Canada: Hamilton woman pleads guilty to HIV exposure

A 28 year-old woman from the same Ontario town as Johnson Aziga yesterday pleaded guilty of one count of aggravated sexual assault for not disclosing her HIV status to a man she met for a one-night stand in 2007. She will be sentenced in August.

The case was reported today in The Toronto Star and highlights the real problems HIV-positive Canadians are facing due to the current oppressive, discriminatory – and ultimately harmful – legal obligation to disclose before sex. When the woman was arrested in March 2007, police held a press conference saying the woman posed “huge threat”. According to the CBC website on the day of the press conference:

Det. Joseph De Lottinville called [the woman] “a huge threat” to public safety, amid police fears that she deliberately slept [my italics] with a number of people without revealing that she had HIV, the virus that causes AIDS.

Police allege that [she] has known of her HIV status since March 2003, but didn’t follow the legal requirement that people with HIV disclose the condition to sexual partners.

Officers said [she] is believed to have frequented several bars in the Greater Toronto Area, specifically in Hamilton, Brantford and Toronto, particularly in its downtown Entertainment District.

More than 10 men who allegedly had sexual contact with her are being interviewed by police.

This is phrased slightly differently on CityNews.ca, published the same day:

The 26-year-old from Hamilton was arrested on Sunday and police are alerting the public of her case. They allege she deliberately withheld [my italics] her important health information in order to have sex with men she met in bars in and around the GTA.

Detectives say [the woman] frequented bars in Hamilton, Brantford and Toronto on a regular basis and had sex with men she met at those establishments. She was diagnosed with HIV four years ago.

[She] deliberately failed to tell [my italics] one Toronto man about her HIV-status, according to police, and allegedly did the same to other men in order to have sex with them, often unprotected. Authorities are urging anyone who’s had sex with her to seek medical attention immediately.

“From what we’ve learned, she will disclose it sometimes and she won’t disclose it on other times,” Det. Joseph De Lottenville said Thursday.

The use of ‘deliberate’ in these different ways is really interesting. The first allegation that she “deliberately slept with a number of people without revealing that she had HIV” suggests that she intended to infect these men. However the second allegations, that she “deliberately failed to tell” one man that she had a one-night stand with that she was HIV-positive, is purely about nondisclosure. The knee-jerk reaction of the police was to create the myth of a female ‘HIV predator’ when the reality was that she and another man agreed to have (or probably did not even discuss) unprotected sex, putting themselves equally at risk – she of infecting another to HIV, he of becoming infected with HIV. I assume the man had the capacity to protect himself. Did he really need to be specifically warned about the risks? Why, then, is he is not held responsible for putting himself at risk?

And so, even after police released the woman’s name and photo for their ‘fishing expedition’, and even after interviewing more than ten of her other past sexual partners, she was still only charged with one count of aggravated sexual assault for nondisclosure. How then was this woman “a huge threat”? Aren’t the ten or more men who slept with her without using condoms who will have gone on to sleep with others, much more of a threat?

Canada: Prosecutions having negative impact on disclosure; Edwin Cameron speaks out

In my news story for aidsmap earlier this week, I wrote:

Over the past week, the global movement against criminalisation of HIV transmission received its biggest boost since the International AIDS Conference in Mexico last July. In rallies and meetings in Australia, Canada and Sweden leading judges, lawyers and politicians joined with HIV-positive advocates and civil society organisations to condemn the criminal justice system’s current approach to HIV non-disclosure, exposure and transmission.

I’ve already posted more detailed information about the Australian meeting, one of the two events in Canada, and highlighted the situation in Sweden. Below I’m posting highlights from newspaper coverage of South Africa Constitutional Court Justice Edwin Cameron’s speech in Toronto last Friday.

Update: The official text of Edwin Cameron’s address is now available from the Canadian HIV/AIDS Legal Network website. (Une version française est disponible ici). An audio recording, which captures both the passion of his delivery, and some off-the-cuff changes, is available in the same location. Video may also be made available at a later date.

