Is HIV transmission a crime?

Posted by: A.U.F.A.P. (Nov. 07 - 07)
Photo: Justice Edwin Cameron, Supreme Court of Appeal, South Africa highlighted the importance of public health strategies as an alternative to the criminalization of HIV transmission.

Several countries have recently introduced laws to criminalise HIV transmission, or exposing another person to the virus. A number of jurisdictions have used general laws against serious bodily harm in cases where someone is accused of knowingly transmitting HIV or willingly exposing others to HIV transmission.

Subject of controversy, these measures are sparking debate and concern among policymakers, legal and public health professionals, international organizations and civil society, on whether criminal law is applicable in such cases and if such application is accomplishing or damaging public health goals such as universal access to HIV prevention, treatment, care and support.

Addressing these issues, UNAIDS brought together a range of stakeholders in Geneva for a three-day international consultation (31 October – 2 November) to discuss the apparent trend of criminalization of HIV in the context of national responses to AIDS.

The purpose of the consultation, co-hosted by the UNAIDS Secretariat and UNDP, was to foster dialogue and provide an opportunity to reach an understanding of what constitutes appropriate application of criminal law to HIV transmission, if at all, given public health and human rights imperatives. Participants in the meeting included parliamentarians, members of the judiciary, criminal law experts, civil society representatives and people living with HIV, alongside representatives of WHO, ILO and the Office of the UN High Commissioner for Human Rights.
Consultation participants expressed concern about the apparent rise in the number of cases in which people living with HIV have been criminally charged for transmitting HIV, or engaging in acts that risk transmitting HIV. In some cases, criminal charges have been laid for conduct that is “perceived” as risking transmission, but where no real risk exists, and sometimes with very harsh penalties imposed. Participants also expressed concern that there are jurisdictions moving to enact or amend legislation specifically to criminalize transmission and exposure. While noting that many legislators may be acting out of good intentions, consultation participants stated clearly that such laws are not an effective way of dealing with the transmission of HIV.
“Like in the early years of the epidemic when I declared that we have now ‘HIL – Highly Inefficient Laws’, when there were the proposals for testing everyone in society, we now have a new wave of HIL. And it’s a wave that’s coming particularly in Africa, but also in other parts of the world,” stated Justice Michael Kirby, judge in the High Court of Australia, in the concluding session of the consultation.

While little is known about the impacts of criminalizing HIV transmission, many are concerned that it may have a negative impact on the uptake of HIV testing and access to HIV prevention, treatment and care services. Sensational media reports can exacerbate stigma and discrimination, and jeopardize HIV prevention strategies currently in place. “Applying criminal law to HIV transmission has a heighten role in stigmatizing HIV, it is ineffective and public health strategies are better used to advance HIV prevention,” said Justice Edwin Cameron, Supreme Court of Appeal, South Africa. Furthermore, there is also concern that criminal proceedings may compromise basic civil rights such as the right to privacy, especially among the most vulnerable populations. Some legislators and women’s rights groups think such laws will protect women from HIV infection, but as Susan Timberlake, UNAIDS Human Rights and Law Advisor noted, “There is great concern that in fact these laws would hurt women most, as it is women who first find out their status and thus will be first subject to prosecution. Laws to ensure women’s equality inside and outside marriage would protect them more than laws criminalizing HIV transmission.”

Recommendations from the meeting will inform the finalization of UNAIDS’ policy position and other guidance documents on the criminalization of HIV transmission. “A clear message from the meeting was that criminal law is a very blunt tool to deal with HIV,” said Seema Paul, UNAIDS Chief of Policy Coordination. “The real goal of policy makers is preventing new infections but, in fact, criminalizing HIV transmission – excepting in a very small sub-set of cases dealing with retributive justice – will create disincentives for learning about one’s HIV status and accessing health and other services,” she added.

Who is Dr. Michael Worobey?

