HIV Infection and AIDS in the Public Health and Health Care
The Role of Law and Litigation
JAMA HIV/AIDS Information Center
Vol. 279, pp. 1108-1113, Apr. 8, 1998
Lawrence O. Gostin, JD; David W. Webber, JD
The AIDS Litigation Project has reviewed nearly 600
reported cases involving individuals with human
immunodeficiency virus (HIV) infection and acquired
immunodeficiency syndrome (AIDS) in the federal and state
courts in the United States between 1991 and 1997. Cases were
identified through a federal and 50-state computer and library
search. An important subset of litigation relates to HIV/AIDS
in the public health and health care systems, since the law
affects health care institutions and professionals, patients,
and public health policy in America. This subset of HIV/AIDS
litigation includes testing and reporting; privacy, the duty
to warn, and the right to know; physician standards of care in
prevention and treatment; and discrimination and access to
health care. In broad terms, the review demonstrates a
reliance on voluntary testing and protection of patient
privacy through HIV-specific statutes and the common law.
Negligence with potential civil and criminal liability has
been alleged in cases of erroneous or missed diagnosis of HIV
infection. In the first AIDS case to be considered by the
Supreme Court, the Court will decide whether patients with
asymptomatic HIV infection are protected under the Americans
With Disabilities Act. Considerable progress has been made,
both socially and legally, during the first 2 decades of the
epidemic, but much still needs to be accomplished to protect
privacy, prevent discrimination, and promote tolerance.
Editor's Note: For a comprehensive report on the AIDS
Litigation Project, see 2 articles from the AIDS & Public
Policy Journal that are available in full text on this site
with the kind permission of that journal's publisher. The
articles analyze cases involving the duties of government and
individuals in preventing HIV transmission (Part I), as well
as those involving the rights of individuals (Part II).
THE EPIDEMIC of human immunodeficiency virus (HIV)
infection and the acquired immunodeficiency syndrome (AIDS)
has had powerful personal, social, and economic effects
throughout America—in employment, housing, insurance,
education, prisons, and many other aspects of life. Yet,
perhaps the most profound effects of the epidemic have been in
the public health and health care systems. Public health
and medicine have responsibilities to monitor, prevent, and
treat HIV infection. At the same time, the nation has
struggled with the task of reconciling patients' rights to
privacy and nondiscrimination with collective rights to public
Given the high degree of ongoing social conflict caused by
the epidemic, it is not surprising that, unlike past
infectious disease outbreaks, attempts to resolve contentious
issues consistently involve the courts and legislatures at all
levels. Furthermore, because of the high level of patient
activism and advocacy, as well as immediate public access to
new developments in scientific and medical information,
including that available via the Internet, law and
policymaking have not been the exclusive preserve of medical
experts or other professional specialists. The resulting
democratization of policymaking processes has heightened the
impact that legislatures and courts have had on the public
health and health care systems.
Deeply divisive questions have emerged relating to informed
consent for HIV testing, named HIV reporting, confidentiality
vs the duty to warn, and an HIV-infected physician's right to
practice. These and many other questions have come to be
decided by legislatures and courts. The results are by no
means uniform or consistent. Court decisions in similar cases
sometimes conflict, and legislatures in different
jurisdictions at times take markedly different approaches.
Nevertheless, legislation and litigation provide a window
through which the HIV epidemic's troubling questions, arising
in relation to the delivery of health care services and the
formulation of complex public health policy, can be examined.
This article is part of the AIDS Litigation Project,[3,4]
which has reviewed nearly 600 cases reported in the federal
and state courts in the United States between 1991 and 1997.
The methods involved a federal and 50-state computer and
library search of all reported cases involving HIV infection
or AIDS. This article discusses an important subset of
litigation relating to HIV/AIDS in the public health and
health care systems. (The complete AIDS Litigation Project
report can be found in the Library section of the HIV/AIDS
Information Center at http://www.ama-assn.org.)
IDENTIFYING CASES OF HIV INFECTION: TESTING AND REPORTING
Issues of law and public policy take on new urgency as the
HIV/AIDS epidemic experiences a paradigm shift. Combination
antiviral therapies and clinical prophylaxes provide for the
first time an opportunity for a longer, higher quality of life
for persons living with HIV. Combination therapies have
markedly reduced the incidence of AIDS, have lowered rates
of perinatal transmission,[7,8] and potentially may diminish
infectiousness by decreasing viral load. With these new
treatment opportunities, it becomes critically important to
identify persons at the earliest stages of HIV infection and
to ensure full and fair access to the health care system.
