Canada: Review undertaken as part of government’s examination of HIV nondisclosure laws confirms risk of sexual transmission when viral load is suppressed is virtually zero

Risk of sexual transmission of human immunodeficiency virus with antiretroviral therapy, suppressed viral load and condom use: a systematic review

Abstract

Background: The Public Health Agency of Canada reviewed sexual transmission of HIV between serodiscordant partners to support examination of the criminal justice system response to HIV nondisclosure by the Department of Justice of Canada. We sought to determine HIV transmission risk when an HIV-positive partner takes antiretroviral therapy, has a suppressed viral load or uses condoms.

Methods: We conducted an overview and systematic review update by searching MEDLINE and other databases (Jan. 1, 2007, to Mar. 13, 2017; and Nov. 1, 2012, to Apr. 27, 2017, respectively). We considered reviews and studies about absolute risk of sexual transmission of HIV between serodiscordant partners to be eligible for inclusion. We used A Measurement Tool to Assess Systematic Reviews (AMSTAR) for review quality, Quality in Prognosis Studies (QUIPS) instrument for study risk of bias and then the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence across studies. We calculated HIV incidence per 100 person-years with 95% confidence intervals (CIs). We assigned risk categories according to potential for and evidence of HIV transmission.

Results: We identified 12 reviews. We selected 1 review to estimate risk of HIV transmission for condom use without antiretroviral therapy (1.14 transmissions/100 person-years, 95% CI 0.56–2.04; low risk). We identified 11 studies with 23 transmissions over 10 511 person-years with antiretroviral therapy (0.22 transmissions/ 100 person-years, 95% CI 0.14–0.33; low risk). We found no transmissions with antiretroviral therapy and a viral load of less than 200 copies/mL across consecutive measurements 4 to 6 months apart (0.00 transmissions/100 person-years, 95% CI 0.00–0.28; negligible risk regardless of condom use).

For full study see: http://www.cmaj.ca/content/190/46/E1350

Bringing Science to Justice: End HIV Criminalisation Now

News Release

Networks of people living with HIV and human rights and legal organisations worldwide welcome the Expert Consensus Statement on the Science of HIV in the Context of Criminal Law

Amsterdam, July 25, 2018 — Today, 20 of the world’s leading HIV scientists released a ground-breaking Expert Consensus Statement providing their conclusive opinion on the low-to-no possibility of a person living with HIV transmitting the virus in various situations, including the per-act transmission likelihood, or lack thereof, for different sexual acts. This Statement was further endorsed by the International AIDS Society (IAS), the International Association of Providers of AIDS Care (IAPAC), the Joint United Nations Programme on HIV/AIDS (UNAIDS) and 70 additional experts from 46 countries around the world.

The Expert Consensus Statement was written to both assist scientific experts considering individual criminal cases, and also to urge governments and criminal justice system actors to ensure that any application of the criminal law in cases related to HIV is informed by scientific evidence rather than stigma and fear. The Statement was published in the peer-reviewed Journal of the International AIDS Society (JIAS) and launched at a critical moment during the 22nd International AIDS Conference, now underway.

“As long-time activists who have been clamouring for a common, expert understanding of the current science around HIV, we are delighted with the content and widespread support for this Statement,” said Edwin J Bernard, Global Co-ordinator of the HIV Justice Network, secretariat to the HIV JUSTICE WORLDWIDE campaign. “Eminent, award-winning scientists from all regions of the world have come together to provide a clarion call for HIV justice, providing us with an important new advocacy tool for an HIV criminalisation-free world.”

The Statement provides the first globally-relevant expert opinion regarding individual HIV transmission dynamics (i.e., the ‘possibility’ of transmission), long-term impact of chronic HIV infection (i.e., the ‘harm’ of HIV), and the application of phylogenetic analysis (i.e., whether or not this can be used as definitive ‘proof’ of who infected whom). Based on a detailed analysis of scientific and medical research, it describes the possibility of HIV transmission related to a specific act during sexual activity, biting or spitting as ranging from low to no possibility. It also clearly states that HIV is a chronic, manageable health condition in the context of access to treatment, and that while phylogenetic results can exonerate a defendant when the results exclude them as the source of a complainant’s HIV infection, they cannot conclusively prove that one person infected another.

“Around the world, we are seeing prosecutions against people living with HIV who had no intent to cause harm. Many did not transmit HIV and indeed posed no actual risk of transmission,” said Cécile Kazatchkine, Senior Policy Analyst with the Canadian HIV/AIDS Legal Network, a member and key partner organisation of the HIV JUSTICE WORLDWIDE campaign. “These prosecutions are unjust, and today’s Expert Consensus Statement confirms that the law is going much too far.”