By A.U.F.A.P (Nov. 3rd. 07) - Disclaimer: Dr. Michael Worobey's Research published recently in The Science Journal that claims one single Haitian brought the HIV/AIDS virus to the whole world, has stirred up a huge controversy in the web community. A.U.F.A.P. (Artists United For Aids Prevention) as an independent entity whose goal is to educate and bring awareness as a way to prevent the spread of HIV/AIDS, feels obligated to inform our readers about Dr. Michael Worobey. Posted below, is his biography and contact information. We know some of our readers are frustrated, but we urge you to be civilized if ultimately you make a personal decision to contact him personally.

Dr. Michael Worobey, Assistant Professor

Positions and Education

Assistant Professor, Ecology and Evolutionary Biology, University of Arizona, 2003-present.

• Postdoctoral researcher, Department of Zoology/St. John’s College, University of Oxford. 2001-2003.
• D. Phil., Department of Zoology, University of Oxford. 2001.
• B. Sc. (Hons), Department of Biological Sciences, Simon Fraser University.
  
  Honors and Awards
  
• Junior Research Fellowship, St. John’s College, University of Oxford. 2001.
• NSERC postgraduate Scholarship. 1999.
• Rhodes Scholarship, 1997.

Research Interests

Michael Worobey uses an evolutionary approach to understand the origins, emergence and control of pathogens, in particular RNA viruses and retroviruses such as HIV and influenza virus. He integrates fieldwork; theory and methodology; molecular biology; and (especially) molecular evolutionary analysis of gene sequences in a phylogenetic framework.

Questions under investigation include: (1) When, where, and how have AIDS viruses crossed into humans? (2) How does recombination shape viral genetic diversity? (3) What can viral sequences sampled from different time-points reveal about the tempo and mode of evolution? (4) Could ancestral viral sequences be useful for developing vaccines against HIV or hepatitis C virus? (5) Can a computational forward-simulation approach be used to accurately forecast future viral evolution and genetic diversity in a probabilistic framework?

Current wet-lab projects in his Biosafety Level 3 facility involve recovery of damaged and/or ancient DNA from a variety of sources including paraffin-embedded human tissue specimens, blood smears, and museum specimens. The two main efforts are (1) reconstructing the emergence of HIV-1 group M in central Africa and North America using “fossil” HIV-1 sequences, and (2) investigating the evolution of AIDS-related viruses in wild-living African primates using non-invasively-collected samples.

Contact Info

Dr. Worobey, Michael
Assistant Professor
Office: BSW 324 626-3456
Lab: BSW 401 621-4881
worobey@email.arizona.edu
Assistant Professor; Ph.D., Oxford University, 2001

HIV/AIDS Basic Information

HIV

HIV stands for human immunodeficiency virus. This is the virus that causes AIDS. HIV is different from most other viruses because it attacks the immune system. The immune system gives our bodies the ability to fight infections. HIV finds and destroys a type of white blood cell (T cells or CD4 cells) that the immune system must have to fight disease.

AIDS

AIDS stands for acquired immunodeficiency syndrome. AIDS is the final stage of HIV infection. It can take years for a person infected with HIV, even without treatment, to reach this stage. Having AIDS means that the virus has weakened the immune system to the point at which the body has a difficult time fighting infections. When someone has one or more of these infections and a low number of T cells, he or she has AIDS.

Origin of HIV

Scientists identified a type of chimpanzee in West Africa as the source of HIV infection in humans. The virus most likely jumped to humans when humans hunted these chimpanzees for meat and came into contact with their infected blood. Over several years, the virus slowly spread across Africa and later into other parts of the world

History of HIV In the United States

HIV was first identified in the United States in 1981 after a number of gay men started getting sick with a rare type of cancer. It took several years for scientists to develop a test for the virus, to understand how HIV was transmitted between humans, and to determine what people could do to protect themselves. During the early 1980s, as many as 150,000 people became infected with HIV each year. By the early 1990s, this rate had dropped to about 40,000 each year, where it remains today.

AIDS cases began to fall dramatically in 1996, when new drugs became available. Today, more people than ever before are living with HIV/AIDS. CDC estimates that about 1 million people in the United States are living with HIV or AIDS. About one quarter of these people do not know that they are infected: not knowing puts them and others at risk.