The Toronto Star ran a major article headlined, Judge slams criminalization of HIV, which put forward, without critique, Mr Justice Cameron’s international policy arguments as to why Canada needs to think again about its nondisclosure law.

Canada’s relentless practice of invoking the criminal law against people with HIV and AIDS is only intensifying the stigma surrounding the conditions and contravenes United Nations guidelines, argues a judge of South Africa’s Constitutional Court, who is HIV-positive himself.

African countries that look to Canada as a world leader on human rights issues are getting the wrong message when it puts people with HIV/AIDS on trial for having unprotected sex, even when the virus has not been transmitted, Justice Edwin Cameron said yesterday.

“Canada’s wide approach to exposure offences is sending out a terribly retrograde message to other countries, especially on my own continent, in Africa,” said Cameron, who delivered the keynote speech last night to kick off a weekend symposium on HIV and human rights issues, hosted by the Canadian HIV/AIDS Legal Network.

With human immunodeficiency virus still steeped in so much stigma in Africa that many are afraid to be tested, Canada is not providing a good example of dealing rationally and justly with the epidemic, said Cameron, noting Canada is a “world leader” in targeting HIV-positive people for prosecution.

[…]

AIDS activists, Cameron said, must accept there may be instances in which criminal liability is justified, noting that one example might be the recent case in Hamilton of Johnson Aziga, convicted of first-degree murder for actively deceiving women about his HIV status and infecting them.

But Canada needs to rethink its sweeping use of the criminal law and question why it is singling out HIV-positive people for prosecution when the same Criminal Code powers are not being used against those who expose people to other potentially deadly conditions, he said.

“Let’s take, for example, the two recent health scares, swine flu and the highly, highly contagious forms of tuberculosis. We had a case where somebody got onto an aircraft with a highly transmissible form of tuberculosis, and no one ever suggested that person should be prosecuted.”

“Queer activist” Andrew Brett also wrote about Mr Justice Cameron’s speech on rabble.ca. It’s becoming clear that the fallout of the Johnson Aziga verdict is hitting HIV-positive Canadians really hard. The few I’ve spoken with personally are feeling under attack. Mr Justice Cameron, himself HIV-positive, feels their pain. Brett writes:

Earlier this year, a court in Hamilton, Ontario became the first in the world to convict a man of murder for failing to disclose his HIV-positive status to his sexual partners, two of whom later died of AIDS. Since then, criminal prosecutions have increased and the degree of charges being laid has been elevated.In some cases, Toronto police have even issued “public safety alerts” with names and photographs of HIV-positive people who allegedly failed to disclose their status, asking their sexual partners to come forward. Cameron likened this practice to a proposal by a Swaziland parliamentarian to brand people with HIV/AIDS on the buttocks.

An article published on Tuesday in Xtra.ca, entitled Attempted murder the new aggravated assault? eloquently highlights the impact this culture of fear is having in Toronto.

Rita Shahin, associate medical officer for Toronto Public Health, says that public health can be required by law to tell police if a particular individual has tested positive for HIV.

“When the police get a complaint in front of them then they will come to us with a search warrant and if we have a file on somebody then we have to produce it,” says Shahin.

However individuals who have been tested anonymously — through the Hassle Free Clinic’s anonymous HIV-testing program, for example — will not show up in public health’s records.

Although Shahin says public health hasn’t yet seen a decrease in the number of people getting tested as a result of the recent charges laid, “it’s definitely creating a lot of anxiety and especially for those people who are behaving responsibly it’s [a question of] how do they protect themselves? How do they prove that they’ve disclosed to someone?”

[Angel] Parks [coordinator of the AIDS Committee of Toronto’s Positive Youth Outreach programme] says she’s also hearing from people living with HIV/AIDS (PWAs) who are afraid that they’ll be charged even though they’ve disclosed.

“With any other criminal charge it’s always relied upon for having forensic-type evidence and these cases seems to only be based on he-said, she-said scenarios,” says Parks.