Countless people living with HIV around the world are currently languishing in prisons having been found guilty of HIV-related ‘crimes’ that, according the Expert Consensus Statement, do not align with current science. One of those is Sero Project Board Member, Kerry Thomas from Idaho, who says: “I practiced all the things I knew to be essential to protect my sexual partner: working closely with my doctor, having an undetectable viral load, and using condoms. But in terms of the law, all that mattered was whether or not I disclosed. I am now serving a 30-year sentence.”

While today’s Statement is extremely important, it is also crucial to recognise that we cannot end HIV criminalisation through science alone. Due to the numerous human rights and public health concerns associated with HIV criminalisation, UNAIDS, the Global Commission on HIV and the Law, the UN Committee on the Elimination of Discrimination against Women, and the UN Special Rapporteur on the Right to Health, among others, have all urged governments worldwide to limit the use of the criminal law to cases of intentional HIV transmission. (These are extremely rare cases wherein a person knows their HIV-positive status, acts with the intention to transmit HIV, and does in fact transmit the virus.)

We must also never lose sight of the intersectional ways that — due to factors such as race, gender, economic or legal residency status, among others — access to HIV treatment and/or viral load testing, and ability to negotiate condom use are more limited for some people than others. These are also the same people who are less likely to encounter fair treatment in court, within the medical system, or in the media.

“Instead of protecting women, HIV criminalisation places women living with HIV at increased risk of violence, abuse and prosecution,” says Michaela Clayton, Executive Director of the AIDS and Rights Alliance for Southern Africa (ARASA). “The scientific community has spoken, and now the criminal justice system, law and policymakers must also consider the impact of prosecutions on the human rights of people living with HIV, including women living with HIV, to prevent miscarriages of justice and positively impact the HIV response.”

HIV criminalisation is a pervasive illustration of systemic discrimination against people living with HIV who continue to be stigmatised and discriminated against on the basis of their status. We applaud this Statement and hope it will help end HIV criminalisation by challenging all-too-common mis-conceptions about the consequences of living with the virus, and how it is and is not transmitted. It is indeed time to bring science to HIV justice.

To read the full Expert Consensus Statement, which is also available in French, Spanish and Russian in the Supplementary Materials, please visit the Journal of the International AIDS Society at https://onlinelibrary.wiley.com/doi/full/10.1002/jia2.25161

VIsit the HIV JUSTICE WORLDWIDE website to read a short summary of the Expert Consensus statement here: http://www.hivjusticeworldwide.org/en/expert-statement/

To understand more about the context of the Expert Consensus Statement go to: http://www.hivjusticeworldwide.org/en/expert-statement-faq/

HIV JUSTICE WORLDWIDE is a growing, global movement to shape the discourse on HIV criminalisation as well as share information and resources, network, build capacity, mobilise advocacy, and cultivate a community of transparency and collaboration. It is run by a Steering Committee of ten partners – AIDS Action Europe, AIDS-Free World, AIDS and Rights Alliance for Southern Africa (ARASA), Canadian HIV/AIDS Legal Network, Global Network of People Living with HIV (GNP+), HIV Justice Network, International Community of Women Living with HIV (ICW), Southern Africa Litigation Centre (SALC), Sero Project, and Positive Women’s Network – USA (PWN-USA) – and currently comprises more than 80 member organisations internationally.

UK: Avon & Somerset police withdraw untrue claims that HIV could be contracted through spitting

Police finally change false HIV claims after being accused of ‘preying on people’s prejudices’

Avon and Somerset Police falsely claimed that HIV could be transferred through saliva

Bristol’s police force has finally changed untrue claims it made about HIV, eight months after it was accused of “preying on people’s prejudices.”

Avon and Somerset Police announced last November that it would be rolling out controversial spit hoods to be used on suspects to protect officers.

But during the announcement, the force made untrue claims that HIV could be contracted through spitting, causing outrage amongst campaign groups.

The force did apologise for “any offence caused” to anyone living with HIV, but then repeated the claim that Human Immunodeficiency Virus (HIV) can be transferred through spit.

Now eight months after police made the claim, Avon and Somerset Constabulary has now confirmed that HIV will not be used as a reason to introduce spit guards after national guidance was changed.

Assistant Chief Constable Steve Cullen said: “I’d like to thank both charities and our communities for the advice and feedback they gave us following our announcement last year.

