News

Sex Without HIV Disclosure: Should It Remain a Crime?

Why the Supreme Court is about to hear public health experts say it's time to soften the law. A special report.

By Stephanie Law, 12 Jan 2012, TheTyee.ca

Living with HIV

Some fear stigma, even abuse, if they say tell their partners they are HIV positive.

Related

Imagine you are a single mom who happens to be HIV-positive.

On one hot summer day, you meet the man of your dreams on a grass field while both you and the man's children are playing soccer. You go on a first date with him. And then another. Eventually, you fall in love with him. But you haven't told him you're HIV-positive. And pretty soon, you have sex with him -- just once, before finally, one day, you muster up the courage to tell him that you're HIV-positive.

He doesn't leave you. And your relationship continues to grow year after year, but it ends four years later. You never transmitted HIV to him. It doesn't end because of your HIV-status. But it ends because he starts to physically abuse you and your child. So you call the police to report him, and the case goes to trial. He gets charged and convicted with assault. But a year later, perhaps out of vengeance, he decides to call the police and tell them that you failed to tell him you were HIV-positive before you had sex at the beginning of your relationship. He claims that had he known you were HIV-positive, he wouldn't have consented to having unprotected sex. He also claims that you didn't use protection even though you vividly remember having done so. He presses charges against you for sexual and aggravated assault for non-disclosure of your HIV-status, which is equivalent to having sex with someone without consent, better known as rape, and for putting him at risk of serious bodily harm.*

You probably should have known better. You probably should have told him about your HIV status earlier. But you didn't, or maybe, you couldn't. As a result, the judge finds you guilty on both charges, and you're now officially a sex offender. And to the legal and criminal system, you're just as bad as a Rohypnol-slinging date-rapist.

This woman isn't just your imagination. She's a real person and on appeal, the Quebec Court of Appeal reversed the trial judge's decision initial decision, and found her not guilty of the two charges. And now, her case, R v. D.C., is headed to the Supreme Court of Canada, and will be heard on Feb. 8.

Some people might feel sympathy for her. Others might think she deserves to be convicted. But regardless of your feelings towards her, one question remains: why didn't she tell him she was HIV-positive before they'd ever had sex?

'Nobody wants to be rejected'

"You never know when's the right time to disclose," said Jason Black, a 25-year-old who's living with HIV. "There are so many different issues that you think about when you're deciding whether or not to disclose, and a lot of it is based out of fear."

"Because nobody wants to be rejected."

Jason Black's name has been changed in this story to protect him against unnecessary harassment from those who might not know his status. Black was diagnosed with HIV when he had just turned 20. At the beginning of his HIV journey, Black found himself going through numerous scenarios and asking dozens of questions in his mind before disclosing his status.

"Should I even disclose? What is the relationship going to become and is it really going to go anywhere? What kind of sex are we going to have? Are we even going to have sex? Is this person open-minded?"

Black is one of about 48,000 people living with HIV in Canada. He has to take one pill every day for the rest of his life. Although the pill isn't a cure, it does make his illness manageable and not life-threatening. It does so by keeping the amount of virus flowing in his blood so low that diagnostic tests wouldn't even be able to detect the HIV. Without the daily pill, HIV would kill off his immune cells and make him susceptible to all kinds of diseases that could end his life.

HIV used to be a death sentence, but with scientific innovation over the last decade, it's become a manageable chronic condition, much like diabetes or high blood pressure.

Taking the daily medication doesn't bother Black. He doesn't get worried about HIV affecting his physical health. What he does worry about, is what happens when he tells people, especially potential sexual or relationship partners.

"That's the hardest part about living with HIV, it's the whole relationship aspect of it," he said. "But you get used to people being weirded out by it."

It wasn't an easy journey for Black, who was born and raised in Vancouver, B.C., to get used to people's negative reactions. When he first found out he was HIV-positive, Black didn't know as much about HIV as he does today. He didn't know that he could live a long and healthy life. And he didn't know that HIV could be controlled with treatment, at least not to the extent that the virus becomes undetectable.

"When I found out I was positive, I held all of the stigma that many people today hold," he said. "Walking home, I was completely devastated."

Black had misunderstood his doctor when she told him that people were living up to 25 years after diagnosis. He didn't catch on that what she meant was, with proper treatment, people who were diagnosed back in the 1980s are still well and alive 25 years later.

"I was freaking out about that, and I started like planning my life," he said. "I was in my third year of university at the time, and I thought, 'What am I doing with my life? Maybe I should just quit school and go travelling.'"

He also worried about the casual contact he had with people.

"What if I gave that person HIV too? What if I gave some of my family HIV?" he'd asked himself. "It was really horrible when I found out because I didn't really understand fully how HIV was transmitted, I mean I knew to use a condom, but I wasn't quite sure about other things like oral sex or kissing."

In fact, many research studies have found that the risk of HIV transmission in a single act of unprotected sex is lower than one in 10,000, if the HIV-positive person has undetectable levels of HIV. The transmission risk is more than 10 times higher if the person has higher levels of HIV and isn't on HIV treatment. Transmission through oral sex and kissing is nearly impossible.

The tide turned for Black when he found a new doctor at the B.C. Centre for Excellence in HIV/AIDS at St. Paul's Hospital.

"The doctor was like, 'Okay, chill out, you're going to have lots of sex in your life, and you're not going to die anytime soon.'"

'It's always better to disclose'

Stigma, misinformation and lack of knowledge around HIV are the most common reasons for why people living with HIV have a hard time disclosing their status. That was certainly the case for Black, who found himself reluctant to start new relationships, thinking his status could harm others.