“Now they’re are even more afraid of what the consequences will be when they do disclose… like what if things fall out in a relationship where disclosure has happened? What can they do to protect themselves to ensure they can provide a credible defence if such an incident did occur?”

Because public health also deals with complaints against individuals for nondisclosure this is a scenario Shahin has seen play out.

“That’s why we have to really investigate the complaint to sort out, is it true? Is there a basis to the complaint or is it a relationship that’s gone sour where somebody’s being vindictive?”

Both Parks and Shahin recommend the recently published HIV Disclosure: a Legal Guide for Gay Men in Ontario, produced by the HIV and AIDS Legal Clinic (Ontario).

“It is meant to target gay, bi and men who have sex with men,” says Parks, “but the information contained in it is applicable really to any person living with HIV…. They talk about how to protect yourself against malicious lies or attacks.”

It’s going to take some time before public opinion catches up with the idea that the Canadian criminal justice system’s approach to HIV nondisclosure is at best flawed, and at worst, severly and negatively impacting on the human rights of people living with HIV, as this comment from a Toronto Star reader (agreed with by 15 others, and disagreed with by only one) suggests:

The carrier should still be charged: If a person with HIV has unprotected sex with another person who doesn’t have HIV and doesn’t inform his or her sexual partner that he or she has HIV, that person should be charged. I think the same would apply to someone who has herpes and doesn’t inform his or her partner that he has it. Just because the unsuspecting sexual partner doesn’t get HIV from the carrier doesn’t mean that the carrier shouldn’t be charged. It would be like saying that if you go into a bank to rob it and you are carrying a gun but don’t use the gun, you shouldn’t be charged with bank robbery. That doesn’t make sense.

No, actually, its the gun analogy that makes no sense. Or is it the case that people with HIV are now thought of in Canada not just vectors of transmission but actually walking deadly weapons? It seems that when it comes to HIV-positive people, attitudes in ‘conservative’ Texas and ‘liberal’ Ontario are exactly the same.

US: Judge gives HIV-positive pregnant woman longer prison sentence ‘to protect unborn child’ (updated)

A judge in Maine has more than doubled the prison sentence of an HIV-positive woman in order to protect her unborn child, according to a report from The Bangor Daily News. The judge admits he based the decision entirely on the woman’s HIV status.

The 28 year-old woman, from Cameroon, had previously pleaded guilty for having fake documents. She was not legally entitled to be in the United States and was planning to seek asylum. The case has now been taken up by the Maine Civil Liberties Union.

Both prosecution and defence had asked U.S. District Judge John Woodcock to sentence the woman to 114 days, or time served (she has been in custody since January 21st). However, citing the welfare of the woman’s unborn child, the judge sentenced her to 238 days (to coincide with her due date of August 29th).

Woodcock told [the woman] at her sentencing on May 14 in U.S. District Court that he was not imposing the longer prison term to punish her further but to protect her unborn child. He said that the defendant was more likely to receive medical treatment and follow a drug regimen in federal prison than out on her own or in the custody of immigration officials. The judge also said that his decision was based entirely on her HIV status. If Tuleh were pregnant but not infected with the AIDS virus, he would have sentenced her to time served.

[…]

In sentencing Tuleh, Woodcock said that the law required he take into account a defendant’s medical condition in fashioning a sentence. Although a defendant’s medical condition most often is used to lower a sentence, the judge found that there was nothing in the federal sentencing guidelines to prevent him from imposing a sentence longer than the guidelines recommended because of Tuleh’s HIV status.

“My obligation is to protect the public from further crimes of the defendant,” he said at Tuleh’s sentencing, “and that public, it seems to me at this point, should likely include that child she’s carrying. I don’t think that the transfer of HIV to an unborn child is a crime technically under the law, but it is as direct and as likely as an ongoing assault.

“If I had — if I were to know conclusively that upon release from imprisonment a defendant was going to assault another person,” Woodcock said, “I would act in a fashion to prevent that, and similar to an assault, causing grievous injury to a wholly innocent person. And so I think I have the obligation to do what I can to protect that person, when that person is born, from permanent and ongoing harm.”

