UPDATE – Canada: Gay man acquitted of HIV exposure in Vancouver, risk not significant enough for liability

Update: May 12th

Yesterday, the Canadian HIV/AIDS Legal Network issued a press statement on the case, available here.

The reasons for judgment in the case (R. v. J.A.T., 2010 BCSC 766) were made public on June 2nd.

Today, aidsmap.com published a news story that I wrote last night highlighting the most salient points. Read the full story here

The case before the courts in Vancouver, British Columbia hinged on how many times an HIV-positive gay man’s boyfriend had insertive, unprotected anal sex with him, and whether the risk of him acquiring HIV was ‘significant’.

[…]

Both sides accepted that the accused had failed to disclose his status, although there had been several discussions around HIV-related risk and an agreement to practise safer sex from the start of the relationship. The accused testified that he had been diagnosed HIV-positive two weeks prior to meeting the complainant and hadn’t been ready to disclose his status at that point.

“I was still dealing with social stigma, personal prejudice; I was mentally a mess,” he told the court.

The prosecution’s expert witness, Dr Richard Matthias, testified that the per-act risk of HIV transmission for the insertive partner was similar for both unprotected anal and vaginal intercourse and estimated the risk to be 0.04%, or 4 in 10,000.

Justice Lauri Ann Fenlon ruled that unprotected sex took place three times, and that the cumulative risk – 12 in 10,000 – did not reach “the standard of significant risk of serious bodily harm that must be met to turn what would otherwise be a consensual act into aggravated sexual assault.”

An equally important part of Justice Fenlon’s decision was that she found the harm of HIV infection to be less than it was perceived to be in 1998.

“It’s no longer the case that people infected with HIV will develop AIDS and die prematurely,” she said. “HIV, while still a deadly virus, can generally be treated and held in check.”

This is relevant, explains the Canadian HIV/AIDS Legal Network, which worked closely with defence counsel Jason Gratl, and provided expert testimony at trial, “because, as the severity of the possible harm decreases, the higher the risk of harm must be in order to warrant criminal prosecution.”

Original post: May 7th

In a groundbreaking ruling for Canada, Justice Lauri Ann Fenlon today ruled that the risk to the insertive partner during anal sex without a condom is not ‘significant’ enough to be considered either aggravated sexual assault nor sexual assault in the absense of disclosure.

Her ruling, reported in Vancouver’s daily paper, The Province, and Canada’s gay paper, Xtra, was based on expert evidence that the per-act risk of acquiring HIV via insertive anal sex was 4 in 10,000. Of interest, the defendant had been recently diagnosed (within the previous six months) and was not on treatment but the expert witnesses’ testimony did not draw attention to the possibility of a higher risk due to higher viral load during early infection.
Full details of each day of the court case have been painstainkingly reported in a blog by Nathaniel Christopher on Xtra.ca. This report of the expert witness statement is below

An expert witness said an HIV-positive man on trial for aggravated sexual assault had a 0.04 percent chance of infecting his partner every time they had sex. Dr Richard Mathias told the court he believed HIV transmission rates in anal intercourse are comparable to those in vaginal intercourse. He explained that a penetrative partner in anal sex is at risk of contracting HIV through anal fluid, which can travel up their urethra. He mentioned that in the case of uncircumcised men the risk is even higher as the fluids can infect the insertive partner through the tissue beneath the foreskin.

Crown counsel Brendan McCabe asked Mathias if he was aware of any individual incidents in the gay community of the virus going from an HIV-positive receptive partner to a negative partner. “No,” said Mathias, who has worked in public health for 35 years and conducted research on HIV and AIDS in the early days of the disease. He explained that the risk in the case of the accused would be 4 in 10,000 per act but that number would multiply with each encounter.

McCabe suggested that if the accused and complainant had had five unprotected encounters then the risk would be 20 in 10,000. Mathias said the risk is comparable to protected sex between an HIV-negative bottom and an HIV-positive top.

The complainant testified that he had engaged in insertive anal sex a total of five times with his former partner; the defendant testified that this happened only once, and that he had thought his partner was wearing a condom at the time. Justie Fenlon ruled that unprotected anal sex had taken place three times, but that a 12 in 10,000 risk was not significant enough to be considered a criminal act. Transmission did not occur.

I have concluded that the Crown has failed to prove that the risk of HIV transmission here — 12 in 10,000 sexual encounters or 0.12 percent — meets the standard of significant risk of serious bodily harm that must be met to turn what would otherwise be a consensual act into aggravated sexual assault.

This verdict should not be understood to mean that the court condones the behaviour of the accused. He had a moral obligation to disclose his HIV-positive status to his partner so that the complainant could decide whether he wanted to take the risk of engaging in unprotected sexual activity with the accused, no matter how small that risk. But not every unethical act invokes the heavy hand of the criminal law.

A previous posting yesterday, reposting an excellent article from Xtra, highlighted the potential significance of the case. It will be interesting to see what others make of it. More on Monday.

Canadian HIV law at a crossroads (Xtra.ca)

Reposting this article from Xtra.ca published online today. Tomorrow’s verdict (due to be issued 9am Vancouver time) will be as important to people living with HIV – and public health – in Canada as the outcome of UK’s general election. Will provide full details of trial and commentary on Monday.

Canadian HIV law at a crossroads
CRIMINALIZATION OF HIV / Vancouver, Edmonton and Hamilton cases could affect future police & crown decisions
Nathaniel Christopher & Neil McKinnon / Toronto / Thursday, May 06, 2010

Cases in three provinces could shape the way HIV non-disclosure is treated by the courts in this country.

