Sexual transmission of HIV and the law: an Australian medical consensus statement

Boyd, Mark; Cooper, David; Crock, Elizabeth A; Crooks, Levinia; Giles, Michelle L; Grulich, Andrew; Lewin, Sharon R; Nolan, David; Yarwood, Trent

doi:10.5694/mja16.00934

Topics

Abstract

Introduction: Criminal cases involving human immunodeficiency virus transmission or exposure require that courts correctly comprehend the rapidly evolving science of HIV transmission and the impact of an HIV diagnosis. This consensus statement, written by leading HIV clinicians and scientists, provides current scientific evidence to facilitate just outcomes in Australian criminal cases involving HIV.

Main recommendations: Caution should be exercised when considering charges or prosecutions regarding HIV transmission or exposure because:

Scientific evidence shows that the risk of HIV transmission during sex between partners of different HIV serostatus can be low, negligible or too low to quantify, even when the HIV-positive partner is not taking effective antiretroviral therapy, depending on the nature of the sexual act, the viral load of the partner with HIV, and whether a condom or pre-exposure prophylaxis is employed to reduce risk.
The use of phylogenetic analysis in cases of suspected HIV transmission requires careful consideration of its limited probative value as evidence of causation of HIV infection, although such an approach may provide valuable information, particularly in relation to excluding HIV transmission between individuals.
Most people recently infected with HIV are able to commence simple treatment providing them a normal and healthy life expectancy, largely comparable with their HIV-negative peers. Among people who have been diagnosed and are receiving treatment, HIV is rarely life threatening. People with HIV can conceive children with negligible risk to their partner and low risk to their child.

Changes in management as result of the consensus statement: Given the limited risk of HIV transmission per sexual act and the limited long term harms experienced by most people recently diagnosed with HIV, appropriate care should be taken before HIV prosecutions are pursued. Careful attention should be paid to the best scientific evidence on HIV risk and harms, with consideration given to alternatives to prosecution, including public health management.

1 Lyell McEwin Hospital, University of Adelaide, Adelaide, SA
2 Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine, Sydney, NSW
3 Kirby Institute, University of New South Wales, Sydney, NSW
4 Australian and New Zealand Association of Nurses in AIDS Care, Melbourne, VIC
5 La Trobe University, Melbourne, VIC
6 Monash University, Melbourne, VIC
7 Peter Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital, Melbourne, VIC
8 Royal Perth Hospital, Perth, WA
9 Cairns Hospital, Cairns, QLD

Correspondence: Levinia.Crooks@ashm.org.au

Acknowledgements:

On behalf of all the authors: for the full author list, see the Appendix at mja.com.au. Endorsed by the Australasian Society for Infectious Diseases (ASID) and the Australian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM).

Competing interests:

Mark Boyd receives grant funding and honoraria for preparation and delivery of educational materials from AbbVie, Merck, Gilead, Bristol-Myers Squibb, Janssen-Cilag and ViiV Healthcare. Levinia Crooks receives a fee from Gilead for sitting on their fellowship committee; the full fee is allocated to the ASHM International Gift Fund. Andrew Grulich has acted as an expert witness in legal cases concerning HIV transmission. Andrew Redmond is a board member of the HIV Foundation Queensland.

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