Canada: Johnson Aziga and questions about the virological evidence

Here’s an excellent piece analysing flaws in the recent Johnson Aziga trial by Chris Morley, HIV Policy, Information and Publications Coordinator at George House Trust in Manchester, England. He writes this in a personal capacity.

He has had first-hand experience with some UK criminal HIV transmission cases, and contributed significantly to the HIV Forensics chapter of my book. He originally wrote this as a comment on my posting about the scientific evidence in the trial, but I thought it deserved a posting in its own right. He’s also written about the trial on the GHT website.

Johnson Aziga and questions about the virological evidence

by Chris Morley

Call a virologist

The defence lawyers failed to follow a key lesson from some recent English cases – which is to call a virologist, expert in HIV, as an expert witness, or at the very least commission an expert HIV virologist’s report to use as evidence.

Because the state called Dr Paul Sandstrom, director of the Public Health Agency of Canada’s national HIV and retrovirology laboratories as its scientific witness, there was a critical need to have an internationally respected independent expert HIV virologist giving evidence for the defence.

In well represented recent English cases, some level of expert HIV virologist involvement has led to a not guilty verdict, acquittal, case dismissed, and cases being abandoned. It makes a crucial difference to the outcome. It may not always cast enough reasonable doubt on all prosecution claims, but the English experience so far is all of prosecution failures where this is used, and usually of prosecution successes when it isn’t used.

From my reading of reports about the scientific evidence an expert virologist would have been able to question, or even demolish the assumptions and conclusions put forward by the prosecution.

Here’s the report, from The Hamilton Spectator, of the testimony of Dr Sandstrom:

“We were able to determine that all of the complainants and Aziga had a phylogenetically distinct form of HIV and that Mr. Aziga had the virus prior to contact with any of the women,” Sandstrom said. …..

Aziga and the women in the Hamilton infection cluster all had Clade A, which is rare in North America but endemic in Aziga’s native Uganda.

In this country, fewer than 2 per cent of those newly diagnosed with HIV have subtype A.

Phylogenetic analysis examines small differences in HIV genes by coding sequences of the HIV genome and comparing them to other HIV sequences in public databases.

HIV virologists can only determine the degree of similarity between two samples. They can’t produce a definitive match because unlike human DNA, HIV is not unique to an individual.

The analysis is also unable to determine the direction of transmission, Sandstrom said. So, theoretically, one of the women could have infected Aziga, instead of the other way around.

To resolve that issue, Sandstrom obtained a frozen blood-plasma sample drawn from Aziga after his HIV diagnosis 12 years ago. The specimen — collected before Aziga met any of the women — was phylogenetically analyzed and found to be nearly identical to the Hamilton infection cluster, comprising Aziga and the seven HIV-positive women.

“It means Mr. Aziga did not become infected by any of the women and that he had already been infected prior to contact with any of the women,” Sandstrom said.

No Proof

This does not fully address or prove transmission from Johnson Aziga at all – other explanations are at least a possibility, and need to be ruled out. Mr Aziga and the women complainants are not the only people in Canada with subtype A – there are over 1000 other people diagnosed with it and more who are undiagnosed. One or more of the others with HIV-A might have been the source of one or more women’s HIV.

Sandstrom did not consider it part of his job to explore this, or try to exclude this as a possibility. As the leading state HIV virologist he had a professional obligation to attempt to resolve this uncertainty and present the full picture. It would either have strengthened or weakened the prosecution case. Either way it needed checking.

Not my job to check

He was cross examined about this by the defence who argued that although Aziga and the women share a related virus, that did not mean that other persons, still unknown, might not also be carriers and part of the same transmission network. “It still remains, that your investigation does not rule out the possibility that there are other people ‘out there’ who are a part of the same infection cluster,” suggested the lawyer. Sandstrom said his investigation was “not directed at finding additional complainants or additional suspects,” but at providing confirmatory evidence for the footwork done by Hamilton police.

