Reducing Harm or Producing Harm? Public Health Implications of Prosecuting HIV-positive People. Warren Michelow

Transcription

1 Reducing Harm or Producing Harm? Public Health Implications of Prosecuting HIV-positive People Warren Michelow University of British Columbia School of Population and Public Health

2 Outline Prosecuting HIV+ people Canadian policy What do other countries do? Risk of HIV transmission From risk to infection What does this mean for public health? What could we do about it? Questions to ask your organisation 1 of 14

3 Prosecuting HIV+ People Background Fear of HIV Quarantine Discrimination and stigma against gays, MSM, drug users, sex workers Who are the real victims? Turning to the courts Increasing public support for charges 2 of 14

4 Canadian Policy No policy left to courts to decide 1995: attempt to criminalise any sex between HIV- person and person HIV+ or at risk for HIV, failed to pass 1999: Cuerrier: duty to disclose if significant risk of transmitting HIV Many cases plead guilty so no trial Mostly male to female No transmission needed, only risk 3 of 14

5 Canadian Policy Significant risk of serious harm Aggravated ated assault Feb 2008: Leone 15 counts, 18 years May 2008: Montreal woman 1 year April 2009: Aziga 2 x 1 st degree murder difficult case he was not a good man 4 of 14

6 What do Other Countries Do? England and Wales, CPS Wide consultation starting in 2002 Clear policy as of March 2008 All communicable diseases not just HIV Evidence: factual and scientific Prosecuted as grievous bodily harm Must have intended d to transmit, or recklessly and actually transmitted HIV Exposure alone is not a crime 5 of 14

7 What do Other Countries Do? USA No clear or consistent policy Extreme charges and rulings E.g. spitting in police officer s face got 35 years with no parole for 17 years saliva = deadly weapon 6 of 14

8 Average Per-Episode Risk of Tx (Exposure to HIV-infected Source) Mucocutaneous (blood) a 0.09% Percutaneous (blood) b 03% 0.3% Oral sex female on female c 4 case reports Oral sex on a male receptive d 0.06% 06% Vaginal sex male partner e % Vaginal sex female partner f % 0.2% Anal sex insertive partner g 0.06% Anal sex receptive partner h % IDU needle sharing i 0.67% Mother to child (no prophylaxis) j 24% 7 of 14

9 From Risk to Infection Behaviour with risk of exposure How big must risk be for it to count? Exposure occurs Harm reduction options Responsibility for protection? Infection occurs Individual factors Social and environmental factors 8 of 14

10 Where is Infection Happening? Acute HIV infection Most infectious i during first days People who inject drugs (IDU) Prisons, no needle exchange, no SIS Access to HIV treatment Treatment reduces transmission Sexual power dynamics Vulnerable women and MSM 9 of 14

11 What Does This Mean for Public Health Organisations? Most vulnerable are hardest to help Reduced d HIV testing Reduced access to services and treatment Need to be prepared Search warrants and subpoenas Duty to warn or obligation to report Professionals, staff and volunteers No simple solutions!! 10 of 14

12 What Are the Options? Communicable disease regulations Public health h orders Develop ppolicy in advance Communicate fully with clients Minimal recording in case files Does disclosure even matter? Limits of testing, universal precautions Civil disobedience?! 11 of 14

13 What to Ask Your Organisation Position on disclosure and prosecution? What info needed to provide services? Documenting HIV status? Policy for search warrant? Process for duty to warn Professionals Staff and volunteers Who monitors legal developments? 12 of 14

14 Acknowledgements Canadian Institutes of Health Research Integrated Mentor Program in Addictions Research Training NEXUS, Social Contexts of Health University of British Columbia Canadian HIV/AIDS Legal Network 13 of 14

15 Thank You Warren Michelow: Questions? Comments? Thoughts? 14 of 14