Raymond O'Brien, An Argument for the
Inclusion of Children Without Medicare, U. Louisville J. Fam. L. 567
The author here points out that the AIDS disease is shifting from one
in which the victims are white, middle class homosexuals to women, and
especially minority women. In the future these women will be the single
most infected group with HIV along with their children. The author states
that infants born with AIDS almost always are products of women who have
suffered discrimination, racism, and poverty. Because of this there is
little public outcry or support for these children and women.
The author here is proposing coverage by Medicare of children, because
of the racism in the treatment of infected persons, and the lack of access
to health care and treatments that clearly occurs to minority children.
The author believes that factors such as racism and discrimination clearly
effect the treatment that especially minority children receive and by expanding
Medicare to include them they will get proper treatment.
Racism and access to health care clearly have profound impact on the
treatments that minority children receive. This program would help eleviate
some of the major problems that minorities face today in getting AIDS treatments.
However, it also faces some big problems. For example, who is going to
pay for this expansion of Medicare. Medicare already costs hundreds of
billions of dollars, the likelihood that it would be expanded is slim.
Additionally, cost and access is only one of the problems minorities face.
Many of those infected are uneducated about the disease itself and unaware
of the treatment options that are available. There is also a distrust of
the medical community in the black community itself. While this program
would address some concerns that the minority community faces there are
other important ones that go unaddressed.
SOURCE: 46 Pages, Included Bibliography.
Abigail Trafford, Bridging the health
care gap, Washington Post, April 28, 1998, at Z06
The author in this article puts forth several statistics to show that
there is a difference between the health care that minorities receive in
this country and that which whites receive. The author directly points
to the incidence of AIDS in the minority community. Currently 50 percent
of all new Aids cases involve racial and ethnic minorities, although they
only make up 25 percent of the population.
The article states that the new surgeon general, David Satcher, worries
about this because liberty and the pursuit of happiness will remain elusive
goals for minorities without the first essential life. To combat this problem
the CDC is testing outreach programs in 30 cities to target prevention
and early detection.
Clearly a discrepancy exists between minority and white health care
in this country. Traditional health care systems are not closing this gap.
Therefore, new and innovative techniques to educate and treat minorities
are needed to close the gap that exists. Many of the individuals in these
cities will never find out about treatments and prevention unless we take
it to them. This is a sound way to do it.
SOURCE: No Bibliography, 2 pages.
M. Fordice et al., Childbearing
and Contraceptive-Use Plans Among Women at High Risk for HIV Infection--
Selected U.S. Sites, 1989-1991, 41 Morbidity and Mortality Weekly Report
In this study a group of women who were of childbearing age and were
at high risk for HIV infection were interviewed and studied. Of the 736
women interviewed 507 (69%) were members of racial minorities.
In the editorial note of this article the author states that special
efforts should be made to reach minority women, because they are disproportionately
affected by the AIDS epidemic. This should be done through federally funded
community-health centers. This will improve access to these women and HIV-prevention
and family-planning services can be extended.
One of the saddest parts of the AIDS epidemic is the babies who are
born with the HIV virus. These children must suffer the effects of the
disease through no fault of their own. Pre-pregnancy and pre-natal education
and treatment should receive a top priority in the fight against AIDS for
minorities and non-minorities, because an innocent life is also affected.
However, the problem with the author's argument is that she wants the clinics
to be federally funded. We are in a time of cutting spending, therefore
it is probably unlikely that she will be able to get funding for this program.
SOURCE: 9 Pages, Includes Bibliography
David Rose, AIDS Drug Regimens That
Are Worth Their Costs, 279 The Journal of the American Medical Association
For the first time in 15 years that AIDS related illness and death has
decreased. However, there has been an increased tendency in AIDS related
illness for blacks, hispanics, and homosexual women. The author states
that the reasons for this are the hesitancy of these groups to be tested
and the high cost of AIDS drugs. To confront the issue of the high cost
of drugs the author points out that the cost per quality-adjusted life
year (QALY) is $29,000 for AIDS treatments. The QALY for breast cancer
treatment is $22,000, for coronary bypass surgery $26,000, and for renal
dialysis $46,000. These standard therapies are widely considered worth
their costs. While these new AIDS treatments are expensive they clearly
fall within the accepted range of medical care. As a result, cost is no
reason to deny treatment.
Because of the media it seems that AIDS treatments are astronomically
more expensive than the treatments for other diseases. This study shows
that this is not true. If insurance companies and the government are willing
to pay for these other treatments then they should pay for the treatments
that will treat this disease too. Especially when it is disproportionately
affecting one segment of the population like this is. This is important
factual information which should be made known to the public. It provides
a strong argument for expanding medical coverage to include AIDS treatments.
