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Profiling Populations and Health Disparities

“There it was: AIDS as the litmus test for nurses and physicians, a means of identifying who would and who wouldn’t. I had seen this before in Boston…..

“So,” I asked, “is this kind of stuff still going on now, with Gordon?”

“Hell yes! Except they know who is and who is not willing to take care of a patient like Gordon. I am willing. Mary is willing. And quite a few others. But I don’t think they should take advantage of us for that reason. It’s convenient for them. Because if they bitch and moan and if they don’t take care of the patient right, then I feel like I have to step in. I can’t let that happen.”

Verghese, Abraham. My Own Country: A Doctor’s Story. Vintage, 1995.

Through this exchange with a nurse, Abraham Verghese recalls attitudes in the 1980s among medical staff engaged in the care of the first HIV patients in rural Tennessee. His remarkable memoir of his years as an Infectious Disease specialist during the early days of HIV recapturesthe palpable possibility that contamination with HIV was a death sentence faced by many in operating rooms and on medical wards, a belief held by some among medical professionals and civic leaders. In repeated vignettes Vergesse describes how these attitudes affected the resources and care gay men received.

In those days the U.S. was even more homophobic, especially rural America, and the fear of HIV and judgments about homosexuality were conflated in places like Mountain Home, Tennessee. I was a medical student and resident in those days and I remember conversations overheard in surgeons’ lounges and between specialists in hallways. The fear of the disease spilled over into profiling a community. The victims were vilified as vectors of contagion. Instead of being mobilized to fight the disease, some physicians castigated the gay community and avoided HIV patients,contributing instead to a great harm done to men already ravaged by illness and suffering.

It is hard to believe sick men and women were treated this way, especially now that lesbian, gay, bisexual, and transgendered individuals are championing their right to be a respected part of the American fabric, and now that HIV is a treatable chronic disease.

In hindsight this human tendency to shun the sick who scare us is not a trait we extole as a people. We like to think the cowardice of those days is far behind us. Certainly, those among us who have taken oaths to care for the sick and to “do no harm” do not proudly identify with those“who wouldn’t,” indeed we distance ourselves. We like to think we are more sophisticated now,more enlightened, and the 80’s were relatively dark ages given all we have learned since. Yet the recent Ebola epidemic in West Africa, and the relocation of thousands of migrant children fleeing violence in Central America and Mexico have rekindled this temptation to vilify victims and to smear entire communities with a fear of contagion.

Instead of employing what we have learned about infection control, screening, and prevention there are still those that would step away from evidence and compassion, away from targeted testing, treatment, and informed quarantine and step toward blanket sanctions and sweeping judgments about groups of people unfamiliar to them. Sadly, there are political leaders and health care professionals among us who conflate fear of a virus with an ethnic group or nation and then employ scare tactics to mobilize others through fear and prejudice to isolate and abhor.

Should we see these days captured in novels or on film in the years to come, those leaders mayshift uncomfortably as they recognize how fear mongering, prejudice and profiling eclipsed – as Lincoln would say – “our better angels” of public health science and compassion, how fear overran the head and the heart.

Recently a group of medical professionals coalesced to take a firm stand against profiling and fear mongering and to write policy that would make it a violation of professional ethics to whip up unfounded fear, especially of homeless migrant children. Several efforts have moved forward to introduce into professional associations referenda that would affirm our professional ethics to marry science and compassion in service to the most vulnerable and injured.

Because immigrant groups are historically those vilified and feared as sources of disease there are links to this effort highlighted on EthnoMed. I invite you to review these efforts, follow the links, and join the effort to hold leadership, both medical and civic accountable for engendering fear instead of employing science and compassion.

Photo by Michael Righi (cc license).