Posted June 19, 1997
To Stephen Murray:
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Murray's experience of losing his job -- and his health
insurance -- is a real
fear that those living with HIV and AIDS face. Although the Americans With
Disabilities Act should cover HIV/AIDS, discrimination is difficult to prove.
And it is still perfectly legal in thirty-nine states to fire someone for
gay. As Murray notes, contact tracing for syphilis and gonorrhea includes
treatment. Coburn shows no interest in this and in fact his bill includes a
provision that would deny Medicaid funding to those states that fail to
comply with the bill's reporting requirements. (Medicaid is the main
source of health insurance
for more than 50 percent of adults and 90 percent of children living with
I, too, would ask Representative Coburn where he stands on the issue of needle exchange. If he truly is interested in reducing HIV infection then he should endorse needle exchange as a proven public-health measure.
To Traci Watson:
The simple -- and frustrating -- answer to Watson's question is leadership. Yes, we do know how to prevent HIV, but we have yet as a nation to implement those strategies -- all of which is made clear by looking at content restrictions on CDC prevention messages, bans on the use of federal funds for needle exchange, and restrictions on condom distribution to at-risk populations.
Unfortunately, many people believe that if you talk honestly about HIV transmission you somehow encourage sexual behavior. What is needed is leadership on public health. Chandler Burr's comments state as much when he says that "good public health includes ... using mass-media campaigns to create behavioral change, and increasing our focus on preventive health, such as needle-exchange and pre-natal-care programs." At almost every turn, health policymakers have been stymied by politics that have watered down prevention messages about what works. Fortunately there are communities around this country -- Tacoma, Washington, is one example -- that have ignored the politics and implemented sound public-health strategies that are known to prevent HIV.
To Nancy Shute:
In the first six months of 1996 women accounted for 20 percent of newly reported AIDS cases. And more than 30 percent of new HIV infections in 1994 and 1995 appeared among drug users. More than half of pediatric AIDS cases and 66 percent of AIDS cases among women can be linked to drug use. Needle-exchange programs target a difficult-to-reach population -- drug users, their sex partners, and their children -- for whom HIV prevention and access to drug treatment is vital.
Margot's personal story is tragic. It also illuminates the reality that people with HIV change their behavior. Not because of mandatory programs, but because, given the facts, they do the right thing. Eric Kline, when informed of his HIV status, changed his behavior. He had a supportive family that was well-informed and had access to treatment.
Margot also raises an interesting point when she mentions that "mandatory treatment" does not violate anyone's civil rights. This goes back to Murray's comment about countries that offer health care to all citizens. I believe firmly that if this country were to provide treatment on demand, all those at risk for HIV would voluntarily seek testing. Mandatory testing does not save one person's life. It is Eric's type of behavioral change that does.
Introduction and opening questions, by Cullen Murphy
Round One -- posted on June 3, 1997
Copyright © 1997 by The Atlantic Monthly Company. All rights reserved.