Key HIV transmission study shows no risk to HIV-negative partner when person with HIV is on suppressive antiretroviral therapy

By Simon Collins, HIV i-Base

Tuesday 12 July 2016

Published to coincide with IAS 2016 conference that opens in Durban next week, the PARTNER study showing the impact of HIV treatment (ART) on reducing transmission will benefit millions of people globally.

The results set a new challenge about whether transmission is anything other than a theoretical risk when someone is taking effective ART. This reverses the common assumption that, by definition, some level of risk always exists when one partner is HIV positive.

The PARTNER study provides good evidence that undetectable viral load might be a threshold below which sexual HIV transmission does not occur. The importance of the PARTNER study is that it included both gay and straight couples, that it measured risk in people who were not using condoms and that it estimated absolute risks.

Previous studies have been almost exclusively in heterosexual people who still reported high rates of condom use. The PARTNER study provides more than three times the amount of follow-up time from people not using condoms than all the previous studies combined. This includes 500 couple-years of follow up from people having anal sex without condoms.

Methods

Between September 2010 and May 2014 the PARTNER study prospectively enrolled 1166 serodifferent couples at 75 clinical sites in 14 European countries. Entry criteria included that the positive partner had an undetectable viral load on ART and that the couple were not always using condoms when they had sex.

Follow-up included routine sexual health checks (including HIV testing for the negative partners) and each participant also completed sexual history questionnaires to look at risk for different activities. Couples were only included in the final analysis when the most recent viral load for the positive partners was undetectable – defined as <200 copies/mL. The primary endpoint was the rate of within-partner transmissions, determined by phylogenetic analyses for all couples in which the negative partner became positive.

Results

Of 1166 couples enrolled, 1004 couples had at least one follow-up visit and 888 couples provided 1238 couple years of follow-up (median 1.3 years (IQR 0.8 to 2.0) per couple. This included 548 heterosexual (HT) couples and 340 gay male couples. The main reasons for data not being included in the follow-up analysis was: not yet reaching first follow-up visit (n=162), lack of HIV test (n=20), use of PEP or PrEP (n=9), no condomless sex (n=15), viral load >200 copies/mL (n=55) and lack of viral load result (n=17). There were no significant differences between couples who contributed to follow-up data compared to those who didn’t.

Although 11 people became HIV positive, none of these infections were phylogenetically linked transmissions. This was after at least 58,000 distinct times when couples had penetrative sex without condoms.

Baseline demographics were reported – as with all results – by categories of HIV status, gender and sexuality, with some differences between groups. This makes summarising results complex, but the median age ranged from 40 to 44 (with IQR overall ranging from 31 to 50 years). Gay men and HT women were a few years younger than HT men. Approximately 80% of the HT men were white compared to 70% of women and 90% of gay men. A higher percentage of gay men had education to college/university or higher (approximately 50% compared to 19% to 35% for heterosexuals. Although some of these differences were significant, other than there were fewer very young adults involved, they reflect the diversity of people living with HIV.

HIV positive partners had been on ART for a median of 10.6 (IQR: 4.3 to 15.6), 7.5 (IQR: 3.3 to 14.2) and 4.8 (IQR: 1.9 to 11.4) years, for HT men, HT women and gay men respectively. At baseline, couples reported having had sex without condoms for a median of 2 years (IQR 0.5 to 6.3), with differences between groups. For example, straight couples had been having sex without condoms for roughly 3 years (IQR 0.7 to 11 years) compared to 1.5 years (IQR 0.5 to 4 years) for gay couples. Approximately 23% of couples were in new/recent relationships (<6 months). Self-reported adherence to ART was similarly high at >90% in the three positive groups.  Similar proportions of each group also had CD4 counts >350 cells/mm3 (85% to 91%).

