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Introduction

Acquired immunodeficiency syndrome (AIDS) is the most legally troubling problem facing the health care system in the United States. The epidemic has frightened the public, highlighted the flaws in our public health system, and exacerbated the inequities in the health insurance and indigent care systems. Many authors have stressed the special problems of AIDS and why traditional medical and public health practices are inappropriate for AIDS and HIV infection. In our view, AIDS poses no new and unique medical problems. It is unique only when the history of communicable disease control in this century is ignored.

This is not intended to diminish the significance of AIDS or, more properly, HIV infection. Careful study of epidemiologic models without the distortions induced by politicization of HIV leads us to conclude that HIV will reach a higher equilibrium prevalence than is predicted by current models.[132] We also believe that dementia and communicable secondary infections such as tuberculosis will make the management of HIV infection much more complex than is anticipated. The efforts to quell fears of the casual spread of HIV have made it controversial to discuss any risks posed by HIV-infected persons. This denies the reality of the disease and risks a backlash that will further stigmatize HIV-infected persons.

HIV infection is a difficult subject for a chapter in a book because our knowledge changes so rapidly. This chapter reviews the political and medical history of HIV as necessary to provide a context for the discussion of the legal problems posed by the disease. This is not a survey of applicable state laws or a comprehensive discussion of HIV-related illness. Physicians must ascertain the current laws concerning HIV and AIDS reporting, counseling, and warning in their states. The objective of this chapter is to help physicians understand the legal issues posed by HIV infection within the larger context of public health law and practice.

[132]Brookmeyer R: Reconstruction and future trends of the AIDS epidemic in the United States. Science 1991; 235:37-42.


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