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Am Fam Physician. 1999;59(11):2983

to the editor: For about 50 years, reporting cases of syphilis and tuberculosis, as well as a host of other communicable infectious diseases, to the U.S. Public Health Service (USPHS) has been mandatory. The USPHS is also required to follow patients who have these diseases and the persons with whom they come in contact. Issues of civil liberties, stigma and discrimination associated with mandatory reporting of infectious diseases were addressed long ago. In the case of Jacobson v. Massachusetts 197 U.S. 11 (1905), the Supreme Court ruled: “An individual can be made to submit to vaccination against contagious diseases because of the governmental and societal interest in preventing the spread of disease.”1
Why does this ruling not apply to persons who are infected with human immunodeficiency virus (HIV)? Why have citizens of the United States been told for the past 20 years of the HIV epidemic that it is for “political reasons” that our government leaders have abandoned the science of public health and have given the responsibility of controlling such diseases to the people? The “political reasons” for this decision have never been explained; therefore, we must draw our own conclusions.
A hint of the reasoning comes from an editorial in The New York Times, which stated: HIV tracking “. . . is justified by the changing nature of the epidemic . . .”2 Another editorial in The New York Times read: “The changing nature of the AIDS epidemic . . . make[s] it necessary to rethink the public health response to the disease.”3
Twenty years ago, the HIV epidemic was essentially confined to persons who were homosexual or used intravenous drugs. This confinement occurred simultaneously with massive closings of public health hospitals and cutbacks in public health funding. These groups of people must have been considered “marginal”; our government leaders must have believed they were expendable. This belief fit perfectly with the promotion of the rationale that we need to “protect their civil liberties” by not reporting them to the USPHS. Now millions of persons who were infected with HIV have died with their civil liberties intact.
Pandora's box is open; the people are angry at the government's betrayal of our trust and are demanding laws to protect the public health. Richard N. Gottfried, a New York State Assemblyman, said: “Large parts [of a proposed bill on HIV] look like someone just Xeroxed a 45-year-old statute dealing with syphilis and changed syphilis to HIV.”4 This is exactly what has happened. The government should get back to the basics that were previously abandoned. Dr. Lloyd Novick, Health Commissioner of Onondaga County, said about the HIV bill that was proposed in New York: “This is a major step forward for the prevention of HIV infection.”4 Is this truly a step forward, or is it a step backward into a plan that worked in the past?

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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