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pinto

(106,886 posts)
Wed Dec 17, 2014, 07:53 PM Dec 2014

Panic, Paranoia, and Public Health — The AIDS Epidemic's Lessons for Ebola (New Eng Jour Med)

Panic, Paranoia, and Public Health — The AIDS Epidemic's Lessons for Ebola

Gregg Gonsalves, B.S., and Peter Staley
N Engl J Med 2014; 371:2348-2349
December 18, 2014

For those of us who lived through the early days of the U.S. AIDS epidemic, the current national panic over Ebola brings back some very bad memories. The toxic mix of scientific ignorance and paranoia on display in the reaction to the return of health care workers from the front lines of the fight against Ebola in West Africa, the amplification of these reactions by politicians and the media, and the fear-driven suspicion and shunning of whole classes of people are all reminiscent of the response to the emergence of AIDS in the 1980s.

The first decade of the AIDS epidemic spawned a similar kind of hysteria, predominantly targeted at people living with HIV–AIDS, but also directed against what the Centers for Disease Control and Prevention (CDC) unfortunately called the four Hs, the four high-risk groups: homosexuals, heroin addicts, hemophiliacs, and Haitians. Various politicians called for quarantining of anyone who tested positive for HIV, and commentator William F. Buckley infamously penned an op-ed in the New York Times saying that “everyone detected with AIDS should be tattooed.” There was an AIDS-quarantine ballot initiative in California, and various states threatened or passed conditional quarantine measures. Fortunately, such measures were used infrequently. Far more common then and now is the use of criminal law to target people who may have exposed their partners or others to HIV or transmitted the virus to them; between 2008 and 2013 alone, there were at least 180 such prosecutions.

People living with HIV–AIDS in the 1980s and 1990s also faced other kinds of discrimination, including the loss of employment and housing, as well as outright violence, including assault and murder. Some HIV-positive children were excluded from school; two such cases — those of the three Ray brothers in Arcadia, Florida, and of Ryan White in Kokomo, Indiana — received national attention.

Although there is not an Ebola epidemic in the United States, the first case of the disease in Dallas, the subsequent infections of health care workers there, and the case of a New York City–based doctor working with Médecins sans Frontières (MSF) have resulted in proposals for 21-day quarantines of health care workers returning from West Africa and other people coming to the United States from the region. Prominent scientific and medical institutions have criticized state-based protocols that impose isolation and quarantine on asymptomatic health care workers and travelers, in contradiction to the CDC's protocol, and the overly broad application of these measures to people with no known contact with patients with Ebola. Though it is difficult to assess how many people in the United States are currently in quarantine for Ebola, New York, New Jersey, Connecticut, Georgia, California, Maine, Louisiana, the District of Columbia, Illinois, and Florida have all enacted such measures. Connecticut until recently had nine people in quarantine, none of whom had any documented exposure to patients with the disease.

http://www.nejm.org/doi/full/10.1056/NEJMp1413425

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