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Another no-go area for those with HIV

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William Crawley | 15:48 UK time, Friday, 13 April 2007

The Australian Prime Minister John Howard has raised the possibility of a new law which would prohibit people with HIV from entering the country. His comments have triggered an angry response from human rights campaigners. A ban already exists in the United States, Armenia, Brunei, China, Iraq, South Korea, Moldavia, Russia, and Saudi Arabia.

Australia has witnessed a sharp increase in the number of new HIV infections in the past five years, but Mr Howard's comments may be more concerned with electioneering than epidemiology. After all, HIV is not contagious, unlike tuberculosis.

There are enormous ethical issues raised by an HIV exclusion policy: it further stigmatise people with HIV; HIV doesn't need a visa to travel with people who don't know they are carriers; and this kind of exclusion policy may discourage people from having an HIV test, since the exclusion only applies to those who know their status.

Instead of exclusion and stigmatisation, we might make more progress in a common battle against the spread of HIV by making up-to-date health information more available, resourcing community-based testing and support programmes, and dealing with the underlying causes of unsafe sexual behaviour. One such underlying cause may be a tendency to self-harm that is shaped by a culture of exclusion and stigmatisation.

Comments

  • 1.
  • At 07:20 PM on 13 Apr 2007,
  • Stephen G wrote:

William, are you suggesting people have unsafe sex because they want to catch a disease like HIV because they want to harm themselves because they've been excluded and stigmatised? Or have I misunderstood? I must have misunderstood, since I can't see how such a position is remotely plausible.

Anyhow, I'd have thought that a culture in which people no longer want to take responsibility for themselves is a much more likely candidate for explaining the spread of HIV.

SG

  • 2.
  • At 07:24 PM on 13 Apr 2007,
  • Stephen G wrote:

William, are you suggesting people have unsafe sex because they want to catch a disease like HIV because they want to harm themselves because they've been excluded and stigmatised? Or have I misunderstood? I must have misunderstood, since I can't see how such a position is remotely plausible.

Anyhow, I'd have thought that a culture in which people no longer want to take responsibility for themselves is a much more likely candidate for explaining the spread of HIV.

SG

  • 3.
  • At 09:39 PM on 13 Apr 2007,
  • Terry wrote:

Stephen I can understand why you might have difficulty getting the point made by Will's post, but what Will writes here is supported by a lot of research.

There are many reasons why men and women engage in unsafe sex. As you say, sometimes people fail to take responsibility for their actions. There are many other reasons too, including ignorance of what constitutes safer sex (paricularly a problem in young people).

One other reason why a person might engage in unsafe sex is that they hate themselves for being gay. Some people take their own lives in those self-loathing scenarios. Other cut themselves or show other signs of self-harm. Some others engage in reckless bahaviour, not fully understanding the dynamic of recklessness underlying their behaviour.

In HIV counselling, we often come across closetted gay males who have acted unwisely and have become infected.

Homophobic cultures can produce mental illness in gay men and women (this is a massive problem in Northern Ireland).

It's vital that we do not sterotype al cases of HIV infection, but Will is right to note that some cases are linked to feelings of isolation.

  • 4.
  • At 10:06 PM on 13 Apr 2007,
  • Jilly Green wrote:

Terry thanks for that. Very interesting comments. Homophobia kills.

  • 5.
  • At 10:09 PM on 13 Apr 2007,
  • Mark wrote:

"After all, HIV is not contageous, unlike tuberculosis."

Wrong....Dead Wrong. The vector of contegion is a retrovirus which is found in human fluids and bodily secretions. It is most commonly transmitted by semen during sexual intercourse and by blood left in used hypodermic needles of intravenous drug users. Also by careless failure to test blood prior to transfusions. It can be found in saliva and tears but is not commonly transmitted that way. Therefore casual contact with infected individuals does not carry the same high degree of risk of infection as with influenza or tuberculosis. This is the same mistake many people all over the third world made, believing it was not contageous and the mistake Thabo Mbeki, President of South Africa made which resulted in millions of infections and hundreds of thousands of deaths which might have been prevented had he listened to the WHO and all other scientific experts around the world in the field instead of insisting on his own hairbrained theories about poverty and nutrition.

http://en.wikipedia.org/wiki/Thabo_Mbeki

Australia not only has a right but a duty to keep new sources of infection out of its nation to prevent unnecessary additional new cases of HIV and to avoid the possibility of burdening the taxpayers with the high cost of treatment. Australia is an advanced nation which does not get anti retroviral drugs for aids treatment for next to nothing.

