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CIRA events focus on the ethics and science of HIV

Yale Medicine Magazine, 1999 - Summer


An impromptu debate over the case of NuShawn Williams, an upstate New York man accused of infecting at least nine women with HIV, explored the legal and public health consequences of criminalizing sexual behavior linked to deliberate HIV infection. The debate took place at “Using Law to Regulate Behavior: AIDS and the Criminalization of Sex,” a symposium sponsored by the Law, Policy and Ethics Core of the Center for Interdisciplinary Research on AIDS (CIRA). Some states already have laws on the books that make it a crime to expose others to HIV infection through sex or blood donations. Williams, already in prison on drug charges, pleaded guilty to two counts of reckless endangerment for exposing women to HIV, and one count of statutory rape for his relationship with a 13-year-old.

Leslie Wolf, J.D., M.P.H., an assistant professor of medicine at the Center for AIDS Prevention Studies at the University of California San Francisco, set forth arguments in favor of and against criminalization of HIV transmission. She suggested that criminalization of HIV transmission may be appropriate, but only if statutes are drafted to target a narrow range of cases and to minimize negative effects on public health efforts.

In the ensuing debate, Scott Burris, J.D., professor of law at Temple University, noted that issues of race and poverty were missing from her discussion. “Criminalization of HIV exposure is fine in principle,” Burris said, “but impossible in any social setting.”

The following day CIRA, in collaboration with the Yale AIDS Program, held AIDS Science Day ’99 to highlight AIDS research at Yale. Neal Nathanson, M.D., director of the Office of AIDS Research at the National Institutes of Health, delivered the conference’s keynote address, “AIDS Research and the Global Epidemic.” “Right now in the developing world there are 30 million people living with HIV/AIDS,” Nathanson said, “and almost all of them will be dead in 10 years and they will be replaced by 60 million people.” Although drug therapies may help stem the spread of AIDS, a vaccine remains elusive, he said. Once candidate vaccines are identified, he continued, it could take five years to evaluate their efficacy. “The future of AIDS research depends on convincing the world that it is important to sustain research.”

Presentation topics included needle exchanges, prenatal HIV counseling and testing, and drugs users’ social networks. Gerald Friedland, M.D., director of the Yale AIDS Program, cautioned that more study is needed on the pharmacokinetic interactions between anti-HIV drugs and drugs employed in drug-abuse treatment programs. “Methadone may alter the pharmacokinetics of antiretroviral drugs and, conversely, antiretroviral agents may alter the disposition of methadone and other opiate substitution therapies,” Friedland said, adding that very little data on these interactions is available, and this is an active area of research at Yale.