Based on data from the negative partners, overall, couples reported having sex without condoms a median of 37 times a year (IQR 15 to 71), with gay couples (median 41; IQR 17 to 75) reporting condomless sex at least 22,000 times and heterosexual couples (median 35; IQR 13 to 70) more than 36,000 times. These were rough estimates from recall and partners did not always report the same numbers. Some couples reported sex outside the main relationship: 108 gay couples (33%) and 34 heterosexual couples (4%).

None of the 11 incident HIV infections in negative partners (ten gay and one heterosexual) were phylogenetically linked to the positive partner. Most people (8/11) reported having sex without condoms with people outside the main relationship. All samples (n=22) were successfully sequenced for pol and 91% (n=20) were sequenced for env. None of the partner sequences clustered together and the results were consistent after using using several different analyses. Additional details for these analyses are described in the online supplementary material. [2]

With zero transmissions, the upper limit of the 95% confidence interval (95%CI) for the overall study was 0.3 per 100 couple years of follow up (CYFU). Each category of specific risks, given that the calculations are a factor determined by study numbers and power, had different upper 95%CI boundaries: for example, 0.88 for HT sex overall vs 0.84 for gay sex overall.

This means that the upper 95%CI for receptive anal sex for gay men (2.70 with ejaculation and 1.68 without ejaculation) needs to be interpreted as a factor of sample size: there were fewer CYFU so the upper limit is by definition higher. While this calculation is developed to define the potential range within which the true risk might lie, the 95%CI should not be interpreted as indicating a risk that has been observed in the study. To illustrate this difficulty, the higher estimated risk for heterosexual anal sex with upper 95%CI of 12.71 and 8.14 (with and without ejaculation, respectively) are driven by fewer CYFU with this as the primary risk rather than any biological reason for this to be much higher. Of note though, more than 20% of straight couples reported anal sex.

The ongoing PARTNER 2 study continues to follow up gay couples in the PARTNER study and to recruit additional gay couples, in order to produce a similarly powered evidence base for gay mean as for straight couples, with follow up until 2019. [2]

Also of note during the study, 91 HIV positive partners reported other STIs (n=16 HT men, 16 HT women and 59 gay men) – closely matching STIs in the negative partners, also without any increased risk reported for HIV transmission.

An non-technical i-Base Q&A on these results is also online. [3]

An extension of the PARTNER study is continuing to collect further data on risk for gay men. [4]

Simon Collins is a community representative on the steering committee of the PARTNER study.

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These results are simple to understand – zero transmissions from over 58,000 individual times that people had sex without condoms. They are also notable for the complexity of the analysis that was needed to prove that none of the new diagnoses were linked transmissions from within the couple.

Together, this provides the strongest estimate of actual risk of HIV transmission when an HIV positive person has undetectable viral load – and that this risk is effectively zero. While no study cannot exclude the possibility that the true risk might lie within the upper limit of the 95%CI, even if the true value is actually zero due to some as yet unproven mechanism, the 95%CI can never be zero, just becomes increasingly close. Neither the presence of STIs nor likely viral load blips between tests had any impact in enabling transmission.

The results provide a dataset to question whether transmission with an undetectable viral load is actually possible. They should help normalise HIV and challenge stigma and discrimination.

The results challenge criminalisation laws that in many countries, including the United States, continue to imprison hundreds of people based on assumptions of risk that these results disprove, even when condoms are used and viral load is undetectable.

Activist Sean Strub, from the SERO project (www.seroproject.com) said:

“Hundreds of people living with HIV in the US have been charged with criminal offences for the perceived or potential risk of HIV exposure or transmission. Some are serving or have served long prison sentences for spitting, scratching or biting and others for not being able to prove they had disclosed their HIV positive status before having sexual contact (even in the absence of any risk of HIV transmission). HIV criminalisation has created a viral underclass in the law, further burdening a disenfranchised community, putting a disproportionate share of the shared responsibility for preventing sexually-transmitted infections on one party, and discouraging people at risk from getting tested for HIV.”

The results will also positively impact on the quality of life for both HIV positive and HIV negative individuals who are in serodifferent relationships, irrespective of the choice to use condoms.

