Minorities and HIV

WHAT ARE THE MAJOR LEGAL ISSUES AND STUDIES WHICH IMPACT MINORITIES INFECTED WITH AIDS AND HIV?

Annotated Bibliography

2nd Year Law Student
The University of Dayton School of Law
Spring 1997

Introduction

After reading the annotations, the reader can expect to understand how many issues dealing with AIDS and how it affects minorities. Also, the reader can expect to learn about studies conducted in the last few years regarding minorities, AIDS and possible prevention programs.

THIS BIBLIOGRAPHY SHOULD BE UPDATED AS RELEVANT, NEW INFORMATION IS ACCUMULATED AND NEW TREATMENTS ARE DISCOVERED.

The following articles and cases are included in this annotated bibliography:
 

A Shot On the Arm, Legal and Social Obstacles to United States Needle Exchange Programs

AIDS Among Racial/Ethnic Minorities - US, 1993

AIDS Knowledge in Minorities: Significance of Locus of Control

Discrimination: The Difference With AIDS

Evaluation of Two AIDS Prevention Interventions for Inner-City Adolescent and Young Adult Women

HIV Risk-Related Sexual Behaviors Among Heterosexuals in New York City; Associations With Race, Sex, and Intravenous Drug Use

Minorities Dissatisfied With Outpatient HIV Care

Symposium: HIV Infection Among Women and Children and Antidiscrimination Laws: An Overview

Targeting Intervention Strategies

The Criminalization of Perinatal AIDS Transmission

The Impact of Managed Care on Doctors Who Serve Poor and Minority Patients.

The United States' Denial of the Immigration of People With Aids

Traufler v. Thompson

What Every U.S. Business Should Know About Aids and HIV Infection

Women's Health at a Crossroad: Global Responses to HIV/AIDS

Annotation

In 1993, African-Americans, Hispanics, Asians/Pacific Islanders, and American Indians/Alaskan Natives represented 55% of all of the AIDS cases reported in the United States.⁽¹⁾ AIDS rates for African-Americans varied according to geographic regions.⁽²⁾ The highest rates of infection for both African-Americans and Hispanics were highest in the Northeastern states.⁽³⁾

For minority males, male-male sex was the most common reason for infection (39%) with intravenous drug use being a close second (38%).⁽⁴⁾ However, minority females were infected the most through intravenous drug use (47%) and male-female sex (37%). ⁽⁵⁾[Back]

This article focuses on the Locus of Control (LOC) as a variable to explain the impact of health education programs and general health outcomes.⁽⁶⁾ It is important to study this impact because it is the goal of preventative medicine that to teach individuals that they can alter their risk of disease by their own behavior.⁽⁷⁾ This study conducted by the researchers focused on 587 subjects from Harris County, Texas.⁽⁸⁾ The subjects were low income and mainly minorities.⁽⁹⁾ the subjects were interviewed regarding their knowledge of AIDS, how it is transmitted, and how AIDS can be prevented.⁽¹⁰⁾ The researchers, using the Wallston Health Locus of Control (HLOC) Scale determined that the HLOC was a strong independent predictor of the subjects knowledge of AIDS.⁽¹¹⁾ The study showed that the higher the internal orientation (lower HLOC score) and higher educational levels are associated with a greater knowledge of AIDS. This supports the view that HLOC is strongly related to the accumulation of knowledge regarding health issues, including knowledge of AIDS. The researchers suggest that the results of this study could be used to identify those people who have little or no knowledge of AIDS. In minority groups, low HLOC scores indicate that little is known about AIDS and is also an independent factor related to other factors, such as literacy problems, lower educational levels, language barriers which also lead to little knowledge of AIDS.⁽¹²⁾

Therefore, this study can be used to target those minority populations which have little or no knowledge of AIDS and set up prevention programs which would lead to minority groups gaining more knowledge. Hopefully, more knowledge would lead to a decrease in the rate of infection of AIDS in minority groups. [Back]

This article states that AIDS is spreading quickly among the inner cities in the United States.⁽¹³⁾

Many of the people being infected with AIDS are African-Americans and Hispanics. Many states and private groups have arranged needle sharing programs with the intent to help stop the spread of AIDS through the sharing of needles used for intravenous drug use.⁽¹⁴⁾ Many of the groups who oppose these programs claim that African-Americans will be affected by these programs because these programs encourage drug use resulting in an adverse impact on African-Americans.⁽¹⁵⁾ However, this article support the notions that these programs benefit minorities in the effort to prevent and stop the spread of AIDS. [Back]

