Discrimination | HIVAIDS | Massachusetts

Yes. Massachusetts has enacted anti-discrimination laws protecting people with HIV from discrimination in employment, housing, and public accommodations. In addition, there are a number of federal laws that protect people from discrimination based on their HIV status.

• Menschen mit AIDS oder HIV-positiv, auch wenn sie asymptomatisch sind und keine äußeren oder offensichtlichen Anzeichen einer Krankheit aufweisen.
• Menschen, die eine HIV-Infektion haben oder von denen angenommen wird oder die als HIV-infiziert gelten.
• Under federal law, but not Massachusetts law, a person who does not have HIV, but who “associates” with a person with HIV – such as a friend, lover, spouse, roommate, business associate, advocate or caregiver.

People with HIV are protected under Massachusetts General Law Chapter 151B and the federal Americans with Disabilities Act (ADA).  Both of these statutes prohibit discrimination in employment on the basis of a person’s disability. Massachusetts law covers workplaces with six or more employees. The ADA covers workplaces with 15 or more employees.

An employer may not take adverse action against an applicant or employee simply on the basis that the person has a disability such as HIV or AIDS.  This means that an employer may not terminate, refuse to hire, rehire, or promote, or otherwise discriminate in the terms or conditions of employment, based on an individual’s HIV/AIDS status.

Dabei steht im Vordergrund, ob eine Person mit AIDS oder HIV anders behandelt wurde als andere Bewerber oder Mitarbeiter in vergleichbaren Situationen.

Beispiele für unrechtmäßige Diskriminierung sind:

• Ein Arbeitgeber darf die Einstellung einer Person mit HIV nicht aus Angst vor einer HIV-Übertragung auf andere Mitarbeiter oder Kunden ablehnen.
• Ein Arbeitgeber darf die Einstellung einer Person oder eine Einstellungsentscheidung nicht aufgrund der Möglichkeit oder sogar Wahrscheinlichkeit ablehnen, dass eine Person krank wird und die Arbeit in Zukunft nicht mehr ausüben kann.
• Ein Arbeitgeber kann die Einstellung einer Person nicht mit der Begründung ablehnen, dass dadurch die Beiträge zur Kranken- oder Unfallversicherung steigen würden.

No. Massachusetts law (M.G.L. c. 111, § 70F) prohibits an employer from requiring that an employee take an HIV test under any circumstances at any stage of the application or employment process.

Under the ADA and Massachusetts law, prior to employment, an employer cannot ask questions that are aimed at determining whether an employee has a disability.  Examples of prohibited pre-employment questions are:

• Waren Sie schon einmal im Krankenhaus oder in ärztlicher Behandlung?
• Haben Sie jemals eine Arbeitsunfallentschädigung oder eine Erwerbsunfähigkeitsrente bezogen?
• Have you ever had any medical problems that would make it difficult for you to do your job?
• Welche Medikamente nehmen Sie?

An employer may, however, ask whether an applicant has the knowledge, skill and ability to perform the job functions.

Under the ADA, after a conditional offer of employment, an employer may request a medical examination or any medical information, without limitation.  However, the ADA does require the employer to follow certain practices:

• The employer must require the medical exam or inquiry of all applicants in the job category.
• The information must be kept strictly confidential. It must be on separate forms and kept in a segregated file apart from a general personnel file.
• The information may not be shared with others, with a limited exception for supervisors or managers who need to be informed of necessary job restrictions or accommodations, or safety personnel who may be told if the person with a disability requires emergency treatment.
• The results of the medical examination cannot be used to withdraw the job offer unless the results indicate that the individual is not able to perform the essential functions of the job with reasonable accommodation.

After employment has begun, an employer may only require a medical exam of a current employee if it is “job-related and consistent with business necessity.” The employer must demonstrate that the medical examination is necessary to measure the employee’s actual performance of job functions.

Of course, as noted above, employers in Massachusetts are prohibited from requesting an HIV test at any time.

In general, Massachusetts law limits employer health inquiries more strictly than federal law. Under Massachusetts law, after a conditional offer of employment, an employer may only require a medical examination for the purpose of determining whether the employee is capable of performing the essential functions of the job with reasonable accommodation.

