CLINICAL MICROBIOLOGY REVIEWS, Oct. 1989, p. 425-436 Vol. 2, No. 4 0893-8512/89/040425-12$02.00/0 Copyright © 1989, American Society for Microbiology Acquired Immunodeficiency Syndrome: More Than a Health-Related Dilemma MATTHEW J. SEVERIN Department of Medical Microbiology, Creighton University School of Medicine, Omaha, Nebraska 68178 INTRODUCTION ...................................................... 425 PROGRESS TO DATE ....................................................... 425 MEDICAL AND PROFESSIONAL ISSUES ...................................................... 426 Blood and Blood Products as Sources of HIV Infection ...................................................... 426 Transmission of HIV to Health Care Professionals ...................................................... 428 Issues Affecting Relationships between Health Care Workers and PWA ......................................... 429 Acceptance of a PWA for professional service ...................................................... 429 Informing a patient of possible AIDS diagnosis ...................................................... 429 Obtaining consent to diagnose, treat, or assist in rehabilitation ................................................. 429 Negligence by failure to provide the standard of care ...................................................... 430 Continuation of care ...................................................... 430 DISCRIMINATION ISSUES ...................................................... 431 In Education ...................................................... 431 In Employment ...................................................... 431 In Insurance ...................................................... 432 CRIMINAL ISSUES ...................................................... 433 THE FUTURE ...................................................... 433 SUMMARY ...................................................... 433 LITERATURE CITED ...................................................... 434 INTRODUCTION The episodes of pandemic infectious disease that mankind has experienced over recorded history are numerous, al- though often incompletely chronicled. The Yersinia pestis plagues that decimated European populations in medieval times and Asian populations in modern times, as well as the influenza pandemics of the early 20th century, are examples of such epidemics, in which millions died. The more recent outbreaks of polio and hepatitis B, although economically devastating to those affected, were less significant in terms of human mortality. We are now experiencing an infectious disease pandemic that manifests both a high mortality rate and economic devastation. This scourge is acquired immunodeficiency syndrome (AIDS) caused by a retrovirus, human immuno- deficiency virus (HIV). In its brief history, this communica- ble disease has already changed the legal and social relation- ships that health care workers depend on for the delivery of their professional services to those seeking aid. Secrecy and stigma compromise the actions of those afflicted with the disease. Fear and fascination affect the actions of the phy- sicians, scientists, and other health care professionals pro- viding service to those with AIDS. Coincidentally, the concern and confusion of those exhibiting any signs of infection with the virus are being translated into societal reactions that involve litigation. Litigation through the U.S. legal system is designed so that an impartial arbitrator, a judge or a jury, decides which of two parties presenting conflicting claims merits the pro- tection of the law. The rights of one party may or may not bind the duty of another. The rights of the person(s) with AIDS (PWA), which in this paper include those with AIDS- related complex, have resulted in new interpretations of the duties assumed by those who provide health care services. Our courts, as the arbitrating authorities, have just begun to rule on conflicts involving PWA. Legal suits involving blood banks, insurance coverage issues, employment and educa- tional disputes, and criminal conflicts have already surfaced. In other areas, the courts are still in the process of estab- lishing the priorities of the rights and duties of the contesting parties. Disputes concerning screening of patients or appli- cants for positions, diagnostic procedures for those seeking medical care, and issues of confidentiality involving identi- ties as well as laboratory results have arisen. The purpose of this paper is to discuss the issues that have evolved from the HIV epidemic. An overview of the societal conflicts that have arisen in both civil and criminal justice systems of the United States is also offered. No attempt has been made to detail all of the suits involving PWA; rather, only the initial cases of a specific issue are discussed. Since only 8 years have passed since the recognition of this disease, it is premature to define legal trends. Speculation, however, is included when appropriate. PROGRESS TO DATE In June 1981, the Centers for Disease Control (CDC) recorded five cases of Pneumocystis carinii pneumonia in young male homosexuals in southern California (15). This report in the weekly government disease digest Morbidity and Mortality Weekly Report was followed several weeks later by a report of 26 cases of Kaposi's sarcoma diagnosed over a 30-month period in male homosexuals. Six of these men also had Pneumocystis pneumonia (16). In their discus- sion of these early reports, the CDC editors noted that the homosexual males involved seemed to have an impaired cellular immune response to systemic disease. With these initial reports of AIDS, originally called GRIDS for gay- related immunodeficiency syndrome, a new chapter in the history of communicable diseases was begun. 425 Downloaded from https://journals.asm.org/journal/cmr on 11 July 2023 by 2402:800:62f0:1c62:7420:b26e:d448:ad9e.
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