"Ultimately, it's always better to disclose and it's always better to be honest," he said. "It's really important to disclose before you get into any sexual activity with anyone to give them the option of protecting themselves and so they are fully aware of what they're doing."

Black never got that option before he had unprotected sex and became infected with the virus. He said he'd be devastated if he ever passed it on to someone else, not because of the physical impact of the disease, but because of the emotional burden that comes with it. He doesn't feel anger towards the person who passed it to him because he recognizes that he was at fault as well.

"The onus of public health should be on the individuals, everyone shares that responsibility," he said. "If you're going to engage in unprotected sex with someone than you should take precautions and wear a condom."

Black never considered pressing charges against the person who transmitted HIV to him. He actually didn't know at the time that such a sex crime existed.

The Supreme Court of Canada formalized the crime of non-disclosure of HIV in a 1998 ruling. The case is known as R v. Cuerrier. In the ruling the court stated that an HIV-positive person has to disclose his or her status before engaging in behaviours that could put someone else at "significant risk of serious bodily harm." The court, however, left a lot of room for lower courts to interpret what qualifies as "significant risk." To date, more than 130 people living with HIV have been charged in Canada for not disclosing their status, a majority of whom were later convicted. These charges included cases in which a condom was used, although the bulk of these have resulted in acquittals.*

If found guilty, like the HIV-positive single mom, someone can be convicted of both aggravated assault and sexual assault. The aggravated assault component is because you've put someone at significant risk of serious bodily harm. The sexual part comes from the argument that full consent to sex isn't possible without full information about the risks involved. So if an HIV-positive person doesn't disclose their status, then they put the partner at risk and any consent would be nullified.

The objective of this ruling is to try and legally enforce HIV disclosure. And in fact, some physicians actually do use this legal obligation as a tool to get their patients to disclose status to their partners.

"There's a general protocol for what to do when you have a new patient who just got diagnosed with HIV, and the first thing is to tell them not to infect anyone else and to tell their partners about it," said Norbert Gilmore, a Montreal-based physician who's been treating HIV-positive patients since the early 1980s. "We tend to warn them, 'If you go out and have unprotected sex without telling them before hand of your status, then you are at great risk of going to jail.'"

"That's enough to make people sit up and listen."

Fear of disclosure

But despite this use of the legal tool, some qualitative research shows that the criminalization of HIV actually makes people less likely to disclose. The bottom line is that the barriers to disclosure of status are still present, even if non-disclosure is made a crime. Whether it's a crime or not, for people living with HIV there's still the undeniable fear of rejection because of discrimination or worse -- the fear of violence or abuse as a result of disclosure.

More and more doctors and researchers are coming together to say "criminalization is wrong," Gilmore said. "Not disclosing your status when you know the risk of transmission is trivially low shouldn't be considered as criminal negligence, or reckless behaviour."

Gilmore doesn't disagree that there are cases where an HIV-positive person should be charged criminally for knowingly, and deceivingly, transmitting the virus. For example, one Ontario man was convicted for having unprotected sex with 11 women without disclosing his status. Johnson Aziga was found guilty in 2009 of two counts of first-degree murder for two women who died from AIDS-complications, 10 counts of aggravated sexual assault and one count of attempted aggravated sexual assault. Seven of the 11 women contracted HIV from Aziga. The high rate of transmission is due to the high levels of HIV virus in his body at the time of sexual intercourse.

"Criminalization should apply when there's a reckless disregard of health and welfare of other people," Gilmore said. "But we have a lot of people who don't feel that they're a danger to others because they are on treatment and their HIV is undetectable, and they're using condoms, but still get charged."

"These people aren't harmful."

Gilmore, like many other critics of the HIV disclosure law, believes that the law does more harm than good. For one, he says that the law deters people from getting tested for HIV.

"If you don't know your HIV status then you have nothing to disclose and you can't be found guilty, so why get tested? Why get care?" he said. "This is completely opposite of what doctors and public health people say, because if you don't get tested you won't get treated and get better."

And the disease will continue to spread.

"There are a lot of people who would prefer not to know their status so they won't have to deal with these troubles," he said. "They'd rather go on with their happy lives and not know, than to carry the burden of having HIV, of having to take the medications, and of having to disclose to people that they have sex with."

'Law needs to change': BC Health Officer

Most people would agree that it's simply immoral and unethical for an HIV-positive person to have unprotected sex, or even protected sex, with someone without disclosing their status. But illegalizing this unethical conduct seems to be counterproductive with regards to the public health goal of stemming the HIV epidemic.

Perry Kendall, provincial health officer for B.C., says the Ministry of Health works closely with the Attorney General and Crown prosecutors to share guidelines on the criminalization of HIV, and on the levels of transmissions risks.

"The issue up until this time was that there hasn't been good treatment for HIV, earlier on it was a death sentence, a fairly horrible one for that matter," Kendall said. "The drugs had serious side effects, but now it's treatable and manageable, and I think the law needs to recognize that and change itself to reflect that."

Kendall expects the upcoming Supreme Court hearings on Feb. 8 -- there are two: one is with the single mother C.D., and the other is R v. Mabior -- will reflect this new reality of treatment and HIV, and would give more clear guidance on what constitutes a "significant risk" of transmission and serious bodily harm. In the case of R v. Mabior, the Manitoba Court of Appeal acquitted him on four out of six counts of aggravated sexual assault for HIV non-disclosure, stating that there was no significant risk of transmission in those four sexual acts because Mabior had carefully used a condom or had had an undetectable viral load.

