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Will a Michigan Court Force an HIV-Positive Man to Take His Medication?

January 12, 2012

A few weeks ago, the media was buzzing with sensationalized reports about a Comstock Park, Mich., man who walked into a police station and confessed to attempting to infect hundreds of people with HIV either through unprotected sex or sharing needles. News reports claimed he had a history of psychological problems, and was charged with multiple counts of "sex with an uninformed person" (a violation of Michigan’s HIV disclosure law) and held on a $100,000 bond.

But now, another controversy has reared its head.

According to The American Independent, Sangeeta Ghosh, the assistant corporate counsel for Kent County, Mich., stated that if the detainee was to make his bail, the county would try to force him to take antiretroviral medications as a means to stop him from transmitting the virus to someone else. Given the nature of this alleged crime, the county believes that this move is the right thing for public safety.

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Reader Comments:

Comment by: Rhiannon (Louisville,KY) Mon., Jan. 23, 2012 at 3:10 pm UTC
Okay. I so understand what others are saying.. However to force one to take HIV meds is ridiculous.
He has a right to say NO and has a right to not take medications if he so chooses not to.
To think that we would make him take HIV medication to help stop the spread of HIV.. Umm. That wont happen.. if this is true then why is HIV still being spread through- out the world. HIV meds will not stop the virus or anyone getting infected if they do take the meds. yes this man should be punished, however to force him to take medications is not right. not to mention it will save us money while in prison. Give the money that will be spent on HIV meds to someone who really needs it.
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Comment by: steve j (cincinnati, ohio) Thu., Jan. 19, 2012 at 5:27 pm UTC
i have not had sexual relations since 2006, was not diagnosed til 2007. i am late stage aids, not just poz. my life has been hell , i take my meds to be here for my parents (who are dying, cancer), when they are gone i have every intention of stopping meds. there would be no other reason to be alive. i am sick and tired of do gooders trying to tell me what i need to do.
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Comment by: John Eisenhans (St. Louis, MO) Thu., Jan. 19, 2012 at 3:18 pm UTC
If I get tuberculosis, obtain treatment and become non-contagious, do I have an obligation to disclose my status to everyone who breathes the same air I breathe? Why/not?

If I get HIV, obtain treatment and become non-contagious, do I have an obligation to disclose my status to everyone who comes in contact with my bodily fluids? Why/not?

Let's say for the sake of discussion that recent findings are confirmed and it turns out that ARV meds, taken faithfully and successfully (which we shall define as long-term undetectable viral load) not only protect the HIV+ person from further viral activity but also render the HIV+ person uninfectious. Why would there be an obligation to disclose?

Missing in this discussion is the fact that one must (except in a case of rape) consent to an act that we all know could put one at risk of infection. HIV is NOT like TB, which can be transmitted through the air. In light of that fact, I'm still not sure why there is ever an obligation to disclose one's status.

Lily is concerned with, and Bruce apparently makes his living aggressively defending "society's right to protect itself" from people with HIV. But "society" already has all the means it needs to protect itself: don't engage in risky behavior (and assume that sex is always risky). There is no justification for criminalizing HIV, forcing medical treatment on the unwilling or dumping the responsibility for protecting others from HIV infection on the already-overburdened shoulders of the HIV+.
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Comment by: Charles Sat., Jan. 21, 2012 at 8:16 pm UTC
Part of the problem with this case, and others like it, is that it appeals to our own polarized notions of when disclosure is appropriate. People tend to say "always" or "never", and their answer is usually more reflective of their own serostatus and paranoia than any sense of fairness. The ten pound gorilla in the room is that situational ethics should apply to the expectation of disclosure. SOMETIMES we should disclose. SOMETIMES, it is absolutely ridiculous that we expect people with HIV to constantly blurt out their status.

It is the height of paranoia to ALWAYS assume that a long term partner would could be poz. It is callous and mean to insist that someone infected by a long term partner only has themself to blame. This is especially true if they belong to a low risk population. The fact that we ask these people to "take ownership" of what was essentially an act of murder displays an insensitivity to what has happened and how rational people think. A person who is crippled in a traffic accident would never be told that he "brought it on himself" if he didn't wear a seatbelt. Inexplicably, this type of reaction is the norm from the poz community when someone says they were infected by a nondisclosing long term partner.

On the other hand, it is ridiculous that in the context of casual sex, we shift the burden of prevention to the person who is infected. If you are looking for BB sex with a stranger, ESPECIALLY if you're in a "high risk" group, its safe to assume that stranger is already infected whether they realize it or not. In this context, disclosure only serves to marginalize the person who was tested and enables the other party's sense of denial about the risk they are subjecting themself to.

