If Only AIDS Were Different!

Abstract

In most Western European countries and North America, strategiees to contain the spread of AIDS have emphasized civil liberties. This may be due more to the epidemiology of the disease than to moral progress. When the plague claimed its first victim in the Derby, shire village of Eyam on 7 September 1665 the villagers were faced with a terrible dilemma, one that presents itself to all those with a communicable disease. The dilemma, simply stated but often agonizingly difficult to resolve, is how those who have the disease or are at acute risk are to understand and discharge their responsibility to limit its spread. Eyam presents one celebrated and terrible solution. As the infection spread, the rector, William Mompesson, and his nonconformist colleague, Thomas Stanley, persuaded the villagers to impose on themselves a voluntary quarantine. remaining in the village and so reducing the chances of the plague's spreading throughout Derbyshire. In accepting this responsibility the villagers must have known that they would probably contract the plague and so die. As the plague took hold, Mompesson arranged for supplies of food and other necessaries to be left at the boundary stone of the village; the payment was disinfected by placing the coins in running water or vinegar. All in all about 260 villagers were claimed by the plague, a heroic shouldering of civic and moral responsibility felt and acted upon in the absence of any social welfare provision or reciprocal care for the diseased. Nor was there compensation for those who took on the burdens and dangers of voluntary quarantine. AIDS has not so far required (or even raised questions about) a comparably dramatic response. In most Western European countries and in North America the response to the AIDS epidemic has been characterized by a relatively liberal approach, thereby distinguishing it from the draconian measures often instituted in the past when an epidemic arose. We do not expel those infected with HIV from society, require them to wear special clothes, or demand that they ring a bell and shout unclean when they enter human habitations.[1] Nor for that matter have those infected with HIV imposed such restrictions on themselves. There have of course been departures from the liberal approach, but all in all, the Western European and North American countries have put a value on the individual liberty of citizens higher than that put on the interests of society in controlling the spread of the disease. The liberal nature of the present response could be taken to indicate that our societies have progressed morally, leaving an old ethics of control, punishment, or self-denial behind and embracing a new morality of individual autonomy and freedom. There is undoubtedly some truth in this interpretation. We would, however, like to suggest that the difference in the response to the AIDS epidemic compared to previous epidemics is not only the result of a change in society's ethics. Specifically we want to suggest that two crucial features in the natural history of HIV infection have allowed a more liberal response toward this epidemic than would be possible or even desirable toward other actual and possible epidemics with a deadly disease. These features are: 1. the low infection rate of the human immunodeficiency virus, which is a result of 2. the inability of the virus to be transmitted by normal social contact or even through ordinary contact with, for example, excreta from infected persons (see below). If it is true that the liberal response to the AIDS epidemic is not primarily caused by a change in social ethics, but is predicated on features specific to the natural history of HIV infection, then this fact has major implications, not only for our understanding of how social ethics have evolved but perhaps more crucially for our use of the AIDS epidemic as a model for future policy. …