SOURCE: 2 Pages, Included Bibliography.
Michael T. Isbell, AIDS and Access
to Care: Lessons For Health Care Reformers, 3 Cornell J.L. & Pub.
Pol'y 7 (1993).
The author of this article points to studies regarding the offering
of new AIDS treatments to different segments of the population. For example,
one study showed that doctors offered 97 percent of white gay males AZT
when it became available, while doctors offered it only 58 percent of the
time to non-white intravenous drug users. The author contends that these
differences can not be explained by variations in health care coverage.
To combat this problem the author proposes that several steps be taken.
First, that the United States institute a single tier universal health
care system. Second, that health care be progressively financed to reduce
out-of-pocket expenses. Third, the health care system should be drastically
simplified by reducing third-party payers, standardizing claim forms, and
instituting mandatory electronic billing. Finally, it must maximize the
patients ability to choose providers.
The authors plan certainly would improve access to AIDS treatments and
physicians. It is beneficial in that it would reduce many of the high out-of-pocket
expenses that AIDS patients face today when their insurance runs out. However,
the problem with the author's plan is going to be instituting it. This
system would generate huge costs for the state and federal governments.
It would probably require an increase in taxes. This is a step that most
people in our country do not want to take. They probably do not want their
taxes raised to help people who cannot afford proper treatments. The plan
is good. but probably has no chance of being initiated.
SOURCE: 36 Pages, Included Bibliography
Author Unknown, Aids Among Children,
45 Morbidity and Mortality Weekly Report 46 (1996).
As of September 30, 1996 there were 7472 children reported with AIDS.
Of these children 82 percent are of non-white racial/ethnic groups. The
author states that this disparity probably reflects socioeconomic access
to and use of medical services, or differences in behaviors associated
with HIV transmission risks among women. To combat this problem the author
proposes implementing comprehensive integrated-service delivery programs
to ensure that women have access to HIV counseling and voluntary testing,
and to services for related needs. For example, antiretroviral therapy,
substance-abuse treatment, and support services.
Clearly this plan would help reduce the number of babies born with HIV
in the minority community. However, this program would have to implemented
in areas where this women are located or many of them would not be able
to get the treatment. Also, there are cost concerns with a program like
this. Probably the government would have to pay for it. Many in the government
probably would not want this expense.
SOURCE: 6 Pages, Included Bibliography.
Joelle Weiss, Controlling HIV-Positive
Women's Procreative Destiny: A Critical Equal Protection Analysis,
2 Seton Hall Const. L. J. 643 (1992).
Women and minorities are disproportionately affected by the AIDS virus.
Women are the fastest growing HIV-infected group, and AIDS disproportionately
kills black and hispanic women. The author states that the research, prevention,
and treatment of AIDS in the United States has almost exclusively been
directed at white men. Because of the number of women who have AIDS the
CDC and many state and local governments have advocated that HIV positive
women do not bear children.
The author argues that there is a strong likelihood that the federal,
state and local governments will soon implement laws to prohibit the reproduction
of HIV positive women. The author argues that any such classification would
be race, gender, and class based and would violate the Equal Protection
Clause. She argues instead that the government should focus on attacking
the disease's cause by equalizing treatment and prevention.
I agree with the author that laws should not be constructed which take
away a woman's right to become pregnant. I also agree that we need to have
more equal access to AIDS treatments and prevention in this country. However,
I do feel that women who are HIV positive should be encouraged not to become
pregnant. Simply for the reason that the child may contract the disease.
I think there is a clear line between counseling and coercion and the former
SOURCE: 56 Pages, Included Bibliography
M.J. McCollum, Minority Aids Council
Institutes New Campaign Methods, Philadelphia Tribune, March 25, 1997,
In 1996 there was a 13 percent drop in AIDS deaths. However, there was
a 21 percent drop in the white community, and only a 2 percent drop in
the black community. There was a 10 percent drop in the hispanic community.
In response to this problem the minority AIDS council established a toll
free line through which callers can receive brochures on how HIV works,
medical advances, and treatment options. The director of the Minority Aids
Council states that while this may help, the real problem for minorities
is access to the health care system. This lack of access is preventing
minorities from getting the new drug therapies. To solve this he believes
we need a universal health care system, where drug treatment is available
to all. This would greatly reduce the level of HIV transmission.
The actions taken by the Minority Aids Council are good initial steps.
