Questions on Prop. 64: Clearing the Confusion

Proposition 64 on the Nov. 4 ballot is the first time voters anywhere have been asked to set health policy on AIDS. It is also a rarity for a measure to draw such widespread opposition from California leaders.

Besides dealing with an emotional subject, Proposition 64 can be confusing to people not familiar with state health laws. Lawyers, too, disagree on its potential effects.

The only thing all agree on is that, if passed by a majority of voters, Proposition 64 will be tied up in lengthy court battles.

The language of the initiative takes a different tack from existing health codes, which require medical officials to justify use of their vast powers to quell epidemics. Proposition 64 seeks to change that traditional role and require health officials to take steps they do not believe are warranted in the battle against AIDS.

Below, The Times answers some often-asked questions about Proposition 64.

Q Why does Proposition 64 appear on the ballot?

A It was proposed as an initiative last October by followers of Virginia political extremist Lyndon H. LaRouche. They formed the Prevent AIDS Now Initiative Committee (PANIC), circulated petitions asking voters if they wanted to “make AIDS a reportable disease,” and gathered almost 700,000 signatures.

Leaders of the PANIC group said state and county health officials had failed to take AIDS as a serious threat because of pressure from homosexuals and the federal Centers for Disease Control. The initiative was needed, PANIC’s leaders said, to force health officials to apply “traditional public health practices” to AIDS.

AIDS also is viewed by LaRouche, a four-time fringe presidential candidate who backs local candidates around the country, as an issue that will help his movement win support from voters fearful of the disease.

Q Is there any agreement on what would happen if Proposition 64 passed?

A The measure, as written, is open to interpretation. But lawyers and health officials agree it would make AIDS, as well as the condition of carrying antibodies to the AIDS virus, reportable infectious diseases in the legal sense.

State officials already keep a confidential registry with names and personal information on AIDS patients. Proposition 64 would require adding to that registry anyone with a positive antibody test. Doctors, lawyers, employers and the public would be required to report anyone they learn has a positive test.

Q What about the new state law that bars even health officials from learning the results of antibody test results?

A An initiative takes legal precedence over laws passed by the Legislature, in most cases. Thus the law passed last year that established special test sites to protect the blood supply from infected blood donors and that made it a crime to reveal test results (to encourage people in high-risk groups to seek testing) would probably be circumvented.

Surgeon General C. Everett Koop, state Health Director Kenneth W. Kizer and other public health officials and AIDS researchers have said that any provision that undermines confidential testing would seriously undercut efforts to slow the spread of AIDS.

Q Would Proposition 64 require mass public testing for the AIDS virus?

A This is where legal analysts begin to disagree. State Health Director Kizer said the only way to enforce the initiative would be to test virtually the entire population periodically, at a cost of millions of dollars. The state legislative analyst said the initiative itself does not require widespread testing. In any case, before any mass testing program could be imposed, the state Legislature would have to pass a bill appropriating the money.

Q Would anyone lose their jobs?

A Again, uncertain. LaRouche and his supporters want anyone infected with the AIDS antibodies removed from jobs handling food, from schools and from close-contact professions like beauticians or barbers. Health experts say, flatly, there is no risk of AIDS being passed by infected food handlers, in schools, at home or in any everyday situation without sexual intercourse or blood transfer. But legal experts say Proposition 64 might, nonetheless, force some people out of their jobs.

State laws permit health authorities to remove people from jobs only if they are capable of spreading the disease. But regulations written over the years have confused the issue, sometimes requiring removal from jobs of anyone who simply carries a disease, whether contagious or not.

Court interpretation might hinge on a clause in Proposition 64 that says health officials shall carry out the intent of the initiative.

Q What about quarantine?

A Health officials have the power now to quarantine people with AIDS, or any other illness, if putting people in isolation will protect the public. Proposition 64 would extend that authority to carriers of the AIDS virus antibodies.

