AIDS IN THE FIRE SERVICE: SETTING DEPARTMENT POLICY
Acquired Immune Deficiency Syndrome (AIDS) has become a major concern of emergency responders. But how many fire departments have formally adopted policies covering the spectrum of issues that this relatively new epidemic (the first cases in the United States were identified in 1981) has raised, primarily the issues of fire department employees living and working with AIDS?
Few fire departments have AIDS policies that are written, and those that do, have policies that basically address emergency medical exposure precautions only. These limited policies describe how to use universal infectious disease procedures and how to decontaminate first-aid equipment. Most fire department personnel I interviewed expressed concern regarding the need for an employee AIDS policy, but little guidance on how to develop such a policy is offered by fire service organizations. Therefore, I have developed an AIDS policy guideline for fire department employees living and working with AIDS (see sidebar). This guideline also could serve as a checklist for modify ing an existing AIDS policy.
The issues of AIDS and its repercussions for firefighters have been ignored by most fire departments in the United States. According to a student project survey of students at the National Fire Academy conducted during August 1989, only five (17 percent) of the 28 fire departments represented had an AIDS policy.1 The results of a survey I took of 163 fire departments (67 responded) during July 1990 showed no significant change from those of the August 1989 survey. Only 12 of the fire departments responding (18 percent) had an AIDS policy. These policies, however, were limited to emergency-rtinresponse procedures. During June 1990, a review of papers written on AIDS by executive fire officers (EFOs) at the NFA Learning Resource Center revealed that only four of them addressed AIDS as it related to the fire service. Two of the papers indicated the need to develop a policy that covers members infected with and affected by AIDS and its related viruses.
Nevertheless, AIDS is an issue that demands progressive action. Today’s executive fire officer has a responsibility to bring positive change to a tradition-heavy occupation. Executive fire officers can develop a comprehensive and compassionate AIDS policy only if they themselves first recognize the problem and become sensitized to it. To accomplish this, they must base their perceptions of the problem on valid data and educate themselves and their employees about the problem.
WHAT IS AIDS?
AIDS is caused by the Human Immunodeficiency Virus (HIV), which is relatively new. Its origin is unknown. When the HIV virus enters the body, it attaches itself to a specific type of white blood cell, the I-lymphocyte. The virus then multiplies inside the Tlymphocyte until the cell explodes and is destroyed. During this cell explosion, the new multiples of this virus spread. The additional HIV attacks other T-lymphocytes until they all are destroyed The T-lymphocytes, referred to as T-helper cells, regulate the immune system and help the body fight off bacterial, viral, and fungal infections. When the virus destroys these T-helper cells, the body cannot adequately protect itself against infections.3
There are three stages to the AIDS syndrome: Human Immunodeficiency Virus seropositive (HIV+), Acquired Immune Deficiency Syndrome-Related Complex (ARC), and Acquired Immune Deficiency Syndrome (AIDS), sometimes referred to as “fullblown AIDS.” The virus can be transmitted during any one of these stages.
The first stage: HIV. In the HIV + stage, no signs or symptoms are present, but the HIV virus can be transmitted from one person to another. Some people falsely equate having HIV with having AIDS. Studies have shown, however, that it could be 10, 20, or even more years before HIVinfected individuals progress to the next stage; a small percentage never do move to the next stage. Two blood tests—enzyme immunoassays (EIA or ELISA) and a Western blot or similar, more specific assay—are used to determine whether the HIV virus is present.
Firefighters who have had documented HIV exposures should be tested immediately, and then again at six weeks from the time of exposure. Even if the results of the second test are negative, the firefighters should be tested at 3-, 6-, and 12-month intervals following the exposure. During this time frame, and especially during the first 6 to 12 weeks, they should be counseled about the risk of infection, consider themselves HIV +, and take the necessary precautions to prevent spreading the virus.6
The second stage: ARC. Signs and symptoms during the ARC stage may include loss of appetite, weight loss, fever, night sweats, skin rashes, diarrhea, tiredness, lack of resistance to infection, and swollen lymph nodes. During this period, the HIV virus begins to destroy the body’s T-helper cells. The duration of this stage is unknown.
The third stage: AIDS. In this stage, very few, if any, T-helper cells are present. Signs and symptoms include the presence of opportunistic infections and diseases such as Pneumocystis Carinii Pneumonia (PCP), cytomegalovirus (CMV), and Kaposi’s sarcoma. Individuals may react differently to the AIDS virus. During this final stage, the body’s immune system is severely compromised and ultimately destroyed by the HIV.