In Vancouver, an HIV-positive man awaits a verdict after a lengthy trial. He and his boyfriend had unprotected sex very rarely — possibly just once — and the poz partner was always the bottom. The trial judge has ordered a publication ban on both men’s names.

In Hamilton, a poz guy had charges against him stayed because the complainant and accused only engaged in oral sex.

And in Edmonton, a straight man in his 50s is facing an assault charge for HIV non-disclosure, but police — who have a history of splashing names and photos around in the media — are refusing to release his name.

Although there is no HIV law on the books, Canadian police have, since the mid-’90s, been charging people with offences — ranging from assault to murder — for failing to disclose their health status before having unprotected sex. HIV activists have long said that transmission should be a public health matter, not a criminal one.

In Vancouver, Justice Lauri Ann Fenlon was, as Xtra goes to press, expected to render a verdict on May 7. But she has already hinted that the case could be appealed on constitutional grounds.

The defendant is represented by BC Civil Liberties Association lawyer Jason Gratl. Gratl called Richard Elliott, executive director of the Canadian HIV/AIDS Legal Network, to the stand to testify about the adverse effects of HIV criminalization.

At the trial, Fenlon said Elliott raised important policy issues that an intervener might put before the appeal courts or the Supreme Court of Canada, but that his testimony was not relevant to the issue before her.

The court, consequently, did not consider Elliott’s testimony, but if the accused is convicted, they may end up making their case in appeals.

Elliott testified to the challenges of requiring disclosure in all circumstances, saying that approximately one quarter of all people in Canada infected with HIV don’t know they have it.

“I think people recognize challenges of HIV disclosure, including stigma and negative consequences that can very easily flow from their HIV status,” Elliott told the court. “Rather than expect people to overcome those barriers in every circumstance and impose a criminal penalty when they don’t, the emphasis should be on personal responsibility and risk reduction, a sensible prudent strategy in the ability of all people.”

He told the court that the stigma associated with HIV could be a disincentive to disclosure.

“People, quite legitimately, have concerns over employment, housing, loss of personal and other social rela-tionships, ostracism in community and denial of service by service providers,” Elliott testified. “Although we only have limited systemic research on HIV stigma, we certainly do have enough to document that there is still a pervasive stigma associated with HIV.”

He stressed the need for clarity in the law to better define what sexual activities between HIV-discordant couples constitute “significant risk” of serious bodily harm as set out in the 1998 Supreme Court of Canada case R v Cuerrier.

***

In the Vancouver case, the issue of what constitutes significant risk is paramount, because the defence is arguing that the risk of HIV transmission was as low as 1 in 2,500. In none of the three cases did transmission occur.

Dr Richard Mathias told the court he believes HIV transmission rates from anal intercourse are comparable to those from vaginal intercourse. He explained that a penetrative partner in anal sex is at risk of contracting HIV through anal fluid, which could travel up the urethra. He mentioned that in the case of uncircumcised men, the risk is higher as the fluids can infect the insertive partner through the tissue beneath the foreskin.

Crown counsel Brendan McCabe asked Mathias if he is aware of any incidents in the gay community of the virus going from an HIV-positive bottom partner to a negative top.

“No,” said Mathias, who has worked in public health for 35 years and conducted research on HIV and AIDS in the early days of the disease. He explained that the risk in the case of the accused would be 4 in 10,000 per act, but that number would multiply with each encounter.

McCabe suggested that if the accused and complainant had had five unprotected encounters, then the risk would be 20 in 10,000.

Mathias said the risk is comparable to sex between an HIV-negative bottom and an HIV-positive top when a condom is used.

The definition of “significant risk” was also at the heart of the Hamilton case, where the prosecution stayed an aggravated sexual assault charge in April. A gay man was charged in February 2009 after an ex-partner alleged they had oral sex without his disclosing that he had HIV. The charges were based on the accused’s performing oral sex, rather than receiving it.

The ex-partner has since been tested and is HIV-negative.

Elliott said in a statement:

“There was never any solid basis for significant risk of transmission. It’s a misguided overreaction to lay and pursue some of the most serious charges in the Criminal Code when no harm has occurred and the risk of HIV transmission was miniscule at most.”

***

In the Hamilton case, the name of the man who was accused is public, but, at his request, Xtra chooses not report it. In the Edmonton case, police declined to release the accused’s name. And in Vancouver, the judge ordered a publication ban on the accused’s identity.

In all three cases, the complainant’s identity cannot be disclosed by law, akin to the way the identities of rape victims are protected.

Police across the country often disclose the names of people accused of sexual assault for HIV-nondisclosure, which, among other things, outs them as HIV-positive.

The Edmonton case is unusual because, from the outset, the name of the accused has been kept under wraps.

The charge follows a March 31 police complaint by a woman claiming she slept with an Edmonton man who failed to disclose that he has HIV.

An RCMP spokesperson, Jodi Hei-denger, says the move has nothing to do with public disclosure of the health status of the accused, and everything to do with protecting the identity of the alleged victim.

“Releasing any details would without a doubt identify the victim. We are not releasing the name of the accused strictly to protect the identity of the victim,” says Heidenger.

Which could mean that the Vancouver case, where at trial the accused’s name is protected, could be more precedent-setting. The move, however, may have come too late, since the publication ban came only after the name had been bandied about in media reports and police press releases.

