Peace Corps Struggles With HIV Policy

By Stephen Barr
Friday, May 16, 2008

As best the Peace Corps knew, Jeremiah S. Johnson was "the first instance of a volunteer" who tested positive for HIV and wished to remain with the agency rather than return to the United States for medical treatment.

But Rebecca M. Coulborn, a Peace Corps volunteer in the West African nation of Burkina Faso, said she was forced out in 2001 when an exam showed she had HIV. "I did not want to be medically separated," she recalled.

Like Johnson, who was brought back to Washington from Ukraine this year, Coulborn was on an airplane headed for D.C. within 48 hours of having her diagnosis confirmed. "I was told that was Peace Corps policy," she said. "If you did test HIV-positive, you were medically separated from the Peace Corps."

Coulborn spoke about her experience with the Peace Corps after reading about Johnson in the April 28 Federal Diary column. Johnson said the Peace Corps' decision to not allow him to serve is contrary to federal anti-discrimination laws, and he has asked the American Civil Liberties Union to help him bring about a change in the agency's practices.

The Peace Corps, in a May 7 letter to the ACLU, described Johnson as the first case of a volunteer "to our knowledge" who wished to remain with the agency after testing HIV-positive.

Amanda H. Beck, the Peace Corps press director, said the statement about Johnson being the first was "based on personal knowledge of the currently serving Peace Corps staff members," who typically turn over every five years under the agency's staffing rules.

"Our primary concern is that Peace Corps volunteers receive the best medical care and treatment possible," Beck said. "In the case of HIV, the Peace Corps Office of Medical Services has historically determined that the best testing, evaluation and treatment for volunteers is available from specialists in the United States."

Since 1989, volunteers have undergone medical screenings at the beginning and end of their tours. Most receive a mid-tour exam, too, but a test for HIV, the virus that causes AIDS, was voluntary at first.

About 75,000 Americans have served in the Peace Corps since 1989, and 36 have tested positive for HIV during or at the close of their overseas tours, Beck said.

Under the agency's general policy, if a volunteer develops a condition that cannot be resolved within 45 days, the person is medically separated from the Peace Corps. Because initial assessment and treatment of HIV can take from three to six months, volunteers who are HIV-positive face what the ACLU has called automatic separation.

In its letter to the ACLU, the Peace Corps' policy appears to be evolving. "The Peace Corps is now committed to extending the individualized assessments in these types of cases to include whether a newly infected volunteer could be reasonably accommodated and either kept at post or sent to another post in lieu of medical separation," the letter said, adding that "we cannot commit to a guarantee of reassignment."

Coulborn, 32, an epidemiologist who works at the University of Michigan, said she was not given any option except to leave the agency. "I really thought it was their policy to automatically separate people," she said. "I felt for a long time that this was something done to me that was wrong, and very unethical."

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