The Maine Civil Liberties Union told The Bangor Daily News.

“We are enormously sympathetic to the desire to ensure that Ms. Tuleh receives adequate health care, including prenatal care,” Zachary Heiden, legal director for the MCLU, said in an e-mail. “Federal immigration law has developed in truly arbitrary and punitive ways. Here, even a federal judge could not get assurances that Ms. Tuleh would not be deported before the end of her pregnancy. He could not get assurances she would not have her medical care arbitrarily cut off. That is wrong.

“Judges cannot lock a woman up simply because she is sick and pregnant,” he said. “Judges have enormous discretion in imposing sentences, and that is appropriate. But jailing someone is punishment — it is depriving them of liberty. That deprivation has to be justified, and illness or pregnancy is not justification for imprisonment.”

The sentence was objected to primarily by the prosecution, however.

Assistant U.S. Attorney Todd Lowell objected to Woodcock’s decision. Lowell said Tuleh’s sentence set a precedent that “could affect the many other sorts of cases that come before this court in which defendants have serious medical conditions. In the end, Bureau of Prisons custody is designed to incarcerate,” Lowell told Woodcock at the sentencing hearing. “Incarceration is mostly designed for the purpose of punishment, deterrence and community protection. The Bureau of Prisons is not well-designed to accomplish necessarily the end of providing medical care to a defendant and her unborn child.”

The US Attorney’s office has appealed the sentence to the 1st U.S. Circuit Court of Appeals in Boston, but arguments will not be heard until late July. The MCLU is also planning on submitting amicus curiae briefs on the issues of HIV, pregnancy, immigration law, and prisoner rights.

Update: June 18th The woman will now give birth in hospital rather than prison after Judge Woodcock heard new evidence that she will be looked after in the community, according to a report in The Bangor Daily News.

“I recognize that the sentence turned out to be controversial,” he said. “I can certainly understand how some have misinterpreted what the court intended to do in this case.”

Woodcock said that what he had wanted to do was “to step in between the prison system and the social [safety] net” to ensure that Tuleh remained healthy and that the child was born healthy.

“At the time of the sentencing, I had no clear understanding of what the community could do,” Woodcock said.

[…]

A three-judge panel in Boston has agreed to hear the appeal on an expedited schedule, but oral arguments are not expected to be held until late July and early August. In addition to appeals filed by the prosecution and the defense, a group of 15 individuals and organizations have filed in Bangor and Boston a “friend of the court” brief in support of Tuleh.

Woodcock said Monday that he found the brief “articulate and helpful” in making his decision about whether to release Tuleh on bail.

More details at the National Advocates for Pregnant Women site here

Click here to see the results of the paper’s poll asking whether a judge should be able to impose a longer sentence in order to protect an inmate’s unborn child?

Canada: Another attempted murder charge for HIV nondisclosure; rally planned in Ottawa

A 46 year-old bisexual Toronto man has become the second man in Canada to be charged with attempted murder following allegations that he did not disclose his HIV status before having unprotected sex.

According to a Toronto Police Service news release quoted on Xtra.ca

“the accused had unprotected sexual intercourse on multiple occasions after being informed that he was HIV-positive in March 2009” and that although the charges stem from sex the accused had with a woman “his partners may have been in both the gay and heterosexual communities.”

The Montreal Gazette quotes Constable Wendy Drummond, who provides an emotive, rather than legal, reason for the attempted murder charges.

“We’re dealing with somebody’s health. This could ultimately lead to somebody’s demise, to their death.”

The man actually faces one count each of attempted murder, aggravated sexual assault, assault causing bodily harm and assault with a weapon – all of the charges are based on him not telling his female partner that he had recently tested HIV-positive and continuing to have unprotected sex with her.

As has become common practice amongst Canadian investigations, police have released a photo of the man, claiming public health interests. However, it is obviously a fishing expedition for more complainants (the more complainants, the more likely charges will stick).

