Mobile Phones and the STD Test Application...

After the Ugly Meter which seems to be nothing more than a little frivolity there is the possibility that scientists will hit the STD test jackpot so to speak. It is being reported that in the not too distant future STD testing can be done at home or with the help of your trusty mobile phone. The test will be as simple as providing a little urine sample on a computer chip and placing it into your phone and waiting for the phone to spit out the results.

Not all experts are of the belief that this technology is imminent in the consumer-ready sense. However, it seems that it is not something that is outside the realm of possibility. The experts have developed simple test kits for HIV. So, the future is nigh, so to speak.

However, the technology raises some interesting nocturnal entertainment possibilities, don't you think? Going out on the turps on a Friday and Saturday night and entering the one-night stand lottery need not result in a recurring case of STD. The reality will be that right next to the condoms in the wallet or purse will be the STD computer chips. It would be pretty funny to be a fly on the wall for that conversation. "So, I am really looking forward to getting down and dirty with you, but before we do would you mind if I watched you pee on this computer chip?" Sort of crushes the moment, doesn't it?

Nevertheless, the old adage of "it is better to be safe than sorry" might make it cheaper in the long run. All the same, I am wondering what happens when the mobile phone pipes up..."Warning, Warning, Warning, don't do it, Chlamydia!" or "Warning, Warning, Warning, do not go there...Gonorrhea!"

It is a good idea. Anything that keeps our young, and perhaps old, people healthy is a worthwhile cause. Yet, it is still one of those things that you find yourself shaking your head at, like will it still work once the beer goggles are on?

Extradition and a Fear of HIV...

There are many people out there in this big bad world of ours who fear being exposed to HIV and developing AIDS. This fear seems to be further intensified where a person is under threat of a prison term in a nation where HIV / AIDS is prevalent, or rampant, in the prison system where they would serve a sentence if convicted.

Adrian Kiki Ariawan, a convicted Indonesian felon, currently detained in Australia is fighting his pending extradition to Indonesia based on an argument that sending him back to a prison system where he may contract HIV is a breach of his human rights and a breach of prevailing international humanitarian law.

At this point, you might be shaking your head and saying, "what?" But, this is not as far-fetched as it sounds. And, more importantly the approach has been successfully argued in the Australian Federal Court in 2004. In de Bruyn vs. The Minister for Justice and Customs (FCAFC 2004), the Federal Court allowed the appeal of the lower court decision that granted the extradition.

The Federal Court also quashed the arrest warrant with the reasoning that the Minister had not given sufficient consideration to the humanitarian grounds associated with extraditing someone to a penal system where there is a risk of contracting HIV.

de Bruyn was fighting extradition to South Africa. The support for the petition included a number of articles that noted increased risks of HIV infection, particularly post-incarceration.

With respect to the risk, it would be interesting to see whether the Australian courts would consider a response from Indonesian authorities in the form of a guarantee that Ariawan would be jailed in isolation or only with other inmates of negative HIV status. This would presumably reduce and perhaps eliminate any risk of Ariawan contracting HIV while serving his sentence.

I am sure that serving the rest of your life in solitary confinement is most probably a breach of one's human rights, but if the fear is of contracting some disease whilst in prison then being separated from all other prisoners would seemingly resolve that fear, and it would be the choice of the convict themselves.

It must be noted that Australian prisons are not HIV-free nor are they violence-free, sexual or otherwise, although medical treatment is considerably better than what is available in the Indonesian penal system. It also needs to be noted that all prisoners in New South Wales are tested on entry into the system, usually three months after entry into the system and on release back into the community. As I remember it, tests can also be conducted at other times if thought warranted or if requested by the relevant authorities or the prisoners themselves.

I am going to have to do a little more reading on this subject, as I find it really interesting. It has not much to do with my life now that I have moved from lawyering work into teaching, but the legal stuff still remains a fascination (some might say an obsession) for me.

Ariawan has been sentenced to a life term for his role in the embezzling of Bank Liquidity funds offered to Bank Surya.

USA & HIV / AIDS -- A Travel Decision...

