months in prison. Geneva’s deputy public prosecutor, Yves Bertossa, called for the appeal, told the newspaper Le Temps that although there is still some debate regarding the slight risks of transmission in people on successful treatment this should not be used unfairly: "One shouldn't convict people for hypothetical risks,” he said.

Swiss statement did what it set out to do

Professor Hirschel said that he was very pleased with the outcome. It was, he said, the main reason that he and his colleagues issued their January 2008 statement of advise for courts and prosecutors.

The Swiss panel has had enormous global attention and a great deal of criticism for openly talking about and applying the lessons of modern HIV treatment to the lives of people living with HIV. Swiss HIV clinicians wanted to put a stop to much of the jailing of people with HIV - simply for having unprotected sex without any HIV transmission.

Deborah Glejser of Groupe SIDA Genève added that Monday’s ruling means that, in Switzerland, HIV-positive people on treatment which is working properly should no longer be prosecuted for having unprotected sex. She hopes that this ruling will help people in other countries that prosecute HIV exposure – and she’s been contacted by many already.

Hopes for fall in global prosecutions

Last May, a five member US Court of Appeals for the Armed Forces panel rejected, but only by a narrow majority, an appeal by an HIV-positive soldier who had previously pleaded guilty to HIV exposure, following unprotected sex with two women without disclosing his HIV status. And last July, a Canadian court considered and rejected the Swiss statement in the case of a man charged with having unprotected sex with six women.

Following Monday's ruling, however, Geneva’s deputy public prosecutor, Yves Bertossa, believes it is only a matter of time before other jurisdictions realise that prosecutions for HIV exposure should not take place when the accused is on successful antiretroviral therapy. He told Radio Lac: “There are some medical advances which can change the law. I think that in other [parts of Switzerland] or in other countries, the same conclusions should apply to their laws."

source

Don't Prosecute HIV Young People

posted: 09/03/2009

Young people living with HIV should not face the threat of prosecution for passing on HIV, leading HIV charities are urging.

A conference at the end of February looked at the impact of prosecutions for HIV transmission on young people. At least one person under 18 has been investigated and the recent report, Policing Transmission, included a review of one case.

Now HIV charities are lobbying the Crown Prosecution Service (CPS) to clarify guidelines for charging young people with the offence.

The move follows the London conference at the National Children's Bureau, attended by George House Trust and Barnardo's, which discussed the prosecution prospects and the harm caused to young people living with HIV.

Prosecutions opposed

George House Trust is opposed to HIV transmission prosecutions in principle because they cause far more harm than good to public health. They worsen stigma, shaming and blaming around HIV and make it less likely people will be tested early and start treatment on time, which are the most effective ways of stopping the spread of HIV.

Young people with HIV have all been infected through mother to baby transmission (which is now rare). This is the first generation of teenagers with HIV and as pioneers the young people have had a particularly tough time. Some are vulnerable and have been looked after by the state. Some have learning difficulties as a result of HIV.

Any teenager has a tough time growing into the world of sex and relationships amid raging hormones, and having HIV makes this far more complicated. In the view of the charities at the conference, prosecutions of teenagers for HIV transmission would not be in the public interest.

The charities at the conference called on the Crown Prosecution Service guidelines on prosecution for sexual transmission of disease to ban prosecutions of all teenagers and other young people.

HIV, Police and Prosecutions - Call for Change

posted: 29/01/2009

A new report by the Terrence Higgins Trust (THT) launched yesterday at the House of Commons has revealed a systematic mishandling of complaints for alleged criminal HIV transmission in England & Wales. The report, Policing Transmission was welcomed by the Association of Chief Police Officers (ACPO), which acknowledged that “too many times we have got it wrong". George House Trust was represented on the panel which reviewed police handling of some of the key cases.

There have been “scores, if not hundreds” of arrests since the first conviction for reckless HIV transmission in England and Wales (Mohammed Dica in October 2003), noted THT's Sir Nick Partridge speaking at the launch of the report in the House of Commons, hosted by Lord Norman Fowler, Vice Chair of the All Party Parliamentary Group on AIDS.

Investigations harm even when they are dropped

Sir Nick said that whilst most police investigations were dropped due to a lack of evidence, during the course of these ‘failed’ investigations - which had lasted up to a year - “lives had been turned upside-down and some came close to being destroyed”.

