Matthew Weait

HIV forensics: pitfalls and acceptable standards in the use of phylogenetic analysis as evidence in criminal investigations of HIV transmission

Phylogenetic analysis – the study of the genetic relatedness between HIV strains – has recently been used in criminal prosecutions as evidence of responsibility for HIV transmission. In these trials, the expert opinion of virologists has been of critical importance.

Intimacy and responsibility: the criminalisation of HIV transmission

Book synopsis: In what circumstances and on what basis, should those who transmit serious diseases to their sexual partners be criminalised? In this new book Matthew Weait uses English case law as the basis of a more general and critical analysis of the response of the criminal courts to those who have been convicted of transmitting HIV during sex. Examining cases and engaging with the socio-cultural dimensions of HIV/AIDS and sexuality, he provides readers with an important insight into the way in which the criminal courts construct the concepts of harm, risk, causation, blame and responsibility. Taking into account the socio-cultural issues surrounding HIV/AIDS and their interaction with the law, Weait has written an excellent book for postgraduate and undergraduate law and criminology students studying criminal law theory, the trial process, offences against the person, and the politics of criminalisation. The book will also be of interest to health professionals working in the field of HIV/AIDS genito-urinary medicine who want to understand the issues that may face their clients and patients.

Partners of people on ART - a New Evaluation of the Risks (The PARTNER study): design and methods

BackgroundIt is known that being on antiretroviral therapy reduces the risk of HIV transmission through sex. However it remains unknown what the absolute level of risk of transmission is in a person on ART with most recent measured HIV plasma viral load<50 c/mL in the absence of condom use. There are no data on risk of transmission for anal sex in MSM when the index partner is on ART.Methods/DesignThe PARTNER study is an international, observational multi-centre study, taking place from 2010 to 2014 in which HIV serodifferent partnerships who at enrolment reported recently having had condom-less vaginal or anal sexual intercourse are followed over time, with 46 monthly reporting of transmission risk behaviour through a confidential self completed risk behaviour questionnaire and with 46 monthly HIV testing for the HIV negative partner. The objective is to study (i) the risk of HIV transmission to partners, in particular in partnerships that continue not to use condoms consistently and the HIV-positive partner is on therapy with a viral load<50 copies/mL and (ii) why some partnerships do not use condoms, to describe the proportion who begin to adopt consistent condom use, and factors associated with this. For any negative partner who becomes infected phylogenetic analysis will be used following anonymisation of the samples to assess if transmission had been from the HIV infected partner.DiscussionThis observational study will provide missing information on the absolute risk of HIV transmission for both vaginal and anal sex when the index case is on ART with a VL<50 copies/mL in the absence of condom use.

Keeping confidence: HIV and the criminal law from HIV service providers’ perspectives

We present qualitative research findings about how perceptions of criminal prosecutions for the transmission of HIV interact with the provision of high-quality HIV health and social care in England and Wales. Seven focus groups were undertaken with a total of 75 diverse professionals working in clinical and community-based services for people with HIV. Participants’ understanding of the law in this area was varied, with many knowing the basic requirements for a prosecution, yet lacking confidence in the best way to communicate key details with those using their service. Prosecutions for HIV transmission have influenced, and in some instances, disrupted the provision of HIV services, creating ambivalence and concern among many providers about their new role as providers of legal information. The way that participants approached the topic with service users was influenced by their personal views on individual and shared responsibility for health, their concerns about professional liability and their degree of trust in non-coercive health promotion approaches to managing public health. These findings reveal an underlying ambivalence among many providers about how they regard the interface between criminal law, coercion and public health. It is also apparent that in most HIV service environments, meaningful exploration of practical ethical issues is relatively rare. The data presented here will additionally be of use to managers and providers of HIV services in order that they can provide consistent and confident support and advice to people with HIV.

HIV-related restrictions on entry, residence and stay in the WHO European Region: a survey.