“We apologised unreservedly at the time if we caused any offence to people living with HIV.

“It has never been our intention to reinforce stigma. Every day we work to reduce stigma and discrimination experienced by communities and individuals who are victims of hate crime in all its guises.”

In January, 2018 Bristol Live reported that Avon and Somerset Police said the false claims about the transfer of HIV were taken from national guidlines.

The Bristol wing of the HIV advocacy group ACTup! Launched a petition calling for the force to retract the statement.

A spokesperson for the group said officers deserve not to be spat at while working and the group is not calling for the recall of spit hoods but raised issues with the “poorly researched” press announcement.

ACC Cullen added: “Our aim has never been to focus attention on people living with health conditions, but to target people who use spit as a weapon.

“We assured our communities we would seek to ensure that we learn from this and would share our learnings across the police service, providing clarity and direction.

“We also invited Brigstowe to help support our training for officers and staff

“I’m delighted that this has now been done.”

The National Police Chiefs Council, which issues guidance to police forces across the UK, said in January the advice on spit guards has not changed since it published a report in March 2017, but specific guidance on HIV was sent to police forces after feedback was received by Avon and Somerset.

The police chiefs’ council guidance on spit guards released in March last year said the national picture for blood-borne viruses like HIV affecting officers was “unclear “.

HIV is found in many bodily fluids of a sufferer including semen, vaginal and anal fluids, blood and breast milk.

The disease is most commonly contracted through unprotected sex and the sharing of needles. NHS England states HIV cannot be contracted through saliva.

Spit hoods made of mesh are shaped like a plastic bag and are put over the heads of suspects who had threatened to spit, have attempted to spit or have spat before.

UK: New research confirms HIV cannot be transmitting through spitting and risks from biting are negligible

HIV cannot be transmitted by spitting, and risk from biting is negligible, says detailed case review

Use of spit hoods not justified to protect emergency workers from HIV

Michael Carter

Published: 08 May 2018

There is no risk of transmitting HIV through spitting, and the risk from biting is negligible, according to research published in HIV Medicine.

An international team of investigators conducted a meta-analysis and systematic review of reports of HIV transmission attributable to spitting or biting. No cases of transmission due to spitting were identified and there were only four highly probable cases of HIV being transmitted by a bite.

The study was motived by the use of spit hoods by police forces in the UK because of the perceived risk of the transmission of HIV and other blood-borne viruses from spitting. The researchers’ findings endorse the position of the National AIDS Trust and Hepatitis C Trust that neither HIV nor hepatitis C virus can be transmitted by spitting, and that the use of spit hoods by police forces to protect offices against these viruses cannot be justified.

“We undertook a systematic literature review of HIV transmission related to biting or spitting to ensure that decisions about future policy and practice pertaining to biting and spitting incidents are informed by current medical evidence,” explain the study’s authors.

They identified published studies and conference presentations reporting on transmission of HIV via spitting or biting. Inclusion criteria were: discussion of transmission by biting or spitting; outcome described by documented HIV antibody test. Two reviewers independently identified studies that were included in the full analysis.

There were no cohort or case-control studies. The investigators therefore assessed the plausibility of HIV being transmitted to a spitting or biting incident according to baseline HIV status, nature of the injury, temporal relationship between the incident and HIV test, and where, available, phylogenetic analysis.

The plausibility of transmission being related to an incident was categorised as high, medium or low.

A total of 742 studies and case reports were reviewed by the authors.

There were no reported cases of HIV transmission attributable to spitting.

A total of 13 studies reported on HIV transmission and biting. The studies consisted of eleven case reports and two case series relating to HIV transmission, or its absence, after a biting incident.

None of the possible cases of HIV transmission due to biting were in the UK or involved emergency workers. The reports included information on 23 individuals, of whom nine (39%) seroconverted for HIV. Six of these cases involved family members, three involved fights resulting in serious wounds, and two were the result of untrained first-aiders placing fingers in the mouth of an individual experiencing a seizure.

“Of the 742 records reviewed, there was no published cases of HIV transmission attributable to spitting, which supports the conclusion that being spat on by an HIV-positive individual carries no possibility of transmitting HIV,” write the authors. “Despite biting incidents being commonly reported occurrences, there were only a handful of case reports of HIV transmission secondary to a bite, suggesting that the overall risk of HIV transmission from being bitten by an HIV-positive person is negligible.”

There were only four highly plausible cases of HIV transmission resulting from a bite. In each case, the person with HIV had advanced disease and was not on combination antiretroviral therapy and was therefore likely to have had a high viral load. The bite caused a deep wound and the HIV-positive person had blood in their mouth.