It may surprise people in the EU but there are still some nations in the world which believe that borders in part define their nation and that they have a right to decide who may and may not traverse those borders into their country. There are even a few people left in the United States who believe that. Evidently, neither the President nor many in Congress are among them. The border pratrol of the INS has been punished for overzealously enforcing the law.

  • 6.
  • At 10:44 PM on 13 Apr 2007,
  • Jeffrey leitch wrote:

Mark, calm down, you're losing the plot here. I can hear you yelling while you type.

Read the news piece linked in the post:

"The Medical Officer of the Commonwealth does not consider HIV to be a public safety concern," he was quoted by the Australian newspaper as saying. He added that HIV should not be compared with tuberculosis as the latter is airborne and contagious, while HIV is transmissible but not contagious."

That's a crucial distinction. HIV is a virus that is not airborne.

Thabo Mbeki's bizarre attitude to HIV and Aids is an entirely different matter. His views are based on a scientific theory that is overwhelmingly rejected - the claim that HIV is not the virus causing Aids. No-one in this discussion is defending Mbeki's view. No one except you even raised his view.

Will is right to see a distinction between "contagious" diseases (which may be passed on, for example, by touch or by sharing the same air space) and infectious diseases. TB is a contagious disease; HIV is a virus tranmitted differently.

  • 7.
  • At 10:52 PM on 13 Apr 2007,
  • Mary Maken wrote:

Peter Duesberg is the scientist whose work Thabo Mbeki applauds. Duesberg argues that "various non-infectious factors such as recreational and pharmaceutical drug use are the cause of AIDS, and that HIV (human immunodeficiency virus) is a harmless passenger virus" (the Duesberg Hypothesis).

No-one in the debate around Will's post is arguing this.

Will clearly believes HIV is a harmful virus and suggests ways of combatting the spread of that virus. He also clearly regards HIV as the virus causing Aids.

What's at issue here is this: there is a difference between a disease that can be passed on by someone sitting next to you on a plane and a virus that may be passed on through the sharing of bodily fluids in intimate contact. This is a well accepted distinction. You cannot "catch" HIV in the sense that you can "catch" a cold or a flu. If HIV could be passed on this easily, no one would challenge the Australian government's decision to prevent carriers travelling into their country. In fact, all countries would introduce such a ban.

Another point here. No one, I think, is denying the right of the Australian people to introduce this kind of ban on travel. Will, and I think he is right, merely raises "ethical" questions in opposition to such a ban.

And on the issue of drug therapies. I think anti-retroviral drugs should be available free of charge the world over.

  • 8.
  • At 11:01 PM on 13 Apr 2007,
  • helenanne smith wrote:

Mark you've misundertood Mbeki. I disagree with Mbeki's views on HIV and AIDS but his views are not as you've summarised them.

Mbeki foolishly argues that HIV is harmless. He does not argue that it cannot be passed on from one person to another.

  • 9.
  • At 01:40 AM on 14 Apr 2007,
  • sam.scott wrote:

is mark "pb" in another guise??

  • 10.
  • At 02:53 AM on 14 Apr 2007,
  • Mark wrote:

OK, there is a fine line of distinction between contagious and infectious related to the mechanism of transmission of the infectious agent from one person to another. This is quibbling for purposes of this discussion as far as I am concerned. Once an infected individual enters a country, he becomes a new possible source of further infections to people already in the country.

The ethical question as I see it is whether or not a government has a right to establish and enforce laws to protect its citizens as it sees fit. This is generally accepted as ethical in a democracy. Had the original group of infected people been quarantined as was common practice decades ago with diseases like cholera, typhoid, and measles, the entire pandemic might have been averted. But that would have been considered politically incorrect. I remember very distinctly when the mayor of New York City Ed Koch and the mayor of San Francisco Diane Feinstein wanted to close down the public bath houses because that was where many homosexuals found partners and it was felt that closing the bath houses would help slow the rate of new infections. The homosexual "community" was up in arms. I remember at least one homosexual on television saying "They can't tell us how to live our lives." Now there are over 40 million people around the world infected according to WHO and entire nations are at risk of social collapse because the spread of the disease was not checked when it was still possible. That's nearly 7 out of every 100 people on earth in about 25 years. It's not as fast as bird flu could be when it mutates but for a disease which is hard to catch, it has gone very far very fast. Is it unethical for a government to prevent HIV infected people from entering their country? A much better question would be is is unethical for it not to.

