Criminal prosecutions involving HIV: What is the policy agenda?


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An overview of policy issues related to Criminal prosecutions involving HIV transmission by Darryl O'Donnell, NSW Health. This presentation was given at AFAO's May 2009 General Meeting.

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Criminal prosecutions involving HIV: What is the policy agenda?

  1. 1. Darryl O’Donnell Manager, HIV and Sexually Transmissible Infections Unit NSW Department of Health 8 May 2009 Criminal Prosecutions Involving HIV – What is the Policy Agenda? AFAO General Meeting and Workshop
  2. 2. Overview <ul><li>Recent public policy responses </li></ul><ul><ul><li>National Guidelines </li></ul></ul><ul><li>Criminalisation – what do we mean? </li></ul><ul><li>Prosecutions – is there a trend? </li></ul><ul><li>Defining the policy response </li></ul><ul><li>Options for future community action </li></ul>
  3. 3. Recent Public Policy Responses <ul><li>Griew Review </li></ul><ul><li>Trigger – Public health response in Victoria and South Australia </li></ul><ul><ul><li>Not a “concern about increasing numbers of prosecutions” </li></ul></ul><ul><li>Public questioning of sufficiency / effectiveness / competence of public health action </li></ul><ul><li>HIV is (still) different. Today, the difference is latent. </li></ul><ul><li>Blood-Borne Viruses and STIs Sub-Committee-led response </li></ul><ul><li>‘ New’ distinction made between ‘unwilling’ and ‘unable’ </li></ul><ul><li>Clearer protocols for referral to the police </li></ul><ul><li>Police action does not obviate public health action. </li></ul><ul><ul><li>Parallel, distinct, independently operating systems. </li></ul></ul><ul><li>Preserving public confidence via effective control is a shared interest </li></ul>
  4. 4. National Guidelines <ul><li>National Guidelines preserve (?and strengthen) underlying principles </li></ul><ul><ul><li>voluntary testing; </li></ul></ul><ul><ul><li>non-exclusion from social and sexual activities; </li></ul></ul><ul><ul><li>responsibility for protecting self and others; </li></ul></ul><ul><ul><li>people with HIV are motivated to prevent transmission; </li></ul></ul><ul><ul><li>information, education and resources; </li></ul></ul><ul><ul><li>graded intervention avoiding premature escalation; </li></ul></ul><ul><ul><li>equitable and transparent dealing and review and appeal; </li></ul></ul><ul><ul><li>separation of public health and law enforcement. </li></ul></ul><ul><li>Significant principles within the review context </li></ul><ul><li>[Not a stepwise approach, but the right measure relative to the assessed risk] </li></ul><ul><li>Endorsed by Australian Health Minister’s Conference </li></ul><ul><li>Guidelines as a recommitment to the effective Australian partnership approach </li></ul><ul><li>Guidelines do not suggest a shift to a most conservative posture </li></ul>
  5. 5. Criminalisation <ul><li>A verb. A process. But from what to what? </li></ul><ul><ul><li>lawful to criminal? </li></ul></ul><ul><ul><li>rare / non-occurring to occurring? </li></ul></ul><ul><ul><li>un-prosecuted to prosecuted? </li></ul></ul><ul><ul><li>private to public? </li></ul></ul><ul><li>What is the matter that is becoming criminal? </li></ul><ul><ul><li>Sex by people with HIV? Unprotected sex by people with HIV? </li></ul></ul><ul><ul><li>(Failure to prevent / be responsible for) infection of others? </li></ul></ul><ul><li>Who is criminalising this? Government? Police? Prosecution? Courts? How? </li></ul><ul><li>Who is being criminalised? </li></ul><ul><ul><li>All people with HIV? Heterosexual people with HIV? </li></ul></ul><ul><ul><li>Transgressive people with HIV? </li></ul></ul><ul><ul><li>Is HIV a side matter? </li></ul></ul><ul><ul><ul><li>?Criminalisation of deception, intent to cause harm, failure to protect others </li></ul></ul></ul><ul><ul><ul><li>?Affront to community norms (preponderance of heterosexual prosecutions) </li></ul></ul></ul><ul><li>What should be criminal? Does this match current law? Does this match current prosecutions? </li></ul>
  6. 6. Prosecutions <ul><li>Increasing number of cases, but arguably not a singular trend </li></ul><ul><li>Vic: n=12 of 20, including all 7 Australian cases pre-2002. 2002 onwards – Vic: n=5; all other (n= ≤2 each) </li></ul><ul><li>Why the disproportionate prosecutions / continuation in Victoria? </li></ul><ul><li>Why the emergence of prosecutions elsewhere since 2007? </li></ul><ul><li>May require examination of individual cases (including trigger / pathway): </li></ul><ul><ul><li>?Increasing number of heterosexual infections </li></ul></ul><ul><ul><li>?Earlier detection and increasing life expectancy of complainant and accused </li></ul></ul><ul><ul><li>?Reduced stigma and shame for complainant </li></ul></ul><ul><ul><li>?Increased awareness of rights at law </li></ul></ul><ul><ul><li>?Co-incidence of HIV offences with other offences </li></ul></ul><ul><li>Police action and successful prosecution requires a complainant. </li></ul><ul><li>Criminal law is not a public health instrument. What is its function? </li></ul><ul><li>Police and prosecutors are not responsible for public health. </li></ul><ul><li>But prosecutions (actually, media commentary) does impact on public health response. How? </li></ul>
  7. 7. Defining the Policy Response <ul><li>Form follows function. </li></ul><ul><li>Is the ‘problem’ clear? Is it a single problem? </li></ul><ul><li>Either way, what is / are the problem to be solved? </li></ul><ul><ul><li>Fewer offences? </li></ul></ul><ul><ul><li>Better legislation? </li></ul></ul><ul><ul><li>Fewer prosecutions? </li></ul></ul><ul><ul><li>Better / reduced media coverage of prosecutions? </li></ul></ul><ul><li>Solution varies by problem. </li></ul><ul><li>Is the solution acceptable to your community / the wider community? </li></ul><ul><li>Who should take this action. </li></ul><ul><li>Legal advocacy / defence is different to community representation. </li></ul>
  8. 8. Policy Directions <ul><li>Responding to Prosecutions / Criminalisation </li></ul><ul><li>What outcome would be achieved through increased cooperation between police and public health officials? </li></ul><ul><li>Less interaction / more separation of criminal and public health action may be desirable (anti-whole-of-Government). </li></ul><ul><li>Supporting public health action </li></ul><ul><li>Effective public health management can obviate referral to police </li></ul><ul><li>Unguided advocacy may re-position community from a partnering to adversarial role </li></ul><ul><li>Best public health outcomes will be achieved with community partners inside the problem </li></ul><ul><ul><li>Complex needs and co-morbidities </li></ul></ul><ul><ul><li>Multiple disadvantage and marginality </li></ul></ul><ul><ul><li>Peer education and norms </li></ul></ul><ul><ul><li>Maximising graduation of escalation </li></ul></ul><ul><ul><li>Providing practical support </li></ul></ul><ul><ul><li>Community level action as a response to individual behaviour </li></ul></ul><ul><ul><li>Preserving a successful community-lead response to HIV </li></ul></ul><ul><ul><li>Contextualising risk in a context of personal and community commitment to prevention </li></ul></ul><ul><li>Addressing jurisdictional variance – a continuing task. </li></ul>