“Two cases occurred in the context of a seizure whereby an untrained first-aid responder was bitten while trying to protect the seizing person’s airway,” note the researchers. “It is therefore important that both emergency workers and first-aid responders are trained in safe seizure management including non-invasive airway protection and use universal precautions.”

The investigators emphasise that they found no cases of an emergency worker or police officer being infected with HIV because of a bite. They point out that bite injuries are a common reason for attending accident and emergency departments: a review of A&E admissions over a four-year period at a hospital in the United Kingdom found that one person was admitted with a bite wound every three days, on average.

“Current UK guidance on indications for PEP [post-exposure prophylaxis, emergency HIV therapy after a high-risk exposure to HIV] state that ‘PEP is not recommended following a human bite from an HIV-positive individual unless in extreme circumstances and after discussion with a specialist,’” conclude the authors. “Necessary conditions for transmission of HIV from a human bite appear to be the presence of untreated HIV infection, severe trauma (involving puncture of the skins), and usually the presence of blood in the mouth of the biter. In the absence of these conditions, PEP is not indicated, as there is no risk of transmission.”

Reference

Cresswell FV et al. A systematic review of risk of HIV transmission through biting or spitting: implications for policy. HIV Med, online edition. DOI: 10.1111/hiv.12625 (2018).

Published in aidsmap on May 8, 2018

Canada: Recent case in British Columbia demonstrates the "cycle of fear, stigma and misinformation surrounding HIV"

Misinformation is the real culprit in British Columbia HIV case

Police and media left out key details of HIV non-disclosure charges – By Niko Bell

The case of Brian Carlisle shows that when it comes to HIV, what you don’t know can hurt you.

Last summer, Mission RCMP reported that Carlisle, a 47-year-old marijuana activist, had been charged with three counts of aggravated sexual assault for not disclosing to his sexual partners that he has HIV. The RCMP posted Carlisle’s name and photo, asking for any other partners who might have been exposed to come forward.

At the time, the RCMP said that while they would not normally publish private medical information, “the public interest clearly outweighs the invasion of Mr Carlisle’s privacy.”

Xtra does not usually publish the names of people charged with HIV non-disclosure, but Carlisle has given permission to Xtra to publish his name and HIV status.

In the following months, three charges of aggravated sexual assault against Carlisle swelled into 12.

But the RCMP failed to mention a crucial fact: Carlisle couldn’t transmit the virus to anyone.

After studying thousands of couples over decades of research, HIV scientists around the world have reached the consensus that people with HIV who regularly take medication and achieve a suppressed viral load cannot transmit the virus through sexual contact. Like most HIV patients in British Columbia, Carlisle’s viral load was suppressed, so none of the women he had sex with were in any danger of contracting the virus.

Months after publicly disclosing his HIV status, Crown prosecutors stayed all charges against Carlisle. But it became stunningly clear that not only had the police not fully informed the public that Carlisle was uninfectious, they also hadn’t properly informed Carlisle’s alleged victims.

One woman who had sex with Carlisle told the CBC anonymously about going through PTSD, anxiety and depression, losing her job and going bankrupt because she thought she might have HIV.

Not only did the woman mistakenly think she could have contracted HIV, she also said she thought she still might become infected. Nine months after charges were laid against Carlisle, she told the CBC she still had to “wait one more year to know if I have HIV or not,” and that she was still taking HIV tests every three months to ensure the virus did not appear. She said she still avoids sexual relationships out of fear of having to disclose that she might have HIV.

This understanding of how HIV testing works is catastrophically wrong. Modern HIV testing technology, like that used by the BC Centre for Disease Control, catches 99 percent of new HIV infections only six weeks after a new infection. If even that window is too large, new technologies like RNA amplification, also used in BC, can cut the time down to only two weeks.

Even if Carlisle’s viral load had been high enough to transmit the virus, which it was not, the women he had sex with could have been given a clear bill of health only days after the RCMP knocked on their doors.

The CBC, however, did not correct the woman’s misinformation, and reported as fact that the women involved would have to undergo annual testing to make sure they do not have HIV.

Mission RCMP would not confirm at what point they discovered that Carlisle’s viral load was suppressed, or when they informed the women involved, because they say the investigation into Carlisle is still open. It’s also not clear who told the women they might be infected, or that they required yearly HIV testing.