The Hamilton case, because it never went to trial, will likely have the least impact on jurisprudence.

The Vancouver case, with the spectre of a Supreme Court challenge hanging in the air, could be one of the most important in a decade.

Canadian HIV/AIDS Legal Network welcomes Crown decision to drop criminal charges in Hamilton HIV case: guidelines needed

Press Release
AIDS ORGANIZATION WELCOMES CROWN DECISION TO STAY CRIMINAL CHARGES IN HAMILTON HIV CASE
But guidelines needed to avoid unsound, unjust prosecutions

TORONTO, April 22, 2010

The Canadian HIV/AIDS Legal Network welcomed the announcement at Hamilton’s courthouse this morning that the prosecution is staying the criminal charge of aggravated sexual assault against Justus Zela. He was charged in February 2009 after an ex-partner alleged they had oral sex without Zela disclosing that he had HIV. The ex-partner has not tested HIV-positive.

“We’re pleased with the Crown’s announcement this morning, but it must go further. This case should never have proceeded in the first place, and the charges should be withdrawn entirely,” said Richard Elliott, Executive Director of the Canadian HIV/AIDS Legal Network. “There was never any solid basis for significant risk of transmission. It’s a misguided overreaction to lay and pursue some of the most serious charges in the Criminal Code when no harm has occurred and the risk of HIV transmission was miniscule at most.”

According to information available to the Legal Network, the charges were based solely on the claim that oral sex had taken place on a few occasions — and mostly with Mr. Zela performing oral sex, rather than receiving it.

“This case is yet another example of why the Attorney General of the province should work with community groups to develop some clear guidelines for prosecutors and police about when criminal charges are, and are not, warranted,” said Elliott. “Guidelines should be informed by the evidence about actual risks of transmission. They should also consider the damage that misusing the criminal law does to individual lives, and how it undermines public health, including HIV prevention efforts, through contributing to misinformation, fear and stigma.”

In 1998, the Supreme Court of Canada ruled that a person living with HIV has a duty to disclose his or her status to a sexual partner only if there is a “significant risk” of transmission, but much uncertainty remains about what this means.

Over the past decade, there has been an alarming increase in both the frequency and severity of charges against individuals with HIV for not disclosing their status to a sexual partner. Prosecutors have pursued serious assault charges even in circumstances where the risk of HIV transmission, already statistically small in any single sexual encounter, has been lowered further by the responsible practise of safer sex. In light of this “criminalization creep,” it is all the more urgent to address legitimate questions about where, as a matter of public policy, we should draw the lines.

Leading organizations and members of the HIV community — including health care providers, service providers, people living with HIV, academics and lawyers — have questioned the expansive use of the criminal law with respect to HIV non-disclosure in Canada. While recognizing that there is a limited role for criminal law on this issue, many legitimate concerns exist as to the impacts of this trend. Not only is studying, evaluating and critiquing the application of the criminal law appropriate, it is absolutely necessary to ensure it is used sensibly and fairly.

About the Canadian HIV/AIDS Legal Network
The Canadian HIV/AIDS Legal Network (www.aidslaw.ca) promotes the human rights of people living with and vulnerable to HIV/AIDS, in Canada and internationally, through research, legal and policy analysis, education, and community mobilization. The Legal Network is Canada’s leading advocacy organization working on the legal and human rights issues raised by HIV/AIDS.

“Criminal Law and HIV”
A series of 5 info sheets on-line at: www.aidslaw.ca/criminallaw

US: Media, police, judge conspire in ‘hate crime’ against gay HIV-positive man in biting case

I am so mad I could spit and bite! I’ve seen a lot of bad reporting and bad legal decisions during my time blogging, but never before have I seen the media conspire with the criminal justice system in such a calculated, prejudiced, stigmatising, and ultimately harmful way.

A gay man from a small city in Michigan who has been harrassed and beaten up by neighbours for years, has been charged with “assault with intent to maim, assault with intent to commit great bodily harm and possession or use of a harmful device” after the latest assault resulted in biting his neighbour the lip whilst he was defending himself.

The story first appeared on October 30th in the Detroit News.

Although police allege [the accused] was the lone attacker — biting neighbor Winfred Fernandis Jr., 28, on the lip following the Oct. 18 confrontation — [the acccused] says he’s long been the target of bigotry on his street, and Fernandis, along with several of Fernandis’ family members, took turns beating him.

“I have no memory of biting him,” said [the accused], who is due in 41-B District Court for a preliminary hearing Monday. He divulged his HIV status after questioning from the media. “This person has been threatening me for years. The hatred needs to stop.”

“He divulged his HIV status after questioning from the media.”

How did that happen? Well, Fox News did some ‘investigating’ and discovered he was HIV-positive. They asked him to confirm it on camera – he did. They then told the bitten neighbour on camera. That’s when it got ugly.

Here’s the Fox News report.


Since HIV is involved, Clinton Township District Court Judge Linda Davis said during a preliminary hearing on November 2nd that just knowing he was HIV-positive and biting the neighbour is enough to sustain these very serious charges, reports a second story in the Detroit News.

“He knew he was HIV-positive, and he bit the guy,” Davis said. “That on its own shows intent.”

No it doesn’t, Judge Davis, because saliva from a bite does not expose someone to HIV. Now she is implicated, along with the police and the complainant (and his wife), in a hate crime.

