Monday, July 31, 2006

Human rights and HIV prevention/care

I've been reading with interest the news coverage (and sometimes lack of it) of Human Rights Watch's statement about the effects of human rights abuses in Zimbabwe on HIV prevention and care. Appropriately enough, the coverage focuses, as it was intended to, on the specific issues of discrimination against and persecution of persons with HIV and AIDS in that African nation, noting that these abuses hinder the fight against HIV, even spreading it further.

I'm not seeing much coverage of the report in the U.S., however. This doesn't particularly surprise me. And, if there were such coverage, it would also not surprise me if the reporters failed to make a connection between Zimbabwe and the U.S. or, for that matter, Texas.

I'll just help them out a little. While we don't seem to be bulldozing houses where people with HIV/AIDS live in Texas nor do we show overt patterns of exclusion from health care (on the basis of health status), we still have our little human rights quirks.

Nearly every one of the providers with whom we spoke reported serious violations of medical privacy. In New Mexico, a patient first learned that he was HIV-positive from a receptionist in front of a waiting room full of people. Police in St. Louis found a young man's HIV medication when they searched his car and disclosed his HIV status to his father, saying he had a right to know. The New York City Department of Health disclosed a person's HIV status to his employer. A teacher in Florida informed an entire class that a particular student was HIV positive. A receptionist at a nursing home in Texas told a woman that the man holding her baby might give it AIDS. These incidents are likely the tip of the iceberg, for even people who reported egregious breaches of confidentiality were typically too afraid to confront the problem if it meant disclosing their HIV status to more people. Nevertheless, such breaches of confidentiality can and do unravel HIV-positive people's lives. After their HIV status was disclosed, several people were literally driven out of Paris, Texas with hate mail and vandalism of their homes.

Actually, that passage is from an ACLU study, completed in 2003. Notice how often "Texas" occurs as a keyword in that passage. Somehow I doubt things have changed all that much in the past 36 months.

And what this means is: fear of loss of confidentiality, reluctance to get tested, continued spread of HIV, continuing disparaties in accessing health services even when services are available.

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