And the police, under cross examination, said it wasn’t their job either, to look for other possible sources of the women’s HIV.

Miscarriage of Justice and reversed burden of proof

This leaves me with serious concerns that there has been a miscarriage of justice. The defence is left to carry out an investigation, without police powers or resources, requiring the taking and testing of blood samples and complex and expensive scientific analysis, in an attempt to show there are other credible explanations. Does this not unfairly reverse the legal burden of proof?

Sexual history of complainants must be a central part of all transmission investigations

With HIV transmission cases, the proper police investigative practice of not looking into a rape complainant’s own sexual history, is often adopted. A woman’s sexual history is irrelevant to whether she was forced to have sex by someone; however it is critical to establishing which of her partners might have been the source of HIV in a consensual encounter. To attempt to prove X did it, you have to at least rule out A, B, C etc. And this at least can be proved conclusively with virology (HIV virology can prove someone didn’t transmit that HIV, but it can’t prove who did).

Rarely are the circumstances such that a complainat can be absolutely sure which of several partners might have been the source. The police are used to checking statements and seeking corroboration for everything. Why are claims about who transmitted HIV treated as if they cannot and must not be questionned? Why don’t the police routinely seek, and prosecutors demand, corroboration by ruling out all other possibilities?

For example, one of the women who died (H.C.) had three previous partners in recent years, two of whom were also migrants from Africa and, if HIV positive, likely also to have HIV-A. And an earlier date of infection from one of these men would better explain her surprisingly rapid development and death from Burkitt’s lymphoma, all apparently within 3 years or so of her supposed infection by him. (Reported here based on reports in The Hamilton Spectator )
And regarding the other women, see for example this article in The Hamilton Spectator.

Reasonable doubt opportunity wasted

With prosecution and defence expert witnesses contradicting each other, reasonable doubt would be raised far more strongly. Instead of calling an expert in HIV virology, the defence called Rafal Kustra, an associate professor of biostatistics with the Dalla Lana School of Public Health at the University of Toronto. He was not able to make much of an impact, saying he was “underwhelmed” by the level of analysis used by Ottawa scientists who concluded that Johnson Aziga and seven HIV- positive women carry viruses that are so closely related they can be described as a single “Hamilton transmission cluster.” He criticised the method used by Sandstrom and that was about it. He didn’t produce any new evidence, and wasn’t even invited by the defence to offer a different interpretation of the same facts, or say what further evidence was needed, and which questions need to be answered, before the prosecution’s case can become credible scientifically.

The defence barrister did criticise the prosecution’s scientific claims and failure to eliminate other potential sources of HIV. This does not carry any real weight with judge and jury – in legal terms it is not evidence, more an argument. The defence lawyer is not a scientific expert who can credibly contradict Canada’s head of HIV virology, no matter how right he may be. He tried, but didn’t call an expert virologist as a witness who could have made the argument convincing with fresh evidence and interpretation based on professional expertise.

An independent expert virologist might have been able to show, for one or more of the infected, scientific reasons why the prosecution are drawing the wrong conclusions and missing out vital evidence.

Establishing reasonable doubt is the job of the defence. Succeed, and the judge would then have pointed this out to the jury. The judge’s response to reasonable doubts should lead to a not guilty verdict, or acquittal, on one or more of the charges.

Not guilty verdicts and acquittals might not have produced justice, but there doesn’t seem to be much certainty of justice in this verdict, from what I have seen reported.

No-one knows for a scientific fact whether or not he did transmit HIV to the 7 people whom the prosecution claim he infected. This can never be proved with current scientific techniques. The essential virological analyses and testing of other partners, that might have shown the virological connections between the HIV samples could have more than one credible explanation, seem to have been omitted.

The apparent failure to eliminate from suspicion the women’s other / previous partners raises serious doubts about any scientific claims made that he was the source, because those claims seem based on only some of the potential scientific evidence.