It seems that the US has finally decided to make its decision to overturn the ban on HIV infected people travelling to the US a reality. President Obama has signed an order that will see the ban lifted from early next year. Hopefully, the other dozen or so countries that continue to ban HIV infected travellers will soon follow the US lead and remove the bans in their respective countries as well.

HIV / AIDS treatment has come a long way since the early eighties. So much so, that it is more a chronic illness than the death sentence it once was. People are living much longer with proper treatment, and the majority are able to live full lives and make lasting contributions to the communities in which they live. To discriminate against them on their HIV status is wrong.

Interestingly, there has not been a single HIV conference in the US since 1993. The ban on HIV+ travellers has meant that HIV+ researchers and activists would not have been able to attend to participate in any conference held. If you want to be the leader in any endeavour then you must act like the leader. This decision to remove the ban on HIV+ travellers is definitely a sign of leadership in the fight against HIV / AIDS.

Sexually Transmitted Infections -- Annual Surveillance Report

Sexually Transmitted Infections (STIs) are on the rise in Australia. The rise is currently being attributed to increased levels of risky sexual behaviour, and primarily this is unprotected sex. This is a scary thought. This post sort of follows on from the previous posts I wrote about the AIDS is a mass murderer campaign that has been launched in Germany.

The Annual Surveillance Report for 2009 can be downloaded from here. In fact, all the Surveillance Reports from 1997 can be accessed from this site as well. If one has an interest in the subject matter, then they are clearly worthwhile reading.

The report tells us a lot of things, but some of the figures highlight that rates of chlamydia infections increased by 10% over the previous year, infectious syphilis has reached epidemic proportions amongst gay men, and there were nearly 1000 new cases of HIV. The HIV cases at almost 1000 would not seem to be a large number, but it is still way too many. These figures suggest that the message has stopped getting through or people have become a whole lot more complacent about getting HIV. Complacency kills!

The data also shows that our indigenous brothers and sisters are coming into contact with STIs in increasingly large numbers. The data also highlights that intravenous drug users and homosexual men are afflicted in increasing numbers with HIV / AIDS, syphilis, and hepatitis. The chlamydia numbers are even more alarming as the show an increased in diagnosis from 14,082 in 1999 to 58,456 in 2008.

In another survey by Marie Stopes International of Australian school students found some interesting figures, including that just under half of the students surveyed had experienced oral sex. Even more interesting was that the majority of those did not consider oral sex to be sex. Sounds like a Bill Clinton moment to me, "I did not have sexual relations with that woman!" Which is true if one does not consider oral sex to climax and a subsequent spray of seminal fluid onto a dress, sex.

In another study conducted by the Australian Research Centre in Sex, Health, and Society at La Trobe University, and also of Australian school students, found that one in four Year 10 students admitted to sexual intercourse and one in two students admitted as much by the time they were in year 12. I don't think it was this many when I was in high school. But, then again we were not conducting surveys of our friends either.

What does this tell us? It tells us that there is still a need for the safe sex message. The sooner 'we' refocus that message the sooner we can begin the work of protecting those who are not infected and begin devoting more time, money, and energy to finding cures.

Sexual Barrier Protection Devices.

The Internet is a great repository for all kinds of stuff that can be used as base materials for teaching. I teach the odd legal drafting, plain English legal writing, and English for Lawyers courses, and have found some more material for this subject.

A bill to be entitled

An act relating to state inmates; authorizing a nonprofit or public health care organization to distribute sexual barrier protection devices to inmates in the state correctional system; requiring the Department of Corrections to develop a plan to properly dispose of used sexual barrier protection devices; providing an effective date.

I have the Silent Majority to thank for the link.

This is a piece of legislation that is on the cards for Florida. I am actually not so much against the legislation and do not have any moral or ethical issues with the provision of sexual barrier protection devices to inmates of correctional facilities. There are good reasons for the provision of these devices, such as seeking to prevent the spread of sexually transmitted diseases in jails, including HIV, among others.