But ultimately, Kendall says the root of the problem and the continued spread of HIV in Canada is prejudice and discrimination. "It's more important than ever to get rid of the stigma and encourage people to be tested and get into treatment. We have an opportunity today to wipe HIV and AIDS out within a generation."

Many of those living with HIV and those working in health care and public health tend to agree that criminalization is wrong and outdated. But at the upcoming Supreme Court hearings, the Crown will be arguing that non-disclosure accompanied by any risk of HIV transmission, with or without a condom and regardless of the amount of HIV detectable in the person's blood, should lead to a criminal conviction. That is, the Crown wants to remove the "significant risk" test and to have non-disclosure should always be criminal.

Cécile Kazatchkine, a lawyer and policy analyst at the Canadian HIV/AIDS Legal Network, remarked that the Crown's argument is a move backwards.

"Imposing a legal duty to disclose without considering the transmission risk involved in the activity is very concerning and it contradicts all the development we've seen in science," she said. "Right now, people living with HIV are already being charged with extremely severe offences, they're being convicted of aggravated sexual assault, which could carry a maximum penalty of a life sentence."

And even if the person isn't handed down a long jail sentence, they'd be registered as a sex offender for not disclosing, which has huge consequences on their lives. For example, the person may face limitations around what jobs they can apply for, particularly any that has to do with children or vulnerable people. The registered title as a sex offender is usually reserved for people who are convicted of rape and possession of child pornography.

Kazatchkines argues that the law makes people more reluctant to talk openly about their disclosure and sexual practice with their physicians and counselors, "because this information can be used against them in future investigation."

"If they can't talk to the doctors and counselors, then how is this situation with HIV going to improve?"

Putting aside the public health and legal jargon, criminalization of HIV directly, and negatively, affects the individuals who are living with HIV.

False claims can derail lives

Michael Reid, community engagement manager at YouthCO, a youth-driven organization working with ages 15-29 living with or affected by HIV/AIDS or Hepatitis C, has met many people who have had negative experiences with the legal system. In one case, a young man was in a relationship with an older partner who was abusive.

"This person wanted to leave the relationship, and even though both parties were totally aware of his HIV status, the older abusive partner went to the police and made allegations that he was having unprotected sex without disclosing status," Reid said. "This person ended up in jail for a couple weeks while they were trying to sort out what was actually happening."

The police also released his name through the media and asked for anyone who'd slept with this individual or who'd been in a relationship with him to contact them. At the end of it all, these allegations were found to be false and he was released.

"What's left behind is not only a horrible situation for this member, but everyone who read those story is being like, 'Oh, there's another HIV-positive person spreading HIV.'"

"And it's just perpetuating stigma and misinformation around living with HIV today in 2011."

Twenty-five-year-old Black resents these public broadcasts and appeals to public related to an HIV-positive person who failed to disclose. Just this past summer, a 17-year-old Edmontonian girl's picture and name was broadcasted throughout mainstream media asking people to find her and for anyone who's had sexual intercourse with her to contact the police. In this situation, the police went as far as to get legal exemption to broadcast the young offender's identity, which is usually forbidden for minors under 18 years old.

"All of these images we see in the media again and again and again, they paint a horrible picture of all HIV-positive people subconsciously into the minds of the general public," Black said. "It's a terrible situation that there's so much stigma still when HIV is really a chronic manageable illness, no different from others."

"Criminalization is an erosion of all of our rights and our privacy," he said. "I think it does all of us a disservice, it does public health a disservice, and it does nothing to educate about the present reality of HIV."

Black no longer hesitates with disclosure. He understands that being HIV-positive means he also carries the responsibility of educating people that he meets. He doesn't necessarily always convince them that he's safe to be around, but he tries.

"Really it's just a kind of fear, and it's a reflection of oppression in society," he said. "People aren't taking the time to care for their fellow human beings and to really put themselves in the shoes of someone else who maybe doesn't have it as good as they do."

Black admitted that he grappled with stigma of HIV for a long time. And today, even though he's HIV-positive, he still holds a certain level of stigma against people living with HIV.

"We're all raised with certain views and ideas of society and other people, it's hard work to try and shake that up sometimes," he said. "Making it a crime just makes it easier to point at someone else and say, 'They're a bad person,' rather than, 'That's a person going through a really hard time, what can I do to support them?'"

*Story updated on January 18, 10:12 a.m.  [Tyee]

33  Comments:

Login or register to post comments

  • judycross

    1 year ago

    Watch this

    Nobel Prize Winner Challenges The Myths About Aids
    California microbiologist Kary Mullis, Ph.D. on whether or not HIV is the probable cause of AIDS.

    Created and narrated by Gary Null, Ph.D.

    Find more in-depth investigations and crucial information at http://garynull.tv

    http://www.youtube.com/watch?v=IifgAvXU3ts

  • Granville

    1 year ago

    I vote "YES!" to this proposition

    Knowingly giving someone an incurable and deadly disease should remain a crime. What is there to not understand about that?

    In the real world, there are some absolutes and there aren't always two sides to be argued. Life is not the college debating society and some things are just plain wrong.

    Some people ARE sociopaths who cannot think about anyone but themselves.

  • snert

    1 year ago

    Simple answer: YES

    More complex answer: YES

  • nightbloom

    1 year ago

    Excellent article

    Excellent article. The problem with blanket criminalization of non-disclosure is that such an approach is totally blind to context. It also diminishes the responsibility of every individual to manage the risks they choose to undertake, especially in the case of one-night stands and other transient encounters. For years we've been telling people to treat everyone like they were HIV-positive if they're going to go all the way with people they don't know. I don't understand these people who have unprotected consensual high-risk sex with stangers and then subsequently cry foul.

