Representative William Dannemeyer put forward a number of amendments counter to the advice of AIDS advocates and many public health professionals, including provisions mandating reporting of HIV-positive test results by name to State health authorities. In speaking against those provisions, Waxman clearly laid out the arguments against mandatory name-based HIV reporting in the Ryan White HIV/AIDS Program:
Who are the people that have AIDS? For the most part, they are gay men and drug users, people who have in many States in this country [been] regarded as having committed crimes. If their names are going to be on a list and they are afraid their name is going to be on that list for the purpose of prosecuting them and putting them in jail or putting them in camps, they are not going to come in. This would undermine exactly the public health purpose.
We talk about gay men and drug users. There is another group that is likely to have AIDS, and they have pleaded with us and said, “Don’t adopt this Dannemeyer amendment.” That is the Hemophiliac Foundation.
Well, wait a minute. Hemophilia is not a kind of thing where society has the same perspective as about gay men and drug users. But, they tell us, remember Ryan White, a kid, a hemophiliac who had a blood transfusion and got AIDS and was forced out of school and his family thrown out of the city in which they lived.
Tell these people not to worry, come in and trust the gentleman from California [Dannemeyer] and others who would like to have their names down on a list. If we want people to come in, we need to encourage them to come in. We need to give them the medications that will keep them from getting AIDS, and we need to show them that we are trying to control and treat the disease, not to punish them for possibly having the infection. The way we have handled every contagious disease in this country is to let the States decide how to handle the matter.
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Mr. Chairman, some States will decide they want to have the names down on a list so they can do contact tracing. Other States may decide they do not need to have a name on a list. They can do contact tracing by talking to the individual who has been tested. I ask,‘How are you going to know about the sexual partners of people who are infected without them telling them to you?’12
Ultimately, Title III (now Part C) included provisions that required States or independent entities to provide early intervention services to protect the confidentiality of those receiving care in accordance with State or local law, to counsel those being tested about how test results would be reported in their jurisdiction, and to offer the option of anonymous testing. The bill did not address issues of discrimination because the Americans With Disabilities Act of 1990 (42 U.S.C. § 126) was making its way through Congress at the same time and would be the vehicle for those protections. The provisions did not directly affect Titles I and II (now Parts A and B), the largest components of the Ryan White HIV/AIDS Program, but concerns about confidentiality had a profound impact on how those components were funded.