Herd mentality

A herd mentality can develop in big trials and high profile cases. The pressures to secure a conviction are huge. In cases involving HIV transmission, some of the media behave like a baying mob. Police and prosecutors may become convinced they have their man and be unable to entertain any other possibility. We’ve much experience of this in England and this case has the hallmarks of another, but in Canada.

Dysfunctional justice?

It’s a case that shines a light on the Canadian justice performing badly in a major trial. It seems there are errors as much in the prosecution, police investigation and justice procedures, as well as tactical mistakes by the defence. He’s been five years in prison awaiting trial and this was his 6th team of lawyers. This case makes the Canadian justice system look dysfunctional. I hope it redeems itself at the appeal stage.

Germany: Complexities of scientific evidence discussed in Spiegel magazine article

The plight of Nadja Benaissa, the No Angels singer arrested last week in Frankfurt for alleged criminal HIV exposure and transmission has already resulted in more international media attention on the issues around criminalisation than any other case I’m aware of.

Although the recent murder trial of Johnson Aziga in Canada led to a great of press and soul-searching within its own borders, Ms Benaissa’s celebrity has resulted in coverage far beyond Germany.

Today, Time magazine in the United States, ran a nicely balanced article summarising the case, and including the first quote I’ve seen from No Angels manager, Khalid Schroeder.

…manager, Khalid Schroeder says Benaissa’s arrest is the result of “a witch-hunt against Nadja. She is being prejudged. The investigation is still continuing and there are no hard facts yet. This is unfair. We want her to be released as soon as possible.”

It also quotes yet another spokesperson from Deutsche AIDS-Hilfe, who eloquently sums up their objections to her arrest and to criminalisation in general.

AIDS groups have criticised the authorities’ handling of the arrest and have warned against a rush to criminalise the transmission of HIV. “Based on the information that we have about the detention of Nadja Benaissa, we think she should be released,” says Carolin Vierneisel, a spokeswoman for the AIDS organisation Deutsche AIDS-Hilfe. “When it comes to consensual sex, whether protected or unprotected, we talk about shared responsibility,” she says. “The criminalisation of HIV transmission, as shown in this case, doesn’t support HIV prevention efforts. On the contrary, it fosters the stigmatisation of HIV positive people.”

Meanwhile, Germany’s answer to Time, Der Spiegel, today published an English-language article that examines the difficulties the Darmstadt prosecutor faces in proving that Ms Benaissa actually infected the male complainant. This is the first time I’ve ever seen the discussion of the unreliability of phylogenetic analysis in a mainstream magazine article.

Investigators in the case have since ordered an immunological report to clarify if the 26-year-old singer actually infected her former partner with HIV.

Experts like Norbert Brockmeyer, a spokesman for HIV/AIDS, a network of experts funded by the German government, is doubtful if such a report can be of much value.

“The absolute proof that person A infected person B cannot be provided by medical means after a number of years,” Brockmeyer, a professor of dermatology and allergology, told SPIEGEL ONLINE. He explains that the virus would have mutated too much in each of the bodies — particularly if those infected have undergone medical treatment.

Of course, that isn’t the whole story (and it’s a virological, not an immunological report, this is required). Even if there are stored blood samples available from 2004 – when the alleged transmission occurred – it is still impossible to tell from a virological analysis the timing and direction of transmission. And to rule out that someone with a similar virus (and there will be many, many people with similar viruses) didn’t infect the male complainaint, they would need to test all of the man’s previous sexual partners between his first HIV-negative test and first HIV-positive test (assuming he’d previously taken a test) and include those samples in the analysis. In the English courts, this limitation alone has resulted in charges being dropped in three recent cases.

