Spain: Ministry of Health plans national database of HIV-positive people

Update: 9th October 2008.

The Constitutional Court has rejected an appeal by several Spanish HIV organisations against the Ministry of Health, which will go ahead with establishing a national HIV database.

Spain to establish a HIV register
Oct 9, 2008
typicallyspanish.com

Spain is to set up a registry of people affected with the HIV virus. It comes as the Constitutional Court has rejected an appeal against the Ministry for Health plan presented by several different Non-Governmental associations.

The register will contain files which will hold the latest diagnostic data on those infected. The authorities say the registry will help them to keep control of the real situation of the spread of the virus in Spain, but objectors claim that the project does not guarantee the anonymity of the people included.

It’s understood the files will be labelled with a combination of initials and birthplace to identify each case. Across the European Union, only Italy has a similar registry in existence.

Spanish Health Ministry Announces Plan To Determine Number of HIV Cases by 2015
Thursday, September 13, 2007
Kaiser Network

The Spanish Ministry of Health recently announced a new plan to determine the number of people living with HIV in the country and reduce the spread of the virus by 2015, El Pais reports. The plan replaces an earlier one that expired in 2005 and was not renewed, reflecting what some nongovernmental organizations say is the government’s lack of dedication to addressing HIV/AIDS.

Some HIV/AIDS advocacy groups say the new plan does little to address the disease in the country. Cesida, the largest confederation of NGOs involved in fighting HIV/AIDS in Spain, said the new plan “cannot be considered a plan of action.” Some NGOs are complaining that the plan’s goals are vaguely worded and that the time frame is too long. NGOs also have said that the plan places too much emphasis on those who are already HIV-positive, rather than on the general public, to combat the spread of the virus. In addition, some NGOs have said that the plan singles out high-risk groups, such as injection drug users and commercial sex workers, and does not mention specifically heterosexual men, who are the primary transmitters of the virus in the country, El Pais reports.

The plan also will establish a national database of HIV-positive people. Although NGOs support the health ministry’s efforts to determine the number of people in Spain living with HIV, they are opposed to the national database and are concerned it could become public knowledge and lead to discrimination against people living with the virus, El Pais reports (Benito, El Pais, 9/12).

Zimbabwe: Blame, responsibility, impact of criminalisation on women analysed

Excellent opinion piece in the Zimbabwean newspaper, The Herald, which discusses blame and responsibility and the impact of criminalisation of HIV transmission on women.

 

Blame Game Won’t Change a Thing

The Herald (Harare)

Beatrice Tonhodzayi

4 October 2008She is young and very striking. That type of girl that would give most of my male colleagues’ ideas; if she ever looked their way. She is very pretty, what my male colleagues term the “typical African queen.”

However when you look deeply into her eyes, you can tell she is sad.

But what would make such a pretty and young lady sad?

Mutsa (not her real name) is living with HIV. It is not that knowledge however that is responsible for the sadness that surrounds her very being.

It is anger and a sense of betrayal.

Anger and betrayal, that she feels towards her former lover, a medical doctor, who she says infected her with HIV.

When Mutsa got in touch with me about her story, I felt very betrayed on her behalf.

There she was, going out with a medical doctor, someone who has all the knowledge about HIV transmission. This was the first man she had ever been with and he had the nerve to infect her with HIV, I felt.

But then, I began to wonder!

Did he even know that he was HIV positive?

Yes, he may have slept with other women before or besides Mutsa but this does not mean he knew his status and therefore willingly infected his girlfriend.

And why did Mutsa have unprotected sex with him when she did not know his status?

I am a woman; I champion the women’s cause as much as I can because I sincerely believe that life has not been very kind to woman-kind.

However, I am a journalist and must look at both sides of the coin. I must be objective.

There are many women who are living angry lives unnecessarily. They are filled with so much bitterness at the fact that their husbands and partners have infected them with HIV.

This anger in some cases, is so intense that it eats up one’s very passion for life.

They wish these men could just be thrown into jail for committing such heinous crimes.

Is this necessarily fair to the men in question and the women themselves?

A cursory glance shows that most women who are living with HIV blame a man for their status and this is understandable.

