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Restrictions and Quarantine

Quarantine is not usually appropriate for the control of HIV because HIV cannot be contracted through casual contact. Counseling the HIV-infected patient and anyone who may have had sexual or blood contact with the patient is more effective and less restrictive than quarantine. Specific restrictive measures are the accepted alternative to general quarantine. It is more difficult to defend partial restrictions than quarantine, however. In a common example, the health department may order an HIV-infected prostitute to stay off the street. This will not prevent her from working; it will reduce her contacts and encourage her to find other work. Such a limited restriction will be attacked in court as unreasonable because it does not eliminate all risk. Since it is not perfect, it is not worth inconveniencing the prostitute. The same court might be more willing to allow the quarantine, but few health departments have the resources to quarantine.

The issue of quarantine is complicated by cross-over with the criminal justice system. Prostitution and IV drug abuse are illegal in every state, and homosexual sexual activity is illegal in about 50 percent of the states. Many others criminalize reckless endangering of another person, the usual criminal charge for exposing a person to a communicable disease. There is increasing pressure to prosecute HIV carriers who endanger others. Many cases of HIV carriers who continue to engage in reckless behavior involve persons with some degree of HIV dementia. Given the poor medical conditions in most jails and prisons, it may be more humane to encourage civil commitment under the public health laws than to introduce these persons into the criminal justice system.

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