Washington Blade - July 27, 2006
Rev. Irene Monroe

The new HIV/AIDS prevention push requiring public health authorities and agencies to report HIV-positive patients to the government is an example of how a health care initiative can becomes enmeshed with conservative politics and moral intolerance.

With government funding shrinking more and more for HIV/AIDS prevention these days, public health authorities and agencies will now be requiring physicians to report to the government the name, Social Security number, age, address and date of birth of all HIV-positive patients.

And many of these public health authorities and agencies will find themselves in the compromising position of either adhering to mandatory government-imposed HIV names reporting or upholding the confidentiality of the clinician-client relationship.

I asked Dr. David Duong, a gay Vietnamese emergency room physician at Boston Medical Center, how it would impact the typical encounter between patient and physician if it becomes mandatory for physicians to report to the government the names of those who test positive for HIV.

"Mandatory reporting of HIV-positive patients only engenders mistrust in the patient-physician relationship," said Duong. "This would potentially endanger both public health and individual rights.

PROPONENTS OF NAME-based reporting, meanwhile, emphasize the advantages of more equitable funding to different state and local governments, as well as the uniform accounting and tracking of the epidemic. They claim these would allow for not only a better patient-physician clinical encounter, but a more authentic representation of community-based education and management care.

But if the case for HIV names reporting is so compelling, it's confusing why the government is using the threat of funding cutoff to require it.

The District of Columbia, faces a deadline of Sept. 30 to comply or it will lose millions of dollars; not surprisingly, the D.C. government is close to putting a names reporting system in place.

In my home state of Massachusetts, refusing to adopt names reporting would cost the state Department of Health $9 million a year and the Boston Public Health Commission another $6 million - money for important patient benefits like medication, meals and home healthcare.

THE UNDERLYING POLITICAL motive for HIV names reporting is to both police and profile people who test HIV positive. And the motive is not new.

In 1986, conservative political commentator William F. Buckley Jr. suggested that the judicious way to keep account of those who were infected with the virus, as well as the vectors of transmission, was to tattoo them on their buttocks and forearms - an act reminiscent of American slavery and the Holocaust in which Africans and Jews, respectively, were tattooed and treated like animals.

The people who would be most impacted by this new government intrusion - gay people, I.V. drug users and people of African descent - are already the moral whipping posts for a morally intolerant society in denial about how the epidemic continues to grow at an exponential rate.

So I asked Dr. Duong how reporting HIV-positive patients would differ from physician reports of patients who suffer from other communicable diseases.

"HIV is separate from other reportable communicable infections in that there is no cure and that the medical and socioeconomic consequences of infection are potentially so devastating," he said. "HIV infection is associated with already marginalized and discriminated populations.

"Reporting HIV-positive patients would further alienate and reinforce the vulnerability of these patients. The laws protecting HIV-infected individuals are inadequate, while for other reportable diseases protections are not necessary due to their lack of stigma or their ease of cure."

Not only is the present push an act of moral intolerance toward the targeted groups, it is a symptom of a sick society that tests negative for compassion.

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Rev. Irene Monroe is a Boston-based freelance writer and can be reached at revimonroe@earthlink.net.

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