Originally Posted by Mary_H
We know prison officials lied to Amanda when they told her - twice - that she had tested positively for HIV.
Mr. D.: No evidence for such has been presented here. Please demonstrate that officials knew that Knox's HIV test results were a false positive before she was told of them.
Originally Posted by Mary_H
We know this was a form of psychological torture.
Mr.D.: Unsupported assertion. Bruce, Charlie, halides (or LondonJohn or anyone else for that matter), do any of you agree with this statement unequivocally?
I don't think I can conclusively demonstrate that officials knew that Amanda's HIV tests were negative when they conveyed the information to her, because I don't have access to any documentation of their plans or strategies. I hope I can raise doubts in people's minds, though, about the purpose of the HIV testing in general, so they can come to their own informed conclusions. I will start by using the two following publications as sources:
The UNODC, UNAIDS and WHO Policy Brief on HIV testing and counselling in prisons and other closed settings
http://www.who.int/hiv/pub/idu/tc_prison_policy_brief.pdf
and,
Epidemiological Fact Sheet on HIV and AIDS - Italy - 2008 Update
http://apps.who.int/globalatlas/predefinedReports/EFS2008/full/EFS2008_IT.pdf
The most obvious questions that arise are about why Amanda was tested for HIV in the first place. Also, why was she tested so soon upon her arrival in prison, and under what circumstances was the test obtained?
We might guess that all prison inmates are automatically tested for HIV, but we would not necessarily be correct. It depends on the laws of the country in which one is incarcerated. According to the first source I cited above, though, these are two of the primary policy recommendations regarding the administration of HIV tests to prisoners:
"- Unequivocally oppose mandatory testing or counselling:
"- Emphasize that regardless of whether HIV testing is client- or provider-initiated, it should always be voluntary [page 1]."
[The brief goes on to say] "...Such mandatory or compulsory forms of HIV testing violate ethical principles and the basic rights of consent, privacy and bodily integrity. They are not necessary for the protection of prisoners, staff or visitors and cannot be justified from a public health perspective [page 3]."
Some Perugian prison officials may not have been aware of these guidelines, but there is no doubt the prison's medical staff were. Italy appears to be a country whose medical professionals are very well educated about the international response to HIV-AIDS. On page 6 of the second source I cited, you will find a graph showing that estimated deaths from AIDS in Italy peaked in 1996, then dropped precipitously and have remained low since 1998. In 2006, 273 women in Italy died of AIDS, as opposed to 1,282 in 1996 (page 10).
Even if the prison medical staff were able to persuade Amanda to voluntarily consent to an HIV test, the question again arises as to why. Amanda is not in a high risk group for infection. One might argue that she had had several intimate partners, but prison officials didn't have access to that information until after they read Amanda's diary, as far as we know.
Did the prison test her for HIV in case she was sick and they wanted to treat her? If they did, they also should have tested her for heart disease, lung disease and cancer, all of which kill more people in developed countries than does AIDS. That would have made more sense than testing her for HIV.
We do have anecdotal evidence that prison officials (not the doctors) were trying to get at information about Amanda's sexual history. Here is an excerpt from an interview between Claudio Paglieri and Giuliani Mignini:
Paglieri: Let’s talk about HIV. Amanda in jail was told that she was HIV-positive and was asked to make a list of all her ex-lovers in order to tell them. Then the positivity turns out to be a false positive sample. The suspicion of a trick arises.
Mignini: I never asked Amanda anything like that . We have the utmost respect for the suspect, and on top of it, what would have been the purpose of asking her?
Paglieri: Because the list ended up on the newspapers and contributed to giving a negative image of the girl, of an “easy” woman.
Mignini: Nobody has depicted Amanda as an “easy girl”. Why would I do it? She was totally unknown to the police and the procura. Her sexual life is totally irrelevant in order to describe her personality, though it helps to explain the tense relationships with the other roommates.
http://www.truejustice.org/ee/index...oug_preston_looking_increasingly_incompetent/
Methinks the gentleman doth protest too much. In one sentence he says Amanda's sex life is not relevant, and in the next sentence he says it is. The fact that he considered knowledge of Amanda's sex life helpful in any way at all suggests he had a motive for obtaining more information about it. He certainly did convey at trial and through leaks to the media that Amanda was perhaps "too" sexually active for some people's liking, and he had her diary to prove it.
As to the question of lying, well, the bottom line is that false positives for HIV are extremely rare, and second false positives are, naturally, even rarer. Based on the statistical improbabilty that Amanda could have tested falsely positive twice or even once for HIV, I think it is safe to surmise prison officials gave her false information for one purpose or another.
As to the question of whether or not giving Amanda false positive HIV test results was psychological torture, we have more anecdotal evidence, provided in Barbie Nadeau's book,
Angel Face:
“After she was arrested, the police set a trap for Amanda by telling her she had tested positive for HIV. This sort of psychological trickery is commonly used by investigators in Italy to elicit a confession.” (page 27)
If true, this suggests officials not only were trying to get at knowledge of Amanda's sex partners, but also that they were trying to dismay her to the point of breaking down. Again, though, the same results could have been obtained from other test results -- say, for some kind of fast-moving cancer -- so we cannot rule out the possibility that the test for HIV was intentionally focused on sexuality.
Concerning the issue of psychological torture, we have to ask ourselves why the World Health Organization and other agenices have guidelines specifically set out to protect people from psychological harm upon learning they have tested positive for the virus that causes AIDS, unless such an experience is considered dangerous, if not torturous. From another source, we learn there are recommendations regarding informing clients/patients of their positive HIV status:
“When implementing provider-initiated HIV testing and counselling, equal efforts must be made to ensure that a supportive social, policy and legal framework is in place to maximize positive outcomes and minimize potential harms to patients.”
http://www.who.int/3by5/publications/briefs/hiv_testing_counselling/en/index.html
I certainly wouldn't call being the object of public ridicule a way to maximize positive outcomes. And was Amanda offered counseling? Not that I am aware of; she doesn't mention it in her diary.
From the point of view of health ethics, it is appalling that any one of us knows that Amanda was tested for HIV at all; it is outrageous that the news was spread by the media. Medical professionals in developed countries are bound by strict doctor-patient confidentiality rules. My guess is the prison doctors died a thousand deaths when they found out what they were part of, not only out of concern for Amanda, but also out of concern for their own Hippocratic oaths and professional reputations. I can't imagine they participated willingly.
The use of HIV testing and false positives against Amanda is not a minor issue. It constituted a serious breach of her human rights, and Perugian officials should be censured for it.
I will answer your other questions in another post, Mr. D.
