3 min

Resistant tuberculosis in contrast with HIV

A glaring double standard

A 32-year-old American man with active tuberculosis hopped a flight from Prague to Montreal, May 24. The strain of TB that’s teeming in his lungs and upper airway, called XTR TB, is resistant to four of the six most important antibiotic drugs used to treat and cure it.

That drug resistance makes the disease so much more difficult for doctors to treat that about 50 percent of patients with active XTR TB infections die.

The man was told by public health officials in his hometown in Georgia that he shouldn’t travel because he had a TB infection but on May 12, not wanting to miss his honeymoon, he flew to Europe. He took a total of seven flights around the EU in the subsequent two weeks. American health authorities contacted him while he was in Rome and told him his TB infection is drug resistant and highly dangerous and that he should report immediately to hospital.

But instead the man chose to fly to Montreal, a move calculated by him to avoid a US no-fly order against him. After he arrived in Canada, he drove across the US border into New York, turned himself in and is under mandatory quarantine and armed guard in hospital in Atlanta. Now Canadian authorities are working to track down the other passengers on the flight so they can be tested for this very dangerous and potentially fatal disease.

Dr Martin Cetron of the US Centers For Disease Control said at a press conference May 30 that the man did nothing illegal.

Cetron also said there’s no public health interest served in releasing the man’s name, doing so would only violate his privacy. And on CNN this morning, I watched a panel discussion about the moral implications of publicizing the man’s identity.

XTR TB is not sexually transmitted like HIV, rather it moves through the air on droplets of sputum. The chance that the man infected anyone else over the last few weeks is low, but the chance anyone he did infect will die or at least pass the bug onto someone else is quite high.

The similarities between XTR TB and HIV are significant, but there’s something about the way the mainstream media is approaching this story that is incongruous to how it approaches stories about people who are accused of lying to their sexual partners about being HIV-positive.

There’s a difference between the way people talk on the street about XTR TB and how they talk about HIV. And there’s a big difference in the way Canadian law is applied to someone who hops a flight with an active XTR TB infection and someone who lies about his HIV-positive status to his sex partners.

Instead of rage at this man’s reckless disregard for the health of others, Canadian authorities are miffed at the Americans for not sharing their no-fly list so the man could have been intercepted.

Instead of charging the man with assault or attempted murder, there are calls for an examination of the way international air passengers are screened and the failings of the public health systems that allowed him to travel so widely with a potentially fatal and aerosol-borne disease.

Instead of insinuating that the man is a mass murderer or a filthy, selfish bastard, there’s an intelligent effort by the public health apparatus — not by law enforcement — to track down those who might have come into contact with him.

And instead of publicizing the man’s name, picture and health history in the mainstream press — instead of branding him a modern-day Typhoid Mary in the name of public safety, as is common practice for those charged with aggravated sexual assault because of failure to disclose HIV status — there’s a discussion about what good it would do to complicate the poor man’s life by releasing his name to the public.

What does this tell me? It tells me that the level of hysteria surrounding HIV is far more frothy and irrational than the one surrounding XTR TB. It tells me that society has no problem re-victimizing those who are HIV-positive, particularly if they are gay men, but not so much for any other communicable disease.