So this is wrong wrong wrong! granted i will not hold it against the government because of the lack of knowledge and understanding of the virus. But it would never be okay for this to happen present day.
Aside from this, however, Cuba has done an excellent job of HIV screening and prevention. Perhaps stemming from something they learned in the 80's. Here is what i found about the quarantine santorium.
"The HIV quarantine facilitated the education of patients and their families about HIV, allowed for directly observed patient treatments and safeguarded the general population of Cuba. Meticulous identification of every HIV positive individual in Cuba allowed the tracking back to the “source” of the patient’s HIV infection, whether from overseas or in Cuba. Cuba has an extensive confidential database of HIV positive individuals along with all their intimate contacts who have contracted HIV or remained HIV negative."
Now while I completely agree with Ara and his explanations of how this is wrong, I also think perhaps it did some good in education. While this was going on, the HIV/AIDS stigma in the general population was also attacked.
"Cuba stopped quarantining in 1993 and allows people with HIV to stay at home after a course to teach them how to look after themselves and not spread the virus.Universal free access to locally made generic antiretroviral drugs has kept AIDS cases and deaths very low, said the UNAIDS program. Almost 20 years later, Cuba has one of the lowest rates of HIV infection in the world, a prevalence of less than 0.1 percent of its sexually active population."
So obviously something went right, and Cuba has HIV/AIDS under control. Something that is hard to say about various Latin American countries.
Ahhhh yes, public health law example at its finest once more. It's good to be back! This particular case has international concern written all over it. I'll describe what the challenges are and how this case would be interpreted here in the US. I suppose the clearest way would be in outline form. Bare with me :)
I.Challenge:
A.The benefits of public health information systems, collection of data, etc.: you can detect hazards and health risks and gain information to inform the public, intervene (and evaluate existing interventions), and influence policymakers. The trade-off: individual autonomy, privacy…..public health success is due to the relationship with society: public health authorities safeguard public interests/rights, so as to be trusted. This will then make people feel comfortable enough to cooperate with public health measures and regulations.
B.With compulsory testing and screening, we run the risks of defining a class (generic/specific: which brings forth over/under-inclusive issues).
II.Mandatory Reporting of diseases and other health conditions (in the US):
A.States differ as to: what is reported, who reports, to whom the report goes, when the report is necessary.
B.HIV case reporting:
a.Public health professionalshave a responsibility to protect the population and justify reporting by the ethics of collective responsibility. Doctors however have a priority to safeguard patient interests and their doctor-pt relationship.
b.To breach that confidentiality by reporting names and sensitive personal data, patients believe there will be room for discrimination, invasion of privacy, and political retributions
c.The benefit of HIV reporting: better monitoring, better allocation of resources and services, and, clinical benefit for the patient.
C.Partner Notification
a.Three distinct meanings:
1.Contact tracing: whereby the public health agencies need to identify, locate and inform the sexual partners that are at risk of infection.
2.Duty to warn: the doctor’s duty or power to inform their patients’ sexual partners
3.Right to know: common law duty of infected persons to disclose their sero- status to their partners.
D.Fourth Ammendment: gives right of individuals to be “Secure in their persons” and not subjected to “unreasonable search and seizures”
a.It is seen by the Supreme Court that collecting and analyzing biological samples is a “search”. So, the Question is, is it unreasonable?
b.Court has stated, “special needs beyond the normal need for law enforcement”will
not require warrants/probable-or-reasonable causes for the search.
III.Confinement (US constitutional standards)
A.Three types of Confinement (international application):
a.Isolation: separation for the period of communicability, of known infected persons in such places and under such condition as to prevent or limit the transmission of the infectious agent
b.Quarantine: restriction of the activities of healthy persons who have been exposed to a communicable disease, during its period of communicability, to prevent disease transmission during incubation IF the infection SHOULD occur.
c.Civil commitment: detention for the purpose of care and treatment.
