By the end of this year, about 350,000 Californians will learn for the first time whether they have been exposed to the AIDS virus.
The results of the tests on these people, medical officials say, may herald a new phase in the epidemic of acquired immune deficiency syndrome, bringing home to the heterosexual community as never before that the risks of the fatal disease are shared by everyone.
The people receiving the test results will be those who have donated blood in California since last March, when a federal rule went into effect requiring a test for AIDS antibodies in prospective donors. Medical officials say that virtually all of these people are heterosexuals because the blood banks now turn away gays and other members of high risk groups.
Since the rule went into effect, a moratorium on the release of the test results has been observed by blood banks in this state. That moratorium is to expire at staggered dates--depending on the institution--over the next several months.
The number of people who have tested positive is difficult to estimate, but experts believe that 350 to 700 positive results have already accumulated and that the number is increasing daily.
A positive result does not mean that a person will necessarily develop the disease. It does indicate that the person has come into contact with the AIDS virus and has begun to produce antibodies to it. In most cases, according to studies, the antibodies will prevail and the person will never fall victim to the disease.
Those studies, which examined members of the so-called high-risk groups, also revealed that about 10% of people exposed to the virus will develop AIDS and that 20% will fall ill with AIDS-related diseases. Equally ominous, medical officials say, is that many of the remaining 70% will become carriers of the disease capable of spreading AIDS through sexual contact.
For some individuals, who are unaware that they have been exposed to the virus through sexual contact or blood transfusion, a positive test will come as numbing news. Although a high percentage of AIDS patients are, and possibly always will be, in the gay population, public health experts see AIDS as a sexually transmitted disease that can strike heterosexuals as well.
“Although 98% of the cases in San Francisco are homosexual or bisexual men, this is truly a disease which affects everyone--father, son, brother, friend,” said Dr. Mervyn F. Silverman, former San Francisco health officer, at a meeting of the Los Angeles City/County AIDS Task Force in May.
Like other public health authorities, Silverman advocated greatly expanded health education programs for the general community as well as for high-risk groups. In the past these campaigns, which outline “safe” sex practices and discourage risky sexual behavior, have been aimed almost exclusively at gay people and intravenous drug users.
Education, the experts say, will not only help control the epidemic but will help to dispel myths that compound the fears of those who test positive.
Two weeks ago, a young wife and mother of two who had just been informed that her blood contains antibodies to the AIDS virus ran screaming for help into a Hollywood health facility for gays. Workers at the clinic managed to allay her hysteria and refer her to a crisis center, where the meaning of the test was explained.
The woman appeared to fit none of the categories of people usually considered to be at high risk of acquiring AIDS. Her response may be repeated in coming months as the test results are revealed to people who considered themselves exempt from the threat of the disease. Most positive results will involve those outside high-risk groups because those groups--gay people, intravenous drug users, hemophiliacs and Haitians--are turned away from blood banks.
Aware of the psychological trauma that news of a positive test can cause in donors, blood banks use two tests in order to eliminate as many false positive results as possible. Blood that initially tests positive is tested again. If the second test gives the same result, the sample is retested using a more specific method. Only then, if the result is positive, will the donor be notified, blood bank officials said.
The confidentiality of test records has become a major concern because of fear that the information could be used by employers or insurance companies to discriminate against people exposed to AIDS. Red Cross blood banks, according to Gerry Sohle, a spokeswoman for the Los Angeles-Orange County Regional Red Cross Blood Center, keep no records of positive results that are available to government or private agencies.
No Record of AIDS
Sohle said the Los Angeles-Orange County Red Cross will notify only people whose exposure has been confirmed by two tests. They will receive registered letters from the Red Cross. Other blood banks may use other procedures for notification. “The report does not say an individual was deferred because of AIDS,” she said. “We make no distinction between those who test positive for AIDS and those who are deferred because they have had hepatitis or some other illness. Even if somebody sees our record, they could not tell why a person was deferred.”
People who have not tested positive will receive no communication from the blood bank.
For gays and other individuals in high-risk groups who want to learn whether they have been exposed to the virus, the state is setting up alternate testing centers that have even more stringent means of maintaining confidentiality.
The alternate center for Los Angeles County, not yet in operation, will be located at the Edmond Edelman Health Center, 1213 N. Highland Ave. “No one,” said Hugh Rice, the center’s director, “will be asked his or her name, address or any other means of identification. The test is totally confidential.”
Each individual will be given a numbered piece of paper whose edge has been cut in a configuration that must match the center’s copy when the person brings it back a few days later to get the test result. Results will be given in person only, and anybody who loses his copy will have to take the test over, Rice said.
As is true for the gay community, certain elements of the heterosexual population are at greater risk of AIDS than others. They are males and females of any age who are sexually active with multiple partners.
