In the fall of 1995, freshly out of grad. school, I got a case management job at an Adult Foster Care program, funded by Medicaid, within an elder services agency in the Greater Boston area. An evangelical Christian nurse coworker was allowed to not work with people we served who had HIV, almost all of them being gay men. After so many years since then, it still appalls me that administration and her immediate supervisor allowed her to be so blatantly discriminatory. I’m not at all an expert in legal matters, but I imagine both state and federal law may have been violated, since Medicaid is a federal program administered by each state. And the agency was a quasi public/state organization, under the auspices of the Department of Elder Affairs.
Upon further reflection and reading, I remembered that the Employment Nondiscrimination Act and, later, the broader Equality Act, languished in the U.S. Congress for years. I just read (which reminded me about the ruling when I’d initially heard about it) that not until 2020 did the U.S. Supreme Court rule that Title VII of the Civil Rights Act of 1964 protects employees from discrimination based on their sexual orientation and gender identity.
Then, there is another major area of civil rights, which is more pertinent to this situation with my long ago coworker: the right for customers/clients of a business, or in this case, an agency, to not be denied services based on their sexual orientation or gender identity, let alone their health status. From what I can tell, there continue to be no blanket federal protections in America for these large groups. Some states provide these protections while others don’t. However, in regards to people with HIV receiving health care services, a diligent researcher I know informed me that the ADA (Americans with Disabilities Act) from 1990 requires any federal-based program, or one receiving federal funding, to provide treatment to people with HIV. Hence, from what I can gather, my coworker was enabled by her supervisors to skirt around this law, in order to avoid confrontation and conflict, by assigning only non-HIV cases to her. The clients with HIV didn’t know the difference, since they were always assigned the other nurse who had no issue with them. Still, what a “skirt around” nonetheless, in which a worker’s discrimination was allowed, quietly validated, wrongly and sadly.
The Practical, Fanciful Pagan 
And now all those rights are at increasing risk. The ACLU is currently tracking 452 anti-LGBTQ+ legislation in the US (many targeting trans youth). The only states with no pending legislation are AL, DE, IL, NY, and Washington DC. The door that people worked so hard to crack open seems to be closing again. Makes me sick.
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Oh, I’m aware of this, though I didn’t know just those four states and DC are the only places without any pending discriminatory legislation. Ugh!
Thank goodness for the ACLU.
I didn’t feel like writing on this post anymore, having covered the anecdotal-oriented scope of it that I wanted to.
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What an interesting post! My son had to explain what the (I) in LGBTQI stood for. I had never heard of it before. As someone who did volunteer work at the State Hospital in the children’s ward and seeing all kinds of deformities (I’m not sure that intersex would be considered a deformity), but from where I sit, it sounds like it and I imagine that might create considerable physical and psychological issues.
As far as what your post is really about and having lost a cousin to AIDS at such a young age at the beginning of the epidemic in the 80’s, I am very grateful for those brave health care workers that showed up to help out at that time not really knowing how fatal it could be.
I didn’t know that people could refuse to work with AIDS patients then and still can but imagine there are still those that feel the need to stand up and do what’s right. Thank you for sharing your post!
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Hi…I felt compelled to respond to your post. I am not aiming to criticize or come off as obnoxious, so I do hope you don’t take it that way (if there’s anger coming through, it’s at our society and culture which continues to deny human variety and causes horrendous pain and suffering for people whose differences are defined as pathological).
Intersex is not a “deformity.” We human animals develop in all kinds of various ways—the devastating experience of some of these ways is that the medical community and the culture pathologize people who don’t fit into the tidy little boxes that get called “normal” (ugh concept). Being born Intersex is simply one of the innumerable variations that can occur as a fetus develops in utero.
Many people don’t know they are intersex until puberty, and others don’t know until genetic tests reveal their chromosomes. Infants whose visible sexual organs appear to be “unclear” (i.e. neither male nor female) have long been “assigned” by MDs with a binary sex of male or female. This practice, which I think is shifting, can create utterly unnecessary devastation for a child as they develop. Our culture just cannot seem to accept that sex, sexual attractions, and gender are all spectra, and can be fluid throughout a person’s life.
