Responding to the Criminalization of
HIV Transmission or Exposure
Resources for lawyers and advocates
In response to the increasing use of criminal law internationally, as well as to the great need to develop tools for lawyers representing people living with HIV, this kit provides both informative documentation to support lawyers in the preparation of their cases and selected publications that can ultimately be presented in court.
Prepared by: Canadian HIV/AIDS Legal Network, AIDES,
Groupe sida Genève, Global Network of People Living with HIV (GNP+)
Please note: Resources published prior to October 2012 that describe the current state of the criminal law as it relates to HIV non-disclosure in Canada do not take into account the recent Supreme Court of Canada decisions in R. v. Mabior and R. v. D.C. We are presently working to update all our resources in accordance with these decisions.
Table of Contents
1. Living with HIV
This section provides an overview of the evolution of the epidemic since 1984 and a discussion of the impact of an HIV-positive diagnosis on individuals’ lives worldwide. It includes a chronology of the epidemic and information on the medical implications and social aspects of living with HIV (family, employment, disclosure, sexual relationships, etc.), taking into account the differences in accessing treatments between high- and low-income countries.
2. HIV transmission: the science
This section provides a detailed and fully referenced compilation of the latest scientific evidence and materials regarding treatment, per-act risks of HIV transmission and proving actual HIV transmission from one person to another.
Review and analysis of available scientific research on the risk of HIV transmission during sexual relations
Significant scientific studies and expert statements on the risks of HIV transmission
- Loutfy M.R., Wu W., Letchumanan M., Bondy L., Antoniou T., et al. (2013) “Systematic Review of HIV Transmission between Heterosexual Serodiscordant Couples where the HIV-Positive Partner Is Fully Suppressed on Antiretroviral Therapy.” PLoS ONE 8(2): e55747. doi:10.1371/journal.pone.0055747
- The British HIV Association (BHIVA) and the Expert Advisory Group on AIDS (EAGA), "Position statement on the use of antiretroviral therapy to reduce HIV transmission," January 2013.
- M.S. Cohen, et al., “Prevention of HIV-1 Infection with Early Antiretroviral Therapy,” The New England Journal of Medicine 365(2011): pp. 493–505. (Related news release: United States National Institutes of Health, “Treating HIV-infected people with antiretrovirals significantly reduces transmission to partners: Findings result from NIH-funded international study,” May 12, 2011.)
- S. Attia, et al., “Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis,” AIDS 23 (2009): pp. 1397–1404. (Abstract)
- C. Combescure, et al., “How reliable is an undetectable viral load,” HIV Medicine 10 (2009): pp. 470–476.
- T. C. Quinn, et al., “Viral load and heterosexual transmission of human immunodeficiency virus type 1,” The New England Journal of Medicine 342, 13 (2000): pp. 921–929.
- C. D. Pilcher, et al., “Brief but efficient: acute HIV infection and the sexual transmission of HIV,” The Journal of Infectious Diseases 189 (2004): pp. 1785–1792.
- D. P. Wilson, et al., “Relation between HIV viral load and infectiousness: a model-based analysis,” The Lancet 372 (2008): pp. 314–320.
Reprinted from The Lancet 372 (2008), with permission from Elsevier. Available at http://www.sciencedirect.com/science/journal/01406736
- D. Donnell, et al., “Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis,” The Lancet (27 May 2010) via www.thelancet.com. (Abstract)
- J. Del Romero, et al., “Combined antiretroviral treatment and heterosexual transmission of HIV-1: cross sectional and prospective cohort study,” British Medical Journal 340, c2205: pp. 1–8.
- P. Vernazza, et al., “Les personnes séropositives ne souffrant d’aucune autre MST et suivant un traitement antirétroviral efficace ne transmettent pas le VIH par voie sexuelle,” Bulletin des médecins suisses 89, 5 (2008): pp.165–169. (PDF contains original French version, unofficial English translation, and translator's affidavit.)
- Conseil National du Sida, Opinion and recommendations regarding the potential for treatment as an innovative tool for fighting the HIV epidemic, April 9, 2009
- Deutsche Aids-Hilfe e.V. (DAH), HIV therapy and prevention, April 2009.