    And the article correctly points out that low-risk activities with an HIV-positive partner on meds (i.e. with undetectable viral load) represents a trivially small risk. Infinitesimal, depending on the activity. Ironically, when it comes to that kind of sex you're safer with a positive partner on meds than you are with someone who doesn't know their status at all.

    But my understanding of the relatively recent resort to criminal law in this matter (the issue has been around in hard-hit communities for decades, and has only recently gone mainstream) is that it is partly driven by the failure of medical authorities to exercise their existing powers when it comes to known individuals who engage in high-risk behaviours in disregard of the well-being of others. Medical authorities have always had the power to intervene in such cases, but chose not to exercise it.

  • Palinurus

    1 year ago

    requesting a few extra details

    The article states that "Black is one of about 48,000 people living with HIV in Canada. He has to take one pill a day for the rest of his life...."

    What is the name of this medication? If indeed there is only one. What is the cost of this medication and is it provided in every province? Are some people not able to take this medication because they cannot afford to pay for it?

    One hears about wide disparities in medication coverage in Canada involving expensive drugs for cancer and rheumatoid arthritis which a recent article in the Globe and Mail stated could cost as much as $20,000 a year.

  • wcullen

    1 year ago

    HIV/AIDS Med Info

    The information you're seeking is readily available at:

    1. http://www.catie.ca/en/home

    2. http://www.thebody.com/

    3. http://www.hivmedicationguide.com/

    Medication is approved by Health Canada and, therefore, available across the country. However, its cost and subsidization would vary province to prince (and even internally) depending on how that province allocates the Federally allocated (transfer) funds.

    There are several 'one pill' options, but it is more complicated than simply choosing delivery.

    See, for example, http://www.aidsmeds.com/articles/DrugChart_10632.shtml

  • Palinurus

    1 year ago

    thank you for that

    thank you for that information.

    Has there been an article published detailing the varying degrees of subsidization by the provinces for HIV/AIDS medications, including the 'one pill" option?

    For, if the one pill treatment is expensive, and some provinces don't cover such medications adequately, it could be more problematic to argue in Court that the law can now be changed due to more sophisticated treatments.

  • Granville

    1 year ago

    Here's a nice fantasy for you.

    "Imagine you are a single mom who happens to be HIV-positive.

    On one hot summer day, you meet the man of your dreams on a grass field while both you and the man's children are playing soccer. You go on a first date with him. And then another. Eventually, you fall in love with him. But you haven't told him you're HIV-positive. And pretty soon, you're having sex with him -- mostly protected. Finally, one day, you muster up the courage to tell him that you're HIV-positive."

    This would be a great plot for a pot-boiler TV series. It could be called "Have AIDS, will travel" or "The Gift". How would it play as a Survivor episode? "Survivor HIV".

    I never read such slop in my entire life!

  • RickW

    1 year ago

    Is this article suggesting......

    .....that a comprehensive test be required before sex in general? After all, there are more ailments than HIV that can be passed, not only to the partner, but to offspring that might result. And if passing one afflication on is criminal, than how about ALL afflictions?

  • alive

    1 year ago

    for sure

    Good point Rick W!
    In most places they have stopped inbreeding, but many see no problem passing on genetic faults.

  • wcullen

    1 year ago

    HIV/AIDS Denialism (Pt. 1)--The Conspiracy Theories of Gary Null

    The first post links to information that amounts to nothing more than HIV/AIDS denialism.

    Such attitudes and beliefs should not be confused or accepted as honest ignorance or confusion, rather they are examples of willful ignorance based upon absolutely refuted pseudo-scientific claims made by well-known quacks and HIV/AIDS denialists.

    Simply (and soundly) put: there is absolutely NO evidence to support the denial that HIV causes AIDS.

    In regards to Gary Null: Null received a 'Ph.D'--in 'inter-disciplinary studies (NOT science)--from the Union Institute. This Institute has a dubious history to say the least. They have gone bankrupt at least once; they have come under significant scrutiny regarding the validity of their programs; and, they have had programs suspended.

    After being put on probation for these aforementioned transgressions Union Institute had to re-organize and reapply for authorization. The report stemming from their application for academic re-authorization stated that the " expectations for student scholarship at the doctoral level were not as rigorous as is common for doctoral work ... " (OBR 2002; Reauthorization Report).

    Null is a conspiracy theorist of the worst ilk. Although he's been a radio host for many years, TIME noted the following about his claims as a radio host: "From a young reporter this is to be expected. But two decades later, Null, 54, is still warning of a variety of medical bogeymen out to gull a trusting public."

    A general overview of his dangerous and cavalier attitudes and beliefs can be found here: http://www.quackwatch.org/04ConsumerEducation/null.html

  • wcullen

    1 year ago

    HIV/AIDS Denialism (Pt. 2, a)--The Pseudoscience of Kary Mullis

    Kary Mullis did, in fact, graduate with advanced degrees in science (and from reputable institutions), and did win a nobel prize in science (biochemistry) for his work (as a team) on polymerase chain reactions (PCR). Unfortunately, the expertise and methodological rigour in one field failed to translate into his other areas of endeavor.

    Mullis’ claims regarding, among other things, HIV/AIDS are an astonishing example of ignorance and denial in the face of credentials and training that should otherwise have prevented him from even entertaining such clearly unsound beliefs.