The ongoing PARTNER 2 study is continuing to follow-up gay couples and is still enrolling new couples to achieve a similar statistical power for anal sex compared to vaginal sex. For further details of sites please see the PARTNER2 website. [3]

Reference

  1. Rodger AJ et al for the PARTNER study group. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA, 2016;316(2):1-11. DOI: 10.1001/jama.2016.5148. (12 July 2016). Full free access.

    http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2016.5148

  2. PARTNER study, supplementary material. JAMA (16 July 2016).
  3. i-Base Q&A from the study.

    http://i-base.info/qa-on-the-partner-study/

  4. PARTNER2 website.

    http://www.chip.dk/PARTNER-2

Canada: Activist Christian Hui on why HIV criminalisation harms us all

US: Democratic Party pledges to "address HIV criminalization laws" in its 2016 draft party platform

Democratic Party Comes Out Strong for LGBTQ Equality in 2016 Party Platform

HRC Blog by post by Stephen Peters

Today, the Democratic Party released its draft 2016 party platform, including key provisions that focus on improving the lives of LGBTQ people and advocating for full equality.

“This is the most LGBTQ-inclusive platform of any major U.S. party,” said JoDee Winterhof, HRC’s Senior Vice President for Policy and Political Affairs. “We will continue to work with the Democratic Party to ensure the most robust platform for LGBTQ Americans. From protecting LGBTQ young people to ending the epidemic of violence against transgender people to passing an explicit and comprehensive federal non-discrimination law to bringing about an AIDS-free generation, the platform addresses many of the major challenges facing our community today.”

Here are some of the highlights:

LGBT Rights

Democrats applaud last year’s decision by the Supreme Court that recognized LGBT people— like every other American—have the right to marry the person they love. But there is still much work to be done. LGBT kids continue to be bullied at school, a restaurant can refuse to serve a transgender person, and a same-sex couple is at risk of being evicted from their home. That is unacceptable and must change. Democrats will fight for comprehensive federal non- discrimination protections for all LGBT Americans and push back against state efforts to discriminate against LGBT individuals. We will combat LGBT youth homelessness and improve school climates, and we will protect transgender individuals from violence. We will promote LGBT human rights and ensure America’s foreign policy is inclusive of LGBT people around the world.

Civil Rights

Democrats will always fight to end discrimination on the basis of race, ethnicity, national origin, language, religion, gender, sexual orientation, gender identity, or disability. We need to promote civility and speak out against bigotry and other forms of intolerance that have entered our political discourse. It is unacceptable to target, defame, or exclude anyone because of their religion, race, ethnicity, national origin, or sexual orientation.

HIV and AIDS

Democrats believe an AIDS-free generation is within our grasp. But we know far too many Americans still suffer, which is why we will implement the National HIV and AIDS Strategy, increase research funding for the National Institutes of Health, cap pharmaceutical expenses for people living with HIV and AIDS, address HIV criminalization laws, and expand access for HIV prevention medications, particularly for the populations most at risk of infection. Abroad, we will make the President’s Emergency Plan for AIDS Relief more effective and increase global funding for HIV and AIDS prevention and treatment. Democrats will always protect those living with HIV and AIDS from stigma and discrimination.

Supporting our Troops

[…]Democrats welcome and honor all Americans who want to serve and will continue to fight for their equal rights and recognition. We are proud of the repeal of Don’t Ask, Don’t Tell and the opening of combat positions to women. Our military is strongest when people of all races, religions, sexual orientations, and gender identities are honored for their service to our country.

Racial Justice

Democrats will fight to end institutional and systemic racism in our society. We will challenge and dismantle the structures that define lasting racial, economic, political, and social inequity. Democrats will promote racial justice through fair, just, and equitable governing of all institutions serving the public and in the formation of public policy. We will push for a societal transformation to make it clear that black lives matter and there is no place for racism in our country.

