D.D. from Split first infected his wife, whom he still lives with today, with the HIV virus before he infected his 21 year lover who in the meantime contracted AIDS and died. When the Public Health Institute in the Split-Dalmatian County recently discovered his third victim, epidemiologist and institute director Dr. Mladen Smoljanović decided to take a radical step and announce in the newspapers that the county was under attack by several HIV positive person who were consciously spreading the disease. The majority are drug users who prostitute themselves for drugs or “dancers” in half-legal brothels, however D.D. does not fall into either one of these risky categories. Furthermore, this is a well known person, who owns an exceptionally popular café in the very centre of Split.

The identity of this “free loving family man” is known not only to doctors, but also to police, however, everyone is equally helpless in their intentions to stop him as to date, every one of his victims has refused to sign a statement which could form the basis for charges and a lawsuit. According to the recommendations of the World Health Organization, which state that the names of HIV position persons should not be revealed, as well as due to the Hippocratic oath which also guarantees the same anonymity to each patients, the Split physicians have found themselves in a hopeless situation: everyone knows, and no one is allowed to do anything about it.

“We need to have concrete evidence, and concrete evidence is a written statement by a person of age who signs that he or she was infected by such and such a person. A verbal confirmation which the victim later refuses to sign cannot be used in court. Our hands are tied – the doctors, police, justice system. I am left with only one solution, and that is to speak up in all possible ways to warn people to be cautious. In Split they already know. I have received return information about this, and that is what I wanted to accomplish. That is all I can do,” explained Dr. Mladen Smoljanović, who regardless did not want to confirm or deny the information that Nacional received through unofficial but reliable sources. In the meantime, the Split administration has decided to shut down his café due to an inability to agree on lease payment, and D.D. has decided to spend this winter in Zagreb.

This man, who has only recently turned 40, was known earlier in Split for his promiscuity, and it turns out that after learning he was HIV positive, little has changed. In the beginning, D.D. received the so-called triple therapy which permits HIV positive people to have a somewhat normal life. The therapy also acts to reduce the number of infective cells in the bloodstream which, with proper condom use, reduces the danger of transmission to a minimum. With this, risk is only present in the event that the condom breaks or is damaged in some other way, therefore resulting in direct contact. Furthermore, doctors explain that according to a study conducted among Thai prostitutes, 90% of whom are infected with HIV, that the risk from one sexual contact is only about 5%. This risk progressively rises with each subsequent contact. For that reason, it can be concluded that D.D. did not use a condom during his intimate contacts with his lover, a young girl who died at the age of 21 from the AIDS virus.

It is my duty as a physician to mention that this behaviour, like other forms of destructive behaviour, is not at all uncommon in people infected with fatal diseases. Tuberculosis patients, back in the day when there was not an efficient cure for tuberculosis, behaved similarly. They would intentionally cough into other people’s faces to infect them,” explained Dr. Smoljanović. There is no doubt that an HIV positive person has to feel lovely, for those infected with this modern day cholera are truly treated as contagious, even though today, it is well known that AIDS is not transmitted through social contact. It would be horrible, but an understandable story if D.D. decided for some reason to infect someone else in order to have someone by his side to the end – however, this kind of till death do us part love, in the unpleasant sense of the word, was already provided by his wife. What his motive was when he decided to become involved with a girl half his age is hard to tell, however in the case of his third victim, it is not to difficult to tell. Though little is known or said of this woman, she appears to be in the medical profession, a doctor, nurse or pharmacist. In the meantime, D.D. has given up on the triple therapy. Namely, not a single case is known in which this therapy has succeeded in curing the illness, and the treatment is accompanies by unpleasant side effects such as diarrhoea or frequent nausea. When he refused to continue treatment, the man from Split began to recently show the first signs of the illness, which is how he likely came to the conclusion that he would soon require home medical care.

“I am involved in this whole story, because I received a patient who came to the Infectious ward for a second opinion. Such a diagnosis is usually an indicator of HIV, so I suggested she take the test and it turned out that she was HIV positive,” stated Dr. Nikola Bradarić, director of the Infectious Diseases Hospital in Split. He did not want to reveal the identity of the patient nor the person who infected her. The women who, not suspecting anything, went in for tests in the Infectious Diseases Hospital in Split and received this death sentence given to her by her lover, responded without hesitation to the question of who infected her. However, she decided not to report him for, as she explained, she is in love with him. “And this leads to a dilemma. On the one hand we have the Hippocratic oath which binds us to patient confidentiality and the special recommendations by the World Health Organization to not reveal the identity of those persons suffering from AIDS. On the other had, every citizen has the moral responsibility to report persons conducting criminal acts, and the conscious spread of disease is a criminal act. Neither the Justice Ministry nor the Health Ministry was able to give us a response to this dilemma,” said Dr. Bradarić. In such a delicate situation, the search for the right solution cannot be fruitful, which Nacional was quick to find out. Until recently, not a single such or similar case in Croatia has ended up in court, and so this is unknown territory where Croatian lawyers are having a difficult time.