The CDC has reported that the proportion of AIDS cases among racial and ethnic minorities, as well as women and children, has continued to increase.⁽¹⁶⁾ This increase has led to the increased importance of AIDS and HIV prevention programs designed for the general population because any individual is capable of being infected.⁽¹⁷⁾ However, most new cases of AIDS and HIV infection are occurring in certain populations.⁽¹⁸⁾ If these groups can be targeted with strong prevention programs, the number of HIV infections could significantly decrease.⁽¹⁹⁾ Also, targeting these high risk groups could be in the long run cost-effective.⁽²⁰⁾[Back]

This article is an overview of the basic facts of HIV and AIDS, including issues such as the transmission of the disease.⁽²¹⁾

This article explains that women and children who have contracted HIV experience hostility from the community.⁽²²⁾ HIV infection in the United States is rampant in racial minorities such as African-Americans and Hispanics.⁽²³⁾ These racial minorities experience discrimination which impedes efforts to treat HIV and AIDS. Also, because many of these minorities are poor, they are subject to increased discrimination. Furthermore, women are subject to much more increased discrimination than men because of their gender.⁽²⁴⁾

These groups are protected through federal and state laws. One such example of a law which protects these groups is the Americans with Disabilities Act (ADA). The ADA's predecessor was the Rehabilitation Act of 1973.⁽²⁵⁾. The ADA fills in the gaps left by the Rehabilitation Act. This article describes in detail how these two Acts, plus state laws, work in conjunction with each other to protect minority women and children from increased discrimination as a result of being HIV positive or having AIDS.⁽²⁶⁾ [Back]

This article details the American health care system and the major change the system is facing as the system seems to be shifting to managed care. If this change continues to occur with relatively no regulation, minority physicians, especially those who serve minority and poor patients in communities may be "squeezed out."⁽²⁷⁾ This will affect the minorities which are infected with HIV or have AIDS as there will not be any physicians on hand to provide treatment and counseling.⁽²⁸⁾

If the change to managed care is unregulated, physicians, especially those who serve minorities, may be "disapportionately burdened."⁽²⁹⁾ Minority physicians have always been prominent in the care of minority patients.⁽³⁰⁾ The managed care system has persuaded those minority doctors to disfavor their work in minority communities.⁽³¹⁾ Also, this exposes those physicians to racial discrimination.⁽³²⁾ Also, this article states that managed care will exclude many talented minority physicians from the health care system which will affect the health care of minority patients.⁽³³⁾ This includes physicians which treat patients affected by HIV and AIDS. These minority patients will have to resort to going to other physicians who may be located in inconvenient locations.⁽³⁴⁾ Also, those physicians may not be "fluent" in the culture, language, and life styles of inner city minorities patients.⁽³⁵⁾

Therefore, this article stresses the need for regulation of the health care system as it moves to managed care. [Back]

This article focuses on the United States Immigration Law which prohibits those with AIDS from entering the United States. People who are infected with the AIDS virus in the United States have often criticized the policies of this country which affect them.⁽³⁶⁾ For the United States to attempt to treat and fight AIDS, both Americans and immigrants must be treated with the utmost respect and dignity. People with AIDS typically suffer severe discrimination because the government does not give them adequate protection from discrimination. The majority of those infected with AIDS, such as homosexuals, drug users, prostitutes and people of African descent suffer a great deal of discrimination.⁽³⁷⁾ The United States law which prohibits AIDS infected people from entering the United States is not justified. The government contends that infected immigrants should not be allowed into the country because of the high risk of transmission.⁽³⁸⁾ However, AIDS cannot be transmitted through casual contact; therefore, the government's argue is invalid. Also, the government will spend more money on testing immigrants for AIDS than by treating those immigrants who are allowed to enter the country.⁽³⁹⁾

Also, this article compares the United States' law banning the entry of those immigrants with AIDS to immigration laws of England and Thailand. In England, the human rights of those infected with AIDS is protected and they are allowed to immigrate to England.⁽⁴⁰⁾ However, in Thailand, those with AIDS are not allowed entry into the country. Thailand's policy for denying entry of AIDS infected immigrants is more justified than the United State's to deny entry of immigrants because there is a higher risk for the transmission of AIDS and the Thai people and government do not have the resources to care for those infected with AIDS.⁽⁴¹⁾ Thailand is known for their brothels which about 75% of the male population visits, as well as tourists. Also, Thailand is a very poor country and will be unable to handle a large amount of people infected with AIDS.⁽⁴²⁾

