HYPOCRISY
(Co-authored with Rick Waines)
December 1st, World AIDS Day, came and went with the same coverage we’ve come to expect. Once again this year we heard about the great improvements of the last thirty years, the promising developments in drug treatments, the continued commitments to beat back the disease globally, and, sadly, the perpetually devastating numbers of infected and dying in Africa. However, there is an aspect of this illness hardly getting any attention: the criminalization of HIV/AIDS here at home.
Canada is leading the way in imprisoning people for failing to disclose their HIV positive status. In fact, things are so out of hand that a healthy person living with HIV (someone with undetectable, non-infectious levels of virus in their blood) can practise safe sex using a condom, not transmit the virus to their partner, and still be sent to jail – labeled a sex offender for the rest of their life!
Is HIV/AIDS so virulent and devastating in Canada that it warrants special consideration among all other illnesses? Lets pretend it is. But then, what if I told you there was a very similar sexually transmitted virus, one with no cure that may lead to another life-threatening illness, similar to HIV? And what if, like HIV/AIDS, you were at greater risk for contracting this virus if you’re a gay or bisexual man? Surely said virus would be worthy of the same level of public and legal attention, no?
Well, such a virus does exist: it’s called Human Papilloma virus, or HPV. As you can see, HPV and HIV have significant similarities, but some of the differences are just as important. For instance, infecting the mouth, throat, and genitals of men and women alike, intercourse is not necessary for transmission of HPV – making it one of the most common sexually transmitted infections. As well, troublingly, of the 130 or so types of HPV several lead to rare and hard-to-treat cancers; in fact, more than a dozen can cause cervical cancer.
Cervical cancer alone takes the life of more than 350 Canadian women annually. How do you think this number compares to AIDS? Turns out to be quite a contrast: according to Health Canada’s most recent reporting, in 2009 HIV/AIDS killed 25 Canadians. 14 times as many Canadians succumb to HPV-related illnesses than HIV/AIDS – an illness they could only develop by way of viral infection from someone else. And yet HPV carries none of the stigma attached to HIV/AIDS and its sufferers; and, critically, nobody is sentenced to jail for infecting their partner with this potentially life-threatening, cancer-inducing virus.
AIDS education, or a lack thereof, must be partly to blame for the stigma. In the early 1980’s, when the virus first hit the street and we knew nothing about it, all the fear and paranoia that surrounded this killer probably saved lives. But today we can see some of the repercussions of our phobias, assumptions, and misunderstandings.
Our fears and dis-education was on full display in an important survey of Canadian’s attitudes towards HIV/AIDS, conducted in 2006. (The actual numbers are not as important here as the sentiments expressed. When reading the following data ask yourself how these same survey takers, or you yourself, would respond if the same questions were asked about HPV – or any other illness for that matter.)
According to the 2006 HIV/AIDS awareness survey:
• 2% of those surveyed – representing roughly 680,000 Canadians – feel that people living with HIV/AIDS don’t have the same right to health-care as everyone else. (Another 2% are unsure) • 1.7 million of us – around 5% of Canadians – believe that people living with HIV/AIDS don’t have the same right to employment as those who are not infected. (7%, about 2.4 million, are undecided)
• 11% of those surveyed, or roughly 3.7 million Canadians, would agree that HIV/AIDS infected people should be separated from the public by forced quarantine. (Another 2.7 million more are not opposed to the idea)
• 26% of the surveyed population, representing 8.8 million people, report that they’d be uncomfortable wearing a sweater once worn by someone with HIV/AIDS (!)
• According to the survey, 56% of Canadians, representing about 19 million of us, admit they’d be uncomfortable with a close friend or family member dating someone with HIV/AIDS. (A group representing roughly 3.4 million of us said that what specifically makes them uncomfortable is “being around the type of person who has contracted HIV/AIDS”)
What these statistics illustrate is that we view HIV/AIDS in a very different light than other illnesses, even other sexually transmitted ones like HPV. Why is that? The main difference I see between HPV and HIV/AIDS is that one has garnered a reputation as an illness of injection drug users, sex workers, gay men, and people from sub-Saharan Africa. Of course these minorities are still today slandered, and even openly attacked on our streets, in our schools and workplaces, and in the mediasphere. Even if the virus was somehow limited to these groups (which, of course, it isn’t) would that somehow justify discrimination? Of course not. And yet here we are, for some reason willing to single out and prosecute HIV/AIDS sufferers.
