An editorial...written and distributed by Housing Works:
The media has been giving extensive and voyeuristic coverage this week to the tragic story of many young women in New York City and Chautauqua County who have been exposed to, and in some cases infected with, HIV though sexual contact with the same man. Six women were allegedly infected after the man was tested for the virus and learned that he was HIV-positive a year ago. Conservative politicians in New York and nationally are trying to exploit this tragedy and calling for mandatory partner notification, a weakening of the strict public health laws protecting the confidentiality of HIV-related information, and legislation that would make knowingly infecting another person with HIV a crime. But the facts of the case, and the public health system's response, should lead policy makers to reject such extreme measures.
First, the man in question had willingly provided public health officials with the names of past partners when he learned a year ago that he was infected with HIV; these young women were then contacted. Mandatory partner notification was not necessary, and would not have resulted in a better outcome. His willingness to cooperate with the Health Department indicates both that voluntary notification works, and that he was not at that time withholding information about his partners' possible exposure.
Unfortunately, Dr. Robert Berke, the Chautauqua County Health Commissioner, made statements to the media in which he reviled the accused man as "some kind of scorekeeper" who "seems to take some kind of delight in keeping records" of his sexual partners. Yet these "records" were generated when the man was asked for a list of past sexual contacts and provided it: to demean him publicly for cooperating with the public health authorities is counterproductive at best. Condemning someone for knowing the names of his partners and facilitating their notification about possible exposure to HIV can only deter people who test positive in the future from being fully forthcoming about the names of their contacts, whether that information is being sought in the context of voluntary or coercive partner identification and notification procedures.
USA Today this week cited the case as evidence of the need for mandatory HIV names reporting, which would be irrelevant to the events unless one assumes that there is a connection between collecting lists of names of HIV-infected people in Albany and Atlanta and the future release of those names as a "public health" measure. Clearly, it is not only opponents of names reporting who are making that link.
The facts of the case also suggest that the strict HIV confidentiality laws now in place in New York State are not a barrier to responding to the extremely rare situation in which individuals knowingly expose others to the virus. The current regulations provide that an individual's name may be released where there is "clear and imminent danger to the public health," as it was in this case. The law works: it protects the vast majority of HIV-infected persons who would never knowingly expose others, while allowing possibly-exposed individuals to be notified in an extreme and rare case like this, in which there is substantial evidence of serious danger to the public health. Less stringent restrictions on releasing the identity of HIV-infected individuals would, however, deter many, perhaps most, people concerned about possible HIV exposure from seeking testing, prevention information and treatment.
That being said, the way the shock value of the case has been capitalized on by the media, the thoughtless participation of some Health Department and elected officials in that media frenzy, and the "wanted" style health alert poster issued in Chautauqua are deeply troubling. The coverage seldom mentions that this case is aberrant and that strict confidentiality protections are in place: irreparable harm is being done to well-thought-out education, voluntary notification and testing initiatives. Public health authorities have the responsibility to consider the long-term implications of this particular case: a thoughtful, sober strategy which would encourage everyone who has had unprotected sex with anyone in the last 15 years to seek testing would be in order; establishing a precedent for posting the names and faces of HIV infected individuals, which will only deter people from seeking testing in the future, is not.
Similarly, the case demonstrates that the existing criminal law is more than sufficient; it offers no justification for enacting new legislation that is specific to HIV. The District Attorney intends to charge the man in question with six counts of first degree assault, one for each woman he allegedly infected after learning his own status; there is also discussion of charges of attempted murder. If convicted on the assault charges, he would serve from 8 1/3 to 25 years in prison for each charge-a total of 50 to 150 years. This is surely adequate, if not barbaric. Additional legislation, which would increase the stigma associated with HIV and AIDS while providing no improvement over the existing applicable laws, is unnecessary. It is shameful that fear-mongers would exploit this tragedy for political gain by urging the passage of such legislation. Moreover, HIV-specific criminal codes would bring to New Yorkers the dangerous message that avoiding knowledge of one's status by avoiding testing is the only strategy for protecting oneself from future prosecution.