All major U.S. medical experts agree it would be pointless to quarantine for AIDS, except in the rare case of someone maliciously spreading the virus. Quarantine is seldom ordered in the United States anymore, and only for short-term, treatable diseases. Since AIDS is not curable, such isolation would conceivably be life-long and at great expense since more than 2 million Americans are believed infected. Without medical justification, legal scholars say quarantine would violate basic American rights and is unlikely to be approved by the courts.

However, opponents of Proposition 64 say public hysteria over AIDS could bring pressure on health officials to seek quarantine of people in high-risk groups, such as male homosexuals and users of injected street drugs.

Q AIDS cases are still doubling annually. What do the experts recommend?

A American medical officials--from Surgeon General Koop to the Centers for Disease Control to the researchers who first isolated the AIDS virus--agree that the only way to check the disease until a vaccine or cure is found is to change sexual practices and curb use of tainted needles by drug users.

Because it involves private matters such as sexual relations, and illicit activities such as drug abuse, voluntary compliance is necessary. Thus public education is crucial.

Experts strongly recommend that heterosexuals and homosexuals alike minimize their chance of exposure by practicing safe sex. This includes using condoms for high-risk activities, particularly anal and oral sex, where there is an exchange of bodily fluids, if at least one partner has engaged in high-risk sex since 1978. In addition, medical officials strongly urge drug users not to share needles.

Q Why are they against applying “traditional health measures” to infected AIDS carriers, as Proposition 64’s proponents recommend?

A LaRouche and his supporters say that such health measures--quarantine, tracing sexual contacts, barring infected people from public contact jobs--have been used against all past epidemics and sexually transmitted disease outbreaks. However, state health authorities say that such tactics have only been applied from time to time, and that improved sanitation, purified drinking water and mosquito control have been far more important in reducing disease.

AIDS, they add, is much different. It is not spread through the air, water or by poor sanitation, so the kinds of steps taken against dysentery or tuberculosis are useless. AIDS is spread sexually and by tainted blood, and thus requires different methods to control its spread.

Q Why not just collect names of AIDS patients and carriers and notify their sexual contacts?

A That is done now with treatable venereal diseases, although some counties have stopped doing contact tracing for budgetary reasons. For AIDS, some localities have begun to notify the past heterosexual partners of AIDS victims that they may have been exposed. But AIDS has centered on gay males and on bisexuals who may have only occasional homosexual relations, and state health officials say accurate tracing in such stigmatized social groups has proven ineffective. Also, up to 500,000 Californians may already be infected so costs would be prohibitive, health officials say.

In addition, health officials suspect that gays, bisexuals and illegal drug users who fear public exposure would react to any government investigation of personal behavior by going underground. Health officials say that would seriously hurt the AIDS effort by discouraging those most at risk from seeking testing and place them out of reach of education, and expose far more people to AIDS than would be helped by futile efforts to trace sexual contacts.

Q Do any medical experts support Proposition 64?

A The ballot argument in favor of the measure is signed by a Burbank psychiatrist, a Virginia pathologist who is a follower of LaRouche, and a former employee of the Centers for Disease Control who was fired earlier this year. In addition, a British physician who for years has clashed with the CDC has endorsed the measure.

Opponents include Koop, the California Medical Assn., California Nurses Assn., California Dental Assn., California Hospital Assn., American Red Cross and most AIDS researchers nationwide. In addition, Gov. George Deukmejian, Senators Alan Cranston and Pete Wilson, Los Angeles Mayor Tom Bradley and the leaders of both political parties are opposed.

Q What, precisely, is AIDS?

A AIDS, or acquired immune deficiency syndrome, is the name given to a variety of ailments and cancers that develop after a person’s immune system is rendered ineffective by a virus known as HIV.

It was first recognized as a disease in 1981. Since then 26,566 cases have been counted nationwide with 14,977 deaths. In California, 5,992 cases had been reported through September with 2,966 deaths.