Posts Tagged ‘aids’

Misguided zeal in prosecution of HIV-positive woman

Monday, July 15th, 2013

The Star

A case unfolding in a Barrie courtroom brings home just what mischief can arise from bad, vague criminal laws poorly interpreted by ill-informed police and overzealous prosecutors in a climate of misinformation about HIV.

It also highlights why Ontario Attorney-General John Gerretsen needs to work with scientific experts, community organizations and people living with HIV to prevent unjust convictions and avoid further undermining HIV prevention and treatment efforts — neither of which outcomes are in the public interest.

The allegations have yet to be proved in court and every person is presumed innocent until proven guilty. But even assuming that the claims underlying the charges laid are proven in their entirety, several things are worth noting.

There is no allegation that she was maliciously trying to transmit HIV.

All of the “victims” were casual acquaintances — adult men who were willing, active participants in initiating the hookups.

The encounters were brief — a matter of a minute in one instance.

None of the men contracted HIV. This is not surprising, given the tiny risk of infection based on the alleged facts.

And get this: one of the counts against the accused woman rests solely on an allegation that she received oral sex “for a short period” — an act that poses extremely low risk, indeed close to zero risk, of transmitting HIV.

Most scientific studies have failed to identify cases of transmission through oral sex, although it’s difficult to find study subjects who have exclusively oral sex. Researchers now say the risk of transmission is so low it’s difficult to quantify. Practicing oral sex is a safer sex technique.

Yet this woman sits in jail facing the possibility of conviction for aggravated sexual assault, one of the most serious offences in the Criminal Code. If convicted, she faces possibly years in prison and a mandatory lifetime designation as sex offender.

How did we get to this sorry state of affairs?

Last fall, the Supreme Court of Canada released a pair of decisions that were criticized by HIV groups for authorizing an unjustly wide scope for criminal prosecution — at odds with the evolving scientific evidence about HIV, with most of the lower court decisions to date, and even with the direction previously suggested by the Supreme Court itself.

For instance, a person living with HIV can now be criminally prosecuted and sent to jail even if she or he took highly effective precautions to protect their partner by using a condom, had no intention to harm anyone and did not transmit HIV.

The decisions of the Supreme Court were also criticized for leaving unanswered questions about which sexual act might trigger prosecutions, including possible prosecution for oral sex. This leaves the door wide open for ignorance and prejudice to drive criminal prosecutions, as sadly illustrated by the case in Barrie.

In this case, we also have an additional factor: the accused woman had an undetectable “viral load,” which refers to the amount of the virus in a person’s bodily fluids. Science has conclusively established that the fewer copies of the virus, the less chance of transmission. When a person is under treatment and has an undetectable viral load, the risk of transmission through unprotected vaginal sex approaches zero.

So, on the one hand we have a risk that ranges from zero to extremely small, and on the other hand we have a woman facing conviction for aggravated sexual assault.

It’s out of all proportion and profoundly unjust.

Criminal prosecutions should be driven by reason, by evidence and by what’s in the public interest — not by irrational fear and prejudice that leads to people with HIV, even those who practise safer sex, being treated the same as violent rapists.

There is a better way than testing the limits of the law on the backs of people living with HIV through lengthy criminal proceedings, including months of pretrial detention and sensationalized and stigmatizing media coverage.

Police forces need to receive adequate training about HIV. This could help some of these charges from being laid in the first place.

And as the experience in other jurisdictions has shown, guidelines for Crown prosecutors can help prevent the misuse of the criminal law if developed in accordance with the current scientific understanding of HIV and international recommendations. Ontario’s attorney general needs to develop such guidelines, but with the meaningful participation of community organizations and scientific experts.

People smoking HIV medicine to get high

Monday, April 22nd, 2013

Science Blog

More than 1 in 270 people in the US are living with HIV and every 9.5 minutes someone is else is infected. The economic cost estimates associated with HIV/AIDS exceed 36 billion dollars a year. The development of effective drug treatments have allowed people with HIV to live longer with federal health officials now predicting that by 2015 one-half of the population with HIV in the US will be older than 50.

Efavirenz (tradenames: Sustiva®, Stocrin®) is an antiretroviral (ARV) drug commonly used to treat HIV. Its popularity as a medication, alone or more commonly in combination with other HIV medications (tradename: Atripla®), is due to its superior effectiveness in suppressing replication of the virus that causes AIDS. Though highly effective, a standard dose of efavirenz is known to carry a risk of side effects that include adverse neuropsychiatric complications such as depression, anxiety, sleep disturbances, impaired concentration, aggressive behavior, night terrors, hallucinations, paranoia, psychosis and delusions. However the question remains as to why these side effects occur. Recent anecdotal reports of the recreational use of efavirenz provided some clues.

Dr. John A. Schetz at the University of North Texas Health Science Center in Fort Worth, Texas, utilizes a mechanistic approach to solving problems and answering questions of importance to society. As a neuropharmacologist working to discover and develop new drugs for the treatment of neurological and psychiatric disorders, his experience and intuition helped solve the mystery as to why efavirenz, when taken as prescribed, can cause adverse psychiatric events, as well as why there are reports of efavirenz being diverted for recreational use. The later practice could encourage the emergence of ARV-resistant HIV strains by educating the HIV virus.

People smoking HIV medicine to get highDr. Schetz’s interest was sparked by a network news report covering the topic of ARV abuse in South Africa. The report described how pills used to treat HIV were being crushed and the powder smoked for its psychoactive effects. Though there were no scientific studies on the topic, Dr. Schetz was aware of studies describing neuropsychiatric side effects in HIV patients taking the medication as prescribed, as well as case reports of sudden onset adverse psychiatric events in patients with no history of mental illness. However, research study results suggested that the later patient population were genetically predisposed because they have less effective variants of the enzyme primarily responsible for metabolizing efavirenz, leading to much slower than expected breakdown of efavirenz, and consequently higher than expected levels of drug in the body. Dr. Schetz initiated his investigation with molecular profiling of the receptor pharmacology of efavirenz which lead to the pinpointing of interactions with multiple established sites of action for other known drugs of abuse. He and a number of his colleagues worked together to achieve a pre-clinical understanding of the psychoactivity induced by efavirenz that may help explain reports both of its adverse neuropsychiatric side effects in HIV patients and of its diversion for recreational use.

Dr. Schetz’s work is the first ever study of the mechanisms of efavirenz’s psychopharmacology and these new findings will help stimulate interest to support additional research related to the mechanism of ARV side effects and abuse potential. This would help translate the pre-clinical findings into preventative measures addressing HIV medication-induced adverse side effects in patients living with HIV. Additionally, preventative strategies would improve patient adherence and quality of life, reduce the potential risk for the emergence of HIV drug resistant strains, and could prevent diversion of HIV medication for illicit use.”

His findings will be presented April 21, 2012 during Experimental Biology 2013 in Boston, MA.


Monday, April 22nd, 2013


Human immunodeficiency virus infection / acquired immunodeficiency syndrome (HIV/AIDS) is a disease of the human immune system caused by infection with human immunodeficiency virus (HIV).[1] During the initial infection, a person may experience a brief period of influenza-like illness. This is typically followed by a prolonged period without symptoms. As the illness progresses, it interferes more and more with the immune system, making the person much more likely to get infections, including opportunistic infections and tumors that do not usually affect people who have working immune systems.

HIV is transmitted primarily via unprotected sexual intercourse (including anal and even oral sex), contaminated blood transfusions, hypodermic needles, and from mother to child during pregnancy, delivery, or breastfeeding.[2] Some bodily fluids, such as saliva and tears, do not transmit HIV.[3] Prevention of HIV infection, primarily through safe sex and needle-exchange programs, is a key strategy to control the spread of the disease. There is no cure or vaccine; however, antiretroviral treatment can slow the course of the disease and may lead to a near-normal life expectancy. While antiretroviral treatment reduces the risk of death and complications from the disease, these medications are expensive and may be associated with side effects.

Genetic research indicates that HIV originated in west-central Africa during the early twentieth century.[4] AIDS was first recognized by the Centers for Disease Control and Prevention (CDC) in 1981 and its cause—HIV infection—was identified in the early part of the decade.[5] Since its discovery, AIDS has caused nearly 30 million deaths (as of 2009).[6] As of 2010, approximately 34 million people are living with HIV globally.[7] AIDS is considered a pandemic—a disease outbreak which is present over a large area and is actively spreading.[8]

HIV/AIDS has had a great impact on society, both as an illness and as a source of discrimination. The disease also has significant economic impacts. There are many misconceptions about HIV/AIDS such as the belief that it can be transmitted by casual non-sexual contact. The disease has also become subject to many controversies involving religion.

Signs and symptoms

There are three main stages of HIV infection: acute infection, clinical latency and AIDS.[9][10]

Acute infection

A diagram of a human torso labelled with the most common symptoms of an acute HIV infection

Main symptoms of acute HIV infection

The initial period following the contraction of HIV is called acute HIV, primary HIV or acute retroviral syndrome.[9][11] Many individuals develop an influenza-like illness or a mononucleosis-like illness 2–4 weeks post exposure while others have no significant symptoms.[12][13] Symptoms occur in 40–90% of cases and most commonly include fever, large tender lymph nodes, throat inflammation, a rash, headache, and/or sores of the mouth and genitals.[11][13] The rash, which occurs in 20–50% of cases, presents itself on the trunk and is maculopapular, classically.[14] Some people also develop opportunistic infections at this stage.[11] Gastrointestinal symptoms such as nausea, vomiting or diarrhea may occur, as may neurological symptoms of peripheral neuropathy or Guillain-Barre syndrome.[13] The duration of the symptoms varies, but is usually one or two weeks.[13]

Due to their nonspecific character, these symptoms are not often recognized as signs of HIV infection. Even cases that do get seen by a family doctor or a hospital are often misdiagnosed as one of the many common infectious diseases with overlapping symptoms. Thus, it is recommended that HIV be considered in patients presenting an unexplained fever who may have risk factors for the infection.[13]

Clinical latency

The initial symptoms are followed by a stage called clinical latency, asymptomatic HIV, or chronic HIV.[10] Without treatment, this second stage of the natural history of HIV infection can last from about three years[15] to over 20 years[16] (on average, about eight years).[17] While typically there are few or no symptoms at first, near the end of this stage many people experience fever, weight loss, gastrointestinal problems and muscle pains.[10] Between 50 and 70% of people also develop persistent generalized lymphadenopathy, characterized by unexplained, non-painful enlargement of more than one group of lymph nodes (other than in the groin) for over three to six months.[9]

Although most HIV-1 infected individuals have a detectable viral load and in the absence of treatment will eventually progress to AIDS, a small proportion (about 5%) retain high levels of CD4+ T cells (T helper cells) without antiretroviral therapy for more than 5 years.[13][18] These individuals are classified as HIV controllers or long-term nonprogressors (LTNP).[18] Another group is those who also maintain a low or undetectable viral load without anti-retroviral treatment who are known as “elite controllers” or “elite suppressors”. They represent approximately 1 in 300 infected persons.[19]

Acquired immunodeficiency syndrome

A diagram of a human torso labelled with the most common symptoms of AIDS

Main symptoms of AIDS.

Acquired immunodeficiency syndrome (AIDS) is defined in terms of either a CD4+ T cell count below 200 cells per µL or the occurrence of specific diseases in association with an HIV infection.[13] In the absence of specific treatment, around half of people infected with HIV develop AIDS within ten years.[13] The most common initial conditions that alert to the presence of AIDS are pneumocystis pneumonia (40%), cachexia in the form of HIV wasting syndrome (20%) and esophageal candidiasis.[13] Other common signs include recurring respiratory tract infections.[13]

Opportunistic infections may be caused by bacteria, viruses, fungi and parasites that are normally controlled by the immune system.[20] Which infections occur partly depends on what organisms are common in the person’s environment.[13] These infections may affect nearly every organ system.[21]

People with AIDS have an increased risk of developing various viral induced cancers including: Kaposi’s sarcoma, Burkitt’s lymphoma, primary central nervous system lymphoma, and cervical cancer.[14] Kaposi’s sarcoma is the most common cancer occurring in 10 to 20% of people with HIV.[22] The second most common cancer is lymphoma which is the cause of death of nearly 16% of people with AIDS and is the initial sign of AIDS in 3 to 4%.[22] Both these cancers are associated with human herpesvirus 8.[22] Cervical cancer occurs more frequently in those with AIDS due to its association with human papillomavirus (HPV).[22]

Additionally, people with AIDS frequently have systemic symptoms such as prolonged fevers, sweats (particularly at night), swollen lymph nodes, chills, weakness, and weight loss.[23] Diarrhea is another common symptom present in about 90% of people with AIDS.[24]


Average per act risk of getting HIV
by exposure route to an infected source
Exposure Route Chance of infection
Blood Transfusion 90% [25]
Childbirth (to child) 25%[26]
Needle-sharing injection drug use 0.67%[25]
Percutaneous needle stick 0.30%[27]
Receptive anal intercourse* 0.04–3.0%[28]
Insertive anal intercourse* 0.03%[29]
Receptive penile-vaginal intercourse* 0.05–0.30%[28][30]
Insertive penile-vaginal intercourse* 0.01–0.38% [28][30]
Receptive oral intercourse 0–0.04% [28]
Insertive oral intercourse 0–0.005%[31]
* assuming no condom use
§ source refers to oral intercourse
performed on a man

HIV is transmitted by three main routes: sexual contact, exposure to infected body fluids or tissues, and from mother to child during pregnancy, delivery, or breastfeeding (known as vertical transmission).[2] There is no risk of acquiring HIV if exposed to feces, nasal secretions, saliva, sputum, sweat, tears, urine, or vomit unless these are contaminated with blood.[27] It is possible to be co-infected by more than one strain of HIV—a condition known as HIV superinfection.[32]


The most frequent mode of transmission of HIV is through sexual contact with an infected person.[2] The majority of all transmissions occur through heterosexual contacts (i.e. sexual contacts between people of the opposite sex);[2] however, the pattern of transmission varies significantly among countries. In the United States, as of 2009, most sexual transmission occurred in men who had sex with men,[2] with this population accounting for 64% of all new cases.[33]

As regards unprotected heterosexual contacts, estimates of the risk of HIV transmission per sexual act appear to be four to ten times higher in low-income countries than in high-income countries.[34] In low-income countries, the risk of female-to-male transmission is estimated as 0.38% per act, and of male-to-female transmission as 0.30% per act; the equivalent estimates for high-income countries are 0.04% per act for female-to-male transmission, and 0.08% per act for male-to-female transmission.[34] The risk of transmission from anal intercourse is especially high, estimated as 1.4–1.7% per act in both heterosexual and homosexual contacts.[34][35] While the risk of transmission from oral sex is relatively low, it is still present.[36] The risk from receiving oral sex has been described as “nearly nil”[37] however a few cases have been reported.[38] The per-act risk is estimated at 0–0.04% for receptive oral intercourse.[39] In settings involving prostitution in low income countries, risk of female-to-male transmission has been estimated as 2.4% per act and male-to-female transmission as 0.05% per act.[34]

Risk of transmission increases in the presence of many sexually transmitted infections[40] and genital ulcers.[34] Genital ulcers appear to increase the risk approximately fivefold.[34] Other sexually transmitted infections, such as gonorrhea, chlamydia, trichomoniasis, and bacterial vaginosis, are associated with somewhat smaller increases in risk of transmission.[39]

The viral load of an infected person is an important risk factor in both sexual and mother-to-child transmission.[41] During the first 2.5 months of an HIV infection a person’s infectiousness is twelve times higher due to this high viral load.[39] If the person is in the late stages of infection, rates of transmission are approximately eightfold greater.[34]

Rough sex can be a factor associated with an increased risk of transmission.[42] Sexual assault is also believed to carry an increased risk of HIV transmission as condoms are rarely worn, physical trauma to the vagina or rectum is likely, and there may be a greater risk of concurrent sexually transmitted infections.[43]

Body fluids

 A black-and-white poster of a young black man with a towel in his left hand with the words "If you are dabbling with drugs you could be dabbling with your life" above him

CDC poster from 1989 highlighting the threat of AIDS associated with drug use

The second most frequent mode of HIV transmission is via blood and blood products.[2] Blood-borne transmission can be through needle-sharing during intravenous drug use, needle stick injury, transfusion of contaminated blood or blood product, or medical injections with unsterilised equipment. The risk from sharing a needle during drug injection is between 0.63 and 2.4% per act, with an average of 0.8%.[44] The risk of acquiring HIV from a needle stick from an HIV-infected person is estimated as 0.3% (about 1 in 333) per act and the risk following mucus membrane exposure to infected blood as 0.09% (about 1 in 1000) per act.[27] In the United States intravenous drug users made up 12% of all new cases of HIV in 2009,[33] and in some areas more than 80% of people who inject drugs are HIV positive.[2]

HIV is transmitted in About 93% of blood transfusions involving infected blood .[44] In developed countries the risk of acquiring HIV from a blood transfusion is extremely low (less than one in half a million) where improved donor selection and HIV screening is performed;[2] for example, in the UK the risk is reported at one in five million.[45] In low income countries, only half of transfusions may be appropriately screened (as of 2008),[46] and it is estimated that up to 15% of HIV infections in these areas come from transfusion of infected blood and blood products, representing between 5% and 10% of global infections.[2][47]

Unsafe medical injections play a significant role in HIV spread in sub-Saharan Africa. In 2007, between 12 and 17% of infections in this region were attributed to medical syringe use.[48] The World Health Organisation estimates the risk of transmission as a result of a medical injection in Africa at 1.2%.[48] Significant risks are also associated with invasive procedures, assisted delivery, and dental care in this area of the world.[48]

People giving or receiving tattoos, piercings, and scarification are theoretically at risk of infection but no confirmed cases have been documented.[49] It is not possible for mosquitoes or other insects to transmit HIV.[50]


HIV can be transmitted from mother to child during pregnancy, during delivery, or through breast milk.[51][52] This is the third most common way in which HIV is transmitted globally.[2] In the absence of treatment, the risk of transmission before or during birth is around 20% and in those who also breastfeed 35%.[51] As of 2008, vertical transmission accounted for about 90% of cases of HIV in children.[51] With appropriate treatment the risk of mother-to-child infection can be reduced to about 1%.[51] Preventive treatment involves the mother taking antiretroviral during pregnancy and delivery, an elective caesarean section, avoiding breastfeeding, and administering antiretroviral drugs to the newborn.[53] Many of these measures are however not available in the developing world.[53] If blood contaminates food during pre-chewing it may pose a risk of transmission.[49]


Main article: HIV
A circular structure with purple structures coming out of it and a number of objects inside the circle representing different aspects of the virus

A diagram showing the structure of HIV virus

HIV is the cause of the spectrum of disease known as HIV/AIDS. HIV is a retrovirus that primarily infects components of the human immune system such as CD4+ T cells, macrophages and dendritic cells. It directly and indirectly destroys CD4+ T cells.[54]

HIV is a member of the genus Lentivirus,[55] part of the family of Retroviridae.[56] Lentiviruses share many morphological and biological characteristics. Many species of mammals are infected by lentiviruses, which are characteristically responsible for long-duration illnesses with a long incubation period.[57] Lentiviruses are transmitted as single-stranded, positive-sense, enveloped RNA viruses. Upon entry into the target cell, the viral RNA genome is converted (reverse transcribed) into double-stranded DNA by a virally encoded reverse transcriptase that is transported along with the viral genome in the virus particle. The resulting viral DNA is then imported into the cell nucleus and integrated into the cellular DNA by a virally encoded integrase and host co-factors.[58] Once integrated, the virus may become latent, allowing the virus and its host cell to avoid detection by the immune system.[59] Alternatively, the virus may be transcribed, producing new RNA genomes and viral proteins that are packaged and released from the cell as new virus particles that begin the replication cycle anew.[60]

Two types of HIV have been characterized: HIV-1 and HIV-2. HIV-1 is the virus that was originally discovered (and initially referred to also as LAV or HTLV-III). It is more virulent, more infective,[61] and is the cause of the majority of HIV infections globally. The lower infectivity of HIV-2 as compared with HIV-1 implies that fewer people exposed to HIV-2 will be infected per exposure. Because of its relatively poor capacity for transmission, HIV-2 is largely confined to West Africa.[62]


 A large round blue object with a smaller red object attached to it. Multiple small green spots are speckled over both.

Scanning electron micrograph of HIV-1, colored green, budding from a cultured lymphocyte.

After the virus enters the body there is a period of rapid viral replication, leading to an abundance of virus in the peripheral blood. During primary infection, the level of HIV may reach several million virus particles per milliliter of blood.[63] This response is accompanied by a marked drop in the number of circulating CD4+ T cells. The acute viremia is almost invariably associated with activation of CD8+ T cells, which kill HIV-infected cells, and subsequently with antibody production, or seroconversion. The CD8+ T cell response is thought to be important in controlling virus levels, which peak and then decline, as the CD4+ T cell counts recover. A good CD8+ T cell response has been linked to slower disease progression and a better prognosis, though it does not eliminate the virus.[64]

The pathophysiology of AIDS is complex.[65] Ultimately, HIV causes AIDS by depleting CD4+ T cells. This weakens the immune system and allows opportunistic infections. T cells are essential to the immune response and without them, the body cannot fight infections or kill cancerous cells. The mechanism of CD4+ T cell depletion differs in the acute and chronic phases.[66] During the acute phase, HIV-induced cell lysis and killing of infected cells by cytotoxic T cells accounts for CD4+ T cell depletion, although apoptosis may also be a factor. During the chronic phase, the consequences of generalized immune activation coupled with the gradual loss of the ability of the immune system to generate new T cells appear to account for the slow decline in CD4+ T cell numbers.[67]

Although the symptoms of immune deficiency characteristic of AIDS do not appear for years after a person is infected, the bulk of CD4+ T cell loss occurs during the first weeks of infection, especially in the intestinal mucosa, which harbors the majority of the lymphocytes found in the body.[68] The reason for the preferential loss of mucosal CD4+ T cells is that the majority of mucosal CD4+ T cells express the CCR5 protein which HIV uses as a co-receptor to gain access to the cells, whereas only a small fraction of CD4+ T cells in the bloodstream do so.[69]

HIV seeks out and destroys CCR5 expressing CD4+ T cells during acute infection.[70] A vigorous immune response eventually controls the infection and initiates the clinically latent phase. CD4+ T cells in mucosal tissues remain particularly affected.[70] Continuous HIV replication causes a state of generalized immune activation persisting throughout the chronic phase.[71] Immune activation, which is reflected by the increased activation state of immune cells and release of pro-inflammatory cytokines, results from the activity of several HIV gene products and the immune response to ongoing HIV replication. It is also linked to the breakdown of the immune surveillance system of the gastrointestinal mucosal barrier caused by the depletion of mucosal CD4+ T cells during the acute phase of disease.[72]


Main article: Diagnosis of HIV/AIDS
A graph with two lines. One in blue moves from high on the right to low on the left with a brief rise in the middle. The second line in red moves from zero to very high, then drops to low and gradually rises to high again

A generalized graph of the relationship between HIV copies (viral load) and CD4+ T cell counts over the average course of untreated HIV infection.                      CD4+ T Lymphocyte count (cells/mm³)                      HIV RNA copies per mL of plasma

HIV/AIDS is diagnosed via laboratory testing and then staged based on the presence of certain signs or symptoms.[11] HIV testing is recommended for all those at high risk, which includes anyone diagnosed with a sexually transmitted illness.[14] In many areas of the world a third of HIV carriers only discover they are infected at an advanced stage of the disease when AIDS or severe immunodeficiency has become apparent.[14]

HIV testing

Most people infected with HIV develop specific antibodies (i.e. seroconvert) within three to twelve weeks of the initial infection.[13] Diagnosis of primary HIV before seroconversion is done by measuring HIV-RNA or p24 antigen.[13] Positive results obtained by antibody or PCR testing are confirmed either by a different antibody or by PCR.[11]

Antibody tests in children younger than 18 months are typically inaccurate due to the continued presence of maternal antibodies.[73] Thus HIV infection can only be diagnosed by PCR testing for HIV RNA or DNA, or via testing for the p24 antigen.[11] Much of the world lacks access to reliable PCR testing and many places simply wait until either symptoms develop or the child is old enough for accurate antibody testing.[73] In sub-Saharan Africa as of 2007–2009 between 30 and 70% of the population was aware of their HIV status.[74] In 2009, between 3.6 and 42% of men and women in Sub-Saharan countries were tested[74] which represented a significant increase compared to previous years.[74]

Classifications of HIV infection

Two main clinical staging systems are used to classify HIV and HIV-related disease for surveillance purposes: the WHO disease staging system for HIV infection and disease,[11] and the CDC classification system for HIV infection.[75] The CDC‘s classification system is more frequently adopted in developed countries. Since the WHO‘s staging system does not require laboratory tests, it is suited to the resource-restricted conditions encountered in developing countries, where it can also be used to help guide clinical management. Despite their differences, the two systems allow comparison for statistical purposes.[9][11][75]

The World Health Organization first proposed a definition for AIDS in 1986.[11] Since then, the WHO classification has been updated and expanded several times, with the most recent version being published in 2007.[11] The WHO system uses the following categories:

The United States Center for Disease Control and Prevention also created a classification system for HIV, and updated it in 2008.[75] This system classifies HIV infections based on CD4 count and clinical symptoms,[75] and describes the infection in three stages:

  • Stage 1: CD4 count ≥ 500 cells/µl and no AIDS defining conditions
  • Stage 2: CD4 count 200 to 500 cells/µl and no AIDS defining conditions
  • Stage 3: CD4 count ≤ 200 cells/µl or AIDS defining conditions
  • Unknown: if insufficient information is available to make any of the above classifications

For surveillance purposes, the AIDS diagnosis still stands even if, after treatment, the CD4+ T cell count rises to above 200 per µL of blood or other AIDS-defining illnesses are cured.[9]


A run down a two-story building with a number of signs related to AIDS prevention

AIDS Clinic, McLeod Ganj, Himachal Pradesh, India, 2010

Sexual contact

Consistent condom use reduces the risk of HIV transmission by approximately 80% over the long term.[76] When condoms are used consistently by a couple in which one person is infected, the rate of HIV infection is less than 1% per year.[77] There is some evidence to suggest that female condoms may provide an equivalent level of protection.[78] Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor) immediately before sex seems to reduce infection rates by approximately 40% among African women.[79] By contrast, use of the spermicide nonoxynol-9 may increase the risk of transmission due to its tendency to cause vaginal and rectal irritation.[80] Circumcision in Sub-Saharan Africa “reduces the acquisition of HIV by heterosexual men by between 38% and 66% over 24 months”.[81] Based on these studies, the World Health Organization and UNAIDS both recommended male circumcision as a method of preventing female-to-male HIV transmission in 2007.[82] Whether it protects against male-to-female transmission is disputed[83][84] and whether it is of benefit in developed countries and among men who have sex with men is undetermined.[85][86][87] Some experts fear that a lower perception of vulnerability among circumcised men may cause more sexual risk-taking behavior, thus negating its preventive effects.[88]

Programs encouraging sexual abstinence do not appear to affect subsequent HIV risk.[89] Evidence for a benefit from peer education is equally poor.[90] Comprehensive sexual education provided at school may decrease high risk behavior.[91] A substantial minority of young people continues to engage in high-risk practices despite knowing about HIV/AIDS, underestimating their own risk of becoming infected with HIV.[92] It is not known whether treating other sexually transmitted infections is effective in preventing HIV.[40]


Treating people with HIV whose CD4 count ≥ 350cells/µL with antiretrovirals protects 96% of their partners from infection.[93] This is about a 10 to 20 fold reduction in transmission risk.[94] Pre-exposure prophylaxis with a daily dose of the medications tenofovir, with or without emtricitabine, is effective in a number of groups including men who have sex with men, couples where one is HIV positive, and young heterosexuals in Africa.[79]

Universal precautions within the health care environment are believed to be effective in decreasing the risk of HIV.[95] Intravenous drug use is an important risk factor and harm reduction strategies such as needle-exchange programmes and opioid substitution therapy appear effective in decreasing this risk.[96][97]


A course of antiretrovirals administered within 48 to 72 hours after exposure to HIV positive blood or genital secretions is referred to as post-exposure prophylaxis.[98] The use of the single agent zidovudine reduces the risk of subsequent HIV infection fivefold following a needle stick injury.[98] Treatment is recommended after sexual assault when the perpetrator is known to be HIV positive but is controversial when their HIV status is unknown.[99] Current treatment regimes typically use lopinavir/ritonavir and lamivudine/zidovudine or emtricitabine/tenofovir and may decrease the risk further.[98] The duration of treatment is usually four weeks[100] and is frequently associated with adverse effects (with zidovudine in about 70% of cases, including nausea in 24%, fatigue in 22%, emotional distress in 13%, and headaches in 9%).[27]


Programs to prevent the vertical transmission of HIV (from mothers to children) can reduce rates of transmission by 92–99%.[51][96] This primarily involves the use of a combination of antiviral medications during pregnancy and after birth in the infant and potentially includes bottle feeding rather than breastfeeding.[51][101] If replacement feeding is acceptable, feasible, affordable, sustainable, and safe, mothers should avoid breastfeeding their infants; however exclusive breastfeeding is recommended during the first months of life if this is not the case.[102] If exclusive breastfeeding is carried out, the provision of extended antiretroviral prophylaxis to the infant decreases the risk of transmission.[103]


As of 2012 there is no effective vaccine for HIV or AIDS.[104] A single trial of the vaccine RV 144 published in 2009 found a partial reduction in the risk of transmission of roughly 30%, stimulating some hope in the research community of developing a truly effective vaccine.[105] Further trials of the RV 144 vaccine are ongoing.[106][107]


There is currently no cure or effective HIV vaccine. Treatment consists of high active antiretroviral therapy (HAART) which slows progression of the disease[108] and as of 2010 more than 6.6 million people were taking them in low and middle income countries.[7] Treatment also includes preventive and active treatment of opportunistic infections.