CityNews.ca interprets this as follows:

Police allege that [the accused] is a menace to society. And even though they now have him in custody, they’re not sure everyone who had contact with him is still safe.

The 46-year-old (top left) is accused of having unprotected sex, despite knowing that he’d been diagnosed with HIV last March. As a result, authorities have charged him with attempted murder, aggravated sexual assault, assault causing bodily harm and assault with a weapon.

Cops know of at least one person who had sexual contact with him without knowing his status. But they say [he] was known to hang around in Toronto’s gay and straight communities, and they’re worried he may have had similar relationships with people who may not be aware of his past.

If he’s crossed your path, seek medical treatment as soon as possible, and contact police at (416) xxx-xxxx or Crime Stoppers at (416) xxx-xxxx.

Interestingly, however, the Montreal Gazette story doesn’t buy it. Although they quote Constable Drummond…

“We make their names and images known to the public out of concern that they may have had relations with other people, and may have infected other people.”

…they also include the counterpoint of Richard Elliott, executive director of the Canadian HIV/AIDS Legal Network.

“Police say they’re public safety notices,” he said. “But it’s a police tactic. They’re using the releases as an investigative tool, to build a case against the accused.”

What’s worse, he said, is that actions like this feed into the “very persistent stigma related to HIV and people with it. It creates this image of a person with HIV as a public-health menace. This just perpetuates the misinformation, fear, hysteria and prejudice that has always surrounded HIV.”

Exactly.

RALLY IN OTTAWA, CANADA

In response to this, and other draconian measures taken by police and prosecutors against HIV-positve individuals, a grassroots collision of concerned community groups and individuals in Ottawa, fuelled by anger, and inspired by hope, have come together to condemn the criminalization of HIV. They will be rallying in Canada’s capital, Ottawa, next Wednesday June 10th 2009, between 12:30pm – 1:30pm, meeting at Parliament Hill in front of the eternal flame.

For more information visit their the Facebook event page: Stop The Criminalization of HIV Positive People!

Canada: Gay man charged with attempted murder for HIV non-disclosure

In an escalation of the usual charges facing people in Canada for allegedly not disclosing their HIV status before unprotected sex, a 28 year-old Toronto man is now facing attempted murder as well as aggravated assault charges.

How do we know this? Because the Toronto police held a press conference, making it appear as if the man was some kind of serial killer. Xtra.ca reports:

“We have reason to believe he attended Church and Wellesley and may have actually engaged in sexual activities without disclosing his HIV status,” said Const Brad Stapleton of the Toronto Sex Crimes Unit at a May 7 press conference.

There appears to be no evidence of this, but according to the Globe and Mail:

“We are appealing to the gay, lesbian, bisexual and transgender community. If you had any contact with this male, contact the Toronto sex crime unit,” Constable Stapleton said.

A more obvious fishing expedition is hard to imagine (it was issued under the smokescreen of a ‘public safety alert’). There’s scant information from any of the Toronto papers that ran stories, most of which published the man’s name and photo. The most detailed is from the aforementioned G&M:

Police laid charges after the alleged victim, who is said to have met [the man] on an Internet dating service, came forward. Police believe [he] has had sexual relations with additional people in which he did not disclose his status. Constable Stapleton said [the man] has known he was HIV positive since 2000 and has been a regular in the Church and Wellesley area for the past five years…He wouldn’t elaborate on the charges or say whether the alleged victim contracted HIV from [the accused man].

The man is due in court in Toronto for a bail hearing tomorrow.

Germany: Justice Minister says prosecutor handled Nadja Benaissa arrest properly

Hessian Minister of Justice, Joerg-Uwe Hahn has dismissed all criticism of the actions of Ger Neuber, the Darmstadt prosecutor who arranged for the public arrest and immediate incarceration of Nadja Benaissa, and then issued a press release.

According to the Frankfurter Allgemeine Zeitung (English translation here), he announced on Wednesday that Neuber’s actions were “legally and technically acceptable”; that he had been aware of Benaissa’s impending arrest two days prior; and that the public interest outweighed Ms Benaissa’s right to privacy.