Testing, since the approval of an HIV antibody test in
early 1985, has been considered essential for HIV
prevention. With more recent advances in antiviral and
prophylactic treatments, testing has also become important as
an entree into the health care system. Public health and
medical authorities recommend that all persons at risk should
know their serologic status, and many want to see the "routinization"
of HIV testing. A broad range of testing services are
desirable, such as testing by primary care clinicians and
hospitals, public clinics, "alternative" (anonymous)
test sites, and home testing. The technological development of
"rapid" tests and analyses of saliva and urine will
make testing easier for the public.
Despite the manifest clinical and public health benefits,
testing may result in loss of privacy, increased social
stigma, and discrimination. As a result, many state
legislatures have enacted special requirements for HIV
testing. State legislation requires informed consent, often in
writing, as well as pretest and posttest counseling. While
counseling and consent are thought to be important to enhance
patient autonomy, ironically, they do make it more burdensome
for health care professionals to "routinize" HIV
testing and bring it into the mainstream of medicine.
Voluntary testing is almost universally recommended, and
most states have abided by an ethic of voluntarism.
Compulsory, nonconsensual testing has been undertaken only in
limited circumstances and principally for nonmedical purposes.
Thus, mandatory tests are imposed, for example, on US
military and foreign service personnel,
immigrants, and certain sex offenders.[13,14] In the
health care setting, however, compulsory testing violates
statutory and common law requirements for informed consent and
may violate nondiscrimination statutes or constitutional
prohibitions against unreasonable searches and seizures.
Although a Pennsylvania court held that HIV testing without
patient consent or knowledge did not violate state common law
doctrines of informed consent or invasion of privacy, that
ruling was subsequently overturned by statute.
Some states permit nonconsensual HIV testing of patients in
limited circumstances. An Alabama statute, for example, allows
testing without consent if (1) the patient is at "high
risk" of infection; (2) knowledge of the patient's
serologic status is necessary for medical care; or (3)
knowledge of HIV status is needed for the protection of health
care personnel. A federal district court found the high-risk
classification to be unconstitutional because a patient could
be arbitrarily classified, but upheld the other 2
classifications. Many states allow compulsory testing to
determine the HIV status of a patient in the event of an
injury to a health care worker, emergency response employee,
or corrections officer that poses a risk of HIV transmission.
Scientific evidence that anti-HIV therapy could
significantly reduce perinatal transmission, together with new
treatment opportunities for newborns, has led legislatures to
consider mandatory testing of pregnant women and newborn
infants. Under federal law, states must at a minimum follow
Centers for Disease Control and Prevention (CDC) guidelines
recommending counseling and voluntary testing for all pregnant
women. If federally set targets for reduction of perinatal HIV
transmission are not met, mandatory measures ensue. At the
state level, several legislatures have enacted laws that
mandate counseling and make voluntary testing available. These
federal and state statutes may set a standard of care in tort,
so that failure to counsel and offer testing to pregnant women
may result in physician liability for wrongful life or
wrongful birth in the event that the infant is born with HIV
infection. New York has enacted a law requiring mandatory
testing of newborns, even though a positive antibody test
reveals the serologic status of the mother. New York's law
also requires disclosure to the mother and protects
confidentiality. That law is currently under court
challenge on constitutional grounds.
Since the earliest moments of the epidemic, all states have
required named reporting of CDC-defined AIDS. By contrast, 28
states require HIV reporting, and 3 additional states
conduct HIV surveillance for pediatric cases only. All HIV
reporting states except Maryland and Texas are name based.
The CDC recently recommended that all states move to a system
of HIV surveillance. The CDC also recommends that states
(unless otherwise required by state law) provide alternative
test sites where names of persons with HIV infection are not
reportable. Ten states proscribe nonreportable, anonymous
testing. North Carolina's closure of publicly funded
anonymous HIV test sites was upheld as a valid exercise of the
state's public health powers.
The predominantly voluntary approach to HIV testing and the
absence of a national HIV surveillance system has resulted in
concerns that HIV/AIDS has acquired a special or
"exceptional" status. In New York State,
prominent medical organizations sued to compel the health
commissioner to include HIV in the official list of sexually
transmitted diseases (STDs). By failing to classify HIV as an
STD, the commissioner declined to trigger his powers for
compulsory testing, reporting, and contact tracing. New York's
highest court held that the classification of diseases was
within the commissioner's discretion and affirmed the
reasonableness of his belief that the exercise of mandatory
powers would not serve an important public health purpose.
