previous sub-section
AIDS and the American Health Polity: The History and Prospects of a Crisis of Authority
next sub-section

Surveillance

Disagreements over surveillance policy have highlighted problems of cost and fragmented authority. Until 1987 the definition of a reportable case of AIDS used by the Centers for Disease Control (CDC) excluded many cases of illness related to HIV infection. Because most states have adopted the CDC's definition, the incidence and prevalence of AIDS and AIDS-related complex (ARC) can only be conjectured. The absence of accurate information has impeded accurate study of the onset and duration, as well as the cost, of the AIDS continuum. Surveillance policy, on the surface a straightforward problem in public health practice, in fact understates the severity and the cost of the epidemic.

Moreover, legal standards for the confidentiality of case reports vary among the states. By the end of 1987, nine states routinely collected the names of HIV-positive people. Two of these states, Colorado and Idaho, were using the names to trace sexual contacts.[32] Moreover, because most states classify AIDS as a communicable disease, case reports are not protected as strongly by statutes as they are for sexually transmitted diseases. They can, for example, be subpoenaed, although there is no evidence that they have been.

The lack of uniformity among the states in standards of confidentiality is an old problem made worse by the absence of national leadership in health affairs. On the one hand, surveillance policy has always been the responsibility of state governments, except for Indians, immigrants, and the military. On the other, standards of confidentiality affect civil liberties, an area of policy over which all three branches of the federal government had, until recently, been exerting increasing authority for a generation.[33]

The lack of consensus about standards to protect confidentiality increases the fear of many gay men that they will be stigmatized and persecuted. This fear, already intense, grew after the publication of a survey commissioned by the Los Angeles Times , according to which "most Americans favor some sort of legal discrimination against homosexuals as a result of AIDS."[34] Fear became rage when columnist William F.


329

Buckley, Jr., wrote in the New York Times that "everyone detected with AIDS should be tattooed on the upper forearm, to protect common needle users, and on the buttocks, to prevent the victimization of other homosexuals."[35] The fear is so intense it embraces the entire range of public policy: the irrational—Lyndon Larouche's proposal to screen every American for HIV antibodies; the dubiously effective—bills in several states to quarantine AIDS patients; the debatable—proposals to identify children or school employees with AIDS to school officials; and the traditional—the implementation of such STD-control techniques as the tracing of contacts.

Very little has been written or said to date about the effect AIDS has on the stigmatization of intravenous drug users. Unlike homosexuals, they do not organize to assert their rights, and they do not receive much public sympathy when they claim to do no harm by their private behavior. Drug users are generally stereotyped as pariahs who alternate between preying on innocent victims and receiving treatment and support at public expense. Many of them, furthermore, are also stigmatized because they are black or Hispanic. Addicts who die of AIDS may use fewer public funds than those who survive to receive treatment for their drug problems. Although several landmark civil liberties cases in the past have involved addicts, their rights—unlike those of gay men—have not yet been a subject of litigation during the AIDS epidemic.


previous sub-section
AIDS and the American Health Polity: The History and Prospects of a Crisis of Authority
next sub-section