Discuss the ethical issues related to HIV/AIDS partner notification and highlights the inconsistencies of state reporting and epidemiological surveillance efforts in the United States. Analyze he conflict between individual privacy and public health to offer students a better understanding of the ethical issues that exist in treating and monitoring HIV/AIDS within the United States at the local, state, and national levels.
While many other infectious diseases have always maintained routine partner notification efforts with name identification, the sound epidemiologic practices used to controlling infectious diseases have been severely hampered in dealing with the HIV/ AIDS pandemic. Feared stigmatization and a desire for privacy have created competing ethical pulls with the need to control HIV/ AIDS. As a result, privacy legislation has been passed that has generated compliance fears among healthcare providers - thus limiting HIV/ AIDS surveillance reporting and public health efforts of partner notification. This has been done in the name of ethics, yet the lives of many have been compromised for the sake of individual privacy. With this in mind, this paper will attempt to explore this ethical dilemma and apply a theoretically sound strategy of moral reasoning to resolve this issue in a balanced manner.
Background: Partner Notification
In 1981, HIV/ AIDS first emerged in the United States as a deadly infectious disease that struck fear in the hearts of men and women nationwide. At the time, the disease was predominantly found within the male homosexual population, thus generating significant stigmatization and fear within the general populace regarding any contact with homosexuals (Beauchamp and Steinbock, 1999). A media frenzy ensued that further exacerbated public ignorance about HIV transmission and homosexual prejudice. Therefore, gay rights groups formed a unified front and lobbied in congress to prevent traditional epidemiologic practices from being performed, such as random HIV testing and infected person identification. Forged out of fear of stigmatization, job loss, and/ or loss of health insurance policies, gays rights activists put pressure on the Food and Drug Administration, the Centers for Disease Control (and now Prevention), and other federal agencies to stop these common public health practices in HIV/ AIDS surveillance efforts. As a result, privacy became a priority over the health of the public, as public health officials were blind-sided in their ability to identify and control the spread of HIV/ AIDS.
However, twenty-five years later, in 2006, HIV/ AIDS is not strictly a male homosexual disease, yet the battle continues to rage between privacy and public health practice in HIV/ AIDS surveillance. According to the Centers for Disease Control and Prevention, about half of the more than 1 million AIDS cases are heterosexual, drug, blood transfusion, perinatal, and hemophilia-related cases (2004). In other words, today, the notion that HIV/ AIDS is merely a ¨gay disease¨ is not epidemiologically correct. Rather, other behavior-specific pathologies, such as rectal gonorrhea, would be much more indicative of homosexuality than AIDS (Beauchamp and Steinbock, 1999). Since HIV/ AIDS is spread via exposure to blood, semen, vaginal fluid, or breast milk ("HIV Curriculum," 2003), modes of transmission can occur through the following means:
- Sex with infected person
- Exposure to blood (unclean needles, transfusions, razors, etc.)
- Pregnancy, birth, breast-feeding (infected mother to child)
Therefore, it may be concluded that HIV/ AIDS is a deadly infectious disease that affects a heterogeneous population group - not just homosexuals, but people from many different walks of life.
Nevertheless, key privacy-oriented legislation has generated compliance fears among healthcare professionals. For example, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), currently requires that patient information be kept confidential. Other legislation prohibits random HIV/ AIDS testing, with the exception of blood banks (Beauchamp and Steinbock, 1999). Yet, other sexually transmitted diseases, such as gonorrhea, syphilis, and chlamydia, involve both random testing and name identification in state surveillance practices (Lawrence, Montaño, Kasprzyk, Phillips, Armstrong, and Leichliter, 2002). Since laws geared toward HIV/ AIDS break with traditional epidemiologic practice, many healthcare professionals are unclear how to report HIV/ AIDS cases.
Furthermore, disease surveillance efforts are even more varied among states. Some list both HIV and AIDS cases, some report AIDS cases only, some list names, and others do not report names (Beauchamp and Steinbock, 1999). With this in mind, partner notification in the surveillance and control of HIV/ AIDS becomes a daunting task. If there is confusion about privacy law compliance, and there is variation in healthcare and state disease reporting, then there could reasonably be an unknown number of undetected cases. If this ...