It is a fact that most men sleep with several women at the same time. How many women can safely say they have never been played?

Definitely not me!

But if we know we are or have been played, should we not begin to look out for ourselves?

Another interesting truth is that even women, who have had other sexual encounters before marriage, are quick to point a finger to the man when they test positive.

This is despite the fact that some of them would not have tested before entering this relationship.

Ever think for a moment that you could actually have been positive before, sisters?

If the truth be told, there are some men who have also been infected by women. But how many times do you hear people sympathising with a man?

Is this because men do admit to having been around and done that, unlike their female counterparts?

Multiple concurrent partnerships, especially the “small house” syndrome, are very popular in southern Africa and this is a documented fact.

Such partnerships have been identified as a key driver of HIV in the region.

Because men keep the majority of small houses, whenever transmission occurs, a finger is pointed at them and quite rightly so, mostly.

But what does just blaming them achieve if women do not stand up and begin to look out for themselves.

For argument’s sake, let us say the man is responsible, does this mean by pointing a finger, the virus would disappear?

If we could even go on to punish someone for infecting someone, would we solve anything?

Some would argue that it is high time we criminalised HIV transmission but will this prevent the spread of HIV?

Would it make people more sexually responsible?

Justice Edwin Cameron of South Africa’s Supreme Court of Appeal at the just ended XVII International AIDS Conference in Mexico said criminalisation of HIV transmission makes for bad policy direction around the epidemic.

He said laws and prosecutions don’t prevent the spread of HIV but may actually continue to distract us from reaching our goals of ending deaths, stigma, discrimination and suffering.

He also said something else that I like.

“The prevention of HIV is not just a technical challenge for public health. It is a challenge to all humanity to create a world in which behaving is truly feasible, is safe for both sexual partners, and genuinely rewarding.

“When condoms are available, when women have the power to use them, when those with HIV or at risk of it can get testing and treatment, when they are not afraid of stigma, ostracism and discrimination, they are far more likely to be able to act consistently for their own safety and that of others.”

The responsibility lies with all of us surely?

At the International AIDS Conference Regional Feedback Meeting held at the Harare International Conference Centre, Southern Africa HIV and AIDS Information Dissemination Service (SAfAIDS) Executive Director, Mrs Lois Chingandu also echoed the same comments.

She said the challenge with sexual matters were that they were mostly a “heat of the moment” thing and therefore clearly ascertaining that someone has an intention of infecting someone would be difficult.

“One could look for a condom in the dark and fail to find it. Both parties would go ahead to have consensual sex. Could we blame someone here?” she asked.

Today my message is simple. I am just appealing to Mutsa and others like her who are failing to move on because of the anger and sense of betrayal they feel that someone infected them to let go of it and live their lives.

She once felt like taking him to court but then, she says, she realised there was really no point for her status would not change.

I am also inviting my readers out there to contribute their thoughts and comments to this issue of blame and criminalising HIV transmission. My e-mail address is beatrice@safaids.org.zw

Please note:

Each of us has the responsibility and right to protect ourselves from HIV infection and re-infection

Failing to manage one’s anger is one way of increasing stress levels

You can still enjoy a full and productive life, even if you are HIV positive

Beatrice Tonhodzayi is a Programme Officer-Media with SAfAIDS

Africa’s criminal HIV transmission laws are highly inefficient, says Justice Michael Kirby

Australia’s most eloquent and insightful High Court judge, Justice Michael Kirby, spoke at the International Criminal Law Reform conference in Dublin yesterday, arguing that the move to criminalise HIV transmission in sub-Saharan countries such as Benin, Guinea, Guinea-Bissau, Mali, Niger, Togo and Sierra Leone will do more harm than good.

He also also argued that countries which focused on human rights-based laws that encouraged the undiagnosed to test for HIV did better at containing the epidemic than those which “adopted punitive, moralistic, denialist strategies, including those relying on the criminal law as a sanction.”

 

Third World should help HIV sufferers, not punish them: judge

Victor Violante, Legal Affairs Reporter

The Canberra Times

16/07/2008

Developing countries should introduce laws that encourage potentially HIV-positive people to seek diagnosis and treatment, High Court judge Justice Michael Kirby said last night.

