To the editor:

Earlier in December, as I read The Gloucester Daily Times on line from afar, I could not believe I was reading a story about recently proposed legislation that, if I understood the article correctly, would allow first responders to mandate the people they assist be screened for HIV.

In June, it will be 39 years since the first cases of what ultimately became known as the global AIDS pandemic were detected in a small cohort of seemingly healthy, young, gay men in Laguna Beach, California.

In the almost four decades since that dark June, if there is one thing we have learned about HIV it is that it is, thankfully, a fairly difficult virus to transmit.

First responders and other health care professionals don’t need legislators stoking the flames of fear, ignorance and even bigotry with calls for mandatory HIV screenings of the people they assist. They just need to do what every informed, responsible, and professional EMT, RN, LPN, and MD has been doing for decades now — practice universal precautions all the time.

Even the most efficient modes of transmitting HIV — unprotected, receptive, sexual intercourse, whether vaginal or anal, or the sharing of needles with an infected person — are not terribly efficient.

In fact, statistically speaking, the odds that a person who engages in a single episode of unprotected sexual intercourse, or needle sharing, with an infected person will themselves become HIV-positive are very low.

Does it happen? Of course, but it is rare.

One of the things those of us who worked in HIV prevention, counseling and testing in the 1980s and 1990s learned was that most people who became HIV-positive in those years had other social, physical and behavioral issues in play that likely contributed to their becoming HIV-positive.

We came to call them “co-factors.”

For example, many gay men of my generation who tested positive for HIV often had significant histories of infection with other STDs before becoming HIV-positive. In addition, the risk assessments done during anonymous pretest counseling sessions revealed many men were under the influence of alcohol or drugs, or both, when they engaged in the type of sexual behavior that was the primary means of transmission among gay men.

In short, those men were often already immunocompromised. Among the addicted needle using/sharing population, being severely immunocompromised was the norm.

The introduction of HIV into already immunocompromised populations was a recipe for a public health disaster.

The state representative who has proposed this misguided legislation, and those who have signed on in support of it, ought to be ashamed of themselves. Whether intentionally or not, they are rekindling the kinds of fear and ignorance about the epidemic that were so prevalent 25 and 30 years ago.

If they are truly concerned about stopping the spread of HIV, they should be calling for increased funding for drug and alcohol treatment programs .

If they are truly concerned about stopping the spread of HIV, they should be calling for the restoration of funding for the kinds of comprehensive health and sex education curricula, especially for adolescents and young adults, that proved so effective at lowering HIV and other STD infection rates in the 1990s and early 2000s.

No group of young Americans would benefit more from such a public health initiative than young gay and bisexual men between the ages of 16 and 34.

A visit to the Centers for Disease Control and Prevention’s website is all it takes to see that there is a bad moon rising among this younger generation of men in relation to both STD and new HIV infection rates.

What is needed today are political leaders who have the courage and intelligence to embrace sound public health policies and practices, not politicians who fall back on the disgraced and discredited kinds of fear mongering and ignorance so many people worked so hard to combat over the last 39 years.

Come on, Massachusetts, surely we can do better than that.

Michael Cook


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