By Sydney Buck
The HIV-AIDS epidemic revealed the worst of the healthcare system. Individuals, especially members of the LGBTQ+ community, were targeted in society as conduits of a plague. Physicians, as well as society, constructed their perception of HIV upon the ideologies of homophobia and racism. The repercussions of this decision by providers in the beginning of the epidemic created a system that continues to neglect thousands of individuals. The ultimate result was a healthcare system that lacked an emphasis on public education, commonly deviating from the Hippocratic oath, and a lack of compassion amongst support systems. The discrimination against HIV/AID positive and or at risk individuals encompasses structural violence within America’s healthcare system that must be fixed to ensure adequate care for all. that lacked science, compassion, and violated the hippocratic oath infiltrated as a cultural norm.
The Lack of Medical Education
The HIV/AIDS epidemic began with a few cases in June of 1981. The defining feature of all exposures shared one commonality. All the cases included men who were sexually active with the same sex (“The HIV/AIDS Epidemic in the United States: The Basics”). The Center for Disease Control and Prevention (CDC) convened a panel to investigate the causes of the illness. The conclusion was that the disease was transmitted through blood contact. The committee, however, did not continue to research ways of helping those infected, but rather prevention largely for those not in most impacted communities (David J. Spencer CDC Museum).
By not dedicating resources to find means of prevention and treatment, many of those at risk were unaware of how to protect themselves. The LGBTQ+ community simply knew they were under attack from what seemed an invisible enemy. Dr. Don Chaplin described his early memories of HIV/AIDS as “scary for a gay man” (Chaplin 17:30-18:05). After describing his fear, he draws an emphasis on the lack of knowledge accessible to the at risk community on how to get tested or stay protected. Dr. Chaplin began to help organize various outreach programs educating individuals on HIV/AIDS. He believed only those who were gay or lesbian cared enough to educate themselves. The lack of initiative to inform the population about the disease is riddled throughout healthcare. According to the CDC, the most effective way to protect yourself is to get tested. However, according to a report done by the United Nations, the number of young people who are not educated about HIV/AIDS continues to rise (“Major UN Study Finds Alarming Lack of Knowledge About HIV/AIDS Among Young People”). Those with influence incentivize actors within the system, physicians and administrators, to educate the general population about the prioritization of HIV/AIDS or the system will continue to fail.
The Violations of the Hippocratic Oath
During the onset of the HIV/AIDS epidemic, the worst side of doctors was revealed which further exacerbated the healthcare system failings. A New York Times piece from August, 1987, “When Doctors Refuse to Treat AIDS,” highlights how many physicians viewed AIDS patients. They were not seen as patients, but rather as a deadly disease. Physicians claimed that they had to protect themselves from possible transmission. This attitude is in strict contradiction to the hippocratic oath every doctor must take. The defining features of the oath is “to treat the ill to the best of one’s ability, to preserve a patient’s privacy, to teach the secrets of medicine to the next generation” (Marks). When physicians openly violate the foundations of their profession, patients are reluctant to seek medical help. Thomas Mclaughlin, a coordinator of HIV-positive patients, tells how most patients confide themselves to him rather than their doctor (McLaughlin 04:18-04:42). Due to the first physicians interacting with HIV/AIDS acting with such callus, generations of individuals are now hesitant to seek medical treatment in fear of judgement. This is not due to a single individual, but the many who molded the physicians response instilling discrimination for the following generations.
The Lack of Compassion
The lack of compassion towards individuals about HIV/AIDS spread from physicians to the general public. Due to the open hesitation of providing for positive patients, the vast majority of public opinion was to avoid members of the gay community. With examples of doctors, those whose profession is based on servitude, neglecting those who need help, society easily followed suit. The existence of a healthcare system that allowed for discrimination against individuals due to a disease gave way to discrimination in the support systems surrounding the sick. According to the American Medical Association, “health care personnel have been known to stigmatize patients with HIV, in some cases refusing to treat them or providing substandard care. Frequently, individuals find that even family and friends behave differently around and toward them after learning they have the virus” (Anderson). Andy Hunt described the horrors living as a gay man at the beginning of the epidemic. There was an expectation to keep your true identity hidden in fear that you might be seen as a potential outbreak not as a person. Hunt says, “everybody was in the closet and you didn’t talk about things” (Hunt 12:18-12:38). While it is unreasonable to claim physicians are wholly responsible for this lack of compassion, they are actors in a system that contributes to the misrepresentation of the dangers of AIDS impacting the potential surrounding support systems.
What Can Be Done?
This discrimination is a prime example of structural violence within the United States healthcare system due to suffering amongst a whole people group. A blatant set of actors should not be blamed. Rther, generations of societal thoughts and attitudes dictate a problematic narrative that focuses not on the terminal disease, but the person. As a result, the healthcare system has allowed the fabrication of barriers that prevent individuals from seeking life saving care. All hope is not lost. Physicians can rebuild the structure to include more education and strict adherence to caring for all patients regardless of HIV status. We as a society can too look to help instead of harm; however, the first step is recognizing the person, not the disease.
Anderson, Bebe J. “HIV Stigma and Discrimination Persist, Even in Health Care.” AMA Journal of Ethics, December 2009, https://journalofethics.ama-assn.org/article/hiv-stigma-and-discrimination-persist-even-health-care/2009-12. Accessed 24 April 2022.
Chaplin, Don and Hunt, Andy. Interview with Isabell Moore. 26 November 2018 (Y-0091). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
David J. Spencer CDC Museum. “The AIDS Epidemic in the United States, 1981-early 1990s | David J. Sencer CDC Museum.” CDC, 26 March 2021, https://www.cdc.gov/museum/online/story-of-cdc/aids/index.html. Accessed 24 April 2022.
Hunt, Andy. Interview with Isabell Moore. 3 December 2018 (Y-0102). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
“The HIV/AIDS Epidemic in the United States: The Basics.” KFF, 7 June 2021, https://www.kff.org/hivaids/fact-sheet/the-hivaids-epidemic-in-the-united-states-the-basics/. Accessed 24 April 2022.
“Major UN Study Finds Alarming Lack of Knowledge About HIV/AIDS Among Young People.” WHO | World Health Organization, 2 July 2002, https://www.who.int/news/item/02-07-2002-major-un-study-finds-alarming-lack-of-knowledge-about-hiv-aids-among-young-people. Accessed 24 April 2022.
Marks, Jay W. “Medical Definition of Hippocratic Oath.” MedicineNet, 3 June 2021, https://www.medicinenet.com/hippocratic_oath/definition.htm. Accessed 24 April 2022.
McLaughlin, Thomas. Interview with Maddie Kameny. 28 June 2018 (Y-0040). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.