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HIV/AIDS and legal responsibility

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A number of cases have been reported in which people living with HIV (Human Immunodeficiency Virus) have been criminally charged for a variety of acts that transmit HIV or risk transmission. In some cases, criminal charges have been laid for conduct that is merely perceived as risking transmission, sometimes with very harsh penalties imposed. Some jurisdictions have moved to enact or amend legislation specifically to address such conduct. The issue has also received public and academic commentary. In Europe alone, hundreds of people have been prosecuted, and several have been convicted.

Author / translator Andrea Bandelli

A number of cases have been reported in which people living with HIV (Human Immunodeficiency Virus) have been criminally charged for a variety of acts that transmit HIV or risk transmission. In some cases, criminal charges have been laid for conduct that is merely perceived as risking transmission, sometimes with very harsh penalties imposed. Some jurisdictions have moved to enact or amend legislation specifically to address such conduct. The issue has also received public and academic commentary. In Europe alone, hundreds of people have been prosecuted, and several have been convicted. These developments raise the question of whether criminal laws and prosecutions represent sound policy responses to conduct that carries the risk of HIV transmission, or if public health laws should be applied. Individual cases, and accompanying media coverage, may prompt public calls for such a response.

Created 26 January 2010
Last edited 20 June 2018
Topics Ethics, Health

Policy positions

Policy position 1

Enact HIV-specific criminal law Apply existing criminal law offences (e.g. endangering public health, offence against the person, assault, etc.) to allow the prosecution for all forms of HIV transmission, including reckless and accidental.

Policy position 2

Duty to disclose status Enable a duty by law for HIV positive people to disclose their status before engaging in risk-transmitting activities with other people, even if these activities are consensual.

Policy position 3

Use the law, but don’t create HIV-specific legislation Apply existing criminal law and public health legislation where appropriate, but do not create HIV-specific legislation for deliberate, reckless or accidental transmission.

Policy position 4

Prevention and counselling Use prevention and counselling rather than the law. This means access to: 1. HIV testing, accompanied by counselling 2. information about avoiding HIV transmission and 3. the economic, social and personal support necessary to avoid conduct that risks HIV transmission

Story cards

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Richard Schmidt is a doctor from Louisiana, USA, who was accused of infecting his lover Janice by injecting her with HIV+ blood from one of his patients. Janice alleged that Schmidt had injected her in an act of vengeance after she tried to end their relationship. Scientists were able to determine that Schmidt's patient was extremely likely to have been the source of the virus found in Trahan. Schmidt was found guilty and sentenced to 50 years in prison.

Richard Schmidt
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In June 2004 Morat was found guilty under legislation on poisoning (France has no specific anti-HIV laws) of failing to disclose his status to two women, both of whom subsequently became HIV+. He was sentenced to six years in prison.
Femmes Positives are a French group lobbying for a specific HIV transmission-related law that will give them the right to prosecute former lovers.
These two factors have stimulated a massive debate in France over whether HIV+ people should ever be divided into 'victims' or 'criminals' in the eyes of the law, or whether the conventional doctrine of 'shared responsibility' should remain.

Christophe Morat
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In March 2005 Dica was found guilty in the UK of reckless (rather than deliberate) Grievous Bodily Harm against two women. He claimed that the women had fully consented to the risks of unprotected sex with him. However, the prosecution argued that he had actively persuaded one of the women not to use condoms, even though he knew he was HIV+. He also led the other to believe he was HIV negative and a rich single lawyer, when in fact he was HIV positive, unemployed and married with children. He was jailed for 4 and a half years.

Mohammed Dica
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May 2005: A mother from Hamilton in Canada was charged with criminal negligence causing bodily harm after refusing pre- and post-natal care and ignoring advice that would have prevented her baby from acquiring HIV. Following the birth of a healthy baby in 2003, the woman became pregnant again in 2004 and changed her health care provider. She did not tell her new doctors of her positive status, so her baby did not receive essential medication. Despite having not breast fed her first baby under her doctor's advice, she did breastfeed the second, leading to the baby testing positive.

Unidentified woman
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In June 2005 Dalley, a New Zealander, was convicted of criminal nuisance after having unprotected sex with his girlfriend and failing to disclose his status. She remained HIV negative, but initially told Dalley's family she was positive. She later admitted she had lied, but charges were still brought due to the alleged mental stress and trauma she had suffered on discovering her boyfriend's status. Dalley was sentenced to 300 hours' community work, six months supervision and $1000 reparation to cover his girlfriend's counselling and other expenses.

