HIV exceptionalism
Encyclopedia
HIV exceptionalism is the term given to the trend to treat AIDS
differently from other diseases, including other sexually transmitted
, infectious, lethal diseases in law and policy.
HIV exceptionalists emphasize the human rights of people living with AIDS, in particular their rights to privacy
, confidentiality
, and autonomy
. They also believe that all people seeking an HIV test
always require special services, such as counseling with every HIV test, special informed consent
paperwork, and guaranteed anonymity in public health reporting. In many places, it is illegal to disclose HIV test results over the phone or over the internet.
Part of this is motivated by a desire to reduce the likelihood of suicide
in recently diagnosed people. Other goals include encouraging people to consent to the test by, for example, preventing the government from associating a positive test result with an identifiable individual, or preventing other healthcare professionals from learning that the individual had ever been tested, even if the test result was negative.
As treatment regimes, understanding of the pandemic, and awareness about HIV/AIDS stigma and discrimination evolves, more scholars are arguing for an end to HIV exceptionalism. HIV exceptionalism in testing increases bureaucratic burden, reduces the availability of HIV testing, and stigmatizes it as something "special" instead of a normal part of healthcare.
HIV exceptionalism is the term given to the treatment in law and policy of HIV/AIDS as different from other diseases, including other sexually transmitted, infectious, and lethal diseases.
HIV exceptionalists believe that despite advances in HIV disease treatment, there is compelling evidence that the social stigma associated with HIV and AIDS continues to result in frequent discrimination against and rejection of people with HIV/AIDS. Discrimination against persons with HIV typically originates with irrational fears about casual transmission of HIV or on societal devaluation of specific sexual identities and behaviors (gay men, men on the "down low," bisexual men, MSM, anal sex, multiple sexual partners, transactional sex) and illegal substance use (injection drug users of illegal narcotics). HIV-positive victims of discrimination continue to experience loss of employment and housing, and also report being denied access to social and medical services in many regions of the US and the world specifically because of their HIV status. Many HIV-positive people in the US and around the world continue to be ostracized, arrested, beaten and even murdered because of their serostatus. Many HIV-positive people report recent experiences of rejection by spouses, family members, friends, coworkers, neighbors, whole communities and religious institutions.
AIDS exceptionalists emphasize the human rights of people living with HIV/AIDS, in particular their rights to privacy, confidentiality, and autonomy which protect them against discrimination. They also believe that people seeking an HIV test require services such as pre-test counseling (including risk assessment, harm reduction behavioral interventions and suicidal ideation screening), written informed consent and the option of anonymous rather than confidential HIV testing. In many places, it is illegal to disclose HIV test results over the phone or over the internet because the test results may be inadvertently disclosed to someone other than the person who has been tested.
AIDS exceptionalists also believe that the decriminalization of behaviors which may lead to HIV transmission, as well as the option of anonymous testing, will encourage more people to seek HIV testing. In the US, states have different regulations governing the reporting of HIV or AIDS cases to local or state health departments. Some states require the release of individually identifying information with an HIV-positive test result, while other states do not. Similarly, regulations vary as to whether healthcare professionals may have access to this information without the patient's written consent. Since all health care professionals are required to practice universal precautions with every patient in order to protect themselves against blood-borne disease, in some states it is illegal to inform a provider of a patient's HIV status for the sole purpose of protecting the health care provider against HIV. The practice of universal precautions is sufficient for the provider's protection.
Most opponents of HIV exceptionalism believe that social stigma is no longer an important variable in the testing and treatment of people living with HIV/AIDS. Citing improvements in treatment regimes, a better understanding of the pandemic and greater awareness about HIV/AIDS stigma and discrimination, more public health professionals are arguing for an end to HIV exceptionalism.[1] They believe that HIV exceptionalism in testing increases bureaucratic burden, leading to an unwillingness of health care providers to make HIV testing available to all adolescent and adult patients without regard to perceived risk, and stigmatizes testing as something "special" instead of a normal part of healthcare. Opponents of HIV exceptionalism believe that by destigmatizing HIV testing and treatment in the medical arena, they can simultaneously destigmatize the sexual and needle-sharing behaviors that may result in HIV infection.
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
differently from other diseases, including other sexually transmitted
Sexually transmitted disease
Sexually transmitted disease , also known as a sexually transmitted infection or venereal disease , is an illness that has a significant probability of transmission between humans by means of human sexual behavior, including vaginal intercourse, oral sex, and anal sex...
, infectious, lethal diseases in law and policy.
HIV exceptionalists emphasize the human rights of people living with AIDS, in particular their rights to privacy
Privacy
Privacy is the ability of an individual or group to seclude themselves or information about themselves and thereby reveal themselves selectively...