Canada: Scientific evidence challenged by Aziga’s defence

Two months after the Crown rested its case against Johnson Aziga – accused of first-degree murder due to the death of two women with whom it is alleged he recklessly infected with HIV – his defence team is rigourously questioning the scientific evidence that the Crown had said linked Mr Aziga with the seven complainants allegedly infected with HIV (an additional four complainants allege that Mr Aziga had unprotected sex without disclosing his HIV status, but they are HIV-negative).

Previously, Paul Sandstrom, Director of National HIV and Retroviral Laboratories at the Public Health Agency of Canada, had testified that Mr Aziga and the seven HIV-positive complainants shared the same HIV subtype, clade A, which is rare in Canada but endemic in Uganda, where Mr Aziga is from.

Sandstrom’s evidence was that Aziga and the women had viruses so genetically similar they would have come from a common ancestor. He said they formed a unique transmission cluster when compared to other clade A viruses in Canada and internationally.

(Source: The Canadian Press)

However, defence lawyer, Davies Bagambiire who is aware of the precedent-setting English case from 2006 which established that scientific evidence – specifically phylogenetic analysis – is not as cut and dried as other forensic tests relied upon by the criminal justice system, such as genetic fingerprinting.

The lawyer claimed police and prosecutors had “tunnel vision from the beginning to the end” of the case.

“The fact that there were other possible sources of the HIV for the women who tested positive was never even contemplated,” he said.

Bagambiire noted most of the women had met Aziga in “risky environments,” such as lower-class bars and night clubs in Hamilton and Brantford.

“The evidence is that other men could have been possible sources of the HIV,” said Bagambiire.

He pointed specifically to a Brantford man, who is the current partner of one of the HIV-positive women, and who subsequently was found to have had unprotected sex with both her and another complainant in this case.

“Some men who engaged in sexual activities with the complainants left the country without ever having been directed to take an HIV test. Some of their names are not known and their HIV status is not known,” he said.

Source: The Hamilton Spectator

Sweden: Health agency criticised for not co-operating with police

The Swedish Institute for Infectious Disease Control has revealed in an article in a medical journal that they have refused to co-operate with police in tracking down individuals who may have broken Sweden’s draconian public health and criminal HIV exposure and transmission laws. Following a public furore, they have now backtracked somewhat.

Articles from the Associated Press and The Local.se below.

Swedish health agency blasted for HIV stance

STOCKHOLM, Sweden (AP) — A Swedish health agency revealed in an article published Wednesday that it had refused to help police track down people who knowingly infect others with HIV.

The revelation triggered harsh criticism and the government agency, the Swedish Institute for Infectious Disease Control, agreed later in the day to resume helping police.

Officials for the agency were quoted in a medical newspaper as saying they had declined to cooperate with police because they disagreed with current legislation that criminalizes the willful spread of the AIDS virus.

The report in the Dagens Medicin weekly sparked anger among prosecutors, police and government officials, who accused the institute of placing itself above the law.

The institute backtracked and its officials also clarified their position, saying they had no problem with the law itself, but believed the penalties for spreading HIV were too severe. The willful transmission of the virus is punishable by a maximum 10 years in prison.

Jan Albert, an expert at the agency, said the threat of imprisonment harms prevention efforts because some people who suspect they may have the virus refrain from getting tested for fear of prosecution.

Albert said the agency had declined to help police on many occasions, “but we’ve come to the understanding that we’ll resume work with the police.”

‘Decriminalize spread of HIV’: agency
Published: 22 Oct 08 11:38 CET

A Swedish government agency is refusing to assist the police in an ongoing investigation concerning a person suspected of infecting a woman with HIV.

Under current legislation, a person with HIV risks spending one to ten years in jail on assault charges if he or she knowingly has unprotected sex with another person.

“The criminalization of HIV makes preventive work more difficult. Also, sentences are very tough,” Ragnar Norrby, director-general of the Swedish Institute for Infectious Disease Control (SMI), told newspaper Dagens Medicin.