I worked for several years (1978-82) at a children’s residential home in PA—when I started, I had a hard time because the kids had all kinds of “shocking” obvious variations of their bodies. They lived at St. E’s because their families had abandoned them, or could not manage to live with them. Yet they were kids just like all kids, and more amazing in many ways for the necessary ingenuities they’d managed to get things done, to play, and to respond to the reactions of people to them in public.
They weren’t “deformed” even though that was the word used constantly; they were unique individuals, as every person is. It was (is) our society and culture that deforms the life experience of anyone they don’t categorize as “normal.”
It took me a hot second to recognize that my shock at seeing these kids came from feeling scared. I was 14, but this fear can happen to anyone of any age. These kids didn’t look like any I was familiar with. Some of them looked like aliens to me. So I could have turned away, but I stayed. Once we started interacting, what each looked like/how they used their bodies, faded into a kind of backdrop
and their personalities became what I saw first—their unique and wonderful selves…(lol, not all of them were wonderful—some were total pains…yup, just kids.)
It’s fear of the unfamiliar, the unknown, the “not like me,” followed by the drive to avoid/control/eliminate what or who’s feared that perpetuates most of the awfulness of our world.
Would that we could all see one another’s unique selves and get to know each other so we wouldn’t be afraid. It won’t magically solve every conflict and erase bigotry, but it might allow a big ol’ space to open where folx could actually listen to each other’s truths, maybe build some bridges over their toxic reactivities and ignorances, and maybe—just maybe—begin to see there is no “normal,” no overarching “truth,” and no winning in these perpetual wars we wage against one another.
✌️✨
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Thank you for this wonderful reply, Jazz! What a powerful, moving, eye-opening experience you had as a teenager! And I heartily agree that intersex is not a deformity.
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I don’t think people currently can refuse to work with folx coping with HIV in MA. In some states, I’m sure it’s happening still, sadly.
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You got me sucked in to this topic…partly because what is legal vs what actually occurs often don’t match. So I researched it a bit.
People with HIV or AIDS are protected from discrimination by section 504 of the Rehabilitation Act (1973) and the Americans with Disabilities Act (ADA) (1990). This includes the right to receiving equitable healthcare. These laws apply only in public institutions or institutions that receive public funding (something you acknowledged in your post).
There are loopholes, however, and many folx despite being protected legally under 504 and ADA will still experience discrimination—and their only recourse is to file formal complaints and/or instigate legal action, which is often beyond the scope or abilities or time and energy of differently-abled people.
Additionally, I’d wager my “all” in guessing that if an employee such as a nurse refused the assignment to care for a person with HIV a lot of supervisors/administrators prefer to avoid conflict and confrontation, so just swap out the assignments (unless treatment is an emergency situation).
The ADA states:
Can an employer consider health and safety when deciding whether to hire an applicant or retain an employee who has HIV or AIDS?
Yes, but only under limited circumstances. The ADA permits employers to establish qualification standards that will exclude individuals who pose a direct threat—i.e., a significant risk of substantial harm—to the health or safety of the individual him/herself or to the safety of others, if that risk cannot be eliminated or reduced below the level of a “direct threat” by reasonable accommodation. However, an employer may not simply assume that a threat exists; the employer must establish through objective, medically-supportable methods that there is a significant risk that substantial harm could occur in the workplace. By requiring employers to make individualized judgments based on reliable medical or other objective evidence—rather than on generalizations, ignorance, fear, patronizing attitudes, or stereotypes—the ADA recognizes the need to balance the interests of people with disabilities against the legitimate interests of employers in maintaining a safe workplace.
Transmission of HIV will rarely be a legitimate “direct threat” issue. It is medically established that HIV can only be transmitted by sexual contact with an infected individual, exposure to infected blood or blood products, or perinatally from an infected mother to infant during pregnancy, birth, or breast feeding. HIV cannot be transmitted by casual contact. Thus, there is little possibility that HIV could ever be transmitted in the workplace.
Are health care providers required to treat all persons with HIV or AIDS, regardless of whether the treatment being sought is within the provider’s area of expertise?
No. A health care provider is not required to treat a person who is seeking or requires treatment or services outside the provider’s area of expertise. However, a health care provider cannot refer a patient with HIV or AIDS to another provider simply because the patient has HIV or AIDS. The referral must be based on the fact that the treatment the patient is seeking is outside the expertise of the provider, not the patient’s HIV status alone.
