School AIDS Guidelines Questioned

Arguing that AIDS remains mysterious and only partly understood, two doctors and the father of a San Diego school child on Tuesday challenged the proposal to permit AIDS victims to study and work without restriction in city schools.

Addressing the Board of Education, they said the fatal disease has repeatedly proven researchers wrong since its discovery in 1981. For that reason, they said, they have doubts about assertions that AIDS cannot be transmitted through casual contact.

“I don’t have all the answers either,” said Dr. Theresa L. Crenshaw, a San Diego doctor who specializes in sexual dysfunction. “But I’ve noticed it’s very characteristic for physicians not to be able to say, ‘I don’t know.’ ”

The proposed policy, based on medical evidence that AIDS has been transmitted only through sexual contact and blood products, would bar from the San Diego Unified School District only preschool children and students who might bite or be incontinent.

There are no reported cases of acquired immune deficiency syndrome among students or employees in the district. However, the administration hopes to formulate an AIDS policy before a case comes up.

On Tuesday, Supt. Tom Payzant presented the board with the proposed policy, prepared in large part by researchers in AIDS and pediatrics at UC San Diego. The board took testimony and asked questions about the policy, and intends to vote on it in two weeks.

Crenshaw, the author of “Bedside Manners: Your Guide to Better Sex” and a member of a citizen committee that advises the school system on “social health” matters, argued that the board should beware of claims that casual contact with AIDS victims is safe.

She said researchers initially said AIDS could not be contracted by heterosexuals--a claim that has been refuted. Later, she said, researchers said the AIDS virus was not present in saliva--an assertion now shown to have been untrue.

“I am not secure that this disease cannot be passed through casual contact,” said Crenshaw. “Even though we do not have a documented case, I think there is good reason to wonder.”

Dr. Timothy M. Sankary, a San Francisco doctor, argued that the AIDS risk may be more widespread than some statistics suggest because statistics stress the full syndrome rather than the more common virus believed to play a role in its cause.

Yet people infected with the virus can be contagious, Sankary said. He said the disease may be especially problematic because it is mutating rapidly. He said more than 120 strains have been documented.

Sankary pointed out that ophthalmologists are being warned to take care in fitting AIDS patients with contact lenses. He said health-care workers take special precautions in handling AIDS patients’ bodily fluids, stool and blood.

“There seems to be a contradiction,” he said. “No one will say there has been a single case of transmission through saliva, yet no one will say saliva is safe. No one will say there has been a documented case of transmission through tears,” yet ophthalmologists are being encouraged to take precautions.

“All I’m saying is there are contradictions and unknowns in this epidemic that should inspire caution,” Sankary said. Sankary, who said he has followed AIDS research closely, said he had been in San Diego for a conference and had been persuaded by Crenshaw to testify.

In defense of the proposed policy, Dr. Richard Strahbe, a UCSD specialist in AIDS and infectious diseases, pointed out that there had been relatively few AIDS cases when initial statements were made. Now, he said, conclusions are based on many thousands of cases.

He pointed out that no health-care worker who cared for AIDS patients in the United States has come down with AIDS--even those exposed to AIDS patients in open wards and with no special precautions before the disease was recognized.

Strahbe acknowledged that four or five times as many people are believed to have the AIDS virus as are listed as having AIDS. But he said blood tests for that virus are crude, and most people found to have the virus have not so far contracted AIDS.

However, he noted that researchers have followed the disease for only five years. In response to other questions, Strahbe qualified his answers. For example, he said of a student, “He’s not at risk from the AIDS patient who’s sneezing at all--as far as we can tell.”

Among the questions raised by board members was one from John Witt, who recalled that when he contracted scarlet fever as a child, public health workers posted a sign outside his house and he was forced remain inside for weeks.

“I get the feeling now that this policy is being questioned--whether there is a higher duty to those that might catch (a disease) than to those that have it,” Witt said. “I’m saying that the rules are being relaxed on communicable diseases for AIDS.”

The only parent to testify was Byron Halling, a lawyer who expressed reservations similar to those of Crenshaw and Sankary. He added, “I know for a fact . . . as litigious as I am, if my daughter contracted AIDS (through her school), there would be a giant lawsuit.”