critical analysis forms of discrimination

Running head: CRITICAL ANALYSIS OF FORMS OF DISCRIMINATION1

Critical Analysis of Forms of Discrimination

Affecting Persons Living with HIV/AIDS

Joseph Cerniglia

University of South Carolina

CRITICAL ANALYSIS OF FORMS OF DISCRIMINATION2

Abstract

In this analysis, I’ll discuss the areas by which persons living with HIV face discrimination, the

social work implications, the policy implications, and the social justice perspective. For the

purposes of this analysis this author uses the acronym HIV when referring to the Human

Immunodeficiency Virus, the virus that causes AIDS which is used in place of Acquired Immune

Deficiency Syndrome. Furthermore, this analysis differentiates between HIV and AIDS but uses

the terms together because the findings will show a linkage in the treatment towards the persons

living with HIV whether or not they have acquired AIDS. This analysis will concentrate on

persons living with HIV in the United States despite HIV being a worldwide pandemic.


Critical Analysis of Forms of Discrimination Affecting Persons Living With HIV/AIDS

Introduction

Human Immunodeficiency Virus (HIV), the virus that causes Acquired Immune

Deficiency Syndrome (AIDS), is a chronic medical issue faced by an estimated 1,144,500 people

in the United States (CDC, 2013). In addition to the effects of the disease, persons living with

HIV also face discrimination, stigmatization, and the inadequate and harmful systems created by

people in power operating on their own prejudices and reacting to the prejudices of others.

Persons living with HIV experience discrimination in a variety of ways: employment, child

custody, medical care, education, and legal.

What are some ways persons living with HIV experience discrimination?

Employment

Employment discrimination takes place when a person living with HIV is fired, is refused

employment, or is asked to change jobs without just cause. Although persons living with HIV are

protected under the Americans with Disabilities Act, employers often use the explanation that

they are serving the best interests of the other workers; protecting them from accidental

transmission of the virus. This speaks to an issue of stigmatization that will be discussed later in

the analysis but the crux of the issue is that there is no scientific basis for the possibility of

accidental transmission provided employers follow simple, basic safety procedures applicable to

any infectious disease or blood-borne pathogen. (“HIV/AIDS and employment”, 2010)


Child Custody

In the area of child custody, parents and relatives of minor children undergo

discrimination in the form of denied access to custody of minor children or visitation of minor

children out of fear of health risks to the minor children. One other problem raised by the RAND

Corporation research is that of insufficient support systems to help care for minor children while

suffering consequences of HIV or side effects of HIV medications. This speaks to a broader issue

among families affected by HIV. In an analysis of 33 families with one or more person living

with HIV, 32 reported fear of stigmatization and 26 reported prejudice or discrimination. (“How

parental HIV”, 2009)

Medical Care

“All over the country…doctors, dentists, skilled nursing and psychiatric facilities, and

drug treatment centers refuse to provide services to HIV-positive patients. In the worst cases,

people die as a result of discrimination in medical care” (Lange, 2003). Because of the linkage

between HIV and poverty to be discussed later, medical care can be a complex issue for persons

living with HIV. Inability to pay is one reason why persons living with HIV face discrimination,

but also, stigmatization and fear play an additional role. Persons living with HIV are sometimes

given contact precautions or can even be refused treatment altogether.

Education

Although Ryan White was one of the first individuals to face discrimination in the area of

education, he was not, unfortunately, one of the last. White was removed from public school in

Indiana in 1985 due to being HIV positive and the school system that conspired to maintain his


segregation under the guise of public safety (Witchel, 1992). In more recent times, the foster

families of three students were told they “have to provide documentation that the children are

HIV negative before entering the school” (Bergan, 2013). And at Milton Hershey School in

Pennsylvania a student was denied entry to a private residential school because he has HIV

(Martinez and Johnston, 2011).