Speaking at the International Criminal Law Reform conference in Dublin, Justice Kirby said governments that had focused on educating rather than punishing those with HIV or AIDS were most successful in containing their spread.

”Those countries that have adopted a human rights-respecting approach to the HIV/AIDS epidemic have been far more successful in containing the spread of HIV than those countries that have adopted punitive, moralistic, denialist strategies, including those relying on the criminal law as a sanction,” he said.

Justice Kirby has been heavily involved in the international fight against AIDS, having served as a member of the World Health Organisation’s Inaugural Global Commission on AIDS from 1988 to 1992. Since 2004 he has been a member of the UNAIDS global reference panel on HIV/AIDS and human rights.

While many developed countries, including Australia, had laws that criminalised the deliberate spread of HIV, such laws should not be used as part of the strategy to curb infection rates.

”Legal and punitive laws have been kept in reserve because their aggressive deployment has generally been seen as counterproductive.

”This is so because of the typical ineffectiveness of criminal law as a response to activities important to individual identity and pleasure [such as sex and drug use].”

Justice Kirby, who is openly homosexual, spoke about his indirect experience with HIV, having seen friends die from the virus.

”From 1985, I lost a number of close friends, several of them members of the legal profession. I witnessed the substantial helplessness of the medical profession in the early days of HIV.”

He urged the thousands of lawyers, judicial officers and lawmakers from all over the world at the conference to avoid enacting what he called ”HILs”, or highly inefficient laws.

Of concern were laws introduced in some African nations, including Benin, Guinea, Guinea-Bissau, Mali, Niger, Togo and Sierra Leone, that impinge on the human rights of those infected with HIV or AIDS.

One law criminalised the ”wilful transmission” of HIV, but defined the offence as the transmission of HIV ”through any means by a person with full knowledge of his or her HIV status to another person”.

Justice Kirby said, ”Potentially, [that law] imposes criminal liability, although a person may practise safer sex which reduces or eliminates actual risk of transmission to a sexual partner; takes steps to disinfect injecting or skin-piercing equipment; or involving mother-to-child transmission of HIV regardless of the actual risks involved in the particular case.”

He urged governments to introduce laws and programs that were proven strategies in the war against HIV and AIDS, even if they were unpopular with their cultures.

”Taking the effective measures is not always popular. Yet taking punitive measures, depending on their terms and enforcement, is, on current information, unlikely to succeed in the environment where there is no effective vaccine and no curative therapy which can be offered to persons living with HIV and AIDS.”

Uganda: Influential judge echoes Museveni’s calls for harsh criminal HIV transmission laws

An influential Ugandan judge has joined President Museveni in calling for tough laws for criminal HIV transmission.

Justice David Wangutusi, director of Uganda’s Judicial Studies Institute told a judicial workshop on gender equality that HIV-positive husbands who conceal their HIV status from their wives resulting in HIV transmission, should be given harsh sentences as a deterrent.

Uganda’s president, Yoweri Museveni gave a speech in March calling for the death penalty for anyone who is found guilty of Uganda’s proposed criminal HIV transmission laws. The president’s remarks drew sharp criticism from human rights advocates.

Judge calls for tough law on HIV/AIDS
Sunday, 29th June, 2008
By Vision Reporter

A spouse who knowingly conceals his or her HIV/AIDS status and infects the partner should be prosecuted, a High Court judge has suggested.

During a workshop for judges and magistrates at Pauline Hotel in Lira recently, Justice David Wangutusi said the sentence for such people should be harsh to deter other likely offenders.

“Magistrates should be responsive to the plight of women living with HIV/AIDS. You should also be gender sensitive when handling cases in which women seek judicial redress,” Wangutusi, who is also the director of the Judicial Studies Institute, told the participants.

The two-day workshop drew judicial officers from the north and Masindi district.

It was organised by the National Association of Women Judges of Uganda and the International Association of Women Judges, with support from Irish Aid.

Wangutusi called upon the participants to approach gender issues with critical minds to effect quality and equal justice to all.

