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CDC HIV/AIDS/Viral Hepatitis/STD/TB Prevention News Update
Public Health Strategies for Confronting AIDS
Gostin, Larry O.
March 17, 1989
Journal of the American Medical Association (03/17/89) Vol. 261, No. 11,

Beyond its threat to public health, the ramifications of the AIDS epidemic are evident in the 170 state laws that deal with the disease, writes Larry O. Gostin of the American Society of Law and Medicine and the Harvard School of Public Health. The wide range of the measures demonstrates the political dimension of the epidemic. The legislation falls into several categories: treatment, services, and research; education and prevention; blood and tissue supply protection; screening, reporting, and contact tracing; isolation and criminalization; and antidiscrimination, confidentiality, and the power to warn. The states have a mixed record. Most have decided that well-targeted education and counseling can be remarkably effective. States generally believe that confidentiality and protection from discrimination is critically important. Many jurisdictions, however, persist in labeling the behaviors that put one at risk of HIV infection immoral. This results in educational efforts based on unrealistic goals of abstinence. A review of state and federal legislation shows that many measures are driven by moral and political concerns rather than epidemiologic data. Using coercive powers--compulsive screening, isolation, and criminalization--may fuel the epidemic, writes Gostin.