Currently, there is no cure for AIDS. Although some drug treatments slow the progression of the virus, patients usually are treated for the opportunistic infections and diseases as they occur.
HOW AIDS IS TRANSMITTED
The AIDS virus is spread through direct sexual contact (intercourse), intravenous contaminated needles, contaminated blood products, and the birth process.
AIDS is not transmitted through casual nonsexual contacts at home, school, work, or public places, including drinking from the same glass or drinking fountain, shaking hands, kissing, hugging, crying, coughing, or sneezing. The virus also cannot be transmitted by sharing bed linens, towels, straws, cups, dishes, eating utensils, toilets, doorknobs, telephones, office machinery, or household furniture. Likewise it cannot be transmitted by insect bites or domestic pets.
“Nurses, technicians, and other health-care workers with seemingly high potential exposure to the AIDS virus in body fluids of patients have not been found to be at high risk of acquiring AIDS as a result of their work…,” states Richard Porter, M.D., Corporate Health Services, Digital Corporation. “Our current policy is not to test for the AIDS virus. CPR administration during actual cardiac arrest sometimes prompts questions about communicable disease transmission during the rescue. The CPR experience of the past 20 years, as well as our knowledge of AIDS transmission, confirms the safety of rescuers using this technique. The anxieties of employees whose duties include first responders’ care (nurses, security, first aiders) have been eased by providing them with pocket-sized ventilation devices to be interposed between the mouths of rescuer and victim.”
The Surgeon General’s report on AIDS explains the detailed studies that have been ongoing since 1981. These studies support Dr. Porter’s statement that emergency medical first responders are not in a high-risk category and, in fact, are considered to be at low risk.
Experts say that no one is exempt from the HIV syndrome. The majority of people in the United States, including many fire service personnel, are under the misconception that AIDS is a homosexual disease. Statistics show that it is a human disease that first spread in the United States through the homosexual community and that it now is spreading throughout the heterosexual community. Although it is true that the majority of individuals suffering from AIDS in this country and North America are homosexual, the homosexual community is the only risk group that is currently experiencing a decline in HIV infection and new AIDS cases on a per-capita basis, while all other risk groups are experiencing increased rates in both areas.
More than 140 countries have reported cases of AIDS to the World Health Organization (WHO). WHO states, “Although the immunology and pathogenesis of infection with HIV-1 appear to be similar throughout the world, geographic variations in epidemiology and clinical symptoms and distribution of different human retroviruses have been noted.”
AIDS POLICIES IN BUSINESS
Businesses that have established employee AIDS policies assembled employment policy committees that included representatives from the highest levels of management, labor, and, where applicable, unions. These committees examined AIDS issues to identify potential problem areas relating to employees and employers. The areas encompassed legal, economical, social, political, psychological, and technological considerations and sometimes overlapped. After committee members completed their research, they drafted policies that then were reviewed by the senior corporate executives and implemeted — sometimes with modifications—along with supportive employee education programs.
Paul Ross, AIDS education director, Digital Equipment Corporation, has found through his research and experience that individuals with HIV + and AIDS suffer stress related to job securin’. “W’ork is important. It provides an identity, a support system, and an extended family. We can’t manage AIDS without this type of integration,” he states.
Further, observes Dr. Porter. “The company will not test routinely for AIDS nor will it ask for the results of any prior testing of the employee or prospective employee—with the exception of Digital nurses and physicians who may require this information for purposes of diagnosis. As with any other disease, careful consideration will be given to the effect of the condition of AIDS…on the prospective employee’s ability to do the job for which he or she has applied. The fact that an applicant has AIDS…will not categorically prohibit his/her employment at Digital unless he/she is unable to perform the required duties.”16
The concerns of the noninfected employees also have to be addressed. The main noninfected employee issue for Digital was the risk of becoming infected with AIDS. “As a result of an analysis of the best current medical information, the company believes that fellow employees are not at risk of contracting AIDS…as a result of work-related contacts,” Dr. Porter states in the Digital AIDS policy. “Since there is no evidence of environmental transmission, AIDS patients medically able to work present no risk of infection to fellow employees in the course of their work. There is no medical basis for excluding from the workplace employees who have been cleared medically to return to work.”