- S. C. Weller and K. Davis-Beaty, “Condom effectiveness in reducing heterosexual HIV transmission (Review),” Cochrane Database of Systematic Reviews 1 (2002) No.: CD003255. DOI: 10.1002/14651858.CD003255. (Abstract)
- K. K. Holmes, R. Levine, and M. Weaver, “Effectiveness of condoms in preventing sexually transmitted infections,” Bulletin of the World Health Organization 82, 6 (2004): pp. 454–461.
Biting and spitting
Risks of HIV transmission — general
- K. A. Powers, et al., “Rethinking the heterosexual infectivity of HIV-1: a systematic review and meta-analysis,” The Lancet Infectious Diseases 8, 9 (2008): pp. 553–563.
Reprinted from The Lancet Infectious Diseases 8, 9 (2008), with permission from Elsevier. Available at http://www.sciencedirect.com/science/journal/14733099
- M. C. Boily, et al., “Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies,” The Lancet Infectious Diseases 9, 2 (2009): pp.118–129.
Reprinted from The Lancet Infectious Diseases 9, 2 (2009), with permission from Elsevier. Available at http://www.sciencedirect.com/science/journal/14733099
- F. Jin, et al., “Per-contact probability of HIV transmission in homosexual men in Sydney in the era of HAART,” AIDS 24(6) (2010): pp. 907–13.
Scientific evidence on proving actual transmission of HIV
- NAM (London, UK), National AIDS Trust (London, UK), E. J. Bernard, et al., The
use of phylogenetic analysis as evidence in criminal investigation of HIV transmission, February 2007.
- E. J. Bernard, et al., “HIV forensics: pitfalls and acceptable standards in the use of phylogenetic analysis as evidence in criminal investigations of HIV transmission,” HIV Medicine 8, 6(2007): pp. 382–387.
- E. J. Bernard, “Claims that phylogenetic analysis can prove direction of transmission are unfounded, say experts,” Aidsmap News, November 24, 2010.
- NAT (National AIDS Trust), E. Bernard, et al., Estimating the likelihood of recent HIV infection — implications for criminal prosecution, July 2011.
- A. B. Abecasis, et al, “Science in court: the myth of HIV fingerprinting,” The Lancet Infectious Diseases 11(2) (2011): pp. 78–79, available at www.thelancet.com.
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3. HIV/AIDS in a legal context: the use of criminal law in cases of HIV transmission or exposure
This section provides an overview of the debate regarding the criminalization of HIV transmission and exposure, through the lens of commentary in the media, criminal defence lawyers, and academics and policy experts. It includes diverse materials describing the challenges associated with the use of criminal law in cases of HIV transmission and/or exposure, as well as the impact of criminalization on public health and human rights.
Selected press articles
- S. Syms, “Beyond the Courts — Criminalization of HIV: How do we stop the spread of HIV without dividing our communities?” Xtra, October 1, 2009.
- « Transmission du VIH : La pénalisation dans tous ses États », Le journal du Sida, August 2007, no. 198.
- « Le seul coupable, c’est le virus du sida », Interview de Bruno Spire, président de AIDES, Le Figaro, 2 June 2008.
- « Sida, victimes contre victimes », Christian Saout, président de AIDES, Le Monde, 10 March 2005.
- C. Focas, « Un séropositif qui se soigne est-il inoffensif ? », Tribune de Genève, 20-21 May 2009.
- « Afrique : les séropositifs des criminels potentiels ? », Transversal, 16 February 2006, no. 29.
- E. Favereau, « Sida: Quand la contamination devient crime » , Libération, 12 April 2007.
- T. Rumley, « Sida : La suisse pionnière de la dépénalisation », L’hebdo, 20 May 2009.
Research and policy documents
- Open Society Institute, Ten reasons to oppose the criminalization of HIV exposure or transmission, 2008.
- R. Jürgens, et al., “Ten reasons to oppose the criminalization of HIV exposure or transmission,” Reproductive Health Matters 17(34) (2009): pp.163-172. (Abstract)
- J. Csete, R. Pearshouse, and A. Symington., “Vertical HIV transmission should be excluded from criminal prosecution,” Reproductive Health Matters, 17(34) (2009): pp. 154–162. (Abstract)
- S. Burris, et al., “Do criminal law influence HIV risk behaviour? An empirical trial,” Ariz. State Journal 39 (2007): pp. 467–520.
