AIDS and the limits of control: public health orders, quarantine, and recalcitrant behavior

We undertook a survey to document the extent to which public health powers have been used to warn or restrict individuals infected with human immunodeficiency virus (HIV) whose behavior poses a risk of transmission to others. In the period from 1981 through 1990, 24 state health departments either had no mechanism for receiving reports about individuals whose behavior posed a risk of HIV transmission or took no action if they had received such reports. In states that had developed programs for dealing with such individuals, the most common response was the use of cease and desist orders. As of 1992, 10 instances of quarantine had been reported, almost all of which involved relatively brief periods of isolation. Whatever justification exists for using public health authority to confront individuals whose behavior poses a risk of HIV transmission to others, it is clear that the central focus of HIV prevention efforts must remain education, counseling, voluntary testing and partner notification, drug abuse treatment, and needle exchange programs.