DISCRIMINATION CONSIDERATIONS
A number of federal, state, and local laws cover the rights and opportunities that must be afforded to AIDS patients. The majority of these statutes or case laws define AIDS as a disability or handicap. An individual who is HIV + may or may not be covered under specific statutes.1
Virtually all states have adopted laws forbidding discrimination on the basis of physical disability. According to the American Civil I.iberties Union, the number of AIDS discrimination complaints filed between 1983 and 1988 grew 35 percent faster than the number of newly diagnosed AIDS cases during the same period. The specific discrimination areas showing the highest growth rate cited are parents, doctors, policy makers, and employers who fire individuals testing HIV + or with AIDS on flimsy excuses.18
Much of society, through fear and ignorance, supports discrimination. We must look at specific court cases to see how the laws have been interpreted. The laws and cases cited in this report were selected because they reflect a generic legal opinion or law. When developing a similar study or research project for a specific state or region, the laws and court opinions for that state or region must be examined.
HIV+ and AIDS employment discrimination has taken many forms. Employers have fired or refused to hire individuals who have tested positive for the HIV. A few employers have resorted to covert methods such as creating fear within employee groups about contracting the infections and making working conditions so intolerable that many of these HIVand AIDS-infected employees voluntarily resign. This type of discrimination also has been used by some employers against employees perceived to be from populations at high risk for AIDS such as Haitians, homosexuals, unmarried men, HIV+ individuals, and employees who arc relatives and friends of individuals who have AIDS.
Some employers have required all employees and applicants to submit to HIV testing. Those who test positive or who refuse to be tested have been denied employment.
Discrimination does not always take the form of termination. Some employees have been denied work assignments or have been moved to isolated work stations, and some have been forced to take medical leave even though they did not require it.19 One of the first employee-AIDS discrimination cases was Shuttleworth t>s. Broward County Office of Budget and Management Policies, FCHR No. 85-0624, Dec. 11, 1985. The Florida Commission on Human Relations ruled that Broward County was guilty of unlawful handicap discrimination when it fired an employee because he had AIDS. Most states have had similar cases in which state physical handicap laws have protected people with AIDS from employment discrimination.20
However, law language and interpretation could vary in every state. Several state statutes that appear to protect only the disabled actually have been interpreted to protect persons perceived to be disabled. People with AIDS are considered disabled, whereas HIV + people are not; many employers, however, perceive HIV + people as disabled.21
The latest federal law addressing AIDS and employment is the Americans with Disabilities Act, which was passed July 26, 1990, but will not become effective until July 26, 1992.22
The Act states: “…Disability—the term ‘disability’ means, with respect to an individual —(A) a physical or mental impairment that substantially limits one or more of the major life activities of such individual; (B) a record of such an impairment; or (C) being regarded as having such an impairment.” Items (A) and (B) clearly cover persons with AIDS; and Items (B) and (C) clearly include individuals who are HIV + or perceived to be HIV +. The Act further states: “Every employer, employment agency, labor organization, or joint labor/management committee covered under this title shall post notices in an accessibleformat to applicants, employees, and members describing the applicable provision of this Act, in the manner prescribed by section 711 of the Civil Rights Act of 1964 (42 U.S.C. 2000c10).”23
Prior to this Act, the Federal Rehabilitation Act of 1973 covered discrimination against handicapped individuals. The 1973 Act had several limitations or exceptions that made it unclear whether individuals who tested positive for the HIV and AIDSinfected individuals were covered. Most courts ruled, however, that both were covered. In addition, an individual with AIDS who is too sick to work is entitled under federal law to receive Social Security disability benefits. An HIV+ individual does not qualify for such benefits.24
The Americans with Disabilities Act, while addressing “state immunity,” clearly states that a state or any public or private entity other than a state is not exempt from this Act, under the 11 th Amendment to the Constitution of the United States.25