I was intrigued by what a sexual barrier protection device is. Unfortunately, the bill does not specify in the limited extract I have as to what might be included. It does mention condoms, but I get the distinct feeling that there is more to this than just condoms. Nevertheless, it is still a good lesson in legal drafting.

When one wants legal certainty then it pays to be specific or in this case explicit. It is worth noting that a simple Google search turns up a lot of hits for the term but not a lot of definitive answers.

Oral Sex

The heading of this post reflects the content and is by no means a cynical attempt to boost visitor numbers to my humble abode. Then again maybe it is that too!

Let's face it oral sex is no longer taboo like it might once have been and it certainly is no longer solely practiced by members of the oldest profession in the world. The Australian Sexual Health Congress being held in Perth that some 90 per cent of those under 30 have partaken in what is conveniently named "going down under" seeing the congress is in Australia and all. It is interesting that so many people have now started to poke their collective heads around down stairs so to speak

Sex experts (I have always wondered whether or not this means you have had more practice than others and are therefore an expert?) suggest that the sharp rise in those prepared to try are doing so because of better hygiene standards and feminism. I am not sure how the feminism angle plays out but I am guessing more women are exercising the right to be pleasured and get pleasured (not sure that sounds right, but whatever).

Besides oral sex lost a lot of the taboo associated with it when good ol' Billy Clinton decided that oral sex was not really sex when he shook his finger at the assembled media and uttered those now famous words, "I did not have sexual relations with that women!" The rest they say is history. It certainly gave "that woman" aka Monica Lewinsky more than 15 minutes of fame, it did give us the now infamous blue dress with the seminal stains of a serving US president, and myriad of bit part players and their testimony.

The sexperts are also theorizing that people are looking for greater variety in their sexual experiences. Hence going where they have not gone before is perhaps an exciting challenge. It is also theorized that oral sex means that there is no need to think primarily of contraception. The list of theories continues with that oral sex is less likely to result in HIV infection. However, don't count your chickens before they hatch as it seems some other sexually transmitted diseases (STDs) such as gonorrhea and herpes are on the increase in practitioners of oral sex.

So, if you are one of those people that have never been downstairs then you should be happy knowing that you are part of an ever-decreasing minority.

Governments Regulating Morality

It seems that the Government of Jakarta has decided the best way to break the chain of HIV infections plaguing the capital is to regulate the morality of its citizens and to pass the burden of testing and screening onto businesses. Sometimes you have to worry about the policy wonks and drafters sitting in City Hall and their inability in putting together a coherent policy and a workable law.

What follows might be too analytical for some. However, it is worth pondering some of the points raised.

It might be argued that this Regulation has been a long time in the making and an equally long time in the coming. The Regulation, No. 5 of 2008, seeks to break the chain of HIV infections that, at least, statistically have seen a rapid spike in the upwards direction. HIV/AIDS is a serious problem in the capital and there is no doubt that the government needs to be more proactive in the fight against the virus.

The basic premise of the Regulation is to break the chain of infections. Furthermore, the Regulation is designed to ensure that the quality of life of HIV / AIDS suffers and intra-venous drug users improve. However, the responses that the government proposes to this end are interesting for many reasons. In many ways the provisions of the Regulation seem to be more suggestion in nature than enforceable as the provisions seem to be aimed at regulating moral behaviour and criminalizing poor moral judgment.

The rest of the Regulation deals with matters that provide a loose framework for ensuring that people living with HIV / AIDS have access to adequate medical treatment and are not discriminated against once their HIV status is known either to an employer or the community at large. It is not explicitly clear from the construction of the Regulation but it appears that generally this provision would make it an offence to discriminate against and vilify a person with HIV.

Furthermore, the Regulation requires businesses that are considered to be high risk and potentially sources and spreaders of the virus to be more pro-active in screening their staff for HIV infection. Through to June 2008 there are 3,123 cases of HIV reported in the capital which on a percentage basis is small considering the size of the population.

There are five components to the Regulation:
1. general provisions;
2. promotion;
3. prevention;
4. medicine; and
5. treatment and support.