“I am still maintaining my client is the victim of a hate crime,” [the man’s attorney, James L. Galen Jr.] said. “He will be exonerated. This is the very first battle in what I think is going to be a long war.”

A pretrial and arraignment will take place on November 16th.

South Korea: Korean man gets 18 months for HIV exposure; calls for HIV-specific laws (updated)

Update: October 27th

The 26 year-old Korean taxi driver arrested in March was found guilty earlier this month under South Korea’s public health law for having unprotected sex without disclosure and has been sentenced to 18 months in prison.

Original post: 16th March

The arrest of an HIV-positive taxi driver in Jecheon, North Chungcheong Province last week – originally for “habitually stealing women’s underwear” but now charged under public health law for having unprotected sex without disclosure with at least ten women – has resulted in a resurgence of panic around criminal HIV transmission in South Korea, and calls for HIV-specific criminal laws.

The case was first reported in English on March 13th in the Korea Times.

An AIDS patient in his 20s has had sex with dozens of women in Jecheon, North Chungcheong Province, over the last six years, police have revealed. The Jecheon Police Station said Friday that the patient, identified as Chun, 27, had sexual relationships with waitresses and drunken passengers while working as a taxi driver since 2003.

More details emerged on March 14th at Donga.com.

Police said he neither told his sex partners of his infection nor used contraceptives. A police search of his house found packets of medicine along with women’s underwear. Police grilled Jeon on what the medicine was for and he confessed to being HIV-positive. Police sought an arrest warrant for him yesterday for violating an AIDS prevention law and began tracking the women who had sex with him.

On March 15th, the Korea Times reported that the local sexual health clinic had been flooded with requests for HIV testing following reports of the man’s arrest.

According to the regional office, 61 people have undergone HIV tests, about 12 times the usual figure, since the arrest of 27-year-old cab driver Jeon, Friday. The official said no one was yet found to have the virus, but it will forward test samples to a higher institute for close examination.

On a positive note, public health officials are being extremely responsible and informing the public that the risk of transmission from a single act of unprotected sex is low, particularly since the man is on effective treatment.

According to health authorities, however, chances are low that his sex partners were infected with the deadly virus. Since he was put under monitoring, he has got counseling and medical checkups 30 times and taken regular medication. This means he is as healthy as an ordinary person, a source at the disease control center said. (Donga.com)

However, experts said the likelihood of catching HIV from unprotected sexual activity with someone who is HIV-positive is a mere 0.5 percent. “Since Jeon had been taking drugs to control the virus, the odds could be even lower,” a health expert said. (Korea Times, 15/3/09)

Nevertheless, according to Donga.com.

Domestic law only prohibits those who are HIV-positive from working at entertainment establishments that require regular medical checkups of their employees. Calls are rising for authorities to draw up countermeasures to control the jobs and private lives of HIV-positive people.

And a Donga.com editorial on March 16th appears to support these calls.

The news of an HIV-infected taxi driver who had sex with scores of women has rocked the nation. Medical Web sites are being bombarded with inquiries about AIDS symptoms and applications for the HIV test have jumped ten-fold. Generally, HIV/AIDS patients avoid contact with people because contracting the disease is lethal for their weakened immune system. If a HIV-positive person attempts to purposely spread the disease, however, there is no way to block him or her from doing so. In the wake of the news, calls are rising that the 1987 AIDS prevention law is ineffective to stem the spread of the deadly disease. The country’s AIDS control and prevention system should be urgently revamped.

Update: March 16th, 5pm: An editorial today in the Korea Times blames the public health authorities rather than the individual himself.

It goes without saying that prevention is the best way of containing the spread of HIV/AIDS. Therefore, the government and the health authorities should establish a firm preventive system before it is too late.

US: Military court sends Naval officer to prison for unprotected sex with disclosure

A US military court has sentenced a 37-year-old HIV-positive Naval officer to three months’ in military prison after he pleaded guilty to having unprotected sex with disclosure with two women. The man, an aviation electronics technician who had been in the Navy for 18 years, was also given a bad-conduct discharge and demoted to seaman recruit.

No, you aren’t misreading this. A man has lost his job, his reputation and his liberty for the next three months, after being court martialled for having sex with two women (one of whom is his ex-wife) who consented to unprotected sex.

Clearly, this man’s lawyer, Greg McCormack (a civilian lawyer), and the military judge, Cmdr. Tierney Carlos, have not done their homework. It took me less than an hour to discover previous US Court of Appeals for the Armed Forces (CAAF) judgements that call into question the aggravated assault charge that Petty Officer 1st Class Steven R. Franklin pleaded guilty to.

First, the facts of the case, as reported in The Virginian-Pilot.

The charges stemmed from Franklin’s ignoring written and oral orders not to have unprotected sex. He also was compelled to advise sexual partners that he was HIV-positive and that condoms are not guaranteed to stop the spread of the virus. Franklin, who was diagnosed with HIV in 2003, was reminded of the restrictions every time he visited the HIV clinic at Portsmouth Naval Medical Center, he told the judge. He also signed an order from his commanding officer at the Aviation Intermediate Maintenance Depot in Norfolk in November 2007 pledging to meet those conditions.

Within a few weeks of signing that document, though, Franklin began a new sexual relationship. The couple used condoms for a few weeks but later stopped at Franklin’s request. After the woman learned of his diagnosis, she continued having unprotected sex with him for a few more weeks, according to testimony. The second woman – now his ex-wife – testified at an earlier hearing that she also had unprotected sex with Franklin after learning he was HIV-positive. Neither woman has contracted HIV, according to testimony.