How HIV Is and Is Not Transmitted

HIV is a fragile virus. It cannot live for very long outside the body. As a result, the virus is not transmitted through day-to-day activities such as shaking hands, hugging, or a casual kiss. You cannot become infected from a toilet seat, drinking fountain, doorknob, dishes, drinking glasses, food, or pets. You also cannot get HIV from mosquitoes.HIV is primarily found in the blood, semen, or vaginal fluid of an infected person.

HIV is transmitted in 3 main ways:

• Having sex (anal, vaginal, or oral) with someone infected with HIV
  
• Sharing needles and syringes with someone infected with HIV
  
• Being exposed (fetus or infant) to HIV before or during birth or through breast feeding

HIV also can be transmitted through blood infected with HIV. However, since 1985, all donated blood in the United States has been tested for HIV. Therefore, the risk for HIV infection through the transfusion of blood or blood products is extremely low. The U.S. blood supply is considered among the safest in the world.

Risk Factors For HIV Transmission

You may be at increased risk for infection if you have

• injected drugs or steroids, during which equipment (such as needles, syringes, cotton, water) and blood were shared with others
  
• had unprotected vaginal, anal, or oral sex (that is, sex without using condoms) with men who have sex with men, multiple partners, or anonymous partners
  
• exchanged sex for drugs or money
  
• been given a diagnosis of, or been treated for, hepatitis, tuberculosis (TB), or a sexually transmitted disease (STD) such as syphilis
  
• received a blood transfusion or clotting factor during 1978–1985
  
• had unprotected sex with someone who has any of the risk factors listed above

Preventing Transmission

Your risk of getting HIV or passing it to someone else depends on several things. Do you know what they are? You might want to talk to someone who knows about HIV. You can also do the following:

• Abstain from sex (do not have oral, anal, or vaginal sex) until you are in a relationship with only one person, are having sex with only each other, and each of you knows the other’s HIV status.
  
• If both you and your partner have HIV, use condoms to prevent other sexually transmitted diseases (STDs) and possible infection with a different strain of HIV.
  
• If only one of you has HIV, use a latex condom and lubricant every time you have sex.
  
• If you have, or plan to have, more than one sex partner, consider the following:
  
• Get tested for HIV
  
• If you are a man who has had sex with other men, get tested at least once a year.
  
• If you are a woman who is planning to get pregnant or who is pregnant, get tested as soon as possible, before you have your baby.
  
• Talk about HIV and other STDs with each partner before you have sex.
  
• Learn as much as you can about each partner’s past behavior (sex and drug use), and consider the risks to your health before you have sex.
  
• Ask your partners if they have recently been tested for HIV; encourage those who have not been tested to do so.
  
• Use a latex condom and lubricant every time you have sex.
  
• If you think you may have been exposed to another STD such as gonorrhea, syphilis, or Chlamydia trachomatis infection, get treatment. These diseases can increase your risk of getting HIV.
  
• Even if you think you have low risk for HIV infection, get tested whenever you have a regular medical check-up.
  
• Do not inject illicit drugs (drugs not prescribed by your doctor). You can get HIV through needles, syringes, and other works if they are contaminated with the blood of someone who has HIV. Drugs also cloud your mind, which may result in riskier sex.
  
• If you do inject drugs, do the following:
  
• Use only clean needles, syringes, and other works.
  
• Never share needles, syringes, or other works.
  
• Be careful not to expose yourself to another person's blood.
  
• Get tested for HIV test at least once a year.
  
• Consider getting counseling and treatment for your drug use.
  
• Do not have sex when you are taking drugs or drinking alcohol because being high can make you more likely to take risks.
  
  To protect yourself, remember these ABCs:
  
  A=Abstinence
  
  B=Be Faithful
  
  C=Condoms

Symptoms of HIV Infection

The only way to know whether you are infected is to be tested for HIV. You cannot rely on symptoms alone because many people who are infected with HIV do not have symptoms for many years. Someone can look and feel healthy but can still be infected. In fact, one quarter of the HIV-infected persons in the United States do not know that they are infected.

