One day in 1987, Stephen J. Gabin sat in his Century City medical office and settled an internal battle he had been fighting for seven years. By testing himself for the AIDS virus, the physician, 42, put an end to the fear he had carried from the time he treated his first HIV-infected patient in 1980.
Gabin, a leading Los Angeles AIDS expert with one of the region's largest AIDS practices, turned his doubt into a personal crusade for early testing for the disease, a crusade that began well before two recent medical reports confirmed the case for early testing for acquired immune deficiency syndrome.
On July 1, Gabin decided to provide free, anonymous testing for the human immunodeficiency virus (HIV) antibody. Director of Century City Hospital's AIDS-care unit, Gabin expected his two-month progrm to administer more than 800 tests.
Experts note that the figure is more than double the number tested at an average county-contracted testing site over the same period. More important, they applaud his effort as a signal to doctors and patients that the battle against AIDS will be a long and difficult one, and that testing and education remain the most effective means of fighting the disease.
"The barriers are that people have denial and the physicians have denial, and that's what his message is trying to overcome," said Dr. Neil Schram, member of the Los Angeles County Medical Assn.'s AIDS Commission.
"He not only is encouraging people to think about getting tested, but he is encouraging people to discuss getting tested with their physicians."
"I was very concerned," said Gabin, "that people didn't fully realize that the idea of testing made more sense than it did a few years ago."
Raised in Philadelphia, Gabin began in medicine as a general practitioner in Orange County 15 years ago. In 1977, he began to specialize in treating gay men, who now make up 95% of his practice, including 700 to 800 infected with HIV.
"I wanted to make a strong commitment both to my patients and the community at large that people who might have been exposed to HIV should be tested."
Gabin, who employs a publicist, also acknowledges that he makes "a good living" at his practice and that his free program has added to it, but he said his intent was simply to fight AIDS with every means at his disposal.
The doctor's program ended just as the nation's largest AIDS advocate groups have endorsed voluntary and confidential testing as the best way to take advantage of new drugs found to delay the onset of AIDS symptoms, findings released in recent reports.
Gabin said the size of response to his offer, about 400 per month, indicated that some people prefer a private setting to government-sponsored clinics for testing.
By comparison, only about 1,100 to 1,200 HIV antibody tests are administered by all seven county-contracted locations each month on average, said John Schunhoff, assistant director of the AIDS program office with the Los Angeles County Department of Health.
About 15% of the participants in Gabin's program have tested positive, similar to the 14.4% infection rate for county test sites.
"The message that could be interpeted by other doctors is that AIDS is such an important disease that as physicians we should do everything possible, including paying for the tests if that's what it takes, to get those patients who have engaged in risky behavior in the past to be tested," said Dr. David Dassey, deputy medical director of the AIDS program.
May Seeking U.S. Funds
Citing a state report, Schram said that as many as 250,000 to 300,000 Californians may be infected with HIV, with up to one-third of those living in the Los Angeles area. A substantial majority has not been tested.
Gabin is considering pressing for government funds to subsidize private physician AIDS testing, he said, but public health experts say that more important is the message sent to other doctors.
"From my perspective, one of the big problems in getting people tested is that gay men and (intravenous) drug users are afraid to share that information with their physicians because they are afraid their physicians will reject them--and in too many instances that is a valid concern," said Schram, an internist and former member of the Los Angeles City Task Force on AIDS. Gay and bisexual men, intravenous drug users and hemophiliacs face the greatest risk of infection, as do sexual partners of people in these high-risk groups.
"Most doctors don't like talking about sex and they don't like talking about illegal drugs, (but) you have to take that step. If you can take that first step, then you can see risky behavior and then you can say, 'Be tested,' " Dassey said.
Ground Floor of Treatment
Gabin attributed his own efforts to being gay himself. He began working on gay issues when friends and relatives told him that their doctors ignored problems often confronting gay males.
His focus brought him in on the ground floor of AIDS treatment, and Gabin has devoted successively more time to the disease.
"My patient population since about 1977 has been largely made up of gay men, and so I found myself in a situation where we were seeing a new disease process in front of our eyes. We didn't have any choice but to learn about it," Gabin said.
Gabin declined to comment on the cost of his program, but Schunhoff of the health department said the county is reimbursed by the state $44 per test to pay for lab and personnel costs. According to figures quoted by Schunhoff, testing for 800 people alone could cost about $3,600.
"There are a lot of similarities between fighting AIDS and fighting a war," Gabin said, "and when lives are on the line, it's hard to be anything but 100% committed.