Laws Should Not Worsen HIV

posted: 02/07/2010

The ‘Vienna Declaration’  sounds like a half-forgotten piece of school history, but it is brand new and all about ending laws and policy across the world that cause HIV harm. The UN has at the same time set up a brand new Global Commission on HIV and the Law  to deal with some of the toughest issues in HIV. Laws and policies across the world are making the HIV epidemic worse and causing harm to many people. Anti-gay, anti-sex-worker, anti-drug, anti-HIV sex and transmission laws and policies are all the UN Commission’s new battle-ground.
 

If you agree that the law should not criminalise drug users because this makes the HIV epidemic far worse and causes more harm than good, you are invited to sign the Vienna Declaration. The Vienna Declaration is a call from the international scientific community to countries across the world (including the UK) to face the facts and recognise that the so-called 'War on Drugs' isn't working, and causes far more harm than good, particularly in the fight against HIV.

It asks the UN and countries to update drug policy and laws to end this HIV harm, discrimination against people's human rights, and to remove the legal and other barriers to effective HIV prevention, treatment and care.
You can read and sign the Vienna Declaration here  and facebook and twitter it from there
 

Why is the Declaration from Vienna? Well, the International AIDS Conference opens in Vienna in Austria later this month.

This conference is the largest HIV conference, and is held every two years, and is the one where big HIV news on treatments and almost everything else is revealed. 

New - Global Commission on HIV and the Law
The Global Commission on HIV and the Law was set up last month – the secretary general of the UN said “I urge all countries to remove punitive laws, policies and practices that hamper the AIDS response … . Successful AIDS responses do not punish people; they protect them … . We must ensure that AIDS responses are based on evidence, not ideology, and reach those most in need and most affected.”

The Commission has a challenging job – its job is to produce practical steps, based on evidence and that support human rights, that will reduce HIV transmission caused by laws and policies. So it will focus its efforts on ending laws that criminalise HIV transmission and exposure, illicit drug use, sex work, and same sex relationships. Global Commission on HIV and the Law
 

HIV and the Law is part of the Law on Trial  season at Birkbeck College this weekend, and Matthew Weait, a long-time ally of George House Trust and who works at Birkbeck as a senior law lecturer, writes about how the law should not worsen HIV discrimination and stigma, and if laws do this they do not deserve our support.

Gay HIV Prosecution Dropped

posted: 20/05/2010

More than 15 months after complaints were first made to the police, a Doncaster (South Yorkshire) gay man had the two cases of reckless HIV transmission against him dropped as his trial began. He was charged with reckless Grievous Bodily Harm for allegedly transmitting HIV to two men.
 

Another fine mess by police and prosecutors

The case was dropped due to lack of evidence – the police had failed to investigate the previous sexual partners of the two men who went to the police. Any of those previous partners could have had HIV and infected the two men, instead of the accused.

And the Crown Prosecution Service again ignored their own policy and procedures in approving the prosecution, despite failing to rule out all the previous partners of the complainants.

The two men who complained to the police both believed that they had been infected by the accused during separate dates. To prove the defendant was the cause (source) of the two men’s HIV infections, the prosecution must prove beyond reasonable doubt that only the accused could have infected them.

No phylogenetic analysis

Edwin J Bernard, who runs the excellent Criminal HIV Transmission blog has spoken with the man’s expert HIV defence lawyer, Khurram Arif. The trial was meant to begin on Tuesday at Doncaster Crown Court. The defence lawyer had prepared a scientific report examining the likelihood that only the accused could have infected both complainants. The report highlighted that the complainants' previous sexual partners may also have infected them and that phylogenetic analysis could not rule this out.

In court on the first day, the prosecution consulted with its own scientific expert and conceded that since both complainants had previous sexual partners and the police did not investigate nor eliminate them as possible sources of infection, there was no case to answer. This is what the CPS guidelines clearly tell them to do before prosecutions are authorised. The Crown Prosecution Service has ignored a key part of its policy once again. 

The same thing happened to the man prosecuted in 2008 in Manchester, and in several other cases elsewhere. 