The problem is Cmdr. Carlos’ interpretation of Article 128 of the Uniform Code of Military Justice (assault with a dangerous weapon) as it applies to criminal sexual HIV exposure.

Regardless of the women’s actions, the law does not allow people to consent to a sexual act that could result in “grievous bodily harm,” Carlos explained. Unprotected consensual sex became aggravated assault because of the likelihood it would cause serious harm or death.

That used to be the case, but not any more.

Now, in military law, you cannot consent to aggravated assault. This is due to a 1997 CAAF decision (US v. Bygrave) which held that, in this case, because both women Bygrave had sex with were on active duty there was a compelling Government interest in protecting the health of military personnel negating their informed consent to the risk of HIV transmission.

But a 2006 ruling, upheld in 2008, found that unprotected sex (without disclosure) might not necessarily be aggravated assault if the HIV-positive individual has a low viral load.

Until 2006, the military court’s position on criminal sexual HIV exposure can be summarised in this quote from US vs. Upham (US Coast Guard Court of Criminal Appeals, 2006)

A person who wilfully and deliberately exposes a person to seminal fluid containing HIV without informing that person of his HIV positive status and without using a condom has acted in a manner likely to produce death or grievous bodily harm.

A specific intent to infect a victim with the HIV virus [sic] or to expose the victim to it is not required for this offense. The accused need only have intended to engage in unprotected sexual intercourse to have committed this offense.

The fact that the alleged victim may have consented to sexual intercourse with the accused is not a defencse to aggravated assault. One cannot consent to an act that is likely to produce death or grievous bodily harm.

In 2008, US v. Upham reached the US Court of Appeals for the Armed Forces (CAAF) which upheld the earlier appeal.

The case of Lieutenant Upham involved him having unprotected sex with a fellow (female) officer (Capt B) without disclosing his HIV status. He testified in his original court martial that since his viral load was low (but detectable)

“there was not a risk of zero transmission,” but testified that he did not believe that he had exposed Cpt B to a fatal disease: “I do not believe that she was going to be infected.”
(US v. Upham, CAAF 2008, p5)

The medical witness testified

that given Appelant’s low viral load, “I cannot say he’s not infectious” (R. at 441-42), but that [Capt B]’s risk of contracting HIV was very low (R. at 465)
(US v Upham, US Coast Guard Court of Criminal Appeals 2006, p 3)

However, when the judge gave intructions for the jury he said

A person who wilfully and deliberately exposes a person to seminal fluid containing HIV without informing that person of his HIV positive status and without using a condom has acted in a manner likely to produce death or grievous bodily harm.

The defense objected to this on the grounds that

“these instructions say that [Appellant] is per se guilty of aggravated assault.” The military judge overruled the objection, and said that instruction “accurately state[s] the that exist[s] today.” (US v Upham, CAAF 2008, p6)

In the 2006 appeal, the court concluded

that the error [of giving this instruction] was prejudicial as to the aggravated assault charge: “Given the medical evidence, it is not inconceivable that the court could have had a reasonable doubt on whether the means employed was likely to produce death or grievous bodily harm.” (US v Upham, CAAF 2008, p6)

The legal arguments are long and complex (maybe even too long and complex for me, a non-lawyer), but what I think they are essentially saying is that the risk of HIV transmission with a low (but not even undetectable) viral load might not have been “likely to produce death or grievous bodily harm” and the jury should have been allowed to decide this rather been told that HIV exposure without disclosure (regardless of other facts) is always aggravated assault.

In the end, Lieutenant Upham was found guilty of the lesser charge of “assault consummated by a battery” and had his prison sentence reduced from eight months to four months. In March 2008, the CAAF upheld this appeal. (However, a similar case was rejected by the C.A.A.F. in May 2008, reported on my blog here, and also discussed on another blog concerned with military law here.)

This is all revelant to the current case because The Virginian-Pilot reports

Franklin…told the judge his HIV is well-controlled and the virus is no longer detectable in certain medical tests.

So, his lawyer should have asked, and/or the judge should known, to consider having the charge reduced from aggravated assault to assault consummated by a battery.

And if there is no aggravated assault, than you can consent, particularly since neither of the women that Franklin had sex with were military personnel, negating the compelling Government interest.

Since Franklin pleaded guilty, it’s not clear that he is allowed to appeal. Let’s hope he, or his lawyer, reads this blog, and finds a way to re-open this egregious example of Government intrusion into the private lives of individuals.

US: Padieu case gets the 20/20 treatment; phylogenetic analysis totally misrepresented

The case of Philippe Padieu, the French-born Texan found guilty in May 2009 on six counts of aggravated assault with a deadly weapon and sentenced to 45 years for five counts and 25 years for the remaining count – all of which run concurrently – was featured last Friday night on US ABC TV’s tabloid-style news magazine, 20/20.

Five and half million viewers watched as Mr Padieu faced trial by media yet again. All six parts of the one hour show (actually 39 minutes minus commercials) are available to watch online.

Part 1: Women recall HIV criminal’s allure
Part 2: HIV diagnosis rocks women’s lives
Part 3: Women take matters into own hands
Part 4: HIV serial dater faces victims in court
Part 5: Man convicted of HIV crime speaks
Part 6: Women want case known to protect others

It’s basically sold as the story of a group of scorned women uniting to put Mr Padieu behind bars, summarised beautifully by the accompanying story on the ABC news website headlined, ‘How Women United to Stop HIV-Positive Man, Women’s Horror at Diagnosis Replaced With Mission: Stop Man From Infecting Others.’