Justin Dalley
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In June 2005 the Canadian Red Cross was taken to court after more than 1,000 Canadian citizens acquired HIV from infected blood products in the late 1980s and early 1990s. The Red Cross had failed to properly implement HIV and hepatitis screening for some years after tests for the diseases became available. Official charges were dropped after the organisation admitted guilt, issued a full apology and agreed to compensate the victims. As well as a $5,000 fine, they gave $1.5 million (not sourced from public donations) to fund, first, scholarships for affected children and, second, research into medical errors.

Canadian Red Cross
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Pavlos Gergiou, a Cypriot fisherman, infected his British lover, Janette Pink, during a holiday romance. Ms Pink eventually managed to persuade the Cypriot courts to bring him to trial in 1997. He was sentenced to 15 months in prison. At the same time, the UK government announced that the 1861 Offences against the Person Act was to be revised so that the deliberate, but not reckless, transmission of illnesses would be punishable by anything up to a life sentence. This has not been done, making possible the first ever case of reckless transmission in 2003 (see 'Mohammed Dica').

Pavlos Georgiou
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In 2000 Feston Konzani, an African asylum seeker living in the UK, was diagnosed HIV positive and advised to warn any future partners of his status. He later had sex with three women without telling them that he was HIV+. The women became HIV+ and eventually brought him to trial. Konzani argued that the women had consented to the risk of catching a sexual disease by agreeing to have unprotected sex with him.
In 2004 he was sentenced to 10 years’ imprisonment. The judge told him the sentence was intended to deter other HIV positive people who did the same.

Feston Konzani

INFO CARDSISSUE CARDS

Poverty and AIDS

Studies have found a direct relationship between poverty and the number of cases of AIDS. In addition, socioeconomic problems associated with poverty, including lack of access to good health care, can increase the risk of HIV infection.

Stigma and ignorance

Too often, stigma and ignorance have fuelled the AIDS epidemic by driving the problem underground. This has been particularly devastating when political leaders have not acknowledged and confronted the epidemic.

Tackling the spread of infections

Three main actions are needed: prevention; treatment and care; and support systems and partnerships. The majority of these actions do not fall within the responsibility of the European Union, but are for individual countries to take.

The aims of policy

The main aims should be:
1. Preventing the transmission of HIV
2. To conform to international human rights.

Does prison work?

Imprisoning a person with HIV does not prevent them from spreading the virus, either during partners’ visits or to other prisoners.

The European strategy

1. Encourage prevention, for example safer sex practices
2. Improve access to HIV testing and health care for all, and in particular for migrants and poor people

Punishment?

Punishment is only justified for conduct that is morally blameworthy. This is unrelated to the main aim of preventing the transmission of HIV.

Stigma

Criminal laws that only relate to HIV, inflammatory media coverage, or politicians’ comments on individual prosecutions stigmatises people with HIV as potential criminals and as a threat to the public.

A deterrent for testing

If people who are aware of their HIV-positive status can be criminally prosecuted, this could put people off from getting tested.

False sense of security

Criminalizing HIV-positive people could create a false sense of security among people who are HIV-negative. They may think that this reduces the risk of unprotected sex.

Personal privacy

There is a risk of invading people’s privacy, if counselling or health records are not kept confidential or through publicising court proceedings.

People’s choices

People do not need to know the HIV status of their sexual partner to make choices. These include omitting risky sexual acts or taking preventive measures such as using a condom.

What should be illegal?

If a person who knows of his/her partner’s HIV-positive status freely agrees to participate in some risky activity, then there is no justification for criminal charges against the HIV-positive person.

The law and the facts

Good laws are based on good data. AIDS laws must not be based upon ignorance, fear, political expediency and pandering to the demand of the citizenry for ‘tough’ measures.

Importance of human rights

Experience with the HIV/AIDS epidemic confirms that the promotion and protection of human rights are essential in tackling HIV/AIDS.

Infringing human rights

Punishing people simply on the basis of their HIV status violates their human rights, especially the right to equal protection before the law and freedom from discrimination.

The benefit of testing

The main incentive to get tested is to get treatment. But most people with HIV/AIDS live in countries where treatment is unavailable or unaffordable.

When is punishment justified?

For some women, simply suggesting that their husband use a condom can provoke physical abuse. If they are HIV positive, should they be punished if they transmit the virus? What if they become HIV positive from unprotected sex with their husband?

What conduct should be illegal 1?

Should it only be conduct that actually results in HIV transmission, or also conduct that risks transmitting HIV even if there is no actual transmission?

What conduct should be illegal 2?

All risky activities undertaken without the consent of the other person should attract criminal liability regardless of the HIV status of the people involved.

The risk of transmission

The main risk factors are the concentration of the HIV virus in the blood, generally highest immediately after an untreated infection, and whether an HIV infection is combined with other sexually transmitted diseases or infections.

