December 13, 2007
AIDS and Quarantine: Looking Backward
Quarantine: Enforced isolation or restriction of free movement imposed to prevent the spread of contagious disease. (American Heritage Dictionary of the English Language, 4th edition).
Last Saturday, the Associated Press revealed Republican presidential candidate Mike Huckabee’s responses to questions about AIDS and homosexuality during his 1992 campaign for the US Senate. On the topic of AIDS, Mr. Huckabee stated:
If the federal government is truly serious about doing something with the AIDS virus, we need to take steps that would isolate the carriers of this plague…. It is difficult to understand the public policy towards AIDS. It is the first time in the history of civilization in which the carriers of a genuine plague have not been isolated from the general population, and in which this deadly disease for which there is no cure is being treated as a civil rights issue instead of the true health crisis it represents.
According to a Sunday AP story, Huckabee stands by his 1992 statement.
“I still believe this today,” he said in a broadcast interview, that “we were acting more out of political correctness” in responding to the AIDS crisis. “I don’t run from it, I don’t recant it,” he said of his position in 1992. Yet he said he would state his view differently in retrospect.
When Huckabee expressed his opinion in 1992, scientific research had identified the human immunodeficiency virus as the cause of AIDS and it was well understood that, unlike many other communicable diseases, HIV could not be transmitted through casual social contact.
That message had been strongly reinforced the previous year when Los Angeles Lakers superstar Earvin “Magic” Johnson publicly disclosed his HIV infection. Indeed, in its November 18, 1991 issue that featured Johnson on the cover, Sports Illustrated included a special “For Kids Only” page that tried to explain the news to readers 12 and younger. Roughly half of that article stressed that HIV isn’t spread through casual social contact. After listing the many ways in which AIDS isn’t contracted, it summarized the message:
The truth is, AIDS is a disease that’s hard for young kids to get. It’s almost impossible for any kid to get AIDS from doing everyday things such as going to school. (p. 46)
There was no credible medical or public health argument in support of quarantining people with AIDS in 1992. Rejecting calls for quarantine and similar punitive measures wasn’t a matter of being “politically correct.” Rather, it was based on sound evidence about the nature of HIV.
Nevertheless, a substantial minority of the US public shared Huckabee’s view. In a 1991 national telephone survey that I conducted with funding from the National Institute of Mental Health, 34% of US adults agreed with the statement, “People with AIDS should be legally separated from others to protect the public health.” (By 1999, only 12% of survey respondents expressed such sentiments.)
What was behind this support for quarantine? For some people, it reflected an unfounded belief that AIDS could be easily transmitted. Their support for quarantine was part of a general fear of contact with HIV-positive individuals.
Such misapprehensions and fears are still around. A 2006 Kaiser Family Foundation national survey found that more than one third of Americans still didn’t know that HIV isn’t spread through kissing, and nearly one fourth didn’t know it can’t be spread by sharing a drinking glass. More than one fifth of the Kaiser survey respondents said they would be uncomfortable about having a coworker who is HIV-infected, and 30% of parents in the sample expressed discomfort at the prospect of their child having a teacher who is HIV-positive.
For others, however, support for quarantine was less about fear of HIV infection than it was about using the AIDS epidemic as an opportunity to express their preexisting prejudices against lesbians and gay men. In analyses of survey data from the latter half of the 1990s with my UCD colleague, Professor John Capitanio, I found that most heterosexuals continued to associate AIDS primarily with homosexuality or bisexuality, and this association was correlated with higher levels of sexual prejudice. In addition, although everyone who contracted AIDS sexually was blamed to some extent for becoming infected, gay and bisexual men were blamed more than heterosexual men and women. Moreover, sexual prejudice was correlated with both misconceptions about HIV transmission and discomfort with HIV-infected people.
This linkage of AIDS-related stigma and sexual prejudice highlights the relevance of Mr. Huckabee’s 1992 survey response on the topic of homosexuality:
I feel homosexuality is an aberrant, unnatural, and sinful lifestyle, and we now know it can pose a dangerous public health risk.
I can’t say whether Mr. Huckabee’s support for taking unnecessary punitive measures against people with AIDS was fueled by his negative attitudes toward homosexuality. However, sexual prejudice apparently has led many Americans to respond in a similar manner.
The fact that Mr. Huckabee is standing by his 1992 comments is disturbing in light of the continuing danger that HIV poses to gay and bisexual men in the United States. HIV infections appear to be increasing among young sexual minority men, the generation too young to have experienced the ravages of the epidemic during the 1980s and 1990s. Those men have reached sexual maturity during an era when homosexuality remains stigmatized, federal law explicitly delegitimizes same-sex relationships, and HIV researchers are advised to delete words pertaining to gay men and homosexuality from the abstracts and titles of their federal grant applications if they hope to be funded.
This situation recently led to a call for a new commitment to combating the spread of HIV among men who are gay, bisexual, or involved in sexual contact with other men (MSM). Writing in the Journal of the American Medical Association, three prominent AIDS researchers stressed the urgent need for leadership from public health officials and within the sexual minority community. Among other actions, they stressed the need to:
… call for the end of stigma toward MSM, which may mitigate the internalization of homophobia leading to sexual risk behavior. This need is particularly critical within racial and ethnic minority MSM communities that bear the stigma of homosexuality along with the discrimination faced by these minorities. Political leadership is also needed to advocate for legal domestic partnerships as a way to promote stable, longer-term MSM relationships. (Jaffe et al., 2007, p. 2413)
Unfortunately, even with such leadership, the prospects for a renewed commitment to implementing effective programs to stop the spread of HIV are bleak as long as serious contenders for national office still believe that quarantining people with HIV was a reasonable idea in 1992.
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For the Associated Press article about Mr. Huckabee’s 1992 questionnaire responses, see A. DeMillo. (2007, December 8). Huckabee wanted to isolate AIDS patients. San Francisco Chronicle.
For the JAMA editorial, see H. W. Jaffe, R.O. Valdiserri, & K.M. De Cock. (2007). The reemerging HIV/AIDS epidemic in men who have sex with men. Journal of the American Medical Association, 298, 2412-2414.
For more discussion of research on the link between sexual prejudice and HIV-related stigma, see G. M. Herek & J. P. Capitanio. (1999). AIDS stigma and sexual prejudice. American Behavioral Scientist, 42, 1130-1147.
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