Arrests every fortnight

During the period 2005-6, there was an average of one arrest every two weeks. Concerned at this number of arrests and aware of the cost, in terms of “public resources and private misery”, THT approached ACPO and the Metropolitan Police Service (MPS) in order to examine the role of the police in criminal HIV transmission investigations.

This resulted in detailed, but anonymised, police notes from six cases that occurred between 2004 and 2007 (some prosecuted, some not) being made available to a community advisory panel that included representatives from HIV civil society organisations, including the National AIDS Trust, George House Trust and the African HIV Prevention Network. The panel reviewed the notes in collaboration with ACPO and the Metropolitan Police Service (MPS) and this report publishes their findings and recommendations.

Good police practice found but mainly examples of failings

The report found that although there were some examples of good practice, much more was found to be lacking, including:

• A poor police understanding of HIV, leading to inappropriate management of cases.
• A lack of clarity amongst police officers about the current law, and what is, and what is not, an offence. (THT is aware of many investigations following allegations of unprotected sex without disclosure where there was no transmission, which is not even an offence in England & Wales.)
• Unnecessarily long and drawn-out investigations, ranging between four and twelve months for cases that did not result in prosecution, and between six and 34 months for those that did.
• Difficulties in reconciling the realities of HIV transmission with the evidence requirements for the criminal charge. The report points out that “police are having to manage cases brought under a law never designed for such scientific complexity” and notes that the police “repeatedly misinterpreted the strength of their scientific evidence”. This is a gentle way of saying the police were dazzled by scientific reports, and misread them to mean person A infected person B, to the exclusion of all other people, when science cannot prove this at all.

What should be done?

The report makes 19 recommendations, including:

• A dedicated police officer should be trained and made available in each force. This officer would specialise in criminal HIV transmission complaints and investigations.
• Easy to understand guides to HIV transmission, disclosure, and the law should be written and made available to every police officer.
• A series of standard questions should be developed to establish at an early stage whether a viable case exists.
• Wider investigations beyond the original complaint should only take place once it is established that the original complainant is HIV-positive themselves.

The price of prosecutions - three people's stories

At yesterday’s launch THT’s Sir Nick eloquently put a human face on the report by highlighting three people's stories of investigations which reveal how difficult, complex and sensitive allegations of reckless HIV transmission are for all parties involved, including the police.

• ‘David’ was accused of recklessly infecting two men and, following his arrest, was held in custody for several months and refused bail because the police erroneously believed he was “a danger to the public”. After phylogenetic analysis had been performed on all three men, it became clear that ‘David’ could not have been the source of either man’s infection, the case was dropped and 'David' was finally released from custody.
• ‘Cesar’ only discovered he was HIV-positive when police told him when they arrived on his doorstep to arrest him for reckless HIV transmission. (Since one of the essentials for this ‘crime’ is to be aware of one’s HIV status, this was a complaint that could not succeed)
• ‘Elizabeth’ accused her married lover of recklessly giving her HIV and complained to the police. However, charges were dropped after months of investigations, which included detailed sexual histories and the release of sensitive medical records, since the evidence suggested that ‘Elizabeth’ had, in fact, infected her lover.

Trying hard but nearly HIV clueless

Sir Nick said that the report suggests that all complaints and investigations were done in good faith, but that in almost every case, the lead officer had neither enough knowledge of HIV issues, nor anywhere to turn for guidance.

He added that the police appear to have an understanding of HIV that is “at least ten years out of date", and that this is not unique in the criminal justice system and is more a reflection of the general public’s lack of knowledge and attitudes about HIV.

We know that HIV ignorance is widespread throughout the criminal justice system - most Crown Prosecution Service prosecutors are as ignorant about HIV as the police, many defence solicitors and barristers are hardly better, the forensic laboratories often don't point out the limitations of their supposed "scientific proof", and judges sometimes appear to share the widespread ignorance. And it is unlikely juries are any better informed than these other players in the criminal justice system.

Lancashire Deputy Chief Constable welcomes report

Mike Cunningham, Deputy Chief Constable of Lancashire, spoke on behalf of the Association of Chief Police Officers (ACPO) which welcomed the report. He said that he appreciated the fact that ACPO had had the opportunity to be part of the review process, and not just to be the subject of it.

“Too many times we have got it wrong,” he admitted. “We want to put things right and not just deny [that things have gone wrong].” Referring to the case studies presented by Sir Nick, he added that the police must be aware of the difficulties involved and “humanise” each individual affected by an investigation.

