Chicago Tribune (CT) - MONDAY March 2, 1987 Edition: SPORTS FINAL Section: PERSPECTIVE Page: 13 Word Count: 760
Joan Beck

Should routine prenatal care include a mandatory test for AIDS virus? (Infected mothers run a high risk of having a baby with AIDS.)

Should AIDS testing be compulsory for all hospital patients? In clinics for sexually transmitted disases? In family planning centers? Should the sexual partners of individuals infected with AIDS virus be notified?

No, no, no, no, no and only with the consent of the infected person, concluded public health officials at a conference called by the Centers for Disease Control in Atlanta last week to recommend a national policy on the use of blood tests to identify individuals infected with the AIDS virus (now called HIV, or human immunodeficiency virus).

Public health officials did urge more voluntary testing, provided it is done with informed consent and in situations where extensive counseling can be provided, total confidentiality can be assured and no adverse consequences will occur.

The reasons for this stance aren't just paranoia over civil rights, although most of those at the conference were so sensitized to this aspect of the AIDS problem that at times it sounded more like a meeting on civil rights than on disease control.

The stark medical problem is that once infected people are identified, they can't be cured; the only drugs available now alleviate some symptoms but do nothing about the underlying disease. Infected persons are assumed to remain infectious for life. Even if anyone wanted to quarantine them, there are far too many--an estimated 1 million to 2 million.

The only way now to slow the spread of AIDS is by education. Those who are infected must be persuaded to stop the kind of behavior that infects others--to practice "safe sex" or abstain, to avoid sharing needles and to avoid becoming pregnant.

Changing such behavior is particularly difficult. Public education is only partially successful in persuading people not to smoke or drive while drunk. It's not likely people can be talked into wearing condoms any more easily than wearing seat belts. And those at highest risk for AIDS --homosexuals, bisexuals and intravenous drug users--are accustomed to ignoring social norms and social pressures.

But persuasion and counseling stand a better chance of working if blood testing isn't compulsory, health officials assume. They are also concerned lest compulsory testing scare people away from other kinds of services they need, such as prenatal clinics, family planning centers and drug treatment facilities.

Very few infected individuals would be screened out if HIV testing were made compulsory before marriage, according to public health officials. Most people in high-risk groups don't get married. Most AIDS babies are born to unmarried, IV drug users who live in poor, minority communities and usually don't seek prenatal care until it is too late to have an abortion. (Abortion is the only option that can be offered to a pregnant, infected woman except giving birth to a baby at great risk for AIDS.)

Public health officials, gay rights groups and civil rights advocates all have cheered the recommendations of the CDC conference that testing be encouraged but not required. The conference also urged that more legislation to protect the confidentiality of test results be passed and more public money for education and counseling be appropriated.

All of this will help. But a major message of the conference went unsaid. It is this: We must all protect ourselves from becoming infected with AIDS. Public health measures are inadequate. Many public health officials are more concerned about protecting the civil rights of victims than safeguarding the health of those not yet infected. Every effort will be made to keep confidential the identity of those who are infected and able to spread the disease.

Many individuals who test positive for the AIDS virus and have been carefully counseled about how to avoid infecting others don't change their behavior (although a substantial proportion say they have). Many others who have reason to suspect they are infectious refuse to be tested because they don't want to change. Hundreds of thousands more don't know that they are infected and no screening programs will pick them out. No one knows how many of these people are still having unsafe sex or sharing IV drug needles.

The burden of protecting ourselves is clearly ours.

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Always watch for outdated information. This article first appeared in 1987. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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