In a reversal of its previous policy, the disease control institute has recently refused to cooperate with prosecutors who requested information on a person suspected of spreading HIV.

“It is now our view that spreading HIV should not be classified as an offence,” Jan Albert, SMI head physician and regional manager, told Dagens Medicin.

“It is at least as much the responsibility of the individual person to understand that unprotected sex involves risks,” he added.

According to Ragnar Norrby, the threat of prosecution leads many people infected with HIV to remain anonymous, making it more difficult to trace the spread of the virus.

SMI also notes that the development of antiretroviral drugs has meant that HIV can no longer be equated to a death sentence.

UK: Reckless HIV transmission case dismissed due to insufficient evidence

Some good news from the UK (actually, it’s the law of England and Wales that this case is relevant to). I reported this story today on NAM’s website, aidsmap.com.

Reckless HIV transmission case dismissed due to insufficient evidence

Edwin J. Bernard, Monday, February 11, 2008

The case against an HIV-positive man charged with grievous bodily harm for allegedly ‘recklessly’ sexually transmitting HIV was dismissed at Manchester Crown Court last Thursday following legal argument.

A 39 year-old man had been charged under Section 20 of the Offences against the Person Act 1861 (OAPA) – recklessly causing serious bodily harm – last September. An application for bail had been refused on the grounds that there was a risk other offences could be committed; consequently, the man had been in custody since his arrest.

The complainant was a 37-year-old woman who tested HIV-positive in September 2007, after the accused man had provided her name to clinic staff for contact tracing purposes.

In his application to dismiss the case, defence barrister, Alan Walmsley, noted that since this was her first-ever HIV antibody test, and since the complainant had admitted to at least five sexual partners in the twelve months before her diagnosis, the evidence was insufficient for a jury to be able to convict.

Judge Martin Rudland agreed, and said that this opened up the “possibility of the infection…being potentially from sources other than the defendant. The more the arguments have unfolded, the more I’ve become alive to the prospect of an injustice.”

“I suspect the defendant probably infected the complainant,” he noted, “but that is a long way short of what the prosecution need to prove.”

According to a report in today’s Manchester Evening News, Judge Rudland freed the defendant with these words: “You are still HIV-positive. You still have clear obligations [to those] with whom you have sexual relations. You are still likely to be a defendant in criminal proceedings if you do not behave. Do you understand?”

The man answered that he did, and then left the court a free man.

This is the third time that a lack of evidence in an English prosecution for HIV transmission has resulted in the defendant being cleared.

In August 2006, a gay man was acquitted of ‘reckless’ HIV transmission at Kingston Crown Court, following evidence that phylogenetic analysis could not definitely prove that the defendant infected the complainant.

In February 2007, in a case that went unreported at the time, a Preston Crown Court judge dismissed a ‘reckless’ HIV transmission charge against a gay man due to the fact that other sexual partners of the complainant – who may have been the source of his infection – did not agree to have blood samples taken for HIV testing or phylogenetic analysis.

The defence lawyer in all three of these cases, Khurram Arif, of London solicitors, Hodge Jones & Allen, tells aidsmap.com: “This case highlights the principle that the Crown Prosecution Service has the burden of proving the reckless transmission of HIV. Proving who caused whom to be infected without scientific and medical evidence is extremely difficult. The sexual history of complainants and medical records are material when considering the possible sources of infection and in my opinion should be made available to the defence very early when causation is in issue.”

UK: Leicester and Manchester cases update

A brief update to ongoing cases in Leicester and Manchester.

The Leicester trial will begin on January 29th at Leicester Crown Court.

A hearing called by the defence to dismiss charges against a Manchester man, due to lack of scientific evidence, will be held on February 5th at Manchester Crown Court.

Editorial: HIV forensics in the BMJ

http://www.newscientist.com/article/mg19526213.900-hiv-sequences-cannot-prove-guilt-in-court.html

HIV sequences cannot prove guilt

19 September 2007

People infected with HIV might well want to know who gave it to them – but the genetic sequence of their virus won’t tell them.

