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The AIDS Exception: Privacy vs. Public Health
Round Two -- Concluding Remarks
Posted June 19, 1997


I'd like to respond first, and primarily, to something Stephen Murray wrote -- something that most everyone, probably including him, considers of relatively minor importance but that is quite central to this debate. "What is most glaringly missing from Chandler Burr's article and the Web forum is any voice of an HIV+ person," Murray writes. He then says that "common sense" tells us that if people's confidentiality were violated they would not push for redress under appropriate laws.
What do you think? Read other reader responses and join the debate in The Body Politic. Specific point and general point. The specific point, as Matt Coles at the ACLU's Gay and Lesbian Law Project has noted to me, is that the reason that civil-rights laws work -- including those covering HIV -- is not really because many people use them (filing a suit is a cumbersome, time-consuming, draining process); it's rather that they put everyone on notice ("Don't do this or you can be made to pay for it"). It's a sort of visible moral and mental deterrent. So of course Murray is right on the average individual level -- frankly, no one but a masochist wants to become involved in these battles -- but he misses the larger point that there will usually be the one or two people willing to press their cases, effectively and aggressively. That, Coles says, is the best one can expect. If the laws are in place -- and they are -- then we have done the best we can. To demand a means of perfect protection lies somewhere between naive and silly.

My general point is that Murray's comment reflects exactly what those who are self-centered have always argued about AIDS. He complains about not hearing the voice of someone who happens to be infected with HIV. How does he know that one or more of the people whom I quote in the piece is not HIV-positive? Having raised the question I'm not going to answer it, for a simple reason: the people who I spoke to during my reporting on public health were focusing not on themselves and their personal situations but on what measures most effectively contain disease within human populations in Western societies. In an age of self-focused identity politics where everything is about "me," this is an alien concept.

Sometimes policymakers must make tough decisions about what is best for a group, despite the fact that those decisions will at times contradict the interests, actual or self-perceived, of individuals. Margot described how her son Eric viewed his HIV-positive status in the context of responsibility to others. I get the feeling that Murray is edging toward the politically correct tradition of attempting to capitalize on one's HIV-positive status to cow everyone else and assert his view as the only legitimate one.

But the policymaker's job is specifically to rise above self-interest, and to represent the general public's best interests -- which is why, to respond to Nancy Shute, I absolutely do not object to routine testing, given appropriate civil-rights safeguards. Perhaps one of those people whose words Murray read in my piece arguing for traditional public health was HIV-positive. Maybe he or she confided this to me, on or off the record. It is completely irrelevant, as irrelevant as whether someone arguing in favor of a non-racist policy is black, white, Hispanic, or Asian -- as irrelevant as whether someone arguing for a just tax system is rich or poor. What matters is not the status of the individual but the merits of the argument.

The merits of Murray's arguments about the need for universal health coverage are solid. There is a huge question of how to provide better health coverage for those who have HIV or AIDS, and we as a nation need to pursue that question.

With all due respect, I think Joel Gallant really overdoes it with "Burr and Coburn can't see that public health is shades of gray." Good Lord, of course it is. But, to defend Tom Coburn, any single piece of legislation is going to be necessarily somewhat monochromatic unless it is truly an immense bill, and, to defend myself, I realize there are many, many ways to fight diseases, and I hope Gallant realizes not even an Atlantic cover story can cover them all. But Gallant and Stachelberg are absolutely correct in noting that Coburn's bill is itself AIDS exceptionalism: names are not reported to the CDC for any other disease. I assume Coburn would argue that there's been so much exceptionalism on the other side that we need to balance it out. I'm agnostic on this at the moment. I'd say simply that we need to debate this aspect of the Coburn bill and of all future AIDS and HIV-related legislation. In the end we should try to do the best we can with a bad situation for all -- not some -- of us.

What do you think? Read other reader responses and join the debate in The Body Politic.

Roundtable Overview

Introduction and opening questions, by Cullen Murphy

Round One -- posted on June 3, 1997

Round Two -- posted on June 19, 1997

Copyright © 1997 by The Atlantic Monthly Company. All rights reserved.
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