“A closer examination reveals that inspite of the existence of equality principle in Constitution, there still exists beliefs, traditions, customs and attitudes that prevent the translation of abstract rights in the law into substantive rights in reality,” Wangutusi said.

He castigated the custom of widow inheritance saying it does not recognize the widow as a human being with a mind and conscience.

“It is in conflict with the equality principle. The tradition that only males may become heirs discriminates against females,” Wangutusi observed.

Under the theme Jurisprudence of equality in a time of HIV/AIDS, judicial officers were sensitised on issues of promoting awareness within the legal fraternity and the public to the passive effects of gender discrimination and violence, the pervasive effects of gender discrimination and violence.

They were also trained in skills needed to decide cases involving discrimination against women in accordance with International Human Rights norms among other issues.

US: Delaware considers mandatory HIV testing for alleged sex offenders

The US state of Delaware is proposing mandatory HIV testing of alleged sex offenders, within 48 hours of their arrest, if the alleged victim, or court, asks for it.

Unlike the existing law, the bill does not require that the state actually show some possibility that the virus may have been transmitted before requiring testing. The bill also authorizes testing around the time of arrest, instead of around the time of arraignment.


It’s not clear if this is primarily for the purposes of ascertaining whether PEP (post-exposure prophylaxis) might be necessary for the alleged victim – which can be the only ethical reason for a change in the law.

Although PEP is thought to be most effective when taken within a few hours of exposure, current guidelines have a recommended maximum window of 72 hours from exposure, so the alleged attacker would have to have been arrested immediately after for that specific purpose.

However, an HIV antibody test would not be accurate enough to detect whether the alleged offender was recently infected with HIV himself (making him much more likely to expose his alleged victim to high enough levels of HIV to transmit the virus).

In any event, PEP should be offered to all alleged victims of sexual assault regardless of the perceived status of their alleged attacker.

One wonders whether the charges would be harsher if the alleged offender did not know his HIV status and transmitted HIV, or did know his HIV status but did not?

However, the story, from the Associated Press, via delmarvanow.com, hints that the change in law is primarily for political, funding reasons.

Supporters say passage of the bill would allow the state to continue to receive up to $500,000 a year in federal grants through the Violence Against Women Act.

DELAWARE: HIV testing eyed for accused sex offenders
June 5, 2008
Associated Press

DOVER — A Delaware House committee has released a bill that would strengthen HIV testing for accused sex offenders.

The bill requires an accused sex offender to submit to HIV testing within 48 hours of arrest, in response to a request from the alleged victim or a court order.

Defendants, including those whose initial tests were negative, also would have to submit to follow-up tests as deemed appropriate.

Unlike the existing law, the bill does not require that the state actually show some possibility that the virus may have been transmitted before requiring testing. The bill also authorizes testing around the time of arrest, instead of around the time of arraignment.

Supporters say passage of the bill would allow the state to continue to receive up to $500,000 a year in federal grants through the Violence Against Women Act.

Angola: Criminal HIV transmission laws under consideration

Angola’s government is considering a new law criminalising ‘intentional’ HIV transmission, according to a report from PlusNews, a UNAIDS-funded HIV/AIDS news and information service for sub-Saharan Africa.

ANGOLA: Should intentional infection be a crime?
LUANDA, 26 May 2008

Proposed reforms to Angola’s Penal Code have divided opinion in the country about whether HIV-positive people who intentionally infect others with the virus should be punished.

The law under discussion calls for a sentence of between three and 10 years in prison for those knowingly pass on infectious diseases, including HIV. Some argue that the law will act as a deterrent; others say it will bring more problems than benefits.

“Criminalisation is going to backfire. It goes against human rights and the fight against discrimination, and it won’t prevent intentional infection,” Roberto Brandt Campos, a coordinator with UNAIDS in Angola, told IRIN/PlusNews.

UNAIDS and the World Health Organisation voiced their opposition to such a measure being introduced anywhere in the world in a document released in 2007, saying that it represented a step backwards in HIV prevention efforts.

This is not the first time such a law has been tabled in Angola: the country introduced legislation relating to HIV and AIDS in 2004 but a measure calling for the criminalisation of purposeful infection was among those not included.

