In regard to James Bovard's March 23 editorial-page piece
"Disabilities Law, Health Hazard": Mr. Bovard makes the case that
the Americans with Disability Act endangers people by exposing them
to the hazards of HIV transmission. To date, there has been only one
documented instance of caregiver-to-patient HIV transmission in
America; this case was reported in Florida a few years ago. On the
other hand, the ADA has kept thousands of Americans with
disabilities working and leading healthy and productive lives. Mr.
Bovard inaccurately incites fear in many readers and leads them to
believe the government is doing the country a disservice by
implementing the ADA.

In one instance, he tells the story of a District of Columbia
court that ruled that a D.C. firefighter was denied his rights by
not being allowed to perform mouth-to-mouth resuscitation because he
had hepatitis B. The ADA requires employers to reach reasonable
accommodations with employees to allow them to continue working.
Reasonable accommodations include the use of flexible schedules,
special facilities and mechanisms that will allow the employees to
continue in their task without unduly burdening the employers. In
the case of the firefighters, there are two simple devices that most
Emergency Medical Services use that can easily solve that problem:
the first is a mechanical respiratory assistance device that allows
the EMS worker to avoid mouth-to-mouth contact completely, and the
second is a mouthpiece developed years ago to prevent mouth-to-mouth
contact between the EMS worker and the patient.

Mr. Bovard also states that there are 7,000 HIV-positive
physicians practicing in the U.S. This is a gross inaccuracy.
According to the best figures, the highest accurate estimate of the
number of practicing HIV-positive physicians is 2,300. I think that
the number used by Mr. Bovard actually refers to the total number of
cases of HIV infection among physicians since the epidemic began.
Most of those 7,000 infections were contracted outside the
workplace, and of that number, most of the infected physicians have
already died. Mr. Bovard continues by saying that the chance of an
HIV-positive doctor infecting a patient is 8.1%. Probability
arguments tend to be confusing. However, after more than a decade of
dealing with HIV, we have only one documented instance of
provider-to-patient transmission. HIV transmission is preventable,
and we have the tools and the knowledge to keep people safe and
healthy.

The key to dealing with this serious issue is not to discriminate
or incite hysteria. We must be certain that universal precautions
against blood-born pathogens are applied consistently and correctly
in places where risk of occupational exposure may be greater.
Regardless of whether a person is a physician, dentist, nurse or
patient, it is not always possible to know in advance if he or she
is HIV positive. There is no reason to be "extra cautious" only in
select cases. For the safety of everyone involved, all caregiving
situations must be treated the same. Health care workers and
patients should be cautious and safe every time. This is certainly
possible within the framework of the Americans with Disabilities
Act.

Kristine M. Gebbie, R.N.

National AIDS Policy Coordinator

Executive Office of the President

Washington