There’s so much I could say about the show, which is something of a milestone in criminal HIV transmission reporting in the mainstream media, but I’m going to limit my comments about the very worrying misrepresentation of phylogenetic analysis as ‘proof’ that Mr Padieu was the source of all the women’s HIV infection. Perhaps blog readers could fill in the comments sections with insights and criticisms of their own about this programme.

[Update: Catherine Hanssens of The Center for HIV Law and Policy has some terrific comments and insights in her Sept 29th blog post.]

In Part 4 of the show, presenter/journalist Elizbeth Vargas says that it was Mr Padieu’s “own DNA” that proved he was guilty. But phylogenetic analysis is all about testing the genetics of HIV, not the individual. They then showed one of the US’s foremost experts in HIV forensics, Dr Michael L Metzker, of Baylor College of Medicine, Houston, Texas, who testified for the prosecution that Mr Padieu’s virus was extremely similar to that of the six women. Except here he says definitively that Mr Padieu was “the source” of the six women’s HIV. I’ve written about the limitations of phylogenetic analysis many times: the issues are summarised here.

In the final part of the show, we are introduced to ‘Lisa’ who dated Mr Padieu in 1997, and was diagnosed HIV-positive that same year. The show gives Dr Metzker a sample of Lisa’s blood and he says that “preliminary analysis” suggests that Mr Padieu was the source of all seven women’s HIV infection. The show concludes that Mr Padieu “gave Lisa HIV in 1997” and goes on to suggest, without a shred of evidence, that he had been diagnosed earlier than 2005 and knowingly infected Lisa and possibly hundreds of other women.

I’m extremely disappointed in Dr Metzker for totally misrepresenting what phlyogenetic analysis can prove. It is impossible to conclude, given the many limitations of phylogenetic analysis, that Mr Padieu infected Lisa in 1997. It is, in fact, just as possible that Lisa infected Mr Padieu.

I don’t expect 20/20 to explain the science (in fact, I expect them to get it wrong), but I do expect Dr Metzker, who is (was?) considered to be a respected scientist, to be less definitive about his conclusions. Maybe Dr Metzker would like to explain how he could be so sure – it would be very helpful to know if he has developed new, as yet unknown, techniques in phylogenetic analysis that can definitively pinpoint timing and direction of transmission.

Switzerland: Federal Court confirms Geneva HIV exposure acquittal, but does not mention viral load (updated)

UPDATE July 8th 2009

The Federal Court has now confirmed the recent HIV exposure acquital in Geneva, but shied away from explicitly discussing the link between an undetectable viral load and risk of transmission. In effect: they lacked the courage to change HIV exposure law throughout Switzerland.

According to AIDS Geneva’s Deborah Glejser, the Federal Court upheld the Geneva court’s finding that HIV exposure charges were no longer possible because the two female complainants were not exposed to HIV, but they did not actually discuss why this was the case (i.e. because the defendent was on effective treatment).

A brief report (in French) on 20minutes online, notes that the Federal Court emphasized that the women were not infected with HIV during unprotected sex and accordingly are not considered by the criminal courts to be victims. They could have sued for psychological harm in the civil court, but didn’t, and so “in the absence of such a request, their action can only be ruled inadmissible.”

Deborah Glejser tells me that she is extremely disappointed in the Federal Court since this was “a great opportunity missed.” Although HIV exposure remains no crime in Geneva, it will now be down to individual cases – and prosecutors as forward-thinking as Yves Bertossa – to change the law in Switzerland’s 25 other cantons.

ORIGINAL POSTING July 1st 2009

Video and reports (in French) are now available following the May 18th meeting convened by Group SIDA Geneve (AIDS Geneva) featuring a discussion between Professor Pietro Vernazza, President of the Swiss Federal AIDS Commission (which produced the January 2008 ‘Swiss statement’ on infectiousness) and Yves Bertossa, Geneva’s deputy public prosecutor, (who pushed for the recent HIV exposure acquital in Geneva), moderated by AIDS Geneva’s Deborah Glejser.

The meeting highlighted the importance of the Geneva court’s ruling that an HIV-positive person on successful treatment, with an undetectable viral load, and no other STI, could not possibly be guilty of exposing another person to HIV if they had not disclosed their status before having unprotected sex.

The Geneva judgement has now been appealed by the complainant which means it will now be heard by the Federal Court, Switzerland’s highest court. Mr Bertossa appeared confident that the Federal Court would confirm the acquittal, making the ruling relevant throughout Switzerland (and possibly providing more legal ammunition for other jurisdictions).

Highlights of the meeting are available to watch on the AIDS Geneva blog. The meeting also received mainstream coverage, including a report in L’Hebdo (Switzerland’s answer to Time or Newsweek) and in the main Geneva broadsheet, L’evenement.

US: Texan man found guilty of aggravated assault with a deadly weapon for reckless HIV transmission

A Texas jury has found 53 year-old Philippe Padieu of Frisco, Texas, guilty of six counts of aggravated assault with a deadly weapon. He is the sixteenth person with HIV in Texas to be successfully prosecuted for either HIV exposure or transmission since 1997.

Update: May 30th.

Original posting, from May 28th, below:

Mr Padieu was arrested in July 2007 after two women went to police after testing HIV-positive . The police investigation led to four further complainants.

