Ethiopia: New report on HIV criminalisation law with a focus on Ethiopia concludes that the use of criminal law to address HIV is anappropriate

Abstract

States ever since the outbreak of HIV/AIDS have been using different methods in order to combat the pandemic if possible and to reduce vulnerability. In spite of this, HIV/AIDS continues to be prevalent especially in a less developed countries to the extent that it to be hurdle for development. Criminalization of HIV/AIDS patients is one of the mechanisms that are used in the fight against the deadly disease. However, employing criminalization as prevention and vulnerability reduction strategy poses a question and stimulates a debate. Hence, the main thrust of this article is to identify this challenge and to assess whether criminalization of HIV/AIDS patients reduce vulnerability to HIV/AIDS. This being the aim it will also go on to analyze the role of criminal law in a public health issue. In doing so, the article will discuss experience of countries in criminalization of HIV/AIDS patients along side with international frameworks. At a glance, criminal law through a vehicle of punishment seems to play a role in reducing vulnerability to HIV/AIDS but, the writer based on the analyses of relevant literature and experiences of countries, argues that the use of criminal law to address HIV is inappropriate except in rare cases where a person acts with conscious intent to transmit HIV and does so, and this is because of the high degree of proof required in criminal case and the difficulty of using criminal law in HIV related issue due to the nature of the disease and the absence of technology used for the required proof in the criminal law, i.e. beyond reasonable doubt.

Ekubu, Y. (2016) Reducing Vulnerabilities to HIV: Does the Criminalization of HIVAIDS Patients Contribute?. Beijing Law Review, 7, 292-313. doi: 10.4236/blr.2016.74027.

The report can be downloaded here

US: New Report from the William Institute finds HIV criminalisation laws in California do not reflect medical science

LOS ANGELES — In California, outdated HIV criminalization laws do not reflect the highly effective medical advances for reducing the risk of HIV transmission and extending the quantity and quality of life for people living with HIV.

HIV criminalization is a term used to describe laws that either criminalize otherwise legal conduct or that increase the penalties for illegal conduct based upon a person’s HIV-positive status. California has four HIV-specific criminal laws.

In HIV Criminalization in California: Evaluation of Transmission Risk, researchers Amira Hasenbush and Dr. Brian Zanoni suggest that these HIV criminal laws in California are not in line with medical science and technology related to HIV and may, in fact, work against best public health practices.

“Nine out of ten convictions under an HIV-specific criminal law or sentence enhancement have no proof of exposure to HIV, let alone transmission,” said Amira Hasenbush. “No HIV criminal laws in California require transmission for a conviction.”Key findings include:

From 1988 until June 2014, 379 incidents resulted in convictions for an HIV-specific felony or sentence enhancement.
- Of those, 100 percent required no actual transmission of HIV.
- 98 percent did not require intent to transmit HIV.
- 93 percent involved no specific allegation of conduct that is likely to have transmitted the virus:
  - Ninety percent of convictions were in solicitation incidents in which it is unknown whether any contact beyond a conversation or an exchange of money was initiated, thus possibly not having any exposure to HIV.
  - Three percent of incidents involved oral sex, a sex act whose transmission risk is estimated as “low” by the CDC.
  - Only seven percent of incidents involved vaginal or anal sex by definition of the crime.

HIV criminal laws have been disproportionately applied to sex workers. This has a disproportionate impact on women and people of color. Since solicitation by definition includes survival and subsistence sex work, these laws are also likely to disproportionately impact LGBT youth and transgender women of color.

Laws that criminalize conduct of a person who knows that they are HIV-positive may disincentivize testing and work against best public health practices.

The Williams Institute, a think tank on sexual orientation and gender identity law and public policy, is dedicated to conducting rigorous, independent research with real-world relevance.

Full report can be read here

Social Science Update: Where criminalisation of sex work intersects with HIV criminalisation

In this article, authors Sienna Baskin, Aziza Ahmed, and Anna Forbes examine the interlocking webs of anti-prostitution laws and HIV criminalisation. Throughout the piece, the authors demonstrate critical research ethics by taking, as their starting point, the lives, freedom, and dignity of sex workers living with HIV.

Baskin et al. describe the ways in which, for sex workers, criminalisation is about so much more than the simple existence of laws. Instead, it is the particular policing and prosecutorial practices in a jurisdiction, based on the laws in place, that shape the lives of sex workers.

Similar to HIV-specific criminal laws, laws criminalising sex work are generally broadly written and arbitrarily enforced, enabling systemic discrimination and bias to turn into prosecutions of people of color and poor people.

The authors detail the consequences of arrest and prosecution that are frequently ignored in discussions of the criminal laws, including violence at the hands of police and fellow inmates, costly fees, possible loss of custody of one’s children, loss of employment and housing, and even loss of the right to sue police for violence that the police enact against sex workers in custody.

When HIV ‘exposure’ is also a crime in a state, then the legal penalties for sex work become even more harmful. If a sex worker is living with HIV, then she or he more often faces a felony rather than misdemeanor charge.