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This is great to know. I appreciate your patient, diligent way with researching. So, my coworker was being enabled by her supervisors in order to avoid conflict, even though it was within the law for that organization, whose AFC program this woman and I worked within, was entirely funded by Medicaid, a federal program administered by the state of MA. And there was no physical risk of harm to this woman if she had served the HIV clients, since she didn’t give injections or handle needles with their blood. So, my initial thought was indeed correct after all. Hence, I revised my last paragraph to this post, incorporating some of your researched information.
Wow, just wow.
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This is the link to the ADA information page just in case you wanted to see the whole piece:
https://archive.ada.gov/hiv/ada_qa_hiv.htm
As to why the supervisor allowed the discriminatory behavior, it was just my guess that the choice was to avoid conflict. A more generous interpretation of the supervisor’s motivation would also include wanting to ensure that the patient/client would receive compassionate and dignified care by their provider—unlikely if the supervisor were to have compelled that nurse to provide it.
Sadly, I think this stuff happens all the time. And it gets very messy and convoluted if an employee objects to following the law based on their religious beliefs. In my limited experience of witnessing this kind of stuff, when religious beliefs are wielded as a right to refuse to comply with existing laws that apply to the workplace, supervisors/administrators (at least those who personally support and agree with the law) can feel threatened by the potential for lawsuits from both directions so kind of hold their noses and scurry around in an attempt to keep things going smoothly.
This kind of stuff allows bigotry and discrimination to continue. That supervisor you worked with probably had no awareness that their release of that nurse from caring for that patient DID cause harm and was itself discriminatory. Even though the patient received care, any worker who was aware of the allowance and was gay or had HIV or loved and/or supported equality etc. for people who are gay or HIV positive experienced harm—kind of discrimination by proxy.
I think I made up the term “discrimination by proxy” btw. When this occurs in a workplace, it makes clear to those aware of it that the institution’s function and success is more important than the workers who make it run. Not only does it devalue employees, it erodes confidence/trust in the promise of equitable treatment.
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I appreciate all you say here, including your own term “discrimination by proxy,” which, as a gay man, I clearly was a victim of, according to your criteria.
This problematic coworker left the agency about a year after I arrived at the job. I was there for another three plus years. With all new workers in the AFC program, we employees conducted team interviews, including of program director candidates. I made it a point to ask all prospective new coworkers how they felt about working with gay people and those with HIV. From then on, no coworker was discriminatory like that one nurse had been. It was empowering to help change the face of that part of the agency.
In my opinion, that nurse should never have been hired, at least not in that particular program, since AFC (Adult Foster Care) served a good share of people (mostly gay men) with HIV. For one thing, this person was given unchallenged leeway to vent her homophobic-based passion in a team meeting, all to “keep the peace,” I’m sure. I’ll never forget that meeting, which was led by a program director younger than myself at the time. I harbor no resentment towards that director, who later quietly told me and the other program nurse that she did not agree with that ranting (my descriptor) coworker.
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Wow what a horrible experience to have been through, especially in the time when you were powerless to change things as a worker. It’s shocking that the nurse’s homophobic vitriol was left unchallenged. Wow. Just wow. How painful and hurtful that must have been.
I guess I sort of get why she wasn’t challenged though…it’s a big risk to call out colleagues on “hot” topics in front of other colleagues. I did it a few times where I worked when I just couldn’t tolerate it anymore—and I paid a high price for it each time both with some peer colleagues who shunned me and others who said nasty things, and with administrators who accused me of being unprofessional. (The callouts were in the same time frame as your experience, but in a high school, and related to certain teachers use of both homophobic slurs and misogynistic language in the presence of students and other teachers.) I felt good about doing what I believed was the right thing, but I sure suffered for it. So I do have compassion and understanding for folx who choose to let things slide publicly, but make their views known privately. I just wish that organizations invited more venues for people to actually talk with one another in real conversations about these divisive issues.
We need this evermore as our culture becomes increasingly polarized.
I keep singing this chant to myself…(I’m fond of Glen Thomas Rideout…). I sing it with “people” instead of “sisters”. https://youtu.be/soWiJ-isHFg
And what a positive shift after that opened the opportunity to interview potential new employees! It is heartening to hear that nothing like that nurse’s behavior occurred again! You can certainly take some credit for fostering that new kind of environment!
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