In this conservative era of politics and religion, I have noticed how the animus toward people with HIV/AIDS has not abated although we are now at the quarter-century milepost of the epidemic being in the U.S.
One of the ways a health care initiative becomes enmeshed with conservative politics and moral intolerance will be the new HIV/AIDS prevention program mandating all public health authorities and agencies to report HIV-positive patients to the state.
With government funding for HIV/AIDS prevention shrinking more and more these days, many public health authorities and agencies will be requiring physicians to report to the state the name, social security number, age, address and date of birth of all HIV-positive patients. And many of these public health authorities and agencies will find themselves in the compromising position of either adhering to mandatory government-imposed HIV name listing or upholding the confidentiality of the clinician- client relationship.
I asked Dr. David Duong, a gay Vietnamese ER physician at Boston Medical Center, 'If it becomes mandatory that physicians report to the state patients who test HIV-positive, how might that impact the patient-physican clinical encounter?'
He replied that ' [ m ] andatory reporting of HIV-positive patients only engenders mistrust in the patient-physician relationship. This would potentially endanger both public health and individual rights. There are existing therapies and programs available to those with HIV. Due to the social stigma and risk of social and economic losses from a known HIV infection, these individuals would be less likely to seek testing, treatment and precautions in spreading the infection if doctors are seen as law enforcers more than patient advocates. To view that there is a conflict between public health and individual rights in mandatory reporting is not quite accurate. This view downplays the therapeutic nature of the patient-physician encounter in promoting both public health and patient well-being.'
Proponents of name-based reporting, however, contest that equitable funding and uniform accounting and tracking of the epidemic can be obtained that would allow for not only a better patient-doctor clinical encounter, but it would also allow for a more authentic representation of community-based education and management care.
However, public health authorities and agencies failing to comply will feel the government's punitive sting by substantial monetary lost.
Washington, D.C,. has a Sept. 30, 2006 deadline to comply or it will lose millions of dollars. And in my home state of Massachusetts, the Department of Health would lose $9 million a year and the Boston Public Health Commission would lose $6 million—money that is used for medication to meals to home healthcare.
The underlying motive, however, for this health care initiative is politically driven to both police and profile people who test HIV-positive—and the motive is not new.
In 1986, conservative political commentator William F. Buckley, Jr., suggested that the judicious way to keep account of those who were infected with the virus and vectors of transmission was to tattoo them on their buttocks and forearms, an act reminiscent of both American slavery and the Holocaust in which Africans and Jews, respectively, were tattooed and treated like animals.
But the people who would be most impacted by this government intrusion in their lives—LGBTQ people, IV drug users and people of African descent—are already the moral whipping boards for a morally intolerant society in denial about how the epidemic continues to grow at an exponential rate.
So I ask Duong: Given the fact that physicians must report certain communicable diseases how would reporting patients who test HIV-positive different and/or similar?
'HIV is separate from other reportable communicable infections in that there is no cure and that the medical and socioeconomic consequences of infection are potentially so devastating,' he stated. 'HIV infection is associated with already marginalized and discriminated populations. Reporting HIV-positive patients would further alienate and reinforce the vulnerability of these patients. The laws protecting HIV infected individuals are inadequate, while for other reportable diseases protections are not necessary due to their lack of stigma or their ease of cure,' Duong stated
And with this intrusion the epidemic would continue to soar rather than abate because the moral and ethical issues of patient confidentiality; their Fourth Amendment right to bodily integrity and unreasonable searches; and their Fourteenth Amendment right to privacy are all violated at the expense of our government funding unproven HIV/AIDS prevention programs. These programs convey the impression of restoring traditional family values rather than fielding scientifically proven ones that address the issue of HIV/AIDS prevention head on.
For, example, the present administration has done more to hinder the fight against AIDS than to prevent it by promoting an abstinence-only ideology, taking monies from proven disease prevention initiatives, denouncing the effectiveness of condoms and refusing to fund needle exchange programs.
The Rev. Dr. Martin Luther King said that, 'Of all forms of inequality, injustice in health care is the most shocking and inhumane.'
And most shocking and inhumane is when a government continues to believe, in the face of hard evidence, that contracting the AIDS virus is a direct and divine consequence of engaging in a lifestyle that is fraught with both disease and sin—and that it will continue to devise and to justify various name-based approaches to erect its colonies for 'lepers.'
Once a government-imposed health care initiative such as this one is mandated for the sake of restoring traditional family values, we as a nation will have built our moral high ground by riding on the backs of our weak.
And this is not only an act of inhospitiality and moral intolerance toward the targeted groups who test HIV-positive, but it is also a symptom of a sick society that tests negative for compassion.
