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Sound Counsel on AIDS

January 02, 1988

The United States is being well served, in the face of the acquired immune deficiency syndrome pandemic, by the steadiness and professionalism of the leaders of the American Medical, American Dental and American Hospital Assns. They have set an appropriate standard for the elaboration of public policy.

All of the professional organizations oppose general mandatory testing programs for the presence of the human immunodeficiency virus that causes AIDS. All of the organizations affirm the responsibility of their members to care for those with AIDS and those with the virus. All of them advocate compassionate respect for those with the virus and the disease, and all of them insist on rigorous protection of the confidentiality of HIV test results and the diagnosis of AIDS.

Patient consent is essential before testing for the presence of HIV, the board of trustees of the American Hospital Assn. has concluded. The trustees have not supported the proposal of a few hospitals that all patients be tested at the time of admission. Trustees of the American Medical Assn. concluded that mandatory testing should not be extended beyond blood, organ and semen donors and three categories established by the federal government covering immigrants, military personnel and prison inmates.

The AMA supports reporting to public-health officials about all persons testing positive to the AIDS virus "on an anonymous or confidential basis with enough information to be epidemiologically significant." That recommendation underscores two important points: The fight against the disease will be facilitated by better information on the extent of the infection, but personal identifications of persons with the virus can be protected without handicapping the public-health effort.

All three organizations emphasize the importance of better public-education programs. The AMA trustees specifically have criticized as inadequate the level of federal funding and have supported proposals of Rep. Henry A. Waxman (D-Los Angeles) to increase resources for testing and counseling those who test positive.

The realistic but calm appraisal of the situation is the more impressive because physicians, dentists and hospital workers are regularly exposed to the risk of infection. All three organizations assert confidently the ability of their members to minimize the risk of infection so long as they observe the protective procedures that have been developed. The Centers for Disease Control has tabulated only a dozen cases of infection of health-care workers through accidental exposure to the virus--a further indication of the difficulty of transmitting the disease casually. In almost all cases it is transmitted through sexual intercourse; through exchanges of blood, including transfusions of untested blood and sharing needles among intravenous drug users, and in pregnancy from an infected mother to her child.

As extremists seek to exploit AIDS for political purposes or out of misguided fears and prejudices, the three professional associations can play a continuing role of guidance--guidance that voters will be well advised to heed. Fanaticism will only divert precious resources from priority programs, or force underground the very people who are most likely to spread the disease.

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