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Intimacy and Responsibility: The Criminalization of HIV Transmission by Author: Dr Matthew Weait

Is the criminal law a useful tool in the early detection or treatment of HIV infection or in the prevention of its onward transmission? With admirable clarity and thoroughness, Dr Matthew Weait, an academic lawyer who earlier wrote in this journal on HIV forensics, explains why the question is even being posed and then takes the reader through the legal, philosophical, medical and moral reasons why he considers the answer to be a resounding ‘NO’, arguing that HIV exposure and transmission must be an issue of public health policy rather than a problem for which the criminal law can provide a solution. As therapy for HIV infection becomes increasingly sophisticated and efficacious, the associated mortality and morbidity in those parts of the world with access to care show gratifying falls, other than in those who access care too late and who still die. These biomedical advances drive the agenda to increase diagnosis through widespread testing programmes, ensuring that care is available before it’s too late. And yet, as Weait elegantly explains, that same piece of information that allows access to life-saving treatment can also make a person liable to criminal prosecution for reckless transmission. Taking the reader carefully through the background of the current legal position, both in the UK and in other jurisdictions, the book gives a worked example of the problem. In a fascinating chapter, using detailed descriptions of the trail of Feston Konzani, who has been convicted for reckless transmission, the true nature of the problem is displayed. For those of us engaged in the dayto-day treatment and care of people with HIV there are constant reminders of the complexity and fragility of the human condition and of the subtleties and nuances that are integral to trust, relationships and sexual behaviour. To see how these attributes are reduced to their basic components in a courtroom setting, and in so doing are used to shape legal argument, is indeed an eye-opener and acts as a selfevident explanation of why current criminal legal processes are ill-suited to the task of prevention of HIV transmission. That responsibility for the prevention of onward transmission of HIV between people is a two-way affair is discussed in detail, and the fact that the criminal law currently places that responsibility squarely on the shoulders of the person with HIV forgets that there is a need to avoid acquisition as well as prevent transmission. Weait argues that an ‘individualised model of fault and conduct ignores the fact that HIV exists in populations and that its transmission occurs between people’. As with so many aspects of HIV, the subject requires an analysis of how people with HIV are seen and constructed within society, and how the virus itself is understood, not only from a biomedical perspective but with a wider-angled lens. There are few authors with Weait’s depth and breadth of scholarship who can pull such disparate theoretical strands together in such a skilful and readable way. This is an excellent and important synthesis of the current place of HIV in UK society, and our collective responses to risk.