Last Saturday, The Guardian ran an (rather oddly worded, perhaps badly translated?) opinion piece by German journalist Sabine Rennefanz, outlining her criticisms of Neuber’s actions, and comparing the case to that of German MP, Joerg Tauss, whose child pornography charges were dismissed.

What is worrying is how the state prosecution made the private case into a public drama. The singer was arrested publicly before a gig in a Frankfurt nightclub and was taken into custody “because of the danger of repetition”, as the prosecutor’s office put it. The suspect was treated as if it was already proven that she had infected the man that sued her, which is not the case. It is not the first time that a prominent person has been the subject of an aggressive information policy from a state prosecution service, but questions remain: Benaissa was arrested and kept in custody “because of the danger of repetition”. But, if it was so urgent, why did they not arrest her earlier? The police had been on the case since June 2008.

When a member of parliament, Joerg Tauss, tried to defend himself against charges of dealing with child pornography, his claims were publicly dismissed by the Karlsruhe prosecutor, Rüdiger Rehring. Legal experts note a change in the information policy: previously prosecutors had silently worked in the background, shunning the public eye, while the lawyers were the celebrities trying to influence public opinion. Now they appear to be trying to limit control and influence reporting, as in this young woman’s case.

UK: Gonorrhoea prosecution ‘a dangerous development’

I am posting an excellent analysis by Dr Matthew Weait, Senior Lecturer in Law and Legal Studies at Birkbeck College, London (and author of Intimacy and Responsibility: The Criminalisation of HIV Transmission) of the recent successful prosecution of a male migrant for ‘recklessly’ transmitting the sexually transmitted infection, gonorrhoea, through non-sexual means.

A Dangerous Development
by Dr Matthew Weait
Senior Lecturer in Law and Legal Studies
Faculty of Lifelong Learning
Birkbeck College, London

In the recent case of R v Peace Marangwanda [2009] EWCA Crim 60, the English Court of Appeal was called upon to hear an appeal against sentence that has potentially profound implications for debates surrounding the criminalisation of HIV and other serious sexually transmissible infections. Summarised, the facts were that the applicant (PM) had been charged with two offences of sexual activity with a child, contrary to section 9(1) and (2) of the Sexual Offences Act 2003. It had been alleged that PM had met the mother of the children (E and Z), started a relationship and moved in with her in September 2005. In November 2005 PM was diagnosed with gonorrhoea, and he received treatment. A month later, in December 2005, the children, E and Z, were diagnosed as having contracted gonorrhoea. PM was charged, prosecuted and tried in 2007 after E made a complaint fo sexual abuse. The jury could not agree on a verdict after hearing PM’s defence that he was not suffering from gonorrhoea at the relevant time, and that it was rather a severe from of thrush. A retrial was scheduled to take place in June 2007. Prior to the retrial a compromise was suggested by defence counsel whereby PM would plead guilty to two counts of recklessly inflicting grievous bodily harm contrary to section 20 of the Offences Against the Person Act 1861. on the basis that he had recklessly transmitted gonorrhoea to E and Z.

The plea was entered

“ … on the basis that the Defendant, whilst possessed of the knowledge that he was suffering from gonorrhoea, recklessly passed on the said gonorrhoea to the two complainants.

2. Such transmission was carried our not in any way by means of any sexual contact, direct or indirect. Such transmission was likely to have been occasioned in circumstances where the Defendant, after having touched himself and then failing to apply the proper hygiene standards, has then gone on to touch the children in an ordinary way. The Defendant would, on occasion, be involved in the daily care of the two young Complainants. This would include assisting with washing, dressing and general supervisory activities with the same.

3. It was foreseeable that such a condition as gonorrhoea could have been passed and accordingly the Defendant failed in ensuring that he adhered to the proper sanitary and hygienic principles which would have been ordinarily implied.”

PM was sentenced to two years immediate imprisonment on each count, to be served concurrently. He was also recommended for deportation, disqualified from working with children for life and made subject of a Sexual Offences Prevention Order.