The risk of HIV transmission from a health care worker to a patient is considered so small that it approaches zero.  Nevertheless, in cases where hospitals have sought to restrict or terminate the privileges of HIV-positive health care workers who perform invasive procedures, courts have reacted with tremendous fear and have insisted on an impossible “zero risk” standard. As a result, the small number of courts that have addressed this issue under the ADA have upheld such terminations.

The employment provisions in the ADA provide that an employee is not qualified to perform the job if he or she poses a “direct threat to the health or safety of others.” To determine whether an employee poses a “direct threat,” a court analyzes:

• The nature, duration and severity of the risk;
• Die Wahrscheinlichkeit des Risikos; und
• Ob das Risiko durch angemessene Vorkehrungen beseitigt werden kann.

In the case of HIV-positive health care workers, courts have ignored the extremely remote probability of the risk and instead have focused on the nature, duration and severity of the risk. The following excerpt from a recent case is typical of courts’ approach:

“We hold that Dr. Doe does pose a significant risk to the health and safety of his patients that cannot be eliminated by reasonable accommodation. Although there may presently be no documented case of surgeon-to-patient transmission, such transmission clearly is possible. And, the risk of percutaneous injury can never be eliminated through reasonable accommodation … Thus, even if Dr. Doe takes extra precautions … some measure of risk will always exist …”(Doe v. University of Maryland Medical System Corporation, 50 F. 3d 1261 (4^th Cir. Md) (1995)).

It is important to note that only a small number of courts have addressed the rights of HIV-­positive health care workers.  The AIDS Law Project believes that these cases have been incorrectly decided and are inconsistent with the intent of Congress in passing the ADA. Because of the unsettled nature of the law in this area, a health care worker who is confronted with potential employment discrimination should consult a lawyer or public health advocate.

Auch wenn es sinnvoll sein kann, einen Anwalt zu konsultieren, können die folgenden Schritte hilfreich sein, um mit der Betrachtung und Bewertung eines potenziellen Problems der Diskriminierung am Arbeitsplatz zu beginnen.

1. Consider the difference between unfairness and illegal discrimination. The bottom line of employment law is that an employee can be fired for a good reason, a bad reason, or no reason at all. A person can be legally fired for a lot of reasons, including a bad “personality match.” What they cannot be fired for is a discriminatory reason specifically outlawed by a statute.

2. In order to prove a discrimination claim (i.e., that you were fired, demoted, etc. because of discrimination and not because of some legitimate reason), you must be able to show the following:

• Der Arbeitgeber wusste oder hat herausgefunden, dass Sie HIV-positiv sind oder AIDS haben;
• Sie waren qualifiziert, die wesentlichen Aufgaben der Stelle mit oder ohne angemessene Anpassung zu erfüllen; und
• Adverse action was taken against you because of your HIV or AIDS status and the pretextual reason given by the employer for the adverse action is false.

3. If your employer knows that you have HIV or AIDS, identify exactly who knows, how they know, and when they found out. If you have not told your employer, is there any other way the employer would know or suspect your HIV status?

4. Consider the reasons why you believe that you are being treated differently because of HIV status, including the following areas:

• Wurden andere Mitarbeiter in ähnlichen Situationen anders oder gleich behandelt?
• Hat Ihr Arbeitgeber seine Personalrichtlinien eingehalten?
• Begann die ungünstige Behandlung kurz nachdem der Arbeitgeber von Ihrem HIV-Status erfahren hatte?
• Waren Sie wegen einer Krankheit für einen bestimmten Zeitraum arbeitsunfähig und begann die negative Behandlung erst nach Ihrer Rückkehr an den Arbeitsplatz?
• Wie wird die Version Ihres Arbeitgebers zu den Ereignissen aussehen? Wie werden Sie beweisen, dass die Version des Arbeitgebers falsch ist?

5. Do you have any difficulty fulfilling the duties of your job because of any HIV-related health or medical issue? Does your condition prevent full-time work, or require time off for medical appointments, lighter duties or a less stressful position? You might want to try brainstorming to create a reasonable accommodation that you can propose to your employer. Here are some points to consider:

• Wie funktioniert das Unternehmen und wie würde die Unterbringung in der Praxis funktionieren?
• Versetzen Sie sich in die Lage Ihres Vorgesetzten. Welche Einwände könnten gegen die geforderte angemessene Unterbringung erhoben werden? Wenn Sie beispielsweise zu einer bestimmten Zeit wegen eines Arzttermins abreisen müssen, wer würde Ihre Aufgaben übernehmen?

