An ongoing dialogue on HIV/AIDS, infectious diseases,
October 22nd, 2017
Price’s “Quarantine” Comment a Startling Example of Remaining HIV Stigma and Ignorance
In case you missed it, Betty Price, a Georgia state representative, said the following last week:
[youtube https://www.youtube.com/watch?v=mFTGZyVnzo0]
If you head over to the Youtube page with the above video, and read the comments (yes, I know, wading in such waters can give one a dim view of humankind), you’ll see she’s hardly alone in holding this view. The stigma, fear, and ignorance associated with HIV are still very strong; those of us who do this work on a daily basis might forget this sad fact.
And I suspect Price was well aware that she’d have some supporters before she made this public statement. It’s all the more remarkable that she said these things as a physician (she was an anesthesiologist before entering politics), but then again her husband Dr. Tom Price didn’t exactly distinguish himself when the topic of vaccines came up during his brief tenure as secretary of Health and Human Services.
So what should we, as infectious diseases/HIV specialists, say about this regressive and anachronistic perspective?
How about taking the high road and sticking to the science?
- There are multiple proven ways to prevent HIV transmission. Condoms, pre-exposure prophylaxis, and treating people with HIV all work really, really well — and new infections are substantially down in the USA because of them. Do you think that Rep. Price knows that everyone who takes HIV treatment becomes uninfectious to others?
Quarantines for infectious diseases should be reserved for conditions that are an immediate threat to the public health. It’s an extreme measure, one that is both expensive and logistically difficult, so mandating a quarantine should not be undertaken lightly. The CDC graphic on the right depicts diseases for which isolation and quarantine may be warranted. The most recent important example was Ebola (a viral hemorrhagic fever), which is highly contagious, especially during the acute illness, and potentially lethal. Back in 2002, it was SARS. HIV infection, with its long clinical latency period, lack of transmissibility except during sexual or blood contact, and effective therapy does not fit into this category.- There are no data that an HIV quarantine would even work, or be even feasible. Before undertaking such a costly program — costly not only in dollars, but also in the enormous loss of personal freedom — shouldn’t we at least have some evidence that it would reduce HIV incidence? And what criteria would she propose for the quarantine? All 1.1 million people with HIV living in the USA? Only those not on treatment? Or only those not on treatment who are sexually active or sharing needles with others? How would she prove these claims? (Amazing what web cams can do these days, but still.) Would the program provide food, treatment, and housing? If so, where would these sites be, and how would they be funded? (I guess there might be some money that’s no longer being used for private jets,)
To be fair, Price has backed off of her original statement, saying she meant it “to light a fire under all of us with responsibility in the public health arena.”
She certainly drew attention to the dire situation in Georgia, where the ongoing HIV epidemic is considerably worse than in most other states — it has the second highest rate of new cases, after Louisiana. The primary driver is Georgia’s large, underserved, and mostly minority population that cannot access regular care.
It’s people there — and everywhere — who are not on treatment and both get sick and sustain the epidemic, a lose-lose situation.
Grady Memorial Hospital is the famous Atlanta safety-net institution affiliated with Emory. In an account of his experience as an ID fellow at Grady, Dr. Jonathan Colasanti wrote the following:
After finishing 2 weeks on the general ID consult service, I was astonished as I prepared my patient log for submission to the Program Director. One-third of our 62 consults were patients infected with HIV … All of the patients were black. Excluding a patient with acute infection, the mean CD4 T-cell count was 64 cells/µL and over half the patients had <50 cells/µL. The mean viral load was 4.2 log copies/mL … Half of the patients were admitted with OIs or AIDS-defining illnesses, whereas many of the others suffered from processes directly related to living with a suboptimal immune system.
Until we have an HIV vaccine, the solution to stopping the HIV epidemic is to get people tested, on treatment, and keep them in care — regardless of race or ability to pay.
We know that. Do our elected officials?
9 Responses to “Price’s “Quarantine” Comment a Startling Example of Remaining HIV Stigma and Ignorance”
Paul E. Sax, MD
Contributing Editor
NEJM Journal Watch
Infectious Diseases
Biography | Disclosures | Summaries
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I can assure you she knew that patients with viral suppression cannot transmit as immediately before the presentation which led to these comments, I gave a presentation about this and other “HIV 101” facts. This comment was made in response to epi data showing that there are patients “retained in care” who are not suppressed during a hearing focused on barriers to care. The comments once again highlight how little understanding there is of the challenges to reaching viral suppression including STIGMA, transportation to clinics, a shortage of trained HIV providers including provision of culturally competent care, STIGMA, challenges filling prescriptions when Ryan White clinics are not nearby, copays for physician visits, decades of medical mistrust and concerns that medications are more harmful than helpful, a lack of education, STIGMA and I can go on and on. We have a crisis in Georgia affecting highly vulnerable patients, yet comments like this only enhance stigma, make our challenges greater but are a clarion call once again that we need to educate our elected officials and others in positions to influence this crisis in addition to our patients and those at risk.
Thanks Wendy for supplying more context…
I am pleased Ms Price clarified that “I do, however, wish to light a fire under all of us with responsibility in the public health arena – a fire that will result in resolve and commitment to ensure that all of our fellow citizens with HIV will receive, and adhere to, a treatment regimen that will enhance their quality of life and protect the health of the public.”
Lots of us have had resolve and commitment for decades…(and we have made great progress). What we need is for our political leadership to provide support with actions and resources not simply provocative comments!
Hard to decide whether she is knowingly manipulating facts for political gain or willfully ignorant. Either way? Shame on her. And kudos to you for such an insightful piece.
Equally, if not more, disturbing to me was Price’s follow-up comment, per a Washington Post article: “It seems to me it’s almost frightening the number of people who are living that are potentially carriers, well they are carriers, with the potential to spread, whereas in the past they died more readily and then at that point they are not posing a risk,” Price added. ‘So we’ve got a huge population posing a risk if they are not in treatment.'” https://www.washingtonpost.com/news/to-your-health/wp/2017/10/20/georgia-lawmaker-wife-of-tom-price-asks-about-quarantining-hiv-patients
“In the past THEY DIED MORE READILY and then at that point they are not posing a risk”. I wonder if Dr. Price has a clue how that sounds, as if the problem today is that HIV+ patients aren’t dying fast enough. I’ll be generous and assume that isn’t what she meant, but I sure would like to hear her apologize for the insensitivity of that comment.
Great post
Regressive, inflammatory statements are a political strategy these days — capitalizing on fear and desire for easy solutions. Dr/Rep Price is still an anesthesiologist, administering IV MAGA to her constituents. #nottakingthehighroad #letsgoACTUP
Frightening how little insight and compassion can occur in an elected official. The enormity of the cruelty inherent in this suggestion defies belief. Dr. Sax deserves much praise for bringing this to our attention.
She’s just a little late. HIV is an infectious disease that should have been quarantined initially but was not for “social stigma” reasons. The cat was let out of the bag and allowed to multiply then. Past tense now.
Hey Larry, are you aware that HIV was already widely circulating in the 1970’s? The whole “Patient X/flight attendant” theory was incorrect; people who were dying in the early 80’s had already been infected for a decade. The cat was already way out of the bag before anyone even became ill. I’d like to hear the logistics of your quarantine, given reality.