It takes two to tango

Where two individuals enter into sexual relations, both are responsible for taking measures to protect their health and prevent undesirable effects (such as pregnancy or infection with HIV).

The need for legal protection

Adequate protection is available against infectious diseases such as HIV. If people are properly informed about the potential risks and have an opportunity to protect themselves, there is no need for legal protection.

Our responsibilities

Society cannot operate successfully unless everyone takes some responsibility for other people’s well-being. This includes preventing HIV and other infectious diseases.

AIDS and HIV

AIDS (Acquired Immune Deficiency Syndrome) is the most serious stage of HIV infection. It results from the destruction of the infected person's immune system by the virus.

The immune system

Your immune system is your body's defense system. Its cells fight off infection and other diseases. HIV weakens these defences by attacking and destroying these cells.

When are patients with HIV diagnosed with AIDS?

1. When they have too few CD4 cells (white blood cells that fight infection), or
2. They develop an AIDS-defining illness (one unusual in someone not HIV positive).

HAART (Highly Active Antiretroviral Therapy)

HAART is currently the most efficient treatment against the development of AIDS. Possible side effects are:
• liver problems
• diabetes
• high cholesterol
• increased bleeding in patients with hemophilia
• nerve problems

Drug resistance

HIV can mutate (change form) while a person is taking anti-HIV medication. This may result in HIV that can no longer be controlled with those medications.

HIV and pregnancy

No one can tell for sure if a baby from an HIV positive mother will be born HIV infected. A drug called ZDV has been shown to reduce the risk of passing HIV to a baby by almost 70%.

Notifying partners of people with HIV

Some health departments and HIV clinics have anonymous systems for this. Partners are told that they have been exposed to HIV, but are not told when or who provided their name.

HIV infections in Europe

1996
New HIV cases: 7600
New AIDS cases: 4100

2003
New HIV cases: 13300
New AIDS cases: 1800

Change 1996-2003
New HIV cases: +75%
New AIDS cases: -55%

The reduction in AIDS cases is mainly explained by a treatment called HAART (see infocard 4), introduced in 1997.

Epidemic in the Baltic countries

The most drastic increases in the number of new HIV diagnoses have been in the Baltic countries (Estonia, Latvia, Lithuania).

European reporting systems

Reporting on HIV infections is still incomplete: some of the countries with the largest HIV/AIDS epidemics (Italy and Spain) do not yet have a national reporting system.

Italy and Spain

Nearly half of newly diagnosed cases in the 25 countries of the European Union in 2003 were in Italy (27%) and Spain (21%). Yet they only represent 22% of the EU population.

Women newly diagnosed with AIDS in Europe

Women’s raising share of total number of people diagnosed:

1985: 10%
1995: 20%
2003: 27%

Main causes of new AIDS cases in Europe, 2003

42%
Heterosexual contact

31%
Injected drug use

19%
Homo/bisexual contacts

Europe’s neighbouring countries

The rate of new infections in the Russian Federation, Ukraine, and nearby countries has been the highest in the world. In Russia and Ukraine, one adult in every hundred is infected.

Functions of criminal sanctions

1. Prison stops the offender from reoffending while serving their sentence.
2. Help the offender change their behaviour
3. Punishment for wrongdoing
4. Deter people from offending in the future.

Quarantine

The World Health Organization says, “there is no public health rationale to justify isolation or quarantine based solely on the fact that a person is suspected or known to be HIV-infected”.

Activities that risk transmitting HIV

People may be forced into such activities (e.g. being raped or stabbed with a needle) or they may be willing participants (e.g. consensual sex, sharing injection equipment).

Negligence

Generally it is gross negligence, that is reckless disregard for the safety of others, more than mere, ordinary negligence, that must be proved in order for the individual in question to be judged guilty of a crime.

The HIV virus

Despite the treatments currently available, there is still no prospect of removing the HIV virus completely from the body. So there is always a risk of the virus being transmitted.

Preventing infection

Every HIV infection that is detected and treated at an early stage is estimated to prevent between 10 and 20 further infections in the longer term.

The use of a condom

When used consistently, this results in an 80% risk reduction as compared with unprotected sex.

Sexual techniques

With some sexual techniques, the risk of transmitting the HIV virus is so negligible that a person who is HIV-positive can engage in safer sex without using a condom.

Different types of criminal intent

• Wilfulness: you wish to harm someone
• Recklessness: you accept a significant risk that what you do will cause this harm
• Negligence: you did not intend to cause harm, but failed to exercise reasonable care to prevent the results

Conviction for HIV

At least 130 people in Europe have been convicted for transmitting or exposing another person to HIV infection. In 90% of the cases this was through consensual sex.

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