AIDS Panelist Urges Stronger Anti-Bias Law

Calling discrimination “the most significant obstacle to controlling the epidemic,” the chairman of the presidential AIDS commission Thursday issued an exceptionally strong plea for expanded anti-discrimination legislation to protect those suffering from the deadly disease, as well as those infected with the AIDS virus.

“Discrimination is rampant--it’s not just an isolated set of cases,” Adm. James D. Watkins said as he released nearly 600 recommendations. The recommendations are expected to serve as the foundation for the commission’s final report to the White House in a move to create a national strategy to combat the AIDS epidemic. After the report’s delivery to the White House later this month, the commission’s work will be finished.

Didn’t See Linkage

“It impacts on virtually every element (of the epidemic),” Watkins told reporters at a breakfast meeting. “Everything . . . in the report is tied to it. I don’t think any of us (before) really saw the linkage. It’s time to take a strong position.”

Watkins predicted that the 13-member commission would support his proposals when it meets next week. “My sense is that this is acceptable to the commissioners,” he said. “This is straight. This is what I believe is right for the country,” he said. “I would hope it would not be watered down.

“The learning process has been a steep ramp for all of us, (especially) when you hand-hold a person with AIDS who has been through some pretty rough stuff.”

Watkins--in the only proposal not discussed earlier with fellow commissioners--called on President Reagan to immediately declare the AIDS epidemic a public health emergency. He proposed also that legislation be enacted to establish a future public health emergency response plan implementing “the lessons we have learned . . . based on this experience.”

His plan, expected to be the only recommendation to provoke opposition from some commission members, would give the surgeon general enhanced powers to take charge of a major public health crisis, such as the AIDS epidemic, as soon as the President has declared a national public health emergency.

Watkins said he believes that the authority to deal with an immediate and specific public health threat should be given to an individual who is not burdened with other responsibilities, such as that of running a federal agency.

Aiming for Readiness

“I believe the nation should have a public health emergency plan on the shelf, ready to implement at any time, just as soon as the President pushes the button,” Watkins said.

Thursday’s report was the second and final series of recommendations from the chairman, who received high marks for his interim report, released last February. At that time, he proposed a dramatic expansion of drug abuse programs to establish a nationwide system of “treatment on demand” for intravenous drug abusers.

The earlier report was considered surprisingly ambitious for a commission that had been beset with controversy since its creation last summer. Watkins, retired chief of naval operations, assumed the leadership of the beleaguered panel last fall after its two top members resigned, unhappy about personality conflicts and ideological differences among its members on how to approach critical AIDS issues. The commission had also been attacked for its failure to include more individuals with wider AIDS expertise and for including some individuals whose beliefs clashed with widely accepted medical evidence about the disease.

Greater Understanding

But Watkins said that after nearly a year of work--which included site visits and public hearings with nearly 800 witnesses--commission members had grown tremendously and had achieved a much greater understanding of all aspects of the epidemic.

“It’s called ignorance to brilliance,” he said. “I say that for all of us. It’s not a criticism of anybody.”

Watkins estimated that the entire package of proposals, including the earlier drug treatment recommendations, would cost from $2.9 billion to $3.1 billion over the current budget figures. He suggested that a third of the additional funds be provided by the states, with the remainder from the federal government.

In the area of discrimination, Watkins recommended expanding existing federal laws protecting the handicapped (which includes those with contagious diseases) against discrimination to cover the private sector as well as the public sector.

He further proposed that the President issue an immediate executive order banning such discrimination in the executive branch that would deliver “a powerful message from the leadership of the nation.”

Opposition to Federal Law

The Reagan Administration has opposed AIDS anti-discrimination legislation at the federal level, saying it preferred that states enact their own laws. But Watkins said he was optimistic that the White House would respond favorably to the report.

“Times change,” he said. “Maybe we can inspire people to understand the passions building in the country.”

In addition, Watkins proposed new laws on confidentiality, with strong sanctions to protect the identity of those who test positive for infection with the AIDS virus. He said legislation should be enacted that prohibits the disclosure of such information without the written consent of the infected individual, except under certain specific circumstances.

Those exceptions, he said, would include disclosure to limited members of the individual’s health care team; to health care workers accidentally exposed to contaminated blood; for statistical reports “if used in such a way that no person can be identified”; to a state health officer for epidemiologic or partner notification purposes; to blood, organ, semen or breast milk banks; to a spouse or sexual partner “when the individual will not inform them”; by a court order issued in response to an application by a state health officer, and to the victim of a sexual assault.

Health Care Funding Urged

He recommended increased state and federal funding of methods of financing health care for AIDS patients, establishment of partner notification programs “targeted at those who would not know they were at risk for (AIDS) infection” and implementation of a comprehensive health education curriculum from kindergarten through 12th grade to be in place by the year 2000.

He also proposed that criminal liability be extended “to those who knowingly engage in behavior” likely to transmit AIDS infection, which he said is “consistent with society’s obligation to prevent harm to others.”

Members of the commission and others praised the chairman’s report, although some expressed reservations about certain proposals.

“I think it’s solid and I expect a strong consensus,” said Kristine Gebbie, a commission member and the health officer for the state of Oregon. “I think it will move the country. People cannot say that this is just another group of scientists off in a corner, or another bunch of do-gooders--this is a group of people, some of whom are known for having conservative views, who have taken a look and said: ‘This is what should be done.’ I don’t think this report is going to be a dust-gatherer.”

‘Obligation to Society’

Commission member William Walsh, chairman of Project Hope, an international charitable organization, called the report “balanced,” although he described the anti-discrimination proposal as “stronger than I would have put in it--but necessary.” He said he is pleased with the section on confidentiality, saying that “it makes it clear that the (infected) individual has an obligation to society as well.”

Walsh said, however, that he opposes the chairman’s emergency response plan, saying that the country does not need the “creation of a czar” in the form of the surgeon general. “You can’t give anyone in a democracy that kind of power--it just doesn’t make sense,” he said.

Dr. Mathilde Krim, founding co-chairman of the American Foundation for AIDS Research, applauded Watkins for viewing the disease “not only as an isolated event” but from the perspective of “a human society” in which he “clearly respects human beings and their right to individual liberties.”

Rep. Henry A. Waxman (D-Los Angeles), chairman of the House Energy and Commerce subcommittee on health, said that Watkins “has looked at AIDS and has clearly seen that we should make policies to fight the disease and not the patients.”

Although it praised the report overall, the National AIDS Network criticized the proposal to criminalize intentional AIDS transmission, saying that it would be “a disincentive to voluntary testing . . . (and) is an overly simplistic solution to the complex problems of effective behavioral change.”