Antiviral therapy

Two yellow oblong pills on one of which the markings GX623 are visible

Abacavir – a nucleoside analog reverse transcriptase inhibitor (NARTI or NRTI)

Current HAART options are combinations (or “cocktails”) consisting of at least three medications belonging to at least two types, or “classes,” of antiretroviral agents.[109] Initially treatment is typically a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside analogue reverse transcriptase inhibitors (NRTIs).[109] Typical NRTIs include: zidovudine (AZT) or tenofovir (TDF) and lamivudine (3TC) or emtricitabine (FTC).[109] Combinations of agents which include a protease inhibitors (PI) are used if the above regime loses effectiveness.[109]

When to start antiretroviral therapy is subject to debate.[14][110] The World Health Organization, European guidelines and the United States recommends antiretrovirals in all adolescents, adults and pregnant women with a CD4 count less than 350/uL or those with symptoms regardless of CD4 count.[14][109] This is supported by the fact that beginning treatment at this level reduces the risk of death.[111] The United States in addition recommends them for all HIV-infected people regardless of CD4 count or symptoms; however it makes this recommendation with less confidence for those with higher counts.[112] While the WHO also recommends treatment in those who are co-infected with tuberculosis and those with chronic active hepatitis B.[109] Once treatment is begun it is recommended that it is continued without breaks or “holidays”.[14] Many people are diagnosed only after treatment ideally should have begun.[14] The desired outcome of treatment is a long term plasma HIV-RNA count below 50 copies/mL.[14] Levels to determine if treatment is effective are initially recommended after four weeks and once levels fall below 50 copies/mL checks every three to six months are typically adequate.[14] Inadequate control is deemed to be greater than 400 copies/mL.[14] Based on these criteria treatment is effective in more than 95% of people during the first year.[14]

Benefits of treatment include a decreased risk of progression to AIDS and a decreased risk of death.[113] In the developing world treatment also improves physical and mental health.[114] With treatment there is a 70% reduced risk of acquiring tuberculosis.[109] Additional benefits include a decreased risk of transmission of the disease to sexual partners and a decrease in mother-to-child transmission.[109] The effectiveness of treatment depends to a large part on compliance.[14] Reasons for non-adherence include poor access to medical care,[115] inadequate social supports, mental illness and drug abuse.[116] The complexity of treatment regimens (due to pill numbers and dosing frequency) and adverse effects may reduce adherence.[117] Even though cost is an important issue with some medications,[118] 47% of those who needed them were taking them in low and middle income countries as of 2010[7] and the rate of adherence is similar in low-income and high-income countries.[119]

Specific adverse events are related to the agent taken.[120] Some relatively common ones include: lipodystrophy syndrome, dyslipidemia, and diabetes mellitus especially with protease inhibitors.[9] Other common symptoms include diarrhea,[120][121] and an increased risk of cardiovascular disease.[122] Newer recommended treatments are associated with fewer adverse effects.[14] Certain medications may be associated with birth defects and therefore may be unsuitable for women hoping to have children.[14]

Treatment recommendations for children are slightly different from those for adults. In the developing world, as of 2010, 23% of children who were in need of treatment had access.[123] Both the World Health Organization and the United States recommend treatment for all children less than twelve months of age.[124][125] The United States recommends in those between one year and five years of age treatment in those with HIV RNA counts of greater than 100,000 copies/mL, and in those more than five years treatments when CD4 counts are less than 500/ul.[124]

Opportunistic infections

Measures to prevent opportunistic infections are effective in many people with HIV/AIDS. In addition to improving current disease, treatment with antiretrovirals reduces the risk of developing additional opportunistic infections.[120] Vaccination against hepatitis A and B is advised for all people at risk of HIV before they become infected; however it may also be given after infection.[126] Trimethoprim/sulfamethoxazole prophylaxis between four and six weeks of age and ceasing breastfeeding in infants born to HIV positive mothers is recommended in resource limited settings.[123] It is also recommended to prevent PCP when a person’s CD4 count is below 200 cells/uL and in those who have or have previously had PCP.[127] People with substantial immunosuppression are also advised to receive prophylactic therapy for toxoplasmosis and Cryptococcus meningitis.[128] Appropriate preventive measures have reduced the rate of these infections by 50% between 1992 and 1997.[129]

Alternative medicine

In the US, approximately 60% of people with HIV use various forms of complementary or alternative medicine,[130] even though the effectiveness of most of these therapies has not been established.[131] With respect to dietary advice and AIDS some evidence has shown a benefit from micronutrient supplements.[132] Evidence for supplementation with selenium is mixed with some tentative evidence of benefit.[133] There is some evidence that vitamin A supplementation in children reduces mortality and improves growth.[132] In Africa in nutritionally compromised pregnant and lactating women a multivitamin supplementation has improved outcomes for both mothers and children.[132] Dietary intake of micronutrients at RDA levels by HIV-infected adults is recommended by the World Health Organization.[134][135] The WHO further states that several studies indicate that supplementation of vitamin A, zinc, and iron can produce adverse effects in HIV positive adults.[135] There is not enough evidence to support the use of herbal medicines.[136]


Disability-adjusted life yearfor HIV and AIDS per 100,000 inhabitants as of 2004.

  no data
  ≤ 10
  ≥ 50000

HIV/AIDS has become a chronic rather than an acutely fatal disease in many areas of the world.[137] Prognosis varies between people, and both the CD4 count and viral load are useful for predicted outcomes.[13] Without treatment, average survival time after infection with HIV is estimated to be 9 to 11 years, depending on the HIV subtype.[138] After the diagnosis of AIDS, if treatment is not available, survival ranges between 6 and 19 months.[139][140] HAART and appropriate prevention of opportunistic infections reduces the death rate by 80%, and raises the life expectancy for a newly diagnosed young adult to 20–50 years.[137][141][142] This is between two thirds[141] and nearly that of the general population.[14][143] If treatment is started late in the infection, prognosis is not as good:[14] for example, if treatment is begun following the diagnosis of AIDS, life expectancy is ~10–40 years.[14][137] Half of infants born with HIV die before two years of age without treatment.[123]

The primary causes of death from HIV/AIDS are opportunistic infections and cancer, both of which are frequently the result of the progressive failure of the immune system.[129][144] Risk of cancer appears to increase once the CD4 count is below 500/μL.[14] The rate of clinical disease progression varies widely between individuals and has been shown to be affected by a number of factors such as a person’s susceptibility and immune function;[145] their access to health care, the presence of co-infections;[139][146] and the particular strain (or strains) of the virus involved.[147][148]

Tuberculosis co-infection is one of the leading causes of sickness and death in those with HIV/AIDS being present in a third of all HIV infected people and causing 25% of HIV related deaths.[149] HIV is also one of the most important risk factors for tuberculosis.[150] Hepatitis C is another very common co-infection where each disease increases the progression of the other.[151] The two most common cancers associated with HIV/AIDS are Kaposi’s sarcoma and AIDS-related non-Hodgkin’s lymphoma.[144]

Even with anti-retroviral treatment, over the long term HIV-infected people may experience neurocognitive disorders,[152] osteoporosis,[153] neuropathy,[154] cancers,[155][156] nephropathy,[157] and cardiovascular disease.[121] It is not clear whether these conditions result from the HIV infection itself or are adverse effects of treatment.


 A map of the world where most of the land is colored green or yellow except for sub Saharan Africa which is colored red

Estimated prevalence of HIV among young adults (15–49) per country as of 2011.[158]

HIV/AIDS is a global pandemic.[159] As of 2010, approximately 34 million people have HIV worldwide.[7] Of these approximately 16.8 million are women and 3.4 million are less than 15 years old.[7] It resulted in about 1.8 million deaths in 2010, down from a peak of 2.2 million in 2005.[7]

Sub-Saharan Africa is the region most affected. In 2010, an estimated 68% (22.9 million) of all HIV cases and 66% of all deaths (1.2 million) occurred in this region.[160] This means that about 5% of the adult population is infected[161] and it is believed to be the cause of 10% of all deaths in children.[162] Here in contrast to other regions women compose nearly 60% of cases.[160] South Africa has the largest population of people with HIV of any country in the world at 5.9 million.[160] Life expectancy has fallen in the worst-affected countries due to HIV/AIDS; for example, in 2006 it was estimated that it had dropped from 65 to 35 years in Botswana.[8]

South & South East Asia is the second most affected; in 2010 this region contained an estimated 4 million cases or 12% of all people living with HIV resulting in approximately 250,000 deaths.[161] Approximately 2.4 million of these cases are in India.[160]

In 2008 in the United States approximately 1.2 million people were living with HIV, resulting in about 17,500 deaths. The Centre for Disease Control and Prevention estimated that in 2008 20% of infected Americans were unaware of their infection.[163] In the United Kingdom as of 2009 there where approximately 86,500 cases which resulted in 516 deaths.[164] In Canada as of 2008 there were about 65,000 cases causing 53 deaths.[165] Between the first recognition of AIDS in 1981 and 2009 it has led to nearly 30 million deaths.[6] Prevalence is lowest in Middle East and North Africa at 0.1% or less, East Asia at 0.1% and Western and Central Europe at 0.2%.[161]


Main article: History of HIV/AIDS


The Morbidity and Mortality Weekly Report reported in 1981 on what was later to be called “AIDS”.

AIDS was first clinically observed in 1981 in the United States.[22] The initial cases were a cluster of injecting drug users and homosexual men with no known cause of impaired immunity who showed symptoms of Pneumocystis carinii pneumonia (PCP), a rare opportunistic infection that was known to occur in people with very compromised immune systems.[166] Soon thereafter, an unexpected number of gay men developed a previously rare skin cancer called Kaposi’s sarcoma (KS).[167][168] Many more cases of PCP and KS emerged, alerting U.S. Centers for Disease Control and Prevention (CDC) and a CDC task force was formed to monitor the outbreak.[169]

Robert Gallo, co-discoverer of HIV in the early eighties among (from left to right) Sandra Eva, Sandra Colombini, and Ersell Richardson.

In the early days, the CDC did not have an official name for the disease, often referring to it by way of the diseases that were associated with it, for example, lymphadenopathy, the disease after which the discoverers of HIV originally named the virus.[170][171] They also used Kaposi’s Sarcoma and Opportunistic Infections, the name by which a task force had been set up in 1981.[172] At one point, the CDC coined the phrase “the 4H disease”, since the syndrome seemed to affect Haitians, homosexuals, hemophiliacs, and heroin users.[173] In the general press, the term “GRID”, which stood for gay-related immune deficiency, had been coined.[174] However, after determining that AIDS was not isolated to the gay community,[172] it was realized that the term GRID was misleading and the term AIDS was introduced at a meeting in July 1982.[175] By September 1982 the CDC started referring to the disease as AIDS.[176]

In 1983, two separate research groups led by Robert Gallo and Luc Montagnier independently declared that a novel retrovirus may have been infecting AIDS patients, and published their findings in the same issue of the journal Science.[177][178] Gallo claimed that a virus his group had isolated from an AIDS patient was strikingly similar in shape to other human T-lymphotropic viruses (HTLVs) his group had been the first to isolate. Gallo’s group called their newly isolated virus HTLV-III. At the same time, Montagnier’s group isolated a virus from a patient presenting with swelling of the lymph nodes of the neck and physical weakness, two characteristic symptoms of AIDS. Contradicting the report from Gallo’s group, Montagnier and his colleagues showed that core proteins of this virus were immunologically different from those of HTLV-I. Montagnier’s group named their isolated virus lymphadenopathy-associated virus (LAV).[169] As these two viruses turned out to be the same, in 1986, LAV and HTLV-III were renamed HIV.[179]


Both HIV-1 and HIV-2 are believed to have originated in non-human primates in West-central Africa and were transferred to humans in the early 20th century.[4] HIV-1 appears to have originated in southern Cameroon through the evolution of SIV(cpz), a simian immunodeficiency virus (SIV) that infects wild chimpanzees (HIV-1 descends from the SIVcpz endemic in the chimpanzee subspecies Pan troglodytes troglodytes).[180][181] The closest relative of HIV-2 is SIV(smm), a virus of the sooty mangabey (Cercocebus atys atys), an Old World monkey living in coastal West Africa (from southern Senegal to western Côte d’Ivoire).[62] New World monkeys such as the owl monkey are resistant to HIV-1 infection, possibly because of a genomic fusion of two viral resistance genes.[182] HIV-1 is thought to have jumped the species barrier on at least three separate occasions, giving rise to the three groups of the virus, M, N, and O.[183]

There is evidence that humans who participate in bushmeat activities, either as hunters or as bushmeat vendors, commonly acquire SIV.[184] However, SIV is a weak virus which is typically suppressed by the human immune system within weeks of infection. It is thought that several transmissions of the virus from individual to individual in quick succession are necessary to allow it enough time to mutate into HIV.[185] Furthermore, due to its relatively low person-to-person transmission rate, SIV can only spread throughout the population in the presence of one or more high-risk transmission channels, which are thought to have been absent in Africa before the 20th century.

Specific proposed high-risk transmission channels, allowing the virus to adapt to humans and spread throughout the society, depend on the proposed timing of the animal-to-human crossing. Genetic studies of the virus suggest that the most recent common ancestor of the HIV-1 M group dates back to circa 1910.[186] Proponents of this dating link the HIV epidemic with the emergence of colonialism and growth of large colonial African cities, leading to social changes, including a higher degree of sexual promiscuity, the spread of prostitution, and the accompanying high frequency of genital ulcer diseases (such as syphilis) in nascent colonial cities.[187] While transmission rates of HIV during vaginal intercourse are low under regular circumstances, they are increased many fold if one of the partners suffers from a sexually transmitted infection causing genital ulcers. Early 1900s colonial cities were notable due to their high prevalence of prostitution and genital ulcers, to the degree that, as of 1928, as many as 45% of female residents of eastern Kinshasa were thought to have been prostitutes, and, as of 1933, around 15% of all residents of the same city had syphilis.[187]

An alternative view holds that unsafe medical practices in Africa after World War II, such as unsterile reuse of single use syringes during mass vaccination, antibiotic and anti-malaria treatment campaigns, were the initial vector that allowed the virus to adapt to humans and spread.[185][188][189]

The earliest well documented case of HIV in a human dates back to 1959 in the Congo.[190] The virus may have been present in the United States as early as 1966,[191] but the vast majority of infections occurring outside sub-Saharan Africa (including the U.S.) can be traced back to a single unknown individual who became infected with HIV in Haiti and then brought the infection to the United States some time around 1969.[192] The epidemic then rapidly spread among high-risk groups (initially, sexually promiscuous men who have sex with men). By 1978, the prevalence of HIV-1 among gay male residents of New York and San Francisco was estimated at 5%, suggesting that several thousand individuals in the country had been infected.[192]

Society and culture


A teenage male with the hand of another resting on his left shoulder smiling for the camera

Ryan White became a poster child for HIV after being expelled from school because he was infected.

AIDS stigma exists around the world in a variety of ways, including ostracism, rejection, discrimination and avoidance of HIV infected people; compulsory HIV testing without prior consent or protection of confidentiality; violence against HIV infected individuals or people who are perceived to be infected with HIV; and the quarantine of HIV infected individuals.[193] Stigma-related violence or the fear of violence prevents many people from seeking HIV testing, returning for their results, or securing treatment, possibly turning what could be a manageable chronic illness into a death sentence and perpetuating the spread of HIV.[194]

AIDS stigma has been further divided into the following three categories:

  • Instrumental AIDS stigma—a reflection of the fear and apprehension that are likely to be associated with any deadly and transmissible illness.[195]
  • Symbolic AIDS stigma—the use of HIV/AIDS to express attitudes toward the social groups or lifestyles perceived to be associated with the disease.[195]
  • Courtesy AIDS stigma—stigmatization of people connected to the issue of HIV/AIDS or HIV-positive people.[196]

Often, AIDS stigma is expressed in conjunction with one or more other stigmas, particularly those associated with homosexuality, bisexuality, promiscuity, prostitution, and intravenous drug use.[197]

In many developed countries, there is an association between AIDS and homosexuality or bisexuality, and this association is correlated with higher levels of sexual prejudice such as anti-homosexual/bisexual attitudes.[198] There is also a perceived association between AIDS and all male-male sexual behavior, including sex between uninfected men.[195] However, the dominant mode of spread worldwide for HIV remains heterosexual transmission.[199]

Economic impact

A graph showing an number of increasing lines followed by a sharp fall of the lines starting in mid-1980s to 1990s

Changes in life expectancy in some hard-hit African countries.                      Botswana                     Zimbabwe                     Kenya                     South Africa                     Uganda

HIV/AIDS affects the economics of both individuals and countries.[162] The gross domestic product of the most affected countries has decreased due to the lack of human capital.[162][200] Without proper nutrition, health care and medicine, large numbers of people die from AIDS-related complications. They will not only be unable to work, but will also require significant medical care. It is estimated that as of 2007 there were 12 million AIDS orphans.[162] Many are cared for by elderly grandparents.[201]

By affecting mainly young adults, AIDS reduces the taxable population, in turn reducing the resources available for public expenditures such as education and health services not related to AIDS resulting in increasing pressure for the state’s finances and slower growth of the economy. This causes a slower growth of the tax base, an effect that is reinforced if there are growing expenditures on treating the sick, training (to replace sick workers), sick pay and caring for AIDS orphans. This is especially true if the sharp increase in adult mortality shifts the responsibility and blame from the family to the government in caring for these orphans.[201]

At the household level, AIDS causes both loss of income and increased spending on healthcare. A study in Côte d’Ivoire showed that households with an HIV/AIDS patient, spent twice as much on medical expenses as other households. This additional expenditure also leaves less income to spend on education and other personal or family investment.[202]

Religion and AIDS

Main article: Religion and HIV/AIDS

The topic of religion and AIDS has become highly controversial in the past twenty years, primarily because some religious authorities have publicly declared their opposition to the use of condoms.[203][204] The religious approach to prevent the spread of AIDS according to a report by American health expert Matthew Hanley titled The Catholic Church and the Global Aids Crisis argues that cultural changes are needed including a re-emphasis on fidelity within marriage and sexual abstinence outside of it.[204]

Some religious organisations have claimed that prayer can cure HIV/AIDS. In 2011, the BBC reported that some churches in London were claiming that prayer would cure AIDS, and the Hackney-based Centre for the Study of Sexual Health and HIV reported that several people stopped taking their medication, sometimes on the direct advice of their pastor, leading to a number of deaths.[205] The Synagogue Church Of All Nations advertise an “anointing water” to promote God’s healing, although the group deny advising people to stop taking medication.[205]

Media portrayal

One of the first high-profile cases of AIDS was the American Rock Hudson, a gay actor who had been married and divorced earlier in life, who died on 2 October 1985 having announced that he was suffering from the virus on 25 July that year. He had been diagnosed during 1984.[206] A notable British casualty of AIDS that year was Nicholas Eden, a gay politician and son of the late prime minister Anthony Eden.[207] On November 24, 1991, the virus claimed the life of British rock star Freddie Mercury, lead singer of the band Queen, who died from an AIDS related illness having only revealed the diagnosis on the previous day.[208] However he had been diagnosed as HIV positive during 1987.[209] One of the first high-profile heterosexual cases of the virus was Arthur Ashe, the American tennis player. He was diagnosed as HIV positive on 31 August 1988, having contracted the virus from blood transfusions during heart surgery earlier in the 1980s. Further tests within 24 hours of the initial diagnosis revealed that Ashe had AIDS, but he did not tell the public about his diagnosis until April 1992.[210] He died, aged 49, as a result on 6 February 1993.[211]

Therese Frare’s photograph of gay activist David Kirby, as he lay dying from AIDS while surrounded by family, was taken in April 1990. LIFE magazine said the photo became the one image “most powerfully identified with the HIV/AIDS epidemic.” The photo was displayed in LIFE magazine, was the winner of the World Press Photo, and acquired worldwide notoriety after being used in a United Colors of Benetton advertising campaign in 1992.[212] In 1996, Johnson Aziga a Ugandan-born immigrant Canadian was diagnosed as a HIV-positive, but then he had unprotected sex with 11 women without telling them he has HIV. Since 2003, seven of them were infected with HIV, and two of them died of complications of AIDS.[213][214] At last Aziga was convicted of first-degree murder and be liable to a life sentence.[215]

Denial, conspiracies, and misconceptions

A small group of individuals continue to dispute the connection between HIV and AIDS,[216] the existence of HIV itself, or the validity of HIV testing and treatment methods.[217][218] These claims, known as AIDS denialism, have been examined and rejected by the scientific community.[219] However, they have had a significant political impact, particularly in South Africa, where the government’s official embrace of AIDS denialism (1999–2005) was responsible for its ineffective response to that country’s AIDS epidemic, and has been blamed for hundreds of thousands of avoidable deaths and HIV infections.[220][221][222] Operation INFEKTION was a worldwide Soviet active measures operation to spread information that the United States had created HIV/AIDS. Surveys show that a significant number of people believed – and continue to believe – in such claims.[223]

There are many misconceptions about HIV and AIDS. Three of the most common are that AIDS can spread through casual contact, that sexual intercourse with a virgin will cure AIDS, and that HIV can infect only homosexual men and drug users. Other misconceptions are that any act of anal intercourse between two uninfected gay men can lead to HIV infection, and that open discussion of homosexuality and HIV in schools will lead to increased rates of homosexuality and AIDS.[224][225]


Main article: HIV/AIDS research

HIV/AIDS research includes all medical research which attempts to prevent, treat, or cure HIV/AIDS along with fundamental research about the nature of HIV as an infectious agent and AIDS as the disease caused by HIV.

HIV/AIDS research includes following the usual advice given by doctors in responding to HIV. The most universally recommended method for the prevention of HIV/AIDS is to avoid blood-to-blood contact between people and to otherwise practice safe sex. The most recommended method for treating HIV is for HIV-positive people to receive attention from a doctor who would coordinate the patient’s management of HIV/AIDS. There is no cure for HIV/AIDS.

Many governments and research institutions participate in HIV/AIDS research. This research includes behavioral health interventions such as sex education, and drug development, such as research into microbicides for sexually transmitted diseases, HIV vaccines, and antiretroviral drugs. Other medical research areas include the topics of pre-exposure prophylaxis, post-exposure prophylaxis, and Circumcision and HIV.


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Using Facebook to prevent HIV among at-risk groups

Tuesday, February 12th, 2013

Stanford university

New research suggests that social networking sites, such as Facebook, could be effective tools in increasing awareness about HIV and potentially reducing infection rates among at-risk groups.

For the study, UCLA researchers created Facebook groups on topics such as HIV general knowledge, stigma and prevention, and they offered the opportunity for users to request at-home HIV-testing kits. Next, they recruited 112 African-American and Latino men who have sex with men through community organizations, bars, gyms and schools, and through online ads on Craigslist, Facebook and MySpace. The study involved a 12-week intervention and one-year follow-up, and, as described in a Science Daily story:

Participants were randomly assigned on Facebook to either a general health group or a secret HIV-prevention group — one that could not be accessed or searched for by non-group members.

The researchers found that participants in the HIV-prevention group freely discussed HIV-related topics such as prevention, testing, knowledge, stigma and advocacy. Those over the age of 31 were more likely to discuss prevention, testing, stigma and advocacy topics, while younger members were more interested in HIV knowledge–related discussions.

In addition, participants who posted about prevention and testing had over 11 times the odds of requesting an HIV testing kit than participants who did not discuss those topics.

The work appears in the current issue of the journal Sexually Transmitted Diseases.