Gun Violence Prevention

With 33,000 Americans dying every year, Democrats believe that we must finally take sensible action to address gun violence. While gun ownership is part of the fabric of many communities, too many families in America have suffered from gun violence. We can respect the rights of responsible gun owners while keeping our communities safe. We will expand background checks and close dangerous loopholes in our current laws, hold irresponsible dealers and manufacturers accountable, keep weapons of war—such as assault weapons—off our streets, and ensure guns do not fall into the hands of terrorists, domestic abusers, other violent criminals, and those with severe mental health issues.

Canada: Activists challenge Ontario's Premier to intervene in unjust prosecutions

Banner drop! Stop criminalizing people living with HIV!

Posted on July 3, 2016 by AAN

STOP THE WITCH-HUNT:

Activists drop banner with message to Ontario Premier

during Toronto Pride parade

TORONTO, July 3, 2016 —This afternoon, as the Ontario Premier marched in the country’s largest Pride parade, AIDS ACTION NOW! (www.aidsactionnow.org) dropped a huge banner overlooking Yonge Street, calling on Kathleen Wynne to “stop criminalizing people with HIV.”

Ontario continues to lead Canadian provinces in charges against people living with HIV for not disclosing their status, even when they have taken precautions to protect their partners, when there is little to no risk of transmission, and when no transmission has taken place. People are being prosecuted for aggravated sexual assault, one of the most serious charges under the Criminal Code. Conviction carries a maximum penalty of life imprisonment and a mandatory designation as a sex offender for a minimum of 20 years. Analysis of prosecutions shows a disproportionate number of charges against racialized people and a growing number against vulnerable women.

Overly broad criminalization is not only unjust, it also undermines public health. Fear of being criminalized discourages people from testing for HIV or seeking counselling. Fear of prosecution also makes it more difficult for people to disclose their status. This can contribute to the spread of HIV. Two years ago, nearly 80 of Canada’s leading HIV scientists issued a ground-breaking consensus statement reviewing the scientific evidence about HIV transmission risk and expressing their concern about the increasing divergence between that science and the overly broad use of the criminal law.

In 2010, Ontario’s then-Attorney General Chris Bentley committed to developing guidelines to limit such prosecutions. Six years later, his Ministry still refuses to develop guidelines to this effect. Meanwhile, Crown attorneys in Ontario continue to pursue such cases and even seek to expand the circumstances in which people can be convicted. This is not in the public interest.

We call on Premier Wynne to intervene. Her Attorney General must instruct Crown attorneys to respect scientific evidence about HIV transmission and stop unnecessary, unjust prosecutions which undermine public health efforts to control the spread of HIV.

– 30 –

For further information:

▪ AIDS ACTION NOW!: Darien Taylor (Sunday, July 3, only), 416-516-3147

▪ For legal background: Richard Elliott, Canadian HIV/AIDS Legal Network, 416 898 3313

▪ For a timeline on efforts to engage the Ministry of the Attorney General: www.clhe.ca

Webinar: HIV Criminalization Attitudes and Opinions of the American Public (Sero, 2016)

Presenters: Sean Strub and Dr. Rosita Thomas

Canada: In Nova Scotia, glimmers of hope for science in the prosecution of HIV non-disclosure

Analysis by our HIV JUSTICE WORLDWIDE partner, the Canadian HIV/AIDS Legal Network.

Despite very few prosecutions, Nova Scotia has become an interesting place in Canada with respect to the criminalisation of HIV non-disclosure.

In April 2016, a trial judge from Antigonish ruled that non-disclosure before vaginal sex with a condom or a low viral load (< 1,500 copies/ml) did not amount to aggravated sexual assault.

Back in November 2013, a trial judge from Halifax acquitted a young man with an undetectable viral load who had not disclosed his HIV-positive status before sex without a condom.

These decisions represent significant developments in Canada, where the Supreme Court’s 2012 decision in R. v. Mabior opened the door to prosecutions even if a condom was used or the HIV-positive partner had a low or undetectable viral load.

