The New York Times on Nov. 25, 2007, reported “The United Nations’ AIDS-fighting agency admits to overestimating the global epidemic by six million people.”
The World Health Organization states that instead of the earlier estimate of 39.5 million thought to be infected with the virus, the number is now 33.2 million worldwide with 2.5 million new infections per year. A Times article on Nov. 23, 2007, stated “more than two million people — mostly in sub-Saharan Africa — are still dying from the disease each year.” Clearly, as the Times states, “The revised numbers cannot be used as an excuse to relax the campaign against AIDS.”
There is, however, a vast change in outlook on the part of the public, particularly by those suffering from the disease.
Although recent evidence has documented the presence of the human immunodeficiency virus in the United States for close to 40 years, 1981 is the date we accept as the beginning of the AIDS epidemic. Twenty-six years ago, for the vast majority, being given that diagnosis was the equivalent of a death sentence following a short debilitating, incapacitating illness.
The mere mention of the disease spread terror, not only in the groups that were its prime victims — first, homosexuals and then needle-using drug users — but also in the general population unsure of how the disease was spread. In a way, its effect on the public psyche with respect to contagion could be compared to that of leprosy of yesteryear: an uncontrolled irrational fear. Today, those with HIV or AIDS need not, and many will not, panic.
During the past quarter of a century, drugs have been discovered that have converted the disease from terminal to chronic. With treatment, patient’s lives are similar to those with many other illnesses that require continuing medical attention.
For many years testing for HIV/AIDS has required the written permission of the patient. Two salient reasons for this policy were the fact that there was little or no treatment available. Further, as a result of the lack of information and abundant misinformation surrounding the diagnosis, prognosis and communicability of the disease, there was a profound negative reaction on the part of most people towards those suspected of having the disease.
Today meaningful treatment is available and, in the main, the irrational stigma associated with the diagnosis has been significantly reduced. Therefore, it is reasonable to review and perhaps revise this policy. A more rational formulation is, Can the simple oral assent of the patient be sufficient for testing for HIV/AIDS?
Many believe that neither written nor oral consent should be required since testing ordered by a physician for a host of diseases — using blood or other tests — does not require the patient’s permission. Although there are of course still major privacy concerns, I believe allowing the patient’s physician to decide on testing for HIV/AIDS is the appropriate response, if confidentiality can be assured.
I recall the opposition that we faced from many sectors of the public when Drs. David Sencer and Stephen Joseph supported the creation of a needle exchange program intended to reduce contagion in the drug-using community taking their drugs by hypodermic needle and infecting one another through the use of common needles.
The program was presented to community leaders and groups. On one occasion, I met with many leaders of the African-American community who were adamant in their opposition to any clean needle exchange program. I recall the words of then police Commissioner Ben Ward at the meeting. He said, “If it’s such a good idea, let them try it first in Scarsdale before trying it in Harlem.” My recollection is that we tried it first in Chelsea at an existing New York City health station and later expanded the program.
Church groups opposed our handing out free condoms at bath houses and single and gay bars to encourage so-called “safe sex” practices. Actually, the practices should have been called “safer sex.” Nevertheless, we did hand out more than 1 million condoms and closed bath houses, both homosexual and heterosexual, that did not take measures to reasonably ensure safe sex practices.
One of the greatest successes of my administration with respect to government protection of the rights of those having the condition HIV/AIDS occurred when the City of New York in a proactive way maintained in a lawsuit that elementary school children with the condition or disease had a right to attend public school.
We won that case in a courtroom in Queens County, in a case tried personally by the then Corporation Counsel Fritz Schwarz where a local school board had barred a student who had been diagnosed with HIV/AIDS.
The City of New York was fortunate in those early dark days to have as our commissioner of health, Dr. David Sencer, succeeded by Dr. Stephen Joseph. We were fortunate throughout the 12 years to have as corporation counsel, Allen Schwartz, who was succeeded by Fritz Schwarz, who was succeeded by Peter Zimroth.
Public service, then and now, is the noblest of professions, when done honestly and done well. All of these public servants performed superbly.
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