Focus on Education; Legal Rights of Children with AIDS, Part 1 and 2

Welcome to Focus on Education, a continuing radio series highlighting events and programs at the University of New Mexico's College of Education. I'm Roger Kroth. For this today is Professor Ruth Lukasen. Ruth Lukasen is a lawyer and associate professor of special education at the University of New Mexico in Albuquerque, New Mexico. She serves as a coordinator of mental retardation services and teaches graduate courses in special education law and legal rights of persons with handicaps. Previously she was the managing attorney for the New Mexico Protection and Advocacy System. She serves on many national boards and commissions, including the American Bar Association coordinating committee on AIDS.

Professor Lukasen, why is a special education professor on the National Bar Association for AIDS? The American Bar Association recognized early on in the AIDS epidemic that many of the problems people with AIDS or people with HIV would encounter would be legal problems. These problems would include questions of access to health care, of paying for health care, of insurance issues, the employee rights of people with HIV, discrimination issues for people with HIV, housing problems, and also problems of privacy and confidentiality. When the American Bar Association realized that many of these legal problems would be encountered by many people with HIV, the American Bar Association decided to coordinate its efforts and the president of the American Bar Association appointed a 10 member committee

called the coordinating committee to coordinate all of the American Bar Association's efforts in this area. I was appointed because I'm a member of the Commission on the Mentally Disabled, which is an American Bar Association entity, and because many of the issues facing people with HIV are disability-related issues or handicapped-related issues, it was thought to be essential to have a representative from the field of disability on this coordinating committee. I see. You used the initials HIV, is HIV and AIDS, is that synonymous? HIV is the umbrella term that covers all aspects of the infection from the mere presence of antibodies through the full-blown AIDS condition. The AIDS is an infectious disease that destroys the body's immune system over a period of time

and allows opportunistic infections to then cause the serious effects of AIDS that we've come to recognize. Are there children with AIDS in school today? There are in this country some over 1,000 children who have AIDS. There are a smaller number of children with AIDS than there are adults with AIDS. Children with AIDS are currently only 2% of the entire AIDS population. We can be certain, however, that there are some children with AIDS in the public schools that we recognize, that is, we recognize those children who have it. There are also children who have various stages of the infection who we probably don't recognize. Can you tell by just looking at these children that whether they have AIDS or not? No.

You cannot tell. In most cases you cannot tell. There would be some cases where it would be readily apparent, but in most cases you can't tell. Well, how did they get AIDS? These children can be divided into two categories. The group of children who are under 13 probably got AIDS primarily from their parents, primarily from their mothers. Most of these children got the infection from their mother during the perinatal period. 76% of the children acquired it in that way. 14% acquired it from transfusions that were unrelated to hemophilia, while 6% acquired it from transfusions related to hemophilia. There's another 5% of these young children where we can't determine how they acquired the AIDS. In contrast, for adolescents, the transmission of HIV was related more frequently to their own risk behaviors, as opposed to the risk behaviors of their parents.

For adolescents, the categories currently are 49% homosexual or bisexual males, 27% infected blood or blood products, 9% heterosexual contact, and 7% heterosexual intravenous drug users. So there's a real difference depending on the age of the child, how the AIDS was acquired. I think one of the things that is of concern is can other children catch it from a child who has AIDS in the school. Certainly that is a concern that arises very often, because we as a society are extremely concerned about the safety of our children and about keeping schools a safe environment for children. However, there have been no documented cases of children acquiring HIV in the school setting. The transmission of HIV falls within very limited categories.

It is primarily transmission through blood or semen. Sexual contact in a number of research projects has been demonstrated not to be a factor, and thus people are not going to catch HIV from sharing drinking glasses, or from kissing, or touching, or playing together, or using the same toilet, or using the same toothbrush or the same razor, those forms of casual contact will not pass the infection. As children are at risk of acquiring AIDS only in circumstances where they catch it during birth from their mother, or from sharing needles during drug use, or from blood transfusions. It's important to point out that donating blood is not risky.

