HIV Profiling: Symptom of a Sick Society

Originally published in The Witness, July 19, 2006 and The Advocate, July 3, 2006.

In this conservative era of politics and religion, I have noticed how animus toward people with HIV/AIDS has not abated, even though we are now at the quarter-century milepost of the epidemic.

The new HIV/AIDS prevention program mandating all public health authorities and agencies to report HIV-positive patients to the state is an excellent example of how health care initiatives can become enmeshed with conservative politics and moral intolerance.

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. This places public health authorities and agencies in the awkward position of having to choose between adhering to mandatory government-imposed HIV name-listing or upholding the confidentiality of the clinician-client relationship.

Those who uphold confidentiality risk losing essential funding, while those who follow the new regulations risk undermining the trust health care workers need to serve clients most effectively, as Dr. David Duong, a gay Vietnamese E.R. physician at Boston Medical Center, explains:

The Rev. Dr. Martin Luther King once said, “Of all forms of inequality, injustice in health care is the most shocking and inhumane.”

“Mandatory 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 take precautions in spreading the infection if doctors are seen as law enforcers more than patient advocates. (To say 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, argue that such reporting allows for more equitable funding, uniform accounting, and effective tracking of the epidemic, all of which would not only facilitate better clinical relationships between patient and physician, but also improve community-based education and management care.

But public health authorities and agencies failing to comply will be punished with the loss of government funding, which could force cutbacks in vital services.

Washington D.C., for one, has to comply with a Sept. 30, 2006, deadline or it will loss millions of dollars. And in my home state of Massachusetts, without compliance the state Department of Health will lose $9 million a year and the Boston Public Health Commission $6 million — money that represents medications, meals, home health care, and other services that extend life and health.

Sadly, the underlying motive for this initiative is not health: it is politically driven to both police and profile people who test HIV-positive. And the motive is not new.

You can’t build moral high ground by climbing on the backs of our weakest.

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 methods of transmission was to take those with HIV and tattoo their buttocks and forearms, an act reminiscent of the ways in which human beings were tattooed and treated like animals in colonial slavery and the Holocaust.

But the people who would be most affected by this government intrusion in their lives — LGBTQ people, IV-drug users, and people of African descent — are already the scapegoats for societies in denial about how the epidemic continues to grow at an exponential rate.

But given the fact that physicians must report certain communicable diseases, is it that much of a destructive innovation to require reporting patients who test HIV-positive? Physicians who work with people with AIDS/HIV say yes. In the words of Dr. Duong:

“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. 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.”

This kind of intrusion threatens to exacerbate rather than alleviate the epidemic, and furthermore runs roughshod over moral and ethical issues of patient confidentiality, patients’ Fourth Amendment right to bodily integrity and protection from unreasonable searches, and their Fourteenth Amendment right to privacy. And in the absence of any scientifically proven benefit to health care or health education, the only demonstrated advantage of such programs is that they help politicians to claim that they are restoring so-called “traditional family values.”

… a government that expresses such inhospitality and intolerance is a symptom of a sick society that tests negative for compassion.

But the eagerness of the Bush administration to promote such programs anyway is hardly surprising in light of its other policy initiatives with respect to HIV/AIDS. Under pressure from the evangelical base, they may have increased funding to some initiatives to combat HIV/AIDS in the developing world, but the Bush administration has done far more to hurt than to help: they promote programs that present only abstinence for prevention and eliminate or distort life-saving information about condoms, pull funding from scientifically proven disease prevention initiatives that don’t meet their ideological standards, and refuse to fund needle exchange programs.

The Rev. Dr. Martin Luther King once said, “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 proclaim, despite hard evidence to the contrary, that contracting the AIDS virus is a direct and divine consequence of engaging in a particular “lifestyle” and treats those with HIV/AIDS with the kind isolating, dehumanizing, and fear-based approaches that previous generations employed toward their neighbors with leprosy.

You can’t build moral high ground by climbing on the backs of our weakest, but government-imposed health care initiatives guided more by “traditional family values” than by the needs of the poor do precisely that.

Our response to the HIV/AIDS pandemic is a test of our cultural values: a government that expresses such inhospitality and intolerance is a symptom of a sick society that tests negative for compassion.

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