    As George Johnson noted noted: "after grabbing a piece of the 1993 Nobel Prize in Chemistry, [Mullis] dove head first off the platform, expounding on the virtues of LSD and astrology and expressing his doubts about global warming, the ozone hole, and H.I.V. as the cause of AIDS" (New York Times; Oct. 2007).

    Mullis is an "AIDS denialist with scientific credentials [who] has never done any scientific research on HIV or AIDS" (Skeptical Inquirer; http://www.csicop.org/si/show/aids_denialism_vs._science/ ). As such he represents a ‘worst case scenario’ in that his credentials are sometimes enough to lead others down the garden path. Given his training and experience his actions are inexcusable—they are, in fact, unethical.

    You cannot get any clearer (evidence an science based) a response regarding this than the statement in the opening abstract from the National Institute of Allergy and Infectious Diseases fact sheet ("The Evidence That HIV Causes AIDS) than this: "AIDS is caused by the human immunodeficiency virus" (http://www.niaid.nih.gov/topics/hivaids/understanding/howhivcausesaids/pages/hivcausesaids.aspx ).

    In certain cases lay-people can be excused for being on a garden path; however, in regards to HIV causing AIDS, there is simply NO excuse for any one holding such a belief.
    Such beliefs are more than erroneous: they are demonstrations of willful ignorance, amounting to egregious wrongs, exhibiting callous disregard of—while contributing to—the suffering of others.

    As Michael Reid stated above, such beliefs and attitudes are “ just perpetuating stigma and misinformation around living with HIV."

  • wcullen

    1 year ago

    HIV/AIDS Denialism (Pt. 2, b)--Kary Mullis’ Association with Pet

    Mullis is a supporter of the 'work' done by known (and soundly and roundly debunked) HIV/AIDS denialist, Peter Duesberg.

    Jon Cohen, of the journal Science, investigated Duesberg’s opinion and came to the following conclusion: "...although the Berkeley virologist raises provocative questions, few researchers find his basic contention that HIV is not the cause of AIDS persuasive. Mainstream AIDS researchers argue that Duesberg’s arguments are constructed by selective reading of the scientific literature, dismissing evidence that contradicts his theses, requiring impossibly definitive proof, and dismissing outright studies marked by inconsequential weaknesses."

    In fact, any support for the opinion of the likes of Duesberg and Mullis is NOT support for their conclusions, rather in the idea of dissent and free speech.

    Duesberg later went on to work on panels in Africa that aided in some African governments denying the medication to those suffering with the disease thereby extending the death and suffering of untold thousands of people.

    Max Essex, Mary Woodard Lasker Professor of Health Sciences at Harvard University, Chair of the Harvard School of Public Health AIDS Initiative (HAI), noted that "history will judge Duesberg as either "a nut who is just a tease to the scientific community" or an "enabler to mass murder" for the deaths of many AIDS patients in Africa"(Discover; 2008).

    A word of caution: when media outlets allow such ignorance—directly or indirectly (i.e. article comments)—they need be aware that they cannot excuse themselves out of complicity by directing people towards disclaimingers regarding content; nor, can they hide behind otherwise sound concepts like 'allowing dissent', the 'promotion of open dialogue', or in support of 'free speech'. Doing so allows ideologues a stage and, thus, are complicit in the dissemination and perpetration of clearly unsound and unethical attitudes. They are, then—however intentionally or unintentionally— contributing to the continued stigmatization, marginalization, and discrimination of people suffering from the disease.

  • Marysue52

    1 year ago

    disclosure is a must

    ALL STDs and ailments should be disclosed before ANY bodily fluids get exchanged! Long before the first kiss. Even suspicions..."I may have contracted...etc." Maybe a comprehensive test should be required...but it would be hard to enforce in a timely fashion--e.g., after several drinks by the maybe unwitting soon-to--be participators, sober or not, who may or may not be aware of what they are doing...

  • Granville

    1 year ago

    Actually, it IS a crime to knowingly pass on a disease

    It is just that most STD's are curable and AIDS isn't.

  • dzen

    1 year ago

    "You never know when's the

    "You never know when's the right time to disclose," said Jason Black, a 25-year-old who's living with HIV.

    Actually, it's pretty easy to figure out the right time to disclose. I'll insert it into the leader story for Jason's benefit.

    On one hot summer day, you meet the man of your dreams on a grass field while both you and the man's children are playing soccer. You go on a first date with him. And then another. Eventually, you fall in love with him. But you haven't told him you're HIV-positive. And pretty soon, [AFTER TELLING THEM YOU ARE HIV+,] you're having sex with him -- mostly protected. Finally, one day, you muster up the courage to tell him that you're HIV-positive.

    There's no excuse for knowingly exposing someone to a lifelong, often severely debilitating chronic illness. Whether or not it's a death sentence is irrelevant; it's a health violation just as much as injecting children with live polio and saying it's the vaccine.

  • Granville

    1 year ago

    Tanks Dzen: it is nice to know that sanity persists

    The right time to disclose is before you have sex with a new partner. Any other interpretation is just a bunch of waffle. Mother never said life was going to be easy.

    By the way, the part of the story that is missing is how the protagonist contracted the virus. That would be interesting to know. Was she a sex trade worker, a drug taker or was she given the disease by an irresponsible AIDS victim?

