HIV: Covered By Disabilities Act, Supreme Court Rules
In a close decision yesterday, the U.S. Supreme Court ruled that Americans with HIV are protected from discrimination under federal law. The Court ruled 5-4 that the 1990 Americans with Disabilities Act, which prohibits discrimination in employment, housing, medical care and other public services, covers HIV-positive people even if they have no symptoms of AIDS. At the center of the case was Sidney Abbott, a Maine woman who was refused care in her dentist's office because she was infected with HIV. While "the Court stopped short of ruling flatly that HIV infection is automatically covered by the disability law," the New York Times reports that the court found the woman's infection put her within the law's definition of a disability by "substantially limit[ing]" a "major life activity" -- reproduction (Greenhouse, 6/26). "Reproduction falls well within the phrase 'major life activity,'" Justice Anthony Kennedy wrote in the Court's majority opinion. "Reproduction and the sexual dynamics surrounding it are central to the life process itself" (Elsasser/Berger, Chicago Tribune, 6/26).
An Important Victory
The Washington Post calls the ruling "a striking mixture of compassion and precise clinical understanding about a disease that often has been highly stigmatizing." AIDS activists said the Court's ruling could be a boon to public health, prompting more people to be tested for the virus without fear that infection could jeopardize their jobs or access to services (Biskupic/Goldstein, 6/26). "This decision is a timely reminder that license must never be given to employers, doctors, dentists, or anyone else to mistreat, punish or turn away people with AIDS," said Gay Men's Health Crisis Executive Director Mark Robinson (GMHC release, 6/25).
Medicaid Coverage For HIV?
Others noted the decision could provide leverage in the push for Medicaid coverage for HIV-infected patients. (The federal assistance program now covers only individuals with full-blown AIDS.) In a letter to Health Care Financing Administration head Nancy-Ann Min DeParle, AIDS Action Executive Director Daniel Zingale wrote, "[D]espite the Court's recognition of the new medical significance of asymptomatic HIV disease, federal programs have yet to make this important distinction ... [T]he federal government is telling low-income HIV-positive Americans that they can't receive AIDS-preventing drugs until they develop AIDS. If automobile safety regulations followed this model, air bags would only be required in cars that have already crashed" (AIDS Action release, 6/25).
More Than AIDS
Observers say the ruling has broad implications for all disabled Americans, not just people with HIV, the San Francisco Chronicle reports. It could affect Americans who have "such diseases as diabetes, epilepsy, asthma and breast cancer but who display no symptoms" because they have been successfully treated for the disease. "It is bizarre and ironic that as medical technology has improved and people can now live their lives fully ... that they would lose their civil rights protection and the courts would condone discrimination," said Arlene Mayerson, an attorney for the Berkeley, CA-based Disability Rights and Education Defense Fund (Freedberg, 6/26). ACLU attorney Jennifer Middleton, asked if there are other diseases will be covered by the ADA now that this ruling has been handed down: "I think what is exciting about this decision is that it is rejecting some of the narrow and hyper-technical readings of those terms that the courts were doing below. Some of the lower courts have been setting up an obstacle course for people with disabilities to jump through to prove just simply that they have a disability and should be covered by the law. This decision doesn't do that. It looks at what Congress was thinking ... when it wrote the law and said this is a civil rights law. ... This will help everyone in the lower courts who's trying to defend their civil rights" ("Morning Edition," 6/26).
But the ruling's significance to the AIDS community is even more far-reaching, advocates say, because discrimination is widespread even in communities where HIV is common. "I talk hourly and daily with people who face employment discrimination, people who are told they can't receive services, people who tell me a chiropractor or a massage therapist refuses to treat them," said Betsy Johnsen, an attorney with the San Francisco-based AIDS Legal Referral Panel (San Francisco Chronicle, 6/26).
Is AIDS Ever Asymptomatic?
The Washington Post reports that Centers for Disease Control and Prevention statistics show about 400,000 to 650,000 HIV-infected individuals are not "sick enough" to qualify as having AIDS, though "[i]t is unclear how many of those people are symptom-free." In writing for the Court yesterday, however, Justice Anthony Kennedy said it is a "misnomer" to call the virus asymptomatic. "In the light of the immediacy with which the virus begins to damage the infected person's white blood cells and the severity of the disease, we hold it is an impairment from the moment of infection," Kennedy wrote (6/26).
Still unanswered is whether Abbott's dentist, Randon Bragdon, was right in insisting she pay to have cavity filled in the hospital instead of in his office, USA Today reports. The ADA "permits the disabled to be treated differently if they pose a 'direct threat to the health or safety of others.'" The Supreme Court sent the case back to a Massachusetts federal Court of Appeals to decide if the dentist's refusal to treat her in his office was "medically justified" (Bayles, 6/26). The ACLU's Middleton said the Court's ruling rejects Bragdon's claim that "he could essentially use his own judgment to decide whether Ms. Abbott posed a risk" to the health and safety of his staff. "The CDC has repeatedly found that treating people in dentists' offices ... is perfectly safe, and I'm sure that the courts below will find the same thing," she said ("Morning Edition," 6/26). Click here to read an excerpt of yesterday's ruling.