Newly identified natural protein blocks HIV, other deadly viruses

Tuesday, February 12th, 2013


A team of UCLA-led researchers has identified a protein with broad virus-fighting properties that potentially could be used as a weapon against deadly human pathogenic viruses such as HIV, Ebola, Rift Valley Fever, Nipah and others designated “priority pathogens” for national biosecurity purposes by the National Institute of Allergy and Infectious Disease.
In a study published in the January issue of the journal Immunity, the researchers describe the novel antiviral property of the protein, cholesterol-25-hydroxylase (CH25H), an enzyme that converts cholesterol to an oxysterol called 25-hydroxycholesterol (25HC), which can permeate a cell’s wall and block a virus from getting in.
Interestingly, the CH25H enzyme is activated by interferon, an essential antiviral cell-signaling protein produced in the body, said lead author Su-Yang Liu, a student in the department of microbiology, immunology and molecular genetics at the David Geffen School of Medicine at UCLA.
“Antiviral genes have been hard to apply for therapeutic purposes because it is difficult to express genes in cells,” said Liu, who performed the study with principal investigator Genhong Cheng, a professor of microbiology, immunology and molecular genetics. “CH25H, however, produces a natural, soluble oxysterol that can be synthesized and administered.
“Also, our initial studies showing that 25HC can inhibit HIV growth in vivo should prompt further study into membrane-modifying cholesterols that inhibit viruses,” he added.
The discovery is particularly relevant to efforts to develop broad-spectrum antivirals against an increasing number of emerging viral pathogens, Liu said.
Working with Jerome Zack, a professor of microbiology, immunology and molecular genetics and an associate director of the UCLA AIDS Institute, the researchers initially found that 25HC dramatically inhibited HIV in cell cultures. Next, they administered 25HC in mice implanted with human tissues and found that it significantly reduced their HIV load within seven days. The 25HC also reversed the T-cell depletion caused by HIV.
By contrast, mice that had the CH25H gene knocked out were more susceptible to a mouse gammaherpes virus, the researchers found.
In collaboration with Dr. Benhur Lee, a professor of pathology and laboratory medicine and a member of the UCLA AIDS Institute, they discovered that 25HC inhibited HIV entry into the cell. Furthermore, in cell cultures, it was found to inhibit the growth of other deadly viruses, such as Ebola, Nipah and the Rift Valley Fever virus.
Intriguingly, CH25H expression in cells requires interferon. While interferon has been known for more than 60 years to be a critical part of the body’s natural defense mechanism against viruses, the protein itself does not have any antiviral properties. Rather, it triggers the expression of many antiviral genes. While other studies have identified some antiviral genes that are activated by interferon, this research gives the first description of an interferon-induced antiviral oxysterol through the activation of the enzyme CH25H. It provides a link to how interferon can cause inhibition of viral membrane fusion, Liu said.
He noted some weaknesses in the research. For instance, 25HC is difficult to deliver in large doses, and its antiviral effect against Ebola, Nipah and other highly pathogenic viruses have yet to be tested in vivo. Also, the researchers still need to compare 25HC’s antiviral effect against other HIV antivirals.
Additional study co-authors were Roghiyh Aliyari, Kelechi Chikere, Matthew D. Marsden and Olivier Pernet, of UCLA; Jennifer K. Smith, Rebecca Nusbaum and Alexander N. Frieberg, of the University of Texas–Galveston; and Guangming Li, Haitao Guo and Lishan Su, of the University of North Carolina–Chapel Hill.
The National Institutes of Health (grants R01 AI078389, AI069120, AI080432, AI095097, AI077454, AI070010 and AI028697), the Warsaw Fellowship, the UCLA Center for AIDS Research (CFAR), the UCLA AIDS Institute, the UCLA Clinical and Translational Science Institute (CTSI), and the Pacific Southwest Regional Center of Excellence (PSWRCE) for Biodefense and Emerging Infectious Diseases funded this study.
The UCLA AIDS Institute, established in 1992, is a multidisciplinary think tank drawing on the skills of top-flight researchers in the worldwide fight against HIV and AIDS, the first cases of which were reported in 1981 by UCLA physicians. Institute members include researchers in virology and immunology, genetics, cancer, neurology, ophthalmology, epidemiology, social sciences, public health, nursing and disease prevention. Their findings have led to advances in treating HIV, as well as other diseases, such as hepatitis B and C, influenza and cancer.

Anti-HIV drug simulation offers ‘realistic’ tool to predict drug resistance and viral mutation

Monday, September 3rd, 2012


Pooling data from thousands of tests of the antiviral activity of more than 20 commonly used anti-HIV drugs, AIDS experts at Johns Hopkins and Harvard universities have developed what they say is the first accurate computer simulation to explain drug effects. Already, the model clarifies how and why some treatment regimens fail in some patients who lack evidence of drug resistance. Researchers say their model is based on specific drugs, precise doses prescribed, and on “real-world variation” in how well patients follow prescribing instructions. Johns Hopkins co-senior study investigator and infectious disease specialist Robert Siliciano, M.D., Ph.D., says the mathematical model can also be used to predict how well a patient is likely to do on a specific regimen, based on their prescription adherence. In addition, the model factors in each drug’s ability to suppress viral replication and the likelihood that such suppression will spur development of drug-resistant, mutant HIV strains.

“With the help of our simulation, we can now tell with a fair degree of certainty what level of viral suppression is being achieved — how hard it is for the virus to grow and replicate — for a particular drug combination, at a specific dosage and drug concentration in the blood, even when a dose is missed,” says Siliciano, a professor at the Johns Hopkins University School of Medicine and a Howard Hughes Medical Institute investigator. This information, he predicts, will remove “a lot of the current trial and error, or guesswork, involved in testing new drug combination therapies.”

Siliciano says the study findings, to be reported in the journal Nature Medicine online Sept. 2, should help scientists streamline development and clinical trials of future combination therapies, by ruling out combinations unlikely to work.

One application of the model could be further development of drug combinations that can be contained in a single pill taken once a day. That could lower the chance of resistance, even if adherence is not perfect. Such future drug regimens, he says, will ideally strike a balance between optimizing viral suppression and minimizing risk of drug resistance.

Researchers next plan to expand their modeling beyond blood levels of virus to other parts of the body, such as the brain, where antiretroviral drug concentrations can be different from those measured in the blood. They also plan to expand their analysis to include multiple-drug-resistant strains of HIV.

Besides Siliciano, Johns Hopkins joint medical-doctoral student Alireza Rabi was a co-investigator in this study. Other study investigators included doctoral candidates Daniel Rosenbloom, M.S.; Alison Hill, M.S.; and co-senior study investigator Martin Nowak, Ph.D. — all at Harvard University.

Funding support for this study, which took two years to complete, was provided by the National Institutes of Health, with corresponding grant numbers R01-MH54907, R01-AI081600, R01-GM078986; the Bill and Melinda Gates Foundation; the Cancer Research Institute; the National Science Foundation; the Howard Hughes Medical Institute; Natural Sciences and Engineering Research Council of Canada; the John Templeton Foundation; and J. Epstein.

Currently, an estimated 8 million of the more than 34 million people in the world living with HIV are taking antiretroviral therapy to keep their disease in check. An estimated 1,178,000 in the United States are infected, including 23,000 in the state of Maryland.

Cellphone HIV test studied

Monday, September 3rd, 2012

South African and South Korean researchers are working on making a smartphone capable of doing Aids tests in rural parts of Africa that are the worst hit by the disease, a researcher said on Friday.

The team have developed a microscope and an application that can photograph and analyse blood samples in areas far from laboratories to diagnose HIV and even measure the health of immune systems.

“Our idea was to obtain images and analyse images on this smartphone using applications,” said Jung Kyung Kim, a professor in biomedical engineering at Kookmin University in South Korea.

The gadget, called Smartscope, is a small 1-millimetre microscope and light which clips over a smartphone’s camera.

A standard chip with a blood sample then slides into the gadget in front of the microscope. Next, a special phone program photographs the sample and analyses the cells.

The team hopes that trials in clinics may start next year, Kim told AFP.

A different prototype developed in the United States takes tests in the field that need to be sent to a computer for analysis.

But the Smartscope will itself be able to do a CD4 cell count – a measure of white blood cells, which determines when treatment starts.

“Its basic function is to count those CD4 cells for diagnosis,” said Kim.

The new technology is destined for AIDS treatment in remote communities in South Africa and Swaziland, where clinics often don’t have the technology to do these tests effectively.

Almost six million South Africans are infected with HIV, while a quarter of Swazi adults carry the virus.

“In community health mobile technology is not a gimmick. It becomes an essential part of access,” said Professor Jannie Hugo, who heads the family medicine department at the University of Pretoria, the partner in the study.

New immune-system disease found in Asians, causes AIDS-like symptoms

Sunday, August 26th, 2012

Vancouver Sun

Researchers have identified a mysterious new disease that has left scores of people in Asia and some in the United States with AIDS-like symptoms even though they are not infected with HIV.

The patients’ immune systems become damaged, leaving them unable to fend off germs as healthy people do. What triggers this isn’t known, but the disease does not seem to be contagious.

This is another kind of acquired immune deficiency that is not inherited and occurs in adults, but doesn’t spread the way AIDS does through a virus, said Dr. Sarah Browne, a scientist at the National Institute of Allergy and Infectious Diseases.

She helped lead the study with researchers in Thailand and Taiwan where most of the cases have been found since 2004. Their report is in Thursday’s New England Journal of Medicine.

“This is absolutely fascinating. I’ve seen probably at least three patients in the last 10 years or so” who might have had this, said Dr. Dennis Maki, an infectious disease specialist at the University of Wisconsin in Madison.

It’s still possible that an infection of some sort could trigger the disease, even though the disease itself doesn’t seem to spread person-to-person, he said.

The disease develops around age 50 on average but does not run in families, which makes it unlikely that a single gene is responsible, Browne said. Some patients have died of overwhelming infections, including some Asians now living in the U.S., although Browne could not estimate how many.

Kim Nguyen, 62, a seamstress from Vietnam who has lived in Tennessee since 1975, was gravely ill when she sought help for a persistent fever, infections throughout her bones and other bizarre symptoms in 2009. She had been sick off and on for several years and had visited Vietnam in 1995 and again in early 2009.

“She was wasting away from this systemic infection” that at first seemed like tuberculosis but wasn’t, said Dr. Carlton Hays Jr., a family physician at the Jackson Clinic in Jackson, Tennessee.

Nguyen was referred to specialists at the National Institutes of Health who had been tracking similar cases. She spent nearly a year at an NIH hospital in Bethesda, Maryland, and is there now for monitoring and further treatment.

“I feel great now,” she said Wednesday. But when she was sick, “I felt dizzy, headaches, almost fell down,” she said. “I could not eat anything.”

AIDS is a specific disease, and it stands for acquired immune deficiency syndrome. That means the immune system becomes impaired during someone’s lifetime, rather than from inherited gene defects like the “bubble babies” who are born unable to fight off germs.

The virus that causes AIDS — HIV — destroys T-cells, key soldiers of the immune system that fight germs. The new disease doesn’t affect those cells, but causes a different kind of damage. Browne’s study of more than 200 people in Taiwan and Thailand found that most of those with the disease make substances called autoantibodies that block interferon-gamma, a chemical signal that helps the body clear infections.

Blocking that signal leaves people like those with AIDS — vulnerable to viruses, fungal infections and parasites, but especially micobacteria, a group of germs similar to tuberculosis that can cause severe lung damage. Researchers are calling this new disease an “adult-onset” immunodeficiency syndrome because it develops later in life and they don’t know why or how.

“Fundamentally, we do not know what’s causing them to make these antibodies,” Browne said.

Antibiotics aren’t always effective, so doctors have tried a variety of other approaches, including a cancer drug that helps suppress production of antibodies. The disease quiets in some patients once the infections are tamed, but the faulty immune system is likely a chronic condition, researchers believe.

The fact that nearly all the patients so far have been Asian or Asian-born people living elsewhere suggests that genetic factors and something in the environment such as an infection may trigger the disease, researchers conclude.

The first cases turned up in 2004 and Browne’s study enrolled about 100 people in six months.

“We know there are many others out there,” including many cases mistaken as tuberculosis in some countries, she said.

AIDS Conference Changes the Dialogue

Monday, August 13th, 2012

Asia Sentinel

Translating clinical efficacy into public health effectiveness

The recently concluded XIX International AIDS Conference in Washington, DC, appears to have gone a considerable distance on changing the dialogue on ending AIDS, with new emphasis on preventing transmission in the first place as one of the strategies that wouldl complement a comprehensive HIV prevention, treatment, care and support plan to end the disease.

In this context, it is necessary to look beyond the current phase of trials in HIV prevention research so that if the product being tested is proved to be effective, the means and well-thought plan to make it available for those people in need can be developed without delay.

HIV prevention research is going ahead with rectal microbicides phase II efficacy clinical trials about to begin in the US, Thailand, South Africa and Peru. Other hopeful developments include the US Food and Drug Administration’s approval of the microbicide Truvada as pre-exposure prophylaxis for HIV prevention, vaginal microbicide research and HIV vaccine science progress and unprecedented emphasis on treatment as prevention.

“We need a plan that the day efficacy trials are over participants, should continue to have access to the products,” said Mitchell Warren, executive director of AVAC – Global Advocacy for HIV Prevention. “We have spent a lot of time talking about how difficult rolling out pre-exposure prophylaxis is going to be, we don’t yet have fully funded demonstration projects to tell us how to translate clinical efficacy into public health effectiveness. I want to make sure that when we do get the results of the phase III rectal microbicides study, we do know what to do then and that we have resources to do it.”

Warren is right. For example, the FDA approved female condoms as early as 1993. Even 19 years after, and despite their effectiveness in preventing HIV as well as other sexually transmitted infections and unintended pregnancies, female condoms are yet to be made available in the way they should have been to address the unmet needs of women to protect themselves.

“Nineteen years after the FDA approved female condoms, we still do not have fully funded, well designed, and well-monitored programmes, because we focus too much on the product, whether it is a female condom, microbicide (rectal or vaginal) or oral PrEP it is not the product, it is the program that will matter,” Warren continued.

There must be a clear strategy that is described scientifically and costed financially to move the products that have proven effective in preventing HIV in clinical studies into actual products and robust programs, he said.

“It is not just a one-year deal, we need to be looking at the next three, five or seven years to seek how exciting science transits into actual products,” Warren added.

A microbicide trial of 1 percent tenofovir gel, the results of which were the hallmarks at the 2010 International AIDS Conference in Vienna, showed that there were 39 percent fewer infections among women who received the gel compared to women who received a placebo gel in the trial, known as CAPRISA004.

“CAPRISA004 finished almost two years ago and we are still waiting for a follow on study,” Warren said. “A follow-on study after CAPRISA004 is going on but what about ensuring access to trial participants of CAPRISA 004 to the gel?

FACTS001 is a follow-on large-scale placebo-controlled study which is currently underway to test the safety and effectiveness of vaginal tenofovir gel used before and after sex to protect women against HIV infection and also against the Herpes Simplex virus. The FACTS001 study is aimed at confirming and expanding the groundbreaking findings of the CAPRISA 004 tenofovir gel trial.

If the FACTS studies confirm that tenofovir gel is effective, these combined data could contribute to the licensure of the first vaginal microbicide product and subsequently provide women with a powerful new women-controlled HIV prevention method.

Whether there is a plan post-licensure is a big question that needs answers and discussion. Socio-economic, cultural, legal and policy environment, and other factors that are a barrier for many key populations to have access to existing HIV prevention services must be addressed. This will not only possibly increase the utilization of existing services but also prepare health systems well for a better uptake of new technologies (when they become available) as well.

Rectal microbicides advocacy is gaining support around the world. Although anal sex happens between men who have sex with men, transgender people and heterosexual couples, the culture of silence has kept the unique prevention needs and contexts less talked about. Now not only is the issue more talked about but also research for rectal microbicides has gained momentum and growing community engagement.

Dr Ross D Cranston, Protocol Chair, Division of Infectious Diseases, University of Pittsburgh, said before the AIDS 2012 conference that “We have just received regulatory approval for MTN017 (phase II trial of rectal microbicides) from the Division of AIDS.” MTN017 is an extended safety study (in phase II now). Participants will be randomized either in daily rectal formulation of 1 percent tenofovir gel or the same gel with associated rectal sex, and third sequence is oral truvada.

Since people who have anal sex often use some kind of lubricant, there is a hope that if rectal microbicides, if found effective, are introduced as a lubricant, then the uptake might be more because people already are comfortable in using lubricants for anal sex.

“We had done a small study on lubricant use in transgender people earlier and nearly 95 percent of study participants reported to use lubricants. Introducing rectal microbicides when found safe and effective for STI/HIV prevention in future might be easier in transgender people because they are already using lubricants and if lubricants have an added ingredient that provides protection against STIs including HIV that will be so good,” said Suwat Chariyalertsak, Director, Research Institute for Health Sciences, Chiang Mai University, Thailand.

But we know very little whether lubricants that are available in the market today are safe, unsafe or have no effect in preventing STIs including HIV. The way lubricants are regulated by the governments is not consistent.

“Regulatory agencies in various countries classify lubes differently – as medical devices or cosmetics, for example,” said Marc-Andre LeBlanc, IRMA Secretary, who also leads lube safety initiatives. “Typically they require no safety data on the rectal use of lubes in humans.”

Clearly a lot more planning needs to be done to ensure we are really prepared to take rectal microbicides that come out of clinical trials forward to the communities that need them to protect themselves from STIs including HIV. As Mitchell Warren had said above, we need a robust ‘programme’ vis-a-vis ‘product’ to turn the tide.

Dr Ian McGowan, co-principal investigator of the University of Pittsburgh-based Microbicide Trials Network (MTN) said: “I am a firm believer that these drugs (rectal microbicides) in the right amount, at the right place, at the right time, will work.”

Unique Vancouver clinic provides comfort to HIV/AIDS patients Read it on Global News: Tucked away in a corner of St. Paul’s Hospital in downtown Vancouver is a one of a kind clinic for HIV/AIDS patients.

Sunday, August 5th, 2012

Global Edmonton

VANCOUVER – Tucked away in a corner of St. Paul’s Hospital in downtown Vancouver is a one of a kind clinic.

The waiting room at the John Ruedy Immunodeficiency Clinic (IDC) is filled with people from all walks of life – professionals, students, mothers, fathers, and grandparents. Some come from middle-class families, others from one of Canada’s poorest neighbourhoods – Vancouver’s downtown eastside. And many who come here have left unspeakable abuse and torture and come to Canada as refugees.

But there is one thing they all share in common – they have all been diagnosed with HIV.

Unlike in the 1980s when this clinic first opened its doors, living with HIV today means just that: living.

With tireless research into finding – not just a cure – but better treatments to live with the disease, people who test positive are no longer sentenced to death. Many live healthy, full lives with new drug treatments that make their viral counts almost undetectable.

It’s a message clinical nurse Carole Kellman, who has worked on the front lines of HIV care in Vancouver for more than 20 years, is dedicated to getting across. “I’ve always had that passion to keep pushing the envelope, keep raising awareness,” she tells Global News.

Despite advances in care, people living with HIV still have to pay more attention to their health than the average Canadian living without the disease. As a result, the clinic doesn’t just have doctors and nurses, but counsellors, nutritionists and social workers as well. It’s the only clinic in Canada to offer this kind of care under one roof.

Patient comfort is obviously a top priority. Staff don’t just treat the medical conditions caused by HIV, but also the other issues that come with living positive.

“We look at patients not just in terms of their blood work. We see them as more than just their HIV. They are a whole person with very different needs and every patient is different,” explains IDC program director Scott Harrison.

Julie Kille, a nurse and the operations leader, says she and her colleagues have gone beyond the call of duty to help patients. “(If) you need a way to get to the clinic, we’ll help you do that. There’s a lot of things that we go sort of outside the box on. We’ve come up with some interesting ways of dealing with some client needs.”

“We’ve had people actually go out and buy bags of food for people,” Kille adds.

HIV also still needs to be managed with drugs. Left unchecked or untreated, it can be deadly.

An estimated 25 per cent of Canadians still don’t know they have contracted HIV, and that means it can be spread unintentionally.

With infection rates on the rise among women and heterosexuals, Kellman urges everyone to practice safe sex, get tested and educated.

“Twenty-seven per cent of new diagnoses are heterosexuals, and out of that population, women are most at risk
and particularly, women over the age of 50,” says Kellman.

New rapid HIV tests are available, meaning there is no longer a tense waiting game.

For anyone hesitant about getting tested, one HIV-positive patient who frequents the clinic has this advice. “I would say get over it, go get tested. It’s the only way you can live a happier, healthier lifestyle, really.”

According to amfAR (the American Foundation for AIDS Research)

• More than 34 million people live with HIV/AIDS

• About 10 per cent of them are 15 years old or younger

• Every hour, almost 300 people are infected with HIV (that works out to roughly 7,000 people per day)

• In 2011, an estimated 2.5 million contracted HIV

• 230,000 of them were 15 years old or younger

© Global News. A division of Shaw Media Inc., 2012.

AIDS cure may have two main pathways, say experts

Monday, July 30th, 2012

Business Recorder

Investigators are looking into two main paths toward a cure for AIDS, based on the stunning stories of a small group of people around the world who have been able to overcome the disease.

Despite progress in treating millions of people globally with antiretroviral drugs, experts say a cure is more crucial than ever because the rate of HIV infections is outpacing the world’s ability to medicate people.

“For every person who starts antiretroviral therapy, two new individuals are infected with HIV,” Javier Martinez-Picado of the IrsiCaixa AIDS Research Institute in Spain told the International AIDS Conference in Washington on July 24.

While a cure remains a distant prospect, he said scientists can now “envision a cure from two different perspectives,” either by eradicating the virus from a person’s body or coaxing the body to control the virus on its own.

The most extraordinary case of an apparent cure has been seen in an American man in his 40s, Timothy Ray Brown, also known as the “Berlin patient,” who was HIV-positive and developed leukemia.

Brown needed a series of complex medical interventions, including total body irradiation and two bone marrow transplants that came from a compatible donor who had a mutation in the CCR5 gene which acts as a gateway for allowing HIV into the cells.

People without CCR5 appear to be immune to HIV because, in the absence of that doorway, HIV cannot penetrate the cells.

“Five years after the transplant the patient remains off antiretroviral therapy with no viral rebound,” said Martinez-Picado.

“This might be the first ever documented patient apparently cured of an HIV infection.”

However, while the case has provided scientists with ample pathways for research on future gene therapies, the process that appears to have cured Brown carries a high risk of death and toxicity. “Unfortunately this type of intervention is so complex and risky it would not be applicable on a large scale,” he said.

Another group of intense interest is known as the “controllers,” or people whose bodies appear to be able to stave off HIV infection.

One type, known as the “elite controllers,” test positive for HIV but do not appear to have the virus in the blood, even without treatment. Researchers estimate there may be a few hundred of these people in the world.

Another type is the post-treatment controllers, or people who started therapy early and are able to stop it without seeing the virus rebound. Some five to 15 percent of HIV-infected people may fit this category.

More details on a group of “controllers” in France known as the Visconti Cohort is expected to be released at the meeting this week, as international scientists share their latest data in the hunt for a cure.

“We now actively talk of potential scientific solutions in a way perhaps we weren’t some years ago,” said Diane Havlir, AIDS 2012 US co-chair and professor of medicine at the University of California, San Francisco.

The end of AIDS? We have the tools

Monday, July 30th, 2012

Globe & Mail

The 19th International AIDS Conference has just come to a close amid much talk of the beginning of the end of AIDS, turning the tide on HIV and even a potential cure. It is now more certain than ever that we have the tools, medicines and expertise to stop this epidemic.

However, without the political will to expand antiretroviral treatment to everyone in need, the audacious goals set before us in Washington last week will never be met and infection may spiral out of control once again.

While we make gains in certain areas of the globe, we remain mired in a growing epidemic. For every person placed on highly active antiretroviral treatment (HAART), two more people become infected. We now have 34 million people living with HIV/AIDS and are treating only eight million of the 15 million eligible people in resource-limited countries. At least 25 per cent of HIV-infected individuals do not know they are infected and, as a result, cannot protect themselves or their loved ones. And they contribute disproportionally to the spread of HIV. When you do the math, it’s crystal clear: HIV and AIDS remain daunting foes.

However, our situation does not need to be so dire. We unequivocally know that HAART prevents death and also stops AIDS. Furthermore, HAART dramatically reduces HIV transmission. The primary benefit of a healthy person and the secondary benefit of healthier communities should be the tipping point that gets politicians falling all over themselves to mobilize and fund the universal rollout of HAART.

But that’s not happening. Politicians have paid little more than lip service to supporting the rollout of antiretroviral treatment in their home countries and around the globe. But in Washington, some strides were made. The United States, already one of the world’s largest HIV/AIDS donors, added another $150-million to get more medicine into the hands of people in resource-limited countries. And leaders such as President Barack Obama and Secretary of State Hillary Clinton reinforced their support for creating an AIDS-free generation. France pledged to support the implementation of a tax on financial transactions to generate much-needed resources to fund the universal rollout of HAART.

Regrettably, Canada’s contribution in Washington was uninspiring. Federal Health Minister Leona Aglukkaq spent more time and energy avoiding protesters and ducking out of her events than providing leadership and vision. This isn’t surprising: The federal Conservatives have done everything in their considerable power to decimate Canada’s HIV response, including trying to close the country’s only supervised injection site and further criminalizing injection drug users and sex workers. Criminalization drives these Canadians underground and away from health services, leaving them susceptible to HIV infection.

In most of Canada, the epidemic continues on or is growing, with first nations people among the hardest hit. In other words, even though we have HAART treatment to prevent AIDS in the individual and HIV transmission and we know how to curtail the epidemic, we are not doing it. This goes completely against Canada’s tradition of compassion and commitment to human rights. British Columbia stands alone as the only Canadian jurisdiction to see a significant decline in new HIV diagnoses, from approximately 900 cases per year in the early 1990s to 289 in 2011. The decline stems from B.C.’s adoption of “treatment as prevention,” pioneered by the B.C. Centre for Excellence in HIV/AIDS. The strategy includes normalizing HIV testing to help find those who are infected and don’t know it; harm reduction programs such as supervised injection sites and needle exchanges; safer sex work spaces that allow sex workers to better negotiate condom use; and contacting hard-to-reach individuals to facilitate their engagement on life-saving HAART.

In North America, other cities are starting to follow suit and implement innovative testing and harm reduction measures. In Washington, a community hit hard by the epidemic, you can now get tested for HIV in motor-vehicle offices, grocery stores and high schools and on the street corners where people with addictions congregate. San Francisco has similarly adopted treatment as prevention and is already reporting declines in new diagnoses. Globally, China, Swaziland and several districts in South Africa are moving to implement the strategy.

It is truly heartening to see more and more communities implement evidence-based policies to combat HIV and to find people from groups long marginalized come together and demand change.

We leave Washington with a clear sense of purpose. The full HIV/AIDS community has found a consensus. Treatment as prevention represents the fundamental building block to achieve our goal. We must find the resolve to deliver on the promise of an AIDS-free generation.