Victim and executioner

According to Campos, one of the main difficulties with such a law is determining the intention to infect. In his view, proving transmission from one specific individual to another is already difficult, and proving that an infection was intentional even more so. “Transmitting the virus out of negligence is different from transmitting it in on purpose,” he stressed.

Carolina Pinto, an activist with the non-governmental organisation Luta pela Vihda (Fight for Life in Portuguese), believes those who infect their partners on purpose should be punished, but acknowledges that the line between negligence and intention is a thin one.

“Doing it on purpose is different from not telling, but those who have the virus must accept their condition and protect their partner’s life,” she said, adding that both partners should take some responsibility for protecting themselves.

Even so, Pinto, who is HIV positive, said there were some behaviours that suggested deliberate transmission. “If it happened once, okay; but if the person continues to practice unprotected sex even while knowing that he or she is infected, I think it’s on purpose,” she told IRIN/PlusNews.

In cases of sexual transmission, Campos worries that such a law would only deepen the damaging perception that people who contract the virus are victims and those who give it to them are their executioners.

“There is no such thing as a victim; people are the subjects of their own life stories,” Campos said. “Sex is a two-person relationship, in which responsibility is necessarily shared.”

In cases of mother-to-child HIV transmission, Campos said criminalisation could set a precedent for children to take their parents to court. He cited a case in Florida, in the United States, where a boy sued his mother for giving him HIV. “Parents will feel intimidated about revealing their condition. All this does is feed the chain of stigma and discrimination.”

Unintended consequences

In a country where people often don’t reveal their HIV-positive status out of a very real fear of rejection, Campos argued that criminalisation would only heighten such fears, and mentioned the example of an HIV-positive woman who became an activist and went public on television. The residents of her neighbourhood did not want their district to be shown in the television report.

“With this level of discrimination, how can you expect someone to have the courage to take the test and then tell their partner?” he said.

Criminalising intentional transmission could also have the unintentional affect of discouraging voluntary testing. “People are going to think: ‘if there’s a law that says I’m going to be penalised, it’s better not to know my HIV status’,” Campos said.

António Coelho, director of the AIDS Service Organisation Network (Anaso), believes a more practical approach to breaking the chain of HIV transmission is to counsel people on how to change their behaviour.

Fiji: Updated: Moral, legal panic after one man linked to two women’s HIV infections

Update: 28th April. There have been fewer than 260 HIV diagnoses in Fiji since records began (I originally quoted a source claiming fewer than 30), so it must come as something of a shock for Fijians to have to come to terms with the fact that an HIV-positive man is not disclosing his status before having unprotected sex.

The hunt is now on for a 33 year-old Fijian man who allegedly transmitted HIV to two women. The Fiji Times has published four stories since Friday covering the issue.

Update: 28th April. In fact, Fiji now seems to be hunting down six HIV-positive individuals.

Interestingly, according to one of the articles, reckless or intentional HIV transmission (or exposure) is not a crime in Fiji, although the transmission of HIV via shared needles is.

Police spokesman Corporal Josaia Weicavu said wilfully passing on the HIV virus had not been criminalized.

Police can only advise women in Labasa to be careful when engaging in sexual activity after health and police authorities mounted a search in recent weeks for a 33-year-old man of Labasa.

Consequently, Reverend Sekove Veisa, head of a Methodist church circuit, has “called for lawmakers to criminalise the wilful spread of the disease by anyone.”

Highlights of the four news stories from The Fiji Times are below, followed by a brief report from the Australian Broadcasting Corporation on the missing six.

Hunt for HIV man
SERAFINA SILAITOGA
Saturday, April 19, 2008

HEALTH authorities are on the hunt for a HIV positive patient who they believe is engaged in promiscuous sex and deliberately spreading the disease.

Acting general manager community health North Doctor Pablo Romanik confirmed the search for the 33-year-old Fijian man started early this month after two women who were admitted to the Labasa Hospital tested positive for HIV (human immunodeficiency virus).

Dr Romanik said what worried them was that the patient did not have a stable address and efforts to find him the past three weeks were unsuccessful.

