New Zealand: 'HIV predator' is named; seventh complainant adds further charges

The man dubbed the 'HIV predator' had his name and face splashed all over New Zealand's media today in what has become the biggest criminal HIV transmission case in NZ history. There are now seven complainants (six men, one woman) of whom five are alleging that the man was source of their HIV infection.

As well as his name and several photos, today's report on GayNZ.com includes many of the details left out of their earlier reporting, including his online dating profile nicknames and the name of the street he lived on in Auckland. They also highlight that HIV testing centres are anticipating a rise in HIV testing today and over the weekend as people recognise the man. But surely this is as much a 'fishing expedition' as a public health warning.

Today's story on TVNZ.com includes a quote from Bruce Kilmister, chief executive of NZ's PLHIV organisation, Body Positive

[Kilmister] said the alleged charges significantly changed a lot of people's lives. "Everybody who has had an association with him in the past should come forward for a test. But it's also a timely reminder that everybody has a responsibility to keep themselves safe and follow safe sex practice. HIV positive people have an added responsibility not to transmit the virus, and the best way they can do that is to have safe sex."

To put the case into perspective, according to data from New Zealand's Ministry of Health (AIDS New Zealand Issue 63 – March 2009 ) only 184 people were newly diagnosed with HIV in 2008 – of whom 91 were acquired via sex between men, but only 70% of these were acquired in New Zealand, most of whom lived in Auckland – and this was the highest number ever recorded. Since there are now five gay men (aged between 17 and 31) who claim the accused man infected them, this 'cluster' alone would represent around 8% of new diagnoses.

Adding to the panic is the 19 year-old female complainant (who has not tested positive). Between 1999-2008 there were only 52 women diagnosed with HIV that was heterosexually acquired in New Zealand. The TVNZ article continues

The fact a woman had allegedly been affected raised concerns the virus may have spread into the heterosexual community. "The reality is that most women think of the pill as the beginning and end of safe sex. It needs to be a message that goes right across the broad spectrum," [said Kilmister.]

If this man is the source of five (or possibly more) infections, this certainly is a public health concern, and the criminal justice system involvement is, indeed, a result of the failure of public health. The call for new and better public health laws in New Zealand are understandable, and certainly would be better than the current system which required media and CJS intervention.

However, last year the NZ Ministry of Health published a study examining HIV prevalence in New Zealand, both diagnosed and undiagnosed (AIDS New Zealand Issue 62 - November 2008) which found a prevalence of 4.4% amongst men who have sex with men attending sexual health clinics, of whom only half were diagnosed. Undiagnosed people can't disclose – and cannot be publically (or even privately) named and shamed as a way to warn others about specifically avoiding them. Undiagnosed people may also be having as much – or more – 'promiscuous' sex as the so-called 'HIV predator'.

Earlier in the week, TVNZ ran an in-depth look at the case and interviewed Michael Stevens, the man who orginally brought the allegations to GayNZ.com and Simon Harger-Forde, director of HIV prevention at New Zealand AIDS Foundation. It makes for uncomfortable viewing by making patient confidentiality appear to be something bad, and conflating two issues (non-disclosure resulting in HIV exposure or transmisison being a criminally liable act and the lack of an effective public health response) without any examination of the issue of shared responsibility for sexual health. Only at the very end does Mr Harger-Forde say that laws don't protect anyone, and that everyone should be using condoms.



Finally, an interesting blog posting from a feminist commentator, which highlights other concerns - that this case will end up leading to further stigmatisation of gay men and people living with HIV in New Zealand, and concludes:

Safe sex is crucial, of course, but it's also crucial that the ... case doesn't become an exercise in victim-blaming, with homophobic overtones. And it's also important that [his] behaviour doesn't prompt a backlash against HIV positive people, who have the same needs for affection, companionship and intimacy as the rest of us.

Spain: Ministry of Health plans national database of HIV-positive people

Update: 9th October 2008.

The Constitutional Court has rejected an appeal by several Spanish HIV organisations against the Ministry of Health, which will go ahead with establishing a national HIV database.

Spain to establish a HIV register
Oct 9, 2008
typicallyspanish.com

Spain is to set up a registry of people affected with the HIV virus. It comes as the Constitutional Court has rejected an appeal against the Ministry for Health plan presented by several different Non-Governmental associations.

The register will contain files which will hold the latest diagnostic data on those infected. The authorities say the registry will help them to keep control of the real situation of the spread of the virus in Spain, but objectors claim that the project does not guarantee the anonymity of the people included.

It’s understood the files will be labelled with a combination of initials and birthplace to identify each case. Across the European Union, only Italy has a similar registry in existence.

Spanish Health Ministry Announces Plan To Determine Number of HIV Cases by 2015
Thursday, September 13, 2007
Kaiser Network

The Spanish Ministry of Health recently announced a new plan to determine the number of people living with HIV in the country and reduce the spread of the virus by 2015, El Pais reports. The plan replaces an earlier one that expired in 2005 and was not renewed, reflecting what some nongovernmental organizations say is the government's lack of dedication to addressing HIV/AIDS.

Some HIV/AIDS advocacy groups say the new plan does little to address the disease in the country. Cesida, the largest confederation of NGOs involved in fighting HIV/AIDS in Spain, said the new plan "cannot be considered a plan of action." Some NGOs are complaining that the plan's goals are vaguely worded and that the time frame is too long. NGOs also have said that the plan places too much emphasis on those who are already HIV-positive, rather than on the general public, to combat the spread of the virus. In addition, some NGOs have said that the plan singles out high-risk groups, such as injection drug users and commercial sex workers, and does not mention specifically heterosexual men, who are the primary transmitters of the virus in the country, El Pais reports.

