Assassins on the Loose?

Danielle Toppin

Danielle Toppin explores an HIV prevention strategy proposed by Dr. Ray Noel, HIV Specialist for the Tobago Health Promotion Clinic, in an article in the Trinidadian newspaper The Sunday Guardian.

I have a friend who was once involved with a woman who knowingly "exposed him" to HIV, having tested positive years before and previously lost an infant to the disease. For years they were in a monogamous relationship, and suffered the loss of an infant son, while he remained ignorant to the fact (i) that his partner was positive and (ii) of the true cause of his son's death. He was told that the child died of pneumonia, and he took that at face value, doing no research or making no further inquiries about the extent of his son's illness. He is now out of that relationship, and thankfully remains HIV-negative.

He came to mind recently when I read an article in the Trinidadian newspaper The Sunday Guardian (June 17th, 2007), entitled "Assassins on the loose". The article, written by Dr. Ray Noel, HIV Specialist for the Tobago Health Promotion Clinic, makes reference to a "subset of HIV infected people who for diverse reasons react [to their infection] by developing a culpable state of mind, which consists of deceit in hiding their HIV status from their multiple sexual partners". Making reference to the HIV/AIDS epidemic in Tobago, he notes that while health care practitioners may know the identity of these "assassins" victims, "confidentiality rules and the lack of legal options prevent any form of intervention being initiated". Calling for the criminalization and prosecution for "deliberate and malicious sexual exposure and transmission of HIV", Dr. Noel notes that this would be a form of HIV prevention as it would eliminate "a potential source of infection".

The current legal situation which governs the activities of the Tobago Health promotion Clinic protects the client, ensuring that all information remains confidential, and therefore forbidding the discussion or disclosure of any information by employees with any third persons. This law also extends to persons who have been alleged to be HIV positive. While I know first-hand the pain and turmoil that my friend went through, I can't see the wide scale benefit of amending this law in the ways suggested by Dr. Noel.

Personally, I find the term "AIDS Assassins" very unsettling. It sensationalizes a very serious issue. It does not capture the fear, the identity crises, the cultural nuances, nor the social upheaval that may cause many people to remain silent in the face of a positive diagnosis. AIDS does not just happen on a physical level … it does not just happen to an individual. Defining this as maliciousness becomes extremely problematic, especially when we throw into the mix issues such as poverty, cultural and gender values, and societal discrimination, which may further influence infected persons' decision to keep their diagnosis secret.

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In the face of a legal framework that would prosecute infected persons for knowingly exposing others to the disease, other negative outcomes would likely occur. For one, those who may suspect that they are infected may be unwilling to get tested, and importantly, many who do test positive, may resist informing their partners for fear of prosecution, and the inevitable publicity that would come with it.

If the main goal of such a law is the prevention of HIV transmission, we should consider how much could be gained by such a law, and weigh it with what could be lost. Undeniably there are those people who maliciously seek to infect others. However, with stigma and discrimination still among the main challenges in the fight against HIV/AIDS, criminalization laws may compromise the health of the wider population, while attacking a minority in the infected population.

It raises another big issue, that of personal responsibility. My friend can now accept that not only did his former partner "expose him" to HIV, but also that he exposed himself. At no point did they get tested; at no point did they practice safe sex; and after the loss of his child, he remained in the relationship because he did not seek to educate himself about what had happened. Criminalization laws reinforce the idea of a victim and a perpetrator, and can potentially compromise our responsibility to protect ourselves.

Although Dr. Noel's article does have a sidebar of "Criminalisation Problems", which range from increased discrimination to reduced testing, the fact remains that those are not sidebar issues. They are major reasons why criminalization laws are not the best answer.

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