“We are looking for this man to counsel him. The reason for our search is because he is the same man identified by his two ex-girlfriends who were admitted and tested HIV positive,” he said. “All we want to do is counsel him and help him. The fact that he does not have a stable address is of great concern because he could continue to have other partners and spread the disease.”

Dr Romanik said the second woman was admitted in January this year after health officials carried out a blood test on her which tested HIV positive.

He said they interviewed the woman who then told them about her partner who is a known HIV positive patient.

“That’s when we found out, and strongly believe, that she contracted the disease from him because he is a known patient who was tested positive in 2004 when he came to donate some blood to the hospital,” Dr Romanik said.

“The first case involved his other girlfriend who was also admitted last year and tested HIV positive. She also identified the same man as her boyfriend.”

Stop, HIV lover told

Sunday, April 20, 2008

THE head of a Methodist Church circuit has pleaded with a HIV patient being hunted by health authorities to stop infecting women.

And Reverend Sekove Veisa, who leads the Macuata circuit, called for lawmakers to criminalise the wilful spread of the disease by anyone.

[…]

Mr Veisa said the fact that the HIV positive man was deliberately infecting women was hard to fathom.

He said the church had a program that dealt with such issues as HIV and urged the man not to destroy lives.

Police assistant spokesman Corporal Josaia Weicavu said he had to clarify whether wilfully spreading the disease was a criminal offence.

Isolate HIV suspect
AMELIA VUNILEBA
Sunday, April 20, 2008
Update: 4:47PM

HEALTH authorities have the power to isolate people that have contracted HIV, police said today.

Police spokesman Corporal Josaia Weicavu said wilfully passing on the HIV virus had not been criminalized.

Police can only advise women in Labasa to be careful when engaging in sexual activity after health and police authorities mounted a search in recent weeks for a 33-year-old man of Labasa.

Acting general manager community health North Doctor Pablo Romanik said the search for the man started early this month after two women who were admitted at the Labasa Hospital tested positive for HIV.

The ministry has identified 28 HIV positive cases since 1995.

Of this, there is one case under the age of 20, 15 cases between the ages of 20 to 29, three cases between the ages of 30 to 39, seven between 40 and 49 and two cases over the age of 50.

Out of this, 40 per cent are males and 60 per cent females. Fijians top the list at 84 per cent, Indo-Fijians at 8 per cent and 8 per cent for other races.

No laws on HIV

Monday, April 21, 2008

WHILE there are no laws to charge people living with HIV and wilfully spreading the virus, the Ministry of Health has powers to isolate these people.

Police assistant spokesman Corporal Josaia Weicavu said the act of knowingly passing on the HIV virus was not a criminal offence yet.

“It’s not criminalised yet, however, the Ministry of Health has powers to isolate these people who have HIV,” said Cpl Weicavu.

He said people could be charged if they were caught passing on the virus through needle injections. However, this did not apply to transmission of the virus through sex.

Attempts were made to get comments from interim Health Minister Jiko Luveni.

[…]

Ministry of Health permanent secretary, Doctor Lepani Waqatakirewa, said health officials could search for HIV positive patients for counselling.

Fiji seeks missing HIV patients
Updated April 28, 2008 04:25:33

Fiji health officials are trying to find six people with HIV in the country’s northern division.

The Division’s acting Chief Medical Officer for Community Health told Fijilive there are 15 known AIDS cases on record in the north, but that health officials only have addresses for nine of those individuals.

The youngest known HIV patient in the North is a 20-year-old student in Labasa.

Fiji has reported 259 HIV cases since 1989, with more than 15 reported cases last year alone.

Uganda: President Museveni calls for death penalty in criminal HIV transmission cases

President Yoweri Museveni has given a speech calling for the death penalty for anyone who is found guilty of Uganda’s proposed criminal HIV transmission laws.

“I am glad to learn that the parliamentary committee on HIV/AIDS is coming up with a law to punish people who deliberately infect others. I would advise that they be condemned to death by hanging,” he said, to murmurs from the crowds.

Museveni chided the residents for the lukewarm reception to his proposal of a death penalty. “I hear some of you have not welcomed this proposal; but why would one knowingly infect others,” he asked.

Article from Uganda’s Sunday Vision newspaper, below.