  • cityzen

    1 year ago

    Fear is the mind-killer

    Thanks, Stephanie and Tyee, for a comprehensive article on this subject. As can be seen in some of the moronic comments posted, irrationality still rules. HIV-stigma and discrimation won't end unless people get educated (and this article is a good start). Law should be rational and based on fact, not based in unfounded fear. Since facts now seem to say that medically-treated HIV+ people are non-infectious, then the law should be swiftly changed to match the reality, otherwise the law is discriminatory. The law is only correct in prosecuting those who choose to willfully spread HIV and not access treatment. I agree that the media is largely to blame for inflaming ignorant opinion about HIV; but then, most journalists aren't medical experts, and thrive on hype, scandal, info-tainment. The supposed "issue" about expensive medical treatment costs to society ignores one obvious fact: if HIV+ people all received treatment, then new infections would cease, the spread of the disease would cease, and only those still affected would require medication. It would be ideal that HIV testing should be mandatory and regular for everyone to wipe out the disease (and I understand that all routine blood tests may soon include an HIV test); but our country isn't a complete dictatorship yet, people still have the freedom to avoid needles and be careless, and society must collectively bear the price of that freedom.

  • Palinurus

    1 year ago

    Not exactly sure if Cityzen's

    Not exactly sure if Cityzen's comments beginning "The supposed "issue" about expensive medical treatment costs to society ignores one obvious fact..." pertains to my inquiries - however i was not asking about the costs to society, but rather, if all provinces and territories made the "one pill" treatment available to those who need it, at a cost that they can afford.

    I referred to a recent Globe and Mail article that found wide and deep disparities among the provinces in the cost of medications to patients with various types of cancer rheumatoid arthritis, to the point where a person who lived in Quebec would pay about $1,800 a year but a resident of New Brunswick or PEI would be required to pay $20,000 per year for the same medications.

    My point being: if the "one pill" treatment referred to the Tyee article is not readily and easily available across Canada, it weakens the Court argument that the current law should be changed in view of new developments in AIDS medications.

    I simply posed the question and still look forward to the answer. Online searches have not produced the answer but surely there must be people who know.

  • Palinurus

    1 year ago

    a sentence in the second

    a sentence in the second paragraph above should read...

    "various types of cancer and rheumatoid arthritis...."

  • wcullen

    1 year ago

    Palinurus--sorry, this had to be posted in two parts...

    The 'one pill' options (plural), as I mentioned previously, are available to patients because they have been approved by Health Canada. But it is more complicated than simply this, and although I have some knowledge here, I'm no expert.

    I think part of the confusion you seem to be having may stem from being unaware of the medical complexity that is actually involved--forgive me if I'm mistaken in this.

    These are simply one or two observations:

    First, any drug approved by Health Canada is a drug available to patients via prescription by the health care professional (usually, but not always, the doctor).

    Second, the question of funding varies province to province because of the structure of funding, how that funding is allocated in the province (i.e. via 'transfer funds'); however this is complicated by the fact that who determines the scope of a drugs prescription is/can be a shared responsibility. In other words, the scope of prescription for some drugs is set by the federal authorities, but, the difference could be off-set, by decision, of the provincial authorities. Other drugs are simply left to the provincial authorities budgetary discretion. And, to make matters more confusing, this changing quite often due a very wide variety of factors (medical and non-medical).

    Third, although patients are, of course, informed and consulted in regards to which method of delivery they'd prefer, ultimately, this field of options is limited by the condition as it exists in each patients, and NOT simply by choice.

    To say this another way, for many patients the 'one pill' (i.e. Atripla) is not always an option, for many medical reasons.

    You may not be aware (which is why I provided the links previously), but drugs like Atripla are combinations of others drugs presented in one pill. Therefore, each of the ingredients (aka individual drugs) must be considered along with the potential side-effects, as well as other co-morbid conditions in the patients.

    Furthermore, tolerances to these drugs can change--as can a patient’s underlying medical conditions--over time, thus forcing a change of medication.

    On to Pt. 2...

  • wcullen

    1 year ago

    Pt. deux

    Finally, on top of all this, and to return to financial concerns, the percentage of what government--provincial and/or federal--covers is a matter of degree (there are lists of what is covered and to what percentage available on the Ministry of Health websites for all the provinces and the fed's); and, this, too, changes over time, and for a wide variety of reasons. Also, what coverage a person has outside of government supported will also impact the end-user (aka patient's) costs.

    Additionally, some provinces have been more proactive in regards to public health concerns and approaches to funding drugs for certain conditions that represent what that province has individually identified as being beyond the scope of simply medical concerns (public health is broader than medical in this sense).

    For example, here in BC we have the incredible folks at the IDC clinic at St. Paul's (and, for example, satellite supports like the Dr. Peter Ctr). BC is, simply put, much more pro-active regarding HIV/AIDS. Here it is a public health issue broader in scope than, I believe, any other province. For many patients in BC HIV/AIDS drugs are funded 100%, and are funded outside of the scope of both the federal and provincial health authorities.

    St.Paul's hospital/community has opted--along with other partners public and private--to cover funding virtually independent of the BC Ministry of Health because they do not agree with the bureaucratic meat-grinder patients had to/have to go through to receive full-subsidy. This isn't simply a political or ideological decision, rather an evidence-based medical/public health decision (as discussed in the article vis-a-vis compliance and criminalization).

    Sometimes, in situations like this the provincial authorities will not support funding at all, but will allow the institutions to allocate the funding as they see fit (again, evidence-based); sometimes the provincial authorities will fund, but stay at arms-length; sometimes they will be outright antagonistic and it becomes a battle; and, sometimes, the province is on board, but it is the fed's who are antagonistic (i.e. Insite).

    Hope this helps, but I would suggest doing your own research into this through--as a starting point--some of the links I provided previously: they're an excellent starting point.

