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Sterilization: HIV infections in the workplace Comments on Vancouver City Council recommended guidelines

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The B.C. Civil Liberties Association unreservedly supports Mayor Campbell’s recommendation that Council adopt the policy Statement and Policy Guidelines for Managing Persons with HIV infections in the Workplace as reported to Council by Mayor’s Task Force on AIDS.

The Mayor’s task force has, in our view, given carefully considered and conservative form to Council’s decision in the Spring to undertake to protect its own infectious employees from unjustified discrimination. The B.C. Civil Liberties Association would like to amplify and offer support for some of the elements of the Guidelines that might attract critical attention.

Preventing transmission of AIDS 

First of all, and most importantly, we believe that the statement made in the first sentence of section four of the guidelines goes to the heart of the matter: “All reputable medical authorities state that the AIDS virus cannot be transmitted through casual contact in the home or the workplace.”

After all, if the AIDS virus could be transmitted by, say, sharing a handkerchief, the B.C. Civil Liberties Association would be irresponsible to be urging Council to use its authority to possibly force unwilling employees to run a real risk of contracting an incurable, fatal disease. And Council would certainly be wrong to approve the guidelines if there were even a one in ten thousand chance of catching AIDS by casual contact with infectious persons in ordinary workplace situations. Believing this, we also believe that it would be an abuse of our sympathy for the infectious were we to carelessly canvass the evidence that bears on the vital issue of the non-transmission of AIDS.

Dr. John Blatherwick has done a good job of advising all of us in this regard. However, as Council moves to give working shape to its earlier commitment to adopt an AIDS in the workplace policy, Aldermen may wish to be brought up to date on where the research community stands.

To this end, the B.C. Civil Liberties Association met this week with Professor Martin Schechter, head of AIDS research at UBC, to obtain references to the latest primary material in this area. Professor Schechter kindly supplied a list of such important references accompanied by his latest (as yet unpublished) note on non-transmission. Please find this material enclosed.

We have also enclosed a copy of an overview article (suggested by Professor Schechter) from a recent (Oct. 29, 1987) issue of the prestigious New England Journal of Medicine. Of most relevance to the issue before Council is the table on page 1132 of this article, since household-based infection is the closest analogue to infection in ordinary workplace situations. This table shows that we remain without any evidence of transmission of AIDS in familial settings which is not accounted for by the presence of established risk factors.

It is true that being “without evidence” of casual transmission of AIDS is different than scientifically proving that such transmission could never occur. It is important to realize, however, that our inability to provide such a proof is not indicative of anything about AIDS, but is due to the very nature of science itself.

Science cannot, for instance, provide any proof that mermaids cannot occur in nature. What it can and must do in such circumstances is very carefully search for evidence of such a possibility in all the most promising places. As exhaustive scrutiny of all the Earth’s oceans, and endless interviews with bibulous and/or ancient mariners piles up a record of “non-evidence,” science reasons inductively that we are without mermaids. And, an invariable finding of “no mermaids” becomes, not a proof that mermaids cannot possibly be, but a compelling body of evidence that there aren’t any such creatures.

It might be urged against this analogy that we haven’t been looking for casual transmission of AIDS nearly as long as we have been looking for mermaids. This is true, but two considerations need to be stressed in this connection.

First of all, we have been looking for casual transmission of AIDS with an almost desperate ingenuity and intensity. Such momentous issues of public health and safety hinge on this question that it is safe to say that medical science has never looked harder for anything than it has for casual transmission of AIDS. Ironically, scientists have been helped in this search by ignorance. In the early part of this decade, before we were alerted to the AIDS threat, tens of thousands of infectious persons were living absolutely ordinary lives in the Los Angeles and San Francisco areas. We had, therefore, a huge “natural experiment” in those areas; an experiment that should have yielded some cases of casual transmission if it were even a remote possibility. The most exhaustive study of health care professionals and family members of infectious persons has failed to yield a single case of infection that has not been accounted for by the presence of established risk factors.

Secondly, although we don’t have to do anything about mermaids, we certainly have to do things about AIDS. We know that public health and safety depend upon the creation of a relationship of mutual trust between society and those infectious with AIDS. This entails, as Council itself decided this Spring, the provision of Human Rights protections against unjustified discrimination for the infectious. If we were to wait until the epidemic had run its course, holding out for ever more “non-evidence” to make a compelling case even more compelling, we would have failed to take a step which could have substantially changed the power of AIDS to hurt us all.

“Cutting bait” is sometimes the wisest course … just in case it isn’t demonstrably harmful to put off fishing. The Mayor’s proposed guidelines are, in the view of the B.C. Civil Liberties Association, a carefully crafted and conservative political step that would place Vancouver in the forefront of those who can recognize a responsibility to act.

Use of disciplinary procedures 

We would now like to turn to the issue of enforcement, as it is addressed in sections five and six of the proposed guidelines. There may be understandable reluctance to use the City’s authority over its workers to enforce a measured commitment to the protection of AIDS people. It would certainly be unfair, perhaps even counterproductive, if discipline was used as anything but a last resort in identified cases of discrimination. Two points should be made here.

First, the guidelines make it clear—both in section five and in section eight—that the City is formally committed to the use of general and specific education as its first initiative in the workplace. And it is clear that even in identified instances of discrimination, management is directed to use education and counselling as its first AND second response; and discipline is to be resorted to only when these measures have failed.

Second, to shrink from the provision of enforcement for its guidelines must be seen by Council, and will certainly be seen by its workers and the public, as shrinking from the political task of clearly meaning what it says about AIDS. A “commitment” to provide a measure of protection for AIDS people in the workplace that was not backed up by the authority of Council would be a counterfeit initiative. Silence would be preferable to such a weak and mixed signal to the public.

Safety first

Finally, it should be stressed that the proposed guidelines have been crafted with a view to giving the City an important measure of flexibility in dealing with work situations that involve or could involve the presence of risk factors such as blood. This is wise, and it shows that the policy reflects a careful consideration of the need to face instances of “justified discrimination” where circumstances warrant. It should reassure employees of the City that they will not be blithely directed to accept real personal risk; on the contrary, it is clear that the City is alert to its responsibility to protect its employees from the risk of being infected, and will not confuse its Human Rights commitments with a continuing regard for its workers’ safety.

Conclusion

AIDS is first and last a public health problem. Between that “first and last,” however, we are going to stand very much in need of genuine political leadership. Government doesn’t need to apologize for governing when society is threatened by a deadly, incurable, and infectious disease. But it must be, in the case of AIDS, a humane governance with the farthest-seeing regard for public health results. The AIDS In The Workplace guidelines that have been recommended for adoption by Mayor Campbell are, in the view of the B.C. Civil Liberties Association, a good example of legislating to win. And what is won by them is not the interest or comfort of any special group, but public health results for all Vancouverites.