When I was a high school senior, I participated in a model U.S. Congress simulation. The statewide event was meant to show us how laws were made. Each of us submitted a bill ahead of time, and it was assigned to a committee where it was debated and put to a vote. If passed, it would go on to the full floor. I was assigned to a health and education committee.
One of the bills on the docket proposed sending all AIDS patients to quarantine in Alaska to keep the rest of the country “safe” from HIV.
It was 1989. The AIDS epidemic was still relatively new. Misinformation was abundant, and people were scared. Actual lawmakers had proposed similar legislation. But even as a 17-year-old, I knew that the answer was not to imprison or exile people. I could not wait to tear into this bill during committee debate.
I hadn’t thought about that debate in years until last Tuesday, when Georgia state Rep. Betty Price (R-Reardon) brought up quarantine in comments that seemed to look back fondly on the days when people erroneously thought HIV could be transmitted via toilet seats and those with AIDS often died painful deaths.
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In the almost 30 years since my experience sponsoring mock legislation, medicine has made great strides in treating HIV as a chronic condition and enabling people live long, healthy lives. But Price’s comments show that, medical advances aside, we’ve yet to overcome the stigma that has always surrounded this epidemic.
What She Said
Price’s comments were made during a meeting of the House Study Committee on Georgians’ Barriers to Access to Adequate Healthcare, of which she is a member. Price (the wife of former U.S. Health and Human Services Secretary Tom Price, who resigned after a scandal over inappropriate use of taxpayer funds for travel) was questioning Dr. Pascale Wortley, head of the state health department’s HIV epidemiology division, about the large number of Georgians with HIV who are not getting regular care.
She asked: “I don’t want to say the quarantine word, but I guess I just said it.”
She continued: “Is there an ability, since I would guess that public dollars are expended heavily in prophylaxis and treatment of this condition? So we have a public interest in curtailing the spread. What would you advise, or are there any methods legally that we could do that would curtail the spread?”
And finally, she said: “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. So we’ve got a huge population posing a risk if they are not in treatment.”
Though the idea of quarantines made most national headlines, the further suggestion that it was better when HIV-positive people died quickly is far more offensive. No one should want to go back to a time when we didn’t have effective treatments—not just because treatment helps people with HIV live long and productive lives, but also because treatment is prevention and the main reason the epidemic has slowed.
What She Should Know About Advances
The troubling thing is that Price is a physician. She graduated from McGill Medical School in Quebec and did her residency in anesthesiology at Emory University. It was there that she met her husband Dr. Tom Price, who served as the U.S. Representative from Georgia’s Sixth District before he was tapped by President Trump to be secretary of Health and Human Services. Though their training was many years ago and neither practice medicine anymore, both Drs. Price should have kept up with the advances in the the treatment of HIV and AIDS.
Today, people who test positive for HIV are given a combination of drugs called anti-retroviral therapy (ART). These drugs prevent the virus from replicating in blood, which in turn prevents it from attacking the immune system and making the person unable to fight off infection. The amount of virus in a person’s blood is referred to as their “viral load.” Less than 200 copies of the virus per milliliter of blood is considered a low viral load. Sometimes, these drugs do even better than that and suppress the virus to the point where it cannot be detected in a blood test.
As Rewire recently reported, the Centers for Disease Control and Prevention (CDC) now says that people with an undetectable viral load cannot transmit the virus. In fact, the CDC fact sheet on transmission now reads: “People living with HIV who take HIV medicine as directed and get and keep an undetectable viral load have effectively no risk of transmitting HIV to their HIV-negative sexual partners.”
Low viral loads can also prevent mother-to-child transmission of HIV. If a woman takes HIV medications during pregnancy and her baby is given medicine for the first four to six weeks after birth, the chance of the baby having HIV is just 1 percent or less.
What She Failed to Ask About Georgia
As outrageous as Price’s comments were, her question did hint at actual issues. For one thing, she correctly identified a problem: the number of people in her state who are not receiving proper care.
The Georgia Department of Public Health reports that in 2016, 64 percent of the 53,385 people living with HIV received care at least once, but only 49 percent were retained in care (defined as having been seen twice during the year at least three months apart). Ultimately, only 51 percent of HIV-positive people in Georgia are virally suppressed. The data show that retention is the most important factor, as 85 percent who continue care are virally suppressed.
Rep. Price is also not wrong that a lot of money is spent in her state to treat and prevent HIV. A CDC model from several years ago suggested that Georgia spent $761 million in lifetime treatment fees for the roughly 2,000 people newly diagnosed in 2009. Costs may have changed since then, but the number of new cases diagnosed annually remains similar—there were 2,688 new diagnoses in 2015.
And, of course, she’s not wrong that the state has a public interest in curtailing the disease. It is incumbent on all states to protect their citizens from preventable diseases.
Rather than jumping from costs and treatment to quarantine and bygone eras of quick deaths, Price should have urged her committee to examine barriers that inhibit prevention and treatment efforts.
It is clear, for example, that race and ethnicity play a role in HIV treatment in Georgia. Among those diagnosed with HIV in 2015, 76 percent of whites were linked to care within 30 days compared to 65 percent of Latinos and 62 percent of Black people. Within this group, 69 percent of whites were retained in care compared to 62 percent of Latinos and 58 percent of Black patients. Not surprisingly, as a result of this imbalance in care, more whites newly diagnosed in 2015 reached viral suppression than Latinos or Black Americans.
But Price didn’t address these disparities in her remarks. Instead, she illustrated the very stigma that HIV-positive individuals in her state and around the country continue face.
An Apology of Sorts
I don’t remember what I said during my model Congress committee debate. Maybe I pointed out that quarantine has always been reserved for diseases that spread quickly and easily from one person to another: tuberculosis, smallpox, and the plague. And that HIV did not meet this standard because—even 30 years ago—transmission was not possible with casual contact. Even at the height of hysteria about the virus, very few public-health institutions took the idea of quarantine seriously. That said, the idea popped up as recently as 2013, when a Kansas proposal tried to include people with HIV in quarantines of those with communicable diseases.
I also hope that I screamed really loudly about the injustice of taking away freedom and civil liberties from fellow Americans. Maybe I even touched on the homophobia that was so clearly behind all of the discussions of quarantine or calls to punish those with the virus for sexual activity or blood donation.
After critics disparaged her comments and her medical knowledge, Dr. Betty Price walked back her comments on quarantine—a little bit. In a statement to the Atlanta Journal Constitution on Saturday, she wrote: “I made a provocative and rhetorical comment as part of a free-flowing conversation which has been taken completely out of context. I do not support a quarantine in this public health challenge and dilemma of undertreated HIV patients.”
Price’s apology seems slightly more informed than her original statements. “We have come so far in HIV treatment, to the point where an HIV patient receiving recommended treatment is no longer able to transmit the disease to another person,” she noted.
But while she didn’t banish anyone to Alaska, even her apology had a note of stigma in it. She seemed to put the blame on HIV-positive individuals, as she questioned why “too many of our fellow citizens who have HIV are not compliant” and praised “stemming the transmission from a mother to her newborn baby” above all else.
We can only hope that the intense national scrutiny Price brought down on these committee hearings will renew Georgia lawmakers’ commitments to educating themselves, reducing stigma, and increasing investment in both treatment and prevention.