Drs. Ram Yogev and Patricia Garcia have much in common with Bernard Rieux, the physician and secular saint of Camus’ The Plague. Yogev, director of the Section of Pediatric and Maternal HIV Infection at Children’s Memorial Hospital, and Garcia, director of the Women’s Program of the HIV Center at Northwestern Memorial Hospital, must daily roll up their sleeves and battle despair as the infection rate in the populations they serve continues to climb, and the ignorance and misunderstanding of self-appointed experts flows unabated. Ten years ago women made up only 6 percent of reported HIV infected persons in the country; today the figure is 18 percent. Of those women, over three-quarters are African American or Latina–a particularly sobering statistic considering that African Americans and Latinas represent only 20 percent of U.S. women. The Centers for Disease Control and Prevention (CDC) say that by the year 2000 AIDS will be the number-two killer of women between the ages of 18 and 44. Given the dismal record of government-funded preventive education directed toward women, as well as the current lack of access to health care faced by so many poor women of color, no one realistically expects that the percentage will drop any time in the near future.
“I have no pressure to bear on Ram or anyone else at Children’s,” Garcia says calmly. “I’m just trying to get him to understand from the perspective of a woman and a mother.”
Such initiatives failed in large part because their punitive agendas patently overshadowed any claims made in the name of public health. It was impossible to justify rounding up huge numbers of people and testing them for something that couldn’t be cured, and for which standard medical treatment included the administration of some of the most toxic and expensive drugs ever devised–assuming, of course, that those infected could find competent doctors willing to touch them. (The AIDS division of the New York City Commission on Human Rights found that two-thirds of the clinics and private doctors surveyed would not keep their appointments once the caller identified her serostatus.) Given this climate, the real intent behind such legislation was clear: we don’t want to help you, we just want to know who you are.
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On the morning of Friday, March 3–the day after Roy Baron, Maureen’s husband, had testified before the Health Care and Human Services Committee–the mood at the AIDS Foundation of Chicago was cautiously pessimistic at best. Spirits had been high a week before, when the Illinois State Medical Society, one of the most powerful lobbying presences in Springfield, came out against the bill (perhaps trying to atone for its current support for the mandatory reporting of all HIV positive individuals by name to the Department of Health).”The bill may be dead,” Michelle Mascaro, policy associate for the AFC, had told me enthusiastically. But now the bill’s passage seemed as imminent as Christmas decorations on the day after Thanksgiving: Baron, the only one to testify that day, reportedly had had everyone weeping. “Mr. Baron’s tragedy is very real,” Mascaro told me, “but I don’t know what it has to do with the legislative process.” A second day of testimony was scheduled for Wednesday, March 8, and to the great alarm and dismay of most AIDS service providers, Dr. Yogev–smart, articulate, and well-respected–planned to testify in favor of the bill. Dr. Garcia was testifying on the other side.
If Yogev is the right-wing zealot his detractors make him out to be, he does an expert job of concealing it. Rather, he seems deeply troubled, caught in an ethically ambiguous position. “We’re doing wrong by taking away the right of the woman to make the decision, yes or no, to have the test,” he admits. “But we’ve reached a point in my personal book of ethics where there is more good that outweighs the bad I’m doing.” The good Yogev foresees is twofold. First, routine testing affords the opportunity to provide early intervention to HIV positive pregnant women. “As a physician,” he explains, “I need to identify that person as early as possible to then work with the person, connect her with the experts.” Second, of course, is the potential for AZT to reduce the risk of HIV transmission to her baby. “In treating pregnant women,” he says, “we’re dealing with two human beings.”
Most supporters of HB 1314, including Yogev, generally discuss only the risk of perinatal transmission. But what of the risks for the woman, the social stigma and discrimination she faces when she discovers she’s HIV positive (factors Yogev did ultimately acknowledge in his testimony)? What of the risk of losing her job, her insurance, and the support of a frightened family? And perhaps most important, what of the risk that the very doctor who delivers the devastating news will turn his back on her at the time she needs him most?