It is illegal under both Massachusetts law (M.G.L. c. 151B) and the federal National Fair Housing Amendments of 1989 to discriminate in the sale or rental of housing on the basis of HIV status.  A person cannot be evicted from an apartment because of his or her HIV status, or because he or she is regarded as having HIV or AIDS.

In addition, a person cannot be discriminated against in housing because of their “association” with a person with HIV.  This means a person cannot be discriminated against because their roommate, lover, friend, relative, or business partner has HIV.

Yes. Massachusetts law exempts owner-occupied two-unit housing. In addition, the Fair Housing Act exempts, in some circumstances, ownership-occupied buildings with no more than four units, single-family housing sold or rented without the use of a broker and housing operated by organizations and private clubs that limit occupancy to members.

Yes. Under both Massachusetts law (M.G.L. c. 272, § 98) and the ADA, it is unlawful to exclude a person with HIV from a public place (what the law refers to as a “public accommodation”) or to provide unequal or restricted services to a person with HIV in a public place. Under both statutes, the term “public accommodation” includes any establishment or business that offers services to the public. In addition, the Federal Rehabilitation Act of 1973 (29 U.S.C.A. § 794) prohibits discrimination on the basis of disability in any agency or program that receives federal funding, including hospitals, medical or dental offices, and educational institutions.

Therefore, people with HIV are protected from discrimination in virtually every public place or business, including bars, restaurants, hotels, stores, schools, vocational or other educational programs, taxi cabs, buses, airplanes and other modes of transportation, health clubs, hospitals and medical and dental offices, as long as these facilities are generally open to the public.

Believe it or not, persons with HIV are still faced with discrimination by hospitals, doctors, dentists, and other health care providers.  This discrimination can take the form of an outright refusal to provide medical services or an illegal referral because of a patient’s HIV status.

Ärzte versuchen die Diskriminierung von Menschen mit HIV typischerweise mit einem von zwei Argumenten zu rechtfertigen:

• „Die Behandlung von Menschen mit HIV ist gefährlich“ (Einige Ärzte weigern sich, Menschen mit HIV zu behandeln, weil sie eine irrationale Angst vor einer HIV-Übertragung haben); und
• „Die Behandlung von Menschen mit HIV erfordert spezielle Fachkenntnisse“ (Einige Ärzte überweisen Patienten an andere medizinische Dienstleister, weil sie fälschlicherweise glauben, dass Allgemeinmediziner nicht für die Behandlung von Patienten mit HIV qualifiziert sind).

Both an outright refusal to provide medical treatment and unnecessary referrals on the basis of a person’s disability are unlawful under the ADA and Massachusetts law.

Courts and medical experts have responded to these arguments in the following ways:

1. “Treating People with HIV is Dangerous”

Doctors and dentists may claim that a refusal to treat a patient with HIV is legitimate because they fear they might contract HIV themselves through needle sticks or other exposures to blood. However, studies of health care workers have concluded that risk of contracting HIV from occupational exposure is minuscule, especially with the use of universal precautions.

For this reason, in 1998, the United States Supreme Court ruled in the case, Bragdon gegen Abbott, that health care providers cannot refuse to treat people with HIV based on concerns or fears about HIV transmission (524 U.S. 624 (1998)).

In addition to the legal perspective, both the American Medical Association and the American Dental Association, and many other professional health care organizations, have issued policies that it is unethical to refuse treatment to a person with HIV.

2. “Treating People with HIV Requires Special Expertise”

In diesen Fällen hängt die Begründetheit einer Diskriminierungsklage davon ab, ob aufgrund objektiver medizinischer Beweise die vom Patienten benötigten Leistungen oder Behandlungen eine Überweisung an einen Spezialisten erfordern oder in den Leistungs- und Kompetenzbereich des Anbieters fallen.