    Cheers.

  • Palinurus

    1 year ago

    Complexity with clarity.

    Complexity with clarity. Thanks.

  • judycross

    1 year ago

    One of the best examinations of the whole issue

    was done by Canadian film maker Brent Young.
    House of Numbers
    http://www.youtube.com/watch?v=_p-ttLfkZHQ

    "Born in 1980 (on the cusp of the epidemic), Leung reveals a research establishment in disarray, and health policy gone tragically off course. Gaining access to a remarkable array of the most prominent and influential figures in the field -- among them the co-discoverers of HIV, presidential advisors, Nobel laureates, and the Executive Director of UNAIDS, as well as survivors and activists -- his restrained approach yields surprising revelations and stunning contradictions.

    The HIV/AIDS story is being rewritten, and this is the first film to present the uncensored POVs of virtually all the major players -- in their own settings, in their own words. It rocks the foundation upon which all conventional wisdom regarding HIV/AIDS is based. If, as South African health advocate Pephsile Maseko remarks, "this is the beginning of a war...a war to reclaim our health," then House of Numbers could well be the opening salvo in the battle to bring sanity and clarity to an epidemic clearly gone away."

  • wcullen

    1 year ago

    More Unsubstantiated Claims and Conspiracy Theory--Pt. I

    I don't know who this 'judycross' is, but it has become evidently clear that 'her' position comes not from ignorance of the topic, rather 'she' is one of those most reprehensible and unethical of folks: the HIV/AIDS denialists.

    As I've stated earlier, to hold such unsound and re-soundly debunked positions as HIV/AIDS denliaist do is absolutely unethical, and I question the editors of the Tyee for even allowing this (for reasons I've stated previously).

    This mock-umentary is a joke except for those who have clear ulterior agendas and who are abysmally ignorant of both reason and science.

    As stated earlier: there are absolutely NO reputable organizations, scientists, or medical professionals who deny the connection between HIV and AIDS (for direct links, see my previous posts).

    The evidence demonstrating--unequivocally--that HIV causes AIDS has been long established and has survived both peer-review, scrutiny, and replication. Furthermore, the basis of this knowledge has directly contributed to the advancement of treatments regarding this disease.

    These low-life denialists have contributed nothing; they have been absolutely incapable of substantiating their claims; and, their claims have been resoundly debunked. The only thing they have contributed to is the continued marginalization and discrimination of those suffering with the disease, as well as to the willful ignorance that--in places like Africa--allows the disease to continue to spread when it need not.

    Here are some reviews regarding the propagnada that is "House of Numbers":

    Jeanette Cosoulis of the NYT: "Couched as a “personal journey” through the history of H.I.V. and AIDS, “House of Numbers” is actually a weaselly support pamphlet for AIDS denialists. Trafficking in irresponsible inferences and unsupported conclusions, the filmmaker Brent Leung offers himself as suave docent through a globe-trotting pseudo-investigation that should raise the hackles of anyone with even a glancing knowledge of the basic rules of reasoning."

  • wcullen

    1 year ago

    More Unsubstantiated Claims and Conspiracy Theory--Pt. II

    More importantly, Leung has been caught red-handed editing interviews to make his spurious claims seem to have the support of actual scientists and researchers.

    Two professors in the mock-umentary, Niel Constantine and Robin Weiss, are interviewed here demonstrating Leung's under-handed approach: http://www.aidstruth.org/features/2009/constantine-and-weiss

    As Jeanne Bergman noted: "Leung is an HIV denialist—he has said he is “neutral” on the issue of HIV/AIDS, which means he rejects the evidence-based science that has conclusively proved the existence of HIV and its causative role in AIDS, a fatal disease syndrome. His film is supported and promoted only by denialists" (http://www.aidstruth.org/features/2009/real-answers-fake-questions-%E2%80%9Chouse-numbers%E2%80%9D).

    Ben Goldacre, of the website 'Bad Science' presents an excellent discussion of the problems and the dangers denialists represent in such willful misrepresentations: http://www.badscience.net/2009/09/house-of-numbers/

    Leung and the likes of this poster here are nothing more than callous, ignorant, conspiracy theorists. The Wall Street Journal also did a recent expose on conspiracy theorists here: http://online.wsj.com/article/SB10001424052748704238104574602042125998498.html

  • wcullen

    1 year ago

    To the Editors of the Tyee (who seem to be asleep at the wheel)

    One final note to the editors of the Tyee: in the previous post I added a word of caution regarding the difference between presenting opposing opinions and/or balance in a genuine way versus the veneer of balance that amounts to little more than support for these people. It is in YOUR best interest to realize that such posters as 'judycross' should not be given a stage.

    There is no more balance here than there is in giving stage to a holocaust denier.

    As Ben Goldacre notes at the end of his article: "Do you give idiots a wider audience when you respond to them? Are they marginal and irrelevant? I’d like to believe that they are. But the duping of Caspar Melville (who has since recanted from his uncritical response to the film, albeit only on his blog), and the attention-seeking smugness of Cambridge film festival in putting on such a moronic film, both suggest otherwise."

  • judycross

    1 year ago

    To wcullen

    Attempts at censorship are usually the result of fear of exposure and calling people who try to present facts for examination "deniers" can be a clue that the topic needs examination.

    Whether discussing climate or HIV, we are discussing a question of science. If by decree, neither subject may be examined,then it is not a scientific topic we are being prevented from examining, but dogma.

