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Friday, 15 February 2008

Canada: Carl Leone was 'in denial' testifies psychiatrist

Sentencing hearings for Carl Leone continued this week. Today, psychiatrist for the defence, Dr Paul Fedoroff, testified that Mr Leone was in denial of his HIV status when he had unprotected sex with fifteen women, rather than intentionally deceiving them.

"His problem is one of not being aware of the nature of his (condition) and engaging in unsafe sexual activity."
I've often wondered why the 'denial' defence hasn't been used before. It seems obvious to me that many of the people prosecuted for 'reckless' HIV transmission have been in denial of their status and/or of their infectiousness. This is not the same as being an HIV denialist. Denial – the refusal to acknowledge the existence or severity of unpleasant external realities or internal thoughts and feelings – is a classic manifestation of grief.

Following diagnosis, HIV-positive people are likely to experience an initial period of shock often followed by confusion, social withdrawal and depression. It can take months, if not years, to adjust – depending on an individual’s own situation – and whilst it may seem that onward HIV transmission ought to be a priority, in reality it vies for importance with many other issues.

Heath advisor guidelines list some common issues that may need to be discussed in post-test counselling, including:
• Adjustment to living with HIV
• Beliefs: health, medical, religious, cultural
• Children / pregnancy issues
• Disclosure of status to friends and family
• Employment issues
• Fear and anxiety for the future
• Partner notification
• Personal and social relationships
• Risk reduction and behaviour change
• Shock and uncertainty
• Social/financial situation

In this situation, newly-diagnosed people are unable to take in more than a fraction of any information provided in a single post-test counselling session. In addition, although limited research has been conducted regarding the content and quality of post-HIV test counseling, one study found that it varied widely between clinics and between individual advisors .

After post-test counselling, information on HIV transmission, and how to reduce the risk (rather than eliminate the possibility of risk) is only provided to patients at HIV clinics on an ad hoc basis. Since there is no specific guidance provided to health advisors regarding the advice on specific sexual practices, what may be considered ‘high risk’ by one health advisor may be thought of as ‘low risk’ by another.

HIV carrier said in 'denial'
by Gregory Bonnell, THE CANADIAN PRESS

WINDSOR, Ont. - A man convicted of knowingly spreading the virus that causes AIDS was in "extreme denial" of his HIV status until his trial a decade later, a psychiatrist testified Wednesday at Carl Leone's dangerous offender hearing.

Crown prosecutors immediately took exception to Dr. Paul Fedoroff's denial argument, calling Leone's guilty plea an admission of the "dishonesty and deceit" that was at the root of his failure to tell his 15 victims he was HIV-positive.

Still, the psychiatrist said based on his two meetings with Leone last month he found "evidence of extreme denial of the seriousness of the disease he had been diagnosed with."

"Mr. Leone's problem is not an overly high sex drive," said Fedoroff, who was called as a defence witness.

"His problem is one of not being aware of the nature of his (condition) and engaging in unsafe sexual activity."

Leone, who helped run his wealthy parents' music store, was told in 1997 by Windsor Essex County Health Unit workers that he was HIV-positive - seven years before his arrest on June 6, 2004.

"Mr. Leone himself came to the conclusion that the test must have been a so-called false positive," said Fedoroff, a psychiatrist at the Royal Ottawa Hospital.

"He tells me that he has changed his opinion, that he now believes he is HIV-positive and requires treatment."

That epiphany apparently came at Leone's trial, which ended abruptly after several weeks of testimony last April when he suddenly entered a guilty plea - a clear admission, the Crown argued Wednesday, that he had knowingly spread HIV.

"What lies at the foundation of all this was the fact that there was dishonesty, there was deceit," said prosecutor Frank Schwalm.

"Simply put, he defrauded them of the ability to consent, in an informed way, to have sexual relations with him."

Schwalm cited an HIV pre-test counselling form dated March 3, 1997 as evidence that Leone "suspected something was wrong" some 10 years before his trial began in 2007.

"He suspected that he contracted, or was exposed to, some sort of sexually transmitted disease," said Schwalm.

Despite the HIV diagnosis, Leone didn't develop any symptoms of AIDS and concluded the test must have been wrong, said Fedoroff. To this day, Leone has shown no symptoms of full-blown AIDS.

"He never did anything to help himself. Most people, if they're HIV positive, seek treatment," Fedoroff said.

"It supports his version, that he believed he didn't have HIV."

The denial argument is also bolstered by Leone's low scores on a psychopathy test, which would suggest he was not purposely out to harm others, Fedoroff added.

The Crown is seeking to have Leone declared a dangerous offender.

Such a designation would see Leone jailed indefinitely, with his detention subject to review after seven years and then every two years after that.

The judge can also opt to sentence Leone as a long-term offender, which would see him placed under community supervision for up to 10 years after his release from prison, or hand him a straight prison sentence.

Closing arguments were expected Thursday with the hearing concluding on Friday.



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