Discrimination | HIV/AIDS | New Hampshire

Yes, New Hampshire 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.

• 患有艾滋病或艾滋病毒阳性的人，即使他们无症状且没有外在或明显的疾病迹象。
• 被视为或被认为感染艾滋病毒的人。
• 根据联邦法律（但不包括新罕布什尔州法律），未感染艾滋病毒但与艾滋病毒感染者“有联系”的人（例如朋友、恋人、配偶、室友、商业伙伴、倡导者和艾滋病毒感染者的护理人员）属于同谋关系。

People with HIV are protected under the New Hampshire Law Against Discrimination (RSA § 354-A), and the federal Americans with Disabilities Act (ADA).  Both of these statutes prohibit discrimination in employment on the basis of a person’s disability.  New Hampshire 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 the fact that a person is HIV-positive or has AIDS.

这里的重点是艾滋病患者或艾滋病毒感染者是否与类似情况下的其他申请人或员工受到不同的待遇。

以下是非法歧视的例子：

• 雇主不得因担心艾滋病毒感染者会传染给其他员工或顾客而拒绝雇用该感染者。
• 雇主不得基于某人将来可能生病而无法胜任工作的可能性或概率而拒绝雇用或做出雇用决定。

雇主不能因为这会增加健康或工人赔偿保险费而拒绝雇用某人。

Under the ADA and New Hampshire 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:

• 您曾经住院或接受过医生的护理吗？
• 您是否曾经领取过工伤赔偿或残疾福利？
• 你吃什么药？

If an employer has 15 or more employees, they must comply with the ADA.  After a conditional offer of employment, the ADA permits an employer to require a physical examination or medical history.  The job offer, however, may not be withdrawn unless the results demonstrate that the person cannot perform the essential functions of the job with or without reasonable accommodation.  The same medical inquiries must be made of each person in the same job category.  In addition, these physical examination and medical history records must be segregated from personnel records, and there are strict confidentiality protections.  After employment has begun, the ADA permits an employer to require a physical examination, only if it is job-related and consistent with business necessity.

If an employer has at least six but fewer than 15 employees, only New Hampshire law applies.  New Hampshire law allows employers, after making an offer of employment, to inquire into and keep records of existing or pre-existing physical or mental conditions (RSA § 354-A:7, III). New Hampshire law, however, does not mandate the specific requirements and limitations that are contained in the ADA regarding a post-offer exam.

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.

《美国残疾人法案》中的就业条款规定，如果员工“对他人的健康或安全构成直接威胁”，则其不具备从事该工作的资格。为了确定员工是否构成“直接威胁”，法院会分析以下因素：

• 风险的性质、持续时间和严重程度；
• 风险的概率；以及
• 是否可以通过合理的安排消除风险。

然而，在涉及HIV阳性医护人员的案件中，法院忽视了风险发生的可能性极小，而专注于风险的性质、持续时间和严重程度。以下摘自近期一个案例，体现了法院的典型做法：

“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^日 巡回法院，1995 年）。

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.

虽然咨询律师可能会有所帮助，但以下步骤可以帮助您开始考虑和评估潜在的就业歧视问题。

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:

• 雇主知道或得知您是艾滋病毒阳性或患有艾滋病；
• 无论是否有合理的便利条件，您都具备履行该工作基本职责的资格；并且
• 由于您的 HIV 或艾滋病状况而对您采取了不利措施，并且雇主给出的不利措施借口是虚假的。

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:

• 处于类似情况的其他员工是否受到了不同的待遇或相同的待遇？
• 您的雇主是否遵守了其人事政策？
• 雇主得知您的艾滋病毒状况后不久就开始对您进行不利的待遇了吗？
• 您是否曾因病缺勤过一段时间，并且返回工作岗位后是否开始受到不良治疗？
• 你的雇主对此事的描述是怎样的？你该如何证明雇主的说法是错误的？

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:

• 该公司如何运作？实际的住宿安排如何？
• 站在主管的角度想想，对于你提出的合理安排，主管可能会提出哪些异议？例如，如果你需要在某个时间离开去看医生，谁来接替你的工作？

It is illegal, under both New Hampshire law (RSA § 354-A:12) and the 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 or AIDS status, or because he or she is regarded as having HIV or AIDS.

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

是的，新罕布什尔州法律对以下情况有例外：业主出租的单户住宅；业主居住的公寓数量不超过 3 套且公寓业主自己占有一套公寓的住宅；以及业主或业主的家人居住在一套公寓数量不超过 5 套房间的住宅（RSA § 354-A:13）。 此外，公平住房法在某些情况下豁免以下住房：不超过四个单元的自住建筑、不通过经纪人出售或出租的独栋住宅以及由组织和私人俱乐部经营且仅限会员入住的住房。

Yes, under New Hampshire law (RSA § 354-A:1) 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.

