ATLANTA — Participants at a two-day conference to debate the expanded use of the controversial AIDS antibody test Wednesday overwhelmingly opposed mandatory testing under any circumstances, such as when couples apply for marriage licenses or when patients are routinely admitted to hospitals.
However, they endorsed wider use of the test on a voluntary basis--including for marriage license applicants and hospitalized patients--if the procedure is offered with comprehensive pre- and post-test counseling, confidentiality of test results and the informed consent of the patient.
'Adjunct to Counseling'
"The test should only be done as an adjunct to counseling," said Robert J. Levine, professor of medicine at Yale University Medical School. "Most of the good that occurs comes from the counseling."
Counseling involves, for example, explaining that the test determines only whether a person has been exposed to the acquired immune deficiency syndrome virus and that a positive result does not necessarily mean that one will contract the deadly disease.
A person who tests positive is presumed to be infected and infectious to others. Thus, counseling also entails an explicit description of the behaviors that transmit AIDS, including unprotected anal and vaginal intercourse and the sharing of unsterilized hypodermic needles. The virus also can be transmitted by an infected woman to her unborn child. There is no medical treatment for the infection.
Participants also urged the enactment of new federal legislation and other safeguards to protect confidentiality of test results and to prohibit discrimination against those found to be infected by the AIDS virus.
The federal government must "firmly support" the concept that "confidentiality breaches will not be tolerated and that they will be punished," said William J. Curran, professor of legal medicine at the Harvard University School of Public Health and School of Medicine.
The meeting was called to examine possible expanded uses of the procedure that would also include patients at drug, family planning, and sexually transmitted disease clinics.
Walter Dowdle, acting deputy director of the federal Centers for Disease Control and director of its AIDS programs, said federal health officials will evaluate the conference findings and issue recommendations to Robert E. Windom, assistant secretary for health, in about a month.
Since its introduction in 1985, the AIDS antibodies test has been the focus of intense controversy. Many medical and public health personnel and gay rights and civil liberties groups have feared that test results, unless kept anonymous or confidential, would result in stigmatization and be used to discriminate in such areas as employment, life insurance and medical insurance.
AIDS destroys the immune system, rendering the individual powerless against otherwise rare infections and cancers. The virus can also invade the central nervous system, causing serious neurological disorders.
In a related development Wednesday, a bipartisan group of senators in Washington proposed that Congress establish a "medical war cabinet" to oversee and coordinate all AIDS activities nationwide.
Sen. Pete Wilson (R-Calif.) said at a news conference that he will introduce legislation today to form a national advisory panel, with annual funding of $3 million for five years, "to help marshal America's financial and scientific resources in first controlling and ultimately curing the deadly AIDS disease."
Other sponsors are Sens. Alfonse M. D'Amato (R-N.Y.), Daniel Patrick Moynihan (D-N.Y.), Dave Durenberger (R-Minn.), Lowell P. Weicker Jr. (R-Conn.), Alan Cranston (D-Calif.), Bill Bradley (D-N.J.), Lloyd Bentsen (D-Tex.) and Frank R. Lautenberg (D-N.J.).