THOSE WHO SPREAD AIDS SHOULD HANG
By Cyprian Musoke

PRESIDENT Yoweri Museveni has called for death penalty for people who knowingly spread the HIV/AIDS virus.

He also called for the outlawing of primitive methods used by the Bagishu and Sebei in eastern Uganda of using knives for circumcision that are likely to spread the virus.

Speaking at the commemoration of 25 years since the first case was identified at Kasensero landing site in Rakai District on Friday, the President lauded the parliamentary committee on HIV/AIDS for coming up with the draft Bill.

“I am glad to learn that the parliamentary committee on HIV/AIDS is coming up with a law to punish people who deliberately infect others. I would advise that they be condemned to death by hanging,” he said, to murmurs from the crowds.

Museveni chided the residents for the lukewarm reception to his proposal of a death penalty. “I hear some of you have not welcomed this proposal; but why would one knowingly infect others,” he asked. “Even the Bagishu and Basebei, we also need to warn them against using knives to cut people left and right,” he said.

Reminiscing on the origin of Uganda’s AIDS realisation, Museveni said when the first case was reported in Kasensero in the 1980s, he called all the health experts who informed him that it is contracted from promiscuity and, not insect bites. “I felt relieved to hear that it is only transmitted through promiscuous sexual relationships. My biggest worry was that insect bites could transfer the virus. I was relieved when they told me it was through sex, because I knew that it would that way be easy to stop,” he said.

He said at the time there were only two places with testing equipment in the country: Nsambya and Lacor hospitals, upon which he directed that every hospital in the country get one. On realising the magnitude of the problem, Museveni said, he turned to political rallies to spread the anti HIV/AIDS gospel, because the messages the Ministry of Health was putting out were too frail.

He amused the audience when he recalled: “They were putting adverts on the radio saying, ‘Love carefully, zero grazing’. “I told them that is not loud enough,” he said while gesturing and rolling his eyes.

He thanked Parliament for recognising him and his wife Janet with plaques for their contribution.“I approached it as a soldier — when there is a problem we just attack it directly,” he said.

He recalled when retired Cuban President Fidel Castro called him aside on the periphery of the Non-aligned Movement in Harare and told him there was a big problem in Uganda. “I had sent 60 soldiers for training in Cuba, he told me they had checked them and found 18 of them sick of AIDS. He told me that was a high number which made it possible for a huge number of people in the country to be infected,” Museveni recalled.

He called for more sensitisation, ensuring safe blood transfusion, and prevention of mother-to-child transmission.

Although he is not against condom use, the President added, he wouldn’t advise his children to sexually interact with people whose status they do not know simply because they have condoms.

Parliament Speaker Edward Ssekandi said that President Museveni’s bold fight against Aids had catapulted Uganda onto the international map, and made Museveni a senior global consultant on HIV/AIDS prevention.

HIV/AIDS committee chairman Elioda Tumwesigye said the fact that Uganda now has an ARV factory should not make people complacent, saying that after 25 years, the figure had stagnated again. He called for a re-awakening of the fight.

Museveni said countries with highest condom use have the highest infection rates, adding that had Uganda dwelt on only abstinence and faithfulness, the 6.3% infection rate would be lower.

Australia: New Victoria public health policy clarifies when ‘risky’ HIV-positive individuals should be reported to the police

I spoke too soon in my posting yesterday regarding reassurances from Victoria’s chief health office, Dr John Carnie, on a new policy from the public health department about reporting HIV-positive individuals who did not disclose or use condoms to the police.

A report in today’s The Age quotes Dr Carnie as saying:

anyone who had intentionally infected someone else, had committed crimes such as rape, or had shown they were unwilling to change their behaviour after being ordered to do so by the department, would be reported to the police.

Full story from The Age below.

Police to be told about reckless HIV acts

Julia Medew
February 26, 2008

HIV-POSITIVE people who ignore warnings not to have unprotected sex will be reported to police under new Department of Human Services guidelines.

Victoria’s Chief Health Officer, Dr John Carnie, said that, under the system, anyone who had intentionally infected someone else, had committed crimes such as rape, or had shown they were unwilling to change their behaviour after being ordered to do so by the department, would be reported to the police.