因此，艾滋病毒感染者在几乎所有公共场所或企业都受到保护，免受歧视，包括酒吧、餐馆、酒店、商店、学校、职业或其他教育项目、出租车、公共汽车、飞机和其他交通工具、健身俱乐部、医院以及医疗和牙科诊所，只要这些设施通常向公众开放。

信不信由你，HIV 感染者仍然面临医院、医生、牙医和其他医疗机构的歧视。这种歧视可能表现为直接拒绝提供医疗服务，或因患者的 HIV 感染状况而进行非法转诊。

医生通常试图用以下两个论点之一来证明对艾滋病毒感染者的歧视是合理的：

1. “治疗艾滋病毒感染者是危险的”（一些医生出于对艾滋病毒传播的非理性恐惧而拒绝治疗艾滋病毒感染者）；
2. “治疗艾滋病毒感染者需要特殊的专业知识”（一些医生错误地认为全科医生没有资格为艾滋病毒感染者提供护理，因此将患者转诊给其他医疗服务提供者）。

根据《美国残疾人法案》和新罕布什尔州法律，直接拒绝提供医疗和以患者残疾为由进行不必要的转诊都是违法的。

法院和医学专家对这些论点作出了如下回应：

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 needlesticks 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 v. 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)).

除了法律层面，美国医学会、美国牙医协会等很多专业医疗保健组织都出台政策，认为拒绝为艾滋病病毒感染者提供治疗是不道德的。

2. “Treating People with HIV Requires Special Expertise”

在这些情况下，歧视索赔的是非曲直取决于基于客观医学证据，患者所需的服务或治疗是否需要转诊给专科医生，或者是否属于服务提供者的服务和能力范围。

In United States v. Morvant, a federal trial court rejected a dentist’s claim that patients with HIV require a specialist for routine dental care (898 F. Supp. 1157 (E.D. La 1995)). The court agreed with the testimony of experts who said that no special training or expertise, other than that possessed by a general dentist, is required to provide dental treatment to people with HIV. The court specifically rejected the dentist’s arguments that he was unqualified because he had not kept up with the literature and training necessary to treat patients with HIV. While this case arose in the context of dental care, it is applicable to other medical settings as well.

根据《美国残疾人法案》第三章（42 USC §§ 12181-12188），医疗保健提供者的以下行为属于违法行为：

• 剥夺艾滋病病毒感染者“充分、平等地享受”医疗服务的权利，或者剥夺艾滋病病毒感染者与其他患者一样“受益”医疗服务的机会。
• 建立接受医疗服务的“资格标准”，往往会筛选出艾滋病毒检测呈阳性的患者。
• 为艾滋病病毒阳性患者提供“不同或单独”的服务，或未能在“最综合的环境中”为患者提供服务。
• 拒绝向已知与艾滋病毒感染者有“关系”或“交往”的人（如配偶、伴侣、子女或朋友）提供平等的医疗服务。

将上述 ADA 的具体规定应用于医疗保健实践，以下做法是违法的：

1. 除非所需治疗超出医生的常规执业范围或专业范围，否则医疗保健提供者不得将 HIV 阳性患者转诊至其他诊所或专科医生。ADA 要求 HIV 阳性患者的转诊应与其他患者的转诊相同。但是，如果患者的 HIV 相关疾病超出了医疗服务提供者的执业能力或服务范围，则可以将患者转诊至专科护理机构。
2. 医疗保健提供者不能因为认为存在艾滋病毒传播风险或只是因为医生不愿意治疗艾滋病毒感染者而拒绝治疗艾滋病毒感染者。
3. 医疗保健提供者不能仅仅因为患者感染了艾滋病毒就同意仅在医生常规办公室以外的治疗环境（例如专科医院诊所）中为患者进行治疗。
4. 医疗保健提供者不得为了在强制规定的职业安全与健康管理局 (OSHA) 和疾病预防控制中心 (CDC) 感染控制程序之外采取额外预防措施而增加 HIV 阳性患者的服务费用。在某些情况下，采取不必要的额外预防措施甚至可能违反《美国残疾人法案》(ADA)，因为这些措施往往会仅仅因为 HIV 感染状况而使患者蒙受耻辱。

医疗保健提供者不能限制治疗艾滋病毒阳性患者的预定时间，例如坚持要求艾滋病毒阳性患者在一天结束时来就诊。