The case has had widespread media coverage throughout the United States, highlighted in today’s Dallas Morning News story summarising the trial.

After five hours of deliberations, the [jury’s] guilty verdicts were read in a large ceremonial courtroom where the trial was moved to accommodate local and national TV crews covering the case, including ABC’s 20/20.

Prosecutors likened Mr Padieu to a “ticking time bomb, a lethal weapon.”

“It’s as if he took a gun and shot all of them,” prosecutor Lisa King said during closing arguments earlier in the day. “But a gunshot wound heals. In this case, he gave them a virus that causes a disease that may well kill them.”

[Assistant District Attorney Curtis] Howard said, Padieu is “a ticking time bomb, he’s a lethal weapon,” and he likened Padieu to Typhoid Mary. He told jurors that Padieu broke the law by knowingly, recklessly and intentionally having sex with multiple women, exposing them to HIV, the virus that causes AIDS, without telling them.

His defence attorny, Bennie House, argued that Mr Padieu was in denial and that the six female complainants should have protected themselves knowing that unprotected sex can result in the transmission of sexually transmitted infections.

“They asked Mr. Padieu if he was safe, he said yes,” said House. “He’s in denial.” He added, “Mr. Padieu is not a predator. … He likes sex…House said his client’s partners had a responsibility to practice safe sex. “They should have invoked a mantra – no glove, no love,” House said. “If that didn’t happen, they should walk out.”

Another of Mr Padieu’s defence lawyer, George A. Giles, argued – rather unsuccessfully given the many previous Texan convictions for HIV-positive bodily fluids being classed as deadly weapons, including Willy Campbell, who was sentenced to 35 years for spitting at a cop – that Texan law did not specifically say that his client had committed aggravated assault.

[He said that] what Padieu did does not constitute aggravated assault. He suggested that prosecutors go to Austin to lobby for changes in the law if they want to use the criminal code to address the practice of unsafe sex by someone with HIV. “When does he have to tell them or anybody he’s got a disease?” Giles said.

However, since the law in Texas is not HIV-specific, the bar was set much higher for the prosecution to prove that Mr Padieu actually infected the six women. They used one of the US’s foremost experts in HIV forensics, Dr Michael L Metzker, of Baylor College of Medicine, Houston, Texas, to testify that Mr Padieu’s virus was extremely similar to that of the six women, although he came to a conclusion that may not have been totally scientific.

The news website of NBC Dallas Fort/Worth reported:

He said he used a national database of HIV positive blood samples and compared the samples taken from Padieu and his six alleged victims. In what was called a blind study, Metzker never knew who each sample belonged to.

“I wanted anonymous samples,” he said. “I did not want to know the identity of any of the individuals, we treated them all equally, generated the data, generated the alignments.”

Metzker said Padieu is the source of his accusers’ infection.

“One sample stood out as the potential source of most, if not all, of the other samples,” he explained.

However, Padieu’s attorneys got Metzker to admit that the study reaches a conclusion, but cannot be called an absolute fact.

The defense is focusing on the fact that HIV can mutate and change over time.

Mr Padieu will be sentenced tomorrow (Friday May 29th). He faces sentencing that ranges from five to 99 years in prison on each of the six counts.

UK: Gonorrhoea prosecution ‘a dangerous development’

I am posting an excellent analysis by Dr Matthew Weait, Senior Lecturer in Law and Legal Studies at Birkbeck College, London (and author of Intimacy and Responsibility: The Criminalisation of HIV Transmission) of the recent successful prosecution of a male migrant for ‘recklessly’ transmitting the sexually transmitted infection, gonorrhoea, through non-sexual means.

A Dangerous Development
by Dr Matthew Weait
Senior Lecturer in Law and Legal Studies
Faculty of Lifelong Learning
Birkbeck College, London

In the recent case of R v Peace Marangwanda [2009] EWCA Crim 60, the English Court of Appeal was called upon to hear an appeal against sentence that has potentially profound implications for debates surrounding the criminalisation of HIV and other serious sexually transmissible infections. Summarised, the facts were that the applicant (PM) had been charged with two offences of sexual activity with a child, contrary to section 9(1) and (2) of the Sexual Offences Act 2003. It had been alleged that PM had met the mother of the children (E and Z), started a relationship and moved in with her in September 2005. In November 2005 PM was diagnosed with gonorrhoea, and he received treatment. A month later, in December 2005, the children, E and Z, were diagnosed as having contracted gonorrhoea. PM was charged, prosecuted and tried in 2007 after E made a complaint fo sexual abuse. The jury could not agree on a verdict after hearing PM’s defence that he was not suffering from gonorrhoea at the relevant time, and that it was rather a severe from of thrush. A retrial was scheduled to take place in June 2007. Prior to the retrial a compromise was suggested by defence counsel whereby PM would plead guilty to two counts of recklessly inflicting grievous bodily harm contrary to section 20 of the Offences Against the Person Act 1861. on the basis that he had recklessly transmitted gonorrhoea to E and Z.

The plea was entered

“ … on the basis that the Defendant, whilst possessed of the knowledge that he was suffering from gonorrhoea, recklessly passed on the said gonorrhoea to the two complainants.

2. Such transmission was carried our not in any way by means of any sexual contact, direct or indirect. Such transmission was likely to have been occasioned in circumstances where the Defendant, after having touched himself and then failing to apply the proper hygiene standards, has then gone on to touch the children in an ordinary way. The Defendant would, on occasion, be involved in the daily care of the two young Complainants. This would include assisting with washing, dressing and general supervisory activities with the same.