Under the previous system, Dr Carnie said there were no guidelines to indicate when a case required police attention.

“This system makes it much more explicit,” he said.

On the department’s website, the previous guidelines for the management of people living with HIV who put others at risk says the police will only become involved if someone outside the department makes a complaint to them.

When the department receives allegations that an HIV-positive person is not disclosing their status and having unprotected sex, trained staff contact the person to remind them of their legal obligations to disclose their status or practise safe sex.

If they do not change their behaviour and the department receives more allegations, the person can be served with a legally binding public health order restricting their behaviour. The orders can impose restrictions on people’s movements or ban them from a gay beat or sex-on-premises venue.

If the Chief Health Officer believes the person poses an urgent risk to public health, he can detain the person under the Health Act in a secure facility.

Dr Carnie exercised this power in December when he placed an HIV-positive person in an undisclosed secure location. The person, who has the right to appeal to the Supreme Court, is still there.

Dr Carnie, who replaced Dr Robert Hall after he was sacked by the government last year, has ruled out genotyping new HIV infections — developing a genetic profile of the virus in patients — to track who or what is driving up infections in Victoria.

Former health minister Bronwyn Pike sacked Dr Hall last April after a string of communication failures over his management of HIV cases and a fatal outbreak of gastroenteritis at a nursing home.

HIV infections recently reached their highest level in Victoria in 20 years. The department was notified of 334 cases in 2006, 17% higher than the 285 in 2005 and the highest since 1987.

Australia: Review critical of Victoria’s public health response to ‘risky’ HIV-positive individuals

A review of the Victorian Health Department’s management of ‘risky’ HIV-positive people has been published. The Age puts its own negative spin on the story, but somewhat reassuring is the response from Dr John Carnie, Victoria’s chief health officer.

He said cases warranting police intervention were rare and that the review reinforced education and counselling to change people’s behaviour rather than criminal prosecution.

The full story, from The Age, is reproduced below.

‘Reckless’ HIV patients not reported
Julia Medew
The Age
February 23, 2008

HEALTH authorities failed to refer to police HIV-positive people who ignored warnings not to have unprotected sex, a report has found.

A review of the Department of Human Services’ management of “risky” HIV-positive people has also revealed authorities lost track of people they were monitoring and did not take action against some who breached public health orders restricting their behaviour.

The review, of 15 cases before the department last year, urges an overhaul of procedures.

The review was ordered by former health minister Bronwyn Pike last year after she sacked Victoria’s chief health officer Dr Robert Hall for his management of HIV-positive people who exposed others to the virus.

The review found that while swift and decisive action was taken against some people, there were “occasions where the evidence demanded action but none was forthcoming”.

Most of the cases under review involve either recent migrants or gay men.

The examination, carried out by former Western Australian police commissioner Bob Falconer, and former health bureaucrat Dr John Scott, said: “The reviewers believe . . . that involvement of police without the client being referred to police has not always happened when it should have, and this is by no means a recent issue.

“The authors have found the system is in need of significant overhaul and improvement.”

It is understood that more than one of the cases reviewed included examples of criminal behaviour that should have been referred to the police.

The report said people who had been served with public health warnings controlling their behaviour were often “uncontactable for a period of time” and that a number of clients who breached behavioural rules were not properly controlled.

The review also found:

■There was no dedicated facility to isolate HIV-positive people who posed a risk to public health under the Health Act.

■Internal procedures for managing cases left a perception that decisions about people’s cases were made in an “ad hoc” fashion.

■Legal advice for “contentious” decisions resulted in “significant delays in action being taken” against people.

■Access to interpreters was minimal.

Victorian chief health officer Dr John Carnie yesterday said changes had been implemented to ensure the department returned to “world’s best practice”. He said the department had been working with Victoria Police to create a shared understanding of each agency’s role in managing cases of concern. He said cases warranting police intervention were rare and that the review reinforced education and counselling to change people’s behaviour rather than criminal prosecution.

A Canadian expert who reviewed the report said the department’s new protocols were in line with world best practice.

Health Minister Daniel Andrews said the Government was committed to implementing the review’s recommendations.