In general the Regulation targets those individuals that are considered high risk or work in high risk businesses. These businesses are identified in the Elucidation to Article 15(g) as, among others, employees of massage parlors, spas, discotheques, and karaoke joints. However, the Regulation also makes special mention of ensuring that pregnant women and nursing mothers have access to suitable and continuing services to ensure the health of any children born to a HIV positive mother.

Promotion is a matter of communication, information, and education. The promotion role is to be filled by the community, the Central Government, and the Government of Jakarta as required. However, it is expected that there is to be a degree of synergy developed among these promoters to ensure efficiency and effectiveness of any promotions undertaken.

It is expected that the promotion activities will focus on two core elements, namely: changing lifestyle patterns and reducing the stigma attached to being HIV positive.

The educational aspect of the promotional program is to include both internal and external (extracurricular) elements within schools. This means that schools are required to develop a personal development or sex education program that includes materials on HIV / AIDS. Interestingly, the Regulation uses the word “schools” and the Elucidation to the relevant article does not provide any assistance to how schools must be defined. So it is therefore reasonable to assume that the word schools can conceivably include from the primary level through to the senior secondary level.

Nevertheless, the likely target will be senior high school. Yet, if statistics were to bear out that increasingly larger numbers of junior high school students were engaging in high risk behaviours then it would seem to make sense to start the education program at the junior high level.

In a more general sense the promotion elements of the HIV / AIDS program are aimed at promoting the idea that a harmonious and loving family is one that does not tolerate high risk behaviours.

The prevention strategy on face value is a good one. Unfortunately, neither the Regulation nor the Elucidations provide enough detail about how the prevention strategy is going to be implemented in full. There is considerable scope for further regulations in order to “fill” out the regulatory framework.

The prevention strategy includes, among others, the following:
1. abstinence for unmarried people;
2. sexual relations only with those who are your legal partner;
3. use of preventive aids (presumably condoms although nothing is mentioned) by people of known HIV status;
4. programs to reduce the negative impacts of intra-venous drug use;
5. standard operating procedures for organ transplants and blood transfusions;
6. programs to ensure that pregnant women of a known HIV status have prioritized access to antiretroviral drugs to lessen the risk of transmission to their unborn child;
7. programs that require high risk business to routinely screen for HIV infections in their employees;
8. universal precaution for health workers who are at risk of contact with HIV; and
9. family counseling.

The above strategy gives rise to a number of questions. These questions will need to be answered going forward either in a legislative manner or in terms of a commitment to allowing certain strategies to take shape. There is also considerable scope for public / private partnerships to develop in such areas as needle exchange programs and injecting rooms as a means of reducing the negative impacts of intra-venous drug use and abuse. Other possibilities include the development of community health programs that promote the use of condoms and make them readily available to the masses.

Furthermore, the compulsory nature of the obligation on employers to test employees who work in high risk businesses is an interesting one on a number of different levels. For example, the costs of the testing are to be borne by the businesses themselves. However, the Regulation is unclear as to whether the government is going to appoint an accredited screener for the process or are the businesses free to choose a screener of their own? The Regulation is also unclear as to what the employer is to do with an employee who is HIV positive once they are uncovered through the screening process.

Another interesting question not properly addressed in the Regulation is how are bars and pubs to be tested and screened in this process. Admittedly, the Regulation would cover employees of bars but it would not conceivably cover freelance female and male sex workers who might inhabit such establishments. It would appear that there would also be a need to screen these people as well. However, if they are not employees then who does that responsibility fall to? And isn’t the screening of high risk individuals one of the pillars of this piece of legislation?

In a perversely funny kind of a way, the Regulation seems to suggest that certain entertainment venues are places of prostitution. It is clear that prostitution is illegal in Indonesia so if the government of Jakarta is making such an admission then would the more common sense approach be to close these venues down and reduce the level of prostitution in the city.

The reality is that the Regulation is far from being as comprehensive as it might have been. Considering the intent of the Regulation is to break the chain of HIV infection, then to leave large numbers of high risk individuals to voluntary testing would seem to undermine the good intentions of the provisions as they currently stand.