Kit Malthouse, London’s Deputy Major for Policing, and deputy chairman of the Metropolitan Police Authority also welcomed the report which he hoped would lead to the production of an “easy guide” to HIV for London’s police. He added that with yesterday’s appointment of Sir Paul Stephenson as the replacement for Sir Ian Blair as Metropolitan Police Commissioner, policing in the capital would become “more open”, and that the London police service was committed to providing “the best possible service to everyone”.

Next Step - a Good Practice Guide

The project will now begin its second stage - the National AIDS Trust will now lead the  production of good practice guidance for the police in criminal HIV transmission investigations, supported by THT, ACPO, the MPS and a community advisory panel, to which George House Trust hopes to contribute.

Policing Transmission report 

also available direct from THT here.

Source

HIV - Gay Men's Crime and Punishment

posted: 26/01/2009

Sexually charged is the latest report on what gay and bisexual men think about criminal prosecutions for sexual HIV transmission. It finds strong evidence that HIV stigma is all pervasive among gay and bi-sexual men and this needs HIV prevention attention.

In recent years a number of people have been criminally prosecuted in the UK for the sexual transmission of HIV, yet little is known about how gay men and bisexual men feel about this.

In the annual Gay Men's Sex Survey, men were asked about their awareness and understanding of prosecutions (those results are in Sigma's report Multiple Chances). The men who did the annual Gay Men's Sex Survey onliine answered some extra questions on prosecutions.

Prosecutions shape attitudes and affect HIV prevention. Have prosecutions made things better or worse for gay men's HIV prevention?

More than 8,200 men said whether they agreed, disagreed or were not sure about prosecutions, and just over 6,700 went on to say why they felt that way. Sexually Charged presents a full analysis of the men's responses.

Blame and Jail majority

More than half (57%) of all respondents said yes, they think it is a good idea to imprison people who know they have HIV if they pass it to sexual partners who do not know they have it. About a quarter (26%) were unsure and the remainder (18%) thought it was not a good idea.

Diagnosed men disagree

Men diagnosed with HIV were much less likely to support prosecutions, most probably because they regard prosecution from the viewpoint of being a potential defendant. On the other hand, men who have never had an HIV test were most likely to agree with prosecutions.

The report ends by discussing how far the findings challenge the way in which we think about HIV prevention for gay and bisexual men, given the pervasive HIV-related stigma that emerged.

Prosecution Delusions

The majority of gay and bisexual men who do not have diagnosed HIV believe prosecutions for the transmission of HIV to be justified. Often this is based on serious misunderstandings.The biggest misunderstanding (in fact it is a delusion) is that the law provides negative and untested men with added protection from HIV in sexual interactions. Expecting to be told that the man you are about to have sex with has HIV, is a problem both because a third of people with HIV do not know they have it, and because many people who do know they have HIV will not tell sexual partners before sex. Expecting people with diagnosed HIV to disclose their status before sex result in the perception that if one is not told this, then the partner does not have HIV. This can clearly lead to misjudgements of sexual risk.

In the Gay Men’s Sex Survey 2006 three quarters (74%) of all men expected HIV positive disclosure from potential sex partners. This expectation was far more common among men under 20 (91%); men that had never tested for HIV (85%); men with lower levels of formal education (82%); and men with fewer male partners. Of all the needs of gay men and bisexual men described across all the GMSS surveys this is the most commonly unmet need.

Prevention updating

Prevention campaigns will have to ensure that no man now assumes that the law will protect him from HIV exposure or transmission, whether or not people think it should. The naivety with which some men approach sex is consolidated and exacerbated by the prosecutions.

Helping men who have limited experience of HIV to recognise that their sex life could unknown to them involve men living with HIV and providing these men with the knowledge and skills needed to maximise pleasure and minimise harm, remains the crucial role of HIV health promotion.

Stigma - Blame and Shame effect of prosecutions is stark

Another task in HIV health promotion is to deal with the stigma associated with HIV among gay men and bisexual men. Gay and bisexual men tend to stigmatise members of their own communities on the basis of known (or assumed) HIV infection. 

What is shocking is how much the reality of living with HIV is misunderstood, and the strength of fear and loathing with which many undiagnosed and untested men characterise those of us with HIV is clearly evident in the findings. The way HIV is used by so many gay and bisexual men to divide the gay community continues to be the greatest challenge.

The research was funded by Terrence Higgins Trust as part of the CHAPS national HIV prevention programme for gay men and other men that have sex with men.

The report is available