In 1994, when Sidney Abbott visited Bangor, Maine dentist Dr. Randon Bragdon to have a cavity filled, the goal of nondiscrimination against people with HIV was one of the most important tools in fighting the epidemic. People simply would not come forward for testing and medical care so long as HIV discrimination was legal. The problem of doctors and dentists refusing to provide basic care to people with HIV was a significant barrier to treatment. As director of the AIDS Law Project at Gay and Lesbian Advocates and Defenders (GLAD), I regularly received calls from people denied dental, OB-GYN or emergency room care simply because they were HIV positive.
Dr. Bragdon had a written policy against treating people with HIV and refused to treat Abbott when she disclosed her HIV status. GLAD represented Abbott in her successful federal discrimination lawsuit and Bragdon appealed the decision to the U.S. Supreme Court.
It was 15 years ago this week that the Court ruled in Bragdon v. Abbott that people living with HIV and AIDS are protected against discrimination by the federal Americans with Disabilities Act (ADA). The decision heralded a culture-shifting moment: it was a declaration by the nation’s highest court that the myths, fears and stereotypes about HIV that pervaded our society since the early 1980s were bunk.
We litigated Abbott’s case because we believed the ADA, a 1990 federal law prohibiting discrimination based on disability in employment, government services and public accommodations—including medical and dental offices—was designed to protect all people with serious health conditions.
It was unfathomable to us that the Court would deny necessary healthcare access to any American, but Bragdon v. Abbott was the first U.S. Supreme Court case to address HIV and the first test of the scope of ADA protections. I remember feeling naïve as federal justices grappled with their concerns about subjecting healthcare workers to real harm, though they were ultimately persuaded by evidence demonstrating that the risk of patient-doctor transmission was virtually nonexistent. In the end, the fundamental principle of nondiscrimination survived by a one-vote margin, 5-4.
There are still barriers to healthcare for people with HIV. Today, for instance, MassHealth and private insurance companies refuse to cover treatment for lipodystrophy, a side effect of life-saving but highly toxic HIV medications. Lipodystrophy causes disfiguring and debilitating abnormalities in body fat distribution that can create profound physical and psychological harm. While there are inexpensive, effective medical treatments, insurers routinely deny coverage. The inability to receive treatment causes some people to stop taking their HIV meds. That’s why GLAD and the Treat Lipodystrophy Coalition are working to pass An Act Relative to HIV-Associated Lipodystrophy Treatment, requiring health insurers in Massachusetts to provide treatment for people living with lipodystrophy.
Fifteen years after Bragdon, people with HIV live long lives. But the stigma has certainly not gone away. There is still work to do to ensure that people with HIV can live full, productive lives unencumbered by discrimination.•
Bennett H. Klein is director of the AIDS Law Project at GLAD, which engages in litigation, public policy advocacy and education in New England and nationally to create a just society free of discrimination based on gender identity and expression, HIV status and sexual orientation.