Chicago Tribune (CT) - SUNDAY December 15, 1985; Page: 10
Robert Blau, Tribune feature writer

In Illinois until recently--when the state Department of Public Health changed its policy regarding donor notification--blood banks could do nothing more than simply discard blood from any donor with a confirmed positive antibody test and say nothing about it to anyone.

"We were between a rock and a hard place," Behzad says. "On the one hand, you're concerned about mistakes in the test. What if a person isn't really positive? On the other hand, (in the case of) a female who has a husband and a family, I felt I should report her positive results. She may also give birth to a child. The state has a department that keeps track of people with venereal diseases. With AIDS someone should sit with these people and explain to them what it is.

"The first week or two, I would notice that this donor is a high school kid, that one is a man who has donated blood 26 times," Behzad continues. "Now it's become more of a routine process, discarding the units. What I am looking forward to is detecting the virus itself, not just the antibody. We're going through the same thing we did with hepatitis. The question is whether the person carries the virus and the antibody simultaneously."

If AIDS poses a moral dilemma for the blood banks, it offers a logistical nightmare for public health authorities. Their experience with other sexually transmitted diseases like syphilis and gonorrhea simply does not apply in the fight against this new disease.

In the beginning the experts predicted a swift solution to AIDS. It was recognized as an elusive menace of a virus, but many thought it would be beaten down like other sexually transmitted diseases. Syphilis, too, was once a killer, but with the right mixture of penicillin and detective work, it can now be overcome with virtually no side effects to its victims other than some embarrassment.

Sometimes, though, a disease can make fools of the experts. There is as yet no vaccine for AIDS, and when the medical community even discusses the possibility of one, they say it is at least 10 years away.

Contact tracing, the method by which public health officials track the spread of sexually transmitted diseases, thus far has been rejected, for the simple reason that once a caseworker finds potentially infected subjects, no remedy can be offered to them. Both syphilis and gonorrhea have easily available and administered cures. There is, so far, no cure for AIDS. And because the incubation periods for syphilis and gonorrhea are relatively short, between 30 and 90 days, infected sexual partners are easier to track down and counsel. AIDS, it is believed, can be dormant for periods of five years or longer.

Yet contact tracing--using the AIDS screening test--is precisely what the San Francisco Public Health Department director, Dr. Dean Echenberg, has proposed. It is now being seriously considered by various state public health departments.

The routine contact-tracing procedure involves tracking down all sexual contacts that an infected person has had within the entire period of incubation. In the case of AIDS, however, its long incubation period makes it virtually impossible to reach every sexual partner who may be at risk. Addresses change, names are forgotten. Health officials also point out that it is not uncommon for a homosexual with AIDS to have had numerous anonymous sexual contacts, further complicating contact tracing. With the old venereal diseases, the partners, once known, are quickly brought to a local health clinic for treatment and counseling.

"In some situations it might be worth tracing someone's contacts," says the CDC's Peterman. "But what if there's a guy with 50 different lovers? You simply have to tell people not to have sex with people they don't know."

Furthermore, Echenberg claims that AIDS is gradually working its way into the heterosexual population because many heterosexuals are in fact carriers of the HTLV-III virus and are spreading it unknowingly among their heterosexual partners.

It is estimated that less than 1 percent of AIDS patients have contracted the disease from heterosexual contact. What makes this so dangerous, Echenberg says, is the fact that the heterosexual community is much less aware of the need for safe sexual practices, a message that is generally believed to have reached the homosexual community.

"We propose," Echenberg wrote in the Oct. 18 issue of the Journal of the American Medical Association, "that all AIDS patients be interviewed to obtain their heterosexual contacts and that these contacts be tested for the antibody. All contacts who are positive would then be counseled and educated about the nature of AIDS and its transmission, and their contacts would in turn be tested. The main thrust of this program is individual education and counseling of infectious heterosexuals.

"Identifying infectious heterosexuals outside the classic high risk groups," Echenberg concluded ominously, "will only be more costly in the future in terms of both economics and cases not prevented."

Illinois public health workers, however, are claiming that they are already overworked handling cases of other sexually transmitted diseases.

Bill Borzon, a federal public health official in Chicago, has been driving the streets of the South Side like a deliveryman. Wearing blue jeans and a tweed sports jacket, he bounds through back yards and up and down staircases and knocks on strange doors with three raps of his keys to deliver his message, which is anything but good.