All Canadians, regardless of their political inclination, should demand that our political leaders join Mr. Obama’s call for an AIDS-free generation. It can be done, it should be done and it must be done.

International AIDS Conference aims to finally stem spread of virus

Monday, July 23rd, 2012

CTV News

From dark days to a critical turning point in the AIDS epidemic: The landscape has changed dramatically in the two decades since the world’s largest AIDS conference last met in the United States.

Back in 1990, the first good medicines were still a few years away. Before they arrived, caring for patients with HIV was like “putting Band-Aids on hemorrhages,” said the leading U.S. AIDS researcher, Dr. Anthony Fauci.

Fast forward: Today’s anti-AIDS drugs work so well they not only give people with HIV a near-normal life expectancy, they offer a double whammy — making those patients less likely to infect other people.

On Sunday, the International AIDS Conference opened in the U.S. capital with the goal of “turning the tide” on HIV. Even without a vaccine or a cure, the goal is to finally stem the spread of the virus, using that so-called “treatment as prevention” and some other powerful protections. The conference runs through Friday.

“There is no excuse, scientifically, to say we cannot do it,” Fauci, infectious disease chief at the National Institutes of Health, told reporters Sunday.

But the challenge that more than 20,000 scientists, doctors, people living with HIV and policy-makers will grapple with this week is how to get to what the Obama administration calls an AIDS-free generation. Where’s the money? What works best in different countries and cultures?

And with HIV increasingly an epidemic of the poor and the marginalized, will countries find the will to invest in the most vulnerable?

“Rich countries think, ‘Who cares? We have the treatment, I hear now that HIV is a chronic condition,”‘ a worried French Nobel laureate Francoise Barre-Sinoussi, co-discoverer of HIV, told The Associated Press. “I really think there is not the same political commitment as it was in the past.”

That political commitment must expand to fight laws that are driving some of the populations most at risk — gay and bisexual men, sex workers and injecting drug users — away from programs that could help protect them from getting or spreading HIV, said Michel Sidibe, director of UNAIDS, the United Nations AIDS program.

“It’s outrageous that in 2012, when we have everything to beat this epidemic, that we still have to fight prejudice, stigma, exclusion,” he said.

More than 1,000 people — many of them living with HIV — marched through downtown Washington Sunday to urge the public and policy-makers to pay attention to a disease that, in the U.S., doesn’t get much publicity anymore.

Organizers said the aim of the “Keep the Promise” march was to remind world leaders and policymakers that AIDS remains a threat to global health. Marchers used red umbrellas to create a human red ribbon in advance of the march. Some carried balloons in the shape of globes as they marched, and others carried signs reading “Test & Treat Now” and “Yes we can control AIDS.”

“The war against AIDS has not been won and now is not the time to retreat,” said AIDS Healthcare Foundation president Michael Weinstein in an interview Sunday.

Weinstein’s Los Angeles-based group organized the march, which began near the Washington Monument. He said that despite financial hardships worldwide, the struggle against AIDS needs to keep advancing. Weinstein’s organization called for the funding of programs that fight AIDS and lower prices on AIDS drugs. They also are pressing for universal access to condoms and increased rapid HIV testing.

Comedian Margaret Cho, civil rights leader Al Sharpton, former United Nations ambassador Andrew Young, and radio cohosts Tavis Smiley and Cornel West spoke to the crowd before Sunday’s march. Musician Wyclef Jean also performed.

The AIDS conference — remarkable for giving a forum not just to leading scientists but to everyday people who live with HIV — hasn’t returned to the U.S. since 1990, in protest of the longtime ban on people with the virus entering the country. The Obama administration lifted the travel ban in 2010, finishing a process begun under the Bush administration. Not lifted was a ban on sex workers and injecting drug users, and protesters briefly interrupted the opening news conference to decry their absence from the meeting.

The conference comes at a time when scientists increasingly say they have powerful new tools to add to tried-and-true condoms.

Studies show treatment-as-prevention, treating HIV right away rather than after someone is sick, lowers patients’ chances of spreading the virus through sex by a stunning 96 per cent. Already, Fauci said regions that are pushing to get more people tested and rushed into treatment are starting to see infections drop, from San Francisco and Washington to part of South Africa.

The U.S. Food and Drug Administration just approved a daily AIDS medicine, Truvada, for use by healthy people hoping to lower the risk of infection by a sexual partner. Hard-hit poor countries are grappling with how to get that protection to their highest-risk populations.

Other goals include getting more HIV-infected pregnant women treated to protect their babies, and getting more men circumcised in developing countries to protect them from heterosexual infection.

But the hurdles are huge.

Since the first reports of AIDS surfaced 31 years ago, a staggering 30 million people have died from the virus and 34.2 million now are living with HIV around the world.

There’s still no cure and no vaccine. For every person who starts treatment, two more are becoming infected.

In poor countries, a record 8 million people are getting HIV drugs, but the United Nations says it will take up to $24 billion a year — $7 billion more than is being spent now — to reach those most in need.

The epidemic is worst in developing countries, especially in Africa. Progress has stalled even in the U.S., which has seen about 50,000 new infections every year for a decade. Here, nearly 1.2 million people live with HIV, and one in five don’t know it.

AIDS killed 28,000 in China in 2011, study says

Saturday, January 21st, 2012

BEIJING — AIDS killed 28,000 people in China last year, and another 48,000 new infections from the HIV virus were discovered in the country, according to an official report on Saturday.

In China 780,000 people live with the HIV virus, of which 154,000 developed AIDS, a report jointly produced by China’s Ministry of Health, the Joint United Nations Programme on HIV/AIDS and the World Health Organization said.

In September 2011 there were 136,000 people receiving anti-viral treatment for the disease, it said, making the treatment coverage rate 73.5 percent, an increase of 11.5 percentage points compared to 2009.

The report, quoted by China’s official state media Xinhua, said some new trends had appeared, notably “a rise in the number of imported cases and those transmitted sexually”.

Sexual relations are the first source of contamination of the HIV virus in China, where a huge blood contamination scandal erupted in the central Henan province in the 1990s.

HIV/AIDS sufferers have long been stigmatised in the country, and rights groups estimate the number of sufferers to be higher, but increased government education has helped raise awareness.

HIV/AIDS becomes more manageable to live with

Monday, January 16th, 2012

Times Republican
They were the headline-grabbing diseases of several years ago that don’t seem to get talked about much these days.

The diseases, HIV and AIDS, have seemingly been put on the back burner, but cases continue to be added in Iowa.

Statewide there are nearly 200 new diagnoses of HIV/AIDS each year and males account for 84 percent of the new diagnoses, according to the Iowa Department of Public Health. The total number of Iowans reported to be living with HIV/AIDS was 1,828 as of Dec. 31, 2010.

In Marshall County, there were 26 people living with HIV/AIDS at the end of 2010, according to a report by the IDPH. That rate equates to 64 per 100,000 people, which is slightly above the state average of 60 per 100,000 people.

Both Tama and Grundy counties have less than four cases. Any number less than that is not revealed to protect the identity of those who have the disease. Hardin County had six reported people living with HIV/AIDS at the end of 2010.

Randy Mayer, chief of the Bureau of HIV, STD and Hepatitis with the Iowa Department of Public Health, said the disease has become more manageable medically, which has kept it out of the headlines.

“We know a lot more about it and have treatment to manage it,” Mayer said.

The challenge for health leaders are those cases which do not get tested and go unreported. Mayer could not estimate how many people in Iowa have HIV/AIDS and are not reported in the IDPH numbers.

“That’s something that we really can’t measure,” Mayer said. “The estimates nationally are about 21 percent of people who are positive have not been diagnosed.”

As a result of the disease being more manageable, deaths have decreased through the years statewide as five people died as a result of HIV/AIDS in 2010. The peak year for Iowa deaths of the last 12 years was in 2000, when 28 people died from the disease in the state.

Ghana Finds AIDS Drug?

Monday, January 16th, 2012

Ghana is on the verge of manufacturing anti-retroviral drugs for the treatment of HIV/AIDS locally. This is because three traditional herbal medicines submitted to Noguchi Memorial Institute for Medical Research, are beginning to show results of efficacy for the treatment of HIV/AIDS, a source close to the health sector has told the Times.

The three drugs were among 20 others submitted to the Institute by local plant medicine producers, to determine their efficacy against the AIDS virus.
A clinical test of the products is currently test of the products is currently ongoing to determine their antioxidant and other toxicological properties.

“When successful, it will be Ghana’s response to managing the HIV/AIDS pandemic,” the source said.

The drugs, according to the source, had the potential of reducing the viral loads in HIV-positive patients and could be best used as anti-retroviral therapy (ART).

The National AIDS and STI Prevention and Control Programme (NACP) bulletin of 2011, indicated that an estimated 267,069 people were living with HIV and AIDS in the country, but only about 40,575 people were receiving anti-retroviral therapy.

The source was confident that with the new development, the country stood the chance to make up for the shortfall of anti-retroviral drugs needed to treat HIV/AIDS and better the physical well-being of people living with AIDS.

Explaining issues further, the source said the positive results being shown by the herbal medicines were the results of attention being given to traditional herbal medicine practice by successive government since 1991.

It said presently, the Mampong Centre for Scientific Research into Herbal Medicines had approved 34 of scientifically evaluated herbal medicines, while the Food and Drugs Board (FDB), had also approved about 300 of similar products.

“Though some of the medicines have been approved by the various regulatory bodies, they are still under continuous evaluation to forestall any sub-standard and fake products on the market.”

The source said the Ministry of Health, through the Ghana Health Services had selected 86 of such products to be dispensed in 17 hospitals across the country.

“The measure is aimed at integrating traditional herbal medicine as part of the health service delivery system in the country.”

It said well-performing products, would be patented as a means of safeguarding the intellectual property of the sector.

Meanwhile, the Noguchi memorial Institute for Medical Research, has confirmed in its 30th Anniversary Journal that systematic research on Ghanaian medical plants has indentified six anti-HIV plants’.

Scientist at the Institute have been researching into Ghanaian traditional medicine comprising largely plant medicines.

The Institute which works closely with the Traditional and Alternative Medicine Directorate at the Ministry of Health has also been working constantly with a number of local plant medicine producers to train them on quality measures to improve their products.

Source: Ghanaian Times

Dumb, Dangerous, and Hateful: Bryan Fischer Denies That HIV Causes AIDS

Friday, January 6th, 2012

Decades ago, the causes of HIV and AIDS were a mystery–and one that, because the disease was thought to only kill gay men and drug users, many researchers, politicians, and members of the public didn’t feel like solving. Public perception and research have come a long way since then, but some individuals, like Christian extremist Bryan Fischer, of the American Family Association (AFA), are still set on preaching a dangerous, hateful message: that HIV doesn’t cause AIDS, that it’s a scam, and that it’s not something that straight people need to worry about. Do not listen to these false prophets.

Speaking on his radio show, Focal Point, this week, Fischer claimed that HIV was created as a way to get money for research of AIDS, which gay people get, he says, from drug use. From the show:

The reason that HIV was invented as the cause of AIDS is it was a way to get research money…If AIDS is caused by behavior, then there’s no money in that because you just tell people, ‘Hey, stop doing the behavior.’ that’s why they have to find some bug that they can blame it on. ‘We gotta kill this thing, we need billions of dollars of research…’ so we’re chasing after something…that even if we got it, it wouldn’t do a single, solitary thing.

The AFA may have an innocent-sounding name, but the group’s dispersal of extreme (and extremely unfounded) anti-gay information has led some policy centers to classify them as a hate group, citing that their potentially influential message (that AIDS something that only gay people get, that HIV is made up to drum up research dollars, that both HIV and AIDS aren’t transmitted sexually) could potentially lead to the deaths of thousands, if not hundreds of thousands.

Fischer was joined on the show by a known AIDS-denier (who holds a PhD), Dr. Peter Duesberg, who has been widely condemned in the medical community for distributing dissenting information about AIDS. At one point, Duesberg spent time in South Africa, a country torn apart by the disease–and by misinformation about who can get the disease and how. Its then-President was also an AIDS denier, and the two of them have been cited as possibly being responsible for the death of as many as 330,000 individuals, and the infection of thousands more, including infants. And yet, because he holds a doctorate, his damaging message continues to be listened to.

Duesberg’s conclusion in the interview? That “about half” of the people who have AIDS are intravenous drug users (which isn’t true), while the other half are promiscuous gay men (not, he clarifies, your “all-American homosexual next door”) who have “hundreds [or] thousands of partners” and who take “tons of drugs.” And while homosexual men are still one of the biggest risk groups for full-blown AIDS, the perception that all gay men living with AIDS are “promiscuous” is just ignorant and hurtful. Additionally, both of these men might be surprised to find themselves in the company of the highest-rising risk group: heterosexual baby boomers. In 2011, older straight people were the fastest-growing HIV-positive demographic.

That individuals in the United States who hear this message may believe it, and as a result, stop taking simple measures to protect themselves (in many cases, a condom is truly all it takes) is just the beginning of what is so concerning. There are also much more deep-seating notions of intolerance and hate. This line of thinking is a one-two punch of harmful pseudo-science and extreme bigotry. It is rooted in anti-gay sentiments that the LGBT and ally community have been battling against for decades, but is backed by roundly-criticized “medical” science–which makes it doubly dangerous. And it has widespread consequences–many in Africa are still clinging to the beliefs espoused by Duesberg, and, as a result, continue to spread the disease.

It’s time to stop conflating medicine with morals in this way, and end the politicizing of diseases like AIDS. Maliciously condemning the victims of a disease that impacts everyone and spreading hateful information that could potentially lead to the deaths of thousands gets us nowhere.

AIDS group rejects allegations against France’s Bruni

Friday, January 6th, 2012

The Geneva-based Global Fund, a multi-billion-dollar fund set up 10 years ago to combat AIDS, malaria and tuberculosis, said Friday that a media report of alleged financial misconduct implicating French first lady Carla Bruni, an ambassador of the fund, was “inexact and misleading.”

The statement was issued after French weekly magazine Marianne published an article saying the Global Fund had awarded $3.5 million to companies controlled by a friend of Bruni, the wife of President Nicolas Sarkozy, at her request. The funds were issued without a public tender, the magazine said.

“The article makes several allegations that are groundless regarding a campaign that the Fund launched in 2010 with the backing of Mme Bruni-Sarkozy,” said the statement.

Bruni, a singer and former supermodel who married Sarkozy in early 2008, was appointed “first ambassador” in the same year of the Global Fund.

The fund was set up in 2002 and says it has saved 7.7 million lives with funding for AIDS treatment and programs worldwide to fight malaria and tuberculosis.

Sarkozy’s office said it had no comment to add to the statement.

Circumcision Gains More Acceptance in AIDS Fight

Wednesday, December 28th, 2011

Growing acceptance of male circumcision, in Africa especially, is having a dramatic and positive effect on the fight against HIV/AIDS.

AIDS has killed 30 million people around the world since it was first reported in 1981, but according to a Johns Hopkins University affiliate, for men and adolescent boys, the one-time procedure of circumcision can mean a lifetime of reduced risk of getting HIV, the virus that can lead to AIDS.

The good news is that “in some areas, it’s becoming a social norm to be circumcised, particularly among adolescents,” said Kelly Curran, director of HIV and infectious diseases at the Hopkins affiliate Jhpiego. In sub-Saharan Africa, the region of the world most devastated by AIDS, Kenya and Tanzania are making the most progress in reducing HIV infections, she added. Jhpiego implements HIV/AIDS treatment and prevention programs funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development.

The fight to stop new HIV infections accelerated in 2007, when the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization began to scale up voluntary medical male circumcisions to reduce transmission of the virus. According to Curran, the groups that year also endorsed three surgical methods for performing the procedure following successful trials in South Africa, Uganda and Kenya. Since then, 1 million men around the world have been circumcised. Three-fourths of the procedures were funded by PEPFAR, Secretary of State Hillary Rodham Clinton said November 8 while stressing that the U.S. goal is to see a global AIDS-free generation. Clinton has noted that about 34 million people still live with the disease.

“Virtually every other strategy we have to prevent and treat HIV/AIDS depends on people doing things that are not easy,” Curran said. She cited behavioral changes such as remembering to use a condom, reducing the number of sexual partners and learning the HIV status of partners. (Jhpiego offers circumcision to men and adolescents as part of a package of services that includes teaching the correct use of condoms, testing and treating sexually transmitted diseases, promoting safe sexual practices and offering antiretroviral therapy for people who are HIV-positive.)

Circumcision is a safe and simple procedure done by well-trained and -equipped medical providers that takes 20-30 minutes, she said. There is compelling evidence that circumcision reduces the risk of sexual transmission of HIV by 60 percent, according to UNAIDS. Circumcision also has been shown to reduce urinary tract infections.

Three men wear T-shirts reading “Tohara ya Mwanaume,” or “Male Circumcision” in a Tanzanian language.

Male circumcision benefits women because it reduces the transmission of other sexually transmitted diseases such as herpes and the virus that causes cervical cancer, according to Curran.

Curran said taking HIV prevention services close to where people live has been a successful strategy. In Tanzania, for instance, Jhpiego works with a nonprofit group that uses mobile health centers so men don’t have to walk long distances to be circumcised. Jhpiego also uses radio programs and short text messages to communicate information about HIV/AIDS prevention methods to targeted groups.

In order to help other countries reach the success levels that Kenya and Tanzania are experiencing, UNAIDS and PEPFAR announced December 5 a five-year plan to expand male circumcision services for HIV prevention in 14 countries in sub-Saharan Africa. The plan was developed by the two groups along with the World Health Organization, the Bill & Melinda Gates Foundation and the World Bank, in consultation with the national ministries of health of those countries.

If 80 percent of men in the 14 countries are circumcised, 3.4 million new infections could be averted and $16.5 billion in HIV/AIDS treatment costs could be saved, Curran said. Reaching 80 percent would entail performing 20 million circumcisions on men ages 15-49 by 2015, according to UNAIDS.

The 14 targeted countries are Botswana, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe.

The joint plan to scale up voluntary medical male circumcision is on the UNAIDS website. More information about PEPFAR and Jhpiego is on their websites.

Gay conference in Ethiopia may face ban

Thursday, December 1st, 2011


Religious leaders and government authorities in Ethiopia have ended a meeting on November 29, with an apparent dispute over how to and whether or not ban an upcoming continental gay conference scheduled to be held in Addis Ababa.

Just a day before the 16th International Conference on AIDS and Sexually Transmitted Diseases (STIs) in Africa (ICASA) opens, about 200 gays as well as UN and U.S. officials are expected to gather at Addis Ababa’s Jupiter International Hotel, on December 3 to discuss what the organizers call men having sex with men (MSM) issues.

Gay conference in Ethiopia may face banOrganized by African Men for Sexual Health and Rights (AMSHeR), the meeting dubbed ‘Claim, Scale-up, and Sustain’ seeks to increase attention on MSM and HIV related issues in Africa, to reflect on the state of the response in MSM communities in Africa and to identify ways forward for scaling up MSM and HIV interventions, according to News from Africa website.

Religious leaders from Ethiopian Muslim Council, the Ethiopian Orthodox, Catholic and Evangelical churches have called a press conference to oppose the gay conference. While they were expected to ask for the banning of the conference Health Minister, Tewodros Adhanom, showed up for what later turned to be an hour long meeting behind closed doors.

“The Minister came to convince the religious leaders to call off the press conference as the government believes it would affect the ICASA turnout,” an informed source said. “In return, the minister may offer to quietly cancel the gay conference.”

At the end of the meeting neither the minister nor religious leaders spoke about what they agreed on. With signs of disappointment on their faces, religious leaders told journalists “the press conference has been postponed to undetermined date.”

If not cancelled, a number of speakers including UNAIDS Executive Director, Michel Sidibe, United States Global AIDS Coordinator, Eric Goosby, and current Chairperson of the Committee for the Protection of the rights of PLHIV, Reine Alapini – Gansou, are expected at the gay conference. They are set to discuss health and human rights issues facing gays, including criminalization of same-sex practices.

Ethiopia’s criminal law strictly prohibits any form of homosexuality on grounds that they are against country’s cultural norms and astray normal sexual practices. Homosexual or same sex marriage and unethical activities in the country are considered as criminal and the person who is engaged in such activity would be imprisoned from 3 to 10 years.

Exactly three years ago, Ethiopian religious leaders gathered to lobby lawmakers to enact a constitutional ban on homosexuality. The clerics said the current laws were inadequate.

Abune Paulos, head the Ethiopian Orthodox Church, said then that Ethiopia’s special place in biblical traditions means a firm stance is warranted. “We strongly condemn this behaviour. They have to be disciplined and their acts discriminated, they have to be given a lesson,” he said.

His idea was shared by other religious leaders who attended the December 2008 meeting.

Dr. Seyoum Antonios, Executive Director of United for Life Ethiopia – a local NGO – had said a tough stance is timely as some visitors come and engage in sex tourism and the prostitution business is also experiencing changes. According to him, the practice was a new phenomenon brought about with the increased exposure to globalizing trends, adding that orphans are especially at risk as they do not have proper family protection.

The religious leaders deemed homosexuality part of “cultural colonization” and a sign the new generation is “loosening”. They cited preaching in religious institutions, schools, societal institutions and societal out-casting as key to ensuring the practice does not become widespread.

The final resolution of the meeting had called on Ethiopian lawmakers to act forcefully against homosexuals: “We urge parliamentarians to endorse a ban on homosexuality in the constitution.”

Homosexuality is illegal in about 80 countries throughout the world and nine countries prescribe death as a punishment.

NYC Recommends AIDS Drugs For Any Person With HIV

Thursday, December 1st, 2011


City health officials said Thursday they are recommending that any person living with HIV be offered AIDS drugs as soon as they are diagnosed with the virus, an aggressive move that has been shown to prolong life and stem the spread of the disease.

Standard practice has been to have patients put off the expensive pill regimen — which can cost up to $15,000 a year in the United States — until the immune system weakens.

But New York City Health Commissioner Thomas Farley said recent studies have shown that the benefits of early treatment, combined with education and testing, appear to be a promising strategy for countering the epidemic.

“I’m more optimistic now than I’ve ever been about this epidemic that we can drive our new rates down to zero or close to it — eventually. I don’t know how soon. But I’m very optimistic of the direction that it’s going to take the epidemic to,” Farley said in an interview Wednesday.

More than 110,000 people in New York City are infected with HIV, more than in any other U.S. city and about 75 percent of all cases in the state. San Francisco, which had more than 18,000 people living with HIV, is believed to be the only other major city to have made a similar recommendation in 2010.

City health officials said the new recommendation could initially help about 3,000 people get on medications. About 66,000 New Yorkers living with HIV that the Health Department tracks are being effectively treated with AIDS drugs, they said. But they said it was difficult to estimate how many people would eventually need the medications.

Some doctors agree with the Department of Health that it is time to update the guidelines for initiating AIDS drug treatment.

“The New York City health department is a little bit ahead of the curve. In my opinion, the rest of the country will follow and I think it will be pretty quick,” said Dr. Michael Saag of the University of Alabama at Birmingham and past chairman of the HIV Medicine Association.

The standard measure of the CD4 count — a way to measure the strength of the immune system — is an outdated trigger for therapy, a relic from research on early antiretroviral drugs, Saag said.

“It’s an anachronism. It’s old school. It’s yesterday,” Saag said. “I agree completely with the New York City health department.”

Dr. Joel Gallant of Johns Hopkins University School of Medicine and vice chair of the HIV Medicine Association also agrees with the New York recommendation for offering early treatment. He recommends early treatment for his own patients.

“Nobody I know who is an HIV expert feels that it’s a bad idea to treat HIV at high CD4 counts from a medical or scientific standpoint,” Gallant said. “If there are objections, they’d usually be based on cost or feasibility.”

Saag said the cost questions are very important because brand-name drugs can retail for $1,200 to $1,600 per month.

“For sure, they’re very expensive drugs and we should be careful about that,” he said, though he added that the medications are going generic so costs should come down.

City health officials said they anticipated that the cost for expanding the use of AIDS drugs would be covered by private insurance or by the AIDS Drug Assistance Program, a $270 million program for the uninsured or underinsured that is partially funded through federal dollars. The health officials said they expect the benefits over the long term would far outweigh the initial costs because there would be fewer hospitalizations and new HIV cases.

“There will be some increasing costs over the short term,” said Farley. “But over the long term, it’s absolutely the right thing for the epidemic.”

HIV experts are split about whether early therapy should be recommended or optional. Besides the high costs, the pills have side effects from nausea to liver damage. Patients unwilling to take them religiously for life could develop drug resistance.

A panel that recently updated U.S. guidelines was divided evenly, with half favoring starting therapy early for everyone and half regarding an early start as elective.

But there’s growing evidence that untreated HIV can lead to cancers and heart disease. What’s more, antiretroviral drugs are safer, have fewer side effects and work better than they did in the past. New research also indicates that people live better, healthier lives and their sex partners are less likely to get infected.

The new research cited by the city’s Health Department in making its recommendations includes a nine-nation study whose preliminary results were announced earlier this year and showed that earlier treatment meant patients were 96 percent less likely to spread the virus to their uninfected partners.

Dr. Moupali Das, the director of research at the San Francisco Department of Health HIV Prevention Section, said its surveillance data indicated that physicians were treating their HIV patients early even before the city recommended doing so. She said the average amount of time from diagnosis to having no virus in the blood went from 32 months in 2004 to eight months in 2008.

“That reflects that the newer medications are more potent and efficacious, and the doctors were likely initiating them earlier,” she said.

She said they are currently analyzing what has happened since the recommendations went into effect. But, anecdotally, she said that there has been a change among patients seeking treatment. “It’s changed the dialogue and empowered our patient population,” she said.

Public health experts predict the guidelines for starting AIDS drugs treatment will shift toward a clear recommendation for early treatment.

But New York City’s health commissioner said officials there could not wait to respond.

“What we’re doing here is we’re making a really clear and unequivocal statement that we think this is good for the health of the patient, good for the health of the entire population, good for the response to the epidemic,” Farley said.

AIDS society to honour Layton

Thursday, December 1st, 2011


ormer NDP leader Jack Layton will be honoured with a special lifetime achievement award tonight at the Canadian AIDS Society World AIDS Day Gala.

Trinity-Spadina MP Olivia Chow will accept the award on behalf of her late husband, in addition to her duties as the evening’s celebrity auctioneer.

“Mr. Layton has been a champion for HIV and AIDS from the very, very early days when he was a city councillor in Toronto, standing up against raids on bathhouses, making sure that he was very present at every opportunity for HIV and AIDS events, and speaking to the importance of funding for the HIV and AIDS community,” said Monique Doolittle-Romas, the society’s executive director.

The CAS will award this year’s Corporate Leadership Award to Toronto ad firm john st and offer a preview of a documentary on HIV, the Reignite Project, with its producer Paul Saltzman.