It's receiving unscreened blood that is risky. There is currently, in this country, a widespread program for screening blood, and people should no longer be at risk when they are blood recipients. I'm sure that reassures many people. However, I see on the news every once in a while, a policeman wearing rubber gloves and things like this, are we going to have to say to our teachers, well, you have a child with AIDS in your classroom, you're going to start wearing rubber gloves? There are a number of recommendations put out by the Centers for Disease Control on how to limit the risk of HIV transmission in the school setting. Exposure certainly does need to be limited, and there are certain recommendations that if, for example, a teacher is cleaning up a blood spill, or a janitor is cleaning up a blood spill, that they should use proper infectious disease control, which might include wearing

gloves and would also include using a mild bleach solution to clean up the spill. Others recommend wearing rubber gloves, perhaps when changing diapers. Part of the reason for that is that people who have HIV are very susceptible to infection. So the person changing the diaper does not want to pass an infection along to the child. But some people do recommend using rubber gloves when changing diapers. I guess so much of the public's fear has to do with the fact that from what we know, AIDS is a terminal, and we don't have a cure for it. And I suppose this is one of the things that makes people very, very concerned about having children with AIDS in schools or having contact with people with AIDS. Is there been any discussion at all with your group about the legal ramifications of having

a testing program in which all kids entering school would be tested for possibility of having AIDS? The issue of testing comes up frequently in the American Bar Association. That is an important legal issue. It implicates the constitutional rights of an individual to privacy because testing requires an invasion of the person's privacy. The problem with testing and instituting a mandatory testing program is that not only does it implicate the constitutional right to privacy, but it also is very expensive. And when you are doing mandatory testing with a group of people who are not engaged in risk behaviors, the number of false positives is very high.

So there are problems with the results that you get in that with that kind of testing. It's also expensive to test large groups of people. And we have some experience with a mandatory testing program. The state of Illinois passed a state law requiring that all people receive HIV testing prior to being issued a marriage license. The program proved totally unwieldy because of the large number of people involved, because of the large number of false positives, and in terms of cost benefit, it has been found to be not useful at all. I can see the confidentiality issue, but what about the right to know if I'm having to deal with a person who has AIDS or any other infectious disease, a child comes to school with measles, or something that's transmittable?

The measles comparison has come up in a number of states where the state or the local school will attempt to place AIDS or HIV in the same category as airborne infectious diseases like measles. But there's a significant difference in the way that the two are passed, and the conclusion is that AIDS is really improperly placed within that category. The question about right to know does affect some small number of people, but one of the problems in the right to know argument is that the person being tested or her HIV status may not show up for a while, and so the individual that we're seeking to protect from the infection

may be led into a false sense of security because he may or she, for example, a teacher may have a piece of paper that says that the child did not test positive for HIV, but that piece of paper may not reflect the child's current status. He might have acquired the disease since the test was taken, or it might have shown up since that test was taken, and so the conclusion is that we should be treating all children or all people in hospitals as if there is some possibility that they have HIV and be taking proper precautions. Proper precautions include proper infectious byproducts, control, using condoms during sexual intercourse, and taking other barrier kinds of precautions.

Well, now you're talking about some, it sounds to me like some sex education issues. You're talking about that people need to be informed children, need to be informed about the transmission of AIDS. And it seems to me that over the years there's been a lot of controversy over sex education in the schools, aren't you going to run into problems if you try to initiate programs or sex education in schools without, whether it's about AIDS or not? Well, there have been some interesting surveys done on that very topic, and the latest surveys indicate that almost everyone believes that we should be providing AIDS education in the schools, but it's when you get down to the actual implementation that people start to disagree, and the implementation issues involve exactly what you've mentioned, involved issues of how detailed to be in describing the sexual intercourse precautions that are

necessary, how detailed to be in describing the drug using precautions that are necessary, and what the proper balance is between the moral aspects of the issue, or what some people believe to be the moral aspects of the issue, and the purely factual aspects. One of the interesting things about AIDS is that it's really very easy to prevent. We know how to prevent it. You prevent it by making sure that the virus is not passed through semen or bodily fluids like blood, but the change in behaviors that's required in order to prevent it, which is not to share needles to always use a condom, are behaviors that it's taking a while for this population, the population in this country for our society, to acknowledge and accommodate.