PM appealed on a number of grounds, one of which was that he had pleaded guilty to offences that were not medically possible and another that, even if it were medically possible, he had not acted recklessly. (The two other grounds are not of such immediate relevance here and are not discussed – see the case report.) The Court of Appeal agreed that the sentence passed was manifestly excessive and that a sentence of 12 months on each count should have been passed, to be served concurrently. For legal reasons this meant that the order relating to not being able to work with children was quashed, but the other orders were upheld.

Discussion

This is an important and worrying decision for a number of reasons. The plea of guilty to the charges under section 20 were entered on the understanding that the gonorrhoea had been passed through casual touching. PM, it was accepted, cared for E and Z (which included physical touching). The pre-sentence report (which is prepared to assist the judge in sentencing) stated that

“The defendant has pleaded guilty to the offence in accordance with the basis of plea, namely that he inadvertently passed on gonorrhoea to the two children due to poor personal hygiene.

Mr Marangwanda was, at the time of the offence, in a relationship with the mother of the two victims. He was periodically living at the family home and as such will have regular conduct with the children.

The defendant accepts culpability in as much as he acknowledges he passed on the sexually transmitted infection to the two girls due to poor personal hygiene.

…

The defendant accepts that his behaviour was reckless and that as a result, two young children contracted a sexually transmitted infection.”

It was on this basis that PM was sentenced, and the Court of Appeal accepted the reasoning. It states (at paragraph 12) that

In the judgment of this court, by his plea, the defendant accepted the medical possibility of the transmission of that disease. As he knew he had gonorrhoea, provided he knew that that disease may be transmitted by transference of mucosa by hand, that transference would have constituted a reckless act …

The Court goes on to say (at para 13) that

… by virtue of the basis of plea and the applicant’s pleas, he must have been accepting the possibility that in a domestic or familial setting the disease could have been transferred. In such circumstances it would have been his duty to take the necessary protection to ensure there was no transference. We are not persuaded that there is anything in that ground of appeal.

This is, it is suggested, deeply problematic, as are other aspects of the case. First, the Court seems to be suggesting that there is a duty to take the necessary protection against the transmission of disease. With respect, there exists no such legal duty anywhere in English law. A person is not reckless because he fails to take precautions against transmission; he is reckless if it is established that he was aware of the risk of transmission. This might seem a fine distinction , but it is an important one. If the Court is thinking particularly of the positive obligation that a carer has towards children, then it should have articulated that far more clearly. In the absence of clarification it suggests that a person living with HIV has a positive obligation – enforceable at law – to prevent onward transmission to sexual partners. (And, in the light of the recent Hep B case, that those infected with Hep B may have a positive obligation to alert others not to share their razors, for example). This goes beyond the principles established in R v Dica and R v Konzani. The CPS Guidelines on prosecuting cases involving the sexual transmission of disease indicate that the appropriate use of condoms by a person living with HIV would ordinarily preclude a finding of recklessness – they do not (because the law does not require it) state that a person living with HIV is under an obligation to use a condom (or, of course, to disclose status).

Another problematic aspect of the decision is that appears to be a bad compromise. The plea was entered and accepted in part, it seems, to prevent E (the child complainant) to have to give evidence at a retrial. It is for this reason that what would otherwise have been a case involving alleged sexual offences was transmuted into one concerning offences against the person. This was arguably artificial, and (as the discussion above about the Court of Appeal’s comments about the nature of PM’s duty shows) has resulted in – it is suggested – flawed reasoning.

Finally, although it wasn’t addressed in the Court of Appeal’s judgment, there remains the question of knowledge and scientific evidence of transmission. What follows is speculative in the instant case, but important, I think, to bear in mind.