B.Pre-civil Rights Era: Constitutionality of Civil Confinements
a.Essentially, it was believed that there is no liberty to harm others. However, confinements of “public necessity” and or reasonable means can be done.
b.Three general limitations:
i.Subject must actually have the infection in order to be confined: however, “Suspect conduct and association” is justifiable à social prejudice, discriminatory, stigmatization, unequal
ii.Safe & Health Environment during Confinement: people have 14th amendment liberty interests toward “freedom from bodily restraint”, “reasonable safety and care”, and provision of food, shelter, treatment, etc.
iii.Not exercised w/ racism or discrimination against a class or vulnerable group
C.Post-Civil Rights Era: Constitutionality of Civil Confinements
a.Since people are being confined for indefinite periods and for their likely “future risks/dangerousness”, the deprivation of liberties is violating a fundamental right which requires strict scrutiny.
i.Person must pose a significant risk, compelling state interest needed
ii.Well-targeted intervention is needed: not over-or-under inclusive
iii.Least restricted means
iv.Procedural due process is necessary: counsel, hearing, appeal.
a.For compulsory treatment of competent adults: must show high risk and appropriate treatment
IV.Solution?
A. In Lawrence Gostin’s book, “Public health law: Power, Duty, Restraint”, he proposes an idea in which there is maximization of privacy and maximization of use of sensitive data by public health officials when deemed necessary to the social good.First you acquire the identifiable data based off of a legitimate public health purpose.Second, you will store and use the data within the confines of the public health system. And, third, you can disclose the info w/o consent only when: to other public health professionals/doctors.Essentially, are you justified in acquiring the identifiable data? If so, are you taking the necessary privacy and security measures?
B. As we bring all these viewpoints together, it can be said that Cuba’s treatment was
undoubtedly a violation of human rights. Civil confinement should be seen only as a
last resort if it is deemed a necessity toward social interests. Furthermore, to
confine, test/screen, and marginalize subgroups of population—as “unconstitutional”
it is in an international sense of the word—the withholding (or lack thereof) of
treatment to the communicable disease in question further hinders the justification
of violating their privacy, liberties, and autonomy.
When a Disney TV movie has India in the movie, it makes you wonder about what were the executives thinking about sending their stars to a country with such a broken system as seen in the Time's Photo Essay. Then, money comes to light. Disney got plenty of money to filter any member into India's "priority" system: those with either money or power to their name/family name goes first and gets best treatment. Its very unlikely that those with that, would get star treatment which I think every global citizen deserve.
A lost of social medical care compass in India is the best way I can express what I mean and how I feel about the money takeover. India is a country rich in culture, family traditions, and I like to think that India has made long strides in social rights movements after Gandhi. My time spent early this year may not echo that, especially those who lived in the village in the background of my photo (Me outside village near Mathura, India). Very few GIs nearby and many villagers do not know what a specialist even is. Most rely on the elders or drug stores to help diagnose and treat symptoms they have or feel. Foreigners visiting India's towns help create a demand for GIs to be nearby the villages, which in turn will create a growth in the village but also help the local population with their health care. What happen to desire to help from within India, rather than outsiders helping externally?
One caption from the essay, "The government has promised to increase public health spending from 1% of GDP to up to 3% by 2010. Until then, many Indians will just have to wait." Wait for what? Indians are not fortunate to have a Canadian system where they can wait and know that they will eventually be covered. Here, Indians are waiting hoping and praying that one day their problems will disappear. Its a shame and a sad thing that the one day which most Indians wait for will never come first than the day that they pass away. Hopefully their future generations will be lucky enough to have that changed.
Song of Blog: to keep the Indian theme, this song is from the Hindi film Gangster: Tu Hi MeriShab Hai.
'According to the UNAIDS report of 2003 there were an estimated 3,300 Cubans living with HIV/AIDS (approx 0.05% of the population). In the mid-1980s, when little was known about the virus, Cuba compulsorily tested thousands of its citizens for HIV. Those who tested positive were taken to Los Cocos and were not allowed to leave. The policy drew criticism from the United Nations and was discontinued in the 1990s.
How do you feel about this? While this is an obvious violation of human rights, do you see any derived benefit of this action such that it is a worthwhile tradeoff?
India
India’s economic is rapidly growing and has significant impact on its population. In 1985, 93% of the population had an annual household income less than $5.40 per day. In 2005, this number has dropped to 54%. India is emerging out of poverty and many are joining middleclass population. Looking at the picture essay on Time magazine, do you think India is ready to tackle the health and development challenges as it transitions to a developed nation?