PRIVACY, DUTY TO WARN, AND THE RIGHT TO KNOW
Privacy of HIV data has been thought to be necessary for
both patient autonomy and public health. Privacy
safeguards against social stigma and discrimination and allows
each person to make decisions for herself concerning
disclosure. Privacy also supports trusting clinical
relationships and participation in public health services such
as testing, counseling, and partner notification. Most states
have HIV-specific statutes requiring confidentiality of HIV
data. Litigation claiming wrongful disclosure of
HIV-related information has been commenced against numerous
individual and institutional providers during the course of
the epidemic, including hospitals, physicians, and
Guided by the mandates of the provider-patient privilege
and state HIV confidentiality laws, health care professionals
are generally prohibited from revealing a patient's
HIV-related information. In fact, some state privacy
statutes specifically protect HIV information within the
health care or social service setting. Intentional
disclosure is only 1 way to breach confidentiality. A health
care facility's negligent failure to protect a medical record
from disclosure may also violate privacy. However, not all
disclosures result in liability. If the health care provider
can present a compelling reason for disclosure, a court may
allow it. The courts balance the need for the disclosure
against the harm done to both the individual's privacy and the
public interest and often have little difficulty finding
against the individual's privacy right. Using such a test, a
Pennsylvania court authorized a hospital to disclose a
physician's HIV status to 280 patients who had received
invasive procedures. In another case, a court held that a
public health agency's disclosure of confidential HIV
information to aid in a criminal prosecution was permissible;
the criminal activity was deemed a waiver of
confidentiality. In contrast, another court prohibited law
enforcement access to public health records.
A major tension exists between confidentiality and the
"right to know." Health care workers and others who
perceive themselves to be at risk for HIV infection in the
workplace claim the right to know the HIV status of patients
or others. Generally, because infection control precautions in
the health care setting are both the standard of practice and
highly effective, right-to-know claims are difficult to
maintain. For example, a surgeon's lawsuit alleging emotional
distress caused by learning, after the fact, that his surgical
patient was HIV positive was rejected. Similarly, if
morticians and emergency response employees use universal
infection control precautions, the risk of HIV transmission is
negligible. Nevertheless, federal law authorizes, under
certain circumstances, disclosure of HIV information to
morticians and emergency response workers upon their
request. But whether right-to-know claims will be
successful in generating damage awards seems questionable. In
a West Virginia case, a mortician filed a tort action against
a hospital for failing to inform him that a corpse he had
handled was contaminated with HIV. The court found no
liability in the absence of actual exposure.
Fear of HIV Exposure in the Health Care Setting
Many cases have been filed by patients claiming that
individual or institutional health care providers are liable
for exposing them to the risk of HIV transmission without
their knowledge. Patients argue that health care professionals
negligently caused them emotional distress by failing to warn
or failing to prevent some contact that is perceived to pose a
risk of transmission. These plaintiffs seek compensation for
their mental distress and anguish. Recognizing the litigious
nature of American society, many courts limit fear of HIV
claims by requiring proof that the plaintiff's mental distress
is a result of circumstances posing an actual risk of HIV
transmission. Plaintiffs who fear an objectively nonexistent
or unprovable risk generally will not be compensated.[45,46]
Furthermore, many courts limit compensation to distress
occurring during the "window of anxiety," the period
between learning of possible exposure and obtaining a reliable
HIV-negative test result. In 1 case, a surgical patient
provided her own blood for transfusion, but the surgeon
transfused another donor's blood. This negligence caused
emotional distress that, in light of plaintiff's precautions,
was in the court's view both reasonable and foreseeable.
HIV-Infected Health Care Professional's Duty to Disclose
Several courts have held that health care professionals
have a duty to disclose their HIV status to patients or health
authorities, assuming that their professional activities pose
a risk of transmission to patients. The Maryland Court of
Appeals ruled that a surgeon has a duty to inform his patients
of his infection; even if the patient has not actually been
exposed and tests HIV negative, the contact with the surgeon
may subsequently give rise to a claim for the infliction of
mental distress due to fear of transmission. Courts
justify orders to disclose based on a duty to protect patients
and on the doctrine of informed consent. Requiring
disclosure to patients, of course, can severely jeopardize a
health care professional's career. To avoid this result, some
states allow the professional to continue practicing, with
appropriate restrictions and supervision, but without
disclosing his or her HIV status.
