AIDS and Social Work: The Ethics and Civil liberties Agenda

By now, the daunting data associated with acquired immune deficiency syndrome (AIDS) are familiar to all social workers. The exponential growth in the number of the disease's victims during the past decade and the grim morbidity experienced by AIDS patients form a familiar litany in discussions of this compelling pandemic. Social workers, like all other human services professionals, have been confronted with the stark reality of AIDS. No social services setting has been able to avoid it. Practitioners in child welfare and mental health agencies, hospitals, schools, drug and alcohol treatment programs, correctional and psychiatric institutions, and nursing homes are confronting AIDS-related cases. Social workers who a decade ago had scarcely heard of the disease now expect to encounter it regularly. In the past decade, social workers have become much more informed about and skilled at responding to AIDS-related issues. Although the first five years of the disease's history in the United States, beginning in 1981, produced very few publications on AIDS and social work, in recent years social workers have been considerably more prolific. Social work's literature now contains much-needed commentary about such issues as survival styles among AIDS victims (Getzel, 1991), the role of empowerment in work with clients who have AIDS (Haney, 1988), psychosocial issues for people with AIDS (Leukefeld & Fimbres, 1987), AIDS-prevention strategies for at-risk clients (Magura, Shapiro, Grossman, & Lipton, 1989), AIDS and women at risk (Buckingham & Rehm, 1987), and clinical issues in AIDS cases (Ryan, 1988). Clearly, within the past five years or so social work practitioners and scholars have begun to generate insightful and influential statements about AIDS. Although significant gaps in the profession's knowledge remain, recent publications demonstrate impressive, albeit nascent, progress. What has been curiously lacking in social work's evolving discussion of AIDS, however, is in-depth, sustained analysis of the ethical and civil liberties issues that the AIDS crisis has spawned. Although there are several exceptions (Reamer, 1988, 1991a; Ryan & Rowe, 1988), by and large social workers have not paid sufficient attention to the large number of complex ethical and civil liberties issues that have profound implications for the profession. Moreover, since the earliest publications on the subject (Reamer, 1988; Ryan & Rowe, 1988), several years have passed during which a number of new issues have emerged. Thus, at this point in the profession's history, and particularly in light of the rapidity with which new complications continue to appear, it is important for social workers to be acquainted with what is currently known about ethical and civil liberties issues that may affect their work related to AIDS. The AIDS crisis has provided a unique challenge to social workers, who simultaneously value enhancement of public health and protection of civil liberties. Although public health concerns and civil liberties do not necessarily clash, they sometimes do. Regrettably, the AIDS crisis has exacerbated this occasional tension (Bayer, 1989, 1991). At present, there are several ethical and civil liberties issues that have direct bearing on social workers' involvement in AIDS-related cases: mandatory screening and testing of clients for the human immunodeficiency virus (HIV), client access to health insurance, professionals' duty to treat HIV-infected clients, privacy and confidentiality, client involvement in AIDS research, and related legal issues. Mandatory HIV Screening and Testing Since the onset of AIDS, there have been diverse calls for aggressive HIV screening and testing ("screening" usually refers to testing of groups, whereas "testing" usually refers to testing of individuals). Although some of the proposals have pertained to large segments of the population (for example, all newborns and marriage license applicants), most have focused on at-risk groups of particular concern to social workers: hospital and psychiatric patients, substance abusers, inmates in correctional institutions, refugees and other immigrants, and low-income pregnant women (Andrus et al. …