HIV Testing

Once HIV enters the body, the body starts to produce antibodies—substances the immune system creates after infection. Most HIV tests look for these antibodies rather than the virus itself. There are many different kinds of HIV tests, including rapid tests and home test kits. All HIV tests approved by the US government are very good at finding HIV.

Finding a Testing Site

Many places offer HIV testing: health departments, doctors' offices, hospitals, and sites specifically set up to provide HIV testing.

You can locate a testing site by visiting the CDC HIV testing database or by calling CDC-INFO (formerly the CDC National AIDS Hotline) at 1-800-CDC-INFO (1-800-232-4636) 24 Hours/Day. You do not have to give any personal information about yourself to use these services to find a testing site.

Haitians Are Outraged by Dr. Michael Worobey's Research

By Aufap.org (Nov. 01, 2007) — In 1983, the Food and Drug Administration banned blood donations from Haitians who emigrated to the United States after 1977. Since then, Haitians grassroots organizations including doctors, professionals and students were watching and working closely with the agency to change its AIDS stigmatization on the Haitian people.

Although the CDC has dropped its stigmatization in the mid 80's linking Haitians directly with AIDS, Haitians all over the world suffer from a devastating social, psychological and economic discrimination in their everyday's life. In march of 1990, the F.D.A. finally revised this policy to once exclude all Haitians to now certain Haitians from donating blood as a safeguard against spreading AIDS. This new policy change upset even more the Haitian community at large and some Haitians say that's what upstaged the march of April 20th. 1990 across the Brooklyn Bridge.

Traffic came to a halt, as factory workers, professionals, students, old, young, disabled from all over the country marched across the Brooklyn Bridge to protest their outrage against the F.D.A. new policy change. Some have estimated the crowd at 60,000 to 100,000. Later that afternoon in Washington DC, the F.D.A. abandoned its policy on excluding blood donors based on geography or national origin.

Some 17 years later, this new study by Dr. Michael Worobey published recently in The Sciences Journal now brought back the bitter memory of the past to the Haitian people living all over the world. Once again, the radio stations, the print media, the bloggers, your every day man on the street are talking about it. "We are mad, this so called Doctor doesn't know what he's talking about" said Jean-Pierre, a taxi driver we interviewed on the street of New York. People are mobilizing to what could be a repeat of the April 20th. March across the Brooklyn Bridge.

Professionals in the fields of AIDS research have concluded that Dr. Michael Worobey's research is insufficient and failed to provide any new data. His findings are based on calculating and comparing old existing data.

HIV's Path Out Of Africa: Haiti, The US Then The World

ScienceDaily (Oct. 30, 2007) — The AIDS virus entered the United States via Haiti, probably arriving in just one person in about 1969, earlier than previously believed, according to new research