In a United States Supreme Court decision regarding a teacher with tuberculosis, School Board of Nassau County vs. Arline, 107 S. Ct. 1123 (1987), the Court stated: “Allowing discrimination based on the contagious effects of a physical impairment would be inconsistent with the basic purpose of Section 504, which is to ensure that handicapped individuals are not denied jobs or other benefits because of the prejudiced attitudes or the ignorance of others. By amending the definiton of‘handicapped individual’ to include not only those who are actually physically impaired, but also those who are regarded as impaired and who, as a result, are substantially limited in a major life activity, Congress acknowledged that society’s accumulated myths and fears about disability and disease are as handicapping as are the physical limitations that flow from actual impairment.” Although this case was not specifically about AIDS, most analysts agree that both 111V -⅜and AIDS are covered.26
Generally, for an employee or prospective employee to win an alleged employment discrimination suit, he/she must satisfy a number of legal points, referred to as “the burden of proof.” The following are only the main points; there are many other, less clear ones; The employee/applicant must prove that he/she has or is perceived to have an illness or condition that qualifies as a handicap, is qualified to perform the required tasks of the job, and was discriminated against in whole or part due to the handicap or perceived handicap.27
The employer must prove points such as the following when terminating or refusing employment to an individual who is I11V+ or has AIDS (here, too, there are many other, less clear points): The employee or applicant is not capable of performing the required tasks of the job or making accommodations for the employee would be an undue hardship, the absence of handicap is a bona fide occupational qualification (this has been next to impossible for employers to prove), and the employee cannot perform the required tasks of the job without endangering himself/herself or other employees.28
For the most part, fire departments up to now have dealt with the HIV +/AIDS issues from a one-dimensional perspective, addressing only precautions for emergency medical personnel. This narrow focus has eliminated other related HIV issues from consideration and action. Since no employer will be exempt from dealing with employees or prospective employees who are HIV + or have AIDS, today’s EFO has the moral and legal responsibilities to address these issues.
Endnotes
- Fire Executive Development Class Project, “AIDS: Guideline for the Chief Fire Executive Officer,” August 1989, National Fire Academy, Learning Resource Center, Emmitsburg, 3-5.
- Executive Development III Class Project, “AIDS—Legal Issues for Emergency Response Agencies,” 19-30 January 1987, National Fire Academy, Learning Resource Center, Emmitsburg, 5-6; “AIDS: Guideline for the Chief Fire Executive Officer.”
- Surgeon General’s Report on Acquired Immune Deficiency Syndrome, 10-11; Lining and Working with AIDS.
- Ibid.
- Joy Schumacher Interview; Surgeon General’s Report on Acquired Immune Deficiency Syndrome, 10-11; Living and Working with AIDS; AIDS Practice Manual: A Legal and Educational Guide (San Francisco, National Gay Rights Advocates and the National lawyers Guild AIDS Network, 2nd Ed. 1988, ISBN 09602188-0-7) II-4.
- U S. Center for Disease Control, Morbidity and Mortality Weekly Report, 15 November 1985/Vol. 34/No. 45 (Washington, DC.; Government Printing Office. 1985) 681-686; Joy Schumacher Interview.
- Joy Schumacher Interview; Surgeon General’s Report on Acquired Immune Deficiency Syndrome, 10-11; Living and Working with AIDS.
- Ibid.
- Living and Working with AIDS, Interview with Dr. Jerry Groopman.
- Surgeon General’s Report on Acquired Immune Deficiency Syndrome, 13-25; Living and Working with AIDS.
- Living and Working with AIDS. Interview with Richard Porter M.D.
- Surgeon General’s Report on Acquired Immune Deficiency Syndrome, 13-14; Morbidity and Mortality Weekly Report, 683684; Living and Working with Aids, Interview with Dr. Jerry Groopman.
- Center for Interdisciplinary Research in Immunology, AIDS/HLV Reference Guide for Medical Professionals (Los Angeles, CA.: Center for Interdisciplinary Research in Immunology, UCLA School of Medicine, 3rd Ed. October 1988) 3.
- Patrick J. Hannon, Human Resource Manager, Interview by author, 1, 15 August 1990, Novi, interview notes Digital Equipment Corp., Novi; Scott Macready Interview.
- Living and Working with AIDS. Interview with Paul Ross.
- Living and Working with .AIDS; Dr. Porter interview.
- AIDS Practice Manual: A Legal and Educational Guide, IV-1 — IV-6.
- John Seigenthaler, “End Discrimination in the AIDS Fight,” USA Today, 20 June 1990, sec. A, p. 10A.
- AIDS Practice Manual: A Legal and Educational Guide, IV-1 — IV-6.
- Ibid.
- Ibid.
- Americans with Disabilities Act of 1990, US. Code, Vol. 42, secs. 12101-12213 (1990).
- Ibid.
- Ibid.
- Ibid.
- AIDS Practice Manual: A Legal and Educational Guide, IV-3.
- AIDS Practice Manual, IV-3— IV-6.
- Ibid.