Regardless what you think of Carlisle’s choice not to inform his sexual partners that he had HIV, and regardless whether you care about the publication of his name and HIV positive status, much of the psychological harm suffered by the women in Carlisle’s case was for nothing. Accurate medical information might have saved them months or years of anxiety, fear and isolation.

Carlisle’s case is an example of what many HIV experts say is a cycle of fear, stigma and misinformation surrounding HIV, propelled by police and prosecutors’ use of the criminal law against people who are HIV positive. Criminal prosecutions, experts say, make people less likely to seek medical help or get tested, and can increase the likelihood of new infections. One study found thathalf of the targets of HIV non-disclosure prosecutions are Black men, and nearly 40 per cent are men with male partners.

Media reports in other high profile Canadian HIV cases have also skimmed over the medical science, adding to public confusion around HIV safety.

In December, a federal government report recommended that prosecutors should move away from the “blunt instrument” of the criminal law to handle HIV non-disclosure cases, and the government of Ontario announced it would stop prosecuting cases involving people with low viral loads. BC’s attorney general said in December he would also reconsider the province’s policy, but recent updates to the Crown counsel policy manual do not rule out prosecuting people whose viral load makes the virus intransmissible.

Regardless of the law, the least that the police and journalists can do is be honest and accurate about the actual risks involved in HIV cases. Carlisle’s case shows just how devastating ignorance can be.

Published in Xtra on May 5, 2018

UK: Avon and Somerset police statement over risk of HIV from spitting allegedly based on National Police guidelines

Police say false HIV claims over spitting were taken from national guidelines

Avon and Somerset Police still have not retracted their statement despite pressure from campaigners

The police force for Bristol and the surrounding areas say false claims made about the transfer of HIV were taken from national guidelines.

Avon and Somerset Police announced last year it would be introducing the use of spit guards in 2018 to remove the risk of officers catching diseases like the human immunodeficiency virus or hepatitis.

However, campaign groups were quick to point out HIV cannot be passed on through saliva and accused the force of “praying on people’s prejudices.”

The force did apologise for “any offence caused” to people living with HIV or Hepatitis B or C but still has not retracted the statements despite calls from campaigners to do so.

In January 24, a Freedom of Information request revealed no Avon and Somerset Police officers had caught an infection disease after being spat at since 2012/13.

When asked by the Bristol Post if the force would retract the statements about HIV, a spokesman said on January 25: “The information we used previously in the roll-out of spit guards was based on National Police Chiefs Council (NPCC) guidance.

“Following feedback from the public and consultation with local charities, Assistant Chief Constable Stephen Cullen asked the NPCC to seek medical opinion. As a result of ACC Cullen’s representations the NPCC has altered its guidance to forces.”

The Bristol wing of the HIV advocacy group ACTup! Launched a petition calling for the force to retract the statement.

On November 17 Avon and Somerset Police announced it would be introducing the use of ‘spit hoods’ across the force area from next year. The hoods made of mesh are shaped like a plastic bag and are put over the heads of suspects who had threatened to spit, have attempted to spit or have spat before.

The National Police Chiefs Council, which issues guidance to police forces across the UK, said the advice on spit guards has not changed since it published a report in March 2017, but specific guidance on HIV was sent to police forces after feedback was received by Avon and Somerset.

A spokesperson said: “Our position paper on this was published back in March last year and our overall position on this has not changed. However, after receiving feedback from colleagues in Avon and Somerset we wrote to forces to give specific guidance on HIV and spit guards – entirely in line with our position.”

The police chief’s council guidance on spit guards released in March last year says the national picture for blood-borne viruses like HIV affecting officers is “unclear “.

It adds: “There are annually a very significant number of officers who are receiving precautionary treatment to prevent blood-borne viruses initial following spitting and biting incidents. Some of this treatment is intrusive, debilitating and can have a significant impact on officers’ personal lives.”

The conclusion reads: “The NPCC position is that the risk of transfer of blood-borne viruses through spitting or biting is very low, however the impact of infection would be extremely high.”

HIV is found in many bodily fluids of a sufferer including semen, vaginal and anal fluids, blood and breast milk.

The disease is most commonly contracted through unprotected sex and the sharing of needles. NHS England states HIV cannot be contracted through saliva.

Published in the Bristol Post on Jan 30, 2018

UK: Police accused of fear mongering by playing up the risks of HIV and hepatitis C transmission through spitting

Police accused of exaggerating risks of HIV to introduce spit guards

Force plans to issue guards to officers from January, saying people infected with blood-borne viruses use spitting as a weapon

A police force has been accused of fear mongering and stigmatising sufferers of hepatitis C and HIV by playing up the risks of transmission of blood-borne viruses as a reason to introduce spit guards.

