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Tuesday 2 December 2008

Canada: The Johnson Aziga Case: HIV transmission should not be a crime

There's so much to say about the ongoing Johnson Aziga double murder trial that I am now waiting for the verdict before publishing highlights (lowlights?) of media reporting on this landmark case.

In the meantime, I'm posting a commentary by the highly respected Dr Mark Wainberg published yesterday in the McGill Reporter, the online publication of McGill University, Montreal, as food for thought.

The Johnson Aziga Case: HIV transmission should not be a crime
by Mark A Wainberg

The media have done an excellent job in recent weeks covering the murder trial of Johnson Aziga, who has been accused of sexually transmitting HIV to 11 different women, two of whom have died of their infections. Moreover, it is alleged that Mr. Aziga deliberately withheld from these women the fact that he was HIV-positive and that he refused to use a condom during intercourse. Most Canadians probably hope that Mr. Aziga, if convicted, is sentenced and imprisoned for his crimes, and believe that the criminal justice system should pursue these cases with vigour. But people should understand that such legal action, and the willingness of our courts to hear these cases, will only weaken the global battle against HIV transmission.

First, those cases that have gone to court have probably done more harm than good, even when it has been possible to prove wilful transmission. In almost all such instances, defence lawyers have seized upon the discredited notion that HIV may not cause AIDS. Because these cases have often attracted widespread coverage, the result is often confusion about the harmful nature of HIV and to give the so-called HIV denialists a platform from which to promulgate their views.

More important, we must consider that potentially being charged with wilful HIV transmission may deter a significant number of people from being tested for HIV infection in the first place. After all, if you do not know that you are HIV positive, you cannot logically be accused of transmitting it. This leads to two major negative consequences:

The failure to identify as many HIV positive people as possible will lead to higher rates of HIV spread than would otherwise occur. Multiple studies have now shown that individuals who are informed that they are HIV positive will commonly desist from high-risk sexual behaviour to protect sexual partners. This is not the case for the uninformed. This point cannot be over-emphasized, research has also revealed that as many as 50 percent of all new HIV transmissions are attributable to people who have only been infected recently. One reason for this is that levels of virus in the blood and sexual fluids are usually very high for about a six-month period following infection.

Delaying testing also means that many HIV-infected persons may not be diagnosed for several years after infection, thus giving the virus additional time to replicate and cause significant, often irreversible, damage to the immune system. This can sometimes result in life-threatening infections that might otherwise have been prevented. There are also concerns that failure to initiate anti-HIV therapy early may leave people more vulnerable to a variety of cancers.

Earlier initiation of anti-HIV therapy also lowers the amounts of virus in both blood and sexual fluids, thereby rendering people far less infectious to their sexual contacts. Indeed, some groups now proclaim that people whose viral replication is fully suppressed by antiviral treatment need no longer use condoms or take other precautions when having sexual relations with regular partners. Although health authorities have not endorsed this controversial recommendation, its very existence underlines that appropriate use of anti-HIV drugs will not only improve the health of infected people, but may also hold benefits for HIV spread and public health.

All of the above constitute grounds for advocating frequent testing of individuals who might be at risk of contracting HIV. Yet the risk of being accused of the crime of wilful HIV transmission, along with the stigma of being identified as HIV positive, might be powerful deterrents for many.

How can society resolve this problem, while not, in effect, encouraging sexual promiscuity and risky behaviour? We need to recognize that the current criminalization of HIV transmission is not doing any good and, might even have the perverse effect of increasing HIV transmission by people who do not know or don’t want to know that they are infected. We also need to accept that having sexual relations involves personal responsibility: Before having sex with someone, you should know them on more than just a superficial level.

Finally, let’s not confuse the issue of HIV testing and personal responsibility for consensual sexual relations with that of HIV transmission by rapists or other perpetrators of crime. Clearly, people who force others into non-consensual sex should continue to be charged and tried under the law. Probably, as well, a person who throws contaminated blood or needles at someone should be charged with assault, since their intent was most likely to cause harm, notwithstanding that any resultant skin contact with such blood would be extremely unlikely to result in HIV transmission. But the putative crime in such cases would be assault rather than intent to transmit HIV.

If the evidence against Johnson Aziga is upheld in court, this will substantiate that he is the unsavory, irresponsible individual that the prosecutors in the case have made him out to be. But let’s also recognize that our policies regarding criminalization of HIV transmission are having the opposite effect of those that were intended. Let’s fix things in order to have a much better chance at reducing the scope of the HIV epidemic.

Dr. Mark Wainberg is the Director of the McGill AIDS Centre at the Jewish General Hospital.


Oigen said...

What? Is this the same Wainberg that would have anyone summarily tried and jailed for daring to challenge the phantom HIV?
See video..

jonas1453 said...

I am French, hetero, HIV-.