In terms of medicines the Regulation is much more scant on provisions and states that further regulations are to be issued to clarify this matter.

The Regulation creates both Provincial and District / City AIDS Prevention Commissions which in a cynical sense serves to create another level of bureaucracy in the system. However, if the Commissions were able to be developed in a manner that allowed for consolidation of the current diaspora then this may be a positive development.

Interestingly, the Regulation sets out a role for community participation but simultaneously obligates the members of the community to treat people living with HIV / AIDS in a just and humane manner. Combined with the earlier noted provisions, this appears to bring into play the possibility of people being charged and prosecuted for vilifying HIV positive individuals.

The community’s role also seems to include a moral policing aspect as the Regulation is specific in stating that the community must ensure that the is an increase in religiousness of the community and that the existing family units are maintained. The Regulation then goes on to state that the community must create an environment that is conducive for the, presumably, wider acceptance of the fact that there are HIV positive people and drug users living within their midst.

The Regulation also includes a Chapter on investigation and explicitly states that investigators can either be police investigators or appointed civil service investigators. The provisions in Article 27 set out what the investigators are authorized to do but what the Regulation is lacking is specifically what the investigators are to investigate. It is therefore presumed that the matters that would be subject to investigation are those relating to compliance and the specific provisions noted in the Chapter on sanctions.

Yet, it is worth noting that investigators have extensive powers to fingerprint, photograph, and seize property and documents. What is unclear from the Regulation is whether this power is as unfettered as it seems to be.

The provisions require businesses to test staff members at least every three months. Presumably, this means that investigators would be able to demand documents that would prove compliance. The sanctions provisions only note the following offences:

1. failure to keep HIV status data confidential;
2. failure to follow standard operating procedures with regards to transplants and transfusions;
3. non-discrimination against HIV positive people in the provision of medical services; and
4. compulsory HIV screening for high risk employees.

The administrative sanctions would include written warnings to businesses that have failed to comply with screening procedures. Ongoing compliance failures would then allow the government to shut down the business.

The criminal sanctions provide for terms of detention up to three months or fines of up to IDR 50 million. The deliberate spread of HIV is not subject to a specific penalty under this Regulation but rather the Regulation states that the criminal penalty will be whatever is applicable under the prevailing laws and regulations.

The Regulation was issued on 22 July 2008 and came into force on 24 July 2008.

Justice Michael Kirby -- Criminalizing HIV

Australian High Court Judge Michael Kirby has spoken about the growing pressure on States to criminalize the transmission of HIV. Justice Kirby while addressing a criminal law conference in Dublin was speaking about the rising rates of HIV infection in Australia and the pressure to see those that transmit the virus punished.

It is Justice Kirby's view that criminalizing the transmission is going to have a a negligible effect on transmission rates, if any effect at all. The idea of criminalizing the transmission of HIV is likely to be counter-productive as this would be best described as a punitive measure.

The money that the State is likely to have to throw at this to make the policy of criminalizing the transmission of HIV would be better spent on research and development that leads to a vaccine and eventually a cure.

The fact that HIV is no longer the immediate death sentence it once was because of significant advances in the effectiveness of antiretrovirals and other drugs has meant that people have become much less cautious in protecting themselves. Perhaps psychologically the idea of a chronic illness is more palatable and less scary than rapid progression to death from an AIDS related illness.

I know Justice Kirby and I once wanted to clerk for the man. Justice Kirby has lost friends to the disease. So, in that sense he has a personal perspective on this.

New York and Herpes

Well, if you're going to New York and thinking about a dalliance or two make sure that you are condomed-up! The latest research by the New York Department of Health indicates that one in four New Yorkers is positive for the genital herpes virus. For African Americans the rate is even higher at one in two or 50% being carriers of the virus.

The virus is more prevalent in women. The herpes simplex virus 2 normally manifests as sores that will generally heal within 2 weeks but the sores are particularly painful. The sores also mean that a person with them is more susceptible to other virus such as HIV.