The virus is now routinely sequenced in each infected person to uncover drug-resistance genes, but virus sequences have also been used in several high-profile court cases by lawyers seeking to show who infected whom. This has led some HIV carriers to wonder if they might be able to do the same.

“The data won’t work for that,” warns Deenan Pillay of University College London – because HIV evolves too fast. This means that even though the viruses from two people may look similar, other local viruses may even be more alike. Analysing them can’t show whether A infected B or vice versa, whether it went through a third person or whether both were infected by another person (BMJ, DOI: 10.1136/bmj.39315.398843.BE).

However, the British database – now the world’s largest collection of viral sequences from a national epidemic – could answer other important questions. For example, it could tell us whether certain strains tend to spread among certain risk groups, or where the super-spreaders of HIV are.

From issue 2621 of New Scientist magazine, 19 September 2007, page 5

Africa’s HIV transmission laws based on questionable science

Africa’s HIV transmission laws based on questionable science
by Cassandra Willyard, New York
Nature Medicine 13, 890 (2007)
Published online: 31 August 2007

Faced with an AIDS epidemic that kills millions every year, countries in sub-Saharan Africa are contemplating a new prevention strategy: criminal charges.

Uganda, touted as the rare success story in the region, is the latest nation to propose a law that would criminalize knowingly transmitting HIV to another person, the country’s health minister announced in June. Since 2001, Zimbabwe, Lesotho and Swaziland have also adopted similar laws.

Few say the laws do what they’re intended to: reduce the spread of HIV. “They make lawmakers feel good, but they have very limited positive benefits for the public,” says Jonathan Berger, head of policy and research at the Johannesburg-based AIDS Law Project.

Apart from stigmatizing the disease more than it already is, critics warn, the laws ignore the fact that these countries may not have the resources to perform the careful genetic analysis required to distinguish the innocent from the guilty.

Phylogenetic analysis helps pinpoint how closely related two isolates of HIV are. In a criminal case, a virologist would obtain genetic sequences of the virus from both parties involved and compare them to sequences in a database, such as the US National Institutes of Health’s GenBank, or from other infected individuals in the community.

If the viruses appear more closely related to each other than they are to samples taken from the larger population, it increases the likelihood that one person infected the other.

The procedure has its limitations, however. “It doesn’t say anything about the direction of movement. It doesn’t say anything about timing. It doesn’t even really say that the transmission took place between the two people,” says Yusef Azad, director of policy and campaigns at the National AIDS Trust, a UK-based advocacy group. “They both could have been infected by a third party.”

Still, phylogenetics can exonerate the innocent. If the two HIV samples aren’t closely related, it’s unlikely one person could have infected the other. “The greatest power of it is exculpatory,” says Gerald Learn, a microbiologist at the University of Washington. “If I was a defense lawyer, I would insist on it.”

But the procedure is complicated and costly. “Scientists who are not trained in this field couldn’t just read published reports and try to do this on their own without having the proper tools,” says Michael Metzker, assistant professor of molecular genetics at the Baylor College of Medicine in Houston.

Genetic analysis of each HIV sample can require more than 100 sequences, with a price tag between $1 and $5 per sequence—no small sum in a developing country.

A few labs in Uganda are equipped to do the analyses, says Maria Wawer, a professor of population, family and reproductive health at Johns Hopkins University who conducts research in Uganda. “But it is likely to remain too expensive for the foreseeable future,” she says.

Courts in these countries may instead rely on circumstantial evidence, raising the risk of wrongful convictions.

“In the absence of really clear scientific evidence as to who infected whom,” says Azad, “there will too often be an assumption that those categorized as undesirable by society are guilty of infecting other people.”

