THE RECENT controversy over the "forced" revelation by Arthur Ashe that he had AIDS has centered primarily around two questions: whether the press has a right to reveal what it determines as news and whether Ashe has a right to his privacy. It appears that both concerns are clouding the real issue involved: should Acquired Immune Deficiency Syndrome be treated any differently than other sexually transmitted, communicable diseases have been handled historically in the United States?
Our public health policies date back to the end of the 19th and early 20th century and have been revised on several occasions in recent decades.
For many years health officials felt that these methods were the most prudent means of curbing the spread of communicable diseases. And the policies generally held us in good stead, controlling devastating pandemics like the polio scare of the 1950s and the rampant influenza of 1918.
The question raised today is why AIDS has escaped these controlling public health codes. The answer is early and effective lobbying by civil libertarians, physicians and gay rights activists. When AIDS first made its appearance many were concerned that there would be widespread discrimination against the one group known at the time to be infected; therefore, action was taken to sidestep this anticipated loss of confidentiality.
The argument that AIDS affects only one group that is to be guarded against discrimination is no longer tenable, however. What writer Ronald Bayer called "HIV exceptionalism" in a 1991 New England Journal of Medicine article is no longer an appropriate stance for the health care dilemma facing society. One individual's privacy cannot be weighed so heavily that it supersedes the well-being of all.
I appreciate Arthur Ashe's wish to remain private about his illness. I am sure there are many HIV-positive individuals who are not celebrities who feel the same. The fear of exposure, stigmatization, adverse impact on one's source of income, isolation, overt or subtle discrimination are all areas of concern to those with the AIDS virus. It would take a very insensitive person not to understand such feelings.
However, the fact remains that AIDS can no longer be viewed solely through the eyes of those infected. AIDS is now a problem for which we all must become well-versed in order to be able to discuss it without the emotion and fear that color the reality of the disease, and to be able to adequately protect ourselves.
If something good can come from the current debate concerning disclosure, it may be that controversy creates communication. As we proceed toward a more meaningful public discussion about AIDS and a more realistic public health posture, there will be those dual victims of disease and disclosure like Arthur Ashe. While this is regrettable, our collective right to know and to be protected is paramount.
Mallie Z. DiBacco recently completed a doctoral dissertation on AIDS counseling at the American University in Washington.