Ignorance is bliss? HIV and moral duties and legal duties to forewarn

Abstract

In 1997, a court in Cyprus jailed Pavlos Georgiou for fifteen months for knowingly infecting a British woman, Janet Pink, with HIV-1 through unprotected sexual intercourse. Pink met Georgiou in January 1994 whilst on holiday. She discovered that she had contracted the virus from him in October 1994 but continued the relationship until July 1996 when she developed AIDS. She returned to the UK for treatment and reported Georgiou to the Cypriot authorities.1There have been a number of legal cases involving deliberate transmission of HIV, but most have involved forced exposure to infected bodily fluids for example, rape or biting, and have been dealt with using the existing legislation for rape or assault. While it is often difficult to prove responsibility for transmission in cases of forced exposure to HIV, it is even more contentious in cases like those of Janet Pink where an individual has consented to sex but claims that he/she was not forewarned of his/herpartner's HIV-positive status. At present there is no specific criminal offence of having unprotected sexual intercourse without disclosing one's HIV-positive status but a prosecution could possibly be brought under any one of a number of existing offences.2Perhaps a change of policy needs to be considered. The Home Office has issued a consultation document which outlines a proposal that will allow the criminalisation of intentional transmission of diseases, like HIV, that are likely to cause serious harm. This revised legislation would cover all other potentially fatal diseases (including salmonella and legionnaire's disease, for instance) but seems primarily to be targeted at HIV transmission. Should transmission of HIV through consensual sex, without the HIV-positive status of the individual being disclosed, be an offence? This question, and that of whether there is a moral obligation to disclose a positive HIV status prior to having a sexual relationship is the subject of this paper.

Consistent, inconsistent, and non-disclosure to casual sexual partners among HIV-seropositive gay and bisexual men

“…For those who test seropositive, a major focus of HIV post-test counseling revolves around notifying past sexual partners and encouraging individuals to disclose their HIV status to future sexual partners [1]. Sex without disclosure raises a variety of ethical concerns, particularly in terms of denying an uninfected partner the opportunity to make an informed choice regarding acceptable levels of risk [2][3][4]. Given this concern, some public health officials have argued that disclosure to sexual partners is necessary in all cases [5,6].…”

Correlates of sex without serostatus disclosure among a national probability sample of HIV patients

“…Bruner holds that widely shared moral values emphasizing the need to take care of one another compel disclosing HIV-positive status to sex partners (Bruner, 2004). Others write that within sexual partnerships, the possibility that a partner will assume seronegativity obligates HIV-positive disclosure (Bennett, Draper, & Frith, 2000). Individuals with HIV themselves have affirmed, in qualitative interviews, that issues of moral responsibility and informed consent obligate disclosure to sexual partners in certain situations (Klitzman & Bayer, 2003;Sobo, 1995).…”

Examining the Role of Serostatus Disclosure on Unprotected Sex Among People Living with HIV

“…Several reasons underlie serostatus disclosure as one possible component of risk reduction. Serostatus disclosure provides an opportunity for sexual partners to make informed decisions about a tolerable level of transmission risk, 8 leading them to either decide to forego sexual activity or to engage in deliberately safer sexual behaviors. From a public health perspective, disclosing to a sexual partner may prompt those who are unaware of their HIV status to seek testing.…”