Since this is a national problem, and education is supposed to be the responsibility of states, are the things that you're talking about being looked upon as being the responsibility of the federal government, rather than being the responsibility of the state government? No, they're clearly the responsibility of the state and local governments. Education in this country is primarily the responsibility of state governments. What the federal government has been able to do is to promote some guidelines for AIDS education in the schools, and also to contribute some money for the development of proper curriculum and materials and teaching documents that are needed. The AIDS education, which includes both the sex aspects and the drug-using aspects, should be part of any school's good family-living sex education curriculum. It's appropriate for kids from kindergarten through high school.

Now you don't tell all of those kids exactly the same thing, or you don't try to teach them exactly the same thing. A school should develop a curriculum that is an information that's appropriate for kindergartners, then for first graders, then for second graders, all through school. Well, what's to prevent a state then from denying admission to their educational programs if they have AIDS, if it's a state's issue? Well, the states may not act unconstitutionally. And for a state to attempt to deny children with HIV, their right to an education would be a violation of the 14th Amendment of the United States Constitution. It's similar to, and it's useful to think about this, in a comparison to the 1954 Supreme Court case of Brown versus the Board of Education, which was the case that called for a stop to the exclusion of children who are black from integrated schools.

The Brown case indicated that denying education or denying integrated education to children who are black violated their rights to equal protection under the United States Constitution. What principle has been applied not only to children who are black, but to children who are members of other minority groups, and even to children whose parents are illegal aliens. So there is the constitutional equal protection right of all of these children to attend school. There's also two federal statutes that directly apply to this issue. One is Section 504 of the 1973 Rehabilitation Act, which prohibits any program that receives federal funds from discriminating against individuals on the basis of handicap. And for these purposes, we can consider HIV a handicap. There is also a second federal statute commonly called the Education of the Handicapped Act,

or PL94142. PL94142 is the federal statute that creates a right for all handicap children to attend public school. Of course, not all children with AIDS will be handicapped for the purposes of that statute, but many of them will be, and they will have a right to education under that statute. Well, I can see how you can apply the Brown versus the Board of Education in Topeka. This was a race issue, and I can see how you cannot have to discriminate on the matter of sex, but it seems like this might be a little different. Why couldn't someone say, well, we want to do separate but equal, and there's a risk to integrating these youngsters, and so we would like to do hospital schools, for instance. Do you still see that as being a part of the Section 504, or Public Law 94142 that you

referred to earlier? Yes, I do. I believe that that model that you describe would violate the Constitution and would violate at least two federal statutes. Don't I have any constitutional rights as a parent to say I would prefer that my child not go to school with a child who had AIDS? In this country, you would certainly have the right as a parent to prevent genuine harm to your child, but the United States Supreme Court has ruled and re-emphasized again recently that mere ignorance or mere prejudice will not justify exclusion, and what you are describing is not a rational fear, but is a fear based on prejudice and ignorance. Okay.

You've cited a couple of special education laws or statutes. Why is this a special education issue? You said earlier that maybe some of these children would come to school and they're not special education children. Why is this a special education issue? What's going to happen? This is not always a special education issue. For some children with HIV, they will never have the handicaps that will justify their inclusion as a special education child. However, for some of these children, it will be a serious special education issue, and let me describe for you the three ways in which that may happen. Some children will be eligible as handicapped children under the special education statute, because they had a handicap, for example, mental retardation, before they ever acquired HIV.

It's certainly possible, and we can predict that some people who are currently handicapped, who are emotionally disturbed, or who are deaf, or who are blind, or who are mentally retarded, will acquire HIV above and beyond their existing handicap. Those children were eligible for special education services before they acquired HIV, and they will continue to be eligible for their special education services. A second group of children who will be eligible for special education are children who are born with AIDS, who have the AIDS when they're born, and have accompanying handicaps caused by that AIDS. When they're born, they will have central nervous system problems, and they will probably have a developmental disability and maybe some other handicaps. So those children, the minute they are born, are eligible as handicapped, they probably would not have been handicapped, had they not acquired the AIDS from their mother. But once they had the AIDS from their mother, they were an R handicapped and are eligible

for special education. For the third group of children, the children were born normal and acquired HIV, and the HIV is now creating some handicaps in them. For example, they may become health impaired as their health deteriorates further and further. They may become eligible as health impaired under the special education statute. Or they may acquire the dementia that is sometimes associated with AIDS, and that dementia will qualify them as perhaps emotionally disturbed or mentally ill under the special education statute. So the things that happen to them as the AIDS progresses will cause them to be eligible. Those are the three ways that a child might be eligible for special education services. Children with AIDS, these are children that we don't have a lot of history on yet.

