Dr. Donald Francis, who is something of a medical gumshoe, fought epidemics in Africa before the Centers for Disease Control sent him to help California control AIDS. But these days he devotes more and more time to the Nov. 4 election.
And he is angry about it.
On that day California voters will decide the fate of Proposition 64, the AIDS initiative sponsored by two longtime followers of political extremist Lyndon H. LaRouche. Like most of his colleagues in public health, who have had to watch at close hand as AIDS claimed 13,270 lives nationally, Francis said the initiative would ravage the state's effort to control the disease.
"It's an incredible waste of time," Francis said. "It's just an absurd proposition."
The sponsors, who are backed by LaRouche's Virginia-based political and publishing empire, contend that the measure would simply force health officials to treat AIDS with the same seriousness as any other infectious disease.
Storms of Fury
But the measure has whipped up storms of fury among physicians and health officials, who say they have power enough now. Some health officers, citing legal advice that they may be compelled to quarantine AIDS patients without medical justification, have threatened to quit rather than comply.
Legal opinion varies on the initiative's impact on the law. Two lawyers in state government, representing the attorney general and the Department of Health Services, concluded separately that Proposition 64 would make little change in the sweeping powers that public health authorities already have to control infectious diseases, including AIDS.
However, an American Civil Liberties Union analysis said it could require mass testing and possible quarantine. Matt Coles, a professor at San Francisco's Hastings Law School, comes down somewhere in between, but said the measure could be used to remove thousands of people from jobs in agriculture, restaurants and schools.
"Nobody can really be terribly clear because of how the initiative is written," Coles said. "I suspect we're looking at four, five years of litigation."
At the very least, health officials said, it will tie them up in lengthy court battles they can ill afford and seriously curtail the effort against AIDS in California.
"The real movers and doers on AIDS have been the gay community," Francis said. "And what are you doing? You're taking them off AIDS and putting them to work on Proposition 64."
Even worse, health officials said, it could undermine the campaign to convince people who are the most likely to spread the disease through sexual contact--especially gay men--to be voluntarily tested for infection.
A state law now bars the disclosure of test results for antibodies to the human immunodeficiency virus that causes AIDS. The law was passed last year to encourage people to be tested before they donate blood. But the initiative seeks to require that the names of immunodeficiency virus "carriers"--presumably anyone who tests positive for antibodies to the virus--be reported to the government.
"How can we recommend that these people get tested when they might lose their job and be quarantined--and for no reason?" Francis asked.
The California Medical Assn. and physicians who work with infectious diseases said a quarantine would be useless against AIDS, which is sexually transmitted in the vast majority of cases. Besides discouraging voluntary testing, the reporting of names would be a costly and meaningless step, since the state Department of Health Services already has more names of AIDS patients than it knows what to do with, the critics said. (An estimated 300,000 people in California are infected with the virus.)
Other Diseases Reported
Other sexually transmitted diseases, such as syphilis and gonorrhea, are reported and authorities are empowered to investigate their sexual contacts. But many local health agencies lack the money to trace sexual contacts for even those diseases, and health officers said they could not begin to trace the contacts of people who test positive for AIDS.
Under a radical but possible interpretation, according to some legal opinions, the measure could force mass testing of students and anyone who works with food or in schools.
Anyone with a positive test--from harvest workers to grocery clerks to vice principals--would lose their jobs, according to some legal analysts, even though AIDS experts said the disease cannot be transmitted through food or non-intimate contact.
Food workers and school personnel would be affected if the initiative was interpreted by courts to trigger state health regulations that govern carriers of infectious diseases. Although state law requires that there be some chance of transmitting the disease, the regulation that implements the law drops that language and flatly bars anyone with an infectious disease from a food establishment--whether or not the disease can be passed through food.
Seldom Used Rule
Even against diseases that can clearly be food-borne, health officers said, the provision is seldom used.
"Mandatory serological testing and mandatory reporting are simply not going to help," said Dr. John Mills, chief of the infectious disease section at San Francisco General Hospital.
The California Medical Assn., which has strongly denounced the initiative, said the loss of confidentiality for the viral tests would also devastate the state's blood supply and set off a health crisis worse than the AIDS epidemic. People who feared the legal consequences of a positive test would stop giving blood, the group said.