Effective HIV prevention simply cannot be premised on knowing a partner's HIV status. Safer sex isn't supposed to be practiced only with those partners one knows are HIV-positive, but rather demands taking universal precautions. Chautauqua County, New York City and every locality must commit to effective, realistic HIV prevention education, including skills for negotiating safer sex, condom distribution and needle exchange. These programs must particularly target adolescents, women, drug users and others at high risk of HIV-infection.
Public health authorities, HIV prevention educators, advocates and policy makers should instead address the real questions raised by the case. Why were so many young women willing to engage in unprotected sex? And why did a man who previously had facilitated notification of his past partners later keep silent about his HIV infection? And why has this case drawn such extraordinary publicity, when thousands of new infections annually in New York State are ignored?
One of the man's girlfriends pointed out that both partners are responsible for preventing the transmission of HIV. "I could have said, 'put a condom on or I'm not going to sleep with you,'" she told the New York Times. "But I didn't. None of us did." Why not? Chautauqua County officials say the young women knew the risks they were taking. But what they knew was in the context of abstinence only sex education, according to the head of the Jamestown School District's health department. The local school superintendent and other officials added that social factors, such as drugs and alcohol, led the students to ignore what they had been taught. Not surprisingly, former Surgeon General Joycelyn M. Elders was among the few sane voices addressing the Chautauqua panic. She identified inadequate sex education as the root cause of the young women's exposure to HIV. "We deny our children are having sex and that our teen-age girls are having sex with adults," Elders said. She stressed the need to make contraceptives accessible to teenagers and lambasted Congress for supporting abstinence-only sex education.
The same young woman also noted that denial, not malice, underlay her boyfriend's failure to notify and protect her and his other partners. "I think you can lie to yourself so much you believe [that you're not infected]. I think he told himself, 'This couldn't be me.'" Her remarkable insight and compassion should be taken as a lesson by public health officials. Without information about new HIV treatments and access to supportive services and medical care-and the unemployed and recently homeless man accused in the case surely had none of these-denial is predictable. And its consequences can be devastating.
Finally, the attention the case has drawn is clearly motivated by racism. The public's outrage seems focused as much on the number of sexual encounters an African-American man had as on the risk of HIV infection associated with those encounters. And news photographs and television coverage emphasize that many of the young women he knew were white. The outrage evoked by this story reflects deeply embedded cultural archetypes in many white communities of sexually voracious Black men who "prey" on vulnerable white girls. Media discussion of the unusually high percentage of women infected through contact with this man described him as a "super-secretor," further evoking racist stereotypes of super-potency. The articulation of racism through metaphors of contagion is common thoughout modern Western history. In this case, where an actual infectious agent-overtly the virus, in the popular imagination the Black man himself-has been identified, the expression of those racist fears is allowed to rage unconstrained.
And a guest editorial by Rick Shur:
Subject: Nushawn Williams is the best friend Glaxo (etc.) could have.
The Nushawn hysteria is yet another stab at reviving the interest in "treatment" and testing. The pendulum of AIDS is that people get complacent, stop getting tested, stop buying treatment, so a story has to be created that will get people tested (and "treated") again. Either the story is, "Now we have hope from new drugs" or it's "Murderers are out there infecting you on purpose." Politicians have their own election agendas which dovetail nicely with the commercial one. Be sure of one thing. 1998 is a BIG election year and supporting HIV confidentiality will be THE third rail of '98. Watch all the loser Democrats run for cover. The next step is DOT...because we can't be sure that you won't trip out or go nuts and have your hard-on accidentally fall into some innocent, unsuspecting child's orifice. But don't be fooled by politics. This is a commercial campaign. The media are so inextricably intertwined with pharmaceutical interests (and NOT just at the advertising level) that you can be sure the reporting will have one result in mind--forced testing, forced treatment.
Nushawn Williams Heinous TV Newscasts
Nushawn Williams Newspaper Excerpts
Myths and Facts about HIV Names Reporting
NAMES REPORTING...Backward and Sinister