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A Reason to Continue Restrictive HIV Testing Laws? Not Really

By Paul E. Sax, M.D.

August 19, 2011

The pending HIV legislation is much on my mind these days, for reasons I outlined here. Bottom line is that I don't think it's good for patient care, and we're missing a real opportunity to make things better here in the Bay State.

But yesterday I heard a perspective on the bill I hadn't considered, and it went something like this:

We still need the laws about HIV testing -- and the added protection of privacy -- because of the disgraceful response of the medical community to AIDS when it first burst on the scene in the 1980s.

Examples: The physician who refused to operate on an AIDS patient. The hospitals that tried to avoid having AIDS cases since it would scare other patients away. The thoughtless release of the AIDS diagnosis to employers, family members, friends. And so on.

And I get that -- I understand that doctors, nurses, policy makers, and the rest of the large community that makes up the "medical system" didn't always behave so wonderfully when faced with this new and scary disease. Back in 1989, I heard a director of a Cardiac Intensive Care unit say that having an AIDS patient in his unit was a "waste of resources." That wasn't right then, and it isn't right now.

But here's some items to consider as a counter argument:

  1. It was people from all aspects of society behaving badly, not just the medical community. Remember Ryan White? In fact, I'd argue it was a relatively smaller proportion of health professionals compared to the rest of the population.
  2. Things are different now -- so very different. HIV is treatable, for everyone who can get diagnosed and into care. Check out this paper from Hopkins, just published, outlining just how treatable it is, even in a mostly inner city, poor, minority population. Not meaning to diminish the seriousness of HIV in any way, I would argue that this single fact -- the treatability (is that a word?) of HIV -- makes restrictive HIV testing laws obsolete. Paul Farmer has said repeatedly that making a fatal disease treatable dramatically reduces it's stigma. And who are we to disagree with Paul Farmer?
  3. Didn't the medical community also have the opposite response? The doctors, nurses, social workers, research scientists, and other health professionals who devoted their combined efforts to caring for people with HIV, and improving their prognosis? Seems that this should also be acknowledged when citing painful anecdotes about bad behavior.

And since these dedicated HIV specialists are universally in favor of removing restrictions on HIV testing and the proposed barriers to provider communication, that must be telling us something.

Paul Sax is Clinical Director of Infectious Diseases at Brigham and Women's Hospital. His blog HIV and ID Observations is part of Journal Watch, where he is Editor-in-Chief of Journal Watch AIDS Clinical Care.




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