U.S. May Urge AIDS Tests at Hospitals, for Marriages

Federal health officials may recommend expanded use of the AIDS antibody blood test to include all patients routinely admitted to hospitals and even couples applying for marriage licenses, The Times has learned.

Although the move seems certain to be highly controversial, “we feel if a person is infected, the person should know--both for the person’s benefit and the benefit of others,” said Dr. Walter Dowdle, AIDS director for the Atlanta-based federal Centers for Disease Control.

“We think the test has a real value, both for medical reasons, as well as public health uses, in halting further spread of the epidemic and for the individual’s own well-being,” he said.

Since its introduction in 1985, the test, which determines whether an individual has been exposed to the AIDS virus, has been the focus of intense debate. Many medical personnel and gay rights and civil liberties groups have feared that test information--unless kept anonymous--would attach a stigma to those who test positive and would be used to discriminate in such areas as employment, life insurance and medical insurance.

In fact, many insurance companies already have asserted their right to require applicants for coverage to undergo the procedure, which indicates whether an individual is infected but not whether he or she will develop the deadly disease.

The Justice Department last June further fueled these concerns when it ruled that federally funded employers who fire people with AIDS based on fear of contagion cannot be challenged under U.S. civil rights laws protecting the handicapped.

Health officials, acknowledging that the use of such test information can lead to discrimination, nevertheless said they now believe there are sufficient public health reasons to widen application of the test.

“There are legitimate medical uses for this test, and we have to be very careful about where we draw the line on its use,” Dowdle said. “We have to make sure we aren’t letting other considerations interfere with public health.”

Recognizing that their proposals will face substantial resistance, the agency has scheduled a public meeting in Atlanta for Feb. 24-25 to discuss the testing proposals before making any final recommendations. “We are not going to do anything without wide, open and public debate,” Dowdle said.

States Would Implement

CDC officials stressed that it would be the province of state legislatures and state public health departments, rather than the federal government, to implement such measures.

Members of the medical and public health community, medical ethicists and gay and civil rights groups said Monday that they oppose broader applications of the test unless strong safeguards are in place to protect against abuse of test result information. Many believe that mandatory testing will drive individuals “underground,” thus inhibiting efforts to control the epidemic.

Further, some physicians predicted that individuals who feared losing their insurance as a result of the test might avoid hospitalization for reasons not related to AIDS, contributing to increased illness or death.

“After you learn what happens to people who are even suspected of being infected, you know that it isn’t desirable in this society--and it doesn’t help curtail the epidemic,” said Dr. June Osborn, dean of the University of Michigan School of Public Health.

‘More Harm’

Osborn, who served on the prestigious Institute of Medicine panel on AIDS, which last fall recommended a fivefold increase in spending for AIDS education and research by 1990, said that without comprehensive counseling, “the frightening information of seropositivity (infection) can do more harm than any good I can imagine at the moment.”

Carol Levine, a medical ethicist with the AIDS project of the Hastings Center in Hastings-on-Hudson, N.Y., said expanded use of the test should take place only on a voluntary--and confidential--basis.

“We believe there is a benefit for individuals at risk to know their status and there is no question that those who are infected must act to protect others,” she said. “My concern is that this test not be used as a fishing expedition to find out about certain people and that there be a way to ensure people are not harmed or discriminated against when they cannot control the use of that information.”

Counseling Pushed

Because there is thus far no medical treatment for infection, “what are they going to do when they know someone is positive?” said Jeff Levi, executive director of the National Gay and Lesbian Task Force.

“The only value for the test as a prevention tool is the quality of the counseling associated with it, and effective counseling can be done without a test,” he said.

CDC Director Dr. James O. Mason, saying that federal health officials intend to weigh these issues carefully, nevertheless added: “Our first responsibility is to the many, rather than to the few. Our vision has to be: We’ve got 240 million Americans--what are the steps that will protect them?

“If this were not AIDS, with its peculiar social and political aspects, I don’t think there would be any question we would be testing at the time of hospital admissions. In the past, we have used testing for other diseases because it has made public health sense--why should we deny ourselves these tools?”

Would Join Routine Tests

CDC officials said hospital testing would be part of the battery of tests administered routinely to every patient admitted to a hospital. “You do blood pressure and a complete blood count; this would be the same thing,” Dowdle said. “It would be part of a patient’s profile.”

Mason said the purpose of premarital testing would be to inform couples who might consider pregnancy. Infected women can transmit infection to the fetus during pregnancy.

Last year, federal health officials recommended that people engaging in behavior that carries a high risk of AIDS voluntarily undergo the test. AIDS, or acquired immune deficiency syndrome, which cripples the body’s immune system, is spread commonly through anal and vaginal sexual intercourse and the sharing of contaminated hypodermic needles. In this country, it has primarily afflicted homosexual and bisexual men, intravenous drug users and their sexual partners.