If the government is allowed to deny entry of AIDS infected immigrants into the United States, many countries may follow suit and deny AIDS infected Americans from immigrating to their countries.⁽⁴³⁾ Therefore, those who are infected with AIDS, including AIDS infected minorities, will be discriminated against. [Back]

This article stresses that many employers, regardless of the size and location of their business, will be encounter AIDS or HIV issues.⁽⁴⁴⁾ Because HIV cannot be transmitted by casual contact, employers cannot ask possible employees about their HIV status.⁽⁴⁵⁾ However, medical employers have a legitimate interest in the HIV status of employee.⁽⁴⁶⁾

This article concludes by stating advise attorneys can give their non-medical employer clients regarding HIV and AIDS.⁽⁴⁷⁾ The articles author suggests that employers should not test applicants or employees regarding HIV infection.⁽⁴⁸⁾ Also, employers should consider insurance stipulations such as waiting periods, disclosure of prior conditions, physical exams, and caps on AIDS benefits to reduce the cost of health care to employees.⁽⁴⁹⁾ Also, employers should have a written policy regarding the confidentiality of employees HIV status.⁽⁵⁰⁾ Additionally, employers should be advised that if they do learn of an employees HIV status, they should absolutely not disclose it to others either in the business or in the local community.⁽⁵¹⁾ Another important piece of advise is that any employee who discloses another's status should be subject to discipline.⁽⁵²⁾

These suggestions that attorneys should give to employers is important to all employees, especially minority employees to assure HIV infected employees that they will not be discriminated against and their status cannot be disclosed. Also, these suggestions are important to inform employees who have HIV what their rights are. [Back]

As of 1993, the numbers of AIDS cases imputed to heterosexual intercourse has continued to rise.⁽⁵³⁾

Data indicates that minority women are at an increased risk for being infected with the AIDS virus.⁽⁵⁴⁾ The best way to stop the spread of HIV and AIDS is to teach behavioral risk reduction since there is currently no vaccine for HIV infection. The objective of the study done by the authors of this article was to investigate the relationships between the behaviors of heterosexuals associated with HIV infection, ethnicity, sex, and intravenous drug use.⁽⁵⁵⁾ Subjects were recruited from Bellevue Hospital and asked about their sexual behaviors and drug use. Most subjects were recruited from gynecology, prenatal care, sexually transmitted diseases, and dermatology clinics located at the hospital.⁽⁵⁶⁾ The study was based on 1561 black (27%), white (31%), or Hispanic (43%) patients who had heterosexual sexual contact.⁽⁵⁷⁾ It is interesting to note that most of these patients were from lower socioeconomic backgrounds.

The study indicated that blacks were more likely than whites or Hispanics to have had sex at an early age and contracted a sexually transmitted disease. Sex with prostitutes was more likely to take place with Hispanic men. Sex with a female drug users was most likely to occur with white men. Women were also more likely to have a sex with an intravenous drug using partner.⁽⁵⁸⁾

This study indicated that high risk sexual practices are prevalent in today's society. Therefore, it is imperative that AIDS and HIV prevention programs focus on those who are at an increased risk of being infected, such as minorities, intravenous drug users, and sexual partners of these two groups. [Back]

This article infers that people belonging to groups traditionally discriminated against, such as racial minorities and homosexuals, are likely to be discriminated in their attempt to procure medical treatment for AIDS.⁽⁵⁹⁾

AIDS afflicts some people who have already been discriminated in the past, such as African-Americans and Hispanics who live in urban ghettos.⁽⁶⁰⁾ Because AIDS spreads rapidly among these minorities in those areas, it may lead to a potential genocide of those groups.⁽⁶¹⁾ Therefore, it is important to scrutinize the current health care system from which it can be determined that the system abuses the poor, many of which are African-American and Hispanic.⁽⁶²⁾ Because many African-Americans and Hispanics are poor, they often cannot afford insurance. Therefore, minorities infected with AIDS will not be able to receive the care needed to fight this disease since they will need to pay for the treatment without the help of insurance.⁽⁶³⁾ [Back]

These researchers conducted a study on two hundred and fourteen adolescent and young adult women to determine how much knowledge the subject know regarding AIDS and HIV.⁽⁶⁴⁾

