Discrimination | HIV/AIDS | Rhode Island

Yes, Rhode Island has enacted two separate laws that prohibit discrimination against people with HIV or AIDS.

• First, Rhode Island has an anti-discrimination law that explicitly relates to HIV. This law provides that “[n]o person, agency, organization, or legal entity may discriminate against an individual on the basis of a positive HIV test result, or perception of a positive test, in housing, education, employment, the granting of credit, public accommodation, or delivery of services. . .” (RI ST 23-6.3-11)
• Second, people with HIV are protected under laws that prohibit discrimination on the basis of disability. This includes the federal Americans with Disabilities Act (ADA),2  and analogous Rhode Island disability & antidiscrimination laws. (42 U.S.C. § 12101)

Disability antidiscrimination laws protect people with AIDS or who are HIV-positive, even if they are asymptomatic and have no outward or manifest signs of illness. They also protect people who are regarded or perceived as having HIV.

Under the ADA, but not Rhode Island law, these laws also prohibit discrimination against a person who does not have HIV, but who “associates” with a person with HIV — such as friends, lovers, spouses, roommates, business associates, advocates, and caregivers of persons with HIV.

雇主不得仅仅因为申请人或雇员患有艾滋病毒或艾滋病等残疾而对其采取不利行动。这意味着雇主不得基于申请人感染艾滋病毒或患有艾滋病而解雇、拒绝雇用、重新雇用或晋升，或在雇佣条款或条件上进行其他歧视。

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 Rhode Island law, an HIV test shall not be required as a condition of employment (RI ST 23-6.3-11).

Under the ADA and Rhode Island law (42 U.S.C. 12112; RI ST 28-5-7(4)(i)), 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？
• An employer may, however, ask whether an applicant has the knowledge, skill and ability to perform the job functions.

After a conditional offer of employment, an employer may require a physical examination or medical history solely for the purpose of determining if an employee can perform the essential job functions with reasonable accommodation.  The job offer, however, may not be withdrawn unless the results demonstrate that the person cannot perform the essential functions of the job with or without reasonable accommodation.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.

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 Systems Corporation, 50 F.3d 1261 (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.

While it may be useful to consult with a lawyer, the following steps can be helpful in beginning to consider and assess a potential employment discrimination problem:

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, 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 Rhode Island’s HIV-specific antidiscrimination law (RI ST 23-6.3-11), Rhode Island’s disability antidiscrimination law (RI ST 34-37-4), as well as the National Fair Housing Amendments of 1989 (42 U.S.C. §§ 3601-3619), 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.

There are no exceptions to housing discrimination on the basis of HIV status under Rhode Island’s HIV-specific law (RI ST 23-6.3-11). Rhode Island’s disability antidiscrimination law exempts residences where there are three or fewer apartments and the owner occupies one of the units (RI ST 34-37-4). In addition, the federal 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 (42 U.S.C. § 3604).

Yes, under Rhode Island’s HIV-specific antidiscrimination statute (RI ST 23-6.3-11), Rhode Island’s disability antidiscrimination law (RI ST 11-24-2), as well as the ADA (42 U.S.C. § 12182), 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.

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。

Believe it or not, people with HIV still face 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.

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）。

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 Rhode Island law.

Courts 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 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.

因此，1998年，美国最高法院就此案作出裁决 布拉格登诉阿博特案 (524 U.S. 624 (1998)) that health care providers cannot refuse to treat people with HIV based on concerns or fears about HIV transmission.

除了法律层面，美国医学会、美国牙科协会以及许多其他专业医疗保健组织都发布政策，认为拒绝为艾滋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。

在 美国诉莫万特案 (898 F.Supp. 1157 (E.D. La 1995)), a federal trial court rejected a dentist’s claim that patients with HIV require a specialist for routine dental care. 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.

Under Title III of the ADA, it is illegal for a health care provider to:

1. 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。
2. 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。
3. 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。
4. 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：

• 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。
• 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。
• 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。
• 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 even be an ADA violation to use unnecessary additional precautions that tend to stigmatize a patient simply on the basis of HIV status.
• 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。

It is illegal under Rhode Island’s HIV-specific antidiscrimination law (RI ST 23-6.3-11) and Rhode Island’s disability antidiscrimination law (RI ST 34-37-4) to discriminate on the basis of HIV status in the granting of any form of credit or loan.

Under the National Fair Housing Amendments of 1989 (42 U.S.C. §§ 3601-3619), it is illegal to discriminate on the basis of HIV status in the financing of housing.

It is illegal under Rhode Island’s HIV-specific antidiscrimination law (RI ST 23-6.3-11) and Section 504 of the federal Rehabilitation Act of 1973 (29 U.S.C. § 794) to discriminate on the basis of HIV status in public school programs or activities.