3. It was foreseeable that such a condition as gonorrhoea could have been passed and accordingly the Defendant failed in ensuring that he adhered to the proper sanitary and hygienic principles which would have been ordinarily implied.”

PM was sentenced to two years immediate imprisonment on each count, to be served concurrently. He was also recommended for deportation, disqualified from working with children for life and made subject of a Sexual Offences Prevention Order.

PM appealed on a number of grounds, one of which was that he had pleaded guilty to offences that were not medically possible and another that, even if it were medically possible, he had not acted recklessly. (The two other grounds are not of such immediate relevance here and are not discussed – see the case report.) The Court of Appeal agreed that the sentence passed was manifestly excessive and that a sentence of 12 months on each count should have been passed, to be served concurrently. For legal reasons this meant that the order relating to not being able to work with children was quashed, but the other orders were upheld.

Discussion

This is an important and worrying decision for a number of reasons. The plea of guilty to the charges under section 20 were entered on the understanding that the gonorrhoea had been passed through casual touching. PM, it was accepted, cared for E and Z (which included physical touching). The pre-sentence report (which is prepared to assist the judge in sentencing) stated that

“The defendant has pleaded guilty to the offence in accordance with the basis of plea, namely that he inadvertently passed on gonorrhoea to the two children due to poor personal hygiene.

Mr Marangwanda was, at the time of the offence, in a relationship with the mother of the two victims. He was periodically living at the family home and as such will have regular conduct with the children.

The defendant accepts culpability in as much as he acknowledges he passed on the sexually transmitted infection to the two girls due to poor personal hygiene.

…

The defendant accepts that his behaviour was reckless and that as a result, two young children contracted a sexually transmitted infection.”

It was on this basis that PM was sentenced, and the Court of Appeal accepted the reasoning. It states (at paragraph 12) that

In the judgment of this court, by his plea, the defendant accepted the medical possibility of the transmission of that disease. As he knew he had gonorrhoea, provided he knew that that disease may be transmitted by transference of mucosa by hand, that transference would have constituted a reckless act …

The Court goes on to say (at para 13) that

… by virtue of the basis of plea and the applicant’s pleas, he must have been accepting the possibility that in a domestic or familial setting the disease could have been transferred. In such circumstances it would have been his duty to take the necessary protection to ensure there was no transference. We are not persuaded that there is anything in that ground of appeal.

This is, it is suggested, deeply problematic, as are other aspects of the case. First, the Court seems to be suggesting that there is a duty to take the necessary protection against the transmission of disease. With respect, there exists no such legal duty anywhere in English law. A person is not reckless because he fails to take precautions against transmission; he is reckless if it is established that he was aware of the risk of transmission. This might seem a fine distinction , but it is an important one. If the Court is thinking particularly of the positive obligation that a carer has towards children, then it should have articulated that far more clearly. In the absence of clarification it suggests that a person living with HIV has a positive obligation – enforceable at law – to prevent onward transmission to sexual partners. (And, in the light of the recent Hep B case, that those infected with Hep B may have a positive obligation to alert others not to share their razors, for example). This goes beyond the principles established in R v Dica and R v Konzani. The CPS Guidelines on prosecuting cases involving the sexual transmission of disease indicate that the appropriate use of condoms by a person living with HIV would ordinarily preclude a finding of recklessness – they do not (because the law does not require it) state that a person living with HIV is under an obligation to use a condom (or, of course, to disclose status).

Another problematic aspect of the decision is that appears to be a bad compromise. The plea was entered and accepted in part, it seems, to prevent E (the child complainant) to have to give evidence at a retrial. It is for this reason that what would otherwise have been a case involving alleged sexual offences was transmuted into one concerning offences against the person. This was arguably artificial, and (as the discussion above about the Court of Appeal’s comments about the nature of PM’s duty shows) has resulted in – it is suggested – flawed reasoning.

Finally, although it wasn’t addressed in the Court of Appeal’s judgment, there remains the question of knowledge and scientific evidence of transmission. What follows is speculative in the instant case, but important, I think, to bear in mind.

1. PM moved in with E and Z and their mother in September 2005. He was diagnosed with gonorrhoea in November 2005 and the children in December 2005. If there is any possibility that PM may have infected E and Z prior to his diagnosis, and before he had any reason to believe that he might be suffering from gonorrhoea, there was no case to answer (see R v Dica; R v Konzani).
2. If, as the Court of Appeal accepted (albeit because of the “artificial” nature of the settlement that was reached on plea to avoid retrial) that gonorrhoea may be spread manually as the result of poor manual hygiene, then questions should have been raised as to the possibility that the source of the infection may have been elsewhere. There appears to have been no scientific evidence adduced, and the prosecution did not – it appears – seek any. The CPS Guidelines make it clear that there needs to be compelling proof that the defendant is the source of a complainant’s infection – and (critically) that a guilty pleas should not be accepted unless the prosecution believes that there is sufficient evidence to prosecute. Cases involving HIV transmission have fallen because of this.

The Marangwanda case is unfortunate because it appears to be yet another example of the ways in which the ill-thought out approach of the courts to liability for the transmission of sexually transmissible diseases can – in the absence of clear thinking and understanding – have unintended effects.

Matthew Weait
23rd April 2009