With a hat that says "I believe the law should codify acceptable behaviour" on, I think someone who knows they're HIV+ and lies or fails to mention it, then has unsafe sex with someone and infects them, should be guilty of an offense. I think the level of the offence ought to be similar to rape or GBH.
With a hat that says "I believe the law should be written to minimise suffering given the way people are likely to behave", which is my usual hat, my answer is I'd need more time to ponder the likely effects of such a law.
For me it falls under the 'informed choice' thing; by deliberately not disclosing something which might reasonably prevent the other party from having sex with you, you are depriving them of the right to make an informed choice.
Re: Home HIV testing kits... I would use one on the premise that they are as reliable as, say, home pregnancy testing kits. Should such HIV kits become available I believe that like pregnancy testing kits, they should be available off the shelf rather than over the counter - it seems to make people 'less shy' about buying them for starters, plus if an over the counter HIV kit was treated like the morning after pill, as well as a potentially prohibitive price the 'over the counter' thing would put people off (FFS Levonelle is about £20 over the counter and not everyone can get to their bloody doctor in time to get it, and it's not nice being stood in Boots being grilled by a random pharmacist about why you want it etc)
As for using one as an avoidance of a GUM clinic, in my case this would be due to prior poor experiences: I have been treated like shit - one doctor in particular treated me as if I was 'dirty' as soon as I walked in before I was tested (not that they should treat anyone as 'dirty' regardless if they know they have X, Y and Z or not). The nurses and receptionists were all fab though :-)
I disagree with the concept of HIV tests you could do at home and believe such a test should remain illegal if it were available (are they available elsewhere? I’ve never heard of them before). This is purely on ethical grounds because of the potential ramifications of the results for an individual. I believe that anyone going for an HIV test should receive the relevant counselling first. Unlike a pregnancy test, if a person discovers thay are HIV+ they do not have the option of removing it from their body the way they could a foetus (by the way I’m not necessarily advocating abortion here).
I think the same should also apply to any potential home testing kits for hepatitis A and B and a number of STD’s for which a person may require professional counselling on receiving results.
I’m sorry to hear about your experience at the GUM clinic. I hope you complained.
What counselliing do clinics give nowadays? The one time I got tested was in 1992, just after clinics got set up in a hurry and staffed by any fuckwit they could find. The 'counselling' consisted of grilling me about every detail of activity which might have put me at risk, then concluding there was a chance I could have HIV (well duh!) and permitting me to be tested. After taking the blood I was asked offhandedly what I would do if it was positive, and I shrugged. That was it.
What counselling would be relevant? As I see it, the ramifications of the results are the same as the consequences of knowing you have a chance of being infected, except that if you have a test result you can seek treatment. What other issues are there?
Apologies for not replying sooner. I don’t check the email account I use for LJ notifications often enough.
With regard to what counselling is given in clinics nowadays, I do not know. It would be interesting to contact one to find out.
Having been on the receiving end of a similar grilling for a different test I know how annoying it can be to be asked what seem like obvious, irrelevant or personal questions. On the other hand, since then and having worked for the NHS (I’m currently a student nurse) I know how important it is to establish even the most basic of facts from which to draw the right conclusions.
What counselling would be relevant? As I see it, the ramifications of the results are the same as the consequences of knowing you have a chance of being infected, except that if you have a test result you can seek treatment.
As far as I see it counselling is relevant because unfortunately not everyone has the capacity to deal with the bad news of a positive test result very well (by bad news I'm using the definition which describes it as any news that drastically alters for the worse a person’s view of his or her future and/or past). It cannot be assumed that everyone who takes a test will respond in a rational, intelligent manner. This in turn has many implications if home testing were available.
The way the in which bad news is broken influences whether or not the news is accepted. Quite often bad news has to be repeated as the person seeks confirmation of the news, becomes increasingly aware of the situation, or forgets what he or she has been told. It has also been suggested that a recipient’s immediate and longer term reactions are influenced by the way in which bad news is disclosed. Therefore, if a person takes a home test on their own and without access to any information they might need, what they perceive as a bad result may impact on their acceptance of that result and its implications. lovingboth mentions two possible consequences of this which take into account the interests of any one at risk as well as the person taking the test. Also worrying is the possibility that someone who takes a home test may not seek treatment for a number of reasons such as lack of information about what will happen to them. This could also lead to distressing fantasies which might be worse than reality. Distrust and difficult relationships between all concerned are another potential consequence. Therefore, I feel that counselling is necessary even in the most basic form of just having someone present at the time of receiving test results who knows all the relevant information to talk to if the person taking the test feels they need to.
Re: 'If someone who is HIV+ has sex with someone who is HIV- and infects them...'
I find the idea of legislation on this scary, partly because (as with most legislation) there would be so many ways that it could be abused, and also because I think each case would have to be taken on its own merits. There are so many aspects to consider that I don't think a standardised piece of legislation would work. Writing something that would have the flexibility to work would be a job and a half though.