World Aids Day: 30 years since Britain’s first diagnosis

Thursday, December 1st, 2011

The Telegraph

On June 5th 1981, a medical journal in the States documented a mysterious illness that had killed five men in Los Angeles.

It was the first reference to what would later be known as Aids and by December of that year – exactly 30 years ago this month – the first case of Aids was diagnosed in the UK.

Today marks not only that anniversary, but also World Aids Day which, since 1988 has been observed around the world to commemorate those who have died from the disease and also to raise awareness of the issue and to raise funds for continued research into a possible cure and treatment.

Over 86,500 people in the UK are currently living with HIV, part of a world-wide epidemic of which the World Health Authority (WHO) estimates more than 30 million adults and close to 3 million children are sufferers.

In the last 30 years, Aids has claimed many lives in the UK and in 2011 86,500 are HIV positive, four times as many as in 1993.

World AIDS Day 2011: Getting To Zero

Wednesday, November 30th, 2011


n the first of December, World AIDS Day is celebrated.  This day is an opportunity for people to unite in the fight against HIV/AIDS, to remember those who have died of the disease and to celebrate accomplishments, such as increased access to treatment and prevention services.

Today, despite advances in HIV treatment and in laws designed to protect those living with HIV; many people do not know the facts about how to protect themselves and others from HIV or about the stigma and discrimination that remain a reality for many people living with HIV.  World AIDS Day is an important reminder to individuals and governments that HIV has not gone away – there is still a vital need to raise money, increase awareness, fight prejudice and improve education.

The theme for World AIDS Day 2011 is “Getting to Zero.” After 30 years of the global fight against HIV/AIDS, this year the focus is on achieving 3 targets: Zero new HIV infections. Zero discrimination. Zero AIDS-related deaths.

Zero New HIV Infections

It is estimated that 33.3 million people have HIV worldwide, with 1.2 million persons who are living with HIV in the United States, according to the Center of Disease Control (CDC) estimates.  This number is expected to continue to increase over time, as advances in treatments prolong the lives of those who are infected and more people become infected with HIV each year. Despite increases in the total number of people in the U.S. living with HIV infection in recent years, the annual number of new HIV infections has remained relatively stable. However, new infections continue at far too high of a level, with approximately 50,000 Americans becoming infected with HIV each year.  Worldwide, the rate of new infections, or incidence, has decreased. In 33 countries, the incidence has decreased more than 25 percent since 2001, including countries in the hardest hit areas of sub-Saharan Africa.

The CDC estimates that one in five people living with HIV in the U.S. are unaware of their infection.  This highlights the importance of reaching all infected individuals with HIV testing and prevention services. HIV can be transmitted in three main ways: sexual transmission; transmission through blood; and mother-to-child transmission.  These three routes of transmission work in tandem to affect segments of the population.  The number of infections resulting from each route will vary greatly between countries and population groups. HIV counseling and testing are fundamental for HIV prevention, as is access to essential commodities such as condoms or sterile injecting equipment.

Zero Discrimination

According to UN Secretary-General Ban Ki Moon, “Stigma remains the single most important barrier to public action. It is a main reason why too many people are afraid to see a doctor to determine whether they have the disease, or to seek treatment if so. It helps make AIDS the silent killer, because people fear the social disgrace of speaking about it, or taking easily available precautions. Stigma is a chief reason why the AIDS epidemic continues to devastate societies around the world.”

Discrimination against those infected with HIV/AIDS includes both the fear of getting the disease and also negative assumptions about people who are infected.  AIDS-related stigma has had a profound effect on the epidemic’s course. The World Health Organization cites fear of stigma and discrimination as the main reason why people are reluctant to be tested, to disclose their HIV status or to take antiretroviral drugs.

“We can fight stigma. Enlightened laws and policies are key. But it begins with openness, the courage to speak out. Schools should teach respect and understanding. Religious leaders should preach tolerance. The media should condemn prejudice and use its influence to advance social change, from securing legal protections to ensuring access to health care.” Ban Ki-moon, Secretary-General of the United Nations.

Zero AIDS Related Deaths

More than 25 million people between 1981 and 2007 have died from the virus worldwide, making it one of the most destructive pandemics in history.  In the US, nearly 594,500 people with AIDS in the US have died since the epidemic began.

The goal of ‘Zero AIDS Related Deaths’ signifies an increased access to available treatments for all those infected.  Currently, only one third of the 15 million people living with HIV worldwide who are in need of life long treatment are receiving it. Universal access to antiretroviral treatments for those living with HIV will not only decrease the number of AIDS related deaths, but will increase the quality of life among those infected and decrease transmission.

World AIDS Day is an opportunity for all of us to learn the facts about HIV.  By increasing the understanding of how HIV is transmitted, how it can be prevented, and the reality of living with HIV today-we can use this knowledge to take care of our own health and the health of others.

For more facts about HIV/AIDS and where to get tested, please visit

Brazil says it has AIDS under control

Tuesday, November 29th, 2011


Brazil said Monday its AIDS epidemic was under control, with a 0.61 percent cut in new cases between 2009 and 2010, although a rise among young homosexuals was a cause for concern.

“The AIDS epidemic remains stable,” the health ministry said in its latest epidemiological report.

The statistics in Latin America’s biggest country showed that the number of new cases fell 0.61 percent between 2009 and 2010 from 35,979 to 34,212.

“We are seeing a downward trend in the number of cases over the years. People are living longer and better with the disease,” Health Minister Alexandre Padilha told a press conference.

The number of cases since records began in 1980 totaled 608,230 until last June.

The number of deaths from the disease also fell, from 12,097 in 2009 to 11,965 in 2010.

Brazil, with a population of more than 191 million, produces 10 of the 20 AIDS drugs and also distributes them to African and Latin American countries.

It also distributes, free of charge, 500,000 condoms every year.

But health authorities said they were concerned by an increase in AIDS cases among young homosexuals aged 15 to 24.

The percentage of men having sex with men infected with the disease in that age group rose from 25.2 percent of the total in 1990 to 46.4 percent in 2010, the ministry said.

“Last year, for every 16 homosexuals in this age group there were 10 heterosexuals. In 1998, it was 12 for 10,” it added.

Hot acts for World Aids Day concert

Tuesday, November 29th, 2011

In commemoration of the 23rd World Aids Day, the well-known annual gala concert produced and directed by Professor Jimmie Earl Perry will take place at the Cape Town International Convention Centre on Thursday.

Now in it’s seventh year, the event will be presented by funnyman Soli Philander with a line-up of guests that includes Perry himself (the first UN Aids Special Goodwill Ambassador to South Africa), Ladysmith Black Mambazo, Vicky Sampson, Dutch X-Factor winner Sharon Kips, as well as many other artists.

This event has, in the past, been hosted by The Africa Centre for HIV/Aids Management at Stellenbosch University in partnership with the Western Cape Government Health, honouring individuals and organisations who have contributed to the fight against HIV/Aids.

The centre has developed the largest HIV/Aids management training programme in the world and the Educational Theatre and Arts division does education, awareness, prevention and voluntary testing across the country under the leadership of professors Jan du Toit and Perry.

Other artists who will make an appearance include Vuyiseka Dubula, Nombeko Mpongo and Toni Zimmerman, three HIV-positive women who are living healthy lives; Janelle Visagie and Arline Jaftha (opera); a group of young jazz artists that includes Sandile Gonstana, Chad Zerf, Amy Campbell, Spha Mdlalose, Vuyo Sotashe and others; a 20-voice strong youth choir directed by Lynette Petersen and Larry Joe who is well-known for recording his debut album Crazy Life in Douglas Prison, US, a year ago.

This programme of classical, pop and adult contemporary works is also a platform for committed artists to perform in a professional environment in support of this cause.

NE India’s makeshift fight against AIDS

Tuesday, November 29th, 2011


As access to treatment increases, the United Nations says the number of people dying from HIV-AIDS is falling worldwide.

But in India, particularly in the northeast, a constant flow of heroin from its opium-producing neighbour is helping to spread both disease and addiction. Of the 270,000 people in the district of Churachandpur, more than one-quarter of the women use some kind of drugs and suffer from HIV; many, due to a lack of financial opportunities, will end up turning to prostitution to feed their addiction.

Despite this cycle, in an area the size of Barbados, there are no long-term treatments facilities for those suffering from addiction or HIV.

Al Jazeera’s Prerna Suri, in Churachandpur, reports on a cycle that disproportionately affects the women of India’s northeast.

AIDS panel discussion will join Obama, Bush and Clinton on World AIDS Day

Tuesday, November 29th, 2011


WASHINGTON — President Barack Obama and two former presidents, George W. Bush and Bill Clinton, are joining top anti-AIDS advocates for a panel discussion to observe World AIDS Day.

The discussion will take place Thursday at George Washington University and will be streamed live on YouTube. Bush and Clinton will participate via satellite.

Organizers say they hope to build on progress already made in the fight against the devastating virus. The event is sponsored by two organizations, ONE and (RED), that combat global poverty and AIDS. Among the panelists will be Bono, the lead singer of the band U2 and co-founder of ONE and (RED).

Other participants include Tanzania’s President Jakaya Mrisho Kikwete, Republican Sen. Marco Rubio of Florida and Democratic congresswoman Barbara Lee of California.

Aids-related infection the primary killer

Tuesday, November 29th, 2011

South Africa has an estimated 5.7-million people living with HIV and Aids, more than any other country on Earth. This has had a devastating effect on the mortality rate. Life expectancy at birth in South Africa is down to a dismal 49 years. And one can safely assume that HIV and Aids are major factors in that shocking statistic.

Yet neither HIV nor full-blown Aids are in themselves killers. The cause of death for the majority of HIV-positive patients is a number of opportunistic infections that prove fatal because of the patient’s greatly impaired immune system.

The following is a list of the most common diseases associated with HIV and Aids: bacterial diseases such as tuberculosis mycobacterium avium complex; bacterial pneumonia and septicaemia (blood poisoning); protozoal diseases such as toxoplasmosis, microsporidiosis and cryptosporidiosis; viral diseases such as those caused by cytomegalovirus, herpes simplex and herpes zoster virus; and HIV-associated malignancies such as Kaposi’s sarcoma, lymphoma and squamous cell carcinoma.

Of all the opportunistic infections, however, tuberculosis extracts the heaviest toll. Between 30% and 50% of HIV-positive patients in South Africa die because of TB. What makes TB particularly dangerous is that it is so contagious. The mycobacterium is spread through the airborne droplets, which are produced when an infected person laughs, coughs or sneezes.

The other lethal aspect of TB is its drug-resistant varieties: drug-resistant TB, the multiple drug-resistant strain and now, an even more frightening variety, the extreme drug-resistant TB. These strains have occurred as the result of patients not taking their medication as directed or patients who stop taking their drugs before the full course is completed. It has led the tuberculosis bacteria to mutate, which leads to these strains becoming immune to the original drugs prescribed, making TB far more difficult to treat, hence raising fatality rates.

Another fatal condition associated with HIV and Aids is, of course, pneumonia. In the past 20 years the country has experienced an alarming increase in deaths caused by pneumonia. Between 300 000 and 500 000 citizens become infected every year and between 5% to 10% of them die.

This is something that strains the country’s public-sector healthcare resources because even though HIV-infected patients make up only 10% to 15% of the population, they are responsible for up to 80% of all hospital admissions related to pneumonia.

Other than having the highest HIV and Aids figures in the world, South Africa now, thanks to more enlightened government health policies, also has the largest antiretroviral programme in the world. But, according to World Health Organisation (WHO) measures, access to treatment is still low with only 37% of HIV-infected South Africans receiving ARVs.

With ARV’s, people can live an almost normal life. Because of these drugs, HIV can be regarded as a chronic condition that needs to be managed. A recent international study conducted in Uganda showed that HIV-infected patients on ARVs could live as long as people who are HIV-negative. A research study published by Wits University in May showed that early ARV treatment can reduce the incidence of TB in HIV-infected patients by 40%

In addition to ARVs, there are drugs that have proved to be highly effective prophylactics in preventing a wide range of HIV-related infections.

Called co-trimoxazole (but also known as bactrim), these drugs are cheap and widely available. The WHO guidelines state that they should be prescribed to HIV-exposed babies until the threat of HIV is eliminated. They are also suggested for HIV-positive children, adolescents and adults who have mild, advanced or severe symptoms of HIV.

HIV-positive men urge China Premier to end discrimination

Monday, November 28th, 2011


Three prospective school teachers have appealed to Chinese Premier Wen Jiabao to end discrimination against people with HIV after they said they were wrongly denied teaching jobs because their employers discovered they had the virus that causes AIDS.

The landmark petition, delivered Monday by mail to the State Council Legislative Affairs Office, is a bold test of China’s promise to enforce the rule of law.

The three signatories had filed separate lawsuits against their local governments after provincial education bureaus rejected their applications for teaching jobs because mandatory blood tests revealed they were HIV positive, even though they had passed written tests and interviews.

The three men had hoped to persuade the courts that a five-year-old law supposed to protect the employment rights of people with HIV should supersede local regulations that prevent the hiring of HIV-infected civil servants.

Two courts in China have ruled against the two men who filed lawsuits against their governments in Anhui and Sichuan in 2010.

In the third lawsuit filed in Guizhou, the judge told the plaintiff in October the courts “will not accept the lawsuit and that the plaintiff should ask the local government to solve it,” Yu Fangqiang, whose Nanjing-based organization, Tianxia Gong, advocates for people with HIV, told Reuters.

“We know that in a country like China that has 1.3 billion people, 740,000 people who are infected with HIV is just a small portion of the population,” said the petition, a copy of which was seen by Reuters.

“The voices to defend the employment rights of people with HIV tend to be drowned out by the majority’s sense of fear.”

“But we also know that the adherence to the country’s rule of law and the equality of its people is the country’s soul and is the backbone of the country’s modernization,” it said.

“Every Chinese citizen and every department will undoubtedly benefit from this and will not be subject to the threat of the unlawful deprivation of their legitimate rights and interests.”

Beijing was initially slow to acknowledge the problem of HIV/AIDS in the 1990s and had sought to cover it up when hundreds of thousands of impoverished farmers in rural Henan province became infected through botched blood-selling schemes.

But the government has since stepped up the fight against it, spending more on prevention programs, launching schemes to give universal access to anti-retroviral drugs to contain the disease, and introducing policies to curb discrimination.

The virus is now primarily spread in the country via sexual contact.

In a country where taboos surrounding sex remain strong and discussion of the topic is largely limited, people with HIV/AIDS say, however, they are often stigmatized.

Yu said that discrimination of people with HIV, especially in civil service recruitment, is “still a very big problem.”

People in China living with HIV and AIDS are routinely being denied medical treatment in mainstream hospitals due to fear and ignorance about the disease, according to a study released by the United Nations’ International Labor Organization (ILO) in May.

The petition, which was sent to the government office that helps to draft and oversee the implementation of laws, comes ahead of World AIDS Day on December 1.

The signatories to the petition said they had noted that Wen had previously “shown his concern” for people with HIV on the day, by “shaking the hands and embracing” HIV-infected people.

HIV/Aids: Why were the campaigns successful in the West?

Monday, November 28th, 2011


The arrival of HIV/Aids in the early 1980s led to predictions of deaths on a massive scale – yet developed countries largely avoided such a fate. What did the wave of urgent awareness campaigns get right?

Under darkened sky, a volcano erupts. Doom-laden images of cascading rocks give way to shots of a tombstone being chiselled.

“There is now a danger that has become a threat to us all,” intones the actor John Hurt ominously in a voiceover. “It is a deadly disease and there is no known cure.”

The word etched on to the blackened grave is revealed – Aids. “Don’t die of ignorance,” runs the slogan.

With its stark, unambiguous warnings ands bleak message, the advert shocked viewers when it appeared on British screens in 1986. Immediately, it faced accusations of panic-mongering and complaints that it would terrify any children who happened to be watching.

Tombstone ad 1987 The idea of the ‘Tombstone ad’ was to shake a nation into taking charge of its own sexual health

And yet the campaign – the world’s first major government-sponsored national Aids awareness drive – would later be hailed as the most successful.

Its tactics were imitated around the world. France, Spain and Italy were all slower to react, the Terrence Higgins Trust (THT) has noted. Each of those countries has around twice the number of people with HIV as the UK, where there were an estimated 86,500 in 2009, according to the trust.

Those figures are in stark contrast to sub-Saharan Africa, where two-thirds of the world’s 33.4 million people with HIV live. In the three worst affected countries – Botswana, Swaziland and Zimbabwe – around a third of the population lives with the virus, according to the Joint United Nations Programme on HIV/Aids.

Continue reading the main story

Aids: Where now?

Man analysing blood samples

A series of features on Aids and HIV, as the UN marks World Aids Day on 1 December

The disparity between rich and poor nations can partially be explained by resources. However, the Department of Health spends £2.9m each year on national HIV prevention in England, part of the £10.6m spent on sexual health promotion in general. By comparison, in 2008 alone some $15.6bn (£10bn) was spent on HIV/Aids prevention around the world, mostly in developing countries.

Early campaigns are widely credited by experts with making the difference in the West by raising awareness and changing behaviour. And yet in the early 1980s, the UK would hardly have seemed an auspicious location for this revolution to begin.

As reports of a new, deadly virus filtered across the Atlantic from the US, British authorities were initially slow to react, argues Sir Nick Partridge, chief executive of the THT, the sexual health charity which was set up in response to the emergence of HIV.

Continue reading the main story

30 years of HIV

Red ribbon
  • 5 June 1981: The US Center for Disease Control mentions a new virus in its weekly mortality report
  • 1982: The term Aids (acquired immunodeficiency syndrome) first used
  • 1984: Virus identified and named HIV
  • 1985: Rock Hudson dies of Aids, teenage haemophiliac Ryan White expelled from school because infected through treatment
  • 1987: First showing of Aids Memorial Quilt on National Mall in Washington DC
  • 1991: Jeremy Irons wears red ribbon and basketball’s Magic Johnson has the virus
  • 1993: Philadelphia wins two Oscars
  • 2000: Infection rates in US among African Americans overtakes gay men
  • 2011: Global death toll 22m, infections 60m

The climate made this unsurprising. Some headlines spoke of a “gay plague”. The fact that the groups most at risk were homosexual men and intravenous drug users meant outright hostility from certain quarters.

Between the 1982 Aids-related death of Terry Higgins, who gave the charity its name, and the government’s decision to open needle exchanges for addicts in 1985, very little was done to tackle the growing list of fatalities, Sir Nick argues.

“Those three years of people dying seemed a long time,” he says.

“There was a huge sense of anger – if Aids had hit any other group in society, there would have been an immediate response.”

However, those in authority who wanted to take action had to confront high-level antipathy. The then-Chief Constable of Greater Manchester Police, James Anderton, referred to victims “swirling about in a human cesspit of their own making”.

Nonetheless, Norman Fowler, now Lord Fowler, then health and social security secretary, and Sir Donald Acheson, the chief medical officer, were convinced that action had to be taken. By the middle of the decade, scientists were predicting that the cumulative total of UK HIV cases could reach 300,000 by 1992 if nothing were done.

“There were people in government and also people in the media who said, ‘Why are you spending all this time concerned about gay people and drug addicts?’,” Fowler recalls. “But that was a minority view.”

Continue reading the main story

“Start Quote

It’s an advantage it wasn’t done at No 10 – it wasn’t a natural subject for Margaret Thatcher”

Lord Norman Fowler Former health and social security secretary

As a result of the two men’s lobbying, the government’s drive against Aids was not run from Downing Street but instead co-ordinated by a cabinet committee chaired by the plain-spoken Tory grandee Willie Whitelaw.

“It was like he was running a VD campaign in the Army,” recalls Fowler wryly. “I think it’s an advantage it wasn’t done at No 10. It wasn’t a natural subject for Margaret Thatcher.

“We did it in an extremely pragmatic way. We treated it as a public health issue.”

An advertising agency, TBWA, was commissioned to make adverts intended to shock the nation into action.

As well as the tombstone clip, another showed an iceberg which, beneath the surface, bore the legend Aids in giant letters.

The message of both was simple, but apocalyptic – a deadly disease was a threat to everyone, not just the “small groups” who had largely been affected by it so far.

Australia's Captain Condom The message correlates masculinity and responsible sexual behaviour

No-one doubted the strategy was bold and attention-grabbing. But all involved were acutely aware of the risks and the potential to backfire.

“It was done with considerable degrees of secrecy,” remembers Sir Nick, who was consulted on the campaign. “I had to go to TBWA’s entrance at 8pm and go through the goods entrance, such was the degree of political sensitivity.

“There were those who said the adverts increased fear more than understanding. I think they did both. They stopped a lot of people from having any sex at all for quite some time, but one upside was that they got everybody talking about sex and safer sex.”

The iceberg and the tombstone were not all there was to the campaign. In addition, a leaflet was sent to every household in the country and a week of educational programming was scheduled at peak time on all four terrestrial channels.

But it was the television adverts which made the longest-lasting impression on the popular consciousness, instilling a sense of doom easily recalled by anyone over the age of 30.

“They were tremendously effective. They were visually so striking,” says Dr Sarah Graham of Leicester University, who recently organised an exhibition of Aids poster campaigns. “People had to watch because it was so extreme.”

The impact was so immediate that it was widely imitated around the world. Fowler recalls visiting the US in 1987 and discovering to his surprise that there was no national campaign.

“What we found, to our amazement, was the Americans saying, ‘What we think we need to do is what you’re doing in the UK,’” he remembers.

The British strategy was consequently imitated by other countries, although these varied according to cultural backdrop. For instance, it is difficult to imagine the focus of Australia’s campaign, a muscle-bound, prophylactic-wielding superhero named Condoman, receiving official backing in Whitehall.

And in sub-Saharan Africa, the world’s worst-hit area, running such an awareness drive is no easy matter. European HIV/Aids advertisements can be text-heavy as a means of getting information across, Dr Graham says. But she says this is simply not possible in national territories where dozens of languages and dialects may be spoken.

Moreover, antipathy from political leaders has prevented such campaigns in the countries which need them most, according to Simon Garfield, author of The End of Innocence: Britain in the Time of Aids.

2005 campaign in Nigeria A 2005 billboard campaign against HIV/Aids outside a university in the Niger Delta

“If you’ve got a head of state who’s saying there isn’t enough money and this doesn’t happen here anyway, it’s hard to make any headway,” Garfield adds.

“You are talking about different educational cultures, different sexual cultures. But what you can say is that if there had been anything comparable it would have had a major effect.”

For Fowler, however, the issue is not just about variances in national culture. Sexual health, he argues, will invariably be a topic that makes elected leaders unconfortable.

Indeed, a House of Lords committee chaired by the peer concluded in August that HIV campaign efforts in the UK at present were “woefully inadequate”, that a false sense of security had been allowed to set in and that a new awareness drive was needed.

“It’s not a natural area for politicians to be in,” Fowler says. “Sometimes religion comes into it, sometimes there are views about gay people. It’s undoubtedly controversial and some people don’t like being controversial in this area.”

What are your memories of the campaign in the 1980s and what effect did it have on you?

I seem to recall that the Post Office played a major part in the UK campaign. Weren’t all letters franked with the “Don’t Die of Ignorance” slogan?

Ian Yorston, Abingdon, Oxon

The reason it succeeded in the Uk was two-fold. Firstly, the ads did not tie the disease to any religion or superstition. It kept it medical, and in a country where women had a growing say in their own sexual health, it was an encouragement to responsible sexual health.

Jen, Edinburgh

I was at college when the campaigns started. To be honest, they had no effect on my (or indeed our) behaviour at all. We were young, had just discovered casual sex, and were very much of the view that AIDS affected different groups than middle-class college kids in England. If we wore condoms, it was to avoid getting anyone pregnant. Common sense, rather than hysteria, ruled. That said, if I was in that position today, I’d be more cautious now, as AIDS (and other STDs) is more widespread.

Rob, London

I was a teenager in the 80s and I remember the adverts very well. They scared the life out of me and made me conscious of the need to protect yourself when having sex. I have carried condoms with me ever since then and always insist on using them. ‘No glove, no love’, as was the popular saying a while back.

Chaz, Edinburgh

I was a child of the 80s and this advert scared the pants off me! It was so simple, yet hard hitting, that many of my generation were literally scared away from ever having sex. Unfortunately the message seems to have gotten lost and with the amount of teenagers getting pregnant it doesn’t take a genius to figure out that they are, for the most part, not using contraception. We are now in real danger of young people becoming infected and passing that infection on to many others. There should be more publicity about AIDS and HIV as many young people today have no idea what these infections really mean or even what they stand for!

Boris, Somerset

I remember the campaign very well, but let’s not be complacent. I work at an HIV service and there are new diagnoses every month, often from older people who would have seen the John Hurt AIDS campaign. There still seems to be a perception (even among gay people, who are well served in this town with free condoms and leaflets about STIs) that it’s worth taking a chance with risky, [unprotected] sex. We must keep the pressure up regarding sexual health promotion, and this must start in schools for all children without exemptions,

John Gammon, Brighton

UK paedophile with HIV, 30, caught in police sting after arranging online to have sex with children

Sunday, November 27th, 2011

Mail Online

A paedophile with HIV who arranged online to have sex with three young children has been jailed after not realising he was talking to an undercover policeman.

Steven King, who worked in the accounts department in a solicitors’ office, made the two hour journey from his home thinking he was going to abuse the children aged five, six and 10.

The sick 30-year-old also bragged to the undercover officer that he had already raped a young boy aged just 13 years.

In a twisted message he told the policeman: ‘Any age, younger the better.’

King was jailed for four years after admitting arranging the commission of child sex offences and two further counts of possessing indecent images.

The judge, sitting at Southwark Crown Court, was told how King began talking to the undercover officers in July this year when the officer claimed to have three young children.


During the online chats the defendant revealed how he had previously raped a 14-year-old, who he later claimed was just 13.

On July 19 he said ‘any age, younger the better’. in a message and told the officer he was willing to travel the 80 miles from his home in Southampton to London in order for the pair to meet.

Sting: King met an undercover police officer at Waterloo Station, who he thought was going to allow him to abuse childrenSting: King met an undercover police officer at Waterloo Station, who he thought was going to allow him to abuse children

When they met at Waterloo Station on July 27, King confessed that he wanted to abuse the five-year-old boy and six year old girl.

A second meeting was arranged when the paedophile believed he would be taken to the undercover officer’s home and be allowed to abuse the children.

On August 2, King was arrested and in interview confirmed he planned to go to the policeman’s home and sexually assault the children.

He said he had lied about abusing children in the past during his conversations with the undercover officer.

When he was arrested he was in possession of flavoured condoms and some toys for the children.

A number of items were also seized from his home, including a laptop, USB stick and external hard drives, which contained indecent images of children.

King of Southampton, Hampshire, was jailed for four years.