We don't know for sure what their future is or do we? Do we have some information, some longitudinal data yet that will tell us what's going to happen to these kids down the line, the children with AIDS or HIV? The preliminary data are not very optimistic on what will happen to these children who have acquired HIV. Things who are born with full-blown AIDS do not generally live to be more than three years old. Babies who are born with the virus but who do not have a full-blown AIDS are of course living longer than that. There are some new data coming out recently that are suggesting that no one who has the virus that not very many people who have the virus will be able to escape it.

And of course we don't have a cure yet. On the other hand, there are some very promising new treatments and the research is indicating that the treatments are promising for children as well as for adults. So I think it's too early to tell what we can predict for these children although we certainly know that many of these children will have a period during which they are very handicapped and will require services that handicapped children require. What kinds of handicaps do you see? Do they become blind or deaf or is there just a general weakening of the system? I think you see this in adults and I don't know whether it's the same as true with youngsters. Well, for infants and children who have a serious HIV involvement, we will see physical weakness, we'll see small size, weight loss, sometimes a progressive paralysis.

Some of these children will be born with mental retardation and other central nervous system involvement and others of these children will acquire mental retardation along the way. Growth abnormalities have been documented. Some disfigurement has been documented. There are certainly cases where dementia occurs and other mental disorders occur. We also see, as we did with children with disabilities 50 years ago, that some of these kids will have failure to thrive, lack of bonding, lack of affection. They will have disrupted caretaking because if you think about the family circumstances of many of these children, they will be often in a single parent family and if they acquired the AIDS from their mother, their mother may have died since they were born or may be very

sick herself. Many of these babies never get to go home and there are not enough foster care placements for these babies and so they end up having to stay in hospitals. We know from our experience with other children with disabilities that even when a hospital is a very good hospital, it's not the best kind of environment for a baby to grow up in and if the hospital is not a very good hospital, then you might see cases where the infant has a lot of problems that are unrelated to the physical aspects of the HIV but are just related to the deprived environment in which he lives. If he's staying by himself in a crib and no one's talking to him or playing with him or taking him home and he doesn't have the kind of stimulation and love and affection and touching that all babies require, he may suffer disabilities related to that.

We continue our discussion of children with AIDS with Professor Ruth Lucas next time on Focus on Education. If you would like a cassette of this program or more information on this subject, call Area Code 505-277-4806. That number again is Area Code 505-277-4806. Focus on Education is produced by Larry Cronin of KUNM Radio in Albuquerque and Roger Crowth of the College of Education at the University of New Mexico. Welcome to Focus on Education, a series highlighting events, people and programs at the University

of New Mexico's College of Education. I'm Roger Crowth. We continue our discussion of children with AIDS with Professor Ruth Lucason, a lawyer, associate professor of special education, and a member of the American Bar Association coordinating committee on AIDS. Since many of the mothers have these children that are identifiable at birth, I suppose our drug users themselves or prostitutes and so forth and they can't provide adequate care. I understand that. What are we going to have to do? What are some measures that we're going to have to take with these youngsters so they have some kind of an opportunity? Seems to me that foster care is going to be a difficult thing because we already have

problems of getting foster care for special needs children who don't have AIDS or infectious disease. The one issue that everyone agrees on is that we are going to have to educate all members of our society and how to prevent AIDS. The Surgeon General, you may have received in your mailbox a mailing that went out to every household that receives mail in this country, got a mailing from Surgeon General Everett Group, Sea Everett Group, on facts about AIDS. That is certainly a necessary step in educating our population about AIDS. It's not sufficient, clearly, but that is an important necessary step. They're also going to have to do in this country, public service announcements, training programs, additional mailings. We are going to have to openly discuss in this country how AIDS is acquired and how to

