As we reflect back on 1998, the sudden death on September 2 of Jonathan
Mann serves as a dark reminder of the narrow path we all tread between
life and death or even occasional success or failure. Mann will long be
remembered for his expansive vision during his early days as the first
director of the Global Programme on AIDS. He brought together physicians,
biological scientists, epidemiologists, behavioral investigators, community
activists and people infected with HIV, and encouraged all of them to focus
on a common goal. Initially the goal was to prevent the transmission of
HIV and to treat with compassion those who were infected. Over time, however,
Mann shifted his attention to a broader view of human rights, relating
this social construct to the personal and social harm that comes with the
human immunodeficiency virus. While untimely death halted his writings,
others have carried on with clarifications and revisions, elevating human
rights to a level that at times transcends the biological reality of deadly
What happens when the perceived human rights of infected persons to
remain free from disclosure and possible harm come in conflict with the
human rights of susceptible persons to remain free from infection? Which
human right is higher? Or more important, which right favors the virus
at the expense of man? This issue was raised in last week's Lancet in a
letter that attempts to glorify the memory of Mann (see below), but uses
curious logic in attacking the Canadian Supreme Court for an earlier decision
attempting to protect susceptible persons from intentional infection. A
description of the Canadian action (also from The Lancet) follows the letter
As we proceed into the new year, strong views that espouse one philosophy
or another will continue to grab headlines as we strive worldwide to develop
effective and efficient means for controlling the virus. Yet in considering
these views, the fundamental question must remain -- are we saving lives
or preserving cherished illusions? For those committed to public health,
the answer should remain grounded with prevention, as stated well by the
Canadian Supreme Court in their attempt to address a person who cherished
his personal freedom more than the lives of his two lovers.
"Jonathan Mann's mantle"
The Lancet 352 (9145), 19 December 1998
Sir--Paul Wehrwein's Sept 12 news item (p 888)  reports the death
of Jonathan Mann and Mary Lou Clements-Mann. Jonathan Mann spoke and wrote
extensively on the ways that human rights violations result in adverse
health effects. He made clear why confidentiality of HIV status was necessary
for health and ethical reasons, and why laws that target people with HIV
infection, result in worse health for the individual targeted and for the
community. He would have been appalled at the Canadian Supreme Court decision
to criminalise non-disclosure of HIV status. That the decision, reported
by Wayne Kandro, was handed down the day after Mann's death and is published
opposite to Wehrwein's piece is a sad and infuriating irony.
For those of us who have spent the last 15 years picking up mantles
of fallen comrades, the burden of Mann's is daunting. The shockingly ill
considered Canadian decision makes clear why his mantle must be taken up.
- Read Weaver
Schusky, The Canadian College of Naturopathic Medicine,
2300 Yonge Street, 18th Floor, PO Box 2431, Toronto, Ontario M4P 1E4 Canada
Wehrwein P. Jonathan Mann and Mary Lou Clements-Mann killed in airplane
crash. Lancet 1998; 352: 888.
Kandro W. Failure to inform sex partner of HIV status assault in Canada.
Lancet 1998; 352: 889.
What follows is the "shockingly ill-considered decision" Mr. Schusky
referred to, regarding a man who defied public health officers and intentionally
had sexual intercourse with two women more than 100 times without informing
them of his HIV status.
"Failure to inform sex partner of HIV status assault in Canada"
Kondro, Wayne. The Lancet 352 (9131), p. 889, 12 September 1998.
Failure to inform potential sex partners about HIV-positive status can
constitute a form of assault, Canada's highest court has ruled. In cases
where the consequences are potentially fatal, consent is fraudulent unless
the sex partner is informed of the risk of contracting a sexually transmitted
disease (STD), the Supreme Court of Canada decided on Sept 3 in a trailblazing
"The potentially fatal consequences are far more invidious and graver
than many other actions prohibited by the Criminal Code. The risks of infection
are so devastating that there is a real and urgent need to provide a measure
of protection for those in the position of the complainants", Justice Peter
Cory wrote on behalf a seven-member panel.
The court ordered that British Columbia resident Henry Cuerrier be retried
for assault. He had unprotected sex with two women more than 100 times
during 1992-94 without informing them of inform sexual partners of his
But while unanimously rejecting lower-court decisions that it was up
to Parliament to criminalise forms of deceit involving STDs, the Supreme
Court was divided on the degree of disclosure required. Two judges argued
disclosure should be required only in cases involving potentially serious
bodily harm stemming from a STD, while a third wanted an extremely broad
But the remainder, including Cory, adopted a middle-of-the-road approach
in which the duty to disclose is partly mitigated in individual cases,
for example, by the careful use of condoms.
The decision was immediately criticised by AIDS activists and some civil
liberties groups as likely to dissuade people from being tested for HIV
so as to escape the duty to disclose by claiming ignorance of status. They
also argued the ruling will further stigmatise people infected with HIV
and could result in the prosecution of people suffering from non-fatal