Legal

In one investigative report, Hernandez (2013) explores the extensive legal implications of

sexual behavior among persons living with HIV. In many states, it’s a felony sexual offense to

engage in sexual behavior with another person without first informing that person of one’s HIV

status. And in most cases, these laws do not factor in the use of a condom or the viral load of the

HIV positive participant. Rhoades, indicated in the article for being convicted of a 25 year prison

sentence (though later changed to 5 years of probation) for having consensual, protected sex with

another person, will be forever registered as a sex offender and suffer the legal ramifications of

such a registration. Other states have incidences where persons are charged with attempted

murder for biting or spitting and being HIV positive (“Ending & defending against”, 2010). Still

others face inadequate access to lifesaving medication and medical care while in prison (Lange,

2013).

Conceptualization of the problem and the oppressed group using a theoretical framework

Discrimination affecting persons living with HIV/AIDS, like many other forms of

discrimination, has its roots in a multitude of oppressions including racism, sexism, classism,

heterosexism, ableism, and religious oppression. Moral judgment of persons living with HIV,

fear of health risks, and fear of sexuality in general all contribute to the problem. Stigmatization


is at the core of discrimination against persons living with HIV. The ACLU, one of the leading

advocates for civil rights for persons living with HIV, notates stigma, fear of disclosure, privacy,

criminal prosecutions, mandatory testing, and discrimination as the leading concerns of the

community of persons living with HIV and of those affected by HIV (Lange, 2003).

From a historical perspective, HIV is one disease by which society judged affected

persons as deserving of the illness. One assumption expressed about persons living with HIV has

been and continues to be that they are gay, intravenous drug users, or both and through their own

conscious actions (or inactions) they have acquired HIV as a natural consequence (Herek &

Capitanio, 1993). Ryan White, a young boy who contracted HIV from a blood transfusion, was

neither gay nor an intravenous drug user and, having contracted HIV through no direct fault of

his own, was a major factor that led the popular perception to change. In a 1992 interview with

the New York Times, White’s mother spoke to the consequences of the stigma she, her son, and

his sister faced until his death in 1990. The death of Ryan White, Jean White says, offered an

innocent face to place with the illness and a catalyst for a changing dynamic (Witchel, 1992).

The necessary imperative is to analyze the structure of power and the intersection of

social class, race, and sexuality. HIV infection rates are higher among vulnerable groups such as

African-Americans, Latinos, men who have sex with men, and persons living in poverty and the

data offers a corollary to suggest why (CDC, 2013). One seminal analysis from Gillespie,

Kadiyala, and Greener (2007) agrees: “Poverty and food insecurity are thought to increase sexual

risk taking, particularly among women who may engage in transactional sex to procure food for

themselves and their children.”


In terms of sexuality, one hypothesis is that this power structure forced homosexual

relations into bars, clubs, and bathhouses and into more risky sexual explorations thus generating

a higher rate of infection. Similarly, religious doctrine can compel congregants to forego safe sex

practices. And, patriarchy can demand subjugation of women in such a way that increases rates

of transmission.

Social Work Implications

Without a doubt, persons living with HIV represent a vulnerable group that faces

discrimination and stigmatization. Social Workers have a professional ethic that demands service

towards vulnerable and oppressed populations (Code of Ethics, 1996). Social justice is at the

core of this service. One value intrinsically relevant to persons living with HIV is the dignity and

worth of the person. For a group stigmatized as undesirable and flawed, social workers must

demand dignity for these persons and build on the inherent worth of each of them. In carrying

out these tasks, the ethics of integrity and competence reveal a need to be knowledgeable about

the issues faced by persons living with HIV and to confront prevailing fears both personal and

societal.

Social Policy Implications

The necessary social policies to rectify the problems faced by persons living with HIV

should include guaranteed access to life-saving medications and medical care, educational

opportunity, employment and protection from discrimination, and a more modern penal code that

accounts for the complexities of living with HIV. Recognizing the stigmatization of persons

living with HIV, governmental intervention is necessary and proper to ensure a fulfillment of the

rights and freedoms inherent to human life. This change in social structure would not only fulfill


these rights and freedoms but also lower the rates of infection among the poor, oppressed, and

vulnerable populations who are most affected by HIV.

