Expanding Education: Condoms in SchoolsThe AIDS Omnibus Act required AIDS education in public schools for grades 5 through 12. The Seattle-King County Department of Public Health, which had supported outreach programs to schools since the mid-1980s, now undertook new initiatives.
The AIDS Omnibus Act required school curricula to focus on “the dangers of sexual intercourse, with or without condoms” and to promote abstinence, while also providing accurate information on AIDS prevention. When Washington State’s Advisory Council on HIV/AIDS recommended that condom use be included in AIDS education, the Department found itself in the middle of a public debate. Educational programs and materials provided detailed information to promote accurate understanding of condom use and STD prevention. Many saw these campaigns as encouraging teen sex. Some objected to teaching condom use in schools with the argument that condoms were ineffective in preventing HIV infection. The Department challenged this view with a report distributed throughout the Seattle School District in 1992.
Controlling HIV while protecting civil rightsDiscrimination due to the stigma of being HIV-positive was so potentially damaging that lawmakers saw the need to change long-standing public health policies. With other diseases, there had been less concern for protecting patient privacy. Practices such as reporting names to local and state health offices, forced testing, and notifying partners of an infected individual were standard. From the beginning of its response to AIDS, the Seattle-King County Department of Public Health had held firm that protecting patients’ privacy was critical to an effective program. They argued that if people trusted the Department and its community partners, they would be more likely to get tested and engage in prevention efforts. The AIDS Omnibus Act created standard, statewide rules in an effort to balance civil rights and patient privacy with public health and safety. In practice, implementation could still prove challenging.
New protections under the ActGary Goldbaum on how AIDS and the AIDS Omnibus Act changed public health practices. (Oral history interview, August 2015.)
Balancing interests: mandatory testingFrank Chaffee served as the Public Health Official who screened cases where mandatory testing or partner notification might be required. (Oral history interview, October 2015.)
The Steven Farmer CaseIn 1987, the King County Prosecuting Attorney’s Office charged Seattle resident Steven Farmer with felony exploitation of a minor for taking inappropriate photographs of teenage male prostitutes. (The subjects were 16 and 17—the age of sexual consent in Washington State. The state’s exploitation law, however, protects individuals under 18.) The photos had been seized in what was found to be an illegal search, causing the charges to be reduced to a misdemeanor in a plea bargain.
After receiving a tip and corroboration from Farmer’s acquaintances that Farmer had told them he was HIV-positive, prosecutors sought to increase his sentence, accusing him of deliberate endangerment. Farmer denied he was HIV-positive. Amidst an increasing public outcry, the court ordered that Farmer be tested for the virus without his consent. The results (positive) were presented in open court by the head of the Public Health Department’s STD Program, Dr. Hunter Handsfield, who appeared at the request of the presiding judge. The test in question was not performed by Seattle-King County Public Health nor by the AIDS Prevention Project. But the court-ordered disclosure of Farmer’s HIV status by a Public Health official caused people to question whether the Department was protecting patient confidentiality. APP staff worked to rebuild trust and reassure critics that case records were indeed maintained in confidence.
A prosecutor’s perspective
“There was a real mix of reactions back at that time, obviously illustrated by the fact that the judge had to be escorted out of the courthouse.….there was a real public health concern and there was a real concern for these kids. They’re vulnerable, they live on the street, they don’t have any support system. You know, when we look at human trafficking issues today – when I look back at that time, at those boys, they didn’t really have anything or anybody. So part of the concern was making sure they’re protected in all respects, not just from HIV but from sexual assault or any kind of exploitation. We didn’t have the kind of mindset back then…the sensitivity that we have today. I think our office had that, but I don’t know if it was as widespread as it is today, where we embrace our vulnerable and try to make sure that they’re protected. ….it was an important moment in history and it was one where you had concerns about public safety…where a judge found there should be a test compelled. Of course our system works when it goes all the way to the Supreme Court and they can say yea or nay, and they said that was exceeding authority. The thing is, our laws are always changed through the courts…. Our courts really have to handle some of these social, impactful issues. I think we had the first Special Assault Unit in the country in Seattle, and we had a long-term prosecutor that was extremely fair and principled, so if a case is to be tested anywhere on that issue, I think King County would be one of the best places, if not the best…to deal with the issue.” Anne Bremner, Prosecutor in the Special Assault Unit of the King County Prosecuting Attorney’s Office 1983-1988. Bremner prosecuted the initial case against Farmer. (Anne Bremner. Oral history interview, October 2015.)
A softer approachSome felt that public health agencies should take a more aggressive approach to testing, tracing contacts, notifying partners, and reporting HIV infections. The Seattle King County Department of Public Health argued that a softer touch worked better to keep people engaged and to fight HIV’s spread.
Debate over closing bath housesGary Goldbaum explains why Public Health chose not to pursue shutting down bath houses. (Oral history interview, August 2015.)
Debate over mandatory testingHunter Handsfield argues that a heavy-handed approach to HIV testing would have worked against the goal of containing the epidemic. (Oral history, September 2015.)
AIDS activism’s impact on the “Ivory Tower”Frank Chaffee describes how AIDS activism challenged the medical profession to treat people more humanely. (Oral history interview, January 2016.)
Partner notification: the real true story
“Behaviors endangering”Frank Chaffee describes enforcing the AIDS Omnibus Act in cases where a person is knowingly putting others at risk of contracting HIV. (Oral history interview, January 2016.)
Federal funding and the HIV/AIDS Planning CouncilThe State of Washington provided funding for programs required by the AIDS Omnibus ACT. In 1990, the federal Ryan White Comprehensive AIDS Resources Emergency (CARE) Act also allocated money to be used for local AIDS programs. The Ryan White Act required establishment of local councils to coordinate distribution of funds. The first HIV/AIDS Planning Council in King and Snohomish counties was appointed by King County Executive Tim Hill in August 1992 with a membership composed of both Public Health Department representatives and community partners. This was the first time local AIDS funding decisions were consolidated under one regional entity. The Planning Council had to overcome initial opposition from gay and AIDS activists who feared conflicts of interest among Council members, and who questioned the early models used to prioritize and allocate funds. The Council still works today to distribute AIDS funding equitably to organizations in King, Snohomish, and Island counties. By law, one third of the Council members must be agency-unaffiliated people living with HIV who are consumers of care services. The Council is now known as the Seattle Transitional Grant Area HIV Council. Read more about its work here (external link ).
Who was Ryan White? Click here (external link) to find out.
Leadership and recognitionPatricia McInturff led the Department’s response to AIDS as Section Administrator and then Regional Division Director for the Seattle-King County Department of Public Health from 1982 to 1994. She influenced state and national health policy, such as through her service as co-chair of the Ryan White Title I Council and as a member of the National Advisory Committee on HIV/AIDS for the CDC. In 1992, McInturff was awarded the first Washington State Governor’s AIDS Service Award for Public Service for her work as Regional Division Director. In 1994, she was awarded the Municipal League of King County’s Public Employee of the Year.
Posted In: The AIDS Omnibus Act: New Mandates