The evidence that sex with multiple partners increases the risk is based on epidemiological studies among gays that have shown a high correlation between frequent sexual contact with different partners and the development of AIDS. The reason is that the likelihood of having sex with an infected partner increases as the number of contacts increases.
For a heterosexual, the chances of contacting an infected partner are still very low compared to those chances for a homosexual because the infection rate for gays is many times higher than it is for other groups. Nobody knows what that rate is for heterosexuals, but one rough estimate is that it is 1 in 100 or higher in some sexually active groups. A study in a New York clinic for sexually transmitted diseases found that 3.4% of the heterosexual men had evidence of infection by the AIDS virus.
Although most heterosexuals still think of AIDS as a homosexuals’ disease, there is evidence that some non-gays are becoming aware that AIDS may be relevant to them.
“We get a lot of calls from men who have been to prostitutes or who maybe had a one-time contact with a gay,” said David Carlat, a volunteer with LA CARES, an affiliate of the Gay and Lesbian Community Services Center and the agency that soon will extend to heterosexuals a state-funded educational program that has been limited to gays.
Health authorities are concerned, however, that the message about the relationship between sexual behavior and AIDS risk still has not been brought home to most heterosexuals.
14 Cases Out of 1,000
The health authorities note that, to date, the number of heterosexuals who have acquired AIDS through sexual intercourse is small. Only 14 out of more than 1,000 cases of AIDS that have occurred in Los Angeles County are heterosexuals who are not also intravenous drug users or hemophiliacs. Medical officials believe, however, that the number of heterosexuals who actually are infected but who have not yet shown symptoms and therefore are unaware of the infection is greater than has come to light.
In addition to such non-sexual modes of transmission as blood transfusions and the use of contaminated needles by drug abusers, researchers speculate that AIDS is entering the sexually active heterosexual population by way of infected bisexuals who pass it on to prostitutes or other women who in turn infect other males who infect their female partners.
The long incubation period for the AIDS virus poses a special control problem that does not exist for other venereal diseases. Because it may take as long as five years after exposure to the virus for an individual to acquire symptoms, a sexually active individual can spread the infection to a very large number of people before knowing that he is doing so.
According to Dr. Paul Volberding, an expert at the University of California, San Francisco, these carriers may include people on the way to developing the disease. It can also include the 70% of people who come into contact with the virus but have never developed symptoms of the disease.
In an effort to slow the spread of the disease, two Los Angeles-based agencies will soon expand their AIDS campaigns to the heterosexual community.
Carlat, the LA CARES worker, said the campaign should be ready by the end of this year. He predicted that the job will be much more difficult than it has been with homosexuals. The chief reason, according to Carlat, is the deeply impressed conviction that AIDS is a disease that gays, not heterosexuals, need to worry about.
“We’ve had a tremendous impact on gays, but its parameters have been strictly within the gay community,” he said.
The national publicity that accompanied the news that Rock Hudson has AIDS caused more widespread interest in the disease, Carlat said, and the center hopes to maintain that momentum.
“The problem is shaking people out of the belief that it can’t happen to them,” said Rice, of the Edelman Health Center, a component of the Gay and Lesbian Community Services Center in Hollywood. “Even among gays, it was difficult until they had met or seen or worked with somebody who got AIDS.”
According to Bill Misenheimer, director of AIDS Project/Los Angeles, another community agency involved with educational programs, the heterosexual campaign will be aimed at the vulnerable groups of sexually active heterosexuals rather than at the entire population.
Explicit information on sexual practices will be offered in brochures. Other more general kinds of information will be contained in public service announcements on TV and radio and in print media. The campaign is expected to begin in November or December, Misenheimer said.
Carlat said he is skeptical about how deeply the campaign will be able to reach the heterosexual population. The gay community was easier to reach, he said, because it functions differently from the general community.
For example, he said, one technique that proved to be effective in the gay community was to use bartenders and workers in other kinds of businesses frequented by homosexuals as educators. Doing the same thing in businesses catering to heterosexuals might end up with the educators getting punched in the nose, Carlat said.
Neither Misenheimer’s nor Carlat’s organization has yet come up with the exact wording for the brochures. They and public health officials say the recommendations will follow the same general principle that is being followed with gays--namely that the AIDS virus is transmitted by body fluids, whether the mode of transmission be heterosexual or homosexual.
This means that whether the intercourse be vaginal, oral or anal, a partner who is infected with the virus may pass it to his or her partner by way of semen or other body fluid. As the number of partners increases, the risk increases. As far as is known, a single exposure from an infected person may be enough. The basic recommendation, therefore, will be to avoid multiple partners and to use condoms.
“We will not use scare tactics. We will give them information on high-risk and low-risk sexual practices and let them decide for themselves,” Misenheimer said.