01 May 1997 Should Public Health Be Sacrificed At the Altar of Political Correctness? by Roderick Conrad

When names like Arthur Ashe, Rock Hudson, and Kimberly Bergalis are mentioned, people automatically think of AIDS or HIV, the virus that causes AIDS. The fact that most Americans would know that Ashe, Hudson, and Bergalis died of AIDS is in no small part due to the enormous attention HIV and AIDS have received in the press for over a decade. The press is not alone; public health professionals also treat HIV and AIDS unlike any other infectious or contagious disease. Unfortunately, this special treatment may be aiding in the transmission of HIV.

Research clearly indicates that the earlier HIV is detected, the more effective the drugs used to treat it will be. The early diagnosis of HIV in Magic Johnson and his subsequent medical treatment proves the point: Johnson’s latest tests reveal no sign of the disease in his blood.

Congressman Tom Coburn (R-OK), a practicing physician, seeks to rectify the way AIDS and HIV are treated by public health officials. In March, he introduced “The HIV Prevention Act of 1997.”

Key components of the legislation include the following:

1) A confidential national HIV reporting effort. Currently, states do not report cases of HIV infections, but of AIDS, the endstage of HIV, to the Centers for Disease Control.

2) A partner notification provision that provides the partners of an individual with HIV an appropriate opportunity to learn that they have been exposed to HIV, without compromising the anonymity of the individual responsible for exposing them to the disease.

3) HIV testing for sexual offenders. Most states allow rape victims to find out their attackers’ HIV status only after conviction, which may take years.

4) Policies that seek to protect both health care providers and patients from unwarranted HIV exposure.

5) A requirement that any applicant required to take an HIV test by an insurance issuer be informed of the results.

6) Approval of the notification of adoptive parents as to the HIV status of a child they are prepared to adopt.

7) Expression of the sense of Congress that the intentional transmission of HIV should be punished as criminal behavior by the states.

The American Medical Association’s (AMA) Executive Vice President, Dr. P. John Seward, has written that the HIV Prevention Act “…would refocus public health efforts on HIV prevention by using proven health techniques designed for communicable diseases. These public health initiatives which result in early detection of HIV infection are now more important because of the tremendous advances that medical science has made. Early intervention combined with effective treatments will enable those with HIV and AIDS to live longer, healthier lives.”

The Centers for Disease Control’s statistics clearly indicate that a primary group which can benefit from early HIV detection and partner notification is African-Americans. In 1996, non-Hispanic blacks accounted for 41% of adults reported with AIDS, despite only accounting for 12% of the U.S. population.

Adult and adolescent females accounted for 18 percent of the AIDS caseload in 1994, up from 7 percent in 1985. The AIDS rate for black women is 16 times greater than that for white U.S. women. HIV infection was the leading cause of death for black women between the ages of 25-44 in 1993. Early partner notification would especially benefit women since studies indicate that 50-70% of women infected with HIV didn’t engage in high risk behaviors, but were infected by a partner who did. Heterosexual contact with an HIV-infected man is the most rapidly increasing transmission category among women.

Not surprisingly, black children are suffering the consequences of the explosion of AIDS cases among women. Six of every ten U.S. children who acquired AIDS in the womb or upon birth are black. HIV/AIDS is the second leading cause of death for non-Hispanic black children 1-4 years of age in New York. Of the black children under the age of 13 who have AIDS, 95% acquired HIV infection during gestation or upon birth.

Recent National Center for Health Statistics paint a bleak future if something isn’t done soon. There were 259 new AIDS cases reported among non-Hispanic black children under age 13 from January through June in 1995, meaning black children accounted for 63% of all new cases among children during that time period. Black females over 13 accounted for 59% of all new AIDS cases among all women from January to June of 1995. Black men accounted for 37% of new AIDS cases among all men over 13 from the same time period.

The reality is people are dying in epidemic numbers from AIDS. For too long, this disease has been treated as a civil rights struggle, not a public health crisis. With the introduction of the “HIV Prevention Act of 1997,” some of us hope that the foolish rights’ struggle will end, so the appropriate treatment of those infected can begin.

Roderick Conrad serves on the National Advisory Committee of the African-American leadership group Project 21.