Thanks to Nova Scotia judges, science might finally prevail.

In the recent Antigonish case, three medical experts testified, all aligning themselves with the Canadian consensus statement on HIV and its transmission in the context of the criminal law that was developed by eminent HIV experts in response to the 2012 Supreme Court decision.

They clearly testified that condoms are highly effective to prevent transmission (“protection is almost 100% when a condom is used,” said the Crown medical expert) and that being on treatment and having a low viral load dramatically reduce the chance of transmitting the virus.

Remarkably, they were also testimonies that the risk of HIV transmission in the absence of ejaculation is at most “negligible” and that HIV transmission from pre-ejaculate, if even possible, is not proven (there was no ejaculation with the first complainant and a reasonable doubt about ejaculation with the second complainant).

Based on the medical evidence before the Court, the trial judge concluded that the legal test of a “realistic possibility of HIV transmission” established in Mabior, which triggers the legal duty to disclose, had not been met. The accused was found not guilty of aggravated sexual assault.

Disappointingly, despite the absence of a “realistic possibility of HIV transmission,” the accused was nevertheless convicted of sexual assault causing bodily harm due to the psychological harm allegedly suffered by the complainants while waiting for their test results (neither of the complainants has contracted HIV).

Despite the progress made in acknowledging scientific evidence, this ultimate decision is highly problematic and arguably legally unfounded. It remains to be seen if the decision will be appealed.

The full decision can be downloaded from the Supreme Court of Novia Scotia’s website

Advocates fighting to end HIV criminalisation reach a global TV/web audience on The Stream

Last night, HIV criminalisation advocacy reached a global audience on both TV and the internet with The Stream, on Al Jazeera English.

During the 30 minute programme, HIV criminalisation survivor, and Sero advisory board member, Ken Pinkela appeared with co-hosts Malika Bilal and Omar Baddar in the Washington DC studio to discuss his case and the role HIV stigma played in his unjust prosecution and wrongful conviction.

He was joined via Skype by ARASA’s Executive Director, Michaela Clayton, who discussed the impact of HIV criminalisation on women in southern and eastern Africa.

Anand Grover, Senior Advocate at Supreme Court of India, founder of India’s Lawyers Collective, and a former UN Special Rappporteur on the Right to Health highlighted the many human rights concerns with a punitive approach to HIV prevention.

I was also on programme, highlighting the work of the HIV Justice Network and citing data from our recent report, Advancing HIV Justice 2.

Contributions were also seen from US HIV advocates Shawn Decker and Nina Martinez, and Colorado Senator Pat Steadman who worked with the Colorado Mod Squad to recently completely overhaul HIV criminalisation in Colorado.

Watch the entire programme below or on the The Stream’s website.

US: Second HIV is not a crime training academy creates an important intersectional shift in the US anti-HIV criminalisation movement

The second HIV Is Not a Crime Training Academy, which took place in May at the University of Alabama, Huntsville, brought together more than 300 advocates from 34 US states, as well delegations from Canada and Mexico.

Organised jointly by two of our HIV JUSTICE WORLDWIDE partners, the Sero Project and Positive Women’s Network–USA, the meeting was a unique opportunity for the people most affected by HIV criminalisation to take centre stage and have their voices be heard.

As Mark S King’s blog post highlighted in his blog and video produced the week following the meeting:

The intersections of race, gender, and sexuality were given as much weight as strategy sessions on working with legislators and lawyers, and the program repeatedly drove home the fact that criminalizing behaviors related to specific groups of people is as American as apple pie. Plenary speakers included advocates for women (including transgender women), current and former sex workers, immigration reform and drug legalization advocates, and, most powerfully, people who have been prosecuted under HIV criminalization statutes.

The theme of intersectionality and what it means for HIV criminalisation advocacy was further explored in this thoughtful analysis from Olivia Ford at The Body.com.