Avon and Somerset police announced their plan to issue spit guards to all operational officers from January next year. “Each day we face being spat at, putting us at risk of HIV, hepatitis and tuberculosis and the degrading assault can have a lasting psychological impact,” said Assistant Chief Constable Stephen Cullen.

Spit guards are tight mesh hoods that officers can pull over the heads of suspects resisting detention to stop them from spitting or biting. They are used by 25 forces but have been criticised by human rights groups.

Avon and Somerset’s announcement came with an account by an officer, named John, who said people infected with blood-borne viruses use spitting as a “weapon”. He described an incident in which he arrested a drunk woman who had hepatitis C after she attacked a paramedic.

“She was continually spitting, spit that was bloody. It was disgusting; she was trying to infect us,” he said, recounting how officers donned riot gear to protect themselves as they stripped the detainee for her safety. “After the shift we all went home to our kids wondering what we were taking home.”

Rachel Halford, the deputy chief executive of the Hepatitis C Trust, said she agreed that police should be protected from health risks, but rejected the force’s implication that the virus could be transmitted through spitting.

“Hepatitis C is a blood-borne virus and is therefore only transmitted through blood-to-blood contact. The virus cannot be transmitted via spit,” she said.

“Stigma and misinformation about hepatitis C and other blood-borne viruses is a key challenge faced by patients, who are already disproportionately from the most marginalised and disadvantaged groups in society. Many patients report feeling ‘dirty’ and experiencing social exclusion due to misinformation about transmission risks.”

Kat Smithson, the director of policy and campaigns at NAT (National Aids Trust), said Avon and Somerset’s claims about HIV and hepatitis C were wrong and stigmatised people with the conditions.

“HIV is irrelevant to the debate about spit hoods because spitting simply is not an HIV transmission route,” she said. “In the history of the epidemic, there has never been a case of HIV being passed on through spitting, even when the spit contains blood.”

According to Avon and Somerset police, the restraints will be used only when a person threatens to spit, has attempted to spit or has already spat, and only when officers’ body-worn cameras are switched on.

Despite those safeguards, Deborah Coles, the director of Inquest, raised concerns over their introduction to another police force. “There should be no doubt spit hoods are a use of force and have the potential to cause acute trauma and injury,” she said.

“We know from our work that mental health concerns or other difficulties often sit behind agitated behaviour. Our fear is spit hoods will become the default response and used against vulnerable detainees.

“We had hoped that after the restraint death of James Herbert, Avon and Somerset police would have prioritised safer, more humane policing methods with a focus on de-escalation and detainee welfare.”

Avon and Somerset’s police federation backed the decision, which the force said was in support of the national federation’s proposed assault on emergency workers (offences) bill.

Vince Howard, the chairman of Avon and Somerset police federation, said: “This option affords those officers, who are increasingly subject to this abhorrent act, the opportunity to protect themselves from the risks of serious communicable diseases.”

Data for spitting incidents reported on the Welfare Information Form shows there have been 79 spitting incidents out of 487 recorded assaults since April, which a force spokesman said was a sharp increase on previous reports.

UK: The Assaults on Emergency Workers (Offences) Bill proposes mandatory HIV testing following an alleged spitting/biting assault on frontline staff

Stabbed, Spat At, Punched: Emergency Workers Tell HuffPost UK Why New Law Is Needed To Protect Them: Now PM backs Bill to protect 999 staff from assault

A new law to protect emergency workers from assaults has won the personal backing of Theresa May after police, paramedics and nurses lobbied MPs for tougher sentences.

A private members’ bill to specifically target abuse against 999 staff has secured the Prime Minister’s approval, HuffPost UK has been told.

The Assaults on Emergency Workers (Offences) Bill, tabled by Labour MP Chris Bryant, is due to have its Second Reading in the Commons on Friday and is now expected to get enough Parliamentary time to get on the statute book.

Dubbed the ‘Protect The Protectors Law’, the bill follows a rising number of incidents where NHS, firefighters and police staff have been abused, attacked or spat at in the line of duty.

The legislation will for the first time deem assaults on emergency staff as “aggravated”, and subject to heavier sentences. It will also force suspects to provide samples of saliva or blood to ensure rapid testing of HIV and other illnesses.

Asked if the PM was giving her personal support to the bill, a No.10 spokesman told HuffPost UK: “That’s one the Government is backing, so you can take that as a ‘yes’.”