Social Justice

With a personal focus on social justice, this author is compelled to advocate on behalf of

persons living with HIV in such a way as to secure the fundamental rights and liberties of

personhood and a more adaptive societal response to the needs of the individuals affected by

HIV. Johnson (2006) offers an excellent framework for this task: “Identify points of leverage

where change can begin…acknowledge that privilege and oppression exists…pay attention…

learn to listen…do something.” The points of leverage are the denial of access to education to

children, unjust civil and criminal laws that harshly punish individuals pursuing fundamental life

needs and desires, and individuals dying because hospitals and other care facilities refuse to treat

them or because they cannot afford the care they need to survive.

Conclusion

The discrimination persons living with HIV endure is unjust and unfair but takes place

primarily out of lack of information or misinformation. The approximately 1, 144,500 people in

the United States living with HIV require the social work profession to work on their behalf to

eliminate the inadequate and harmful systems that work to oppress this vulnerable population

and replace these with systems that more fully address the unique needs of this community.

Social workers must work to keep families together, ensure fair employment, access to medical

care, and education, and for justice. By listening to the voices of those affected by HIV, social

workers can gain a greater understanding of these needs and promote a greater wellbeing for

these vulnerable members and society as a whole.


References

Bergan, S. (2013). Kids kicked out of school because of HIV concerns, disability group

says. KFSM 5 News. Pea Ridge, AR. Retrieved from website:

http://5newsonline.com/2013/09/13/hiv-concerns-keep-kids-out-of-pea-ridge-

schools-disability-group-says/

Centers for Disease Control and Prevention (CDC). (2013). Diagnosed HIV infection

among adults and adolescents in metropolitan statistical areas—United States

and Puerto Rico, 2011. HIV Surveillance Supplemental Report 2013. Retrieved

from web site: http://www.cdc.gov/hiv/library/reports/surveillance/.

Center for HIV Law and Policy, (2010). Ending & defending against HIV criminalization

a manual for advocates. Positive Justice Project. Retrieved from website:

http://hivlawandpolicy.org/sites/www.hivlawandpolicy.org/files/Criminalization

%20Manual%20%28Revised%2012.5.13%29.pdf

Center for HIV Law and Policy, (2010). HIV/AIDS and employment discrimination: A

primer. Retrieved from website:

http://www.hivlawandpolicy.org/sites/www.hivlawandpolicy.org/files/CHLP

%20Employment%20Primer%20sept%202010%20FINAL.pdf

Code of Ethics of the National Association of Social Workers. (1996). Retrieved from

http://www.socialworkers.org/pubs/code/code.asp?print=1&


Gillespie, S., Kadiyala, S., & Greener, R. (2007). Is poverty or wealth driving HIV

transmission? AIDS, 21(7). Retrieved from

http://www.researchgate.net/publication/5807996_HIV_infection_does_not_dispr

oportionately_affect_the_poorer_in_sub-Saharan_Africa/file/

d912f508e401776a6f.pdf

Herek, G., & Capitanio, J. (1993). Public reactions to AIDS in the United States: A

second decade of stigma. American Journal of Public Health, 83 (4), 574-577.

Retrieved from

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1694493/pdf/amjph00528-

0096.pdf

Hernandez, S. (2013). Sex, lies & HIV: When what you don’t tell your partner is a crime.

ProPublica. Retrieved from website: http://www.propublica.org/article/hiv-

criminal-transmission

Johnson, A. (2006). What can we do? Privilege, power, and difference (2nd Edition). New

York: McGraw Hill.

Lange, T. ACLU AIDS Project, (2003). HIV & civil rights. Retrieved from website:

https://www.aclu.org/files/pdfs/hivaids/hiv_civilrights.pdf

Martinez, M. and Johnston, C., (2011). Student with HIV sues private residential school

for denied admission. CNN. Retrieved from website:

http://www.cnn.com/2011/12/01/us/pennsylvania-hiv-hershey-school


Rand Corporation, (2009). How parental HIV affects children. Retrieved from web site:

http://www.rand.org/content/dam/rand/pubs/research_briefs/2009/RAND_RB937

2.pdf

Witchel, A. (1992, September 24). At home with Jeanne White-Ginder; a son's AIDS,

and a legacy. The New York Times. Retrieved from

http://www.nytimes.com/1992/09/24/garden/at-home-with-jeanne-white-ginder-a-

son-s-aids-and-a-legacy.html

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