BackgroundBack in 1987, the World Health Organization (WHO) concluded that the screening of international travellers was an ineffective way to prevent the spread of HIV. However, some countries still restrict the entrance and/or residency of foreigners with an HIV infection. HIV-related travel restrictions have serious implications for individual and public health, and violate internationally recognized human rights. In this study, we reviewed the current situation regarding HIV-related travel restrictions in the 53 countries of the WHO European Region.MethodsWe retrieved the country-specific information chiefly from the Global Database on HIV Related Travel Restrictions at hivtravel.org. We simplified and standardized the database information to enable us to create an overview and compare countries. Where data was outdated, unclear or contradictory, we contacted WHO HIV focal points in the countries or appropriate non-governmental organizations. The United States Bureau of Consular Affairs website was also used to confirm and complement these data.ResultsOur review revealed that there are no entry restrictions for people living with HIV in 51 countries in the WHO European Region. In 11 countries, foreigners living with HIV applying for long-term stays will not be granted a visa. These countries are: Andorra, Armenia, Cyprus (denies access for non-European Union citizens), Hungary, Kazakhstan, Moldova, the Russian Federation, Tajikistan, Turkmenistan, Ukraine and Uzbekistan. In Uzbekistan, an HIV-positive foreigner cannot even enter the country, and in Georgia, we were not able to determine whether there were any HIV-related travel restrictions due to a lack of information.ConclusionsIn 32% of the countries in the European Region, either there are some kind of HIV-related travel restrictions or we were unable to determine if such restrictions are in force. Most of these countries defend restrictions as being justified by public health concerns. However, there is no evidence that denying HIV-positive foreigners access to a country is effective in protecting public health. Governments should revise legislation on HIV-related travel restrictions. In the meantime, a joint effort is needed to draw attention to the continuing discrimination and stigmatization of people living with HIV that takes place in those European Region countries where such laws and policies are still in force.

Overcoming obstacles to late presentation for HIV infection in Europe.

The central goal of the HIV in Europe Initiative is to promote testing and treatment throughout Europe and Central Asia in order to decrease the number of people living with HIV presenting late for care. This article summarizes the results from the HIV in Europe 2009 Conference and the early results of the projects set up by the initiative, and discusses their implications for the future.

Overcoming obstacles to late presentation for HIV infection in Europe

The central goal of the HIV in Europe Initiative is to promote testing and treatment throughout Europe and Central Asia in order to decrease the number of people living with HIV presenting late for care. This article summarizes the results from the HIV in Europe 2009 Conference and the early results of the projects set up by the initiative, and discusses their implications for the future.

Unsafe law: health, rights and the legal response to HIV

This paper describes the ways in which, over the past three decades, law has come to serve as an obstacle in the fight against HIV, and how it contributes to the stigmatisation of, and discrimination against, people living with the virus. It argues that in order to make unsafe law safer, policy-makers, legislators and those responsible for the interpretation and enforcement of law must base their HIV response not on populist morality but on the strong evidence base provided by three decades of clinical, scientific and social research. Drawing on that research and the authors own involvement in policy development in this area, it suggests that rights-based arguments are, while important, insufficient as the basis for delivering the changes that are necessary, discusses the difficulties involved in achieving those changes, and argues that legal scholarship and research has an important role to play in HIV activism and combating the global epidemic.

Swans reflecting elephants: Imagery and the law

Using legal and literary theory he article explores the ways in which metaphor is used in legal discourse to reflect and refract the real world of corporate crime.

Keeping Confidence: Identifying resources

Keeping Confidence: HIV and the criminal law from service provider perspectives Duration: June 2012 - March 2013 The Monument Trust generously funded Sigma Research at London School of Hygiene and Tropical Medicine and Birkbeck College to undertake a qualitative study on perceptions of criminal prosecutions for HIV transmission among HIV service providers. Five short reports outlining the key findings of the study focus on the main themes arising from our analysis of the focus group discussions. The findings and associated policy and practice recommendations will be of interest to: those who provide HIV health and social care and their professional bodies (for instance NHIVNA, CHIVA, BHIVA, BASHH, SSHA, BPS), police and others who play a role in criminal investigations and trials, and people with diagnosed HIV. Catherine Dodds, Matthew Weait, Adam Bourne, Siri Egede, Kathie Jessup and Peter Weatherburn.