Speaking after the sentencing Detective Chief Superintendent Reg Hooke, head of the MPS Child Abuse Investigation Command, said: ‘The plotting of child abuse over the internet is a sickening crime and one that poses a serious and ongoing threat.

‘Officers from the Met’s Paedophile Unit conduct operations, such as the one that caught King, on a weekly basis.

‘Luckily, this time, King’s appalling intentions remained just that. The result reflects the Met’s continued commitment to fighting child abuse in all its forms.

HIV risk being ignored by Wales’ 50-plus age group says Terrence Higgins Trust

Sunday, November 27th, 2011

OLDER people in Wales are ignoring the risk of HIV despite nearly 10% of new cases in Wales being diagnosed in over-55s, campaigners have warned.

Many people aged 50-plus either missed safer sex messages or don’t think they apply to them, claims Steve Jones director of the Terrence Higgins Trust (THT) Cymru.

With World Aids Day being marked this Wednesday he is calling for better targeted public awareness campaigns.

In the first six months of this year 70 new cases of HIV were diagnosed in Wales, 26 of whom were among people aged 40 plus and six of those 55 plus. But Mr Jones believes the true figure may be far higher with many more cases going undiagnosed.

“One of the problems we have is that about a quarter of people already living with HIV in Wales don’t know they have the virus,” he warned.

“Even if we had a magic bullet stopping new infections we still have several hundred people in Wales who are yet to be diagnosed. We believe the figures in Wales are around 1,800 people with HIV, of which a quarter are undiagnosed.”

Most recent official figures from Public Health Wales show in 2010 1,321 people in Wales had HIV and were being treated for it – a 245% increase on the 383 people seen in 2001.

But Mr Jones says the true figure may be far higher and more needs to be done to encourage people to be tested, especially older people. “Work has been done with younger people in terms of better sexual health but one of the things we’re finding is older people are increasing in numbers of HIV and other sexually transmitted infections,” he said. “A lot are coming out of long-term relationships and particularly with women they think they no longer have to worry about pregnancy and condoms.” He believes people of all ages are becoming less aware of the risks of HIV/Aids with public health campaigns tailing off since the hard-hitting advertisements of the 1980s and 1990s.

And better treatment means HIV is now treated as a long- term chronic disease which lulls some into a false sense of security.

“Because treatments have improved substantially over the last 10 to 15 years some people think there’s a cure, there’s not,” he said. “Some people think it’s no big thing and they can just pop a pill, they can’t.”

And many older people simply don’t think they could be at risk of, or already have, HIV, he added.

“We often worry about younger people thinking ‘it will never happen to me’ but to some extent it’s older people thinking that too. They feel they’re responsible, older people with a nice house and job and don’t associate that with the possibility of having HIV.”

THT Cymru offers one-hour HIV testing in Cardiff every Tuesday between 6pm and 7pm. Testing is free and anonymous, and takes place at THT Cymru’s centre at Canton House, 435 Cowbridge Road East, Cardiff CF5 1JH. The charity is also running an all-day HIV testing clinic on World AIDS Day (on Thursday) from 10am to 5pm at the same venue.

Next page: George’s story – “I was looking forward to retirement when Iearned I had HIV”

Neglecting HIV/AIDS in the Southeast

Sunday, November 27th, 2011


Dr. Vincent Marconi travels to Durban, South Africa, every summer with his family to work with hundreds of HIV and AIDS patients. Despite global support for research and high-profile activists, AIDS continues to batter many developing countries. The Joint United Nations Programme on HIV/AIDS estimates that there are 5.6 million people in South Africa alone living with the deadly disease.

Still, after every trip to Africa, Marconi returns home to Atlanta, Georgia, to continue his work at the Ponce De Leon Center, one of the largest HIV/AIDS facilities in the United States. The center’s staff provides medical services to approximately 5,000 men, women, adolescents and children.

Here in the southeast U.S., he says, HIV/AIDS is very much a neglected problem.

“A great amount of attention has been put overseas,” said Marconi, who’s also an associate professor at Emory University’s School of Medicine. “Especially in these economically challenged times, we tend to be myopic in our efforts in our charitable giving. People say, ‘I’m already giving towards the international HIV effort – I can’t see two epidemics happening.’ No one wants to believe that extreme poverty and neglect exist in such a rich and powerful nation as this one.”

At the end of 2008, an estimated 1,178,350 persons aged 13 and older were living with HIV or AIDS in the United States. And the CDC estimates that approximately 50,000 people are infected with HIV each year.

In the southeast, the epidemic is growing faster than in any other region in the country. African-Americans constitute 12% of the population in the United States but account for approximately 45% of those newly infected with HIV, according to the CDC. And some of the South’s biggest cities topped the CDC’s list of diagnosis rates in 2008: Miami. Atlanta. Memphis, Tennessee. Orlando. New Orleans. Charlotte, North Carolina.

Patrick Packer, executive director of the Southern AIDS Coalition, describes it as the “perfect storm.” The coalition was formed in 2001 to bring attention to the HIV/AIDS outbreak – what the group calls a state of emergency in the South. The problem is three-fold, Packer says: stigma prevents education and promotes fear; socio-economic factors prevent the infected from receiving medical attention; and the lack of a focused strategy prevents agencies from using the few resources available effectively.

This week CNN Health’s team is taking a close look at the epidemic with a series leading up to World AIDS Day on December 1.

CNN technical producer Curt Merrill worked with data from the CDC, the Institute for Health Metrics and Evaluation, and the National Minority Quality Forum to create an interactive map showing the prevalence of AIDS and HIV in the United States compared to our levels of obesity, stroke, heart disease and male/female life expectancy. Click here to see the areas most affected and to search for your county or state.

On Monday, Jacque Wilson profiles Pastor Brenda Byrth, who is taking a stand against the HIV/AIDS stigma in rural South Carolina. Then on Tuesday, Madison Park analyzes the growing HIV rates in northern Florida. On Wednesday, Elizabeth Landau introduces us to Crystal, a homeless drug addict in Atlanta whose top priorities are getting clean and finding a place to live – not dealing with her diagnosis.

The series will culminate with an in-depth look at the work being done at the Ponce De Leon Clinic and the hope for a solution to the HIV/AIDS epidemic in the Southeastern United States.

Please take a moment each day to read these stories and tell us yours. If you or someone you know has been affected by AIDS, visit the CDC’s website or to find out more.

HIV patients die on church advice

Saturday, November 26th, 2011

Herald Sun

AT least six people have died in Britain after being told by evangelical churches they were healed of HIV.

According to a Sky News investigation, there is evidence that evangelical churches in London, Manchester in northern England, Birmingham in central England, and Scotland’s Glasgow are claiming to cure HIV through God.

Three undercover reporters were sent to the Synagogue Church of All Nations (SCOAN), which is based in Southwark, south London. All of them told the pastors they were HIV positive – and all were told they could be healed.

Once a month the church has a prayer line, where people from across Europe come to be cured of all kinds of illness. At registration they have to hand over a doctor’s letter as evidence of their condition

They are filmed giving before and after testimonies, which are put on SCOAN’s website. The healing process involves the pastor shouting over the person being healed for the devil to come out of their body, while spraying water in their face.

One of the pastors, Rachel Holmes, told a reporter, who is a genuine HIV sufferer, they had a 100 per cent success rate. “We have many people that contract HIV. All are healed,” Ms Holmes said.

She said if symptoms such as vomiting or diarrhea persist, it is actually a sign of the virus leaving the body.

“We’ve had people come back before saying, ‘Oh I’m not healed. The diarrhea I had when I had HIV, I’ve got it again’,” Ms Holmes said. “I have to stop them and say, ‘No, please, you are free’.”

The church said patients would be able to discard their medication after their healing and that they would be free to start a family.

Medical professionals said at least six patients who have died after being told by various churches to stop taking their HIV medication.

The church has branches across the globe and its own TV channel. It is also a registered UK charity. In a statement, it said God was the healer, not its pastors.

“We are not the Healer; God is the Healer. Never a sickness God cannot heal. Never a disease God cannot cure. Never a burden God cannot bear. Never a problem God cannot solve. To His power, nothing is impossible. We have not done anything to bring about healing, deliverance or prosperity. If somebody is healed, it is God who heals,” the church said.

HIV/AIDS is no longer a death sentence – in rich countries

Saturday, November 26th, 2011

Montreal Gazette

In the early 1980s, when the AIDS epidemic that went on to kill millions of people around the world was still a mystery, Christos Tsoukas was one of the few doctors in Montreal to treat people with HIV/AIDS. Colleagues would discreetly disappear to wash their hands if they’d shaken hands with him. You would not find an HIV/AIDS clinic in a hospital. It was always called something else, hinting at rather than naming the disease.

Tsoukas lost 100 patients a year to AIDS. It was heartbreaking work.

“One night, I was called when one of my patients was dying,” Tsoukas said this week in an interview in his office at the Montreal General Hospital.

“He was one of two brothers, both of whom had contracted AIDS through blood products. He died just as I arrived, surrounded by his family. Everyone was carrying a single red rose.

“I sat at the kitchen table, signing the death certificate. On one side of me was a beautiful flower and on the other side, a week-old baby, the child of my patient’s cousin. It brought home to me so strongly that there is a cycle of life. I will never forget that moment.”

By 1995, with the advent of effective anti-HIV drugs, the situation had changed, dramatically. Tsoukas has not had a single AIDS patient die in 15 years. “It’s amazing.” Drugs can prevent an infected partner from transmitting the virus, and drugs mean an infected mother doesn’t pass along the virus to her children.

Years ago, testing positive for HIV was a devastating diagnosis. Today, people won’t even get very sick, said Tsoukas. “We have new challenges,” he said. “We have people who are living into their 80s with AIDS and they have specific and complex problems, cardiovascular illness, diabetes, osteoporosis.”

Longer life spans mean that the number of people with HIV or AIDS remains high in Canada and the rest of the developed world. In Canada, an estimated 65,000 people were living with HIV in 2008, compared with 57,000 at the end of 2005. In 2008, new HIV infections numbered between 2,300 and 4,300, roughly similar to the figures from 2005. In Quebec, a total of 5,199 cases of HIV infection were reported between 2002 and 2008, the majority in Montreal. In Quebec as elsewhere in the developed world, homosexual men continue to be more affected than any other group.

In the developed world, the way is open to stopping the virus from spreading. In the lead-up to the annual World AIDS Day on Dec. 1, a British Columbia AIDS expert, Dr. Julio Montenar, told a U.S. medical conference that the province had achieved an astonishing 96.3-per-cent drop in HIV transmission.

Montenar, head of the British Columbia Centre for Excellence in HIV/AIDS, was reported as saying that the key to success is testing, followed by treatment with highly active antiretroviral therapy.

Unfortunately in Canada, an estimated 27 per cent of people infected with HIV are unaware of their infection. Treatment may be the best protection, but they aren’t getting it.

“Today, unless someone is in a community where AIDS is talked about, that person won’t know about it. Years ago, you would see posters or television campaigns, but not today,” said Tsoukas. He would like to see hospitals make an effort to teach patients about HIV. But on even the most basic level, “You still won’t see clinics called HIV/ AIDS clinics,” he said.

In the developing world, the news was heartening, with the United Nations publishing data showing that hundreds of thousands of lives had been saved by the availability of cheap drugs and new infections were down by as much as 30 per cent to 50 per cent. But the good news was sharply undercut this week by the announcement by the Global Fund to Fight AIDS, Tuberculosis and Malaria, hard hit by the continuing economic crisis, that it would cancel its next round of funding. The fund pays for more than 70 per cent of AIDS medicine.

Even with medicine, the developing world is struggling. Last summer, Tsoukas travelled to Tanzania, to visit an HIV/AIDS clinic founded by an Ottawa doctor, Don Kilby (http: //

“There was a 29-year-old girl with lymphoma,” said Tsoukas, “which is treatable. But she could not afford the bus fare to get to Dar es Salaam to be treated. No one in her family could go with her. You have to have someone, because there are so few nurses.”

The young woman died. “You become very pessimistic,” Tsoukas said, sadly. “The medication is available, but people can’t get to it.”

Read more:

Decision Wilcox aids transmission in gay saunas

Sunday, October 23rd, 2011


Criminal and Penal Division










September 12, 2011












[1] The accused, Mr James Stephen Wilcox, is charged with aggravated sexual assault (section 273 (1) ((2) b) of the Canadian Criminal Code) and aggravated assault (section 268 of the Criminal code) endangering the life of complainant G. W. between July 1st and August 31 2005.




[2] Defence invokes that the sexual encounters between complainant and accused in the current stream of the medical and scientific advances did not endanger the life of the accused.


[3] Defence invokes an implicit consent of complainant to a possible HIV infection. Defence invokes it is a well-known accepted reality and that he presumed that people engaged in sexual unprotected activities in sauna for gays who do not put questions on the sexual health or HIV status of their partner, are willing or indifferent to becoming namely HIV infected. He presumed that complainant as a silent partner in a sauna for gays was contextually and implicitly assuming the risks of HIV infection.


[4] The accused alleges disclosure at his initiative of his HIV status to complainant immediately after their first anal sexual unprotected intercourse at the accused’s residence in July 2005.

[5] The accused alleged that complainant was understanding, did not care whether the accused was HIV infected, was ready to marry him.

[6] Complainant would have stated that he did not know of his HIV status as his yearly tests were passed in 2004 as he would have unprotected sex since the last tests and is alleged to have admitted to having had unprotected sexual intercourses before, that they agreed finally to keep on having sex, dating and being careful.

[7] The accused spoke of his experience of becoming and being told he was HIV positive. Complainant was also invited by the accused to be tested within 3 months and that they would be careful in their sexual intercourses in the future.

[8] Complainant would have made reference to his being home sick and as to his difficulties in his relationship with father. Complainant and the accused would have acknowledged their increased pleasure at having unprotected sex.

[9] The accused thought that complainant was rather safe as the unprotected anal intercourse was not risky as he had ejaculated outside complainant’s anus and reminded complainant to go for the HIV testing within three months which was done in September 2005 and proved to be negative.

[10] Complainant was referred to as dishonest in court although he conceded he was honest in an E-mail of October 2011. Complainant was referred to as naïve and vulnerable through his unprotected sexual behaviour.


[11] Defence alleges the pursuit of both protected and unprotected anal sexual intercourse in a regular fashion between both and their ongoing romantic affair witnessed by the accused friends until some time in October 2005 as their boyfriend’s relationship ended. The most significant risky joint penetration of a dildo and penis anal intercourse would have happened somewhere between August and end of October 2005.


[12] The accused refers to the acknowledgement of complainant that he did continue to have sexual intercourses with him and wanted to keep dating and was indeed dating as he had a number of meals with the very good friends of the accused and was presented as the accused boyfriends and as both manifested physical tender proximity as confirmed by the testimony of the accused friends. Defence also pleads that the simple fact of complainant entering unprotected sex without any questions to the accused meant he was acting risky and could be believed to have been infected otherwise, at other times or after disclosure and that it is possible complainant in July was already HIV infected.

[13] Defence also alleges that complainant in a suspect way and out of the blues, when testifying, mentioned that he did not know if the friends that he met from July 2005 and are now living elsewhere were HIV infected.


[14] The accused confronted with complainant living rather poorly in an apartment and with the sudden inability of a good friend of his to take over his condominium for winter 2005-2006, offered complainant to rent his residence for that period at a cheaper rate than the one granted a friend in the preceding winters. Leaving his condominium unoccupied was not wise.


[15] The accused alleges that the joint dildo penis anal intercourse took place somewhere around the end of August or in October 2005. He states his ignorance of the trauma allegedly suffered by complainant until June 2006 after complainant HIV positive testing. The accused cannot be specific on that date, believes it could have happened at the end of August. He is sure that they kept on having sex and dating.


[16] The accused states that during this joint dildo penis anal penetration complainant was lying on his belly as he would have been inserted a rather big size dildo and his penis that could not be observed by complainant. The dildo was not a twin dildo as alleged by complainant serving for a double penetration by lovers and complainant’s description was related to as totally unknown to him. The accused said that he gave that dildo to complainant before his departure in November 2005 and denies that complainant offered him in exchange a smaller dildo.


[17] Defence pleads that complainant’s testimony is frail, questionable and untrustworthy. Complainant’s confusion, contradictions, contradicted eviodence by independent witnesses as to dating and uncertainties in events after July 2005 is invoked to question the trustworthiness of complainant’s testimony. Defence alleges also complainant’s multiple contradictions, vague statements and lack of trustworthiness weakens his credibility and that it should adduce reasonable doubt in favour of the accused. His alleged consent in the sauna for gays is invoked, the fact that he would have been in the past as well at all times relevant in that relationship engaging in unprotected sex, the most significant risky HIV sexual behaviour happening after disclosure, his ongoing dating and alleged sexual intercourse after disclosure and the fact that the HIV infection could have come from someone else and several other facts are invoked to allege the accused total untrustworthiness.


[18] Reference is made to complainant’s weak memory or contradictions as to the sauna policies regarding condoms, as to dates of complainant and the accused gathering. Complainant’s confusion and uncertainties regarding events after July 2005 are invoked to question the whole trustworthiness of complainant’s testimony.

[19] The accused is supported by the statements of account of both telephone and credit card bills and E-mails to which he refers and makes sense of to give an idea of the evolution of their relationship. The accused in a rather precise fashion alleges he recalls ongoing activities, meals, the nature of their dealings, meteo records that were instrumental to their dealings, the extent of exchanges, of phone calls or messages to the best of his recollection.


[20] The accused refers also to a long August 2005 phone call following a meeting where exclusivity was refused to complainant as lover to complainant’s displeasure. The accused describes complainant’s very emotional and adamant reaction to that decision of the accused and his finally yielding to keep on dating after that long phone call. . There would have been an ongoing display of affection, tenderness, love and sexual intercourses.


[21] And indeed, the accused and complainant are alleged to have kept dating, there being several gatherings, meals with a number of very good friends of the accused to whom complainant would have been presented openly as his boyfriend. They would have then an openly and privately truly overtly affectionate relationship with namely kissing and touching their buttocks. They exchanged lots of these marks of sensual reciprocity and were in close physical lovers proximity.


[22] There would save one exception (as immigration was a concern to complainant) at every time they met at the accused residence have engaged in both protected and unprotected sexual and anal intercourses. The first September results of complainant being HIV negative were good news for both.


[23] Complainant is alleged to have remained very much in love with the accused and hoped for the best and as the weeks passed in October and as it came to an end, it was evident that their relationship would not continue.


[24] The accused had some critics about complainant in the October 2005 E-mail regarding what could be qualified as an incoherent and risky sexual behaviour of complainant, proposing the interpretation that he was then referring in that first paragraph to their ongoing sexual intercourse.


[25] Complainant’s demand was also served by the repeated written excuses as the accused said how sorry he was for him as for his 2006 lover who was also infected.


[26] The accused is aware that around fall 2005, the accused was getting more engaged with another friend that has been his companion since then. But he alleges that complainant remained very attached to him and revengeful as the accused truly was in love with a Mr D. at the beginning of 2006.

[27] Defence alleges complainant’s multiple contradictions and lack of trustworthiness also weakens his credibility and that it should adduce reasonable doubt in favour of the accused all the way through.


[28] Both complainant and the accused in their very first statement to the police had stated that their relationship ended in August 2005. In Court, the accused alleges their sexual encounters ended in October 2005 contrary to complainant who alleges it did end in August 2005. Confronted with the telephone records of July 2005, complainant recognised that they met until October 2005 [1].

[29] Complainant is also challenged on his indebtedness to the accused regarding the rental of the accused ‘s residence during winter 2005-2006.

[30] The accused opposes to his 2007 statement to the police the fact that after review, his telephone and credit card accounts and E-mails are a clear reminder of clearly of a longer period of intimacy and relationship between both. These accounts allegedly give credit to his detailed version of facts and to his allegation of revenge on the part of complainant regarding the accused refusal to engage more in a relationship with complainant.


[31] The accused alleges that complainant was simply jealous, revengeful and wanted so much sexual exclusivity with the accused although they kept on dating and was presented as his boyfriend that his account of facts is not trustworthy. Confronted and refusing dating in those circumstances, complainant would have accepted to dating which he would have done in reality accompanied with sexual intercourses.

[32] The first September results of complainant being HIV negative and brought some welcome temporary relief.

[33] Complainant is alleged to have remained very much in love with the accused and hoped for the best and when October came to an end, it was evident that their relationship had come to an end and would not continue. Complainant was in love with that person he worked for in the vicinity of [Company A] in the Old Montreal.

[34] The accused kept on dating Mr M. F., another gentleman, during the summer of 2005 and felt in love at the beginning of 2006 with a Mr D.. The complaint would have been laid according to the accused as a means of revenge as complainant invented and distorted the facts and falsely charged the accused.


[35] Defence alleges the absence of any scientific evidence (philogenetic or genotypic tests) linking the genetics of the HIV condition of both the accused and complainant. Defence points out to the fact that as the first test was done in September 2005, the second test should have been administered around February, not in May and June 2006. The delays in testing according to the accused also contribute to question his guilt or at least give credit to the alleged traumatic intercourse that happened later in the summer or at the beginning of fall 2005.



[36] Complainant states that after oral sex and caresses at their first gathering at the Sauna Oasis, he started by having anal protected sex on plaintiff and that after, the accused did the same on him and that this ended their round of sexual intercourse followed by a shower and the accused taking complainant near his home and exchanging information regarding their phone numbers.

[37] Prosecution alleges that the HIV infection of complainant happened in their first and only unprotected joint dildo and penis anal penetration of complainant at the residence of the accused. That penetration caused trauma and complainant was infected through the emission of pre-ejaculatory liquids of the accused that preceded his ejaculation outside complainant’s anus.

[38] That conduct is alleged to have endangered complainant’s life. The expert is clear that even with pre-ejaculatory liquids, HIV will rapidly infect an anal mucus damaged and bleeding although with a sane one, the risk would be less significant but still real.


[39] Prosecution pleads that their first risky unprotected sexual anal intercourse at the accused residence became an assault as consent was vitiated by the non-disclosure by the accused of his HIV status. Prosecution denies tacit or contextual consent of complainant at the sauna, the absence of any other sexual intercourse after the first gathering at the accused residence and the admission of the accused that can be inferred in an E-mail to complainant regarding complainant’s infection. Complainant if informed of the HIV status of the accused would clearly have refused to have sexual intercourse with him.

[40] The accused confronted by complainant said he thought complainant was HIV at the sauna Oasis.

[41] Complainant states that after their sole unprotected joint dildo penis sexual intercourse as he became aware that the accused was also inserting his penis, his anus bled all day and he came back at the accused domicile and accused upon his questioning disclosed his HIV status. Very excited, the accused came to orgasm rapidly after outside complainant’s anus.

[42] As complainant was furious at himself and at the accused, the accused both tried to reassure him, tell him he had to protect himself for 3 months and as he did not ejaculate in his anus, the results should be favourable. He spoke of all the distress he went through when so advised in 2003 of his condition.

[43] Complainant said if he had known the HIV positive status of the accused, he would certainly not have had any unprotected sexual intercourse with the accused but would have considered taking measures to be with him in consulting if he had been frank. Complainant would not have risked the HIV infection.

[44] He said how he truly hated the accused for being infected and his guilty silence. The accused admitted to complainant that he was not keen on using saves. The accused would have stated that he was fed up being treated « as shit » as he was HIV infected.


[45] Complainant is clear that he did not in the past have sex without the protection of saves except for oral sex. He says he was HIV negative as he goes for testing yearly, as he never risked unprotected sex even when he acted once in a XXX film. Complainant never expected the accused to take advantage of him and remain silent making him risk that infection he is now caught up with.

[46] Complainant states that since September 24 2005, he has a love in his life. It has been going on for four years. Until 2006, they had protected sexual intercourses and since then they only have oral sex and his companion has no HIV infection.

[47] Complainant states that he stayed in touch with the accused to keep track of him and that he had no more sex and did not come to an agreement with the accused regarding dating him because the accused refused him the exclusivity of intimacy.


[48] It is alleged that the circumstantial evidence disclosed leaves no doubt as to the HIV infection of complainant by the accused. That would be so in the opinion of Prosecution as it directs its pleadings on the alleged frailties and total unlikelihood of the accused pretences whatever were the loopholes and apparent frailties of complainant testimonies and on the solid evidence linking the accused to his HIV condition.

[49] Furthermore, the Court is invited to give weight to the fact that within the next two months, the symptoms of which complainant suffered are compatible with the first symptoms of an HIV infection that should be kept in mind as it follows within less than three months an alleged traumatic anal intercourse very likely to cause rapidly an HIV infection.


[50] Complainant is blunt and allegedly constant that he did not have any other sexual encounter after July 2005 except with his companion since September 2005 until 2006.

[51] Prosecution refers to the fact that both complainant and the accused thereafter in their statements to the police believed that their sexual endeavour took place in August 2005. The accused through his records corrected that impression by establishing that the very specific events mentioned happened a few weeks before in the month of July 2005. Moreover, the accused is also the one who amongst his remarks to complainant spoke of that first 3 months waiting period for testing and of the necessity of protecting him in his sexual encounters.


[52] Prosecution alleges that there was a clear admission by the accused regarding his responsibility for the contamination of complainant in an E-mail dated October 14, 2006. The accused would then have stated what is an admission that should set aside according to the Prosecutor any defence on the counts as pursued[2].

[53] The accused was clear that he did not disclose his condition as he was fed up being treated like « shit » as he would have stated to complainant.


[54] The accused E-mail continues and it has to be examined as it attempts to defeat the impression left on complainant that would give credit to the accused’s contempt, belittling and absence of consideration for complainant[3]. Certainly that no one is perfect or meets necessarily the fantasies of personal expectation regarding their partners.


[55] That negative opinion of complainant by the accused could characterise the actions of the accused as being manipulative, not sincere, headed to help avoid or reduce any possibility of criminal pursuits. In feeling bad about that undisclosed HIV risky sexual encounter, the accused took steps to be more inclusive and be very nice to complainant.

[56] No doubt that the accused could find complainant to be otherwise a decent man although not fluid in the English language and although it can be questioned whether truly the accused considered complainant as a boyfriend. There is no doubt that the accused had no plans for the future with complainant and that must have left no doubt in his refusal of sexual exclusivity with complainant and his ongoing affair with Mr Fo..

[57] The serious risk of HIV infection of complainant got the accused to be legitimately nicer with complainant in taking initiatives of dating and shows of love and renting of his residence to earn the indulgence of complainant.


[58] Complainant denied he would never have accepted and did never accept to date the accused as he was insisting on dating a Mr Fo.. That was unacceptable to complainant.

[59] Complainant will reaffirm throughout his testimony that after July 2005, even after meals or walks, he never engaged in more sexual intercourses. A friend of the accused with whom complainant and that accused had dinner, was surprised that if they were boyfriends, complainant did not accept joining to go dancing after.