In Vereinigte Staaten gegen Morvanthat ein Bundesgericht die Behauptung eines Zahnarztes zurückgewiesen, dass HIV-Patienten für die routinemäßige Zahnbehandlung einen Spezialisten benötigten (898 F. Supp. 1157 (ED La 1995)). Das Gericht schloss sich den Aussagen von Experten an, die erklärten, dass für die zahnärztliche Behandlung von HIV-Infizierten keine spezielle Ausbildung oder Fachkenntnis erforderlich sei, die über die eines Zahnarztes hinausgeht. Das Gericht wies insbesondere die Argumente des Zahnarztes zurück, er sei nicht qualifiziert, da er sich nicht über die für die Behandlung von HIV-Infizierten erforderliche Fachliteratur und Ausbildung informiert habe. Obwohl dieser Fall im Zusammenhang mit der Zahnbehandlung auftrat, ist er auch auf andere medizinische Bereiche anwendbar.

Under Title III of the ADA (42 U.S.C. §§ 12181-12188), and similar provisions of Massachusetts law, it is illegal for a health care provider to:

• Deny an HIV-positive patient the “full and equal enjoyment” of medical services or to deny an HIV-positive patient the “opportunity to benefit” from medical services in the same manner as other patients.
• Legen Sie „Berechtigungskriterien“ für die Inanspruchnahme medizinischer Leistungen fest, die dazu führen, dass HIV-positive Patienten ausgesondert werden.
• Bieten Sie HIV-positiven Patienten „unterschiedliche oder separate“ Dienste an oder stellen Sie den Patienten keine Dienste im „integriertesten Umfeld“ zur Verfügung.
• Verweigern Sie einer Person, von der bekannt ist, dass sie in einer „Beziehung“ oder „Verbindung“ zu einer Person mit HIV steht, wie etwa einem Ehepartner, Partner, Kind oder Freund, gleichwertige medizinische Leistungen.

Wendet man die oben genannten spezifischen Bestimmungen des ADA auf die Ausübung der Gesundheitsfürsorge an, sind die folgenden Praktiken illegal:

• A health care provider cannot decline to treat a person with HIV based on a perceived risk of HIV transmission or because the physician simply does not feel comfortable treating a person with HIV.
• A health care provider cannot agree to treat a patient only in a treatment setting outside the physician’s regular office, such as a special hospital clinic, simply because the person is HIV-positive.
• A health care provider cannot refer an HIV-positive patient to another clinic or specialist, unless the required treatment is outside the scope of the physician’s usual practice or specialty. The ADA requires that referrals of HIV-positive patients be made on the same basis as referrals of other patients.  It is, however, permissible to refer a patient to specialized care if the patient has HIV-related medical conditions which are outside the realm of competence or scope of services of the provider.
• A health care provider cannot increase the cost of services to an HIV-positive patient in order to use additional precautions beyond the mandated OSHA and CDC infection control procedures. Under certain circumstances, it may be an ADA violation to even use unnecessary additional precautions which tend to stigmatize a patient simply on the basis of HIV status.

A health care provider cannot limit the scheduled times for treating HIV-positive patients, such as insisting that an HIV-positive patient come in at the end of the day.

To pursue a claim under the Americans with Disabilities Act for employment discrimination, the employer must have at least 15 employees. A person must file a claim with the Equal Employment Opportunity Commission (EEOC) within 180 days of the date of the discriminatory act. A person may remove an ADA claim from the EEOC and file a lawsuit in state or federal court.

To pursue a claim under the Americans with Disabilities Act for discrimination in a place of public accommodation, a person may, without first going to an administrative agency, file a claim in state or federal court for injunctive relief only (i.e., seeking a court order that the discriminatory conduct cease). Money damages are not available for violation of Title III of the ADA unless they are sought by the United States Department of Justice. However, a person may recover money damages under the Federal Rehabilitation Act in cases against entities that receive federal funding.

Um einen Anspruch nach dem Rehabilitationsgesetz geltend zu machen, kann eine Person eine Verwaltungsbeschwerde bei der regionalen Niederlassung des Bundesgesundheitsministeriums einreichen und/oder direkt vor Gericht Klage einreichen.

Um einen Anspruch auf Diskriminierung im Wohnungswesen nach dem National Fair Housing Act geltend zu machen, kann innerhalb eines Jahres nach dem Verstoß Beschwerde beim US-amerikanischen Ministerium für Wohnungsbau und Stadtentwicklung (HUD) eingereicht werden. Innerhalb von zwei Jahren nach dem Verstoß kann auch Klage eingereicht werden. Eine Klage kann unabhängig davon eingereicht werden, ob bereits eine Beschwerde beim HUD eingereicht wurde.