The plan also will establish a national database of HIV-positive people. Although NGOs support the health ministry's efforts to determine the number of people in Spain living with HIV, they are opposed to the national database and are concerned it could become public knowledge and lead to discrimination against people living with the virus, El Pais reports (Benito, El Pais, 9/12).

New Zealand: New bill proposes to make HIV a notifiable disease

A Press release from the New Zealand AIDS Foundation highlights concerns over the forthcoming Public Health Bill to make HIV a notifiable disease. The NZAF supports the Bill as along as all the necessary epidemiological information remains anonymised.

NZAF is keen to point out that this data collection system has not and would not involve identification of HIV positive people.

“This is about collecting the ‘what’, ‘where’ and ‘how’ of new HIV infections, not the ‘who’,” Le Mesurier explains. “The confidentiality of HIV positive New Zealanders must be protected.

“However, we need reliable data to map the changes in the HIV epidemic. For example, treatment-related deaths are a new complication that can only be monitored by analysing HIV diagnoses, rather than AIDS.

HIV data collection must be secured
Friday February 22, 2008

Adding HIV to the Ministry of Health’s list of notifiable conditions will help create an “HIV census”, ensuring that anonymous data collection on New Zealand’s HIV and AIDS epidemic is secured for the future, says the New Zealand AIDS Foundation (NZAF).

NZAF is supporting moves in the forthcoming Public Health Bill to make HIV a “notifiable” condition, providing the current anonymous coding system is retained. AIDS has already been a notifiable condition since 1985 with no breaches of confidentiality.

“AIDS represents the end result of HIV infection, and with the effectiveness of new treatments for HIV, information on AIDS notifications are increasingly less useful as a tool for tracking the spread of the epidemic,” says Rachael Le Mesurier, Executive Director of the New Zealand AIDS Foundation.

New HIV diagnosis information is currently sent by GPs, sexual health clinics and NZAF centres to the AIDS Epidemiology Group at Otago University, who collate the six-monthly AIDS New Zealand reports.

This system has been working very well since 1985 and has been entirely voluntary. Nearly 2,500 New Zealanders with HIV have given their permission for data on their diagnosis to be collected and published in AIDS New Zealand.

“The AIDS Epidemiology Group currently receives information on over 95% of HIV diagnoses, but there is no legal requirement for this data to be collected,” Le Mesurier says. “With the many demands placed on our health services, and the good news that treatments have drastically reduced AIDS deaths, we need to ensure that HIV is given the priority treatment it deserves by making the anonymous data collected secure for the future.”

NZAF is keen to point out that this data collection system has not and would not involve identification of HIV positive people.

“This is about collecting the ‘what’, ‘where’ and ‘how’ of new HIV infections, not the ‘who’,” Le Mesurier explains. “The confidentiality of HIV positive New Zealanders must be protected.

“However, we need reliable data to map the changes in the HIV epidemic. For example, treatment-related deaths are a new complication that can only be monitored by analysing HIV diagnoses, rather than AIDS.”

The Public Health Bill is currently before the Health Select Committee. The closing date for submissions is Friday March 7, 2008.

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.

Australia: Federal goverment plans HIV genotype database to 'trace reckless infections'

'The Age' reports on the HIV Epidemiology Project which may be used to trace people who criminally transmit HIV.

Full report below:

Plan to genetically trace reckless HIV infections
Julia Medew
April 28, 2007

People who have recklessly or deliberately infected others with HIV could be genetically traced under a project approved by the Federal Government.

Documents obtained by The Age reveal the project will investigate whether genotyping HIV infections — developing a genetic profile of the virus in patients — could identify groups of people or individuals responsible for transmitting the virus.

The approach, believed to be a world first, was approved by Health Minister Tony Abbott earlier this month after several high-profile cases raised concern about how HIV positive people were being managed by health authorities.

Three men, including Melbourne man Michael John Neal, are before Australian courts on charges of recklessly or deliberately infecting others with HIV.

Under the plan, titled HIV Epidemiology Project, a team of scientists will be asked to examine the epidemiology of current HIV infection in Australia, including infections in high-risk groups such as homosexual men, injecting drug users and migrants and refugees gaining entry to the country.

They will also look at the movement of HIV positive people across the nation and behaviour that could be contributing to rising infection rates. HIV infections have surged 41 per cent across Australia from 656 cases in 2000 to 930 in 2005.

Associate Professor Andrew Grulich, head of the HIV Epidemiology and Prevention Program run by the National Centre in HIV Epidemiology and Clinical Research, welcomed news of the project but said any effort to map the transmission of HIV across the nation in recent years would be controversial and extremely difficult.

"(Genotyping) may be of use for investigating particular individuals who are alleged to be behaving irresponsibly but at a population level there is more doubt about whether it would be useful," he said.

Dr Grulich believed a national approach to genotyping HIV infections would be a world first. It is only used in criminal cases or to determine a virus' resistance to drugs, he said.

Health Minister Tony Abbott said the project was not designed to target individuals for criminal prosecution, but to help public health education campaigns. "If AIDS is still very much a disease of gays and drug users, there is not much point running a campaign pitched to the general public," he said.

Jamie Gardiner, a vice-president of Liberty Victoria, said any project designed to point the finger at particular people would undermine the public health approach to HIV that Australia had used since the 1980s.

"It's hard to imagine that ethics approval would be granted for a project like this. This is a project whose purpose is not about the curing or prevention of illness but one that is being perverted for the pursuit of inappropriate criminal justice objectives," he said.

Brett Hayhoe, president of People Living with HIV/AIDS Victoria, said "The last thing we need is for an already marginalised community to be marginalised and victimised more."