AIDS and Public Policy: Using Law Against Fear to Re-Member Society

In August, 1985, long before Masters and Johnson fanned fears of new AIDS outbreaks, the Los Angeles City Council fashioned the nation’s first AIDS anti-discrimination ordinance. Since then numerous cities and counties have passed similar laws and state and federal agencies have included AIDS within existing handicap protections.

Laws, not panic, would protect all the people. The goal of such laws is to require us to treat unpopular or frightening groups with the same standard of fairness we would want applied to ourselves. In this manner, anti-discrimination laws compel us to re-member--to use an archaic form of the word remember --to bring all members back into a whole.

People otherwise qualified to perform a task or receive a service despite the actual limitations of their handicap may not be denied employment or services. Someone in a wheelchair, for example, who can type and answer phones has a right to fair consideration for work as a secretary. Employers or service providers must reasonably accommodate the special needs created by a handicap. They cannot say, “We’d like to hire you, but your chair won’t fit behind the desk.” They have the duty to move the desk away from the wall.

This does not mean that directors of musicals must cancel tap dance numbers; someone in a wheelchair is not otherwise qualified to tap dance. Nor may a teacher with active tuberculosis insist on the right to teach. Such rights never mean that others must endure unsafe environments.

But such laws require that the risk to others actually be demonstrated, the inability to work truly established. They will not permit policy to be based upon irrational fears and unfounded beliefs.

Panic about AIDS--acquired immune deficiency syndrome--threatens the ties that bind communities together. Like past epidemics, it drives societies to isolate and scapegoat an unpopular or frightening group, victimizing some to bind together the rest. That is the clear and present danger. How can we chart a course to assure that our social fabric remains whole in the face of growing concern about AIDS? The sensational and highly questionable claims made in a new book by the sex therapists William H. Masters and Virginia E. Johnson, together with Dr. Robert C. Kolodny, suggest that the heterosexual population lives at great risk.

AIDS laws suggest that risks, like fears, can be controlled. Anti-discrimination units were first established in Los Angeles, New York and San Francisco. As we gained experience in enforcing these new laws, we discovered that concerns about civil rights and public health were two ways of expressing precisely the same thing.

A 27-year-old woman with a degenerative neurological condition could no longer live on her own despite regular visits from a social worker and a home health aide. The intermediate-care facility that had accepted her for placement refused her admittance when it learned she was AIDS-virus-infected.

The bruise on the woman’s head from a fall she had suffered attested to the need for a rapid resolution to her problem. She filed a complaint with the City Attorney’s office, which quickly investigated the matter and contacted the facility’s attorney. The attorney for the facility was familiar with the City Attorney’s policies and expertise; he arranged placement for the woman within a matter of days.

The familiarity and fairness of the legal standards involved, even though the facts were new and upsetting to all, immeasurably helped resolve this potentially tragic situation. AIDS discrimination victims need quick resolutions of their problems because the side effects of litigation--conflict, delay and publicity--are especially harmful to people who are ill.

Fortunately, AIDS cases differ from other discrimination cases because they can often be settled by effective communication of medical facts and the familiar principles of physical handicap law. But such intervention requires trust and understanding.

Such intervention also requires a willingness to confront all the complexities involved in our fivefold fears about AIDS as a disease: fears about sexuality, stigma, helplessness, mental illness and death. Such fears make facts about AIDS difficult to teach.

But teaching about the duties imposed by law can make learning the medical facts easier. When people understand their responsibilities to others regarding confidentiality and anti-discrimination, they learn behavior that reinforces clear medical messages about AIDS.

We have found this to be true from our experience helping to implement AIDS education programs for the city of Los Angeles’ 33,000 employees. Unlike most other corporate, school or public health education programs, our program has two goals.

All AIDS education programs seek to teach about preventing further spread of the AIDS virus. But the Los Angeles program, which has drawn praise from Surgeon General C. Everett Koop, also requires education about AIDS legal issues: ensuring confidentiality, preventing discrimination and protecting against liability.

AIDS task forces are being created within each department to coordinate workplace education and problem-solving efforts. Each department has been ordered to do three things: educate its employees; review and revise all policies and procedures in light of AIDS medical and legal issues, and adapt daily department interactions with the community to further public education about AIDS.

An example from the Department of Transportation provides a good illustration of the program’s potential impact. Drivers in city programs to transport the disabled learned that it is illegal to refuse to transport someone with AIDS.

Instead of merely being told that--and thereby creating potential resentment and misunderstanding--every driver was taught why. No precautions are necessary to prevent the spread of AIDS in the normal course of transportation, since there is no way for infected blood or semen to enter an uninfected person’s blood system.

Should a passenger bleed or vomit (which might contain blood), drivers are taught to clean up the mess or assist the passenger only after donning protective gloves (to create a protective barrier against anything entering their blood system). Drivers learn that they need not know who has AIDS and who does not. Lawful and medically safe action would be the same in either case: use gloves to clean up blood or vomit.

Passengers who question the use of gloves learn the truth about AIDS virus transmission from the drivers. Homosexual men or intravenous drug users who otherwise might feel singled out for special treatment need not feel stigmatized since everyone receives similar treatment. And the health of drivers is improved; they avoid all direct contact with blood.

The likelihood of AIDS virus transmission in such a setting is tiny. But gloves are a reasonable response to that tiny possibility so many have urged as justification for more tyrannical measures against the person with AIDS. Everyone learns that protection of individual rights and public health adds up to the same standards: reason and fairness.

Civil rights are easy to bestow upon those of us perceived as “normal.” The AIDS epidemic sets a challenge like no other in recent times for us to treat “others” as we ourselves would want to be treated.