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AIDS: Trouble Over Testing

February 08, 1987

Federal public health officials are considering recommending to the states that tests for AIDS antibodies be given to everyone admitted to hospitals for any reason, to couples applying for marriage licenses and to mothers in prenatal care.

The proposals, to be discussed publicly in Atlanta on Feb. 24 and 25, have set off an intense debate within the medical profession and among others especially concerned with AIDS--acquired immune deficiency syndrome.

It seems to us that mandatory hospital testing is, at best, premature and off the mark, while testing before marriage and birth has more to recommend it.

The government officials say that they have proposed the mandatory hospital testing as one means to warn those who test positive that they are infectious; other government officials suggest that the proposal was made to make it appear that the government is doing something tangible to combat the disease, which has no cure.

Widespread mandatory testing, as for all hospital admissions, raises three principal concerns:

The first is the tests themselves; the simple one yields many false positives; a positive test must usually be confirmed with a more sophisticated and expensive test.

The second is the matter of counseling. AIDS specialists are virtually unanimous in thinking that counseling to those who test positive is essential to the person's handling of the dread news.

The third, and to us the most important, is the matter of privacy and freedom from discrimination. The surgeon general, Dr. C. Everett Koop, has said that he would support mandatory hospital testing, but only if privacy and freedom from discrimination were fully protected. In nearly all states that assurance cannot yet be given. One of the exceptions is California, where mandatory testing is against the law. The potential for cruel and unnecessary discrimination is great, and caution should be the watchword.

That the AIDS antibody tests can be a useful diagnostic tool is not in doubt. They might usefully be extended to couples planning to have children and in prenatal care. AIDS experts, though disagreeing about mandatory antibody testing, tend to agree on the virtues of private, voluntary testing, coupled with counseling. It should be pointed out that not everybody who tests positive has gotten AIDS--though the percentage has been rising, pointing perhaps as high as 50%.

AIDS experts also agree, strongly, on the need for more and more frank and explicit public education on the mortal danger of AIDS and how to avoid getting it. The federal and other governments are spending on education, but by all accounts it is not nearly enough.

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