1. PM moved in with E and Z and their mother in September 2005. He was diagnosed with gonorrhoea in November 2005 and the children in December 2005. If there is any possibility that PM may have infected E and Z prior to his diagnosis, and before he had any reason to believe that he might be suffering from gonorrhoea, there was no case to answer (see R v Dica; R v Konzani).
2. If, as the Court of Appeal accepted (albeit because of the “artificial” nature of the settlement that was reached on plea to avoid retrial) that gonorrhoea may be spread manually as the result of poor manual hygiene, then questions should have been raised as to the possibility that the source of the infection may have been elsewhere. There appears to have been no scientific evidence adduced, and the prosecution did not – it appears – seek any. The CPS Guidelines make it clear that there needs to be compelling proof that the defendant is the source of a complainant’s infection – and (critically) that a guilty pleas should not be accepted unless the prosecution believes that there is sufficient evidence to prosecute. Cases involving HIV transmission have fallen because of this.

The Marangwanda case is unfortunate because it appears to be yet another example of the ways in which the ill-thought out approach of the courts to liability for the transmission of sexually transmissible diseases can – in the absence of clear thinking and understanding – have unintended effects.

Matthew Weait
23rd April 2009

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.

US: Missouri man charged after ‘HIV threats’ during arrest

An HIV-positive Missouri man has been charged with “two counts of reckless exposure to HIV” because he “scuffled” with two police officers who were trying to arrest him and shouted at them that he was HIV-positive and “hoped they would catch the virus and die.”

The report, from The Columbia Daily Tribune, takes the (non-existent) HIV transmission risk seriously probably because the policeman did.

“This is something we deal with,” [a cop] said. “It is not something that happens every day, thankfully. It’s one of those things that we’re aware of” as a risk.

[The man] was eventually subdued and taken to a local hospital for treatment of injuries. The deputies also went to the hospital to begin treatment to minimize the possible risk of infection.

Unfortunately for the man, Missouri has pretty wide-ranging HIV exposure laws, which state:
“It is also unlawful for a person knowingly infected with HIV to act in a reckless manner by exposing another person to HIV without the knowledge and consent of that person…[by] purposely doing anything else which causes the HIV infected person’s semen, vaginal secretions, or blood to come into contact with the mucous membranes or nonintact skin of another person.”

It doesn’t say anything about empty threats, though. This sounds like a repeat of 2008’s Willie Campbell debacle.

Ireland: Court agrees ‘HIV’ spit was provocation to kill

Brendan O’Connor, 25, who killed 50 year-old father of four Edward Clancy, “by stamping on his head with his full body weight” did so because he spat at him and he thought the man was HIV-positive.

His plea of manslaughter was accepted by Ireland’s Office of the Director of Public Prosecutions (DPP) “on the grounds that the spitting… constituted provocation.”

The case, an egregious example of institutionalised HIV stigma reported in today’s Irish Times, has got me spitting mad!

Deirdre Murphy, prosecuting, said the men exchanged words outside a pub in the town in the early hours of that day. Mr Clancy spat at O’Connor before crossing the road and moving away.

Det Sgt Fergal Patwell quoted from witness statements that O’Connor caught up with Mr Clancy and grabbed him.

“Brendan O’Connor began punching Edward Joseph Clancy, knocked him to the ground and stamped on his head,” he said. He said there was no evidence that Mr Clancy resisted.

Ms Murphy said a postmortem found the base of Mr Clancy’s skull was completely fractured and there was extensive bruising to his head and face.

She said the pathologist described it as a targeted attack to the head, and Mr Clancy was pronounced dead at Tralee hospital within an hour.

Det Sgt Patwell also told the court:

it was widely believed Mr Clancy had HIV and that gardaí [police] took precautions when dealing with him. “It appears there was no fact to it,” he added.

O’Connor’s lawyer said that:

his client deeply regretted the killing and expressed genuine remorse. He said HIV could be transmitted by spitting. “In my submission, the provocation was sufficient to cause this particularly violent reaction,” he said.

Until we remove the widespread ignorance about how HIV is transmitted (and it is NOT transmitted via spit or saliva) and the institutionalised HIV stigma across the entire criminal justice system, people actually living with HIV don’t have a chance in hell of justice in court.