Any system of education is good for the minority community and is much
needed. Clearly a universal health care system would be beneficial, because
logically it should decrease the number of AIDS deaths in the minority
community just as it has in the white community. However, you have a cost
problem with a universal health care system. And as we saw with President
Clinton's attempt there is a lack of support for this kind of system. Therefore,
a universal system while it would be beneficial does not seem likely.
SOURCE: 2 pages, No Bibliography.
Lynda Richardson, Syphilis study
leaves legacy of medical distrust - Researchers find black Americans are
leery, now, of AIDS treatments, Austin American-Statesman, April 21,
1997, at A2.
The author states that many in the black community today are suspicious
and refusing to take medication for the treatment of AIDS. While health-care
experts scoff at this they realize that black's suspicions are rooted in
fact. From 1932 to 1972 the Tuskegee syphilis experiment occurred during
which hundreds of poor blacks were denied treatment although it was available
in the 1940's. The author states that the problem for many blacks is not
health care access or money, but the shadow of the Tuskegee experiment.
There can be no doubt that an injustice occurred in the Tuskegee experiment,
and that that experiment is still having an impact on many blacks today.
However, it is important to remember that probably not even close to a
majority of blacks would turn down treatment because of these suspicions.
The real problem is access and cost for most HIV positive minorities, and
while the medical community should try and build up trust with blacks we
should focus on access.
SOURCE: 2 Pages, No Bibliography.
Larry Gostin, A decade of a maturing
Epidemic: An Assessment and Directions for Future Public Policy, 5
Notre Dame J.L. Ethics & Pub. Pol'y 7 (1990).
This author notes that up to 32 percent of new AIDS cases are caused
by intravenous drug use. Further, noted is the fact that minorities are
disproportionately affected by AIDS particularly among intravenous drug
users. The author argues that this epidemic should take priority over the
drug war that is being waged. To combat this problem the author proposes
a two step plan. First, is an outreach program to encourage users to come
forward for education, counseling, and treatment. The second step requires
the government to allow access to sterile needles, to reduce the reliance
of drug users on "dirty" needles.
The argument for access to sterile needles is a common one and one which
has just recently received national attention. Clearly having free access
to needles will reduce the number of times that an unclean needle is shared.
However, this seems to be a lesser of two evils argument. Because it appears
that the government may be helping and even encouraging drug use by providing
this paraphernalia. This is a step which our government has not been prepared
to take and one which I agree with. Education and treatment is very important
in our battle against AIDS, but I believe that supplying hypodermic needles
is going to far.
SOURCE: 19 Pages, Included Bibliography
Marlene Cimons, AIDS Deaths Drop
Further, 46 Morbidity and Mortality Weekly Report 46 (1997).
AIDS deaths have been falling dramatically. The sharpest decrease has
been among white males, while the number of deaths fell less for women
and minorities. The reason given is because new treatments cost about $15,000
a year, a sum out of reach for most without insurance. This has been compounded
by the fact that many health clinics that serve poor and minority communities
have been closing. The director of the Aids Action Council says that because
there is not equal access in this country AIDS will continue to ravage
minority communities and women.
There is a clear theme that the access to AIDS treatments are not equal
in this country and that as a result people of color and women are continuing
to suffer disproportionately. The only way to solve this problem and equal
out the reduction in death rates is to educate women and minorities and
make access equal. To due this education and access are both needed.
SOURCE: 5 pages, Included Bibliography
Josephine Gittler, HIV Infection
among women and Children and Anti-discrimination Laws: An Overview,
77 Iowa L. Rev. 1313 (1992).
The author in this article argues that anti-discrimination laws should
apply to people who have AIDS. Currently the number of women and children
who have AIDS is large and growing. Minorities many of whom are poor presently
account for nearly three-fourths of this population. These individuals
are already discriminated against in this country on the basis of race
and color. Having AIDS is a second problem they have to overcome. Because
of the prejudice there is in our country today they should be able to apply
anti-discrimination laws to AIDS discrimination just as they would to discrimination
based on their race. This would involve allowing them to use the Americans
with Disabilities Act, Rehabilitation Act of 1973, and Title I, II, and
The author's plan to combat discrimination is wise. We already have
these laws in place and discriminating based on an illness is no different
than discrimination based on color. They are both factors that the individual
cannot change. The one concern I have in this case is that AIDS presents
a danger to unsuspecting individuals in some cases unlike race. For example,
a hospital may deny a surgeon privileges if they have AIDS for fear of
infecting a patient. In this case the doctor should not be able to sue
the hospital for discrimination, because the concern of the hospital is
for patient safety. They are not taking the action for discriminatory purposes.
While it would be good to apply anti-discrimination laws to AIDS infected
individuals there should be some limitations.
SOURCE: 69 Pages, Included Bibliography.