People Could Die, but Let’s Not Make Waves

The debate over HIV has irrevocably changed how business is conducted in many segments of America.

The Food and Drug Administration now recognizes alternative routes for approval of new drugs in life-saving situations. Scientific projects are now usually informed by community advisory boards. Congress has become increasingly diversified, providing a voice to groups traditionally stigmatized.

Yet not even the urgency associated with the spread of a life-threatening illness has changed an inviolate rule for government employees: Keep a low profile.

When leadership regarding HIV policies has been demonstrated within government agencies, careers have been ruined. For example, 10 years ago Stephen C. Joseph was ousted as health commissioner of New York City when he advocated needle-exchange programs. Yet needle exchange has been the strategy that has allowed Australia and most of Western Europe to keep infection rates low among injecting drug users. It has been evaluated as a very successful prevention strategy by multiple blue-ribbon panels of American scientific experts. If public debate had been allowed on Joseph’s proposals, it is possible that thousands of people in the U.S. would not have been infected with HIV.

A similar fate befell the New York City superintendent of schools when he advocated condom availability in high schools, a policy that has been demonstrated to protect adolescents from HIV infection (and other sexually transmitted diseases) without increasing sexual behaviors.

In each case, the mandated mission to protect the public good forced the official to make waves and come in conflict with the first rule of a bureaucracy--don’t make waves.

Earlier this month, Dr. Peter Kerndt, Los Angeles County’s chief epidemiologist, was put on involuntary leave for showing just such leadership in the HIV battle. Kerndt was awarded a grant in 1997 by the National Institutes of Health to find adults at high risk for HIV. Unfortunately, misinformation was circulated that the research would be “the next Tuskegee,” a tragedy that occurred when African American men were denied access to penicillin treatment for syphilis during a government research study in the 1940s. Educational outreach could have quickly informed communities that these claims were unfounded. The study would have provided willing participants with state-of-the art HIV prevention programs. And if participants desired, they could choose to be part of future HIV interventions, including vaccine trials. This research initiative is the top item on President Clinton’s HIV agenda and one for which $40 million has been committed.

One would have thought that county officials would be congratulating an employee who took the initiative to ensure that Los Angeles was included in well-deserved federal funding. Instead, personal attacks were launched against Kerndt’s character, professionalism, ethics and commitment. Specifically, a question was raised about whether Kerndt informed his superiors about the grant. The broad dissemination of the grant proposal and involvement of high-level public officials and community agencies in the study and letters of congratulations from supervisors refute this assertion.

If the public’s attention is diverted from public health issues to continued personal attacks, the major losers will be the citizens of Los Angeles, who now may not have an opportunity for early access to innovations in future HIV therapeutics.

In the HIV arena, we have a history of making personal attacks on those government employees who dare to entertain debate. We need our appointed officials to foster discussion and debate, to lead us in consensus building, and to act decisively if the urgency of a matter precludes waiting for the time necessary to build a consensus. Instead of taking to task the people leading the debate, we should take to task those who try to silence it.