Commentaries
Dying At The Altar Of Privacy
The following is a guest commentary written by Dr. Cary Savitch, an AIDS-treating physician and author who heads the organization Beyond AIDS:
A fine line exists between personal rights and public safety. A small retrovirus, 90 nanometers in size, invisible to the naked eye and even to a high-powered microscope, now straddles that line. In this tug-of-war people are walking wounded and dying in large numbers.
Before Randy Shilts died of AIDS, he left the world a gift. Unwrap his book and learn from his message. "People died while public health authorities and the political leaders who guided them refused to take the tough measures necessary to curb the epidemic's spread, opting for political expediency over the public health. And people died while gay community leaders played politics with the disease, putting political dogma ahead of the preservation of human life." (And the Band Played On).
One woman becomes infected in the world every 20 seconds. Six-hundred-thousand babies were born HIV-infected in 1996. Some 1.2 million AIDS orphans have been left behind in Uganda. More than 400,000 Americans have already died of AIDS, and another 1 million harbor this lethal virus. Does the sword of privacy warrant such a death sentence to the human race? At what number does prevention kick in? Public health officials are now relegated to the job of bean counters. But, counting the dead won't bring them back.
A public health emergency is being treated as a public health exception. The primary responsibility for halting deadly diseases has been abandoned. The traditional methods of disease prevention have been trashed by the politics and scare tactics of AIDS activists. For many health experts, testing the political waters has become more important than testing for AIDS. This time the strong arm of the AIDS warriors targeted lawmakers.
Sacramento legislators took a blinded uppercut to the chin. Assembly Bill, AB 1663, authored by San Francisco Assemblywoman, Carole Migden, slipped passed the California State Legislature with little debate. This bill prevents HIV from being a reportable disease by name to public health services. Instead HIV would be reported by a cryptic code or unique identifier--public health officials would NOT be given the names of those who are HIV-infected. Any doctor who dares to report HIV to county public health services, to protect the uninfected, could be slapped with a $30,000 fine.
This politically motivated legislation severely compromises the health and safety of our nation. The AIDS virus is transmissible person-to-person at all stages of infection. Plain and simple, it is impossible for public health officials to control this epidemic without knowing who is HIV-infected. Fifty-two other communicable diseases are reportable by name in order to assist public health officials in partner notification and contact tracing.
HIV should be at the top of this list, not off the list. The benefits of treatment are limited and the promised vaccine may never arrive. The cure rate still locks in at zero. The only survivors of this infection will be those who do not become infected. "Privacy" is the war cry. But, behind this cloak of rights and privacy lurks a more ominous concern. Spreading HIV is spreading death. If you infect someone you kill someone. These are the rules. It is incumbent upon those not infected to stay that way. It is also the responsibility of those infected to help put an end to this horrible plague. Is this asking too much?
In the end, the control of AIDS is in the hands (and hearts) of those who are infected. One recent study from Brown University points out that 41 of those infected do not alert their sexual partners. In Australia this number is reported at 60. 16,000 people on this planet become newly HIV-infected each day, always from someone else. 21 of all new HIV infections in the USA are women, up from less than 1 in 1981. Four out of five of these women are Black or Hispanic. Most did not know they were at risk until the day they were diagnosed..
One teen becomes infected in this country every 15 minutes. Half the new cases in the USA are now acquired under age 24. I am now seeing new patients in my medical practice who were infected by people I took care of years ago. There was no public health support then, and there is none now. Women and children deserve better.
The Centers for Disease Control (CDC) is finally calling for all states to report HIV . The recommendation from this watchdog organization, entrusted to protect the health of our nation, is to report HIV by name, not by unique identifier, not by cryptic code, and not by the Trojan Horse erected by Carole Migden.
Last month New York became the 30th state to require HIV reporting by name. Prior to this legislation, a study in New York pointed out that in only 300 out of 13,000 HIV cases was there directed partner notification. Seventeen additional states are considering name-reporting legislation. Unique identifiers have been tried in only two States. Texas is in the process of reversing cryptic coding in favor of name reporting. Maryland officials, who originally cowered to the politics of this disease, report that their system of unique identifiers is costly and interferes with controlling the spread of AIDS. Federal legislation is now pending to require every state report HIV by name to be eligible for Ryan White funds.
Earlier this year the California Medical Association (CMA) dared to do what is medically right, and proposed legislation that would make HIV reportable by name. The efforts of the CMA were shot down by the political intimidation of AIDS activists. This time around the politicians at the CMA would not accept another political loss. Instead, they agreed to compromise the health of our children, and reluctantly support dangerous legislation (with the hope, of course, that they could reverse this mistake next year). The hierarchy's decision to rank politics above public safety is not supported by doctors in California or elsewhere.
Carole Migden distinguished herself again by being the only Assemblyperson in California to vote against another bill, SB 705. The roll call: Ayes 67, Noes 1 (Migden). This bill criminalizes the intentional spreading of AIDS. Intentionally infecting someone with HIV is a worse crime than rape. I support Carole Migden 100% in her efforts to address the medical and social needs of every person with AIDS. I only question her lack of compassion to protect the uninfected.
The primary purpose of name reporting is to allow public health officials to contact partners of this lethal infection and halt transmission. This is what it will take to save lives. Carole Migden should be leading the charge against her own dangerous legislation. As Randy Shilts reminded us, "AIDS did not just happen to America. Instead it was allowed to happen by an array of public institutions." The only thing stopping this bill is the Governor's veto. It should be swift and emphatic.
Dr. Savitch, author of The Nutcracker Is Already Dancing, can be reached via e-mail at stophiv@aol.com.
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