Chicago Tribune (CT) - Sunday September 27, 1987
Jean Latz Griffin

Using current fees in effect for commercial AIDS antibody tests, a spokesman for the Illinois Department of Public Health said couples who go to a private physician for their required physical examination can expect the examination to cost from $5 to $100 more because of the additional AIDS antibody test requirement.

That cost will be borne by taxpayers for persons on public aid, making the true cost in state funds higher than that incurred by the health department alone.

Gov. James Thompson last week used his amendatory veto power to approve, with changes, a bill requiring those seeking marriage licenses to show proof that they have been tested for antibodies to the AIDS virus. The new version of the legislation must go back to the General Assembly for its approval in the fall veto session.

Critics contend, however, that marriage-license testing will do little to stem the disease because those planning to marry are among the lowest-risk groups for contracting AIDS.

Only 4 percent of the 42,182 persons who have been diagnosed with AIDS in the United States report contracting the disease through heterosexual contact, say the federal Centers for Disease Control (CDC) in Atlanta.

It is also unlikely that the requirement will do much to keep babies from being born with AIDS, since a recent study by the American Medical Association showed that 80 percent of the infants who got the disease from their mothers were born to unmarried women.

Guidelines issued in August recommended that anyone planning marriage be given information about AIDS and offered the opportunity for counseling and testing, said Chuck Fallis, CDC spokesman.

"The guidelines say that decisions about mandatory premarital testing should take into account the prevalence of AIDS in the area," Fallis said. "Those decisions should be based on the cost effectiveness of such testing in preventing further spread of infection."

He said that testing could be justified in an area with an AIDS prevalence rate as low as 0.1 percent "if reaching an infected person through testing can prevent some subsequent transmission to the spouse or infection of a pregnancy." The prevalence rate of AIDS in the Chicago metropolitan area is only one-tenth of that rate, CDC figures say.

Those who do test positive may be asked who their sexual and drug partners have been under another law that encourages the Illinois Department of Public Health to trace the contacts of those who test positive for the AIDS antibodies virus.

"But they will be allowed to marry even if one or both is positive," said Thomas Schafer, public information officer for the Illinois Department of Public Health. "The county clerk will see exactly the same form verifying that the couple has been tested whether the tests are positive or negative."

If the General Assembly approves the bills, marriage-license applicants beginning Jan. 1 will have to show the county clerk a statement that they have been tested to see whether they have been exposed to the fatal disease, which is spread through sexual intercourse and can be passed from an infected mother to her unborn baby.

The results will be kept confidential between the couple and the physician unless one or both test positive. The physician is required to notify the Illinois Department of Public Health of a positive test, but other new laws require that such information be kept confidential.

Schafer said that, based on experience testing other heterosexual populations, 400 positive results are expected from the anticipated 200,000 tests, and of those 320 will will turn out to be "false positives," leaving only 80 real cases discovered from this huge chunk of the population.

"The first test, the Eliza, will produce a number of false positives," Schafer said. "We will follow that with the more sensitive Western blot test, which will determine who has really been exposed to the virus."

Schafer said the Eliza test costs only about $4 to $7 to administer, but the Western blot can cost $75 to $100.

That cost will be paid by the Department of Public Aid for those couples on welfare who go to a public health clinic for their premarriage physical examination and blood tests. A spokeswoman for the public aid department says there are 1.1 million people on public aid in the state, but she cannot estimate how many are likely to apply for marriage licenses.

"If the first test comes back positive, the couple will not be told of the results until the second, confirming test results are in," Schafer said. "That way, we won't have people worried sick for three weeks for no reason."

The legislation also requires that the physician tell both partners of the results of the tests, to explain what they mean and to offer them further testing and counseling.

A spokeswoman for the Illinois State Medical Society said that the society has been "aggressively educating" its 17,000 members on AIDS for the last year and has another information kit that will be mailed to members within a few weeks.

A positive test does not necessarily mean the person has AIDS. It indicates that there are antibodies in the blood that develop when a person has been infected with the human immunodeficiency virus, HIV, which scientists say causes AIDS.

The CDC estimates that 30 percent of the people who are infected with HIV will show symptoms of AIDS within 5 years of infection and that another 20 to 30 percent will show symptoms within 10 years .

AIDS, acquired immune deficiency syndrome, is contracted through sexual intercourse with an infected person or through infected blood. Men can pass it easily to women, but it has not been established how easily women can pass it to men. The great majority of those infected are homosexuals, bisexuals or intravenous drug users who share needles.

Schafer said that because the lawmakers intended that the people seeking the marriage licenses pay for the tests, the health department will not allow people to to get their marriage-test certificates from health department sites where AIDS antibody tests are free.

"We will probably just tell the physicians there not to sign any certificates," Schafer said.

Such a use of the sites would also increase the backlog of people wanting tests. There is a seven-week wait at Chicago's North Side center and a four- week wait at the South Side center. Waits are shorter in the suburbs. The health department sites offer anonymous testing. People can give only a code number when making a test appointment and picking up the results.

"We will not eliminate the anonymous testing, even though another part of the legislation requires physicians to report the names of those who test positive to the health department," Schafer said.

Schafer said county health officials already encourage people who get positive test results to tell their sex and drug partners the bad news. "If they are too embarrassed, we will do it for them," he said. Schafer estimated that the cost of monitoring the labs that do the marriage-license testing and developing new forms to include the results of the test will be $130,000 for the first six months, and after that about $150,000 a year.

No money has been allocated for contact tracing, Schafer said. The estimated cost-$600,000 for the first six months and $1.2 million to $1.5 million each year after that-would take a big chunk out of the department's AIDS budget.

he department asked for $4.6 million for AIDS education, testing and counseling for the next year, but the governor trimmed that to $3.4 million. The department hopes to get the extra money back during the veto session.

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