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From: SECBH%CUNYVM.BITNET@oac.ucla.edu (Jack Carroll)
Newsgroups: sci.med.aids
Subject: Re: (1289)      Re: Health Care Workers and AIDS
Message-ID: <27749@shemp.CS.UCLA.EDU>
Date: 4 Oct 89 13:33:49 GMT
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Approved: aids@cs.ucla.edu
Archive-number: 1297

Ken Miller in response to Steven L. Karon's posting on the resignation
of Dr. Day makes the following observations:

>What confuses me is the attitude that AIDS is a "special" disease which must
>be treated differently than any other disease....then AIDS becomes a matter
>of shame and embarassment.

It is indeed regrettable that AIDS has been treated in this manner, and
that thousands of PWA's have been stigmatized as a result.  I became
familar with AIDS in the early 80s and live in NYC.  Speaking with this
background I would maintain that the health care profession (meaning
doctors, nurses, all hospital staff and administration, as well as
governmental agencies concerned with health care administration) must
take the responsibility in large part for this state of affairs.  Patients
with AIDS were frequently, and in some institutions routinely, treated as
pariahs by the medical and services staffs.  They were allowed to lie in
filth and meals were left outside theirs rooms on the floors because hospital
personnel would not approach them.  Individual complaints to social workers
and patient representatives met with little success and sometimes derision.
This is fact, I was there, I saw and heard it.  Health care professionals
and governmental agencies did virtually nothing to educated the public
nor to enforce the discipline which would have ameliorated the situation.
This lead to the formation of PWA advocacy groups across the country, and
it was their pressure -- in cooperation with the physicians of PWAs --
which brought about a reversal of these conditions.  The extreme and
uncompassionate reaction of many health care professionals in these early
years was routine fare in the daily press, and was communicated to an
ignorant general public and we are still fighting to AIDS hysteria
which this generated.

>...health care workers have the right to know the medical status of any
>patient, especially when that status might put them at risk....quite a
>few medical workers have been infected by HIV as a result of their work.

This latter assertion is totally contrary to statements I have read in the
general press and also is not borne out by conversations I have had with
many, many doctors and nurses in New York City hospitals.  On what facts
is this latter statement based?  What is the size of the "medical worker"
population to which you refer?  What percent has been infected?  Where
has this been reported?  How has it been ascertained that their infection
is job-related?

>...continued emphasis on secrecy with HIV inhibits efforts to stop the
>AIDS epidemic...standard techniques of halting the spread of STD's and
>similar diseases is by testing and contact tracing....doesn't secrecy
>produce the stigma?

I would agree to the extent of saying that secrecy a factor in perpetuating
the stigma, however the stigma preceded the secrecy.  The hysteria and
discrimination which followed upon its heels made secrecy highly desirable
if one wished to remain employed, not be ostracized on the job, keep one's
insurance, etc., etc.  Speaking only of the situation in NYC, I see
many improvements in public attitude and is specific legal protection
against some forms of discrimination.  There are still many areas for
concern, not the least insurance coverage.  I believe that FIRST there
must be nation-wide guarantees against various forms of discrimination
against HIV postive persons and PWAs, THEN we may consider "standard
techniques of halting the spread ..."

Also, I do not think that it is to anyone's advantage to assume that
health care workers across-the-board have entered that profession or
stay in it only for exalted reasons.  The reasons are myriad.  Health care
workers are not demi-gods.  They are people first, and health care workers
after that, and thus they share all of the weakness and strengths of character
and personality which the rest of humanity is heir to.

Jack Carroll
The City University of New York