Reckless transmission of HIV will be vigorously prosecuted in future, the
Crown Prosecution Service (CPS) has warned.
Dr Matthew Weait, a law lecturer from Keele University, told a meeting of
the All Party Parliamentary Group on Aids (APPGA) that the CPS has now changed
its policy and this could lead to more prosecutions.
Rene Barclay, director of services casework at the CPS, was reported as saying
that the Mohammed Dica case was “a groundbreaking prosecution”
and “the implications are that in future people who are reckless will
be vigorously prosecuted.”
The news follows three prosecutions in England over the last two years for
passing on HIV.
Rhon Reynolds of the African HIV Policy Network, said the law was being used
in a discriminatory way and all prosecutions so far had been against African
asylum seekers.
Meanwhile HIV doctors are said to be worried about breaches of medical confidentiality
because they could be forced to appear as witnesses. This may prevent people
coming to clinics for testing and treatments.
The British HIV Association and British Association for Sexual Health are
drawing up guidelines for doctors on HIV prosecutions in an attempt to avert
another public health crisis.
Dr Weait told the meeting that so far prosecutions have been made under Section
20 of the archaic 1861 Offences against the Persons Act whereby awareness
of the risk of causing serious bodily harm has to be proved.
In 1998 the Home Office announced that only intentional transmission of HIV
would be a criminal offence but now the CPS is saying that reckless transmission
will also be prosecuted.
Policing the bedrooms of people with HIV is now becoming a major issue and
there is growing confusion about what people can or cannot do within the law.
Chris Morley, of the George House Trust said that as the law stands: “If
you don't know you're HIV positive, you can't be prosecuted. This could lead
to less HIV testing, more unprotected sex and higher risk of transmission
of the virus.
“Criminalising HIV also increases the stigma and discrimination against
people living with HIV,” he said. “And it puts the whole legal
responsibility onto HIV positive people. Safer sex is a joint responsibility
but the law creates the unrealistic expectation that all HIV positive people
will disclose their status.”
Morley said there is no evidence from Europe that using criminal law reduces
HIV transmission but early testing, treatment and support has been shown to
reduce the number of new cases.
“It's better to stick with what we know works than criminalise HIV,”
Morley added.
But there is no agreement in the HIV sector about how to proceed. Some believe
that deliberate transmission should be a crime, some believe lying should
be a crime and others believe that the police should stay out of the bedroom
and backroom completely.
Neil Gerrard MP, chair of the APPGA, said that any change in the law may make
matters worse for people with HIV, not better.
“And once any new bill gets to parliament, God knows where it will go,”
he warned.
Top HIV doctors are pressing the Department of Health (DH) for more cash for
HIV treatment and care in the face of increasing number of patients and the
high costs of retroviral drugs.
The crisis came to a head as many hospitals and primary care trusts (PCTs)
started negotiating with DH commissioners over next year's budgets.
There are now more than 50,000 people living with HIV in Britain and 30,000
of them are estimated to be on anti-HIV treatments.
London is facing a £10 million hole in its HIV funding this financial
year while treating over 60 per cent of HIV positive people in the country.
The biggest HIV clinic in Europe, at the Chelsea and Westminster Hospital,
has seen patient numbers surge from 3,000 to over 4,000 in the last year without
any substantial increase in funding.
HIV medications are believed to cost between £10,000 and £15,000
per patient a year in the UK, depending on the combination, and doctors are
concerned they will be forced to restrict certain expensive drugs for budgetary
reasons.
Many doctors are coming up with innovative methods to reduce costs whilst
still giving an excellent service to HIV positive patients. One central London
clinic is buying HIV drugs in Europe at a 30 per cent lower rate that the
pharmacos sell them in the UK. Meanwhile others are sending drugs to patients
by courier to avoid paying VAT. Others are doing deals with drug companies
to buy in bulk for each region.
One HIV consultant in the North West told PN he came under pressure every
month from his hospital administrator to reduce his HIV drugs bill.
Expensive treatments which are not considered essential, such as 'New Fill'
face-filler for people with advanced lipoatrophy and acetyl carnitine supplements
for advanced peripheral neuropathy, are also expected to see cuts in the next
financial year.
A top north London HIV doctor told PN that his ward patients were now regularly
visited by NHS debt collectors.
Health Secretary Melanie Johnson said in January that failed asylum seekers
already on ARVs would not have them withdrawn and would still receive them
free of charge.
Across the capital PCTs and boroughs are making cutbacks. Some boroughs have
closed specialist HIV social service support services while others have withdrawn
free travel passes to disabled people living with the virus.
Kensington and Chelsea PCT recently told staff it was £10 million in
the red this year and is cutting its clinical nurse specialist service which
provides care and support at HIV charities and at peoples' homes. This is
despite the fact that the borough, Britain's richest, houses a vast transient
population and a record number of new HIV infections.
Meanwhile the 2004 survey of HIV and sexual health services in England, carried
out for THT, the British HIV Association and the National Association of Providers
of Aids Care and Treatment found that services are still under huge strain.
Gay and bisexual men are 50 times more likely to be diagnosed with HIV or
syphilis than heterosexual men, according to new figures published in the
journal Sexually Transmitted Infections.
Gonorrhoea remains the most common sexually transmitted infection (STI) diagnosed
in gay and bisexual men in England and Wales, followed by genital warts, HIV
and chlamydia. In London, HIV was the second most commonly diagnosed STI among
gay and bisexual men and there was an increased incidence of unprotected anal
sex with casual partners.
Investigators noted that though this increase in high risk behaviour coincided
with the introduction of HAART, they did not believe the availability of effective
anti-HIV treatment could explain changes in behaviour and called for further
research.
Evidence collected in the fifth Gay Men's Health Survey from 2001, further
illustrates ethnic differences in sexual risk-taking amongst gay men, and
helps to explain ethnic differences in the incidence and prevalence of HIV.
According to that survey, UK gay men of black Caribbean and African ethnicity
were more than twice as likely as gay white British men to be HIV positive.
Gay men of Asian ethnicity are, however, three times less likely to be positive. “HIV incidence is higher [among black men] because [they] are more likely
to be involved in sexual HIV exposure, especially while engaging in unprotected
anal intercourse,” the survey found.
This further suggests that sexual health promotion programmes aimed at men
who have sex with men, may be failing to address the needs of black, and particularly
African, men.
