The New York Times - December 1, 2005
Richard Perez-Pena

In an article in the current issue of The New England Journal of Medicine, the commissioner, Dr. Thomas R. Frieden, and other city health officials argue that public health agencies nationwide should track the progress of infected people and talk to anyone those people say they might have infected - the current practice with diseases like syphilis and tuberculosis. They add that to curb the spread of AIDS, the government should widely distribute condoms and clean hypodermic needles.

"The political costs," they write, "include offending both sides of the political establishment," from conservatives who oppose condom and syringe distribution to AIDS activists who object to the government's notifying a patient's sexual partners.

Such recommendations would have been politically explosive in the 1980's and early 90's, when H.I.V., the virus that causes AIDS, carried a heavier stigma and effective treatments were not yet available. For those reasons, the laws of New York and many other states treat it much more cautiously than other infectious diseases.

But changes in politics and medicine have made it time for that approach to change, the authors of the article write. Besides Dr. Frieden, they are Dr. Scott E. Kellerman, assistant health commissioner for H.I.V. prevention and control; Dr. Moupali Das-Douglas, a former special assistant to Dr. Frieden; and Dr. Kelly J. Henning, a special adviser to the commissioner.

In an interview, Dr. Frieden said yesterday that the article reflected the directions in which he was already steering city policy. "We're getting out a million condoms a month, we're testing a lot more people than we used to test," and the city has begun financial support for needle exchange programs, he said.

But some changes, he added, can be pursued only with more money, or with changes in laws that were intended to guard the privacy of people with H.I.V. State law requires a patient to sign a separate written consent form for an H.I.V. test - as opposed to blanket forms that permit whatever tests a doctor sees fit.

Doctors supply to the state detailed information on how individual H.I.V. patients are faring. But the state did not share it with local health departments until this year, and the agencies still cannot legally do anything with it. So while the city closely monitors the cases of people with many other diseases, and has a hand in managing their treatment, it cannot do so with H.I.V. - though tens of thousands of people receive case management from private groups with government funds.

"We could tell you not just who has TB, but what treatment they're on, whether they're responding to that treatment," Dr. Frieden said. "I know who their contacts are, whether their contacts are infected, and if they're infected, whether they've started treatment. All of those things, I can't tell you a single one of them about H.I.V. But TB killed 25 people in New York City last year, and H.I.V. killed 2,000."

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