Acquired Immune Deficiency Syndrome

In light of the history of quarantine and its various ramifications, the position of the AIDS victim and society's response to the disease can be better appreciated. The large majority of AIDS patients in the United States are found in two groups, male homosexuals and intravenous drug users. The disease itself is caused by a virus that is transmitted by means of an infected needle or during sexual activity, especially anal-receptive sex. The disease itself occurs in an uncertain fraction of those who have been exposed to the virus. So far, the mortality rate for AIDS has been nearly 100 percent, although the patient may live a year or two after the diagnosis has been made and then mostly in the community and not in a hospital.

The question is whether AIDS possesses those characteristics that have aroused healthy citizens to call for a quarantine. It is indeed a serious disease with, so far, no cure. In this regard, AIDS patients face an irrevocable death sentence, much like the lepers of the Middle Ages. Furthermore, the groups with which AIDS is most closely associated in this country have typically been held in low esteem by the general population, the objects of discrimination in jobs, housing, and everyday social contact. Also, the disease is generally transmitted among drug addicts and homosexuals by means that have been or are still illegal in the United States. In this regard, AIDS, like other contagious diseases of the past, is associated with minorities who are considered sexually deviant and promiscuous. Like tuberculars and lepers, AIDS patients may have relapses between which life might continue outside the hospital, at home, or, at the least, in the community. During this time, however, the patient remains infectious and is therefore a source of apprehension. Recalcitrant patients who do not follow recommendations for "safe sex" evoke memories of "careless consumptives" whose presence motivated the passage of special laws permitting their involuntary isolation. Like tuberculous patients, AIDS patients have difficulty obtaining insur-

ance and, like members of any rejected minority linked to a serious communicable illness, the group as a whole may be treated as if all its members have the most dangerous form of the disease when any one of them applies for employment or housing, an ascription similar to the widespread association of specific drugs with feared minorities. In sum, AIDS patients have reason to be concerned over the possibility of quarantine or isolation. Are there any countervailing arguments?

The first restraint against a rush to institute quarantine measures against AIDS victims is the extensive experience showing that sustained quarantine for large numbers of people has not been successful. The great efforts to control the individual behavior of drug addicts have obviously been thwarted, or drug users would not now be spreading AIDS by injecting substances into their veins. Further, the spread of AIDS has not been found to be through casual contact, and there is reason to believe that not all of those with AIDS antibodies will develop a serious illness. If, however, longer experience with patients tested positive for AIDS antibodies reveals a very high incidence of illness in later years, or that AIDS is rapidly spreading from groups now chiefly associated with it—i.e., intravenous drug users, male homosexuals, and recipients of blood infected with the AIDS virus—the general population will in all likelihood become highly anxious.

The United States has a long history of mistrust of physicians and the medical establishment. The government also has had difficulty regaining its credibility about dangerous drugs after so many excessive warnings, particularly about marijuana, in the 1960s. When authorities make pronouncements about AIDS, their comments meet with considerable public skepticism. This skepticism must be borne in mind by those trying to provide reassurance, for if their reassurance is later found to have been overstated, the public confidence, which is needed to contain destructive emotions, will be compromised.

Strong reactions to the threat of AIDS will more likely result in restrictions on individuals if the disease continues to spread and to affect many more unsuspecting citizens. Passions could be mobilized politically and could result in a program to mark or isolate persons testing positive for AIDS antibodies. Just because quarantines are not effective does not mean they will not be attempted. The 1832 cholera epidemic in New York City led to politically mandated quarantine in spite of the almost unanimous opinion of leading physicians that it was a useless expenditure of time and funds. Perhaps the most helpful counter to unenlightened outrage is public awareness of the enormous effort under

way to understand and treat AIDS. This effort includes evidence of the growing success of educational programs among the groups most affected by AIDS.

If the AIDS crisis persists for some years, one can speculate that society or the groups most involved may develop ritual forms to recognize the mutual responsibilities between the healthy and the diseased. It would appear that such ceremonies for leprous persons helped both the healthy but vulnerable and the afflicted to accept their condition. Of course, with the absence of a single religious authority today, whatever ritual is developed may take on a more civic character.

If other diseases, say, multiple sclerosis and some cancers, are found to be preceded by a lengthy, asymptomatic viral infection, we may see the establishment of a new class of patients in circumstances common to AIDS victims now: A test may reveal the likelihood of death years in the future. What are these people to do in the meantime? How will they deal with the inevitable shock and grief that follow such a diagnosis? Our society may become motivated to create a sympathetic ritual not only to sustain but also to acknowledge these citizens. AIDS may be the model for ways to help both the well and the sick deal with such conditions produced by medical advances in etiology and diagnosis, but not in curative therapy.

In conclusion, the quarantine of AIDS patients remains a possibility, and depends on such factors as time until an effective vaccine or treatment is available, secondary and tertiary spread of the virus, and the faith of the public in official pronouncements regarding the illness. AIDS possesses many of the characteristics that have motivated past quarantine efforts—association with feared social subgroups, transmission through means the public has deemed unlawful or distasteful, the potential for spread outside these rejected groups to the public at large, and a lengthy infectious period outside hospital confinement. There is no assurance that quarantine will not be attempted, but awareness of its past ineffectiveness, accurate information, and understanding the irrational fears that wrongly prompt quarantine are good defenses against it.