- E. Cameron, “Criminalization of HIV transmission: poor public health policy,” HIV/AIDS Policy and Law Review 14(2) (2009).
- B. G. Brenner, et al., “High rates of forward transmission events after acute/early HIV-1 infection,” The Journal of Infectious Disease 195 (2007): pp. 951–959.
- C. L. Galletly and S. D. Pinkerton, “Conflicting messages: How criminal HIV disclosure laws undermine public health efforts to control the spread of HIV,” AIDS Behav. 10 (2006): pp 451–461. (Abstract)
- Athena Network, Ten reasons why criminalization of HIV exposure of transmission harms women, 2009.
- R. Lowbury and G. R. Kinghorn, “HIV transmission as a crime. Criminal prosecutions for HIV transmission threaten public health,” Student BMJ, 14 (2006): editorial.
4. International recommendations on the criminalization of HIV transmission and exposure
This section provides the recommendations of the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) on the use of criminal law in cases of HIV transmission and/or exposure.
- Global Commission on HIV and the Law, HIV and the Law: Risks, Rights and Health, UNDP HIV/AIDS Group, July 2012 (Recommendations 2.1 to 2.5). (Complete document)
- UNAIDS, Policy brief: criminalization of HIV transmission, August 2008.
- WHO, Technical consultation in collaboration with the European AIDS treatment group and AIDS Action Europe on criminalization of HIV and other sexually transmitted infections, October 16, 2006.
- UNAIDS, International Guidelines on HIV/AIDS and Human Rights (2006 Consolidated Version).
- UN, General Assembly, Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Anand Grover, Human Rights Council, Fourteenth session, Agenda item 3, A/HRC/14/20, April 27, 2010.
- UNAIDS, Expert Meeting on the Scientific, Medical, Legal and Human Rights Aspects of Criminalization of HIV Non-Disclosure, Exposure and Transmission, meeting report, Geneva, 31 August – 2 September 2011.
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5. Key court decisions internationally
This section provides a compilation of key court decisions on significant and developing issues, including the impact of treatment and the use of condoms on criminal liability.
- R. v. Cuerrier,  2 S.C.R. 371. (Canada)
- R. v. Mabior (C.L.), 2010 MBCA 93. (Canada)
- New Zealand Police v. Dalley,  22 C.R.N.Z. 495.
- “S” v. Procureur Général, Arrêt, 23 février 2009 (Chambre pénale) (Genève, Suisse). (PDF contains original French judgment, unofficial English translation, and translator's affidavit.)
Note: Further appeal dismissed on other grounds, Tribunal Fédéral, Arrêt du 30 juin 2009, 6B_260).
- R. v. Edwards, 2001 NSSC 80. (Canada)
- “AA” Case, Supreme Court of the Netherlands, 18 January 2005, Criminal Section no. 02659/03 IV/SB.
Lawyers should be aware of another Canadian case
regarding viral load: R. v. Wright, 2009 BCCA 514, where the British Columbia Court of Appeal accepted that viral load, when it is known or can be estimated, is very relevant in determining the risk of transmission, but decided that, in the absence of evidence of the accused’s viral load, an average estimate of the risk of transmission based on average viral loads is sufficient evidence for conviction.
6. Criminal law and HIV transmission and exposure at the national level
This section provides detailed descriptions of the applicable national laws on HIV transmission and/or exposure, key decisions from national courts (some also included above in section 5), as well as articles from the relevant legal literature. It focuses on
three countries — namely Canada, France and Switzerland; however, information on the criminal law of other countries can be found in section 7, “Additional resources”.
N.B.: A Canadian sentencing chart is available for defence lawyers, upon request. Please contact Cécile Kazatchkine at ckazatchkine [at] aidslaw.ca.
Summary of current law
- Canadian HIV/AIDS Legal Network, "Country summary and analysis", published in Canadian HIV/AIDS Legal Network for GNP+, Criminalization of HIV Exposure: Canada, January 2010.
Key national cases
- R. v. Mabior, 2012 SCC 47.
- R. v. D.C., 2012 SCC 48.
- R. v. Cuerrier,  2 S.C.R. 371.
- R. v. Williams,  2 S.C.R. 134.
- R. v. Mabior, 2008 MBQB 201.