The Ministry of Justice and Home Office are expected to signal on Friday their support for the new legislation.

Backed by trade unions and staff bodies such as the Police Federation, an alliance of emergency workers held a ‘drop-in’ lobby of MPs in the Commons on Wednesday.

Bryant told HuffPost UK: “I’m really encouraged by how many MPs have come along, listened to emergency workers and said they’ll support the Bill.

“It’s not over until the votes are counted though and I’m not counting my chickens yet. All sorts of things could still go awry.”

Alan Lofthouse, national ambulance officer for the Unison trade union, said: “It’s only right that the full force of the law is used against anyone who attacks those trying to save lives and protect the public. This bill will help the courts to bring offenders to justice.”

HuffPost UK talked to five emergency workers, each with their own stories of why a new law was needed.

Read more at: http://www.huffingtonpost.co.uk/entry/theresa-may-backs-new-law-protecting-emergency-workers-from-assaults-in-line-of-duty-five-case-studies_uk_59e7b1cce4b00905bdae7e17

Canada: Legalities around disclosing HIV and other STIs in Canada

Have an STI? What you’re legally obligated to disclose

Jenelle Marie Pierce was 16 when she found out she had genital herpes.

“I was made to sleep on the floor at slumber parties because people thought they were going to contract my herpes from me,” the now 35-year-old from Caledonia, Mich., told Global News. “People can be cruel and really it’s just a product of a lack of information.”

Finding out you have a sexually transmitted infection (STI) may seem like the end of your love life, but according to experts, it’s not true. With the right amount of education, communication in disclosing your status and safe sex practices, you can foster a healthy intimate relationship.

In Canada, STI infections are on the rise. Between 1998 and 2015 (the most recent national data available), chlamydia — the most commonly reported STI in Canada — has risen from 39,372 to 116,499 annual cases among all ages and genders, and gonorrhea rates increased from 5,076 to 19,845 in the same time period. Infectious syphilis rates rose dramatically from 501 to 4,551 cases.

But aside from the obvious health implications these infections have, their emotional burden can be almost equally dangerous. A 2014 study published in the journalAIDS Patient Care and STDs found that STI-related stigma was associated with decreased odds of testing for STIs and decreased willingness to notify a partner of an STI among young African American men.

A similar study from 2009 that was published in Perspectives on Sexual and Reproductive Health also found that STI-related stigma was a barrier to adolescents’ screening behaviour.

“I’ve been called everything from a slut to a whore. People assume that you are a cheater, you are promiscuous … But it [affects] people from all walks of life, all backgrounds. It’s across the board. People from everywhere contract these infections.”

The key is to be open and ethical about your STI to prevent the spreading of any infections.

Legalities around disclosing

In Canada, it’s a crime not to disclose HIV or another STI before having sex that poses a “significant risk of serious bodily harm.” However, most prosecutions have been strictly related to HIV and hardly any have been related to herpes, syphilis, chlamydia or other STIs.

The legal obligation to disclose your status was established in the 1990s, but for people with HIV, the law became harsher in 2012. That’s when the Supreme Court of Canada decided that people living with HIV are obligated to tell their partner about their status before engaging in sex that poses a “realistic possibility of HIV transmission.”

In practice, what that means is if you’re going to engage in vaginal or anal sex and are HIV positive but don’t tell your partner ahead of time, you could face criminal prosecution if you don’t use a condom or if you use a condom but have a viral load higher than “low.”

According to advocates, this test has been applied inconsistently by the courts without proper regard to the science.

“The science is now established that there is effectively zero risk of transmission to a sexual partner if you have an undetectable viral load,” Richard Elliott, executive director of the Canadian HIV/AIDS Legal Network, told Global News.

There have been conflicting court decisions for people with HIV with an “undetectable” viral load. Some have been prosecuted and other’s haven’t.

At least 184 people have faced charges related to HIV non-disclosure after sex in Canada, one of the highest rates of HIV criminalization in the world, Elliott added. Only a few prosecutions have been related to herpes and syphilis. There haven’t been any prosecutions for non-disclosure of chlamydia, gonorrhea or HPV.

Public health

Besides the legal obligations laid out by the Canadian criminal code, some experts believe it’s important to be transparent about your STI in the name of public health.

“You want to be upfront, you want to tell the person, and you also want to reassure them that you will be performing safe and intimate contact,” Jason Tetro, a Canadian microbiologist, told Global News.

Tetro, who used to work in HIV research and policy, says STIs are becoming more and more resistant to antibiotics, which means they’ll be even more of a headache to treat — so, why not be open from the beginning, before any sexual contact?

