The AIDS crisis and civil liberties

By Dr Leslie Ramsammy
Guyana Chronicle
February 29, 2000

EPIDEMIOLOGY encompasses both the systematic study of infectious diseases and the implementation of the means to contain it. Epidemiology has sometimes had to strike a balance between the harshness that may be required to control infectious diseases and the civil liberties of people whose rights may be subjected to abridgement. Guyana, not for the first time, confronts the stark reality of making choices on the side of controlling an infectious agent or respecting people's civil liberties. I am referring, of course, to the continued emergence of HIV infection and AIDS as national public health concerns for Guyanese.

Recently, the Minister of Health, Dr Henry Jeffrey, alluded to the possibility of testing all pregnant women as a means for early detection of the various in one section of the population. This has sparked a debate - a healthy one, I might add. This debate has highlighted the issue that I have raised in this Viewpoint. I suspect that the Minister of Health himself was promoting this debate. In the end an informed judgement will have to be made.

Public health responses are about protecting the population - it pays little attention to the civil liberties of the individual. In fact, many of the public health responses seriously conflict with the rights of the individual. This is not new. Since the turn of the century, with the introduction of bacteriological testing, standard public-health measures have been deployed against infectious diseases. These measures, leaving aside the extreme step of holding people in quarantine, have typically included at least one of the following: routine testing for infection, often undertaken without explicit patient consent, reporting to local health authorities of the names of those who test positive for infection; contact tracing, or the identification of any person who may have been exposed to infection; and notification of these possibly infected persons that they may have been exposed. Some combination of these four practices have been commonly applied against outbreaks of infectious diseases, including sexually transmitted diseases, diphtheria and tuberculosis.

The debate over compulsory testing for HIV seeks to exempt this killer virus from what up to now has been standard public health responses. It would be unfortunate if the virus that is ranked Number One as a cause of mortality in the 20 to 40 age group is exempted on the basis of civil liberties. The hesitancy today to embark on standard public health responses is largely to accommodate civil-rights concerns. We have convinced ourselves that the fight for survival can be waged in a way that is socially acceptable but not always biologically credible. Based on civil liberties concern, most countries have chosen to remain steadfast in their commitment to programmes and approaches that have hidden the identity of HIV carriers, but have failed to halt viral transmission. In the end, this choice makes a winner of the virus, but losers of people.

In the face of this dangerous public health challenge, policies and programmes must focus on the protection of population from becoming victims of this terrible disease. In devising effective programmes, some concessions pertaining to civil liberties will become necessary. One has to weigh the issue of civil rights against the issue of effective disease control.

Some argue that polices must be informed by its potential to interfere with rights of the individual. When such unequivocal interpretation is given to public health responses, that it must attempt effective disease control, but its action must not in any way interfere with individual rights, society has de facto conceded rights to dangerous bacteria and viruses. In the case of HIV, the virus is our common enemy, not the person that carries it. However, that person harbours the virus and society needs to take action to prevent that virus from moving to another person.