- R. v. Mabior (C.L.), 2010 MBCA 93.
- R. c. D.C., 2010 QCCA 2289.
- R. v. Edwards, 2001 NSSC 80.
- R. v. Wright, 2009 BCCA 514.
- R. v. Nduwayo, 2006 BCSC 1972.
- R. v. Nduwayo, 2010 BCSC 1277.
- R. v. J.A.T., 2010 BCSC 766.
- R. v. J.U., 2011 ONCJ 457.
- R. v. Agnatuk-Mercier,  O.J. 4729 (QL).
- R. c. D.C.,  J.Q. 994 (QL).
- R. v. Smith,  S.J. 166 (QL).
- R. v. J.T., 2008 BCCA. 463.
- R. v. Aziga, (4 April 2009), Hamilton CR-08-1735.
- R. v. Imona-Russell, Unreported, Reasons for Judgment, 23 February 2009.
- R. v. Jones,  N.B.J. 375 (QL).
- R. v. Bear, 2011 MBQB 191. (Spitting case)
- R. v. Ratt, 2012 SKPC 154. (Spitting case)
- Canadian HIV/AIDS Legal Network, Criminal Law and HIV, Info sheets.
- Canadian HIV/AIDS Legal Network, HIV non-disclosure and Canadian criminal law: antiretroviral treatment and viral load, Briefing paper.
- Canadian HIV/AIDS Legal Network, HIV non-disclosure and Canadian criminal law: condom use, Briefing paper.
- E. Mykhalovskiy, G. Betteridge, and D. McLay, HIV Non-Disclosure and the Criminal Law: Establishing Policy Options for Ontario, August 2010. A report funded by the Ontario HIV Treatment Network.
Summary of current law description
Key national cases
- Cass. Crim, 10 janvier 2006, n° 05-80787.
- Cass. Crim, 2 juillet 1998, n° 98-80529.
- CA Colmar, 4 janvier 2005.
- CA Rouen, 22 septembre 1999, n° de RG: 99-00018.
- Cour d’assises du Loiret, 3 décembre 2008, n° 50/2008.
- CA d’Orléans, 9 novembre 2007, n° de RG : 07/00291.
- B. Chapleau, « La pénalisation de la transmission du virus de l’immunodéficience humaine par voie sexuelle », Droit pénal, October 2006.
- B. de Lamy, « Administration de substances nuisibles – Transmission volontaire
du virus VIH », Dr. Famille, April 2006, p. 29.
- A. Prothais, « Le sida par complaisance rattrapé par le droit pénal », Dalloz. 2006, p. 1068.
- A. Prothais, « Le sida ne serait-il plus, au regard du droit pénal, une maladie mortelle ? », Dalloz 2001, n° 26, Chr. p. 2053.
- A. Prothais, « N’empoisonnez donc plus à l’arsenic ! », Dalloz., 1998, p. 334.
- G. Mathieu, « Sida et droit pénal », Revue de science criminelle, 1996, p. 81.
Summary of current law description
Key national cases
- Raoul Gasquez, juriste, Groupe sida Genève, Swiss cases on HIV transmission, 2010.
- Cour de Cassation pénale, S. contre Procureur Général du canton de Vaud, 22 février 1990, 116 IV 125.
- Cour de Cassation, X c. Zurich Ministère public du canton, 27 octobre 2004, AFT 131 IV (6S. 176/2004) JDT 2006 IV.
Note: Translation from German to French is published with the authorization of JDT.
- “S” v. Procureur Général, Arrêt, 23 février 2009 (Chambre pénale) (Genève). (PDF contains original French judgment, unofficial English translation, and translator's affidavit.)
- R. Gasquez, « Pour la dépénalisation de l’exposition au VIH », Plaidoyer, April 2009. (Unofficial translation)
- Aide Suisse contre le Sida, Pénalisation de la transmission du VIH, prise de position, January 2001.
- Me A. Cereghetti, « Incrimination de la transmission du virus VIH », Médecin et
droit médical, Ed. Médecine & Hygiène, 2009.
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7. Additional resources
This section provides additional resources on criminal law and HIV internationally and on other issues related to criminalization, including the stigmatization of HIV and the impact
of the use of criminal law on public health.