As with most instances, common sense should basically dictate when a disclosure is appropriate. Sadly, common sense is something neither party seems to have in abundance.
Comment by: John Eisenhans (St. Louis, MO) Mon., Jan. 23, 2012 at 6:22 pm UTC
Charles, I think we ought to distinguish between "should disclose" and "must disclose." "Should" seems more akin to "ought to," while "must" implies to me an obligation. Unfortunately, the law does not recognize this distinction, nor the nuances of situational ethics.

Another unfortunate fact to consider is that the biggest single risk factor for HIV infection around the world is being married. That is, more people acquire HIV from their spouses than from any other source (casual partners, sex workers, etc.). While it may seem the height of paranoia, the cruel irony is that people who think "they belong to a low risk population" are in fact among the most vulnerable (one might argue BECAUSE they believe they are not at risk).

In the specific case of the man from Michigan, it does appear that there was reckless, even malicious intent. If that is the case, then murder is the right word. We don't need a special law to prosecute it. The problem is that the malicious, the paranoid and the cynical sieze upon these extremely rare instances to justify criminalizing HIV infection and relegating HIV+ people to a permanent underclass, even if/when they are not contagious. That is the point I was trying to make.

When have people NOT blamed the victim? Whether it's failing to wear seatbelts, failing to use condoms, failing to refrain from indulging in bacon cheeseburgers, failing to get clean & sober - you name it. Isn't that just "common sense"? IMHO none of these failures it the result of a death wish, but rather, part of being a living human being.
Comment by: Charles Thu., Jan. 26, 2012 at 11:10 pm UTC
You previously made an interesting point about whether or not there SHOULD be an obligation to disclose if one is undetectable. One of the issues that shocks me is that the activist set hasn't argued undetectables are not infectious. Amongst gay men, an undetectable is certainly less infectious than the aggregate of "negative" gay men who actually have a ~10% chance of being poz.

In our treatment of undetectable, postive gay men, there is no prevention achieved by mandatory disclosure. In fact, a negative gay man is statistically safer with an undetectable hookup than someone who brags they are "ddf". Still, disclosure laws persist, and are applied to undetectable gay men. This situation shows us that these laws have stopped being about prevention.

Disclosure laws are about stigmatizing people who happen to test positive. I think we can both agree here. We disagree on whether there is any room to address special instances of nondisclosure

You say the law doesn't recognize situational ethics. This is not true. No lawyer would publicly admit that it does, but when we start talking about "implied contracts" where "reliance" is a precondition (and we do this with increasing frequency), the law is certainly recognizing that situations may alter our understanding of how rules should be enforced, so we do have sitautional ethics within the law.

I have no doubt that there is a mechanism to officially differentiate between victims of nondisclosure who are infected by long term partners, and "victims" of "nondisclosure" who are infected by a stranger they met five minutes prior in a bathhouse. This is a differentiation that is best for everyone involved, but it requires judges and the public to treat an STD with the same detachment they accord every other aspect of the law.

Getting the law to do what is best for everyone is going to require a lot of education and advocacy, and the poz community simply doesn't have the willpower for it.

Comment by: George (Bronx, NY) Thu., Jan. 19, 2012 at 2:18 pm UTC
If a person is mandated by the court to forfet his freedom due to insanity that would put his and others health at risk is one thing. But if he is compedent to make choices about his med's and he has tried to hurt other's by infection maybe he should be in prison.
I'm + and I would never put another human at risk even if she wanted to not use protection out of some kind of misguilded love. but making someone take HIV med's does not protect anyone but the person taking them.
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Comment by: ARTHUR (COMPTON) Thu., Jan. 19, 2012 at 2:11 pm UTC
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Comment by: marissa (canada) Sat., Jan. 14, 2012 at 6:38 pm UTC
I don't think a court should be able to tell someone to take HIV meds. But if this guy is trying to infect someone with HIV he should be court ordered to get professional help. Even if this guy were on HAART he could still possibly trasmit HIV.
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Comment by: Lilly (Earth) Sat., Jan. 14, 2012 at 2:27 pm UTC
The mentally ill, or suspected mentally ill, can already be forcibly incarcerated in a mental hospital and have pyschotropic drugs forced on her/him -- "for their own good" -- if authorities can get two doctors to sign papers that say the patient is a danger to himself or others. (Some states want to change this to only one doctor required.)