The Duty to Warn Third Parties at Risk
Many state laws permit, but do not require, disclosure by
physicians to third parties known to be at significant future
risk of HIV transmission from patients known to be
infected. Thus, if a physician reasonably believes that a
patient will share drug injection equipment or have
unprotected sex without informing a partner of the risk, the
physician has discretion to inform the partner. Under some
disclosure laws, the physician is required to first counsel
the patient to refrain from the risk behavior, and, in
providing the third-party warning, the physician is prohibited
from disclosing the patient's identity. In the absence of
state laws permitting such disclosure, physicians may be held
liable for breach of confidentiality for disclosing patient
information to sex partners.
The "duty to warn" may extend to nonpatient third
parties in other contexts, based on the provider's primary
duty to the patient. Thus, health care professionals have a
duty to inform patients that they have been transfused with
HIV-contaminated blood, and this duty may extend to third
parties. A physician in 1 case failed to inform a teenager or
her parents that she had been transfused with HIV-contaminated
blood. When the young woman's sexual partner tested positive
for HIV, the court upheld his claim against the physician
based on the physician's failure to inform the patient.
Similarly, courts have held that a health care professional's
duty to inform a patient of his or her HIV infection may
extend to those the patient foreseeably puts at risk such as a
spouse or family member caregiver. On the other hand,
courts have ruled that disclosure is wrongful in cases in
which the third party, such as a family member, is not at
actual risk of infection, or the physician has no knowledge
that the patient has failed to disclose to the partner.
PREVENTION AND TREATMENT: PHYSICIAN STANDARDS OF CARE
Negligent Diagnosis of HIV/AIDS
Patients who have been erroneously informed that they are
HIV-infected, when in fact they are not, have filed suit
against their health care providers for negligent infliction
of emotional distress. Some of these plaintiffs have argued
that an HIV-positive diagnosis is a "death sentence"
that inflicts extreme psychological harm. To limit recovery to
only those cases involving a significant claim for
compensation, some courts have refused to award damages unless
the mental distress arose from or led to physical injury. For
example, courts have held that increased blood pressure is not
an adequate injury, but that adverse effects of AIDS
treatments or a patient's attempt at suicide would suffice to
justify liability. Other courts have not imposed a
physical injury requirement.
Providers may also be liable for negligently failing to
diagnose HIV infection. In 1 case, a jury awarded more than $1
million in a case in which an earlier diagnosis would have
delayed by 1 year the onset of symptoms, disability, and
death. A physician may also be liable for unnecessary
delay in notifying a patient of exposure to HIV and may be
liable to the patient's sexual partner who is subsequently
infected. However, providers have not been held liable for
failure to diagnose and effectively treat HIV unless the
plaintiff has shown a causal connection between their failure
and the injury suffered. In the early years of the
epidemic, failure to diagnose HIV infection did not expose the
provider to significant liability, since treatment options and
likelihood of success in treatment were limited. But as
treatments for HIV illness develop to higher levels of
efficacy, failure to render a prompt diagnosis or failure to
initiate prompt and appropriate treatment may expose providers
to increasing liability.
Distribution of Drug Injection Equipment
Public health and medical authorities recommend
that physicians counsel drug users to use a new syringe and
needle for every injection. Syringe exchanges have been
established at the state and local levels to prevent
transmission of HIV and other blood-borne pathogens.
Nevertheless, a web of state statutes create criminal offenses
for the sale, distribution, or possession of syringes and
needles.[64,65] These laws pose the threat of prosecution to
public health officials and community activists who distribute
sterile needles and syringes, and, in some cases, prosecutions
have resulted. The Washington Supreme Court, however, upheld
syringe exchange as a valid public health measure. The court
reasoned that the health department had acted in pursuance of
an AIDS statute that granted the department the general power
to implement prevention strategies. Federal law prohibits
use of federal funds for syringe exchange until the secretary
of health and human services certifies that exchanges are
effective in preventing HIV infection and do not encourage
DISCRIMINATION AND ACCESS TO CARE
The HIV epidemic has been characterized by a high level of
social opprobrium against those infected or suspected of being
infected. As a result, individuals with HIV infection
routinely encounter discrimination in many aspects of their
lives. Discrimination in the health care setting, however, is
especially pernicious, depriving patients of necessary
services and undermining their trust in the system's
commitment to provide them with the care they need. If
individuals fear discrimination in health care, they may forgo
testing or fail to discuss their health and risk behaviors.
Furthermore, because health care professionals are viewed by
the general public as being well informed, their actions set a
poor example for others attempting to respond to the epidemic
in a nondiscriminatory fashion.