[60] Prosecution alleges that an anal unprotected intercourse when there is an exposure to pre-ejaculatory liquids is significantly risky. The expertise speaks as to a much more significant risk of infection when there is a traumatic anal sexual intercourse and exposure even to pre-ejaculatory liquids. It is strongly alleged that it happened in July in their sole intercourse at the accused residence.


[61] The Supreme Court of Canada and several decisions of the Appeal Court of Canada have reminded that the accused benefits from a presumption of innocence until judgment, that the burden is on the Crown to establish the guilt of the accused, that if the accused’s version is trustworthy and raises a valid means of defence or otherwise if the version of the accused raises a reasonable doubt in the context of the whole evidence, he should be forthwith acquitted.

[62] A negative answer to these two tests would leave on the Crown the burden of establishing the guilt of the accused beyond a reasonable doubt[4].

[63] At every step of analysis of the evidence, it would be an error to assess it in a vacuum as Justice Beauregard of the Appeal Court did so well put it[5].

[64] The Supreme Court has reminded that all of those principles of assessment of evidence, of trustworthiness of witnesses or of presumption of innocence are not a matter of form but substance. In any case, the workings of interpretation of the presumption of innocence command a careful examination of all of the evidence to ascertain if guilt is established beyond a reasonable doubt or if a reasonable doubt remains.

[65] Judge Healy comments on how to approach the Supreme Court of Canada analysis of evidence is enlightening. « The credibility of witnesses is a central component in the assessment of the evidence on the whole of the case. This is not only so where there is a conflict between evidence for the prosecution and evidence for the defence… Moreover, questions of credibility are not restricted to gaps or conflicts in testimony. In every case the ultimate question remains whether on the whole of the evidence guilt has been proved beyond reasonable doubt[6].

[66] « More recently the Supreme Court has emphasised that the guidance in W.(D.) is not a dogma in which form should be prized over substance. It is a reminder of the relation between questions of credibility and the practical application of principles that inhere in the presumption of innocence. An assessment of the evidence on the whole of the case necessarily means that all of the evidence of every witness must be fully considered. To this end the Court has said that there is no single way in which to proceed, provided that it is made clear that credibility is an important element in weighing the persuasive strength of the evidence as a whole. »[7]

[67] Whatever conclusions judges come through, they have a duty to justify that they have weighed the whole of the evidence, as it is a rule of justice that any reasonable doubt benefits an accused. Judges have to carefully, courageously, impartially and insightfully assess the whole evidence with an open mind. Judging is quite a terrible and burdensome privilege as a judge should not yield to any ill-temptations of popularity that do not reconcile with those highest timeless responsibilities meeting the core values of that justice to be rendered and appearing to having been so done.

[68] In the stay of Lifchus, the majority stated that a Court is not to speculate on where the truth lies and that a doubt that is reasonable cannot be a frivolous doubt or born through his imagination, it cannot rest on sympathy or on prejudice. Good sense and reason must guide the Court and the verdict must flow logically of the evidence or of the absence of evidence[8].

[69] To terminate these considerations on how to apply the law fairly and equitably, the Court will quote and translate from its French version the opinion of late Justice Michel Proulx of the Quebec Court of Appeal, one of our most learned jurists who was totally dedicated to explaining the law. On contradictory versions, late Justice Proulx expressed the opinion that « it was worth repeating that a trial judge… did not have to decide to reach a verdict on which of the versions wins over the truth… but if the evidence all considered satisfies the Court beyond a reasonable doubt of the guilt of the accused, consequently the accused does not have to meet a burden to show that the victim does not state the truth…The Prosecutor has the burden to establish that the truth proposed is shown beyond a reasonable doubt. The burden of that truth has always to be met by the Prosecutor. To require the accused persons to show the lie of complainants would atrophy the presumption of innocence. A reasonable doubt surges if the Prosecutor fails in its attempts to convince the Court of its truth. »[9]


[70] Prosecution objected to the testimony of Mr Rousseau who was presented as an expert in the field of gay behaviour and interpretation of that behaviour in saunas reserved for gays. That testimony was received under reserve.

[71] The evidence of an expert is only admissible if it is relevant, material and necessary as stated in Mohan[10].

[72] The expert is manifestly knowledgeable about the culture of gay people, his theory a representation or personal understanding here and now of part of the reality of gay people who attend sauna for gays locally.

[73] The expertise of Mr Rousseau relates to a silent understanding in gay saunas that those who have unprotected sex with strangers without disclosing their respective HIV status are namely people who are or HIV infected or are ready to risk so being infected and are indifferent to that possibility. He offered an expertise regarding the assessment of complainant’s behaviour and a so-called tacit consent to be inferred from the attendance in these saunas reserved for gays.

[74] That gentleman offers no scientific expertise but just an opinion that has nothing scientific, nothing but a psycho-sociological understanding and generalisation of the behaviour of some of those who engage in risky sexual practises in gay saunas. His opinion weighs and interprets the conduct of people attending gay saunas and the probative value of the testimony of the accused and of complainant. He testifies about his views about a silent consent of partners and on the contextual understanding of sexual mates entering saunas for gays when there is no disclosure of their HIV status.

[75] In this matter, as it is a matter of opinion, it clearly is the responsibility of the trier of fact to make inferences or draw conclusions and to adjudge on the credibility of the witnesses and to draw inferences and conclusions from the non-expert evidence heard[11]. The possibility or likelihood of it being an implicit consent does not suffice to render that testimony an expert testimony as it has nothing scientific and as it is not necessary.

[76] On the grounds of necessity and absence of scientific expertise of the witness, this so-called expertise fails and is not admitted in evidence.



[77] Section 265 of the Canadian Criminal Code defines assault as follows. « (1) A person commits an assault when (a) without the consent of another person, he applies force intentionally to that other person, directly or indirectly; (3) For the purposes of this section, no consent is obtained where the complainant submits or does not resist by reason of (c) fraud ».

[78] In R. v. Mabior, the accused was charged with having both protected and unprotected sexual encounters with several complainants. In addressing whether endangerment of life had been proved in relation to aggravated sexual assault, McKelvey J. adopted the language of Cory J. in R. v. Cuerrier and held that “the potentially lethal consequences of unprotected sexual contact leave room for no other conclusion than that endangerment of life has been substantiated.” He also referred to the language of the Ontario Court of Appeal in R. v. Thornton (1991), 82 C.C.C. (3d) 530 at 531: « When the gravity of the potential harm is great, in this case “catastrophic”, the public is endangered even where the risk of harm actually occurring is slight, indeed even if it is minimal ».

[79] The Prosecution needs to prove that the life of complainant was endangered by the acts of the accused[12].

[80] There has to be a significant risk of serious bodily injury that actualises consequently an absolute duty to disclose. The duty to disclose increases as the risks of serious bodily harm becomes significant. That risk of harm cannot be trivial[13]. The greater the risk of deprivation, the higher the duty to disclose[14]. The failure to disclose the HIV infection fulfills the requirements attached to fraud, which is dishonesty and deprivation or risk thereof[15]. That dishonesty is to be assessed objectively[16].

[81] Prosecution has to establish that there was an intentional application of force without the consent of complainant[17] and an objective foresight of the risk of bodily harm[18]. The Consent[19] is valid if it is informed, clear and unequivocal[20] and flows from the knowledge of the status of a partner upon who lies the duty to disclose his HIV status[21]. The absence of consent is assessed by reference to the complainant’s subjective internal state of mind toward the touching at the time it occurred.[22] The failure by an HIV infected person to disclose his HIV status vitiates the consent to engage freely in a sexual intercourse.

[82] Furthermore, there shall be no reasonable doubt that complainant would not have engaged into a significant risky sexual intercourse if there had been disclosure of the HIV positive status of the accused[23].

[83] In the case of Williams[24], the Supreme Court of Canada pronounced a verdict of guilt on a charge of attempt [25] to commit an aggravated assault as it could be inferred that most likely, the victim was infected at the time of the sexual intercourse by that accused who ignored his VIH positive status.


[84] The Court benefited from the expertise of a learned specialist, Dr Richard Morrissette. Here is the summary of what the expert stated[26].

[85] Untreated, the HIV infection is lethal.

[86] Without medication, HIV infected people can survive between 10 and 13 years. It is a chronic disease. It cannot generally be cured. The infection can be controlled.

[87] The HIV virus is disseminated through the blood. It can infect a human body namely through the sperm, the post and pre-ejaculatory liquids, through vaginal or anal contacts, through the blood.

[88] HIV can be disseminated through unprotected vaginal or anal sex. A healthy vagina may be less conductive to an HV infection than a healthy anus. However when damaged, confronted with the HIV infection, these tissues are highly vulnerable to becoming rapidly infected.

[89] If infected sperm, liquids or blood infect a sane person, even if it is less likely with pre ejaculatory liquids, the risk of a rapid infection becomes major, most significant and important if at the time of an anal intercourse for example, the mucuous of the anus has been damaged and is exposed to pre-ejaculatory liquids. That risk with a sane anus for example remains real, significant although lighter. One sexual unprotected intercourse will suffice in the case of an anal intercourse where the anus is damaged and where a partner is about to ejaculate, as it is very likely that pre-ejaculatory liquids will flow in the anus.

[90] Oral sexual intercourse is hardly conductive to HIV infection unless there are health problems in the mouth.

[91] The HIV virus is diverse and at times not easily countered. As the HIV infection is an evolving complex virus, new treatments and medication is invented to counter HIV infections and Aids.

[92] The HIV virus can remain alive on an object between 48 and 72 hours. But left in the sun, that HIV virus will last at most 3 hours.

[93] Fatigue, mononucleosis, diarrhea, swollen ganglions are amongst the first symptoms that will appear.

[94] At this period of time, most people may get cured through the administration of a massive dose of medication within 3 days of the risky sexual encounter.

[95] Properly medicated, an HIV infected person’s life span expectation expands to approximately 80 years old. As they are aging, their anti-body is likely to become undetectable. Then they are likely to die of opportunist infections that will strike them, as they are not any more immune as medication for the HIV or AIDS infected persons will not foster and maintain their immunity. The expert said that generally, HIV infected persons do not die of the direct consequences of the HIV infection of AIDS.

[96] Tri-therapy medication helps generally counter the evolution of HIV, as there are several types of medication to control diverse virus. Medication exists today that can help block the entry or the exit of the virus in the cells and reduce it below levels considered at risk.

[97] If well treated and under very close supervision, protective cells can be increased in numbers favouring the defence of the organism as it can induce a negative viral charge after a number of years. USA health institutions have come to conclude that there may circumstances where the viral charge appearing negative, there can be safe sex without contraceptives. If properly treated, then HIV infected people viruses proliferation can be blocked, so that HIV infected persons would not endanger the life of others in sharing unprotected sexual intercourses.

[98] Multi-disciplinary teams nowadays follow HIV infected persons and explain the disease and its consequences, their responsibilities. They are recommended to advise their partners of their illness. There is an absolute necessity for HIV infected persons regarding unprotected sexual intercourse to disclose their health condition as medically stated by the expert. They are being told that condoms well used are generally efficient.

[99] There are .4 of 1 % or less risks of transmission of HIV by fellatio. Risks are truly increased and even real if a partner has a poor dental health.

[100] Properly protected intercourses protected adequately with the use of a latex prophylactic is considered to reduce the risks of HIV infections to below any significant risk.

[101] It took 6 months in 2006 for tests to show the HIV infection. Nowadays, it takes 3 months to get the HIV results.



[102] The accused knew he was HIV infected as of 2003 whereas complainant got the HIV positive testing news in May and June 2006 after a September 2005 clearly interim negative HIV testing passed after a number of compatible HIV symptoms hit complainant.


[103] At the beginning of July 2005, on their first meeting in a sauna reserved for gays, complainant and the accused had sexual intercourse. Complainant and the accused first testified it happened in August 2005. That was the period alleged for their lovers’ relationship in the statement to the police in the following years.


[104] The accused and complainant engaged in unprotected sexual intercourse at a gathering at the accused residence within a short time after their meeting at the sauna for gays. It was around the July 21, or days before as complainant who is not to keen on dates felt.


[105] Disclosure was made by the accused after that intercourse. Versions differ as to the content of the discussions and as to the emotions displayed. However, The accused stated he attempted to reassure complainant as there had been no ejaculation within his anus and as it should be confirmed by proper testing within three months.


[106] If there were any sexual intercourses after the one at the residence of the accused, then any such sexual intercourse took place with complainant fully informed of the accused HIV positive status. The accused and complainant kept gathering, did hike together, shared meals, had diners with the accused friends on a few occasions as he was presented as the accused boy friend.

[107] The accused rented his residence to the accused during the winter 2005-2006.


[108] Complainant and the accused stayed regularly in touch by phone and E-mail and met from time to time and complainant was made to meet the accused friends in August and October 2005. Complainant was then presented as the accused boyfriend.. They had meals together and even met at the accused residence

[109] Then, there were these communications as complainant accepted to become the lessee of the accused who went down south and as the positive results of the HIV testing of complainant got them to interact as well as some allegations of unpaid rental obligations of complainant.


[110] They met as the accused was committed to another gentleman with whom he was involved sexually and kept on doing so as he did not wish to abandon that relationship. They both attended saunas for gays before they met. Complainant became involved with a friend during the course of fall 2005.


[111] Complainant did undergo a first HIV testing in September 2005 as he had been sick and was informed that he was HIV negative. He was told that he should undergo further testing within the 6 months of that risky sexual encounter. It would then be expected that the next testing would take place around February 2006. Tests were conducted in May and June 2006.

[112] Complainant went through periods of fatigue in the winter of 2006 from January on. The results of his tests dated May 17 and June 21, 2005 revealed complainant to be diagnosed as HIV positive. The accused was rapidly informed of those results.


[113] Complainant attempted to obtain a secretly recorded confession of the accused in which he stated as a preamble to a question that they had kept on having sex and dating after their sauna intercourse. Complainant submits an interpretation of what he meant and discussions on their wanting to date and their meeting and on what meant their ongoing sex.

[114] Later on, at complainant’s invitation by E-mail dated October 14, 2006, the accused expressed regrets and admitted by E-mail his difficulty in voicing and disclosing his HIV positive status[27]. He was morally unable to do so. He expressed repeatedly how sorry he was for complainant being infected and his thinking that situation over and over and his being surprised at complainant’s not thinking right and being or acting vulnerable.

[115] There are further allegations by the accused that in his E-mail of October 2006, he was referring to an ongoing sex life with complainant, which is denied.

[116] The accused described complainant as decent and honest in his E-mail. That was one year and 3 months after their July encounters at the Sauna and at the accused residence.


[117] Defence acknowledges that there was indeed at one time a dildo penis penetration. He says he remained ignorant of the trauma suffered by complainant and sets the time frame rather somewhere in August or October 2005. Complainant alleged hat it is that intercourse at the accused residence in July 2005 that worried him and got him to confront the accused as he has suffered a trauma that he denounced to the accused after disclosure.


[118] There were indeed a number of E-mails exchanged that were produced and sggest inferences of the relationship of complainant and the accused and have relevancy to point to the reality of ongoing exchanges.



[119] Was there an implicit consent on the part of complainant expressed as the accused and complainant first met in a sauna for gays? Did complainant flag the fact he was a bug chaser (someone not HIV willing to be HIV infected) or that he was HIV positive? Is there evidence of complainant subjectively accepting that risk?


[120] Was there possibly an unprotected sexual anal intercourse in a second round of sexual encounters at the sauna as the accused alleges? Would complainant have taken by surprise the accused by his rapidity of execution in entering in his anus the penis of the accused?


[121] The accused acknowledges that he did not disclose his HIV positive status to complainant until after the second sexual intercourse at the accused residence. He alleges the continued tacit contextual consent that should be inferred from their first place of gathering and complainant’s behaviour.

[122] When did the unprotected intercourse at the residence of the accused take place? In the afternoon of their meeting or on the following morning as complainant alleges that it is then that there was sexual intercourse? Was it a simple unprotected anal sexual intercourse or was it a traumatic joint dildo penis anal penetration of complainant by the accused?

[123] Who took the initiative of disclosure or asking disclosure? When did it happen? Was there a traumatic intercourse?

[124] Whenever there was that traumatic intercourse, was the accused advised of the trauma suffered by complainant?


[125] The accused and complainant both claim they are the ones who took the initiative regarding disclosing or asking for transparency as to the sexual health of the accused.

[126] There are neat differences in the account of the time and circumstances of disclosure. The accused referring to discussions he had with complainant after disclosure relates in a totally different fashion the ongoing discussions Was complainant so neutral or almost as to that infection? Was he already so attached to the accused that he was ready to marry him? Was complainant so unsure about his HIV status that there was no shock regarding having unprotected sex with the accused? Is it likely or possible that complainant would have been reacting rather as being home sick or relating forthwith his difficult relationship to his father. Is it likely or possible that they would have exchanged on the pleasures of sex without condom.

[127] Or was complainant upset and flabbergasted upon disclosure? Was he coming back allegedly at the accused residence suffering from a trauma as his anus kept bleeding after a July 2005 morning joint dildo penis anal penetration? He stated the trauma suffered. Both speak to the effect that the accused simply tried to reassure him, to calm him down as there was no ejaculation in complainant’s anus and as testing within the following 3 months could affirm an HIV negative status.


[128] Does the material evidence tendered by the accused referring to a number of telephone bills, credit card accounts E-mails and close friend testimonies and E-mail tend to raise a reasonable doubt on complainant having both protected and unprotected sex and kept on dating from august to October? Does the allegation of complainant of his entering a September 2005 love relationship with someone still his companion and still HIV negative together with the continued dating of a lover by the accused contribute to answering the question of guilt. Does all of the tenderness as boyfriends manifested between complainant and accused until October justify a finding of reasonable doubt in favour of the accused?

[129] Does the apparent weakness or confusion or contradicted untrustworthy evidence in the testimony of complainant leave a reasonable doubt as to the guilt of the accused, such evidence relating to dating, to meetings of both and meals even with friends of the accused, those abundant phone calls, many E-mails, close tender physical proximity and boyfriends apparent meetings.

[130] Does the rental situation of the accused residence for the winter 2005-2006 as negotiated, a possible hidden motivation to avoid any complaint has any bearing on the facts of the case? Does the possible indebtedness question the accused trustworthiness or does complainant’s attitude question his trusworthiness?


[131] Is it possible that notwithstanding complainant’s denial, he could have engaged in significant risky sexual intercourses at any relevant time other than July 2005 with the accused or with anyone else at all relevant times? Depending on the answer, if affirmative, does it raise a reasonable doubt taking into account complainant’s denial notwithstanding his peculiar declarations?


[132] Is jealousy or revenge likely or possible to motivate complainant and have him charge the accused when the truth would be not that affirmative and would leave place for a reasonable doubt?


[133] The attorney for the accused pleaded that as during the accused testimony reference was made to a date of infraction being in July 2011, the Court had in amending the indictment to include the month of July in the period of commission of the infraction of aggravated assault, so confirmed the trustworthiness of the accused. The amendment should be considered as confirming the trustworthiness of the accused versions, so claims the defence.

[134] Defence invokes that there can be no amendment unless a trial judge has such evidence. Defence invokes the fact that it should have been evidence as adduced by the Crown[28]. The amendment could only be used to adduce trustworthiness of an accused.

[135] Indeed, there was an amendment ordered by the court during the course of the accused testimony as the accused appeared to state in a likely way that the sexual encounter or encounters between both that could have infected complainant with HIV and as dealing with exactly the same circumstances of the gatherings at the sauna and at the accused residence before any disclosure could truly likely have taken place in July rather than in August 2005. This is no surprise and was not of a nature to prejudice the accused defence as both were speaking of their sauna and accused home gatherings. It certainly asserts the likely and even sure happening of some of the main events not only in August 2005 but also in July 2005.

[136] Does it discredit per se the version of complainant, that is another question alike all those questions where complainant has a version that differs from the one of the accused on some of the other facts where there are serious grounds to believe that the accused was generally truthful.

[137] That the Supreme Court of Canada has settled debate on March 21, 2011[29], as a verdict of guilt for an offence committed some considerable time before as both parties were then referring clearly to the same events was maintained, thus setting aside any worries of prejudice, any prejudice whatsoever. The evidence upon which a conviction was maintained referred to an infraction that was committed a long time before the one appearing in the indictment. In our case, the difference in time is of at most a few weeks from the month of August mentioned in the indictment.

[138] The Supreme Court majority agreed with the conclusion of Duval Hesler J.A., who dissented in the Court of Appeal, as she expressed the view that [translation] “trial fairness was not compromised. The evidence accepted by the trial judge satisfied her beyond a reasonable doubt that the incident in question did in fact occur regardless of the exact time it took place” (para. 69). In our view, (she states) the defence was based entirely on a question relating to credibility. The respondent was in no way prejudiced.[30]

[139] Therefore if there was no need to so amend manifestly according to that ruling, the amendment authorised did not present any prejudice to the accused whose testimony regarding the infraction was referring to the same events where the infraction is alleged to have taken place. However, the amendment as ordered by the Court, invited to keep the focus on the essential of the case without in any way prejudicing the defence case.



[140] The Court is unimpressed by the accused testimony relating to an implicit consent of complainant and relating to disclosure. The accused’s testimony is also totally unlikely regarding a major part of the discussions during disclosure such as a demand of marriage, such as the indifference of the accused as to that possible infection.

[141] The accused E-mail admission of October 2006 reads as follows: « I hope that in the future I can accept my HIV status in my daily life so that this is not a dirty secret that I feel like I am hiding. If I do have any other sexual partners, I plan to be totally honest and practice safe sex ».[31] Furthermore, he had clearly admitted to the complainant that he felt «like shit» and was not able to so disclose.

[142] The Court disbelieves the accused pretences that getting sexually involved in a sauna for gays, he did or could take for granted in the circumstances that complainant was HIV positive or indifferent to being HIV infected. Indeed there may be a number of gays ready to so behave and risk that much. That is magic thinking or wishful thinking and does not at all have any air of reality that the accused could think that way seriously.

[143] The facts above from showing that the accused knows that there may be people ready to risk that much, do not at all show in any way whatsoever complainant subjective clear and unequivocal consent to engage sexually with a potentially HIV infected male and risk that much. No evidence supports any such conclusion.

[144] The accused affirmations of his belief that complainant is a «bug chaser» ranks at best as a pure magic thought that has nothing to do with complainant’s reality. It is no more than a simple manoeuvre on the part of the accused to generalize a surprising reality that may be the one of some gays attending saunas in view of his inability to disclose or otherwise hoping for the best.

[145] It is a hope entertained by the accused to release him morally as he also knows that there were at least with unprotected anal sex some risks of HIV infection or even cross-contamination. It was a pretext and nothing more to justify his shortcomings, his moral inability to disclose.

[146] It cannot be said that the accused expectations that a partner should enquire on the HIV status of his partner would not be a responsible and ethical move to be made by partners engaging namely for the first time in sexual activities whether protected or unprotected with a stranger.

[147] That ethical non legal point of view has a clear legalized binding counterpart, a legal and burdening duty binding HIV infected sexual partners to disclose their HIV status to their to-be partner when engaging in significant risky sexual behaviour.

[148] That allegation of a second round of sexual intercourse, this time an anal unprotected intercourse, was meant to serve his alleged defence of implicit or contextual consent that could then be invoked again at his residence based on what would have been that essential implicit consent.

[149] Facts as related by the accused do not in the opinion of the Court permit per se an assumption that complainant consented implicitly to risking an HIV infection.

[150] The accused alleges that complainant took the initiative of a second round of unprotected sexual intercourse at the sauna on their first intimate gathering. Accused then would have had no time to counter that alleged initiative of complainant who after stimulating again his penis into a second erection, would have surprisingly introduced it in his anus. Both would have reached orgasm, as both were very excited. Ejaculation of the accused would have come rapidly after withdrawal of complainant’s anus and masturbation.

[151] These circumstances did not release the accused of his obligation of disclosure of his HIV status. There is no defence whatsoever of implicit or contextual consent of complainant that can be opposed in these circumstances as it would have needed to meet the ultimate burden of there being a clear and unequivocal consent on the part of complainant.

[152] The accused is disbelieved that there was a second round of unprotected sexual intercourse at the sauna. Complainant’s allegations regarding the absence of a second round of unprotected intercourse is believed. In the affirmative, the accused wanted to use that second round as a show of the accused indifference to whatever the HIV status of the accused is. But at the same time, complainant was not any less at a significant risk of the HIV infection. It was meant to show that complainant was indifferent to having unprotected sex and could already be infected before the sauna sexual gathering.

[153] In fact, the accused on that is totally disbelieved.

[154] As the expert situated that unprotected anal intercourse alleged amongst significant risky intercourses even if less than if there had been a damaged anus, the accused would have had a clear obligation to disclose, to make the moves to impeach the accused to do so if he did not want to disclose his HIV positive status.

[155] There was time for disclosure, to withdraw or impeach that unprotected intercourse of going on. The accused is not a powerless victim of complainant trapped and triggered by complainant’s fast move. The accused failed to show any likelihood at all of a second round of sexual intercourse at the sauna.

[156] Complainant is trustworthy on the facts that after they exchanged kisses and heavy petting, he had protected anal intercourse on the accused and the accused followed doing the same to complainant. That is it and it ended there.

[157] The discrepancies or differences in the testimonies of both regarding saves, their being given or purchased, and even complainants erroneous thought he had two saves, one for him and one for the accused does not at all have any impact on the assessment of the evidence heard. Indeed it demonstrates that sauna for gays are a lieu of gathering for sexual purposes and that practises may vary from one to another and that complainant attended other saunas for gays.

[158] For the Court, there is no doubt whatsoever even through the acknowledged frailties and weaknesses and possibly untrustworthiness of part of complainant’s testimony that it is not at all likely that the accused had before unprotected sex before in saunas for gays. No such admission is recognized as having been made to the accused by complainant. It is not at all believed and was simply invented and meant to serve the accused allegation of implicit consent and unprotected intercourse generally on the part of complainant.

[159] The accused in the opinion of the court would certainly never have admitted any responsibility in his October 14 2006 E-mail if at any time complainant would not have challenged him and said he was forgiving him for that.

[160] The circumstances of the case, the trustworthiness of the complainant on the fact he never engaged before in unprotected sex and the timing of the first symptoms whether compatible or incompatible with the HIV infection do not in the opinion of the Court open any such possibility that the accused was engaged in the past in risky sexual intercourses that could explain this HIV infection confirmed in May or June 2006 after negative testing in September and a few weeks worrying likely symptoms of infection.

[161] The testing of complainant yearly even in 2004 does not necessarily mean the engagement of complainant in significantly risky sexual intercourse. It is simply a tool useful for active gay people in their sexuality and in this case, complainant is believed that this evidence does not justify in the present context question complainant’s HIV status before July 2005.