At the first HIV Is Not a Crime gathering in Grinnell, Iowa, in 2014, the sessions focused largely on unpacking the process of mounting a legislative campaign. Huntsville attendees also received training on important skills such as using data and collaborating with attorneys. The dominant theme, however, was the mandate to understand and combat HIV criminalization as a component of the system of over-policing and mass incarceration that disproportionately and unjustly impacts black people, queer folks, immigrants, drug users, sex workers, transgender individuals and those living with and without HIV at the intersections of this constellation of experiences.

The meeting was also an opportunity to celebrate the recent modernisation of Colorado’s HIV criminalisation statutes by the Colorado Mod Squad and their political allies, notably Senator Pat Steadman; and to hear from HIV criminalisation survivors and their families about what the HIV criminalisation – and the movement to end it – means for them personally.

The biggest political coup of the meeting was a welcome video from Hilary Clinton who said that if she wins the Presidential election, she will work to “reform outdated, stigmatising” HIV criminalisation laws.

Aside from those highlighted above, a number of other blog posts and articles have been produced since the meeting.  As well as a fantastic Storify compilation by PWN-USA of social media produced during the four days, these include pieces from:

In addition, the HIV Justice Network was there with our video advocacy consultant, Nicholas Feustel of georgetown media, capturing the entire event on video, and we will be releasing a film providing a detailed overview of the entire meeting, as well as lessons learned, in the next few weeks.

Australia: Northern Territory AIDS & Hepatitis Council calls on government to engage in community consultation before debating the proposed amendments to the Police Administration Act that forces HIV, Hepatitis B & C blood testing of offenders

NT Aids and Hepatitis Council says amendments to Police Administration Act could breach civil liberties

NT News

The Northern Territory Government’s controversial push to have the Police Administration Act amended to have forced blood tests on those who spit, bite or exchange blood with officers has come under fire.

The NT’s peak representative body for people with blood-borne diseases, Northern Territory AIDS & Hepatitis Council, said yesterday that the amendments were in breach of civil liberties and human rights.

They are calling for the government today to stop and consult.

Community member Sam Bowden said less invasive options than drawing blood against someone’s will needed to be investigated.

“It is possible to develop sound public health policy based on the available evidence, that protects the health and well being of police officers and their families, and which upholds the human rights of HIV key affected populations – but governments have to consult the community to get the balance right,” she said.

Other concerns for the group were the facts that it could unfairly target homeless and indigenous people as well as further create a stigma around those living with blood-borne diseases.

A public education stall run by NTAHC will be out the front of parliament tomorrow from 9am to 4pm.

A petition to call on the Government to consult with the community before debating the amendment in parliament can be found at change.org

Originally published in NT News

Australia: Zaburoni v Queen legal analysis

This analysis is by David Buchanan SC, Barrister at Forbes Chambers, Sydney. It was originally published in LGBT Law Notes and is republished here with his permission.

In a case that should reduce the extent of overcharging in HIV criminal cases, the High Court of Australia (Australia’s apex court) has emphasised the importance of distinguishing between reckless behaviour and behaviour involving intention to transmit HIV.

In Zaburoni v The Queen [2016] HCA 12, a man was sentenced to nine and a half years in prison for unlawfully transmitting a serious diseases with intent to do so.  The evidence was that Zaburoni frequently had unprotected sex with his girlfriend, knowing that he had HIV, and that he lied to her, and later to investigating police, about his status.  However, the offence required proof of actual intention.  The High Court held that, if the evidence had established Zaburoni’s awareness of the probability that his conduct would result in his girlfriend contracting HIV, it would have been open to the jury to infer that Zaburoni meant to bring about that result.  However, the evidence did not rise to that level.