  • 11.
  • At 08:11 AM on 14 Apr 2007,
  • Stephen G wrote:

Terry:

Fair enough I see your point, I wasn't aware that many people would have unprotected sex because of an underlying will to self-destruction due to exclusion.

I still think there are other reasons for unprotected sex which apply to a far greater number of people - and I think irresponsibility is one of the chief reasons.

SG

  • 12.
  • At 11:50 AM on 14 Apr 2007,
  • sam.scott wrote:

Stephen,

I think Terry accepted that there are many reasons why people get infected, including irresponsibility, so there's really no argument.

I think alcohol is one - you get people who behave irresponsibly under the influence.

  • 13.
  • At 12:19 PM on 14 Apr 2007,
  • garethlee wrote:

Mark,

The spread of HIV is fastest among heterosexuals, and HIV was first noticed in the heterosexual community. So let's not make this discussion homophobic.

Read the very intelligent posts on here from commenters who know about this. You've been corrected on your earlier misrepresentations. You might have the grace to apologise and accept you were wrong.

As for your quarantine suggestion, it's been a while since I've heard someone suggest that HIV-positive people should ahev been arrested and held in camps to stop the spread of HIV. That's what your proposal would involve. Think about that then realise what you are suggesting is ludicrous as a public health strategy.

  • 14.
  • At 01:48 PM on 14 Apr 2007,
  • Anonymous wrote:

garathlee #12
It is you and those of your mindset who are trying to obfuscate the central issue of this discussion. This is not about homophobia, it's about whether or not people have a right to elect a government which can pass and enforce laws exclusively in their own interest, a concept which always has been and still is an anathema to most people born and raised in Europe. The monstrousity of the EU and its preposterous constitution is a perfect example.

Yes we know that today in many places like Africa, the virus is being spread to a large degree by heterosexual intercourse and still by IV drug users but when the disease first made its appearance in the United States, it was transmitted exclusively by IV drug users, homosexuals and rarely by medical transfusions of contaminated blood such as in the death of the tennis star Arthur Ashe. The disease was virtually unknown among heterosexuals who did not use IV drugs. The rare exceptions were among the sexual partners of IV drug users and those who contracted it from prostitutes who acquired it as IV drug users but they were a very small minority. Once this observation was made but before the mechanism was understood and a test for the virus was avialable, it was proposed that homosexuals not donate blood to blood banks. And as with the bath houses, they were up in arms. I am not homophobic but these are historical facts. And it struck me as outrageous that when it was determined that this virus was the mechanism of transmission, many homosexuals ignored the warnings against dangerous behavior and then once they contracted the disease, they demanded that the entire medical research establishment drop what they were doing and devote all medical research on finding a cure for them. This was of course preposterous not only because it was not possible but because far more Americans die of heart disease, cancer and other causes by far than died of AIDs. If I seem a little exasperated, it's because I find it annoying that people who deliberately do what they were warned by scientists was dangerous and a risk to their lives, then demand sacrifice by others to get them out of the trouble they knowingly caused themselves...like people who walk on thin ice over a lake and fall in expecting others to risk drowning themselves too in order to save them....or a fool who tempts fate by pursuing dangerous wild animals at close distance and then gets stung though the heart by a stingray. I have no sympathy for victims of their own stupidity and I certainly don't want them coming to my country like a mecca looking to spread their infections or get people like me to pay for their treatment. My taxes and insurance premiums are too high already, another concept seemingly alien to Europeans.

  • 15.
  • At 02:17 PM on 14 Apr 2007,
  • Stephen G wrote:

Sam:

I'm not arguing, just making a point - that irresponsibility is, in my view, a much more important reason. I have no beef with Terry at all. I'm grateful to him for bringing this to my attention, and for clarifying what William wrote.

SG

  • 16.
  • At 03:41 PM on 14 Apr 2007,
  • Mark wrote:

SG what reason other than irresponsibility is there now that blood products use medically are screened? The irresponsibility of those who ignore the warnings about dangerous activities and the irresponsibility of those who keep people ignorant of what those dangerous activities are. Other than that there are the fewer than one in ten thousand cases where someone like a trash collector is accidently jabbed by a hypodermic needle used by an infected IV drug addcit. Why should a responsible government allow dangerously irresponsible people who carry a deadly disease into their country?....unless it's the EU in which case it's OK. Were I infected and living in say North Africa, I'd try to make it to Britain where I could get treatment and all my other expenses paid on the dole. Maybe Brits are just jealous that they have to foot the bill and those in other countries don't. Write your MP...if you can catch up to him.