In 2002, UNAIDS argued against laws that penalize HIV transmission, recommending instead that responsible individuals be prosecuted using standard criminal laws, notes Azad. “Any legislation which singles out HIV for this kind of criminal sanction is breaching international human rights guidelines.”

Australia: Editorial argues epidemiological information should be used to prosecute ‘reckless’ individuals

An editorial in The Age argues that Australia’s HIV Epidemiology Project should be used to track down individuals who are ‘reckless’ so that they can be prosecuted.

This is not only unethical, it is also not scientifically possible given the uncertainties inherent in phylogenetic analysis – the scientific method used when assessing the relationship between HIV genotypes.

A suitable case for treatment. Unsuitable for restriction.
Editorial, The Age
May 14, 2007

The battle against HIV/AIDS in Australia is being waged on shifting territory. In one area there is solid ground: the promise of scientific vigilance to find factors contributing to the rise in infection rates, particularly in Victoria. Elsewhere is a darker, more treacherous landscape: the threat of politically initiated assessments of HIV-positive visitors to Australia and the possibility they could be banned altogether. Both initiatives originate from the Federal Government.

As The Age reports today, the Government’s Health Protection Committee has chosen a team of Victorian scientists to analyse HIV infections over the past three years to determine who or what is responsible for the rise in national infection rates from 656 cases in 2000 to 930 in 2005, an increase of 41 per cent; in this state HIV infection is at its highest level for 20 years: in 2006, 334 cases of HIV were reported to the Department of Human Services, an increase of 17 per cent on the previous year. As part of its investigation, the HIV Epidemiology Project will examine whether genotyping HIV infections – developing a genetic profile of the virus in patients – could help identify groups of individuals transmitting the virus. Three men, including a Melbourne man, Michael John Neal, are before Australian courts on charges of recklessly or deliberately infecting others with HIV.

Although civil-rights groups representing people living with HIV and AIDS have raised ethical concerns over genotyping – previously used only in criminal cases or to determine a virus’ resistance to drugs – the Health Minister, Tony Abbott, who approved the project last month, has said the research is aimed at gathering information on risk groups and not tracking down individuals. This has been supported by the head of the Infectious Disease and Epidemiology Unit at Monash University, Dr Karin Leder, who says risk groups are the focus of the first phase of the project, with any future investigation of individuals dependent on the data received. If, however, this leads to the identification of HIV-positive individuals who, through indiscriminate recklessness are endangering the lives of others, then surely public safety must take precedence over rights to privacy.

The HIV Epidemiology Project should be welcomed. At the very least, it represents a national approach to what is really a national problem, as well as a significant step towards proper research into a condition that knows no boundaries. Any sensible measure that can lead to a reduction in the HIV infection rate cannot be discounted, especially when news of the project comes at the same time as Government funding of almost $10 million over four years for a national HIV-prevention program, including a new media campaign. The project should also, by default, begin to restore confidence in a health system beleaguered by last month’s breakdown in bureaucratic communication at Victoria’s Department of Human Services; this led to the sacking of the state’s chief health officer, Dr Robert Hall, by his minister, Bronwyn Pike, over alleged non-disclosure of three HIV-positive people under police investigation.

A far more sensitive issue, one that stigmatises rather than helps HIV sufferers, is the intention of the Prime Minister, John Howard, to restrict or perhaps ban such infected people from entering the country. Mr Howard has written to his immigration and health ministers seeking advice on the public-health implications of letting HIV-positive people into Australia. This follows Mr Howard’s response last month, when asked about allowing in HIV-positive immigrants, “My initial reaction is no”. Mr Howard also said there could be “humanitarian considerations”.

Some countries, including the United States, Russia and the United Arab Emirates, have absolute bans on HIV sufferers; others, such as Britain and France, are more tolerant. It is difficult to see how Australia could benefit from becoming an HIV exclusion zone without being seen to be unnecessarily discriminatory or alarmist. It would be better for the Government to concentrate on the more effective methods of control through scientific research and public awareness.