'HIV is no longer an epidemic. But the stigma is'

A German court case has shone a light on the social impact of infection

(AFP/Getty Images)

When Silvia Petretti was diagnosed with HIV she thought her life had come to an end.

She was 30 years old and had contracted malaria after a holiday in Senegal. The doctors ordered blood tests and asked whether she wanted to have an HIV test at the same time. When the results came back, malaria was suddenly the least of her worries.

"I was completely devastated, paralysed and terrified," she recalled. "I thought I was going to die a horrible death. I couldn't tell my friends or family. I went home, locked myself in my room and cried for three days straight."

To be diagnosed with such a fearful disease was heartbreaking, but there was one small silver lining. Ms Petretti discovered she had been diagnosed just as the first batch of successful anti-retroviral medicines were coming on to the market. She was immediately put on a gruelling course of medication to stop the virus from replicating.

"To begin with I was on 18 pills a day, some with food, some without food. I had very dry skin, nausea, tingling over the body, diarrhoea. It was incredibly demoralising," she said.

Over the past decade, scientists have drastically improved the medication used to fight HIV, allowing patients to live increasingly normal, healthy lives. With the right treatment, HIV-positive mothers have a 99 per cent chance of giving birth to HIV-negative children. The life expectancy of someone living with the disease has also increased significantly.

Ms Petretti, who is now 44, takes only four pills a day with no side effects. Her viral load – the measure of the amount of HIV in her bloodstream – is undetectable and, she says, she hasn't had a sick day since being diagnosed. But, although improvements in medicine have changed the quality of life of thousands for the better, many in the HIV community are unhappy about the way society views them.

"HIV isn't epidemic anymore, not in the UK," says Ms Petretti. "Do you want to know what the new epidemic is? Stigma. Stigma is everywhere."

Nowhere are society's attitudes towards HIV more fraught than during the criminal prosecutions of people who have passed on the disease to their lovers through unprotected sex. Earlier this week, the German pop star Nadja Benaissa appeared in court charged with one count of grievous bodily harm and two counts of attempted bodily harm for allegedly sleeping unprotected with three men between 2000 and 2004, despite knowing she was HIV positive. Only one of the men is now HIV positive – but that hasn't stopped German prosecutors from charging her for "assaulting" her two other lovers.

For many, such prosecutions are clearly justified. If you are HIV-positive, failing to use protection is wrong, and people who do so should be brought to justice. Infecting someone with HIV, prosecutors argue, is akin to murder.

The prosecution of "deliberate" or "reckless" HIV transmissions, however, is a relatively recent phenomenon and – ironically – has coincided with the disease becoming less deadly.

About 40 countries around the world have either enacted laws or used existing legislation to bring prosecutions against HIV carriers who have infected others. In Britain, at least nine people have been convicted, primarily under the Offences Against the Person Act 1861, a law that treats the HIV virus as a potentially deadly weapon. Nobody has yet been prosecuted for "intentional transmission" because it is so difficult to prove. Instead, prosecutors go for the lesser charge of "reckless transmission", which critics say criminalises behaviour rather than proving intent.

Outside of Britain, HIV carriers have been jailed even when they haven't passed on their infection. There has been no recorded incident of HIV passing through saliva, but that didn't stop a court in Texas in 2008 from handing down a 35-year sentence to Willie Campbell, a 42-year-old homeless man who spat in the face of police officers. Edwin Cameron, a South African judge, commented: "It stuns the mind that someone who has actually not harmed anyone ... could be locked away for 35 years. The inference that his HIV status played a pivotal role in sending him away for so long is unavoidable. In short: the man was punished not for what he did, but for the virus he carried."

Some African states, such as Sierra Leone, have even prosecuted mothers who pass on HIV to their babies.

The desire to punish someone who maliciously passes HIV on to another person is understandable. But many activists are uncomfortable about how such prosecutions affect the vast majority of HIV carriers who do everything in their power to protect their lovers.

What is it about HIV, they ask, that terrifies us so much we feel the need to prosecute transmissions? Police don't arrest people for assault if you deliberately pass on chlamydia or overfeed your child to the point of morbid obesity. Many prosecutions in Britain and abroad, meanwhile, have only been launched once a relationship between an HIV carrier and their partner has broken down.

Angelina Namiba works with Ms Petretti at Positively UK, a charity in north London which offers advice and support to newly diagnosed HIV carriers. She contracted HIV as a woman in her early 20s. "I did what millions of young people in this country do every week," she said. "I didn't use protection."

Summoning up the courage to be open about her status took support and time. But she is concerned about what message prosecutions send out to young and vulnerable people.

"Criminalisation is hampering two decades' work against stigmatisation and discouraging people who think they might be HIV positive to be tested," she said. "Of course it is morally wrong for people to try and harm anybody intentionally. But criminal prosecutions are not the best way to prevent transmission and protect public health."

According to the Health Protection Agency, 27 per cent of people with HIV in Britain are unaware that they are carrying the virus. Yet encouraging people to come forward for testing is vital to stop the spread of the disease.

Ms Petretti believes the law is being used as a blunt instrument. "Of course when someone is infected with HIV a wrong has happened," she said. "I was infected by somebody, I felt angry and cheated. But harsh laws and jail sentences are not right. They increase stigma and they make it much harder for people living with HIV to be more open, disclose their status, negotiate safer sex and go for tests."

HIV in Britain

83,000: Estimated number of Britons with HIV in 2008.

27%: The proportion of UK sufferers thought to not know they have the infection.

7,928: The number of new diagnoses of HIV in the UK during 2008 – a slight decline on previous years.

£1.1bn: The estimated amount of money which would have been saved if HIV infections acquired in the UK in 2008 had been prevented.

Chris Smith

The Labour politician, who was Culture Secretary under Tony Blair and the UK's first openly gay MP, acknowledged that he was HIV positive in a newspaper interview in 2005.

Smith said he had been diagnosed in 1987 and had lived with it ever since, keeping it a secret from his party leader. He said he had decided to go public after the former South African president, Nelson Mandela, announced his son had died of Aids.

"I didn't feel the need to tell people, except for a very, very few, as it was not in any way affecting my work," he said at the time.