Using public health law mapping, the authors examine the US states that have HIV-specific criminal laws, laws criminalising sex work while living with HIV, and court-imposed mandatory HIV testing for people accused or convicted of sex work.

Baskin et al. find tremendous variety in the legislation from differences in when and how mandatory testing is conducted, to whom HIV test results are revealed, to how the results are used in court.

Of the approximately 32 U.S. states that criminalise HIV ‘exposure’, 14 have specific penalties for HIV-positive sex workers. Eleven states require mandatory HIV testing of sex workers and have enhanced sex work penalties for those living with HIV. Further, those prosecuted for sex work while living with HIV can be prosecuted under general (non HIV-specific) laws in any state.

To be prosecuted in eight states, sexual contact need never occur. People need only to be considered to be “loitering” or to make an offer for sexual services. In ten states, laws mandate testing of those prosecuted for sex work and provide enhanced penalties for those who engage in sex work who are living with HIV. In these states, any arrest after the first arrest (and related mandatory testing) leads to an almost automatic conviction. The HIV testing results become part of the person’s court files.

Noting that, 30 years into the HIV epidemic, there is no evidence that criminal law approaches have any positive effect on HIV prevention, the authors contend that criminalising sex work serves only to harm and discriminate against vulnerable populations and to perpetuate the HIV epidemic.

Details

Criminal Laws on Sex Work and HIV Transmission: Mapping the Laws, Considering the Consequences, by Sienna Baskin, Aziza Ahmed, and Anna Forbes (link to pdf download)

Denver Law Review, Volume 93:2, 355-388, Published: 2016

Social Science Update: Review of HIV criminalisation research in the US, 1990-2014

An article reviewing 15 years of U.S.-based social science research on HIV criminalisation was published in the September 2016 issue of AIDS and Behavior. The research team, led by Dini Harsono of Yale University’s Center for Interdisciplinary Research on AIDS (CIRA), Criminalization of HIV Exposure Work Group, described results from twenty-five research studies conducted in the US from 1990-2014. Studies were conducted with women and men living with HIV, gay men and other men who have sex with men (HIV-positive and –negative), public health workers, and medical providers.

Across the studies, the authors found that, while awareness of HIV exposure laws was generally low, attitudes were generally supportive of criminalisation.[1] The studies showed little to no relationship between the existence of laws and decisions to disclose one’s positive HIV status or to test for HIV. The clearest relationships between stigma and HIV non-disclosure laws could be found from the Sero Project study findings that people living with HIV expect to be treated with bias in the courts simply because of their HIV status. The authors call for future studies to pay more attention to health outcomes, rather than attitudes, and to more closely research prosecution and enforcement practices.

For a global overview of HIV criminalisation research, see O’Byrne et al. (2013). “HIV criminal prosecutions and public health: an examination of the empirical research.”

Details

Criminalization of HIV Exposure: A Review of Empirical Studies in the United States, by Dini Harsono, Carol L. Galletly, Elaine O’Keefe, Zita Lazzarini. AIDS Behavior. DOI 10.1007/s10461-016-1540-5. Published online: 7 Sept 2016.

[1] Although the Sero Project study (2012) was included in the research review, one key set of findings was not discussed. In the Sero Project study, support for criminalisation dramatically declined when survey respondents were provided additional response options (beyond only the choice to support criminalization or not) in survey questions.

Criminalization of HIV Exposure: A Review of Empirical Studies in the United States

Australia: Despite absence of risks, mandatory HIV testing of people who spit at police officers will remain

Police Minister Liza Harvey says the government stands by it’s mandatory blood test laws for offenders who spit at police officers.

On Friday leading HIV experts criticized the 2014 law brought in by the Barnett Government saying it had no basis in scientific fact.

Currently an offender who spits at a police officer can be forced to have a blood test to see if they are carrying the HIV virus.

Delegates at the Australasian HIV & AIDS Conference said they had “profound disappointment” in state government’s that brought in laws forcing blood tests for offenders who spit at police.

Scientists say its not possible for the HIV virus to be transmitted via saliva.

“Australia has a proud record of basing its HIV response on evidence-based policy,” Associate-Adjunct Professor Levinia Crooks, CEO of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) said yesterday.

“These laws are anti-scientific. The risk of transmission of HIV or other blood-borne viruses from saliva is practically zero. There is no justification for invading the privacy of people in custody by forcing them to undergo blood tests when there is no risk to the officer.”

“We understand the considerable risks faced by police and emergency services when they go about their jobs, but this is not the solution. There has never been a case of HIV transmission from spitting or biting in Australia,” she said.

Harvey, who is the Deputy Premier and Minister for Police, said the Barnett government has listened to the concerns of police officers and brought in the laws for their protection.

“The Liberal National Government had listened to the concerns of police officers.” the Minister said, arguing that in 2013 there had been a high level of instances where police could have potentially been exposed to infectious diseases.

“In 2013, 147 police were exposed to bodily fluids in a way that they could contract an infectious disease.

“This legislation allows for the taking of blood samples from the offender which helps in diagnosis, clinical management and treatment of the exposed police officer.

Minister Harvey said people were only forced to have a blood test when there was a possibility that an officer may have been exposed to infection.

