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The history of tuberculosis sanitariums and mental hospitals reveals a number of disadvantages to single-disease hospitals that must be reckoned with in the current policy debate. Indeed, the historical record places the burden of proof on those who would encourage single-disease institutions.

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The creation of "HIV-only" hospitals would promote negative stereotyping and bias against those with HIV disease, particularly as the disease comes to affect black and Hispanic persons disproportionately. To segregate their treatment outside mainstream institutions would enlarge the social distance separating them from society and increase the likelihood of discrimination. A single-disease hospital would interfere unduly with the freedom of choice of these patients and bring an inappropriate level of coercion to health care. This would surely occur if all HIV-infected patients were compelled to enter such institutions, whatever their medical history, inclinations, or concurrent health needs. This loss of freedom would occur even in an ostensibly voluntary system in which the single-disease hospital would not be the sole provider of services, because other institutions, private and public, would become less willing to treat patients with HIV infection. Alternatively, general hospitals might admit such persons as long as they had adequate insurance, referring all others to the single-disease facility. The only hospital in the country for HIV-infected patients, the Houston Institute for Immunological Disorders, closed in 1986 after a year of operation; it could not attract patients with insurance because they preferred to use mainstream facilities.


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A preferred policy would be to integrate people with HIV infection into a mixed-use nursing home, serving them, perhaps, in a discrete unit within the larger facility. (The analogue is to a unit dedicated to the treatment of patients with HIV disease in a general hospital.) In this way, the particular needs of the HIV-infected population would be met, and the inclusive character of the nursing home would protect against the disadvantages of a special-purpose facility.