AIDS Debate: Do Victims’ Partners Need to Be Told?
Telling sexual partners of AIDS patients that they have been exposed to the disease “can only give them anxiety,” said Dr. Shirley Fannin, head of communicable disease control programs for the Los Angeles County Department of Health Services. “You cannot relieve anxiety.”
Biochemist Bruce Voeller, an AIDS researcher, called that position “appalling,” saying people who may have been infected “should know they are at some risk and what that risk is so they would be available for early intervention if we find a drug that’s really effective in killing the virus.”
Their contrasting views illustrate the disagreement among health professionals, social workers and researchers over whether notifying sexual contacts of victims of acquired immune deficiency syndrome serves any useful purpose because, as some who question notification note, the disease cannot be treated, prevented or cured.
“It’s a real sticky issue,” said Sally Jue, a social worker who heads psycho-social services at AIDS Project Los Angeles, a support group. “Just because you had sex with an AIDS victim doesn’t mean you’ll get the disease. All you can do is tell somebody they’ve been exposed. Where do you go from there?”
Both sides agree that attempting to find sexual partners of the vast majority of AIDS patients can be a fruitless exercise because so many victims of the incurable disease have had multiple, often anonymous, sexual contacts.
But what should be done in a case where an identifiable partner has been exposed and is unaware of that exposure?
Such a case surfaced last month when a Los Angeles County Jail inmate serving a sentence for unlawful sexual intercourse with a teen-age girl died of AIDS in the jail ward at County-USC Medical Center.
The viral disease that destroys the body’s immune system is transmitted by such body fluids as semen and blood and has been declared the No. 1 health priority by federal health officials. Nearly half the more than 10,000 cases reported to the federal Centers for Disease Control in Atlanta have resulted in death. Seventy-one percent of the cases occur in homosexual men, and intravenous drug users account for 17%.
Wert Granville Yarbrough, 31, of El Segundo died one day before completing a sentence for what is commonly called statutory rape. He had pleaded no contest last October to charges of unlawful sexual intercourse with a teen-ager, and police reports indicated that he allegedly was involved with a second teen-age girl.
Health professionals involved in his treatment disagree on what steps, if any, should have been taken to notify the girls, who were eventually contacted by police and health officials.
“Any kind of rape should have triggered us to talk to the victim,” said Kelsea K. Baggett, director of nursing at the jail hospital, a separate facility from the jail ward.
Baggett, however, said he did not know why Yarbrough was in jail, adding that medical staff at the jail are not informed of an inmate’s offense in order to ensure “objective treatment.”
Doctors who diagnosed Yarbrough’s AIDS at County-USC reported the case to public health officials as required by state law but did not check police or court records to determine if any sexual partners could be identified.
“It certainly hasn’t occurred to me to (check records),” said Dr. Peter Heseltine, chief of epidemiology at County-USC. “All I could do is alarm those individuals, possibly unnecessarily. If there were something we could do to stop the spread, that would be different.”
Voeller called it highly misleading to say there is no medical value in knowing whether one is infected. People who are infected “have a lot of reason not to risk any further exposure to the AIDS virus itself, since additional doses may add to their hazard,” he said.
“Secondly, we know there are a bunch of co-factors which probably determine who of those who are exposed will come down with the disease.” He said estimates are that 80% of people infected have not developed the disease. That may result from reducing such “co-factors” as stress, additional exposure to the virus and infection with other venereal diseases, he said.
“That’s general medical belief,” said Voeller. “There’s darned little proof, but it’s beginning to grow.”
Despite questioning the wisdom of notifying partners, the health department’s Fannin agreed with other health professionals who point out that precautions can be taken by individuals who are infected. They should refrain from sex and from donating blood, she said.
They should also tell their doctors and dentists to use precautions when drawing blood, she added, and women with AIDS should know the risk for their unborn children should they get pregnant.
Although she said all of those precautions are good public health measures, Fannin expressed doubts about how many people are changing their behavior in response to such counseling.
Yarbrough’s was an atypical AIDS case from a public health standpoint. AIDS victims with court and police records identifying sexual partners represent a statistically insignificant number of the nearly 900 cases reported in Los Angeles County.
“I don’t care if there is only one (case),” said Voeller. “Identifiable sexual contacts should be notified to help prevent the spread.”
When Yarbrough’s case was reported, Fannin said, “we were led to believe that this was a case of bisexuality. We didn’t even know that the teen-ager existed.”
As it turned out, a sheriff’s deputy as a courtesy called El Segundo police, who notified the parents that their daughters could have been exposed. Public health investigators later counseled the girls and arranged for “appropriate medical follow-up,” said Ronald Sanders, director of the health department’s Aids Program.
Trying to track down partners in the vast bulk of AIDS cases, however, requires expending a tremendous amount of resources with very little return, Fannin said. If people who have been exposed come into one of the county’s 23 health clinics, public health workers can counsel them, she said. She added that her three AIDS investigators cannot possibly notify the estimated 10,000 partners of AIDS victims reported to her office.
She said that even if her office were offered all the resources it needed to contact sexual partners, that would be a lower priority than other efforts, such as taking blood samples from prostitutes to determine how many are infected with the AIDS virus.
Such a survey was not possible before March, when a blood screening test became available. That test detects the presence of antibodies to the HTLV-III virus, which causes AIDS, but it does not diagnose the disease.
A positive test shows that the virus has been in the bloodstream, but it does not mean that person will develop the disease. He may, however, be able to transmit it. On the other hand, since the disease has an incubation period of up to five years, negative test results do not mean that a person has not been infected.
Uncertainties about the test frustrate many who work with AIDS patients, and if someone who tests positive asks if he will get AIDS, Fannin said, her only answer is: “We have no way of telling that.”
UCLA Psychologist David Martin said he, for one, would not want to know if he tested positive on the blood test. “I could spend the rest of my life wondering what that meant, whether I’d come down with AIDS,” he said. “That’s a terrible way to live one’s life.”
Martin is director of Aid for AIDS, a two-year-old group providing financial assistance to AIDS patients. He said he knew one AIDS patient who had a door slammed in his face when he tried to notify a past sexual partner.
Uncertainties about the test will be removed in “a couple of months,” when the test will be able to diagnose AIDS, according to Dr. Jean Osborn, dean of the University of Michigan’s School of Public Health. Osborne chairs a National Institutes of Health advisory committee on AIDS and the nation’s blood supply and is a consultant to the Food and Drug Administration.
‘I Feel Uneasy’
Even though the test does not now diagnose AIDS, Osborn advocates that it be taken by those who suspect that they have been exposed. “Having the information that you are positive earlier rather than later is very important,” she said. “I feel uneasy, but not foolish, saying that six months from now there might be something we don’t know now.”
The possibility of effective treatment, Voeller said, is all the more reason those who may have been exposed should be notified and take the test. Otherwise, he said, “people who don’t know they’ve been exposed won’t pay any attention to the symptoms,” which include unexplained weight loss, chronic diarrhea, infections that don’t clear up.
Fannin pointed out, however, that so many unanswered questions surround AIDS that “I don’t feel as though I’m obliged to tell people something I don’t know. Just going around raising anxiety without being able to alleviate it is not very rational, and I don’t think you’re doing anybody any favors.”