From a constitutional standpoint, the most sweeping change would occur if the LaRouche-backed sponsors won their central, and unprecedented, goal: To force health officers to restrict the freedom of people whom they do not believe pose any threat to public health.
Since the only major transmission of AIDS is through sexual contact between consenting partners, health officers said, quarantines would be ineffective and an indefensible breach of personal freedom. If it would do any good, they said, quarantines would already have been ordered.
Public Health Powers
Restricting people's lives without medical justification would add a new twist to the far-reaching legal powers of public health officials.
The powers date from an outbreak of yellow fever in Philadelphia in the 1790s and were once used to quarantine the homes of measles and tuberculosis patients, and even to close swimming pools during the polio scare earlier this century. But the powers have not been widely used for decades and now are only occasionally invoked in the case of tuberculosis patients who refuse treatment.
"I don't see this initiative adding even one iota to our powers to control this epidemic," said Dr. Dean F. Echenberg, chief of infectious disease control for San Francisco. "It's just going to make our job a lot harder and cause a lot more people to be infected."
More people would be infected because the high-risk groups--gay men and some drug users--will lose confidence in the medical advice that they should change their sexual practices and stop sharing needles, Echenberg said. That provides the best hope for slowing AIDS until a vaccine or treatment is found, he said.
If the initiative is passed and not ruled unconstitutional, the legal dispute over the powers of health officials will come down to the court's reading of a phrase in the initiative that says that authorities "shall" carry out their duties in following the intent of the measure.
Leaves Some Discretion
The state's lawyers contend that the language leaves health officials the discretion to decide if quarantine for AIDS is warranted. "The initiative does not create any new mandatory requirements to take actions which are now discretionary," Sharon Mosely, Department of Health Services attorney, wrote last November.
However, some attorneys feel that a court could rule otherwise, especially if the measure wins with a big vote in November and political backlash against AIDS sufferers grows.
And the sponsors have left no doubt about their intent.
LaRouche and his followers, who take a widely different view of AIDS than the prevailing world medical opinion, argue that AIDS is transmitted by a wide variety of non-sexual contacts, including bedbugs and mosquitoes. They contend that because of political pressures, public health officials have not acted to protect the public and need to be forced to take action.
"AIDS is the only disease which has not been treated with the standard full arsenal of public health policies and measures," said Khushro Ghandhi, president of the Prevent AIDS Now Initiative Committee (PANIC). Ghandhi is West Coast coordinator of LaRouche's National Democratic Policy Committee, a national campaign group that has frequently been mistaken as an official arm of the Democratic Party.
Proven Standard Measures
Ghandhi said: "What we're doing in the process of this initiative is forcing the state to take those proven standard public health measures--public health measures which are already law in fact in this state, in every other state, and in fact are generally the law in every advanced country around the world--and now implement those public health laws with respect to AIDS."
Even if courts disagree and leave public health officers the power to decide medical questions, Anne Jennings, an assistant attorney general who specializes in civil rights law, said the initiative could present other problems for AIDS victims and people infected with the virus by encouraging employers to fire them.
Jennings also said the measure--while perhaps not forcing health officials to act--would give them even broader powers to restrict the civil liberties of AIDS patients. It could be used to deprive people of their rights by a health officer in a small community who comes under intense political pressure as AIDS spreads.
'A Climate of Hysteria'
"If you get a climate of hysteria, then anything can happen," said Jennings, who cited the quarantining in 1900 of San Francisco's entire Chinatown because of a few cases of bubonic plague. The order was lifted by a federal court.
The state Conference of Local Health Officers, which represents county health officials, has sent a notice to its members warning them that political pressures to take medically unjustified action could grow if Proposition 64 passes.
"I think that's the real danger in it," said Carl Smith, health officer of Alameda County. "When you think about it, these pressures may become important." Smith said he would resign if forced to take steps he feels are medically unsound.
Under the most drastic interpretations of Proposition 64, the cost could run to $15 billion in new welfare claims, testing expenses and lost economic production over four years, according to a study by University of California, Berkeley, professors Robert M. Anderson and John M. Quigley.
State legislative analyst John Vickerman, who looked only at the cost to state and local governments, said the measure would have a negligible cost if discretionary powers were left to health authorities. But if large-scale firings and quarantines were required, the costs "could range from millions of dollars to hundreds of millions of dollars per year," the analyst said.