Institutional health care providers and other employers
have a duty to provide a reasonably safe workplace. The use of
barrier techniques on a universal basis has been the
officially sanctioned approach to workplace safety. As a
result, discrimination against patients is rarely, if ever,
justified by a provider's fear of transmission. The
Occupational Safety and Health Administration's (OSHA's)
blood-borne pathogen safety standard has been challenged
as overly broad, but remains the primary safety standard.
Although employer noncompliance with infection control
standards may give rise to a justifiable refusal to work, the
underlying fear must have an objective basis. Employee
claims of occupational transmission (or fear of occupational
transmission) are generally covered by worker compensation
statutes, which provide exclusive remedies for
work-related claims against employers.
Definition of "Disability" Under the ADA: The
Supreme Court's First AIDS Case
An array of laws at the federal, state, and local levels
prohibit discrimination on the basis of a person's disability
or health status. The primary federal nondiscrimination
statute is the Americans With Disabilities Act (ADA) of
1990,[73,74] although the laws of many states and localities
also specifically prohibit discrimination against individuals
living with HIV/AIDS.
The ADA provides that no individual "shall be
discriminated against on the basis of disability in the full
and equal enjoyment of the goods, services, facilities,
privileges, advantages, or accommodations of any place of
public accommodation." The ADA's definition of
"public accommodation" specifically includes
hospitals and professional offices of health care
providers. Similarly, New York's highest court ruled that
the offices of private dentists are considered places of
public accommodation under New York law.
A critically important issue under the ADA is whether
persons with asymptomatic HIV infection have a
"disability" and thus are protected under the
ADA. Disability is defined as a physical or mental
impairment that substantially limits 1 or more of the major
life activities of the individual, a record of such
impairment, or being regarded as having such an
impairment. In the past, many courts have ruled or assumed
as undisputed that HIV infection, as the underlying cause of a
life-threatening illness, is a disability. However, several
recent court decisions have held that HIV does not
automatically qualify as a disability, and in each case there
must be an individualized determination as to whether the
infection actually limits, in a substantial way, a major life
activity. Given the advent of new combination therapies that
significantly delay the onset of disabling symptoms, this
judicial view could markedly undermine legal protection
against discrimination for persons with asymptomatic or mildly
symptomatic HIV infection. The ADA's legislative history,
however, indicates that Congress intended to include HIV
infection within the definition of disability, and the Equal
Employment Opportunity Commission's regulations embody that
view. In its first AIDS case ever, the Supreme Court will
decide whether and to what extent persons with HIV infection
are protected under the ADA.
In Abbott v Bragdon, a dentist refused to fill a dental
cavity of an HIV-infected patient. The patient then brought
suit alleging that the refusal violated the ADA. The dentist
conceded that his professional office was covered by the ADA,
but argued that providing services to the infected patient,
because of the risk of HIV transmission, would pose a direct
threat to his health. Additionally, he argued that the
plaintiff, who did not have symptoms of HIV illness, was not
an individual with a disability under the ADA. The lower
courts rejected the dentist's defenses, concluding that the
dentist was unable to show that in 1994, when the case arose,
there was evidence that treating an infected patient posed a
significant risk. The plaintiff's infection, which she
testified resulted in her decision against becoming pregnant,
was viewed as substantially limiting the major life activity
of reproduction. The Supreme Court has agreed to consider 3
questions presented by the case: (1) whether reproduction is a
major life activity; (2) whether asymptomatic HIV infection is
a per se disability under the ADA; and (3) whether the courts
should defer to a health care provider's reasonable
The ADA's coverage also extends to individuals merely
regarded as having a disability. Thus, it is unlawful to
discriminate against an individual based on the misperception
that the person is infected with HIV under the ADA as well as
under the laws of many states. Persons discriminated
against because of their association with a person with HIV
infection are also protected, as are persons retaliated
against because of their opposition to discrimination.
The Health Care Professional's Duty to Treat
Courts have consistently held that health care
professionals have a legal duty to treat patients living with
HIV/AIDS. Health care professionals must, of course,
exercise appropriate clinical judgment. If a professional
lacks the skill appropriate to render competent care, she may
legally refuse to treat the person and may lawfully refer him
elsewhere. A clinician cannot, however, simply reject or
refer an HIV-infected patient solely because of his or her HIV
The courts have had to decide the difficult question
whether and to what degree a health care professional can
treat HIV-infected persons differently from other patients.
