The New York Times - November 29, 1986
Jane Gross

"Your test was positive," Ms. Johnson told her client, who was known to her only by a three-digit identification number, "but that does not necessarily mean you have AIDS."

For the next hour and a half, as day turned to dusk outside the windows, Ms. Johnson answered and asked questions, counseled and comforted, as she has in the month since the New York City Health Department opened its first center to offer AIDS antibody tests on an anonymous basis.

Anxiety Over Tests

The test measures the presence of antibodies to the virus causing acquired immune deficiency syndrome. A positive result indicates that the person may be infected with the virus and can pass it to others through sexual intercourse or the exchange of blood.

At the center, in an all-purpose health clinic on Ninth Avenue and 28th Street, it is clear how wide a net of fear has been spread by a disease that is expected to claim 179,000 American lives by 1991. Although most of the positive test results so far have come from homosexuals, they are not alone in their anxiety.

Some men and women come seeking a test because of a risky sexual encounter the night before or the memory of unfamiliar partners a half-dozen years ago. Others come because of a lingering cold, an alarming news report or pressure from a mate.

Altered Lives

Their faces betray little emotion as they come and go, sharing a bleak waiting room with women taking pregnancy tests. But inside the counselors' offices - where fears are put to rest or confirmed, and lives irrevocably altered - there is celebration, anger, denial and tears.

The opening of the center Nov. 3 marked a shift in city policy on a test that has been widely available elsewhere in the nation but restricted locally. Until the center opened, the test had been administered in New York City by 1,200 private physicians who are registered with the Health Department and at certain hospital clinics. But these settings may require that the patient give his name and do not consistently offer counseling, as the new center does.

In its first three weeks of operation, the center did 150 blood tests and received results on 77, with 62 negative results, 11 positives and 4 inconclusives, which require repeat testing. On a recent afternoon, Ms. Johnson's client was one of three to learn the results of tests processed in a city labora-tory that currently handles 100 antibody samples a day, twice as many as a year ago.

The first client - with an inconclusive result - was a homosexual physician who sought the clinic's anonymous environment because his colleagues were unaware of his sexual orientation. The second was a woman on the verge of marriage who had once had a sexual relationship with a bisexual man. Her test was negative and she left the clinic bubbling with plans for an immediate vacation with her fiance.

The third, a homosexual with a history of intravenous drug abuse, was the man who followed Ms. Johnson into her office, where after some brief pleasantries she delivered the news.

At first, Ms. Johnson said, he sat in stunned silence.

"He looked at me," she said, "and I just looked back at him, to give him some time. I tried to show him there'd be no judgmental faces here, no 'You're a bad boy' or whatever."

A Jumble of Questions

Finally, the questions tumbled out: Why? When? What next? Who to tell?

She urged the man to find a physician and a support group, to guard his health and consider his future sexual practices and to think long and hard before confiding in his family and friends.

"He was more accepting than some people, looking to see the next step," said Ms. Johnson. "It's a good feeling for me if I at least know what they're going to do when they leave here."

Counseling like Ms. Johnson's is the nub of the city program, which is similar to one that has been operating for 16 months in San Francisco, where AIDS cases are also concentrated.

'Wrecked Lives'

"Most people aren't prepared for a positive and what that means," said Stephen Schaefer, the director of a hotline that takes appointments for the center. "We're talking about a real mess, wrecked lives."

City officials said they delayed establishing test sites until now because it was prudent to wait until it was clearer what the test meant, how reliable it was and what sort of companion counseling was advisable.

"People think we were being bad guys by making it hard to get," said Susan Rosenthal, the director of AIDS counseling at the health department. "But we needed time to figure things out. We've changed our message and this has become a piece of a public health strategy, but only one piece."

The counseling begins at the hotline (718-485-8111), where callers are asked about their reasons for wanting the free test and told about it. More extensive counseling occurs at the center, both before a patient's blood is drawn and when he returns two or three weeks later for results. These sessions include discussion of safe sex practices for those in high-risk groups or those who test positively. Follow-up counseling is available, but officials said it is too early to tell how many will take advantage of the service.

Bisexuals Most Difficult

The counselors said the pre-test session is crucial. "That's when I make sure they know everything they should know," said Miguel Arenas, a counselor who has handled 7 of the center's 11 clients who tested positive. "At the second session, they're not listening to what I'm saying. It's hard to concentrate when you're involved in your own thoughts and fantasies."

The most difficult clients, the counselors agree, are bisexual men, particularly those whose wives do not know of their behavior. Mr. Arenas recently returned a positive test result to such a man, who peppered the counselor with questions about whether he could claim to have picked up the virus from drinking out of someone's cup, sharing a cigarette or sleeping with a prostitute.

The easiest clients, on the other hand, are homosexuals, who counselors say are very knowledgeable about the disease, its transmission and how to avoid it. "With gays, I assume they have read everything there is to read," said Mr. Arenas. "I ask them, 'What do you want me to clarify?' "

The counselors have noticed that there are people, usually not in a particularly high-risk group, who seek repeated tests. "They take them all over the city," said Karen Solomon, the director of the center. "They don't believe what anybody says and they're taking a lot of social service time. What they need more than anything else is therapy, because they've just hooked their neuroses about sexuality and relationships onto the AIDS issue."

Hypochondriacal symptoms are common while awaiting test results, the counselors say, and some warn clients to expect them. "I don't know if I would recommend anybody doing this, or if I'd do this again," one client told her counselor after experiencing swollen glands and night sweats between taking the test and getting the negative result.

There is also an abiding fear among test-takers that the system of anonymity will somehow be breached and their identities made known, thus raising the specter of serious civil rights abuses.

On the hot line one recent afternoon, Joyce Ramsey, a counselor, assured one caller that "I don't need to know who you are - I don't need your shoe size." At the center, Ms. Johnson reported that several clients panicked when asked their date of birth and ZIP code on an optional questionnaire, so she filed it without the information.

"People are so incredibly paranoid that they don't even like sitting in the waiting room for a few minutes," Ms. Solomon said.

Still, the counselors have discovered that information is a salve for certain people, particularly those at very high or very low risk.

"If the anxiety of not knowing is greater than the anxiety of knowing," said Mr. Arenas, "and if anxiety affects your functioning, do it, by all means."

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