prevent AIDS. That education is absolutely essential and that education must be accessible to everyone. To adults in this country, to children in this country, to people who don't speak English, to people who can't read that brochure because they're blind, to people who can't hear public service announcements because they're deaf, to people who can't read announcements because they're illiterate or have some disability that prevents that. We are going to have to make sure that all of our AIDS education materials in this country are accessible to a full range of people. So education is one topic. Continuing the research efforts is an absolutely essential role for the federal government and for America. The problems in the foster care system are, you are correct, they are monumental and these children who are now acquiring AIDS are adding to an already overburdened foster care system.

And hearings, the United States House of Representatives has held hearings on that issue and Congress is beginning to understand that serious work and substantial resources are going to be required to improve the foster care system not only for these kids who have AIDS but as you mentioned for other children who require for any reason foster care. The medical care issue is another important issue. This country has to make sure that people with this devastating disease have access to health care. For some of the people who have acquired HIV, that health care will be expensive and they won't have the personal resources to pay for it. So we are going to have to in this country make sure that some combination of private

insurance, public health care and other forms of support make health care available to all of the people who need it who have acquired HIV. Ruth, we've already got an overburdened, overburdened special education program. We can't find the teachers that we need, we don't have the diagnostic services, isn't this going to increase the number of youngsters we're going to have in special education? Yes, it probably will increase the number of students that we have in special education. But remember, so far the Centers for Disease Control have only identified a few over a thousand children who have a full blown AIDS and so we can expect fewer children than adults probably, that's the trend that I observe.

That's the good news. But special education will have to be able to accommodate these children because these children are eligible under the categories already described for special education services. And I have a great deal of confidence that with proper in-service training for teachers and with proper teaching in our college courses, this country will be able to provide the good teachers that are necessary for this service. Do you see any modification of the special education training programs at the University of New Mexico based on this information? Will your courses be any different? Yes, I think that the special education department at the University of New Mexico responded very quickly.

I know that this topic has been dealt with in our course on methods and materials for teaching people with severe handicaps. This issue has been dealt with in our legal rights courses, it's been dealt with in the special education law course and it has been dealt with in a number of the courses that we teach in which medical management or ancillary personnel are discussed. So I think that the University of New Mexico has responded very quickly to the issue. Another question that springs to mind, you say that we need to educate the public as to how the disease is transmitted and so forth. Teaching sex education to children who are mentally retarded is a very difficult task. Can we impress on these youngsters the enormity of the disease and the things that we need

to do to help them keep from becoming caught up in the transmission of AIDS? It seems to me that's a real problem. It would seem like these children might be susceptible to the influences of the children around them. I'm thinking of the sexual intercourse instead of the transmission by needles but at the same time, somehow we're going to have to teach them not to, you can't just run around and say no. You're correct, we should not minimize how difficult it's going to be to teach all of our children, all of our school students, including special education students on how to avoid acquiring HIV. And the Surgeon General has identified in several of his recent reports that our education efforts have to include special education efforts for school students who have learning

handicaps such as mental retardation. A number of people across the country have been working on developing the curricula and materials that will be necessary for this kind of teaching. The Young Adult Institute in New York, for example, has developed videotapes and other training materials. And a number of projects on the West Coast have developed materials. So we now have some good resources on how to do it and the materials to use to do it. And I believe that with the proper materials and with proper teaching techniques and with very concerted effort, we will be able to accomplish these education goals. What do you see as your responsibility or our responsibility to work with the families of these youngsters?