After the virus, HIV-1, entered the U.S., it flourished and spread worldwide.
"Our results show that the strain of virus that spawned the U.S. AIDS epidemic probably arrived in or around 1969. That is earlier than a lot of people had imagined," said senior author Michael Worobey.
The research is the first to definitively pinpoint when and from where HIV-1 entered the United States and shows that most HIV/AIDS viruses in the U.S. descended from a single common ancestor. The actual ancestral HIV entered the U.S. long before the storied "Patient Zero," Worobey said.
"Haiti was the stepping stone the virus took when it left central Africa and started its sweep around the world," said Worobey, an assistant professor of ecology and evolutionary biology at The University of Arizona in Tucson. "Once the virus got to the U.S., then it just moved explosively around the world."
The strain that migrated to the U.S. in 1969, HIV-1 group M subtype B, is the first human immunodeficiency virus discovered. It is the dominant strain of the AIDS virus in most countries outside sub-Saharan Africa. Almost all the viruses in those countries descended from the one that emerged from Haiti, he said.
Worobey and his colleagues figured out when HIV reached the U.S. by conducting genetic analyses of archived blood samples from early AIDS patients.
Learning more about the genetic make-up of the various strains of HIV could help vaccine development, Worobey said.
The scientists' research paper, "The emergence of HIV/AIDS in the Americas and beyond," is scheduled for publication in the online Early Online edition of the Proceedings of the National Academy of Sciences the week of October 29.
Figuring out which path HIV/AIDS took as it began its world travels and when it moved from one country to another has long been a topic of scientific investigation and debate.
Worobey and his colleagues tackled the problem by using archived blood samples from AIDS patients to construct genetic family trees for HIV.
The team analyzed blood from five of the first AIDS patients identified in the U.S., all of whom were recent immigrants from Haiti. The team also analyzed genetic sequences from another 117 AIDS patients from around the world who were infected with subtype B, the virus strain that has spread most widely.
Once all the sequences were assembled, the researchers loaded the data into a computer and used Bayesian statistics to investigate all the family trees that were consistent with the genetic data. The researchers then evaluated all possible HIV family trees to determine how probable a particular family tree is.
For the hypothesis that, from Africa, HIV went to the U.S. first, the probability is 0.003 percent -- virtually nil.
For the hypothesis that HIV went from Africa first to Haiti and then on to the U.S., the probability is 99.8 percent, almost 100 percent.
The analysis also shows that the ancestry of most viruses in the U.S. can be traced back to one common ancestor -- the virus that came from Haiti in about 1969.
"Before this study, that had not been nailed down," Worobey said.
The research also reveals that Haiti has a much larger genetic diversity of subtype B than does the U.S.
"The U.S., Australia, Europe plus many countries have just a subset of the subtype B diversity you see in Haiti," Worobey said.
The virus moved from Africa to Haiti in about 1966, he said. Haiti has more diversity of HIV than does the U.S. and other countries because the virus has been there longer and had more time to mutate.
The finding helps explain the early observations of a high prevalence of AIDS in Haiti, Worobey said. "The virus had simply been there longer."
"The main challenge of developing a vaccine against HIV is its tremendous genetic diversity," he said.
Knowing the gamut of diversity within subtype B could be important for effectively developing and testing vaccines that will work in Haiti, Worobey said.
Worobey's next step is following the trail of HIV even further back in time using older archival samples.
Worobey's co-authors are M. Thomas P. Gilbert of the University of Copenhagen in Denmark; Andrew Rambaut of the University of Edinburgh in Scotland; Gabriela Wlasiuk of the UA; Thomas J. Spira of the Centers for Disease Control and Prevention in Atlanta, Ga.; and Arthur E. Pitchenik of the University of Miami in Fla. The National Institutes of Health, the David and Lucile Packard Foundation and a University Research Fellowship from The Royal Society funded the research.
Adapted from materials provided by University of Arizona.

Empire State Medical Association Denounces Incomplete Research Claims made by Dr. Gilbert and Dr. Worobey on "HIV Coming from Haiti"

A Rebuttal Against Incomplete Research by Dr. Michael Worobey and his colleagues(www.nyesma.org)

The Empire State Medical Association is highly concerned about the claims by Michael Worobey that "AIDS virus invaded the United States in about 1969 from Haiti, carried most likely by a single infected immigrant who set the stage for it to sweep the world in a tragic epidemic".
We reject the comments that "researchers think an unknown single infected Haitian immigrant arrived in a large city like Miami or New York, and thevirus circulated for years -- first in the U.S. population and then to other nations."

Gilbert and Worobey, analyzed samples from only five of these Haitian immigrants dating from 1982 and 1983. They also looked at genetic data from 117 more early AIDS patients from around the world. This genetic analysis allowed them to calibrate the molecular clock of the strain of HIV that hasspread most widely, and calculated when it arrived first in Haiti from Africa and then in the United States. The researchers virtually ruled outthe possibility that HIV had come directly to the United States from Africa, setting a 99.8 percent probability that Haiti was the steppingstone.
For Haiti, the history of HIV/AIDS represents stigma, discrimination, and racism. In 1982, scientists at the Centers for Disease Control (CDC)incorrectly inferred that Haitians were at increased for acquiring HIV as a racial group (1). HIV/AIDS therefore became known as the "4H Disease",affecting homosexuals, heroin addicts, hemophiliacs, and Haitians.