  • 17.
  • At 05:57 PM on 14 Apr 2007,
  • helenanne smith wrote:

I'm not who that anonymous person is, but he or she sounds homophobic to me. You may not WISH to sound that way, but you are having a go at gay people when we are discussing a government proposal about HIV. In fact it should be possible to discuss Will's post without even mentioning sexuality. This is about a virus, not a sexuality.

On the government thing - NO-ONE is denying the legal right of Australia to do this, if that's what te country decides to do. All we're doing in this debate is arguing about whether this is a sensible and ETHICAL policy for the Australian PM to be defening.

Can we try to play the ball, not the man (or the sexuality) in this discusion please?

  • 18.
  • At 07:53 PM on 14 Apr 2007,
  • pb wrote:

interesting that you talk about unsafe sex Will.

I was reading a piece recently by a doctor who was detailing how risky anal sex is.

He was saying that even if you wear a condom it is still very risky.
This, he said, was because the anus is not actually designed for sex and not tough enough, neither does it produce any lubricants, both in contrast to the vagina.

The point he was making was that anal sex with a condom is high risk to the passive partner because it damages the internal membranes and causes faecal infections in the blood, also anal tears.

But the main point he was making was that Governments will not inform people that anal sex with a condom is unsafe sex because of political pressure.

Interested in feedback.

PB

  • 19.
  • At 11:45 AM on 15 Apr 2007,
  • pb wrote:

JW

You *seem* to be falling into the trap this particular doctor was talking about.

He was actually saying there is no such thing as "safe anal sex".

Terry from Stonewall, above, more correctly (I understand) more correctly discusses "saf-er" sex which is heading in the right direction, I understand.

This particular doctor I was reading claims that in his period reviewed health professionals could only get around 60% of the gay community (US I think) to practise saf-er sex practises, because they dont feel as natural or as intimate with a condom.

If 40% of a certain community really do persist in practising very unsafe sexual practises that is something that needs to be openly raised in order to take proper educative steps in the interests of public health. No?

This is surely a normal and reasonable direction to go in the interests of improving public health in general, and the health of those who have particualr reservations to practising saf-er sex.

As William is explicitly discussing saf-er sex and community health programmes, above, I feel it is not unreasonable to consider my comments "on topic".

As a tax-payer and a citizen of my own country I feel it might be a trifle unfair of me not to have some interest and reasonble right to join
a free and courteous discussion on matters of public health affecting my own community?

PB

  • 20.
  • At 02:03 PM on 15 Apr 2007,
  • Mark wrote:

helenanne smith #22
You said "most (men, women, and children) became infected (with HIV) through non-sexual routes."

We know that children usually became infected because their mothers were infected, but how do you think most men and women became infected if not through sexual activity and on what do you base your assertion?

  • 21.
  • At 04:36 PM on 15 Apr 2007,
  • David (Oxford) wrote:

I'm glad to see everyone is just ignoring the homophobic nonsense from pb here. He makes no sense at the best of time. I may disagree with Stephen G on a regular basis, but at least he makes arguments that are based on logic. Pb just repeats hatred and no amount of logic can respond to him.

Can we all accept that many sexual practices have associated health risks, including oral sex? Does PB want to argue that oral sex is immoral now?

  • 22.
  • At 05:37 PM on 15 Apr 2007,
  • pb wrote:


just for the record, in my office one guy poured out homophobic abuse on another for about a year.

I was the only one that objected to the abusers face, and I did so every time the abuse was given.

I have also publicly defended a lesbian couple from similar abuse here in NI.

Let's not confuse legitimate inquiry and discussion about facts with "hate" please.

sincerely

PB

  • 23.
  • At 05:37 PM on 15 Apr 2007,
  • Anonymous Gay Christian wrote:

I am gay and i have a boyfriend. we've been together for 2 years and we're in love. I am 23 and he is 26. We go to our church on Sundays and we have a drink in some of the gay bars in Belfast. We've never ha anal sex with each other and I know a lot fo gay guys who are like that. We kiss and cuddle and we have other sex but nothing like what this man pb says. We can't understand why some christians seem to hate us so much. It's like every time you turn on the tv or read a paper there's another anti-gay thing from christians. We are not child molesters. We're just people who love one another and we care about God and the church too. I have a friend who was beaten up in belfast by guys calling him "faggot" while they booted him. Nobody form the church came to se him and nobody from the church ever goes on Tv to talk about that. I left the church from the age of 16 until 21 because i was fed up hearing stuff in sermons that attacked me for who i am. We had a youth worker who used to call kids queers as a joke and he was always making comments about fags and stuff like that. I couldn't take it. I spoke to somebody in the church and they told me the church was against gays. I didnt tell them they were talking to one - but even if the church IS against gays they shouldnt allow people to insult us at church. I wish some of these homophobic people could spend a month living our lives to see how ordinary and decent we are as people. We go to work and we have a few drinks and go o holiday and meet each others friends and parents. All our friends are really accepting. It's only the church that has a problem. I believe God is in favour of people who love each other. I don't see much love in the church on this issue to be honest. I wish I was wrong. We've now found a church were the minister is more openminded. He knows we are a couple and says nothing about it. He doesnt preach antigay stuff in the sermons but he doesnt come out against it either. I suppose that's the best we can hope for in this day and age. One day people will look back and wonder how this kind of thing could happen. I'd like to add my name to this but the attitudes in the church have made our society a dangerous place for people like me.

(RANT ON)

Uh, okay, it's not the end of the world but, as someone who comments regularly here for my mind's benefit and hopefully adds to the collective discussion in a manner which helps to raise the profile of this blog, I was a little piqued to find my comment to PB above (#19 I think) DELETED this morning.... I presume it's because of a link I included to a site which supported my point and contained more explicit language than would be permitted here. Honestly, if the moderatlor was unhappy about the link, only the link needed to be removed, not the entire comment. And I'd be interested to learn why the moderator would think the readership of Will & Testament too immature to read such a link in the first place? The contents of the link dealt with exactly the same kind of concerns raised by PB above. What's the difference? I also included a fair warning about its contents in my comment so that nobody who followed the link would get unduly offended.... a warning that doesn't exist on this thread on Will & Testament with regard to the contents of comments #18, #19, #21, #22. (For example.) No big deal, but annoying.

Beautiful day, by the way.

(/RANT OFF)

John, I plead ignorance of this deletion. I'll look into it and see what can be done.

  • 26.
  • At 09:34 PM on 15 Apr 2007,
  • pb wrote:


Anonymous Gay Christian

Are you also the poster Gay Christian Believer we see here sometimes?

If so its good to see you back.

Regardless of who you are, you do seem like a very caring and sensitive soul, which you would have in common with most other gay folk I have known, all of whom I have liked, by the way.

There seems to be quite a bit of misconception about a biblical view of homosexuality. For example, I have known many people addicted to alchohol abuse and the bible clearly warns and condemns this practise, while also offering a way out.

But can you imagine that I ever abused such people? Never!

And as I detailed in post 22, I have, would and will stand up for any gay folk being abused by others.

However, none of that alters what the bible teaches about sexuality.

I too have had bad experience with churches and Christians and just end up forgiving them and bearing in mind how I am bound to offend others too without meaning to.

You know if you havent come from a backround where the bible is respected as divinely inspired and the authority for guidance I can understand why you may feel I am being hostile to you, but that is not my intention. I am simply trying to follow the bible's teachings in my life as Christians have done for 2000 years.

I certainly welcome you here and would defend you from being verbally or physically abused in person.

I also pray God's blessing on your life.

Hope to see you back here again.

sincerely

PB


William- It's no big deal, but thanks. :-)

  • 28.
  • At 10:42 PM on 15 Apr 2007,
  • Kathy wrote:

Hi friends. It's been real good to read this blog; very informative. And I like hearing all the different opinions; I think that's very important.
I do believe that the Bible speaks out against homosexual practices. But it breaks my heart when I hear how gay people are rejected by Christians. This is not the love that Jesus wants us to show EVERYONE. I'm sorry that some of you have been rejected, or seen others be rejected.
I believe that God loves everyone. And He wants us to love everyone, even if we disagree with them, or do not like the way they are living. . 1 John 4 says "Love one another for love is of God. He who loves is born of God and knows God. He who does not love, does not know God, for God is love."

  • 29.
  • At 05:47 PM on 22 Apr 2007,
  • evangeline wrote:

Hi william, remember some earlier work u did wrt HIV!

U seem so busy.great work though. Take care, E

Evangeline: Of course I remember. Great to hear from you. It's a small world.

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