“Such a case could be considered a criminal act of spreading sexually related disease, however, the criminal charges are then raised exclusively at the request of the victim, or rather the infected person, which is logical, considering that this has to do with a person’s intimate life. It is possible that the death of the girl he infected could be treated as a homicide, however, this claim would be difficult to prove in court,” explained Ksenija Turković, lecturer at the Faculty of Law in Zagreb. Turković warns that charges cannot be filed anonymously. In other words, he who decides to search for justice in court would also have to begin by openly admitting he is HIV positive, which would also be a precedent in Croatia. The situation becomes even more absurd in the case of dancers at the “American Go Go” bar, among whom which according to the word in Split, are HIV positive girls. The Split Institute for Public Health perhaps knows their names as well, but they have not yet found volunteers to report them. Bosnia Herzegovina is on the brink o fan AIDS epidemic due to one infected prostitute who died in Mostar at the beginning of November, and also due to many others who, involved in the world’s oldest profession, are infected and become sources for new infections. Waiting for a volunteer to report that he became infected with HIV in a semi-legal brothel and to point out the dancer whom he paid for sex will obviously not resolve this problem.

One of the possibilities, considering that AIDS is mentioned in the Regulation on Means of Reporting Infectious Disease of the Health Ministry, would be to treat it as an infectious disease in the Criminal Code. In that case, the transmission of infectious disease would be the responsibility of all those not abiding by the provisions and regulations which the competent state body sets the measures for combating or preventing infectious disease. In that case, D.D. could be charged with a fine or jail time of up to one year even for backing away from the triple therapy he was receiving, if that treatment were prescribed as mandatory. But it is not. In every other case, we are back at square one, or the issue of proving someone’s responsibility for spreading the infection when there is not an infected victim prepared to testify.

“Split is a small town in which certain news is spread very quickly, regardless of how we try to protect medical confidentiality. It is not pleasant when rumours circulate that so and so came in for HIV testing, regardless of whether the test results are positive or negative,” explained Dr. Nikola Bradarić, director of the Infectious Disease Hospital in Split. This mentality does not only exist in Split. While the infected keep this secret due to demonization from others, the justice system is confused and at a standstill for, according to a UN study, Eastern Europe is on the brink of a large increase in the number of infected persons. It is assumed that Croatia currently has about 500 HIV positive persons, including those not registered. The implementation of free and anonymous HIV testing should help until the real figure can be determined. Testing is available in all public health institutes, which this year have also begun to open advisory facilities in which doctors, psychologists, social workers and theologists where needed are available to help. Furthermore, the regional centres are also soon to receive money from the national health insurance institute for triple therapy, which now is available only in Zagreb’s Clinic for Infective Disease, which is also the referral centre for HIV. Dr. Bradarić stresses that in that case, Osijek, Rijeka and Split would also receive the medical treatment necessary to assess and monitor the complete immunological status of infected patients, for that is essential for adapting the treatment. All these moves by the Health Ministry could be considered as mobilization in the event of a possible epidemic of infectious disease, which thousands of people die from every one and for which there is still no cure. The increased number of infected, and the fact that which each new HIV positive person, the possibility of spreading the disease increases, could also result in the lack of triple therapy for all patients, as the health insurance institute will not have the money to pay for it. This is the case with all the Hepatitis C patients in Croatia. Not to be taken literally, but healthy people and those already infected with HIV could soon become the victims of irresponsible lover D.D.
“Revealing the identity of infected persons with their consent is also a criminal act of revealing personal and confidential information. If this was a journalist, it would likely not result in criminal prosecution, however, it is necessary to think twice about revealing the name as this is a delicate situation,” responded professor Ksenija Turković when asked about the possible legal repercussions Nacional could have if it revealed the name of the living bomb which is irresponsibly and consciously spreading the disease. Delicate, because D.D. has a family which should not have to bear the consequences of his criminal actions, as they have already suffered enough tragedy. According to Smoljanović, the illness is already in our back yard and infection could happen to anyone.