The truth is, HIV is not that easy to transmit sexually – and we’ve know this for a long time. Passing on the infection in this way depends on your viral load (how much virus there is in a person’s body.) Even without treatment, viral load peaks when someone is first infected and then is quickly suppressed as their immune system kicks in. Viral load increases when a carrier’s immune system becomes taxed, having acquired another sexually transmitted infection or with the progression to symptomatic AIDS. But there are really only these few narrow windows of time when sexual transmission is likely. Of course this likelihood is significantly diminished by condom use and the fact that at such times sufferers are very unlikely to be in the mood for romance and would-be partners are similarly disinterested in someone who feels terrible and probably looks just as bad.
Throw in modern medicine and a healthy lifestyle and HIV/AIDS is not the death sentence it once was. Instead, more of a treatable chronic illness, those infected live close to normal lifespans and do so in a manner similar to any other person suffering from another chronic illness like diabetes or Crohn’s disease, say. I know, I (Rick) have been HIV positive since the mid 80’s. (And even have this tattooed on my arm.) Things have come a long way since then. Of course it is still a virus with a devastating impact on those infected; but, living with HIV can certainly be compared favorably to being treated for cervical cancer.
So, again, why are we criminalizing this one illness? In Canada prosecutors are not burdened to show the accused pulled the trigger, so to speak: had ill intent or even infected anyone. The complainant simply has to state that they wouldn’t have had a sexual encounter with the accused if they knew he or she was HIV positive. Given this pretext the prosecution has only to show the defendant had HIV and didn’t tell the complainant. The accused is then labelled a sexual offender and possibly sent to jail.
Seems reasonable. Right? If I knew you had a sexually transmitted infection, one that could make me very sick or even kill me I wouldn’t consent to sexual contact either.
The problem with this is the accused may be healthy – healthier even than the complainant. They may have regular contact with their doctor, have been on good medication for a long time, and have an extremely low, non-infectious viral load. So why aren’t these facts relevant in a case? Shouldn’t we have to show that the defendant engaged in risky behaviour or actually exposed their partner to something?
This legal situation in Canada feels something like being able to charge someone with speeding, reckless endangerment, and vehicular manslaughter (despite staying below the speed limit, everyone wearing their seatbelt, and no crash occurring) all because a person owns a car capable of exceeding the speed limit.
The Swiss, it appears, would agree. Swiss researchers have proclaimed that the virus would not be transmissible given low viral load, more than six months of ongoing treatment, and the absence of other sexually transmitted infections. And if this is the case then, according to the Swiss, Canadian courts are convicting people for committing sex crimes, and labelling them forever more, for having not infected someone with a virus they were not capable of transmitting. (In which case, of course, we are all guilty!)
We all engage risky behaviour every day, and having unprotected intercourse is one such risk. Everyone should be well aware that HIV/AIDS exists and that it is transmissible through intercourse. People that are sexually active should also know that it can take up to six months for the virus to register on a test and that false-negatives do occur in HIV testing. (This is not a secret.) Therefore, anyone having casual and unprotected sex is putting themselves at a real risk of contracting HIV or any number of other things. And in such a scenario a person knowingly puts themself at greater risk, in fact, than having sex with someone who has HIV but is taking care of themself.
If we’re going to prosecute people for potentially exposing others to HIV/AIDS then why not every other virus, sexually transmitted or otherwise? There are as many as 2,500 deaths in Canada each year from the seasonal flu. So in a good year flu kills more than twice as many Canadians as AIDS and cervical cancer combined! And, of course, besides the deaths, this illness results in countless hours of lost work and pay, not to mention untold amounts of discomfort and downright suffering. Somebody is responsible for spreading the illness. Was it you? Have you ever gone to work or school with a headache or runny nose? Have you sat in a theatre or on the bus when you knew you were coming down with something? What if one of those deaths or sick spells could be traced back to you? Should you go to prison, pay a significant fine, and be labelled an offender for the rest of your life? What if you were just a had the illness and didn’t actually infect anyone, but someone claimed you put them at risk of infection? Should that warrant prison time? Don’t you think that one’s intent should be important? Or how about even showing negligence resulting in transmission of the flu virus? Surely this is the minimum threshold.
I think it’s clear we need to have a much more open and frank discussion about HIV/AIDS, both publicly, in terms of education, and on the legal front, in terms of just guidelines for prosecution.
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