I understand the comments here, concerned about one HIV patient's rights. I also think society has a right to protect itself against people like this patient for many reasons, not limited to the protection of people this patient can hurt and the economic costs of spreading the disease.

In fact millions of dollars are being spent right now giving ARV drugs to HIV+ but asymptomatic persons to try to prevent the spread of the disease to their non-HIV partners and children.

Where's the concern and compassion for the people this guy sought to infect? I hope he is permanently sent to a mental hospital but if his price of freedom is to try to insure he can't infect others, then it's not too high a price, IMO.

Recall how a man with drug resistant tuberculosis was treated not long ago? Forced to take medicines and virtually under house arrest with an ankle bracelet and he didn't TRY to hurt anyone in the first place.
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Comment by: Charles (itsmyearthtoo) Sun., Jan. 15, 2012 at 11:25 pm UTC
Lilly, no one is saying he should be allowed to willfully infect others. I feel bad for his victims. I may have been infected by someone just like him. If convicted of intentionally spreading the virus, I think that he should be incarcerated for life. I'd like to add that this hinges on the phrase *if convicted*, as he is clearly mentally unwell, and his original estimate of activity borders on impossible.

There are other ways to prevent him from infecting other people, but we're not addressing those. The issue is that the consumption of ARVs, like most HIV issues, is less and less about the good of people who actually have HIV. The fact that millions are spent on asymptomatic HIV+ without regard to OUR health should make us angry. We come last in every regard. Not just here, but in the formulation of "gay health" strategies that center around preventing HIV and by default exclude everyone who is already the neglect of HIV related health needs in the public discourse...and the fact that the only way we can justify public assistance is to protect others from some supposed threat we represent, not to preserve ourselves. This is wrong, and it has no place being defended on a HIV website.

If there is a mechanism to force him to consume HAART, I've no doubt there is a means to just keep him in detainment without ever jumping into this awkward situation. Imprisonment would be more effective, cheaper and less complicated. That's not what we're doing though. Instead, the prosecutors have chosen to set a whole new precedent, and we should all be livid.

Comment by: Bruce E. Smith (Lilongwe, Malawi) Fri., Jan. 13, 2012 at 8:12 pm UTC
Thankfully, due to the fact that most people alter their sexual behavior on learning of their HIV status, becoming conscientiously more careful with regard to others whom they might infect. This is not true for all, however, and some seem to adopt a pathologically anti-social and vindictive attitude, as if all of society is responsible for their infection and they will pay society back, as in the case mentioned above. While upholding individual liberties and sexual freedom, surely the cannot be affirmed while denying any accompanying responsibility. The availability of medications to treat HIV effectively should not render nul the responsibility to inform others of status prior to exposure, for which reasons many of these laws have been passed. We can also be thankful that HIV is probably not as easily passed as Tuberculosis, though the two share many characteristics from an infectious and public health standpoint.

Finally, affirmation of the concept "Treatment is prevention" raises interesting possibilities for the use of quarantine laws, which must have been envisioned by the prosecutors mentioned in the post. Since the individual demonstration of "non-infectious" state is clinically not as easily demonstrated as it is in the case of tuberculosis, application of these laws to this aspect of HIV would be more difficult. However, all this is easily avoided by consent to exposure by the uninfected being made possible and tacit through informing the uninfected of the status of the patient by the patient prior to exposure. To this end we should all work. When patients refuse to be responsible, the public, in defense of its own health, may pursue statutory solutions, especially if the truth is denied. As noted before, such solutions have been upheld, especially in egregious cases, and will likely continue to be so.
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Comment by: Charles Sun., Jan. 15, 2012 at 11:43 pm UTC
"Disclose, or you'll be tied down and force fed pills!" Keep it classy Bruce. Anyone who wonders why so many people frantically avoid an HIV test need look no further than this threat.

Comment by: Bruce E. Smith (Lilongwe, Malawi) Fri., Jan. 13, 2012 at 7:56 pm UTC
Laws designed to protect the public health from infectious individuals who might in turn infect others and expand the effects of a contagious disease have long been in place. These laws usually envision detaining or quarantining an individual rather than forcing them to take medications, sometimes in the face of untreatable illnesses. In the case of tuberculosis, however, today these laws have temporally limited application if and when the disease is treatable, or when transmissability is stopped secondary to treatment.

As health jurisdictions have learned, however, there is a due process for application of these laws, and if applied cavalierly and without this process, the right to individual liberty may be upheld in court over the (perhaps not so apparent) need to protect the public health. The laws have stood for years, however, both statutorally and judicially, due to their importance.