HIV Legal Experts Successes
This is one of several cases defended by Mr Arif, where the Crown Prosecution Service ignored expert guidance and witnesses. The CPS embarrasses itself by dropping HIV cases very late in the day. As Mr Arif told Edwin: "The prosecution, when making such allegations, have to prove that they have closed all the doors to the possible sources of infection. Again, in this case, they did not."

The case highlights that in England & Wales, people accused of such 'crimes' should never plead guilty and should immediately contact an HIV organisation for advice in order to be put in touch with an expert defence lawyer, such as Mr Arif, who advises and represents his legal aid customers through Christian Khan Solicitors and any paying private customers through GSC Solicitors.

Complainants' sexual histories are investigated in detail
People thinking of going to the police with a HIV infection complaint need to realise there is only a very small chance that any complaint will result in a conviction. In the investigation process their own sexual history will have to be investigated in detail since their last negative HIV test. All those previous sexual partners must be traced and all of them ruled out as a source for the HIV. If the complainant has never had a HIV test before, that means investigating every partner since they became sexually active. Only then might a prosecution succeed.
 

Source Criminal HIV Transmission blog

Clinics Guide to Law and HIV

posted: 23/04/2010

Have your say about the draft guidance for HIV clinics from BHIVA / BASHH about HIV transmission, the law and the work of the clinical team, 2010. The deadline for your comments is Friday 21 May 2010.

There have been prosecutions for reckless transmission of HIV in the UK since 2001 (Scotland) and 2003 (England & Wales). The prospect of prosecutions raises complex questions among medical practitioners about their ethical and legal responsibilities related to HIV transmission, particularly around disclosure of information on HIV status.
 

Although established generic ethical and professional principles continue to apply, certain features of the HIV epidemic have required special consideration.
 

An underlying principle in the provision of clinical care for people with HIV is the need for a secure and confidential environment in which extremely sensitive matters can be frankly and fully discussed. The importance of ensuring that full trust is maintained by people with HIV in their clinical services is fundamental, not only for the health of people living with HIV but also for people who may wish to seek information or testing and thus for the wider public health.
 

This guidance document sets out these responsibilities, and how these relate to the roles and responsibilities of health care professionals when caring for individuals infected with HIV.
 

Roles and responsibilities of Health Care Professionals

• Health care professionals have a central role to advise and support patients and to maintain confidentiality according to professional guidance and the law.
• For HIV positive individuals, advice must include the routes of HIV transmission, how to prevent transmission, with information about safer sexual practices and the use of condoms.
• Discussion of sexual health needs must take place regularly according to relevant BASHH guidelines to enable the giving of appropriate advice.
• There is individual and public interest in maintaining confidentiality; this may be outweighed in order to prevent serious harm to others.
• It is important when considering breaching confidentiality to weigh up all potential harms as there may be situations where disclosure of HIV status to protect a sexual partner results in considerable harm to an individual e.g. domestic violence.
• In situations where a health care professional believes that an HIV positive individual continues to put close contacts at risk their duties and subsequent action depend upon the type of contact (see figure one).
• No information should be released to the police unless there is verified consent from the patient or there is a court order in place.
• It is up to an individual patient to make a decision about complaining to the police and health care workers should remain impartial during discussions with patients.
• Those involved (complainant and defendant) in cases of reckless transmission are likely to need specialist legal advice and support and referral to THT direct would be appropriate.
• Sources of further information are listed in appendix two.

Vulnerable Groups

There are special considerations with regards cases of alleged reckless transmission in those under 18, or anyone with learning difficulties, discussed in section 5.
 

You can download the document and then submit any comments using this online form. 
 

Please make your comments here by Friday 21 May

HIV Transmission – All the Facts

posted: 14/04/2010

Clear, full, accurate information about HIV transmission can be hard to find. Even recent ‘official’ sources may mislead. For example, one NW England council’s HIV guide for schools suggests HIV transmission could happen at school.

While almost anything could happen at any school, HIV transmission is exceptionally unlikely, without risky sex - and that is not part of the curriculum. Suggesting HIV transmission could happen at school is unhelpful and tends to increase anxiety and feed HIV stigma.
 