“The testing will only happen if there is a possibility of the transfer of an infectious disease – for example the transfer of bodily fluid through broken skin.” Minister Harvey told OUTinPerth. “We are committed to protecting our officers on the front line, who are committed to protecting us.”

Published in Out in Perth

Australia: Delegates at Australia’s national HIV/AIDS conference condemn antiscientific laws mandating HIV testing for people accused of spitting at police officers

Media Release

Adelaide: Friday, 18 November 2016

Delegates at Australia’s national HIV/AIDS conference have condemned the governments of South Australia, Western Australia and Northern Territory over laws that force people accused of criminal offences to undergo mandatory HIV and blood-borne virus testing.

The conference passed a resolution this afternoon expressing its ‘profound disappointment’ in the laws, which make it mandatory for people to undergo blood tests if they are accused of spitting on or biting law enforcement personnel. The laws were passed in South Australia and Western Australia in 2014, and in the Northern Territory in 2016.

Australia has a proud record of basing its HIV response on evidence-based policy,” said Adjunct Associate Professor Levinia Crooks CEO of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM). “These laws are antiscientific — the risk of transmission of HIV or other blood-borne viruses from saliva is practically zero. There is no justification for invading the privacy of people in custody by forcing them to undergo blood tests when there is no risk to the officer.”

The full text of the resolution passed by the conference is:

As researchers, clinicians, and civil society representatives, we are united in our commitment to a HIV response grounded in evidence and protective of the human rights of people living with and affected by HIV. This conference expresses its profound disappointment in the governments of South Australia, Western Australia and the Northern Territory for enacting anti scientific and counterproductive laws mandating HIV testing for people accused of spitting on law enforcement personnel, in the face of overwhelming evidence that such laws are neither effective nor necessary. HIV is not transmitted in saliva and these laws only serve to further marginalise and criminalise people with HIV. We call on all governments to establish evidence-based protocols that protect the wellbeing of police and emergency workers and the rights of people living with HIV.

The Australasian HIV & AIDS Conference is the premier medical/scientific conference in the Australasian HIV and related diseases sector. The 2016 Conference was held in Adelaide from 16–18 November, in conjunction with the Australasian Sexual Health Conference.

For all media enquires, please contact:

Media Contact: Petrana Lorenz — 0405 158 636 | petrana@arkcommunications.com.au

US: American Association of Nurses in AIDS Care publishes new Clinician Guidelines to HIV Criminalization

ANAC believes HIV criminalization laws and policies promote discrimination and must be reformed. The American Nurses Association (ANA) has co-endorsed ANAC’s position statement opposing HIV criminalization and joined ANAC in calling for the end to unjust laws that criminalize HIV. Thirty three states still have laws criminalizing HIV exposure. These laws fuel stigma by institutionalizing discrimination and are based on outdated beliefs. People living with HIV are still being arrested for HIV exposure. ANAC is a member of the Positive Justice Project, a national coalition to end HIV criminalization in the U.S. Read ANAC’s policy statement calling for the modernization of HIV Criminalization laws.

ANAC, with support from the Elton John AIDS Foundation has developed a downloadable tool: Clinician Guidelines to HIV Criminalization.

Download the clinician guidelines here.

BEYOND BLAME
Challenging HIV Criminalisation @ AIDS 2016, Durban

(29 min, HJN, South Africa, 2016)

On 17 July 2016, approximately 150 advocates, activists, researchers, and community leaders met in Durban, South Africa, for Beyond Blame: Challenging HIV Criminalisation – a full-day pre-conference meeting preceding the 21st International AIDS Conference (AIDS 2016) to discuss progress on the global effort to combat the unjust use of the criminal law against people living with HIV.

Attendees at the convening hailed from at least 36 countries on six continents (Africa, Asia, Europe, North America, Oceania, and South America).

Beyond Blame was convened by HIV Justice Worldwide, an initiative made up of global, regional, and national civil society organisations – most of them led by people living with HIV – who are working together to build a worldwide movement to end HIV criminalisation.

The meeting was opened by the Honourable Dr Patrick Herminie, Speaker of Parliament of the Seychelles, and closed by Justice Edwin Cameron, both of whom gave powerful, inspiring speeches. In between the two addresses, moderated panels and more intimate, focused breakout sessions catalysed passionate and illuminating conversations amongst dedicated, knowledgeable advocates

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

By Simon Collins, HIV i-Base

Tuesday 12 July 2016

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

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

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

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

Methods

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

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

Results

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

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

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

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

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

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

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

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

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

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

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

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

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

comment

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

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

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

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

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

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

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

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

Reference

Rodger AJ et al for the PARTNER study group. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA, 2016;316(2):1-11. DOI: 10.1001/jama.2016.5148. (12 July 2016). Full free access.
http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2016.5148
PARTNER study, supplementary material. JAMA (16 July 2016).
i-Base Q&A from the study.
http://i-base.info/qa-on-the-partner-study/
PARTNER2 website.
http://www.chip.dk/PARTNER-2

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

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

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

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

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

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

Thanks to Nova Scotia judges, science might finally prevail.

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

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

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

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

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

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

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