I discovered a few days ago the whole line of argument summed up by Mark Wainberg.
My reaction was similar to that of most people who are not infected : I was baffled by the twisted logic in it and the gross immorality.
Let’s say you are an honest boy or girl, whatever. You meet someone who is very charming and you fall in love. Unfortunately, your lover has a psychopathic personality disorder. He seems perfectly normal and sane, but he is deceitful, manipulative, callous, totally lacking in empathy and conscience. Some of the guys who are being charged, like Johnson Case, may be psychopaths (don't know if they were assessed). One person out of a hundred is a psychopath according to Pr Robert Hare, the leading expert in this field (from Vancouver by the way).
Psychopaths are thrill-seekers and promiscuous individuals. Since they are very charming and don’t bind emotionally, they jump from one person to the other, with utter carelessness for their prey’s well-being.
Let’s say I fall in love with him/her and let’s say he convinces me he really loves me and wants to have children with me.
Let’s say I trust him so much that I believe him when he lies to me coldly pretending that he is HIV- although he knows perfectly he is not.
Or even worse: let’s say he forges a paper to “prove” me that he took a test.
Sure, he/she didn’t want to kill me. He simply didn’t give a shit about me. He simply wanted to use me as a sexual tool whatever the consequences on my health. A few week later, he is gone forever.
That happens all the time. Those people are a real threat because of their hability to persuade people that you can trust them (con-artists, confidence tricksters). They also know how to put the blame on someone else.
It looks like your are defending those irresponsible predators.

The line of argument provided by Mark Wainberg apparently logically makes sense but it doesn’t.
If we were to renounce justice every time we fear that it might provide a platform to foolish or denialist prejudices and ideas, we should as well erase every court in the world.
The principle of justice lies in the confrontation between two points of view so that the truth can emerge. If the guy gets convicted, it means that the defense lawyers failed to convince the jury.
Never be afraid of justice. Use it. If Mark Wainberg knows the truth, he should be called as an expert. But don’t propose censorship.

Mark Wainberg pretends to be very human, concerned with general suffering. But the problem lies there. He is only concerned with a GENERAL and scientifical point of view. But he is cold and inhuman as only technocrats can be.
I suggest he tries to meet the family of John Case and argues like all aids activists do:
“Let him go, let him be free and fool around with other people’s life, and I promise that in two years from now, I will show you some exquisite graphic with the blue line sliding down slowly.”
This is the technocratic point of view.
The moral point of view is : we punish those who wreck other’s lives. It helps alleviates the victim’s grieve and it gives a signal to the other self-centered individuals who might be tempted to be irresponsible.
Let’s consider now this argument: If we punish those who fool around, they will go underground, it plays in the hand of the disease.
And now compare this argument to this one we hear sometimes in France:
If we add taxes to those who are very wealthy, they will go to Switzerland (underground) and we will lose resources to invest.
You can consider it from an economical point of view and from a moral point of view.
Another one from the pedophile activists (needless to say that I make a clear difference between pedphilia and homosexuality):
It’s very dangerous and counterproductive to punish pedophile assaults because it may lead some to think: “Hey, I should get rid of the kid so he won’t be a witness at the trial.”
It sounds logical (it may spare a few lives) but it is outraging from a moral point of view and society never buckle under such blackmail.
It IS blackmail, blackmail from the most despicable members of the community we talk about.
A billionaire who made his fortune in France working with thousands of French citizens and who suddenly decides to vanish to some free-tax paradise is quite despicable.
A guy who decides: “I didn’t use a condom with this guy at the disco the other day… But I won’t take a test, not so much because I am afraid but because I want to keep taking health risks and fuck around without risking to end up in court. I am more afraid of prison than aids” This is both morally despicable and stupid.

You are willing to sacrifice the notion of justice so that these guys can keep on putting other’s lives in danger. And your twisted logic makes you think that the goal is to fight against the disease.
It’s morally totally wrong. And from a technocratic point of view (the pandemy will recede) it is very dubious.
Those who are against criminalization seem to be convinced that justice (bring to court those who knowingly expose their partner to whom they lied, be it actively or by abstaining to reveal their condition) and fighting the disease is a necessary contradiction. But it is not.

You should read Steve Pinker’s article in the New York Times to learn about “moral illusions”. It’s called “The moral instinct”.
You should also learn about psychopathic disorder, because those guys are really vicious. Hare wrote in 1992 I believe, that an American doctor working with aids patients called him because he was worried that many of his patients were particularly irresponsible and seemed to have the same type of personality.

I sometimes feel that the opponents to criminalization are in fact only concerned with defending their right to lie or manipulate in order to have sex with someone (should it harm his/her health). They are mainly lobbying for their chances to be promiscuous. I don’t feel, reading their texts, that they care about the spread of the disease. They are mainly concerned about their “human rights” (which too often basically comes down to having the right to hide their condition to those they want to their prospective sexual partners. And that includes medical secret (very legitimate according to me) and immunity from justice (so they can fool their partner without risking a trial).

Sorry for my English.
Though I generally disagree with you, I appreciate your blog. Keep the good work.


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