In a jurisdiction in which I once worked, we sincerely considered use of such a law for a patient infected with HIV, not for her HIV infection but for her Tb infection for which she also refused to take meds. Thankfully, however, a simple discussion of some of the alternatives open to public health under the law was enough to convince this patient to take her Tb meds under Directly Observed Therapy, and detention was not necessary. Most Tb patients in that jurisdiction were served orders of quarantine while beginning their medications, and complied with the orders. The orders were removed when the disease was demonstrated to no longer be transmissible.

Only once have I known these laws to be considered for use in an HIV patient. Said patient was found by a series of women to have made a post-ejaculatory boast to each in turn that he had HIV and now they would get it. The patient left the state, however, before due process was initiated.

To be continued (if I can)
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Comment by: Joseph (Salem, Mo) Fri., Jan. 13, 2012 at 2:49 pm UTC
I feel like if they can mandate a mentally unhealthy patient to take meds then they can mandate anyone and I am an hiv + man who would like to make those decisions myself it is no ones business if I take meds or not
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Comment by: Charles (Detroit, MI) Fri., Jan. 13, 2012 at 1:53 pm UTC
Alive, HIV probably can't be transmitted if the meds are taken reliably. It is certainly MUCH less infectious. This has been observed with countless anecdotes, and in numerous western studies. Common sense bears the science out, as infectiousness is linked to viral load, and the meds reduce viral load. No one, from the grittiest activist to the most staid corporate talking head, is endorsing this usage, probably for fear of the very conundrum we see before us. The meds come with complications, so the decision to take meds is usually agreed upon after collaboration between physician and patient, two parties that work together to decide what is best for the patient. The state maintains that the defendant's health is secondary to the people he might infect. The precedent being set is that people with HIV may be forced to take certain medications, which MAY be detrimental to them, for the protection of others. Because the meds are ONLY effective when taken consistently, the question is begged of how the state intends to ensure the defendant is compliant. Will they require blood test monitoring? That requires a commitment of additional time. Will they require that they be taken under supervision? How will we ensure access in our quasi-libertarian society, and how can we hold the defendant accountable if he cannot maintain access? Maybe they will round us all up into camps.

Everything about this case smacks of the growing marginalization of people with HIV, and was always the obvious conclusion to the growing arguement in favor of treatment as prevention. We also have the issue that a lawyer is making medical decisions, which should scare us all, and the fact that this story made news in the first place, despite being patently ridiculous.

The defendant's picture is on every media outlet for 1000 miles. He won't be infecting anyone else anytime soon. The debate is really about the rest of us, and whether our health is secondary to other people.
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Comment by: alive2 (buffalo, ny) Tue., Jan. 17, 2012 at 11:01 am UTC
charles, i agree with the fct the virus is easier controled by medications, but, what i understood was the medication would prevent the spread, thats why i disagreed with the article. theres no uarentte it will stop the spred as is mentioned.
as well i agree, this is a slippery slope, to force anyones choice of taking anti virals isnt the right thing either, i beleive its up to the doctor and patient.
however, being this person has mental health issues, thats where they should adress their concerns first, maybe the combinaion of both have something to do with his choices.there is much more we arent getting in the form of information, i think.

Comment by: michael (los angeles) Fri., Jan. 13, 2012 at 3:04 am UTC
hmmmmm....the person has mental health problems. there's a good "chance" that the meds will exacerbate those problems. anyone who has taken HART knows all too well that the meds do change you to a point. not saying it will in this case.

anyways, this step is pretty messed up. next they'll be tagging hiv patients "for our own good".

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Comment by: jc (oregon) Thu., Jan. 12, 2012 at 3:46 pm UTC
it rips at the very ethics of patient choice. The next thing you know a person behind a cubicle will tell us what our meds will need to take. this will not stop here . this would cause non medical people to make medical judments shame on those people
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Comment by: alive2 (buuffalo ny) Thu., Jan. 12, 2012 at 1:25 pm UTC
i dont understand this, if by forcing this person to take meds under the guise it will prevent him from infecting anyone else, this sends the wrong message. taking medications isnt to prevent the spread of the virus, so why does it seem thats the states position? they should have a better position,if they want people to get knowledge thats not only informative, but correct as me its more unhealthy for someone to infer hiv,cant be transmitted if you take medication, i beleive nothing could be further from the truth, and for a person in a position to do good, is only giving misinformation.
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