As Allan Brandt notes, the battle against venereal diseases in the first decades of the twentieth century and the rise of AIDS more recently give evidence that moralism remains a powerful element in the social construction of society's definition of these diseases. Early in the twentieth century, syphilis was a symbol of a "society characterized by a corrupt sexuality. Venereal disease has typically been used as a symbol of pollution and contamination, [and of] … a decaying social order. Venereal disease makes clear the persistent association of disease with dirt and uncleanness as well" (Brandt, p. 5).

The most serious challenge to modern public health by legal moralism entered with the AIDS epidemic and HIV-related diseases. Because anal sex and frequent sex with multiple partners heightens the risk of transmission of the HIV virus and because intravenous drug use also seriously elevates the risk of infection from contaminated needles, legislation that seeks to regulate these behaviors--which are widely proscribed in many states--is always open to the charge of moralism.

Early in the epidemic in the United States, bathhouses frequented by homosexual patrons became targets of public health regulations. Many in the gay community charged that the measures were aimed less at fighting the epidemic than at proscribing homosexuality. These advocates argued, quite plausibly, that the regulations would have little impact on the course of the epidemic in San Francisco or New York, the two cities where conflicts primarily arose. This was because the bathhouses were the site of only a fraction of the proscribed behaviors. Advocates also argued that city officials and state public-health authorities had caved in to political pressures (Bayer, 1991).

The same charge of moralism and discrimination was also brought when public-health officials attempted to introduce methods of identifying the sexual partners of those who were AIDS victims, or when state medical societies sought legislation to make AIDS and HIV diseases reportable to state health authorities (Bayer, 1991). (All states require private physicians to report certain communicable diseases to state health officials.) Ronald Bayer, in his book Private Acts, Social Consequences (1991), has provided the best chronicle of the clash between public-health legislation and the civil libertarians defending AIDS victims. As Bayer says, "These two abstractions, liberty and communal welfare, are always in a state of tension in public health policy" (1991, p. 16).

It is likely, however, that the AIDS epidemic has permanently altered the landscape of public-health policy, and not just in the United States. No longer will it be possible to easily equate public health only with the use of powers to restrict power and liberty to promote the public health or to see the realms of public health and individual liberty as radically distinct. The growing awareness is that a sound public-health policy requires more than restrictions on liberty and property to promote the communal welfare. It also may require the expansion of private liberties and rights for groups suffering social discrimination based on moralism.

References:

1)         Bayer, Ronald. 1991b. Private Acts, Social Consequences: AIDS and the Politics of Public Health. New Brunswick, N.J.: Rutgers University Press.

2)         Brandt, Allan M. 1987. No Magic Bullet: A Social History of Venereal Disease in the United States since 1880. New York: Oxford University Press.

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