Criminal law and HIV
- The Center for HIV Law and Policy and Positive Justice Project, A Legal Toolkit: Resources for Attorneys Handling HIV-Related Prosecutions, Ending and Defending Against HIV Criminalization, A Manual for Advocates, Volume 2 (2013).
- R. Elliott, After Cuerrier: Canadian criminal law and the non-disclosure of HIV-positive status, Canadian HIV/AIDS Legal Network, 1999.
- HIV/AIDS Legal Centre New South Wales (HALC), HIV/AIDS sentencing kit, 3rd ed., 2000.
- R. Elliott, Canadian HIV/AIDS Legal Network, Criminal law, public health and HIV transmission: a policy options paper, UNAIDS, June 2002.
- M. Nyambe, Criminalization of HIV transmission in Europe: a rapid scan of the
laws and rates of prosecution for HIV transmission within the signatory states of
the European Convention of Human Rights, Global Network of People Living with HIV/AIDS Europe (GNP+) and Terrence Higgins Trust (THT), 2005.
- Sénat, Étude de législation comparée n. 151: le traitement pénal de la
transmission du sida par voie sexuelle, October 2005.
- UNAIDS/UNDP, Summary of main issues and conclusions. International consultation on the criminalization of HIV transmission, 31 October – 2 November 2007, Geneva, Switzerland.
- E. Cameron, S. Burris, and M. Clayton, “HIV is a virus, not a crime: ten reasons against criminal statutes and criminal prosecutions,” Journal of the International Aids Society 11, 7 (2008): pp. 1–7.
- UNAIDS Reference Group on HIV and Human Rights, Statement on criminalization of HIV transmission and exposure, 2009.
- HIV/AIDS Legal Centre New South Wales (HALC), Criminal transmission of HIV:
a guide for legal practitioners in NSW,May 2009.
- “Criminalisation,” Reproductive Health Matters 17, 34 (2009).
- “It’s criminal, HIV positive people are increasingly being put behind bars. What you need to know to stay free,” Poz, Health, Life and HIV, Oct. 2009, feature. Available at www.poz.com.
- Terrence Higgins Trust and National Aids Trust, Prosecutions for HIV transmission: a guide for people living with HIV in England and Wales, 2009.
- M. A. Wainberg, “Criminalizing HIV transmission may be a mistake,” Canadian Medical Association Journal, 180(6) (2009).
- NAPWA Monograph, The criminalisation of HIV transmission in Australia: legality, morality and reality, 2009.
- HIV-Sweden’s conference on HIV and criminal law, June 9, 2009, World Trade Center Stockholm.
- R. Pearshouse, “Legislation contagion: building resistance,” HIV/AIDS Policy &
Law Review 13(2/3) (2008): pp.1–10.
- C. Kazatchkine, “Criminalizing HIV Transmission or Exposure: The Context of Francophone West and Central Africa,” HIV/AIDS Policy & Law Review 14(3) (2010)
- GNP+, 2010 Global Criminalisation Scan Report, July 2010. Available at www.gnpplus.net.
- Bernard, E.J., HIV and the criminal law. London: NAM 2010. Available at www.aidsmap.com/law.
England & Wales:
Impact on Public Health
- E. Mykhalovskiy, “The problem of ‘significant risk’: Exploring the public health impact of criminalizing HIV non-disclosure,” Soc Sci & Med (2011) 73(5): 668–675.
- P. O’Byrne and M. Gagnon, “Special issue on the ramifications of the current context of criminal prosecutions for non-disclosure of HIV status on nursing practice,” Aporia: The Nursing Journal 4(2) (April 2012).
- A. MacDonald and H. Worth, “The Mad and the Bad: HIV Infection, Mental Illness, Intellectual Disability and the Law,” Sexuality Research and Social Policy: Journal
of NSRC 2(2) (2005): pp. 51–62.
- C. Dodds and P. Keogh, “Criminal prosecutions for HIV transmission: people living with HIV respond,” International Journal of STD & AIDS 17 (2006): pp. 315–318. Available at ijsa.rsmjournals.com.
- B. D. Adam, et al., “Effects of criminalization of HIV transmission in Cuerrier on
men reporting unprotected sex with men,” Canadian Journal of Law and Society, 23 (2008): pp. 143–159.
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