In a study published in The Lancet in May 2016, “Near real-time monitoring of HIV transmission hotspots from routine HIV genotyping: an implementation case study,” public health workers quickly identified a cluster of drug resistant HIV cases and were able to get these individuals into care and stop "onward transmissions.” In this article about the study, public health commentators point out, however, the "potential for misuse of the data 'in criminal cases of HIV non-disclosure,' a concern that could result in individuals 'withdrawing from valuable studies and treatment databases' or even from testing and treatment."
This article from HPV Live and the study it describes (discussing the monitoring of HIV genotypes to identify hotspots) provides support for the position that HIV criminal laws and policies may jeopardize rapid public health system responses to the spread of HIV (in this case a drug-resistant strain) because they possibly discourage individuals from participating in studies/treatment databases.
Database Can Spot New HIV Hotspots
Oct 18, 2016 | Gale Scott
Applying a monitoring system to the British Columbia drug treatment database—one that holds information of which HIV genotypes infect each of more than 9,000 residents with HIV—public health officers can learn when there are new outbreaks and take action.
Reporting in The Lancet, Art FY Poon, PhD, of the BC Centre of Excellence in HIV/AIDS, Vancouver, BC, Canada, and colleagues said the key to getting quick public health response is making secondary use of the routinely collected HIV genotypes.
HIV evolves rapidly so clusters of new infections with similar genetic sequences are likely linked. On average, five to six new HIV genotypes are added to the country’s database every day. Those additions trigger an automated reanalysis of the entire database. The system generates monthly reports on the growth of characteristics of clusters for distribution to public health officers.
In their study, the team extracted clusters of five or more individuals with short phylogenetic distances between their HIV sequences. They watched to see if the clusters grew. One did. In June, 2014, the monitoring system detected 11 new cases in one cluster in a three-month period. Eight of the cases involved drug-resistance. The cluster was made up mostly of young men who have sex with men. Public health workers followed up to ensure the new patients got access to care, and most started drug therapy.
As a result, of 12 new cases found in this cluster, there was “reduction in the onward transmission of drug resistance.” The approach “is cost-effective, attains near real-time monitoring of new cases, and can be implemented in all settings in which HIV genotyping is the standard of care,” Poon writes.
Responding to the article, Mark Gilbert of the Dalla Lana School of Public Health in the University of Toronto, Toronto, CN, and colleagues wrote that the approach is “powerful and promising” but comes with ethical considerations. There is a potential for misuse of the data “in criminal cases of HIV non-disclosure” a concern that could result in individuals “withdrawing from valuable studies and treatment databases” or even from testing and treatment. That could be an even larger privacy concern globally, as some societies stigmatize HIV, the team wrote.