The sickness of HIV profiling

By Rev. Irene Monroe

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

One of the ways a health care initiative becomes enmeshed with conservative politics and moral intolerance is 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 E.R. physician at Boston Medical Center, how names reporting might impact the patient-physician clinical encounter?

“Mandatory reporting of HIV-positive patients only engenders mistrust in the patient-physician relationship,” he said. “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 view 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, which would allow for not only a better patient-physician clinical encounter, but also allow for a more authentic representation of community-based education and management care.

But public health authorities and agencies failing to comply will feel the government’s punitive sting by substantial monetary lost.

Washington D.C., for one, has a Sept. 30, 2006, deadline to comply or it will loss millions of dollars. And in my home state of Massachusetts, the state Department of Health would lose $9 million a year and the Boston Public Health Commission $6 million, money that is used for everything from medications to meals to home health care.

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.

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 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 board for a morally intolerant society in denial about how the epidemic continues to grow at an exponential rate.

So I ask: given the fact that physicians must report certain communicable diseases, how would reporting patients who test HIV-positive be different?

“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,” Dr. Duong told me. “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.”

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 that convey the impression of restoring so-called traditional family values rather than fielding scientifically proven ones that address the issue of HIV/AIDS prevention head on.

The Bush administration, for example, has done more to hinder the fight against AIDS, rather than help 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 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 believe, in the face of hard evidence, that contracting the AIDS virus is a direct and divine consequence of engaging in a particular “lifestyle” and, therefore, continues to devise and 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 weakest.

And this is not only an act of inhospitality and moral intolerance toward the targeted groups and individuals who test positive for HIV, but it is also a symptom of a sick society that tests negative for compassion.

posted 25 July 2006