  • sservant

    1 year ago

    It's a no brainer

    Honestly, I cannot believe some people. I have HSV2 (aka genital herpes) and I would never, ever, EVER sleep with someone without telling them first. Moreover, because HSV2 is on par in many people's minds with HIV, I don't even bother to date people who don't have HSV2. It's just too problematic. It's true that it severely limits the number of partners available to me (even though 23% of women and 11% of men have HSV2, about 80% of them don't know - because you have to pay for a $200 blood test out of pocket to confirm it - so the "aware" pool of partners is pretty small). But life presents us with all sorts of challenges. In the overall scheme of things, this is pretty minor. I'm not dying of starvation in Darfur, after all.

  • wcullen

    1 year ago

    To 'judycross'--hyperbole abounds

    There is a difference--one would think a rather obvious difference--between allowing for dialogue and dissent, and allowing any quack with an ulterior agenda to have a stage to continue to perpetrate not only unsubstantiated claims, but claims that have been resoundly debunked like those of the folks you've been listing (simply do some actual research).

    Secondly, once such unsound and refuted claims continue to be spread it no longer becomes open discourse or dissent, rather malicious misinformation.

    You, of course, have absolutely NO interest in either science or inquiry; I'd go one step further and say that your knowledge of the topic, the research, how to research, science, and medical science are basically non-existent.

    Simply put: you're either incredibly naive and ignorant in this regard, or--sadly, more likely--you're simply a callous and close-minded propagandist.

    The connection between HIV as the cause for AIDS has been soundly researched and confirmed (no, not everything is known, but that's simply ignorance of how research works). Equally so, the arguments presented by HIV/AIDS deniers has been thoroughly investigated and found to be unsound, fallacious, and/or non-reproducible (for good reason).

    The irony here is that had you even bothered to read the NYT article on conspiracy theorists (as I hope anyone reading this will do to confirm), your 'methods' of approach here--hiding behind words; smoke and mirrors, without providing either clear statements, or sound criticisms or rebuttals (and let's not even get into the ridiculousness of your presenting that mock-umentary as "presenting facts"--LOL)--are exactly hose listed as common approaches of the conspiracy theorists.

    More to the point, people like you represent the lowest, most callous form of ignorance there is. You're NOT participating in honest inquiry; you're parroting the nonsense of debunked fools and liars, and, worse, trying to present yourself as a 'voice in the wilderness' dissent...you're a moral and intellectual coward.

  • Granville

    1 year ago

    Hi Judy Cross: I think you are nuts too. HIV causes AIDS

    There IS no debate. I wonder what some people have for brains. Mind you, I worked in the medical diagnostic field for 20 years. Not everyone has that perspective. The only questions are the false positive tests, the false nagative tests and the timing of the tests vs. antibody producton.

    If HIV doesn't cause AIDS, don't tell that to Abbott Labs; they made $80 billion on their terchnology.

    I remember the early days of this dreaded disease, when hospital labs were refusing to do bloodwork on people with AIDS, and the cause really was unknown. The logic as that if no one knew the cause, whole batteries of lab equipment may have had to scrapped to prevent it from spreadng. Not to mention the justified fear of the labs techs who have to work with unknown blood samples every day of their lives.

    Today, every biological sample has to be treated as if t is HIV-positive, at a cost of billions of dollars to the healthcare industry. AIDS has changed the entire delivery of healthcare.

    Remember that one of the ways it arrived in North America was from unscreened blood from African villages, collected by private for-profit hit-and-run clinics. It turns out that the cheap blood was more expensive than anyone could have possibly imagined.

    AIDS is the new tertiary syphilis.

  • Granville

    1 year ago

    Hi Judy Cross: I think you are nuts too. HIV causes AIDS

    There IS no debate. I wonder what some people have for brains. Mind you, I worked in the medical diagnostic field for 20 years. Not everyone has that perspective. The only questions are the false positive tests, the false nagative tests and the timing of the tests vs. antibody producton.

    If HIV doesn't cause AIDS, don't tell that to Abbott Labs; they made $80 billion on their terchnology.

    I remember the early days of this dreaded disease, when hospital labs were refusing to do bloodwork on people with AIDS, and the cause really was unknown. The logic as that if no one knew the cause, whole batteries of lab equipment may have had to scrapped to prevent it from spreadng. Not to mention the justified fear of the labs techs who have to work with unknown blood samples every day of their lives.

    Today, every biological sample has to be treated as if t is HIV-positive, at a cost of billions of dollars to the healthcare industry. AIDS has changed the entire delivery of healthcare.

    Remember that one of the ways it arrived in North America was from unscreened blood from African villages, collected by private for-profit hit-and-run clinics. It turns out that the cheap blood was more expensive than anyone could have possibly imagined.

    AIDS is the new tertiary syphilis.

  • Granville

    1 year ago

    And on the lighter side; the other side of the coin is...

    ...those people who can't stop talking about their past sex lives. I had one g/f who was always mentiuoning, in little dribs and drabs, the fact that she had had "hundreds" of men in her past. A close friend had the same issue with one of his g/f's. In the end, we both ditched the women in question and moved on.

    I read an Ann Landers-type letter from a guy whose g/f did the same thing, slowly filling him in on the time she and two friends entertained a whole football team in a hot tub.

    I am not making this up, or trying to be salacious. I am just curious; is this a common problem, and if so, what are these women saying to their current partner?

    Do men talk about their past g/f's to their current partner? If so I have never heard of it, but I am not in a position to judge.

    What does it men when women release the details of their previous sex lives to their partners as if it were important? I have often pondered that. Anyone care to comment?

    • The discussion for this story is closed. No more comments can be added.