Clearly these youngsters and their families will require often a great deal of intervention. Many of the families to whom these children will be born will already have problems with poverty, drug abuse, unemployment, other forms of discrimination, nutrition problems. At least at this point, many of these children are being born into families where there are already those needs. And obviously those families are going to require a lot of support, social services support, education support, job support, financial support. Additionally, what we know about helping families create good lives for infants is that one of the best things that we can do as educators or as social workers or as other human service

professionals is to help the family to help the infant. So we'll need to be teaching those families how to care for an infant who has medical problems or serious learning problems. We'll need to be helping them learn how to feed the baby, learn how to properly care for the baby. Of course the other thing we can do is help the family learn enough about the disease so that they can prevent further occurrence of the disease in their family. I don't know whether you have found out or heard much about this kind of problem, but if a mother has a child who has AIDS, what are the probabilities of her having the next child that she has having AIDS? Is that like a 50-50, is that 100% what is the disease just keep on going? I'm sure that a medical researcher could answer this question better than I, but one bit

of information that I can give you is that there are documented cases where a mother who had had an infant born with AIDS then went on to have an infant who did not have AIDS. The most recent percentage that I have heard is that a woman who has the virus has about a 40% chance of having a baby who will have the virus. Well, this raises another social issue. What about forced sterility? Forest sterilizations are part of the history in disability and handicapped. There were of course forced sterilizations beginning in this country in the 20s to try to get rid of incompetence in our society. These forced sterilizations were initially promoted by an organization called the American

Breeders Association that was attempting to improve the gene pool in this country. In my opinion, forced sterilizations would be a gross violation of the human rights of the individuals that we are talking about. It's hard for me to imagine that this country would again cooperate in such grotesque measures. Ruth, what if you knew that this parent was sexually active and was also on drugs? To the extent that she was going to have child after child and the probability was going to be, as you say, 40%, 50%, 60%, what are you going to do? It seems to me that you're going to have a large number of progeny from a particular

source. What can we do about it? We don't have a cure for. We can't say it takes this pill. That's correct. Let me analogize to the criminal law where several states have passed statutes which allow for the quarantine of individuals who are found guilty of criminal actions that place other people at risk for acquiring HIV. For example, a statute where if an adult who had HIV was accused of raping other people and transmitting HIV or attempting to transmit HIV, that the adult could be incarcerated, could be quarantined because of that activity.

Whether this country will see fit down the road to impose that kind of model in the situation you describe, I can't be sure. It's hard for me to imagine that such a thing could happen in the United States. Since this is a social issue, it's an educational issue, certainly a legal issue, are we seeing a number of lawsuits that are coming about by people in society suing parents or raising questions about admission to school and so are we seeing a rash of those kinds of suits coming down the line? We saw what we have seen, especially at the beginning, a number of incidents of really irrational behavior directed toward children who have HIV.

For example, in Florida there was the case where three children who had acquired HIV from blood transfusions for their hemophilia were denied admission to the school, were treated in a very hostile manner by the school, and eventually there was some suggestion that their house had been set afire by neighbors who were opposed to their presence in the community. We did see early on a number of incidents like that. Recently, my reading of it is that there is a decrease in those incidents that as this country has been able to educate its citizenry about the transmission of AIDS and about how the casual contact does not transmit AIDS and has been able to educate people society on the needs of individuals with AIDS.

I think we're seeing a decrease in those incidents. There have been about a half a dozen reported legal cases where children with AIDS were being excluded from school. Most unanimously, those cases have been decided in favor of the children to be included in school, not to be discriminated against or not to be denied their right to education. In my view, the education community has responded faster and more responsibly than some of the other communities that have had to deal with this issue. There was a report in the Fidelta Capin several months ago that described training programs for school superintendents around the country and school superintendents who were acting

very responsibly in educating the children in their school districts, educating the teachers, educating the parents, and including in responsible ways children who have HIV in the school districts without incident. Let me ask another question. It's shifting gears just a little bit, but I think it's in the same ballpark. How about the whole issue of abortion? Will this resurface itself now with the rights of these mothers to abort their children since if they know they have AIDS or if they as a mother decides to take this particular action, you've been very familiar, I'm sure, with a baby doe case. How does this relate to that? Well, certainly mothers who participate in genetic counseling and participate in birth

control or family planning activities and counseling will, I suspect, discuss the possibilities of abortion with their counselor and make that decision for themselves. It will be a very hard issue for a mother to know that she has acquired HIV because sometimes she won't know it until after she becomes pregnant, to know that she has acquired HIV and to know that there is approximately a 40% chance that her child will have HIV. That will be a very difficult issue for that mother in a very trying time and I think we'll call upon the resources of good family planning clinics and good counselors to help the mother think through the options that she has available for her. As you're talking as if these are always responsible people who can sit and make that kind of a decision, what if the medical team sees this situation and the baby is born and