When the adolescents and young women came into the community health center, they were met by a peer educator that was trained in interventions or by a community health care provider.⁽⁶⁵⁾ The peer educator presented the subjects with a video and brochures that dealt with issues such as how AIDS is transmitted and possible preventative measures.⁽⁶⁶⁾ Also, the peer educator was instructed to only provide information, not to ask the subject questions.⁽⁶⁷⁾ The community health care provider, the provider utilized a patient-centered approach to convey the same information that the peer educator did. After the adolescents and young women met with the peer educator or health provider, the researchers studied the subject's knowledge by using a self-administered questionnaires which were designed by the researchers with help from three minority adolescents and two community health providers who all had experience in AIDS and HIV prevention.⁽⁶⁸⁾ The questionnaires were given to the subjects right after the meeting with the peer educator and at the one month follow up appointment.⁽⁶⁹⁾ The questionnaire was designed to evaluate changes in knowledge, attitudes, and behavior.⁽⁷⁰⁾

The questionnaire revealed that significant improvements were evident in the areas of knowledge, especially in the areas of safe sex and clean intravenous drug equipment.⁽⁷¹⁾ Also, subjects stated that it would now be less of an embarrassing question to ask their sexual partners about their past history.⁽⁷²⁾ Also, a significant decrease was shown in the amount of vaginal sex had by the subjects at their one month follow up appointment.⁽⁷³⁾

This study shows that counseling by physicians leads to more changes in knowledge of sexual risks, whereas the trained peer educators intervention led to a greater knowledge of the risks involved in intravenous drug use.⁽⁷⁴⁾ This study is concluded as showing that both the peer educators and the patient providers that counsel adolescents and young women about AIDS can significantly affect knowledge, attitudes and sexual behavior. This study affects minorities in that if these same techniques are used in areas heavily populated by minorities, their knowledge of AIDS and HIV would increase, hopefully leading to a decrease in the rate of infections. [Back]

African Americans, women and intravenous drug users are disappointed with the quality of care they are receiving for the treatment of AIDS and HIV.⁽⁷⁵⁾ These groups believe that they are receiving low quality outpatient care when compared to other groups.⁽⁷⁶⁾ These groups believe that if more nursing care were available, the quality of care would be improved significantly.⁽⁷⁷⁾ Therefore, this validates the significant role nurses play in the treatment of outpatient AIDS cases. [Back]

This article supports the notion that making it criminal for a mother to transmit AIDS to her unborn child should not be embraced in statutes making transmission a crime.⁽⁷⁸⁾ Also, this article supports the idea that preventative systems need to be in place to prevent the creation of another generation of AIDS infected individuals.⁽⁷⁹⁾

The statutes making it illegal to transmit AIDS to another person should not embrace pregnant, HIV infected mothers. These statutes violate these women's substantive due process rights right to privacy and bodily autonomy.⁽⁸⁰⁾ Additionally, these statutes create an equal protection problem.⁽⁸¹⁾ Furthermore, these statutes violate women's basic liberty interest to procreate and have children.⁽⁸²⁾

These statutes also affect minority women in that these statutes place an additional burden on them in their quest to seek out and receive prenatal and contraceptive health care.⁽⁸³⁾ Therefore, these statutes do not accomplish the goal of trying to eliminate the transmission of AIDS with respect to HIV infected women. The article suggests that these statutes be revised to exclude pregnant HIV infected women.⁽⁸⁴⁾ Also, if prevention and educational programs were in place to educate minority women and others regarding transmitting AIDS to unborn children, there would be no need for these statutes to apply to pregnant HIV infected women.⁽⁸⁵⁾[Back]

This article focuses on the inadequacy of international efforts to protect and promote the health of women throughout the world.⁽⁸⁶⁾ The numbers of women being infected with HIV has been rapidly increasing.⁽⁸⁷⁾ However, until recently, international policy makers did not recognize this increase and the threat of AIDS to women's health.⁽⁸⁸⁾ This affects minority women in that international policy makers do not recognized AIDS as a threat to them as well. However, because of the media's attention on the lack of recognition of women's health, women's health is slowly becoming a priority.⁽⁸⁹⁾ International policy making organizations can only have a limited affect on the recognition of women's health.⁽⁹⁰⁾ Therefore, international legislative attempts can only encourage nations to recognize women's health as an important public health issue and pass legislation which does not discriminate against women on the basis of gender. [Back]

Inmates of Illinois' Stateville Correctional Center brought suit, in forma pauperis, claiming that the defendant's conspired to commit genocide by deliberately attempting to spread the AIDS virus among prisoners to eliminate minorities.⁽⁹¹⁾ The inmates claimed that by eliminating minorities, the welfare burden on the public would be reduced.⁽⁹²⁾ The court found that the inmates allegations were broad and unsupported allegations of conspiracy.⁽⁹³⁾ The court commented that "The possibility that individuals such as Illinois Department of Corrections Director Michael Lane, the Directors of the ACLU and NAACP, and United States Attorney General Edwin Meese are acting jointly to infect prisoners with a deadly disease is so remote as to be beyond reasonable consideration."⁽⁹⁴⁾ Therefore, the court found that the inmates complaint was frivolous and their motion for federal protective custody and motion for appointment of counsel denied as moot.⁽⁹⁵⁾ [Back]