“If you happen to be exposed you may be facing a very long and difficult antibiotic treatment before you’re clean, so the fact is, if we all work together to make sure we are not spreading these bugs, it’s going to improve public health overall.”

Having the awkward conversation

There are two approaches to talking to your partner, according to Pierce.

The first is being completely open about your STI status from the get-go. For those who are comfortable laying it out on the table, they can add their status to their dating profiles. The reason behind this approach, explained Pierce, is that you have a lower chance of getting your feelings hurt.

The second approach is more discreet. Just like any relationship that grows organically, some private matters like revealing your STI, are not discussed until trust is gained.

Of course, you need to disclose before there is any sexual contact.

“The idea behind that is that nobody actually puts everything out there on the table when they start dating. That’s kind of the whole dating process, it’s learning about somebody as you go,” Pierce said.

“Nobody says ‘I have horrible debt and my dad is an alcoholic and my brother is in prison’… [it’s a] myriad of things that might be a deal breaker for somebody.”

It really depends on who you are, there is no right or wrong way to do it, she added.

Once you’ve figured out the timing, you then need to figure out the method.

Avoid finding yourself in the heat of the moment. Find a private and quiet place to have the conversation, and approach it in a practical way, Pierce says. Lay out the facts in a neutral and non-emotional manner, because you don’t want to influence their response.

“It’s OK to acknowledge that it might be awkward or weird, but be as open and clear-cut as you can.”

Once you’ve disclosed your status and laid out the options for safe and protected sex, you have to let them decide if they want to take the relationship to the next level. Pierce’s biggest piece of advice? Don’t take the person’s response — positive or negative — personally.

Pierce, who has had a successful career and has had many healthy relationships, says you shouldn’t get discouraged. It’s better to be honest and straightforward, and foster a partnership with someone who will work with you to keep the STI contained to one person.

Published in Global News on October 16, 2017

US: "Undetectable = Uninfectious" isn't reflected in HIV criminalisation laws in several U.S. states

Undetectable = Uninfectious. So why are people with HIV still being criminalised for having sex

By now, most people in the HIV community know that having an undetectable viral load means being uninfectious. It’s just science! But this information isn’t reflected in laws in several U.S. states, dating back to the 1980s and 1990s, that criminalize people with HIV for having sex without telling partners their HIV status — even if they use a condom on top of being undetectable.

Thankfully, there’s a movement of HIV-positive people underway that’s slowly getting states to strip back their outdated criminalization laws. It’s called the Sero Project — and at the 2017 AIDSWatch conference in Washington, D.C., we talked with folks from all over the country who are part of it.

“There’s still criminalization that impacts so many people — and it’s driven by fear,” says Paul Yabor, a longtime Philadelphia-based HIV activist (who sadly died earlier this year after this video was made).

“I’ve experienced this,” says Ken Pinkela, Sero’s director of communications and military policy, who was imprisoned and dishonorably discharged from the U.S. Army for having sex without disclosing his status. “Wrongful accusals and allegations that didn’t exist.”

Says Gina Brown, a community organizer for the Southern AIDS Coalition: “The thing that bothers me the most is that [these laws] keep people from knowing their status. So, if I know that I can go to jail because I have sex with someone whether I use a condom or not — you know, I don’t want to know! And I do community work in New Orleans, and I hear that all the time.” She also decries “the fact that no other sexually transmitted virus is criminalized.”

Says Derrick Mapp, HIV health counselor and national trainer at San Francisco’s The Shanti Project: “Me being HIV-positive — I’m not a criminal. It’s something that happens. Spitting, scratching and fighting — these things don’t transmit HIV.” Yet, HIV-positive folks have often ended up doing years in jail for exactly those actions.

Remember Eric Leonardos from the TV show Finding Prince Charming? He’s part of the decriminalization fight as well: “Martin Luther King Jr. says that an unjust law is no law at all,” he declares. “And these are unjust laws and they have no place.”

Watch our video (edited by Michael Faber) and hear them in their own words. Then consider reaching out to Sero and getting involved in the fight. They’ve already had victories in California, Colorado and Iowa. Maybe, with your help, your state could be next!

Tim Murphy has been living with HIV since 2000 and writing about HIV activism, science and treatment since 1994. He writes for and has been a staffer at POZ, and writes for the New York Times, New York Magazine, Out Magazine, The Advocate, Details and many other publications. He is also the author of the NYC AIDS-era novel Christodora.

Published in the Body on Oct 10, 2017