[162] The alleged admission by complainant that at his initiative he admitted his risky HIV sexuality is totally disbelieved as that is disqualified by the content of the accused E-mails as it is sure that he would never have ventured any expression of sorrow or regret or responsibility. It was on the part of the accused a tricky invention to give hopefully substance to his implicit contextual consent alleged.

[163] Indeed, he did attribute complainant some responsibility of having unprotected anal intercourse saying he had been candid and vulnerable. The accused behaviour and warnings were also a way of saying to complainant he would not have became infected if he had been careful in his dealing with him. Why confess that much if complainant had disclosed a truly significantly risky behaviour? The accused had to believe that there had been no prior unprotected significantly risky sexual behaviour on the part of complainant.

[164] The accused was very firm after disclosure that complainant had to be careful until the results would be known. And that was within those immediate months that followed the residence unprotected intercourse and more than 2 months after the meeting at the sauna. A simple unprotected anal intercourse was considered even when the anus was submitted to the pre-ejaculatory liquids of someone excited, to some risks as these liquids could forthwith be emitted at the time of penetration… even so more when the accused penis had already ejaculated and not been cleaned and evacuated of the post ejaculatory liquids.

[165] As the Court stated, any pretence of prior to the Sauna gathering risky sexual behaviour on the part of the accused is disbelieved and does not hold. Unbelievable that the accused would have admitted to having sex openly and in a significant risky way in saunas or with others in unprotected anal intercourses with others before and after the July 2005 intercourse with other gays That admission is not believed as the accused would certainly have contested his responsibility in his October 14 E-mail and not simply attempted to share the responsibility of the HIV infection with the accused.

[166] The accused is totally disbelieved on his account that he is the one who took the initiative of disclosing his HIV positive status.

[167] That obligation to disclose legally is binding from the time a partner who is HIV positive engages in a significant risky sexual intercourse.

[168] This affirmation that he is the one who at his own initiative disclosed his HIV positive status is disbelieved.

[169] The accused has confirmed by E-mail his inability to disclose his HIV positive status. He describes it as such a « dirty little secret »[32], He clearly does not have the guts and honesty to so disclose. This is exactly the same crucifying and humiliating truth he will not disclose later on to someone he considers so much more important in his life, his February 2006 love or first love ever named D..

[170] The accused conveyed that disclosure on due time was a most difficult and mortifying admission to make. Clearly he is shameful to have to disclose his HIV status as he feels it does not concern the public. It is totally unlikely that the initiative of disclosure originated from the accused. In that E-mail, he undertakes to act responsible and disclose in the future his HIV status. It can only be so because he did not disclose his status to complainant.

[171] How can it be understood in these circumstances that the accused would have flagged that much and disclosed his HIV positive status immediately after his unprotected intercourse at his residence? He did nothing alike at his initiative.

[172] The complainant’s alleged reaction after disclosure is that it is believed he was infuriated and that if it can be believed that the accused spoke of his own difficult experience of getting to know he had become HIV infected, it is totally unlikely that complainant spoke at that period of marriage and offered that much. Exclusive dating was certainly not discussed either at that time. Then dating in that context does not necessarily entail sexual intercourse, does not exclude it but makes it most difficult to believe that both complainant or the accused knowing the accused reaction would have gone further in more significant risky sexual behaviour.

[173] It is reasonable to think that the accused at the time of disclosure described how he got to contract the HIV infection and his reactions to becoming so infected. It is also likely that they had discussions on the HIV infection and careful attitudes to maintain and testing to be done. But the accused in the way he disclosed complainant’s reaction, annihilates any complainant’s allegation of anxiety, fear, anger and that is unlikely.

[174] Whenever there were discussions about the complainant life, history, of being homesick or having lived difficult a difficult relationship with his father, it was not the center of their first discussion and it is believed that these specific discussions were made at some other time.

[175] If there were any marriage discussions, it is likely that it happened at the time of discussions regarding dating and it could only be made at complainant’s initiative as they discussed dating. Exclusivity was clearly not part of the accused intentions and he was blunt with that. He did not reach an intensity of love and appreciation that was to have him engaged.

[176] The evidence does not permit to believe that the accused is the one who took the initiative to disclose although he could have been worried lightly about cross-stains as he did put it.

[177] The perspective of being or becoming HIV has developed in the day of work of the accused and even without there having been the traumatic intercourse referred to, that anal intercourse gave reasons to complainant to be worried as this was not his believed course of action when engaging in sexual intercourse and as it was significantly HIV sexually risky. The court does not doubt that complainant did not have unprotected sex with anyone else than the accused.

[178] The Court finds likely that the accused invited complainant to have only safe sex until the results. That is logic for anyone informed of the risk of being infected. The accused did not speak in an insensitive way but hoped for the best for complainant.

[179] The accused can be believed to have been at best incoherent and if complainant had undertaken not only protected but also unprotected sexual intercourse, he would be incoherent as well. It appeared clear that they had convened that therefore there would be no significantly risky sexual behaviour in between the two. That had truly frightened complainant and it cannot be doubted.

[180] How can it be understood that a careful accused warning complainant would have after July 2005 risked that complainant be submitted to the trauma of a joint penetration of a huge dildo and penis? This pretence is most difficult to believe for both of them.

[181] The first September symptoms that are compatible with an HIV infection do not exclude incompatibility with any other findings. These symptoms gave force to the allegation of an unprotected significantly risky intercourse with the accused in July 2005. Further symptoms showed up in January 2006 and kept on burdening complainant.

[182] That does not exclude in theory the possibility of risky sexual intercourses by both the accused and complainant between July and October 2005.

[183] Complainant has admitted entering at fall a new relationship with a person who has become his companion since then, with whom for a portion of the time he had protected sexual intercourse and never developed an HIV infection.

[184] Most difficult and incoherent for the accused to engage at any time after July 2011 in a dildo penis penetration significantly risky after he would have told the accused to be careful until the tests were done.

[185] More surprising even when the accused states that the dildo was a larger than usual one and that there was at the same time an ensuing joint penis penetration.

[186] There is a strong reason for complainant to be trustworthy as in July 2005 at the accused residence, not only did complainant allege that it was the time of a joint dildo penis traumatic anal penetration as he only became aware at the last moment that there would be an unprotected penetration.

[187] At the time of the joint dildo penis penetration, the accused thought that complainant had not seen him going to engage in an unprotected penis and dildo penetration. That is a very strong argument that will be weighed against the complainant’s testimony from August on.

[188] If in theory and there is no such admission, complainant would have done so in full awareness after July 2005 and risked that much, he could be qualified of being totally incoherent and reckless.

[189] Strangely enough the accused had said that complainant could not see if he was wearing a prophylactic whereas complainant said he became aware of it as it was happening. The accused version is so surprising and close to total unlikelihood, as he would have been reckless and acting contrary to his own recommendations. He would have done so with the impression that complainant was unaware of the fact apart from the dildo penetration, he was about to have a joint penis penetration.

[190] The different account as to the form of the dildo or as to the position of the sexual partners at that very time is noted but does not help the Court to come to a judgment.

[191] The Court cannot exclude the very light possibility of the anal intercourse at the accused residence not being a joint dildo penis traumatic anal intercourse. It could have been an ordinary anal sexual intercourse that ended up worrying the accused.

[192] This very light possibility of an ongoing risky unprotected anal sex intercourses is so close to being frivolous stems from evidence as a whole and more specifically of the frailties of some of complainant’s questionable or even untrustworthy statements.

[193] Complainant offered some understanding that there had been ongoing sex and an intention to keep on dating although he contests strongly having intended to say that much.

[194] Complainant is also confronted by the gatherings acknowledged although in confused or vague ways by him regarding dating or behaving and being presented as a boyfriend by the accused. The trustworthiness of complainant on his denials of unprotected and protected intercourses after July 2005 is under attack even though he might be right.

[195] A slight doubt surges whether the dildo penis penetration happened in or after the month of July 2011. The Court cannot set aside a light possibility that both kept having unprotected sexual intercourses. Even if unprotected intercourses would objectively surprise, in fact, it is not impossible. Coherence in sexuality is not always evident. The magic thinking about the safety of withdrawal before ejaculation in unprotected anal sex might have to do with that.

[196] The accused testimony and the one of his friends combined to the contradictions and frailties of complainant’s testimony, raise a doubt as to when there was that most significant risky sexual behaviour. On that specifically, the Court reads a doubt as to dates and a doubt benefits the accused regarding that aggravating factor.

[197] Dating may not always include sexual intercourses even if there was some overt expression of affection, of tenderness, of love. It surprises as the accused does not have much of a favourable opinion of complainant and dislikes him sexually. That would tend to undermine any pretences of a love relationship in the public eye of his close friends. But there was dating and a love feeling is not essential for all to become involved sexually.

[198] Also the rental of his residence to complainant may question the accused motivation in dating complainant, his wanting to buy peace and consolidate conditions to avoid any criminal pursuits. It does not mean per se that all of that is illegitimate. It does not set aside the doubt born out of complainant’s frail testimony on his after July gatherings and communications with the accused.

[199] Whatever united the accused and complainant was love as difficult as it could be, as hopeful as it could be, as limited in perspective as it could be, as injured as it could be because of that possibility if not likelihood of complainant being infected by the accused. But, these were two intelligent persons who dealt intimately with one another.

[200] But complainant gave overt reasons to believe that there could be an ongoing intimate relationship, ongoing discussions, ongoing dating, ongoing expression of gestures of sensuality and love after July 2005.

[201] That questions complainant’s coherence as alleged by the accused. Complainant has a credibility gap as to what happened with the accused after July 2005. Complainant’s falling in love with his present partner at the beginning of fall 2005 does not exclude an interim period where both complainant and the accused continued to date one another and still getting involved in more intimate intercourses.

[202] But it is the opinion of the Court that on the whole of the evidence, the lack of trustworthiness of complainant does not affect at all the accused allegation of no unprotected evidence with others at all relevant times before the sauna incidents and after the sauna incidents save for his relationship to the accused.

[203] These doubts do not question complainant’s trustworthy account of the sauna and residence intercourses and non-disclosure and how there was disclosure. These doubts do not extend to complainant’s sexual behaviour with others before and after July 2005. The accused exposed complainant to a significantly risky HIV infection.

[204] These doubts are raising the question of complainant engaging in sexual partnership and sexual intercourses with the accused from August on. Complainant’s trustworthiness lacks specifically there and not on his absence of unprotected sexual intercourse with others and not on his unwillingness to engage sexually with someone HIV infected in July 2005.

[205] Clearly complainant would have never engaged in unprotected significantly risky sexual intercourse with the accused if there had been proper disclosure. There and then the elements of the commission of the infraction were established.

[206] The accused testimony was found to be vague, general, at times relying on their constant sexual practises and even argumentative as to their ongoing unprotected and unprotected intercourses. But complainant’s untrustworthiness on dating and ongoing sex and his very vague testimony some of it that would be understandable alike the one of the accused, does raise a slight doubt on the date of that fatal significant risky joint dildo penis intercourse.

[207] The Court is also puzzled by the testimony of complainant. It is not likely that he kept in touch with the accused solely to keep track of him. They kept on dating and it is confirmed that there was such apparent dating.

[208] Complainant who stated that he got aware at the very last moment that the accused would do on him a dildo penis unprotected penetration is confirmed as to that specific intercourse by the accused who doubts that complainant could see what he was doing. Both have a different description of the position of the accused at the time of that intercourse and of the dildo used and of dildo gifts thereafter. The court does not know who says the truth on positions. It is difficult to believe that the most significant risky HIV joint dildo penis penetration did not happen in July. But that slight possibility cannot be excluded as balance of probabilities is not the test and as complainant’s testimony regarding events after July 2005 has been at times questioned and confused and untrustworthy.

[209] Complainant strangely referred to having friends of whom he did not know the HIV status, as he was not even put the question of him engaging in any sexual intercourses with them for the period of July 2005 to October 2005. He also denies any sexual intercourse with anyone else and he is believed.

[210] Throughout he always said he had no unprotected intercourse with anyone save the July one with the accused and further that he had none after July with the accused. On that a doubt remains because of his declaration as to ongoing sex and wanting to keep dating and because of the frailties and contradicted evidence of complainant in the months of August and October 2005.

[211] It has to be remembered that it was the accused who allegedly wanted not to enter an exclusive sexual relationship with complainant as he had at that time a lover.

[212] Complainant’s behaviour is believed to show ongoing dating. In the course of this lack of credibility of complainant as to dating, a doubt surges regarding ongoing sex practises.

[213] Ongoing sexual intercourses with the accused until October is a possibility that cannot be ruled out. Complainant said so in a question to the accused in his recorded 2006 interrogator as he says in a preamble that they kept having sex and that they wanted to keep on dating.

[214] That is a flaw in complainant’s version that leaves the Court abashed and unable to conclude that the joint dildo penis incident that could indispose complainant could not have happened after July although the accused testimony is close to being on major aspects of the July incidents untrustworthy and questionable. It is not that the accused did not admit to that significant sexual intercourse at least at his residence.

[215] The Court can certainly not infer from the accused being untrustworthy on most aspects his guilt as complainant has himself through his behaviour, and version raised a doubt on the date of the joint dildo penis penetration that was and is fatal on his becoming HIV infected. This is where prosecution fails its burden of establishing the aggravating factor of the accused infecting complainant.

[216] The burden on Prosecution is not a burden of establishing on a balance of probabilities or alike in some other countries that it suffices that the judge has developed a moral conviction of the accused guilt. That is not the test. And it is essential for a justice system and for a perception of justice rendered that the burden of evidence be as it is here, namely that the accused guilt be established beyond a reasonable doubt.

[217] It goes per se that no scientific tests could help decide if the infection was caused by the accused in July or thereafter.

[218] The Court cannot come to a definite conclusion that the fatal unprotected intercourse dated to July or thereafter although there is a very strong possibility with the symptoms that it was caused in July before disclosure.

[219] That questions and raises a doubt as to the denial of complainant on the continuation of the sexual intercourses. Complainant’s denial was radical. It is being questioned by circumstances and a possible truthful allegation of the accused that they did continue to have both protected and unprotected sex. This makes it difficult to believe beyond a reasonable doubt that the first sexual intercourse at the accused residence happened as stated by complainant by a dildo penis penetration or that their sexual encounters ended there. But there is no doubt that there was an anal penetration that per se is a significant risky HIV sexual intercourse even if exposed solely to pre-ejaculatory liquids of the accused.

[220] If that traumatic intercourse would have happened at the residence of the accused and would have indeed scared complainant as he says, it is doubtful that complainant would have continued dating or having unprotected sex or would have kept that way in touch with the accused simply to keep track of him.

[221] Indeed the reasonable possibility cannot be set aside that they kept on having that protected and unprotected sex and that the May and June 2006 testing was passed so late as a consequence of a later than July traumatic sexual intercourse with the accused. It could go both ways time wise. But there is evidence that cannot set aside as complainant has been contradictory and untrustworthy and vague and confused on some of the evidence after July 2005 to August 2005.

[222] That traumatic intercourse could certainly be a source of greater concern for complainant and could also contribute to explain why anyone would delay further a test that could have been passed a few months after the time recommended. Complainant would not have felt as vulnerable after the July intercourse if it was a straightforward unprotected anal intercourse risky but never as much as the one with the dildo and penis penetration. The first negative test of September 2005 could also have tricked both in indulging in more.

[223] After the last June 2006 tests, the October 2006 invitation to the accused to confess with the promise he would be forgiven, trapped him into admitting his responsibility, saying how sorry he was. At the same time, the accused attempted to share the responsibility of whatever went on between the parties.

[224] If there were sexual intercourses after July 2005, complainant is the one who took the ultimate risk and responsibility of been carried in risky sexual behaviour and of being contaminated by the accused HIV infection if it had not already contaminated him.

[225] The Court does not believe in jealousy being key to the criminal pursuits by complainant. Seeking justice certainly prompted the accused to lay a complaint. Complainant appeared a man much hurt and the accused has the right to a verdict that gives way to whatever reasonable doubt flows from all of the evidence heard.

[226] The care complainant took to pass HIV tests every year and the absence of significantly risky sexual behaviour prior to the meeting the accused leaves no doubt that the accused did put at risk the life of complainant in July 2005 as was not disclosed by the accused his HIV positive status.

[227] The state of health of complainant in September is worrying and would permit to anticipate the first symptoms of the HIV infection. But the Court would have readily concluded to the HIV infection of complainant in July 2005 if there had been no doubt whatsoever that the traumatic most significantly risky happened in July 2005 and that these symptoms were associated without any doubt in time to July intercourse.


[228] This case offers a straightforward application of the Cuerrier stay of the Supreme Court of Canada.

[229] Prosecution had to establish beyond a reasonable doubt that the accused’s acts endangered the life of complainant as there was no disclosure, no implicit consent and as complainant would never have accepted to have sexual intercourse with the accused if he had been informed and the significantly unprotected sexual intercourse at the accused residence (section 268 (1) and 272 of the Criminal Code).

[230] Complainant was not infected before meeting the accused. There is evidence to so believe beyond a reasonable doubt that complainant was not then infected. Complainant and the accused engaged in an unprotected sexual intercourse at the accused residence that was significantly risky according to the ruling of Cuerrier. The guilt of the accused is established by the simple exposure of complainant to a significant risk of HIV infection before any disclosure was made, as complainant would never have entered a sexual intercourse with the accused if there had been disclosure by the accused of his HIV infection.

[231] The expert Dr Morrissette stated very clearly that the HIV infection is lethal and endangering life when complainant was sexually assaulted.

[232] The anal unprotected intercourse represented a significant risk just through complainant’s anal exposure to the pre-ejaculatory liquids of the accused.

[233] The Court makes the finding that the accused intentionally applied force against the consent of the complainant. Fraud, dishonesty of the accused sufficed to vitiate consent. That had to be assessed objectively to determine it. This was so as consent was not to simply engage in sexual intercourse but to have sexual intercourse with a partner who was not HIV positive. That dishonesty of the accused had to be such as exposing the complainant to a significant risk of serious bodily harm, as HIV has been so characterised.

[234] As dishonesty has to result in deprivation, both the risk of the HIV infection, AIDS as well as that actual harm meet the test by establishing that that dishonest act had such an effect of exposing complainant to that significant risk of bodily harm.

[235] In this case, the accused who to his knowledge was HIV positive since 2003, did not disclose his HIV positive status at any time before the sexual July 2005 gatherings were through. He knew that he could not irresponsibly put the life of anyone at risk in abstaining disclosing is HIV positive status with significant risky sexual activities.

[236] There was no consent whatsoever by complainant to be exposed to such a risk. Consent had to be clear and unequivocal and such was not the case. There was no contextual implicit consent of complainant that could be inferred subjectively from the whole circumstance. The accused was truly dishonest and exposed complainant to a risk of harm that was not trivial but of serious bodily harm that is fatal, lethal. The accused knew it and admitted he was unable to disclose that dirty little secret.

[237] There was only disclosure once confronted by complainant after an unprotected anal penetration.

[238] The Crown had to show that complainant would have refused to engage in unprotected sex with the accused if he had been advised that the accused was HIV positive. The evidence is to the effect that complainant would not at all have accepted to have any sexual intercourse with the accused if he had been advised. Complainant is believed and trustworthy.

[239] The aggravating factor of the HIV infection of complainant prior to August 2005 is not established beyond a reasonable doubt. In criminal matters, there is one and only one test and probability even to a very high degree is not sufficient for a verdict of guilt. Evidence of guilt has to be established beyond a reasonable doubt. The likelihood of complainant’s version does not suffice on the aggravating factor. Complainant’s version of the evidence regarding the timing of the incident of the dildo penis traumatic sexual anal intercourse is shaken but not defeated or shaken anyway as to its happening. Complainant’s version has been shaken as to the continuation of the sexual partnership after disclosure.

[240] It makes a huge difference that this undoubtful causation of complainant’s HIV infection may have happened only probably in July 2005 before disclosure and nonetheless possibly after disclosure. The trustworthiness of complainant’s version as to most of what happened before disclosure did establish beyond a reasonable doubt the guilt of the accused on the infractions as laid.

[241] The accused did his best to be so nice with complainant so as to deter complainant to lay a complaint to the police and avoid criminal pursuits.

[242] As the Prosecution has demonstrated beyond a reasonable doubt the guilt of the accused by exposing complainant to the HIV infection in engaging with him on one occasion before disclosure in an anal unprotected intercourse, the accused is guilty of the infractions, as the accused has been indicted with. There was an assault at the residence of the accused irrespective of complainant being infected and the accused was not at all HIV positive before the July 2005 sexual assault.

[243] The accused is guilty of either of these infractions. But there will be a stay of proceedings on the count of aggravated assault as this infraction situates rightly the wrongful and illegal behaviour of the accused and this is precisely the whole behaviour of the accused that is denounced.





Me Sarah Henningson, Me Sophie Lamarre


Me Jeffrey Boro


Dates of hearing:

10 December 2009, 28 April, 25 June, 20 and 21 October, 16 December 2010, 29 August 2011

Steve Jobs est-il mort du Sida ?

Friday, October 7th, 2011

Selon Wikileaks, Steve Jobs n’est pas mort en raison d’un cancer… mais suite à des complications liés au Sida !

Et on peut dire que les cyber-libertaires n’ont pas perdu de temps : seulement une minute après l’annonce officielle de la mort de Steve Jobs, le compte Twitter de Wikileaks proposait un lien vers une photo des (supposés) résultats sanguins du fondateur d’Apple.

Ces tests auraient été effectués en 2004 par un laboratoire indépendant et affichent un résultat positif au test HIV… Pour enfoncer le clou, Wikileaks ajoute :

« Steve Jobs suivait un régime alimentaire parfois recommandé aux malades du sida comme une thérapie alternative. »

Néanmoins, le site précise que “ces images ne doivent pas être prises à leur valeur nominale”, ce qui signifient donc que les documents ne sont pas certifiés exacts…

Porn’s New HIV Problem

Saturday, September 3rd, 2011

There was a time when porn was a clubby little industry. The studios were all in Southern California. The filmmakers knew their performers, and the performers, to a large degree, knew each other. Through databases and word-of-mouth, everyone was fairly aware of who they were working with. But in the past few years, this familiarity has vanished—and taken the industry’s sense of security with it.
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This week the porn world suffered its latest HIV scare. It was the second such incident in less than a year—in December, male porn star Derrick Burts tested positive for HIV, sending fear rippling through the industry. Few had heard of Burts when he was identified as “Patient Zeta,” and when this newest patient is identified, there’s a good chance that few will know him or her very well, either.

It’s a sign of the changing nature of the industry. As porn continues to expand in nearly every way—from the number of performers to the variety of studios to the increasingly far-flung locations of the shoots—the people involved have less and less idea of who they’re working with.

“Just a few years ago, I would know any guy in the business,” said one female performer who asked that her name not be used for fear that she would lose work. “And if I did not, I could find out about him with a phone call to friends. I knew if he was sketchy and I didn’t want to work with him. There used to only be a dozen big-name guys in the business, and I’m talking less than 10 years ago. But the Internet, the crossovers (guys who do both gay and straight porn), and the move of the industry away from California has changed that. Now, I show up and it’s all these druggy-looking 18-year-olds who no one knows anything about.”

Another performer who used to shoot exclusively in California now finds she travels as far as Brazil to work. She says it’s reached the point where she no longer knows any guy she works with before the day she meets him to shoot a sex scene.
Of course, the explosion in new male talent began years ago, but at least there was a relatively well-trusted database that performers could rely on to help keep them safe. But that database was maintained by the Adult Industry Medical clinic (AIM) in Los Angeles. AIM, which was the medical testing center for virtually the entire industry, closed in May under the financial strain of lawsuits after the Derrick Burts scare. When AIM was open, if a performer tested positive, a quarantine list could be swiftly generated showing who that performer worked with, who those people he worked with had worked with in turn, and so on.

This shuttering of the AIM database caught the industry with its proverbial pants down, and this is the source of much of the current confusion and fear, according to the adult-industry trade group Free Speech Coalition. “We are putting a system into place to replace AIM, but it is not fully functional yet,” says Diane Duke, the Free Speech Coalition’s executive director. On Aug. 28 the group called for an industry shut down until further notice.

But according to adult star Kristina Rose, the fears plaguing the industry began before the shutdown of AIM.

“I’ve been in the business four years,” says Rose. “I’ve seen it spread out to Florida, Vegas, and everywhere. Also, I have seen the number of male talent increase dramatically. They are all young, good-looking party guys. Honestly, I prefer the good old days when it was the dream team of a few guys you could trust.”

As for its geographical dispersion, Rose says that directors outside of California often operate more under-the-radar, and male performers are frequently chosen based on who’s willing to work for the least amount of money. Her agent, Mark Spiegler, perhaps the most powerful agent in porn, no longer allows any of his clients to do bookings outside of California.

The current scare provides an illustrative example. The rumor is that between two HIV tests, a negative and a positive, a not-particularly well-known male performer in Florida managed to shoot scenes with as many as 13 women. A well-placed source in the industry told The Daily Beast that the actual number of women may, in fact, be as high as 20. Meanwhile, the advocacy group AIDS Healthcare Foundation has filed a complaint with Florida health authorities over the production company they think is responsible. That company shoots in Miami, has offices in Canada and Los Angeles, and is based out of Luxembourg.

Taiwan prosecutors probe HIV organ transplants

Saturday, September 3rd, 2011

Physicians at a hospital in Taiwan that mistakenly transplanted four patients with HIV-infected organs may face criminal prosecution, an official said Friday.

The doctors involved may face up to 10 years in prison if found to have caused patients to contract the HIV virus by negligence, Taipei Prosecutors’ Office spokesman Lin Wen-teh said.

Last week, Taipei’s National Taiwan University Hospital performed the transplants of the liver, lungs and two kidneys from a donor it mistakenly believed was HIV negative. Another facility, National Chengkung University Hospital, transplanted the heart into a patient there based on NTUH’s information.

NTUH, one of Taiwan’s best medical institutions, said a staffer misheard the donor’s test results as “non-reactive” when the English word “reactive” was actually given, meaning the donor had HIV. The information was given by telephone, and the hospital admitted the donor’s HIV status was not double-checked as standard procedure required.

The head of the university hospital’s transplant department, Ke Wen-che, resigned Thursday to take responsibility for the blunder. He said he was responsible for the transplant program in its entirety, and declined to blame either the staffer who mishandled the HIV information, or other physicians directly involved in the transplant procedures.

Meanwhile, the Health Department is also looking into the mistake.

But department official Shih Chung-liang says it would be improper to put all the blame on the staffer who mishandled the HIV test results.

Still, he said, if negligence is found to have caused the blunder, NTUH may have to suspend its transplant programs for up to a year in addition to paying unspecified fines.

NTUH has not disclosed if the organ recipients have tested positive for HIV. But health experts say it’s likely they will be infected and it will complicate their treatment.