Footnotes

1. AIDS Among Racial/Ethnic Minorities - US, 1993, 272 (15) JAMA 1163 (1994).

2. Id.

3. Id.

4. Id.

5. Id.

6. John F. Aruffo, M.D., et. al, AIDS Knowledge in Minorities: Significance of Locus of Control, 9 (1) Am. J. Prev. Med. 15 (1993).

7. Id.

8. Id. at 16.

9. Id.

10. Id.

11. Id. at 18.

12. Id.

13. Mary Ann Dempsy, A Shot On the Arm, Legal and Social Obstacles to United States Needle Exchange Programs, 17 B.C. Third World L.J. 31 (1997).

14. Id.

15. Id. at 32-33.

16. H. Gayle, Targeting Intervention Strategies, 3rd Conf. Retro. and Opportun. Infect. 169 (1996 Jan. 28 - Feb. 1).

17. Id.

18. Id.

19. Id.

20. Id.

21. Josephine Gittler and Sharon Rennert, Symposium: HIV Infection Among Women and Children and Antidiscrimination Laws: An Overview, 77 Iowa L. Rev 1313 (1992).

22. Id. at 1329.

23. Id.

24. Id.

25. Id. at 1334.

26. Id. at 1334-1381.

27. The Impact of Managed Care on Doctors Who Serve Poor and Minority Patients, 108 Harv. L. Rev. 1625, 1642 (1995).

28. Id. at 1627 -1631.

29. Id. at 1626 - 1627.

30. Id.

31. Id.

32. Id.

33. Id. at 1627 - 1631.

34. Id. at 1626.

35. Id.

36. Douglas Scott Johnson, The United States' Denial of the Immigration of People With Aids, 6 Temp. Int'l & Comp. L.J. 145, 166 (1992).

37. Id. at 148.

38. Id. at 149.

39. Id. at 150.

40. Id. at 163-4.

41. Id. at 165-6.

42. Id.

43. Id. at 146.

44. Kerry A. Kearney, What Every U.S. Business Should Know About Aids and HIV Infection, 6-Sum Health Law 20 (1992).

45. Id.

46. Id.

47. Id. at 23.

48. Id.

49. Id.

50. Id.

51. Id.

52. Id.

53. MY Kim, et. al., HIV Risk-Related Sexual Behaviors Among Heterosexuals in New York City; Associations With Race, Sex, and Intravenous Drug Use, 7 (3) AIDS 409 (1993).

54. Id.

55. Id.

56. Id.

57. Id.

58. Id.

59. Raymond C. O'Brien, Discrimination: The Difference With AIDS, 6 J. Contemp. Health L. & Pol'y 93 (1990).

60. Id. at 94.

61. Id.

62. Id. at 111-117.

63. Id. at 116-117.

64. Mark E. Quirk, EdD, et. al, Evaluation of Two AIDS Prevention Interventions for Inner-City Adolescent and Young Adult Women, 9 (1) Am. J. Prev. Med. 21, 22 (1993).

65. Id. at 22-23.

66. Id. at 23

67. Id.

68. Id.

69. Id.

70. Id.

71. Id. at 23-25.

72. Id.

73. Id.

74. Id.

75. M. Senak, Minorities Dissatisfied With Outpatient HIV Care, 2 (1) J. Int. Assoc. Physicians 42 (1996).

76. Id.

77. Id.

78. Heather Sprintz, The Criminalization of Perinatal AIDS Transmission, 3 Health Matrix 495 (1993).

79. Id. at 536.

80. Id. at 509, 518-523.

81. Id. at 518 - 523.

82. Id.

83. Id. at 529.

84. Id. at 533 - 536.

85. Id.

86. Allyn L. Taylor, Women's Health at a Crossroad: Global Responses to HIV/AIDS, 4 Health Matrix 297, 299 (1994).

87. Id.

88. Id.

89. Id. at 305.

90. Id. at 324.

91. Traufler v. Thompson, 662 F.Supp 945, 946 (N.D. Ill. 1987).

92. Id.

93. Id.

94. Id. at 946-947.

95. Id. at 947.