Although CDC and OSHA standards require use of
"universal" precautions applicable to all patients
without regard to infection status, imposition of special
precautions for HIV-infected patients has been upheld. One
court, finding that special precautions may be necessary for
certain procedures, ruled that a dentist may lawfully refuse
to treat a patient who refuses to reveal HIV-related
information. But another court ruled that the use of
special precautions, which resulted in delay of services,
beyond those recommended by the CDC constituted unlawful
Nondiscrimination in Health Insurance
Access to health care is often contingent on the ability to
pay or the availability of insurance coverage. Federal and
state law provides little or no protection from adverse
coverage decisions provided the insurance company uses sound
actuarial data. However, an employer's decision to place
severe limits on coverage for HIV/AIDS, but not on comparable
diseases, may be unlawful under the ADA.[90,91] A central
question in determining the extent of health insurance
coverage is whether certain services are "medically
necessary." In an important case, the Eleventh Circuit
Court of Appeals held that skilled nursing care was
"medically necessary" and should be reimbursed under
an employer's self-funded health benefits plan.
HIV-Infected Health Care Professionals
Federal law requires states to comply with CDC
guidance that recommends an individualized determination
of whether HIV-infected physicians engaging in
"exposure-prone" procedures can safely practice. At
present the CDC and the American Medical Association are
reevaluating their policies in light of epidemiologic evidence
showing that the risk to patients, even from invasive
procedures, is negligible. The judiciary has had to decide
whether HIV-infected health care professionals pose a
significant risk to their patients, and thus are not qualified
to continue to practice. Several courts have upheld decisions
to prohibit HIV-infected health care professionals who perform
invasive procedures.[95,96] These courts have reasoned that
the severity of harm if HIV infection were transmitted
justifies practice restrictions. However, the Ninth Circuit
Court of Appeals held that a physician's practice could not be
restricted if he did not primarily perform invasive
procedures. The physician, a general internist, was employed
by the Federal Bureau of Investigation (FBI). The agency
refused to refer patients to the physician after suspecting
that he was HIV positive. The court ruled that the FBI had
failed to make adequate inquiries about the physician's
infection control procedures: "The record shows that Dr.
Doe and the hospital were entirely forthcoming about these
procedures, but that their explanations fell on deaf
Prisoner Health Care
Access to adequate health care for prison inmates living
with HIV/AIDS has been a long-term problem. Gross
inadequacies in state prison health care systems may rise to a
constitutional violation. In New York, inmates living with
HIV/AIDS challenged the state's delivery of medical, mental
health, educational, and prevention services. The court
ordered the state to release records enumerating the inmates,
both living and deceased, who had been diagnosed as having
AIDS or AIDS-related illnesses, in order to aid in the court's
determination as to whether the prison authorities
deliberately neglected the inmates' health care needs.
Inadequate medical care and lack of HIV education services
resulted in a court-imposed remedial plan in another
case. But when a showing of deliberate indifference is
lacking, federal constitutional claims against prison
officials will fail.
Considerable progress has been made—socially and
legally—during the first 2 decades of the HIV/AIDS epidemic.
Reductions in social stigma and new statutes to protect
privacy and proscribe discrimination have emerged. The serious
consequences of the epidemic, however, are not over. While
instances of gross abuse are less frequent, intolerance and
animus stubbornly persist. Even legal advances have been
eroded with some courts denying antidiscrimination protection
for persons with asymptomatic HIV infection, and upholding
discrimination against HIV-infected health care professionals
despite the extremely low risks.
Systematic efforts to confront the HIV/AIDS epidemic are
needed: (1) expanded and nondiscriminatory access to health
care; (2) expansion of counseling, testing, and other
prevention services; (3) educational campaigns to promote
tolerance and reduce social stigma; and (4) better laws to
protect privacy and prohibit discrimination. The health care
and public health systems need these and other kinds of new
strategies to reduce the deep personal and social burdens of
HIV disease in the United States.
From the Georgetown/Johns Hopkins Program on Law and Public
Health, Washington, DC, and Baltimore, Md (Mr Gostin). Mr
Webber is in private practice in Philadelphia, Pa.
Reprints: Lawrence O. Gostin, JD, Georgetown University Law
Center, 600 New Jersey Ave NW, Washington, DC 20001 (e-mail:
Health Law and Ethics section editors: Lawrence O. Gostin,
JD, the Georgetown/Johns Hopkins University Program on Law and
Public Health, Washington, DC, and Baltimore, Md; Helene M.
Cole, MD, Contributing Editor, JAMA.
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