This resulted in unprecedented national stigmatization and devastating economic,social, and psychological consequences, decimating the tourist industry in this island nation. As reported at the time: "Haiti has been made aninternational pariah by AIDS. Boycotted by tourists and investors, it has lost millions of dollars and thousands of jobs at a time when half the workforce is jobless. Even exports are being shunned by some (2)."
In 1985,when it became clear that Haitians share the same risk factors as other groups, the CDC dropped the Haitian association, but it was too late. HIVand Haiti were inextricably linked in the minds of the general public. Haiti's economy has never recovered.
Gilbert et al once again link HIV and Haiti, stating: "Subtype B likely moved from Africa to Haiti in or around 1966" and then on to the U.S. Their entire hypothesis is based on virus isolated from five Haitian-Americans who were living in Miami in 1982-83. No other information is provided exceptthat they "entered the U.S. after 1975 and progressed to AIDS by 1981 and hence were presumably infected with HIV-1 before entering the U.S."
A host of questions remain. What were their risk activities? Where had they traveled? Did they have sex with Americans in Haiti? We do know that theaverage time of progression of HIV infection to AIDS and to death in the pre-ART era was 4.5 and 7.4 years, respectively - these intervals are consistent with the five subjects acquiring the infection in the U.S, which limits the validity of their findings (3).
The authors go on to state: "The HIV-1 epidemic in Haiti exhibits a greater range of viral genetic diversity that the rest of the world's subtype B combined". The authors have not studied the virus in Haiti. Where are the data to support this claim?They also state that their aim is to combine phylogenetic, molecular evolutionary, historical, and epidemiological perspectives in an attempt toreconstruct the history of the subtype B pandemic. However, epidemiology studies conducted in Haiti do not support the author's hypothesis.
If the virus was in circulation in Haiti since 1966, there would not have been a much higher male: female ratio in the early years of the epidemic (80% ofthe first Haitian patients were male in the early 1980's) which rapidly generalized as they spread the virus to their female partners (4,5). In addition, reviews of large samples of banked blood from the 1970's failed to yield a single case of HIV and thousands of autopsies did not diagnose an AIDS defining illness until 1978 (6).
Furthermore, only one case of Kaposi's sarcoma (KS) was noted by Haitian dermatologists prior to 1979 (7). KS is easily recognizable and it would not have been missed by Haitian dermatologists for over a decade. Haiti has overcome enormous obstacles and mounted one of the world's most successful responses to the HIV/AIDS epidemic.
Yet, the authors restate prejudices advanced two decades ago in the publication of Pitchenik et al(8): "Haitians in Haiti and elsewhere are at risk of AIDS". People of all ethnicities in every country are at risk. Scientists need to be very responsible in their assertions, lest they do great harm.

HIV, the Virus That Causes AIDS, May Have Reached the U.S. 12 Years Before AIDS Recognition

By Miranda Hitti WebMD Medical News
Reviewed by Louise Chang, MD

Oct. 29, 2007 -- HIV, the virus that causes AIDS, may have arrived in the U.S. a dozen years before AIDS was recognized in 1981.
So say scientists including the University of Arizona's Michael Worobey, PhD.
They analyzed HIV DNA saved in 1982-1983 from five AIDS patients who had recently emigrated from Haiti to Miami. Those five Haitians were among the first recognized AIDS patients.
Using a computer program, Worobey's team traced the lineage of the patients' HIV DNA, based on the assumption that HIV spread to the U.S. via Haiti.
They concluded that HIV arrived in Haiti from Africa in 1966, around the time that many Haitian professionals were returning from working in Africa's newly independent Congo.
Worobey and colleagues also estimate that HIV spread from Haiti to the U.S. in 1969 (or at least between 1966 and 1972).
HIV "was circulating in one of the most medically sophisticated settings in the world for more than a decade before AIDS was recognized," the researchers conclude.
The researchers acknowledge that their calculations could be wrong. Scientists don't know the precise origins of HIV.
They speculate that HIV "may well have been spreading slowly for an extensive period, perhaps in the heterosexual population, before entering the highest risk men-who-have-sex-with-men subpopulation, where it spread explosively enough to finally be noticed."
Their findings appear in this week's early online edition of the Proceedings of the National Academy of Sciences.