Chicago Tribune (CT) - SUNDAY August 21, 1988 Edition: FINAL EDITION Section: CHICAGOLAND Page: 1 Word Count: 1,327
Jean Latz Griffin, Public health writer

A bill on Gov. James Thompson's desk would give physicians the right to test patients for infection with human immunodeficiency virus, HIV, without their knowledge or consent.

It would exempt doctors from a provision in a year-old AIDS testing and confidentiality law that requires written, informed consent before testing and counseling before and after testing.

The law is considered a model in the nation, and public health experts say the protection it provides has encouraged people who suspect that they may have been infected to seek medical help and counseling.

Health officials say that is giving them a clearer picture of the spread of the virus in Illinois and the opportunity to counsel infected individuals to change their behavior and not pass the disease to anyone else.

In the last three months alone, 415 people-347 men and 68 women-have been diagnosed as being infected with the AIDS virus by Chicago physicians in private practice or hospitals, according to Brian Chapman, epidemiologist in the AIDS activity office of the Chicago Department of Health.

"And that is probably a low number, because doctors are just starting to realize that they have to send me their numbers," Chapman said. Names of those infected are not kept by the Health Department.

The Illinois State Medical Society, which represents physicians, wants to change the law to exempt doctors from getting a patient's written consent to perform the test.

The Illinois Department of Public Health opposes the exemption and wants the law to stay as it is.

"It is not unusual for public health to find itself on the other side of the fence from practicing physicians," said Dr. Bernard Turnock, director of the state Public Health Department.

"Sometimes public health people aren't as sensitive as they could be to the needs of practicing physicians," Turnock said. "And sometimes physicians don't understand the effect of what they do in their private practices on the overall public health."

AIDS activists and gay rights leaders agree with the Public Health Department. Thursday, the Illinois Gay and Lesbian Task Force, which monitors legislation, will picket the offices of the state medical society to protest the society's support of the exemption.

"This is only the second time we have ever called for picketing," said Timothy Drake, legislative chairman of the task force.

"We are very establishment, and we don't do this sort of thing. But we feel that strongly about the danger of this legislation."

To the medical society, opposing written, mandatory consent for HIV testing is simply an extension of its overall opposition to any government intrusion into the relationship between a patient and physician, said Dr. Harry Springer, president of the society.

"We have a long history of opposing mandated written consent for anything," Springer said. "AIDS is an infectious disease and should be treated like an infectious disease. Requiring consent for testing is a government intrusion into the special relationship between a physician and patient.

"It has nothing to do with confidentiality," Springer said. "The confidentiality part of the law is still in place."

But to public health officials and AIDS activists, the exemption of physicians from the requirement of written, informed consent is a threat to the cornerstone of the confidentiality law.

They oppose any secret HIV testing because of the discrimination and stigma connected with AIDS-either having the disease or being infected with the virus.

Children have been excluded from school because they are infected with the AIDS virus. Infected parents have had to go to court to win the right to visit their children.

Men and women have lost their jobs, homes and health insurance due to HIV infection. Illinois dentists this year got a bill passed that would allow them to refuse to treat a patient infected with the virus.

And this month, Washington University's School of Dental Medicine in St. Louis expelled a dental student after they discovered that he was infected with HIV. They obtained this information by reviewing his medical records without his consent, according to an article by the St. Louis Post-Dispatch.

School officials said they expelled the student because they feared he would give AIDS to patients he was treating in a school clinic, even though there has not been a documented case of a patient contracting AIDS from dental treatment.

"We can't just declare this disease to be like any other disease or this test to be like any other test," said Turnock. "We have to address the very real problems of discrimination and stigmatizing that takes place with AIDS that doesn't take place with most other diseases."

Without ironclad protections against secret testing or breaking confidentiality, those at risk for AIDS are likely to stay away from all medical care rather than take the chance of exposure, critics of the exemption say.

That could increase the likelihood of spreading the disease because many who are infected would not be counseled on how to avoid giving it to others.

Acquired immune deficiency syndrome is a fatal disease that destroys the body's immune system. The virus lives primarily in semen and blood and is spread through sex, sharing needles to inject drugs or from a mother to her unborn baby.

By the end of July, 2,044 cases of AIDS had been reported in Illinois, of which 1,488 occurred in Chicago. Nationwide, 70,702 cases of AIDS had been diagnosed by Aug. 15. Of those reported to have the disease, 30,804 are still living.

One major concern is that a physician would do an HIV test without a patient's knowledge and then list that test on a bill submitted to the patient's insurance agency.

"When doctors do an HIV test, and then submit a bill for that test to a patient's insurance company, they don't realize that means something to the insurance company," Drake said.

"That means that the person may have a positive test result, or even if they don't, that the patient's doctor thought they were the kind of person for whom such a test was necessary," Drake said. "The insurance companies will do everything they can to drop such a person from their rolls."

Springer said it would not be ethical for a physician to test a patient for AIDS if the patient said he did not want to be tested.

But he said it is possible that a doctor might order blood tests without spelling out that the test for the HIV was one of those tests.

"Yeah, I suppose that could happen," he said. "And there is the possibility that confidentiality could be breached. But physicians work very hard against that. There has to be a relationship of mutual trust between the doctor and patient."

Gov. Thompson has until Sept. 24 to decide whether he will sign or veto the bill.

The Illinois State Medical Society is one of the major lobbying groups in Springfield and derives its political power from the contributions it makes to lawmakers and other state officials.

In 1986, the medical society's political action committee gave Thompson $77,000 to help his re-election campaign.

CAPTION: Graphic: AIDS.

In number of new cases.

Chicago Illinois

1979 0 1

'80 1 1

'81 4 5

'82 14 18

'83 40 55

'84 102 139

'85 199 262

'86 338 487

'87 516 709

'88+ 274 367

+Through July 29

By risk group in Illinois. In percent.

Cumulative through 1987.

Homosexual/bisexual men 77%

IV drug users 6

Homosexual/bisexual IV drug users 5

Other 12

Jan. 1 through July 27, 1988.

Homosexual/bisexual men 68%

IV drug users 17

Homosexual/bisexual IV drug users 6

Other 9

Chicago Tribune Graphic; Source: Illinois Department of Public Health. (Graphic published in City Edition.)

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