, confidentiality
Confidentiality
Confidentiality is an ethical principle associated with several professions . In ethics, and in law and alternative forms of legal resolution such as mediation, some types of communication between a person and one of these professionals are "privileged" and may not be discussed or divulged to...
, and autonomy
Autonomy
Autonomy is a concept found in moral, political and bioethical philosophy. Within these contexts, it is the capacity of a rational individual to make an informed, un-coerced decision...
. They also believe that all people seeking an HIV test
HIV test
HIV tests are used to detect the presence of the human immunodeficiency virus , the virus that causes acquired immunodeficiency syndrome , in serum, saliva, or urine. Such tests may detect antibodies, antigens, or RNA.- Terminology :...
always require special services, such as counseling with every HIV test, special informed consent
Informed consent
Informed consent is a phrase often used in law to indicate that the consent a person gives meets certain minimum standards. As a literal matter, in the absence of fraud, it is redundant. An informed consent can be said to have been given based upon a clear appreciation and understanding of the...
paperwork, and guaranteed anonymity in public health reporting. In many places, it is illegal to disclose HIV test results over the phone or over the internet.
Part of this is motivated by a desire to reduce the likelihood of suicide
Suicide
Suicide is the act of intentionally causing one's own death. Suicide is often committed out of despair or attributed to some underlying mental disorder, such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse...
in recently diagnosed people. Other goals include encouraging people to consent to the test by, for example, preventing the government from associating a positive test result with an identifiable individual, or preventing other healthcare professionals from learning that the individual had ever been tested, even if the test result was negative.
As treatment regimes, understanding of the pandemic, and awareness about HIV/AIDS stigma and discrimination evolves, more scholars are arguing for an end to HIV exceptionalism. HIV exceptionalism in testing increases bureaucratic burden, reduces the availability of HIV testing, and stigmatizes it as something "special" instead of a normal part of healthcare.
HIV exceptionalism is the term given to the treatment in law and policy of HIV/AIDS as different from other diseases, including other sexually transmitted, infectious, and lethal diseases.
HIV exceptionalists believe that despite advances in HIV disease treatment, there is compelling evidence that the social stigma associated with HIV and AIDS continues to result in frequent discrimination against and rejection of people with HIV/AIDS. Discrimination against persons with HIV typically originates with irrational fears about casual transmission of HIV or on societal devaluation of specific sexual identities and behaviors (gay men, men on the "down low," bisexual men, MSM, anal sex, multiple sexual partners, transactional sex) and illegal substance use (injection drug users of illegal narcotics). HIV-positive victims of discrimination continue to experience loss of employment and housing, and also report being denied access to social and medical services in many regions of the US and the world specifically because of their HIV status. Many HIV-positive people in the US and around the world continue to be ostracized, arrested, beaten and even murdered because of their serostatus. Many HIV-positive people report recent experiences of rejection by spouses, family members, friends, coworkers, neighbors, whole communities and religious institutions.
AIDS exceptionalists emphasize the human rights of people living with HIV/AIDS, in particular their rights to privacy, confidentiality, and autonomy which protect them against discrimination. They also believe that people seeking an HIV test require services such as pre-test counseling (including risk assessment, harm reduction behavioral interventions and suicidal ideation screening), written informed consent and the option of anonymous rather than confidential HIV testing. In many places, it is illegal to disclose HIV test results over the phone or over the internet because the test results may be inadvertently disclosed to someone other than the person who has been tested.
AIDS exceptionalists also believe that the decriminalization of behaviors which may lead to HIV transmission, as well as the option of anonymous testing, will encourage more people to seek HIV testing. In the US, states have different regulations governing the reporting of HIV or AIDS cases to local or state health departments. Some states require the release of individually identifying information with an HIV-positive test result, while other states do not. Similarly, regulations vary as to whether healthcare professionals may have access to this information without the patient's written consent. Since all health care professionals are required to practice universal precautions with every patient in order to protect themselves against blood-borne disease, in some states it is illegal to inform a provider of a patient's HIV status for the sole purpose of protecting the health care provider against HIV. The practice of universal precautions is sufficient for the provider's protection.
Most opponents of HIV exceptionalism believe that social stigma is no longer an important variable in the testing and treatment of people living with HIV/AIDS. Citing improvements in treatment regimes, a better understanding of the pandemic and greater awareness about HIV/AIDS stigma and discrimination, more public health professionals are arguing for an end to HIV exceptionalism.[1] They believe that HIV exceptionalism in testing increases bureaucratic burden, leading to an unwillingness of health care providers to make HIV testing available to all adolescent and adult patients without regard to perceived risk, and stigmatizes testing as something "special" instead of a normal part of healthcare. Opponents of HIV exceptionalism believe that by destigmatizing HIV testing and treatment in the medical arena, they can simultaneously destigmatize the sexual and needle-sharing behaviors that may result in HIV infection.