Ultimately I'd probably go for something along the lines of having it be considered a criminal offence if someone lied and said they were HIV- when they knew there were +, but I'm not sitting too comfortably with that.
To comment on question 4 - I think it would be a very hard law to enforce, which is why I said no, even though I think that to sleep someone with knowing that you have HIV without informing the other person is a awful thing to do.
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baggyeyes
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(no subject)
Date: 2004-08-04 03:50 pm (UTC)With a hat that says "I believe the law should be written to minimise suffering given the way people are likely to behave", which is my usual hat, my answer is I'd need more time to ponder the likely effects of such a law.
(no subject)
Date: 2004-08-05 12:06 am (UTC)(no subject)
Date: 2004-08-04 05:36 pm (UTC)I would use one on the premise that they are as reliable as, say, home pregnancy testing kits. Should such HIV kits become available I believe that like pregnancy testing kits, they should be available off the shelf rather than over the counter - it seems to make people 'less shy' about buying them for starters, plus if an over the counter HIV kit was treated like the morning after pill, as well as a potentially prohibitive price the 'over the counter' thing would put people off (FFS Levonelle is about £20 over the counter and not everyone can get to their bloody doctor in time to get it, and it's not nice being stood in Boots being grilled by a random pharmacist about why you want it etc)
As for using one as an avoidance of a GUM clinic, in my case this would be due to prior poor experiences: I have been treated like shit - one doctor in particular treated me as if I was 'dirty' as soon as I walked in before I was tested (not that they should treat anyone as 'dirty' regardless if they know they have X, Y and Z or not). The nurses and receptionists were all fab though :-)
Ethical concerns
Date: 2004-08-06 09:23 am (UTC)I think the same should also apply to any potential home testing kits for hepatitis A and B and a number of STD’s for which a person may require professional counselling on receiving results.
I’m sorry to hear about your experience at the GUM clinic. I hope you complained.
Re: Ethical concerns
Date: 2004-08-10 02:20 pm (UTC)What counselling would be relevant? As I see it, the ramifications of the results are the same as the consequences of knowing you have a chance of being infected, except that if you have a test result you can seek treatment. What other issues are there?
Re: Ethical concerns
Date: 2004-08-11 02:47 am (UTC)What other issues are there?
Who to tell and the consequences of your behaviour, for two. If you've been risky with more than one person, you may have infected someone.
There can also be insurance issues, pregnancy issues...
Re: Ethical concerns
Date: 2004-08-19 09:38 am (UTC)With regard to what counselling is given in clinics nowadays, I do not know. It would be interesting to contact one to find out.
Having been on the receiving end of a similar grilling for a different test I know how annoying it can be to be asked what seem like obvious, irrelevant or personal questions. On the other hand, since then and having worked for the NHS (I’m currently a student nurse) I know how important it is to establish even the most basic of facts from which to draw the right conclusions.
What counselling would be relevant? As I see it, the ramifications of the results are the same as the consequences of knowing you have a chance of being infected, except that if you have a test result you can seek treatment.
As far as I see it counselling is relevant because unfortunately not everyone has the capacity to deal with the bad news of a positive test result very well (by bad news I'm using the definition which describes it as any news that drastically alters for the worse a person’s view of his or her future and/or past). It cannot be assumed that everyone who takes a test will respond in a rational, intelligent manner. This in turn has many implications if home testing were available.
The way the in which bad news is broken influences whether or not the news is accepted. Quite often bad news has to be repeated as the person seeks confirmation of the news, becomes increasingly aware of the situation, or forgets what he or she has been told. It has also been suggested that a recipient’s immediate and longer term reactions are influenced by the way in which bad news is disclosed. Therefore, if a person takes a home test on their own and without access to any information they might need, what they perceive as a bad result may impact on their acceptance of that result and its implications.
(no subject)
Date: 2004-08-05 01:38 am (UTC)I find the idea of legislation on this scary, partly because (as with most legislation) there would be so many ways that it could be abused, and also because I think each case would have to be taken on its own merits. There are so many aspects to consider that I don't think a standardised piece of legislation would work. Writing something that would have the flexibility to work would be a job and a half though.
Ultimately I'd probably go for something along the lines of having it be considered a criminal offence if someone lied and said they were HIV- when they knew there were +, but I'm not sitting too comfortably with that.
(no subject)
Date: 2004-08-06 08:29 am (UTC)(no subject)
Date: 2004-08-06 09:09 am (UTC)I did think about saying something about this in the lj_uk post, but decided it didn't matter who they are.
(no subject)
Date: 2004-08-06 09:23 am (UTC)(no subject)
Date: 2004-08-06 09:09 am (UTC)(no subject)
Date: 2004-08-06 09:19 am (UTC)