HIV transmission without sex, without injecting drug use, or without mother to baby transmission is exceptionally rare. Of over 34,000 HIV diagnoses in the UK from the beginning of the epidemic to 1997, only 19 happened in non-sexual 'unusual circumstances' . Most of these ‘unusual’ transmissions were at clinics abroad, where infection control procedures were slack.

Everything you ever wanted to know about HIV transmission but were afraid to ask

Visit the HIV transmission section of the NAM / aidsmap website for detailed information on subjects including co-factors that affect transmission, viral load and risk of transmission, and protective measures.

NAM also produce a comprehensive book, HIV Transmission & Testing, available from their online bookshop.
 

HIV - Treat to prevent?

posted: 06/04/2010

The use of HIV treatment for preventing HIV is a hot – and controversial – topic. Now researchers are saying people with HIV should not stop using condoms and start depending on HIV treatment to protect their partner until you have taken treatment and the viral load has been undetectable for at least 12 months.

 
Some, perhaps most, people who are taking HIV treatment, who do not have sexually transmitted infections and who have an undetectable viral load, are not infectious to their sexual partners.

Some of the research suggests that taking HIV treatment and keeping an undetectable viral load is at least as good as using condoms in preventing HIV. Not everyone agrees, and there are heated debates about this at HIV conferences.
 

The debates started about two years ago with what is now called the Swiss statement - it was followed by broadly similar statements from France, Germany and the USA.

Reliably undetectable?
Danish researchers wanted to see if people taking HIV treatment can rely on their viral load remaining undetectable. They looked at the viral load results of every person in Denmark who was taking HIV treatment. Research shows that HIV transmissions are very rare if a person had a viral load below 1000 copies/ml. So they assumed that everyone taking HIV treatment with a viral load above this is potentially infectious. They then calculated the amount of time that people taking HIV treatment had an ‘infectious’ viral load of above 1000.
 

Reliable for most

For people who reached an undetectable viral load, it stayed undetectable 99.5% of the time.
But during the first year of HIV treatment, viral load can suddenly increase to detectable levels – this happens for about 5% of the time. People won't know when their viral load has taken an upward, detectable, blip when HIV transmission becomes more likely.

The risk of transmission was especially high during the first six months of HIV therapy, when 8% of the time was spent with a viral load above 1000 copies/ml. During the next six months, viral load was at potentially infectious levels for a little over 1% of the time. After the first year viral load was only above the potentially infectious threshold for an average of 0.6% of the follow-up period. After five years, only 0.03% of the follow-up period was above 1000 copies.

Different routes of transmission do not seem to make a difference - except for injecting drug users who had a potentially infectious level of viral load 1.5% of the time. The researchers belive this is because of poorer treatment-taking among injecting drug users.

Wait until viral load stays undetectable for 12 months

They therefore think that the Swiss recommendation about using treatment for HIV prevention should be tightened. They believe people should not swop condoms for treatment until there has been an undetectable viral load for at least twelve months, twice as long as suggested in the Swiss statement.
 

Sexual Transmitted Infections and viral load

Sexually transmitted infections can cause undetectable viral loads to suddenly become detectable - especially in the genital fluids. We measure all our viral load samples from the blood but what passes on HIV is HIV in the genital fluids. Many people have undetectable HIV in the blood but can have a detectable viral load in the genital fluids - and these are the ones that transmit HIV in sex. Sexually transmitted infections cause detectable genital viral loads and make us more infectious. Some experts say that among groups of people with high rates of sexually transmitted infections, such as gay and bi men with HIV, undetectable viral load is too unreliable to judge your risk of passing on HIV.

Swiss reminder

The debate on treatment as prevention was kick-started a little over two years ago by the release of what is known as ‘the Swiss statement.’
Senior Swiss HIV doctors and researchers said that HIV-positive individuals who were taking HIV treatment were not infectious to their sexual partners if:

• Their viral load had been undetectable for at least six months.
• They took their HIV treatment properly.
• They did not have any sexually transmitted infections.

Source