"I have some important news about your health," is what he says firmly to whoever answers.

Usually nobody is at home. Or he has been given the wrong address or a false name like "Venus Jupiter" or "Maria Casanova," and he often ends up in some dismal dead end.

He comes to tell people that they have gonorrhea or syphilis, that the body rashes they see erupting uncontrollably will soon disappear and then turn inward to attack internal organs, that sex without protection will spread the diseases, which ultimately can kill.

"Every case we don't get will be responsible for more cases in the community," he says. So, along with his full-time staff of five caseworkers at the District Four Public Health Clinic, he tracks his subjects down as best as he possibly can.

On one of his best days, he left the clinic with eight cases to pursue and by the afternoon had six of his subjects in the clinic for treatment. Today is not one of his better days.

"We're looking for a 19-year-old black male," Borzon says after stops at two make-believe addresses and two empty apartments. "Positive syphilis."

He walks up to an address listed in his file. A young woman answers the doorbell and lets him in.

The apartment is immaculate and stylishly decorated, the furniture high- gloss and angular. The 19-year-old is home. He reaches out to shake Borzon's hand. His palm is covered with lesions and open sores.

"Do you have any more of those?" Borzon asks calmly.

The 19-year-old lifts his shirt to reveal clusters of blisters and says that he had others about a month ago but that they went away.

Borzon begins to explain venereal diseases.

The young man looks perplexed. "Can you tell me about syphilis?"

"You had to have gotten this from sex," Borzon explains.

The young man says that he has had sex only with his 16-year-old live-in girlfriend. She, too, has developed sores, he adds.

Borzon tells him that there had to be someone else. The fact that this is the second wave of blisters indicates that he contracted the infection about six weeks ago, and the fact that his live-in girlfriend now shows symptoms suggests that the young man passed it on to her instead of the other way around.

He draws a picture of the syphilis germ on a napkin and explains what incubation is and how the disease enters the body. It is absolutely essential that he get every name of every contact, be it a man or a woman, or the syphilis germs will spread in continuous, never-ending cycles.

"If a young lady is pregnant, you can do damage to her and her baby," he explains firmly. "Who else did you have sex with?"

"Well, there was someone else, but that was before." "You've got to get in touch with her," Borzon tells him.

Borzon recognizes that were he called upon to do contact tracing for AIDS patients, his communication skills would be challenged by the inability and reluctance of some homosexuals to admit their homosexuality and to identify their sexual contacts, especially when all that information must be written down in his loose-leaf notebook.

Also, by the time AIDS is diagnosed, it usually means that either cancer or fungal pneumonia has set in. Those symptoms put the disease beyond the reach of public health clinics. But he recognizes that the message regarding the prevention of AIDS would be the same as that for other sexually transmitted diseases.

"Information and education are as important as getting someone in for treatment," Borzon says. "But I guess the bottom line is whether it is cost effective to have some of our workers going out to tell people to have safe sex while babies are still dying (from other diseases). It's a tough decision."

"Drawing the line between public and individual responsibility is the key issue," says Dr. Turnock. "The individual responsibility goes back to sexually transmitted diseases of all types. Multiple partners put people at greater risk. That is something that people can avoid doing. The alternative really gets to be one of forced choices and constrained sexual activity. At this point those aren't perceived as viable alternatives."

At this point, Turnock insists, contact tracing would pose too large an undertaking for Illinois' public health resources. But if AIDS continues to spread and the general population does not learn to display a new sexual responsibility, Illinois and every other state may be forced to retrace once again the sensitive line between individual rights and the public welfare.

CAPTION: Photo: (color) Tribune photo by Charles Osgood. A Red Cross lab technician screens samples of donated blood for AIDS antibodies. Photo: (color) Tribune photo by Charles Osgood. The blood-donor room: Red Cross officials vow confidentiality. Photo: UPI Telephoto. White House protesters seek funds for AIDS research. Photo: (color) Tribune photo by Sally Good. The AIDS test: a sticking point. Photo: (color) Tribune photo by Charles Osgood. Screening blood at a Red Cross donation center.

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Always watch for outdated information. This article first appeared in 1985. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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