All Immigrants Face AIDS Test : Health Secretary’s Order Awaits OK From OMB

Despite opposition from public health officials in his own department, Health and Human Services Secretary Otis R. Bowen has signed an order that would effectively require all permanent immigrants to the United States to be tested for exposure to AIDS, The Times has learned.

The order, which is awaiting approval from the White House Office of Management and Budget, would add AIDS to a list of seven conditions--five of them sexually transmitted diseases--that exclude immigrants from entering the United States as permanent residents.

Although the proposed regulation does not specifically mandate that prospective immigrants take the AIDS antibody test, language in its preamble suggests that the secretary formally order the blood test. Immigrants who test positively presumably would be barred from entering the country.

And the practical effect of the regulation would be to require AIDS antibody screening for immigrants because there is no other effective routine test for the deadly disease.

“How do you know for sure if a person has AIDS without doing the test?” one department official asked.

Sources say that language added to the preamble of the rule by HHS officials proposes that the secretary spell out that the AIDS antibody test would be required for immigrants.

An estimated 500,000 to 600,000 persons immigrate annually to the United States, and 200,000 additional temporary foreign residents apply for permanent status, according to the Immigration and Naturalization Service. The order would not apply to ordinary tourists or visitors.

Test Gives False Results

The AIDS test has been the object of intense controversy since it was developed last spring to help clear the nation’s blood banks of AIDS-contaminated blood. Critics have argued that it should not be widely used as a diagnostic tool because it tests only for exposure to the AIDS virus, not the disease itself, and because it frequently produces “false positive” results.

Bowen’s proposal had been sharply criticized within the department by some Public Health Service officials who questioned whether “the public health gains will be worth it,” according to one Administration official familiar with the debate.

The regulation, which must be released for 60 days of public comment before it becomes final, was delayed several days to give officials opposing it “one more hearing in an attempt to reverse it,” department sources said.

One official said that critics fear use of the AIDS test may encourage other countries to “retaliate” against American citizens moving or traveling abroad, because the United States has the largest number of reported AIDS cases in the world.

For example, Saudi Arabia, which recently announced that it had traced its first AIDS cases to transfusions from contaminated blood imported from the United States, recently announced that American citizens who apply for visas must take the test.

Testing Ability Lacking

A department official said that “the concern was over the administration and processing of the tests,” because some countries with high rates of AIDS “might not have the technology to do the testing.”

A positive antibody test does not necessarily mean that the individual has or will contract the disease, only that he has been exposed to the virus. However, someone exposed to the virus is presumed to be infectious.

Department sources said that, if the testing proposal is adopted, it would include confirmatory testing on those with positive results from the initial screening, known as the ELISA test. The followup test, known as the Western Blot, is more complicated and much more expensive.

Those officials said the decision was made based on “the tremendous costs borne by every AIDS victim” and “the desires of the people in this country to use every method possible to halt the spread of AIDS.” The federal Centers for Disease Control has estimated the average cost of treating an AIDS patient from diagnosis to death at about $140,000.

An INS official said that all such required tests are performed at the applicant’s expense in his home country by physicians under contract to the State Department. The current list of exclusionary diseases includes the sexually transmitted diseases syphilis, gonorrhea, chancroid, granuloma inguinale and lymphogranuloma venereum, as well as infectious leprosy and active tuberculosis. Tests for these diseases range from blood tests to waiting for symptoms to appear.

Potential for Abuse

The ELISA test, which was introduced last year to prevent transmission of AIDS through the nation’s blood supply, has raised numerous fears over its potential for abuse. Insurance companies, for example, now want to use it to screen applicants for policies, and homosexual and civil rights groups are worried that employers will seek to use it as a way to discriminate against male homosexuals, the primary victims of AIDS.

The Defense Department began administering the antibody test to all recruits last fall and later announced that the test would be given to all military personnel. Pentagon policy is to follow all positive ELISA tests with a confirmatory test. Last week, the department announced that it would make the ELISA test available on a voluntary basis to family members of military personnel.

Federal public health officials are considering issuing recommendations that would encourage wider use of the test among groups at high risk for AIDS, including male homosexuals and bisexuals, intravenous drug users and prostitutes.

Destroys Immune System

AIDS, or acquired immune deficiency syndrome, destroys the immune system, leaving the body powerless to resist otherwise rare infections.