Newsday - August 2, 1988
Laurie Garrett

Psychiatrist David Ostrow designed a questionnaire aimed at comparing American attitudes toward AIDS to other social problems. Fifteen hundred residents of the Chicago area were selected in a randomized survey and asked a series of questions about AIDS, their personal finances, political views and a number of social interaction issues.

The University of Michigan study results are still preliminary, but Ostrow rushed to deliver initial findings to last week's Second International Lesbian and Gay Health Conference and AIDS Forum in Boston.

The survey yielded a number of surprises. For example, personal income and race do not appear to significantly affect people's attitudes towards AIDS patients, civil rights or public spending for the epidemic. "Throughout the survey," said Ostrow, education proved to be "the key factor." The more college education individuals had received, the more likely they were to support social programs, generally, and AIDS care specifically.

Ostrow said attitudes tend to cluster; people who say, in the survey, that "people with AIDS should not be blamed for their disease, and should feel no shame for their illness" also tend to respond in an empathetic manner to a number of social problems, support sex education in public schools and oppose any effort to bring the criminal justice system into the AIDS picture.

In contrast, people who express the opinion that there should be compulsory screening for infection with the AIDS virus and quarantine of those who test positive also support workplace testing for other sexually transmitted diseases and drug use, and say, in the survey, that "people with AIDS deserve it and are responsible for it."

What surprises and disturbs Ostrow is how tightly these attitudes cluster: "You've got your clusters along traditional lines. You've got your conservative faction and your liberal faction, and that's it." There were virtually no respondents in the survey who were able to separate their feelings about the AIDS epidemic from their overall social and political attitudes. "What this means," says Ostrow, "is that we who are in the business of public health education are going to have to reach people who aren't going to believe what we're saying to them. They've already got their mind made up. I don't know how to deal with that. It's kind of frightening."

Ostrow suspects the unique problem of the AIDS dilemma is threefold:

The primary targets of the epidemic are members of social groups already castigated by society as a whole, gay men and intravenous drug abusers;

The disease involves sex, a subject about which most Americans are quite uncomfortable;

And death, which frightens Americans more than most cultures, permeates all levels of discussion of AIDS.

"These are gut issues," says Ostrow, "basic characteristics that go across the board" in the American psyche. Faced with such disturbing issues, Americans feel insecure and fall back on old pat formulas for social and political response.

The only obvious exceptions were found among people who either knew somebody who had AIDS or had recently experienced an especially grievous death in the family. Such individuals, says Ostrow, might respond in traditionally conservative ways to all other social issues, but displayed strong empathy for people with AIDS.

The take-home message for public health officials, says Ostrow, is a tough one: "If there is a way we can impart that experience (of death or AIDS illness) to people who are not as compassionate about AIDS, then we can accomplish something. But you don't do that with a billboard. Or, for that matter, a one-shot mass mailing."

The University of Michigan is now collaborating with General Motors in Detroit to develop models for workplace-based AIDS education. "I suspect that's one place we might be able to reach people," says Ostrow, "because in the workplace you show them examples of people doing the work they do who have AIDS. You can build a special identity and empathy that way."

Burst of Laws Worldwide

RESEARCHERS AT at the Harvard Schools of Public Health and Law have just completed a "startling" survey for the World Health Organization of laws passed in 77 nations related to the AIDS epidemic.

"What we have found is unprecedented," said Harvard's Larry Gostin. "Never before in the history of health law has a single disease sparked as much legislation as AIDS."

In 1986, said Gostin, there were no specific national laws pertaining to AIDS in any country. By 1988, 45 percent of the world had passed AIDS-specific national legislation. In the industrialized world 91 percent of the countries have passed national AIDS laws."There has been an absolutely frenetic passage of legislation" in the AIDS area, said Gostin.

Gostin describes the bulk of the legislation as "running contrary to the virtually unanimous opinions of the public health communities throughout the world" by seeking to control the spread of AIDS through criminal intervention.

Gostin presented the following examples:

Last January an American was arrested in London's Heathrow Airport when customs officials overheard him discussing the homosexual bar scene in England with a companion. He was deported under a new British law that gives immigration officials broad discretionary powers to prevent entry of individuals suspected of carrying out activity that could lead to the spread of AIDS.

An American soldier who tested positive for the AIDS virus was arrested and convicted of attempted manslaughter in Bavaria last year after having sex with a German citizen.

Also in Bavaria, an HIV-infected man who had sex with a female partner without using a condom was sentenced to a year's imprisonment. The woman was not infected as a result of the sexual encounter.

An HIV-infected heroin user and alleged prostitute has been placed under 24-hour guard for an indefinite amount of time in a Swedish prison, ostensibly to prevent her from infecting sexual partners.

Anybody wishing to spend more than six months in the People's Republic of China must have an AIDS test that certifies they are uninfected. Chinese nationals who have traveled abroad must be tested when they return.

All Cuban citizens are required to submit to periodic AIDS testing, and those who test positive for HIV infection must spend the rest of their lives in isolation housing units akin to mental institutions.

The state of Utah just passed a law which states that if a married person becomes infected with the HIV virus the marriage is automatically dissolved.

In the United States there have been over fifty successful criminal prosecutions related to AIDS.

The United States now requires HIV testing of all immigrants. The Soviet Union has broadened its laws to allow police round-ups and mandatory testing of homosexuals, prostitutes, drug users and other citizens "if there are grounds for suspecting infection."

In the face of such legal practices, said Gostin, the Harvard group "is fearful that such programs will drive the epidemic underground, out of reach of public health authorities and the medical community."

But not all legislation focuses on the repressive side of the epidemic. Gostin said studies of 77 countries shows, "There is a systematic strategy for confronting the AIDS epidemic." Virtually every nation, he said, has passed laws aimed at protecting the blood supply. Such laws cannot be implemented in poorer nations, however, because they lack the equipment necessary to screen for the HIV virus.

Other reccomendations from the Harvard group include:

"All countries with the potential for the spread of HIV should establish high level committees . . . to spread education" about the disease. These committees should have full executive-level support and be empowered to affect social policy. Such committees exist in 21 nations. No such U. S. committee exists.

"Countries should make HIV testing available on a purely voluntary basis, without influence of compulsion or coercion of any kind," and accompanied by counseling for those who test positive.

Large-scale blinded blood test surveys should be done, protecting the identity of those tested, to determine the extent of infection in various nations.

Twenty-four nations now restrict immigration and travel of people infected with the AIDS virus. The Harvard group opposes such restrictions, and, said Gostin, warns that "reprisals from one nation to another are a real possibility, and therefore characterizing this as 'an AIDS War' is not out of line."

All nations should pass laws guaranteeing the rights of confidentiality, privacy and freedom from discrimination to those infected with HIV.

The Harvard report will be officially presented to WHO officials later this month, and is expected to get strong support from the Organization. -
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