Pictured above An article on AZT in the New York Native, a now-defunct publication.
When HIV first erupted onto the U.S. medical scene, doctors desperately needed both clinical research data and institutional support in order to understand, diagnose and combat the mysterious disease. While they looked to the Centers for Disease Control ( CDC ) for descriptions of symptoms and statistics on the demographics of the infection, they also turned to the American Medical Association ( AMA ) for guidance on issues such as the safety of healthcare providers, the confidential nature of the patient-physician relationship, preferred prevention methods and appropriate testing requirements.
As the national association representing doctors and medical students from all state medical societies and all specialties, the AMA is widely recognized as the voice of organized medicine in the U.S. It was founded in 1847 and today, roughly a third of all practicing physicians are members. Its annual meeting is held every year in June in Chicago, and that is when over a thousand delegates debate and vote on dozens of resolutions, thus shaping official policy. While firmly grounded in science and devised as explicit guidelines for physicians, AMA policies are not legally binding
The AMA's first concerted, proactive efforts in the fight against HIV/AIDS were launched at the 1985 gathering. Over the next two years, an AIDS task force consisting of 28 staff members was established, an action plan for AIDS was developed and a detailed status report comprising 17 recommendations was produced. In 1989, an AMA HIV policy update was released.
The 1990s saw a sharp decline in output relating to HIV/AIDS. The reasons for this are not readily apparent, but it can reasonably be assumed that the medical profession's alarm in the face of the Clinton healthcare reform plan as well as the advent of more effective drug cocktails both contributed to a shift in focus.
But in 2003, the AMA consolidated its 60 existing policies regarding HIV/AIDS into 32 distinct entries. No amendments were made at that time, but a number of subsequent resolutions have been adopted in the last three years, most of them dealing with prevention measures and the development of improved testing tools.
What follows is an overview of past and current AMA positions on the HIV/AIDS epidemic. While this selection is not a comprehensive listing of all AMA policies relating to HIV/AIDS, it should encompass the major areas of concern to LGBT readers.
As early as 1983, the AMA was advocating that doctors take a full sexual history of their patients and that they 'create an atmosphere of tolerance and openness.' This recommendation followed the acknowledgment of a CDC report estimating that 70 percent of HIV/AIDS cases occurred in the 'male homosexual' population. In 2005, a further resolution was adopted to encourage medical schools to teach students how to discuss sexual history in a way that is respectful of individual patients' attitudes and behaviors.
Opposition to any acts of discrimination based on a person's HIV status has been official AMA policy since 1986. The association also took a stand against the creation of any piece of legislation that would lead to this type of discrimination. Today, the AMA is on record as condemning Congressional mandates calling for the discharge of armed services personnel who are HIV-positive and as supporting the incorporation of HIV status to future anti-discrimination laws. Refusal to treat a patient based on HIV-positive status is clearly proscribed: 'It is in the best interest of the patient for the physician to focus on treatment … rather than on making value judgments about how the disease was contracted.' At this year's annual meeting, a resolution is pending that would allow doctors to 'conscientiously object to treatment' and refer patients to another provider only outside of emergency situations.
In 1984, the Illinois Delegation introduced a resolution calling on doctors to explain to their patients that donating blood does not expose them to the AIDS virus. It was adopted along with a provision outlining the inappropriateness of 'designated blood donations.' Today, the AMA also suggests that physicians 'inform high-risk patients of the value of self-deferral' from giving blood.
Prevention and Condom Use:
The AMA has long endorsed sexual education as a preventive measure. In 1989, it supported 'the education of elementary, secondary and college students regarding the modes of HIV transmission … .' It also encouraged religious organizations to implement programs to educate their constituencies about HIV. Condoms, considered 'one useful measure to help contain the spread of HIV' in 1989, are now designated 'an effective method of prevention.' The AMA supports their display and sale in appropriate retail locations, and has pledged to pursue legislation making condoms available to inmates in local, state and federal institutions.
Testing and Confidentiality:
Mandatory testing of the general population remains against AMA policy, but the association approves universal HIV testing of all pregnant women as a standard part of perinatal care. The association also believes that all victims of sexual assault should be offered HIV testing. For public safety reasons, blood, semen, ova, organ and breast milk donors; military personnel; and state and federal prisoners are also identified by the AMA as groups who must be tested. In 2005, a resolution was passed that called on the AMA to promote the use of FDA-approved rapid tests like OraQuick as long as accompanying counseling is made available and follows CDC guidelines. Although it 'strongly recommends' that HIV-positive patients be reported ( in confidentiality ) to relevant public health authorities for purposes of contact tracing and partner notification, the AMA rejects the idea that state licensing boards be informed when a doctor has become infected with HIV.
Research and Funding:
As the publisher of JAMA, one of the world's leading medical journals, the AMA has always relied on peer-reviewed research as its knowledge base. In 1986, for an internal report on the state of the epidemic, it looked at national prevalence statistics as well as field studies conducted in other countries in an effort to debunk growing popular myths surrounding risk factors and HIV/AIDS. At this early stage in the U.S., whites made up 60 percent of the infected population, including 17 percent of children cases. Blacks accounted for only 25 percent of total numbers, but 68 percent of cases in children. Homosexual intercourse among white men and the abuse of IV drugs in the Black community were identified as distinct modes of transmission.
When concerns mounted that the disease might be contracted through mosquitoes and other insects, the AMA consulted Project SIDA, a collaborative disease surveillance study by U.S. and Belgian researchers in Zaire ( now the Democratic Republic of Congo ) , which clearly invalidated claims of horizontal transmission without sexual contact or needle sharing.
Today, the AMA is a solid proponent of adequate public funding for HIV/AIDS research. It 'strongly supports full appropriation of the amounts authorized under the Ryan White CARE Act of 2000.' Moreover, some of the association's specific demands include assurances of scientific rigor, the application of results to prevention programs, the allocation of resources for the study of the disease among minority groups and an increase in public awareness about the benefits of animal studies in HIV/AIDS.
Immigration and HIV-Positive Individuals:
One of the AMA's less laudable policy positions has to do with HIV and immigration law. In keeping with the current inclusion of HIV infection on the list of communicable diseases of 'Public Health Significance' the AMA supports refusing HIV-positive immigrants the right to settle permanently in the U.S. However, it does not endorse proposals to restrict entry to HIV-positive travelers and opposes automatic disclosure of HIV-positive status on passports and visa documents.
More AIDS at 25 next week; also see Chicago AIDS online memorial on WCT's web site: www.windycitymediagroup.com