they are now having to make a decision as to whether the child should be allowed to go ahead and live or not. I'm talking about more of the severely handicapped at birth and you're telling me now that the chances are this child will not live to be two or three years old anyway. Isn't that decision again going to revert back? Now here's the mother that may not be as responsible as the ones that you're talking about who have gone through a family planning and education. The medical team I'm sure in those circumstances would not seek to act independently. Certainly the medical team would be familiar with its legal obligation to consult with and get the proper permission from the mother and the father if the father is available and if neither of those people would be available for proper consent then the medical team

would be familiar with its obligation to get legal permission to pursue a denial of health care. My opinion would be that any denial of health care based on existing handicapped or fear of handicapped would be an unconstitutional violation. Would they have to go through an ethics board, isn't that being used now more and more of a disorder? Yes, sometimes this issue will be a very difficult issue and the line, the answer will not be or the question will not be black and white and certainly many hospitals have set up ethics boards to help them think through decision making on extremely complex cases and some of these cases, certainly not all of these cases. Some few of these cases will be complex cases and I'm sure that the medical ethics boards of the various hospitals will provide valuable assistance.

I guess that I'm sometimes concerned too about the nature of a group of these parents not being having access to the kind of information that we're talking about, the education and the counseling and so forth. It sounds like a certain group of these mothers may not be able to read or write and they may get infected through needles or through prostitution and it seems to me we have a real social problem here or maybe that isn't, I don't know. No, I think you're correct Roger that it is a serious social problem and our traditional or our most recent methods of attempting to make social change may not be adequate given the nature of this serious disease. There are a number of communities around the country that are experimenting with social

issues or social accommodations like teaching people about AIDS and the risks of transmission in city parks that are known to be places where people who use drugs come. There have been attempts around the country to pass out needle cleaning kits. There have been discussions around the country of needle exchange programs. There have been certainly a number of discussions about how to make condoms more widely available and there have been disputes over whether a condom machine should be available in college dormitories or whether people who are incarcerated in correctional facilities should be able to have access to condoms and those issues will continue to be the focus of discussion

and this country will have to make the appropriate cost benefit analysis to determine whether it's in their interest to provide the services or attempt to do the teaching that can at least slow down the transmission of the disease and perhaps eliminate it. I can see all kinds of social problems, for instance, around the whole penitentiary, the prison system and homosexuality and the transmission of AIDS and who's liable if, for instance, a young male gets placed in prison and he gets raped and I can see who's liable for something like that, the prisoner who does the raping or the system itself. Yes. That certainly is a question that will arise. Another question that arises in many correctional settings and sometimes with groups of youth

is ear piercing with used needles. It doesn't have to be just drug using needles, it might be an ear piercing issue. It also be a tattooing issue, the performing amateur tattooing on individuals with unclean needles or other sharp objects. Ruth, are you optimistic or pessimistic? I am optimistic. I have been following the big AIDS conclave in Stockholm and I was fortunate to hear part of the introductory speeches by Premier Carlson of Sweden and also by Jonathan Mann who is currently with the World Health Organization but used to be the state epidemiologist in New Mexico and one of the things that Premier Carlson said that has stayed with me is that we may conquer AIDS in the laboratory but lose the fight in the streets and what he meant

was that we may develop the scientific understanding and the scientific knowledge to fight AIDS but we may not be fast enough with the social policies and the education and the anti-discrimination proceedings to really win the battle in what he referred to as the streets. It seems to me that AIDS is a very complex issue and that we cannot try to pigeonhole it as merely a science issue or merely a medical issue or merely a legal issue. It has all of those components and it will require the best efforts of all of us to conquer this and I am optimistic. Well thank you Ruth, I appreciate you being here today and sharing this information. As usual I learn a lot every time I sit down and talk to you. Thank you very much. If you would like a cassette of this program or more information on this subject call

Area Code 505-277-4806. That number again is Area Code 505-277-4806. Focus on education is produced by Larry Cronin of KUNM Radio in Albuquerque and Roger Kroth of the College of Education at the University of New Mexico.