The Court distinguished between intention, on the one hand, and desire or motive, noting that a person can intend a result without desiring it.  Thus a person can have the infection of their sex partner as a purpose of their conduct whilst regretting that consequence.  The plurality observed “(t)he complainant said the appellant preferred unprotected sexual intercourse because it was more pleasurable.  Accepting that the appellant engaged in unprotected sexual intercourse because it gave him pleasure is not necessarily inconsistent with proof that he also had the intention thereby of transmitting HIV to the complainant.   It is the identification of evidence from which the latter inference could be drawn to the criminal standard that is the issue in this appeal.”

Zaburoni had tested positive to HIV and been told he must use condoms for sex.  The evidence was that he understood that advice.  But when he took up a relationship with a woman he told her he had been tested for HIV and was not HIV positive.  He had unprotected intercourse with her, telling her that he found condomless sex more pleasurable.  The complainant suffered seroconversion illness.  Zaburoni told her his brother had died from AIDS.  When the woman asked Zaburoni whether he had HIV, he said he did not.

The relationship later broke down.  About a year afterwards, the woman was diagnosed with HIV/AIDS and when she tackled Zaburoni about it, he admitted he was infected and said he found out after they had broken up.  She asked why he had failed to tell her of his condition.  He replied that he had not wanted to make her unhappy and that he thought that she was having a good time.  He said that he had been told by the doctors that he had had HIV for two years.  A friend of the complainant asked Zaburoni why he had not told the complainant and he responded that “I didn’t want to ruin her life”.

Later, in both a conversation with the complainant monitored by police and in interviews with police, Zaburoni lied about when he knew he was infected and the extent of his unprotected sex with the complainant.  Later Zaburoni, who had migrated to Australia many years previously, admitted having submitted a blood sample from an uninfected friend in order to satisfy Immigration authorities that he did not have HIV.

Although there was evidence that, given the length of the relationship (21 months), the risk of the complainant contracting HIV were about 14 per cent, there was no evidence that Zaburoni knew what the statistical likelihood was of the transmission of HIV as the result of unprotected heterosexual sex.  The plurality said “To the extent that the inference of intent depends upon foresight of the risk of the sexual transmission of HIV, it is the appellant’s understanding, whether informed or otherwise, that is material.  There was ample evidence from which to find that the appellant was aware of the risk of transmitting HIV to the complainant through unprotected sexual intercourse.  Apart from the medical advice that the appellant was given by several doctors in 1998 after he learned of his HIV positive status, his lies to the complainant about that status before their sexual relationship commenced, and during the course of it, point to his awareness of the risk of sexual transmission.  So, too, do his lies to the police about the number of times they engaged in unprotected sexual intercourse.”

The plurality concluded that “(a) rational inference open on the evidence is that the appellant engaged in regular unprotected sexual intercourse with the complainant because it enhanced his sexual pleasure and he was reckless of the risk of transmitting HIV to her.   The existence of that inference lessens the force of reasoning to a conclusion that the appellant intended to transmit the disease from the fact of frequent unprotected sexual intercourse.   Apart from frequent unprotected sexual intercourse, there is no evidence to support the inference that the appellant had that intention.  And the evidence fell well short of proving that the appellant believed that it was virtually certain that he would pass on HIV by regular unprotected sexual intercourse.”   In particular, none of the lies proved that Zaburoni knew that it was virtually certain that he would infect his partner with HIV if he had unprotected sex with her.

Whilst Zaburoni’s conduct was described as a form of “callous deception”, what this meant (as another judge put it) was that the evidence left open “a reasonable hypothesis that the appellant, not knowing the degree of risk, was extremely reckless and also callous.  As appalling as his selfish recklessness was, it cannot be equated with a subjective, actual intent to transmit the HIV virus.  In the absence of evidence of malice or knowledge of the degree of risk, a subjective intent to inflict the HIV virus was not proven beyond reasonable doubt.”

The conviction for intentionally transmitting a serious disease was quashed and a verdict of guilty of unlawfully doing grievous bodily harm substituted.

The full High Court decision can be accessed here.

A number of news reports and other analyses of the Zaburoni case can be found here.