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The AIDS Exception: Privacy vs. Public Health
Round One -- Response
Posted on June 3, 1997


Joel Gallant is exactly right that our response to the AIDS epidemic has been inadequate, and the evidence he cites for why people are not getting tested is on target. The keys to increasing the numbers of people getting tested and to reducing HIV transmission are to offer treatment programs and long-term behavior interventions. An Atlanta study, for example, showed that 96 percent of women chose to be tested after they had been provided with HIV counseling and offered voluntary HIV testing as part of prenatal care.

Testing and treatment for those with HIV needs to be offered on a regular basis to more people as they enter the health-care system. Unfortunately, in this country access to that system is inadequate for many people at risk for HIV. This problem is particularly acute for drug users, given the huge waiting lists that exist for drug-treatment programs and the lack of bridges to drug treatment such as needle-exchange programs and other outreach efforts targeted specifically at the drug-using community.

I was particularly intrigued by Chandler Burr's statement that in order to implement disease-control methods "we need to know who is and who is not infected." The question that statement poses in my mind is, Who are "we"? I believe strongly that people (and their health-care providers) need to know their health status. Proper care and treatment are predicated on this knowledge. What is unclear to me is why the government needs to have this information also. Burr seems to believe that the government, by means of a woefully under-funded and under-staffed public-health system, must force people to "do the right thing" (that is, get tested, notify their partners, change their behavior), because, left on their own, people won't do it themselves. The evidence, as I have cited and Joel Gallant has indicated, does not back up that assumption. When given the opportunity people will "do the right thing." It is the opportunities that are lacking.

I also disagree with Burr's assertion that AIDS and gay activists possess a "whiff of fanaticism" and put forth "unverifiable hypotheses, apocalyptic scenarios, and imputations of invidious motive." No one involved in fighting this epidemic wants anything else but to see it end. If I thought the strategies that Burr and Coburn are putting forth would end this epidemic, I would support them in every way I could.

Coburn implies that the CDC receives the names of people living with AIDS. Names are reported to state health departments, which then report case information (but not names) to the CDC. The Adult Confidential Case Report used by the CDC states clearly that patient-identifier information is not transmitted to the CDC. This fact is important, in that Coburn's HIV Prevention Act includes a requirement that states set up reporting systems for HIV such that names and identifying information can be shared with other states and the CDC in order to construct a national partner-notification program. To support that mandate, he implies that other diseases are reported in this way. The fact is that neither AIDS nor any other disease is reported to the CDC with patient-identifying information. Reporting of disease is a state-level function, which is where it should remain, without unnecessary costly mandates from the federal government.

What do you think? 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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