Philip Hensher: Can you trust people who behave like this?

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The Independent Online

St Ives is an idyllic sort of place, attracting not only hundreds of thousands of visitors, but, for decades now, refugees from conventional urban life. In this remote and aesthetic spot, a relaxed and bohemian style has united the incoming artists and the ordinary inhabitants; there is nothing puritan about this town.

So the press conference held by the local primary health care trust at the end of last week will have had the effect of a bucket of cold Cornish seawater poured over the town. The trust took the unusual, but not unprecedented step of announcing that there were a "cluster" of HIV cases in the town, considerably in excess of what might be expected statistically. They have identified "up to 10" cases of men and women who may have been infected eight years ago or more. In epidemiologist's terms, they are not prepared to specify the lower number - it may be as few as 3. They went on to specify the origin as a single heterosexual man, without identifying him or the people who he is supposed to have infected

You can see the rationale behind the trust's extraordinary announcement. One can't, however, commend their tactics. In a small town like St Ives, publicly announcing HIV cases and, moreover, effectively blaming one man for spreading it seems utterly reckless. The way they announced it inevitably makes it sound like nearly a dozen cases; in reality, it may be no more than three. Even if the trust weren't prepared to identify him publicly, it seems extremely likely that St Ives itself will by now have worked it out. The lives of those with HIV are not easy, and they shouldn't be made more difficult still by a healthcare trust dropping heavy hints in this way.

There must, surely, be a more tactful way of uncovering undiagnosed cases of HIV in a community. Advice from a STD clinic, or the local GP, would seem a better way than holding a press conference and alarming everyone. In any case, if you suspected that you might have HIV, would you not think twice about being tested by a trust which so cheerfully dropped hints about your medical status?

It is hard not to think of this as part of a general tendency to reintroduce the notion of culpability into the HIV debate. The implication of the St Ives conference was rather that there was one man at fault, and people ought to watch out for the others. If there was any reiteration of the sensible healthcare message that HIV is extremely difficult to contract through sex if condoms are involved, it didn't go reported.

Similarly, the criminalisation of HIV transmission, largely invoked, it seems, against immigrants both legal and illegal in an attempt to discourage "health tourism", shifts the emphasis away from responsibility and towards culpability. Anyone who gets on a motorbike without putting a helmet on is acting recklessly. Someone who has condomless sex without knowing the HIV status of their partner is, on the other hand, encouraged to think in terms of culpability. It is not at all helpful.

A trust clearly has a duty towards people at risk of HIV infection, but I wonder whether this duty is best served by alerting people to a specific risk. The risk, in reality, is universal, as present in Truro or anywhere as in St Ives. There is, too, the point that in drawing attention to such cases in so small a community, the trust has come very near to breaking another duty, that of confidentiality. That is just as important.

So much for European values

Alarm has been raised by the appointment of an extremist pig-farmer, Andrzej Lepper, left, as Deputy Prime Minister of Poland. Among his exotic opinions are that "the most dangerous nation for the Poles is the Jewish nation"; on his CV are several arrests for violence during anti-EU protests.

Nothing unusual in Poland these days. "Pro-family" groups have been organising protests, sometimes of stone-throwing violence, against gay rights demonstrations. Kazimierz Marcinkiewicz, the Prime Minister, is reported as saying, "If a person tries to infect another with homosexuality, the state must intervene in this violation of freedom."

Membership of the EU entails signing up to certain human rights commitments involving equality. If national governments won't intervene to protect minorities, we are entitled to ask what the EU is doing to enforce these necessary freedoms.

* The amusing aspect of the story about Charlie Stopford, the American who for years passed himself off as the Earl of Buckingham, is that he apparently sought to make himself less conspicuous in this Day-of-the-Jackal-type scam by assuming an earldom.

Mysteriously, it worked for years: nobody who met him, even his wife, thought to pick up a copy of the Peerage and find out that there was no such person. But how extraordinary that, even in America, there are people who still think an earldom makes any difference at all.

The temptation to pass himself off as a descendant of James I's boyfriend seemed to outweigh the massive increase in risk. Even though no sane person gives such matters any credence any more, it seems tragically likely that, for centuries to come, there will still be people insisting on their titles, real or invented; there will still be people prepared to bow to something which always resided only in the imagination.

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