‘Contacts’ Sought Out, Warned : S.F. Leads Way in Tracing Partners of AIDS Patients
Christine Geoghegan says her most wrenching interview was with a young mother of two who had recently been diagnosed with AIDS.
As the woman was starting to plan for her children’s future without her, Geoghegan gently took her back into the past. Geoghegan asked the woman, who has been separated from her husband for several years, for the names, addresses and telephone numbers of the men she had slept with in the previous eight years. Whether one had given her the virus or whether they had been exposed to it by her, they needed to be warned--for their own health, and for the health of others.
“She was in touch with some of them already, but some she wanted me to contact,” Geoghegan said. “She was very cooperative, very concerned that this doesn’t happen to other people.”
Equal parts detective, therapist, and health educator, Geoghegan works in a San Francisco Health Department program aimed at finding and notifying the past heterosexual partners of newly diagnosed AIDS patients.
Beginning with addresses that may be months or years out of date, Geoghegan searches out as many of these people as she can. She telephones them and asks for a meeting, explaining that they may have been exposed to a communicable disease. She prefers to wait until she is with them, in her office or at their home, to break the news that the disease is AIDS. She reassures them that although they were exposed, they are not necessarily infected. She offers them counseling, assistance in arranging for an AIDS antibody test, medical referrals if necessary, and advice about “safe sex” practices believed to minimize the chance of infection.
“Some women who have had a lot of sexual partners are not surprised” that they’ve been exposed, Geoghegan said. “But somebody from the suburbs who had sex with a man who was bisexual three or four years ago--they’re just panicked.”
The San Francisco program is one of a small but growing number of efforts at AIDS “contact tracing,” as the process is called by health professionals. State health departments in Minnesota, Colorado, and Wisconsin have adopted contact tracing as one weapon in their fight against the disease. In California, health officials in San Bernardino, Riverside, and San Diego counties have active tracing programs, but nothing on the scale of the program here.
Could Halt Spread
Supporters say AIDS contact tracing can be useful in stopping the disease’s spread from the current high-risk groups--primarily homosexual men and intravenous drug users--into relatively uninfected groups, including the heterosexual population.
The goal is “to let people know they’re exposed and to stop them from infecting other people,” said Dr. Dean Echenberg, who started the San Francisco program in early 1985. “If we didn’t do anything, we’d see these rivulets of AIDS spreading out into the heterosexual population over a period of years.”
But critics--including health officials in Los Angeles and New York--call AIDS contact tracing a waste of resources that would be better spent on mass education. They point out that unlike contact-tracing programs for other sexually transmitted diseases like syphilis, AIDS tracing programs offer no cure, only education.
“We do contact tracing for people diagnosed with other sexually transmitted diseases because we can offer a treatment and cure,” said Marvin Bogner, New York City’s assistant health commissioner. “In the absence of something like that, we don’t think it’s appropriate or proper to do.”
Limited to the Spouse
Active notification efforts should be limited to the AIDS patient’s spouse, said Dr. Shirley Fannin, deputy director of Los Angeles County’s disease control program.
“Beyond notifying the steady sex partner, we don’t think there would be much value in doing contact tracing,” Fannin said. “You can put a whole lot of effort in and get no return.”
Since 1981, federal health authorities have reported more than 30,000 cases of AIDS throughout the country. The fatal disease of the immune system is transmitted primarily through sexual intercourse or use of contaminated hypodermic needles. In addition, as many as 1.5 million Americans may be unknowingly carrying the virus and infecting other people. Supporters of contact tracing say it is a useful complement to broad education campaigns for reaching these large groups of people who may still feel that “it can’t happen to me,” health officials say.
“When does behavioral change occur--when one becomes informed, or when one develops a sense of personal vulnerability?” said Michael Osterholm, Minnesota’s state epidemiologist and a founder of the contact-tracing program there. “If I come to you and say that somebody had intercourse with you who is (AIDS virus) positive, it brings it home a heck of a lot more than just knowledge.”
Models for Larger Programs
In addition, tracing efforts may ultimately be most useful as models for larger programs in the event a cure or therapy for the disease is found, said Dr. George Rutherford, director of AIDS programs for the San Francisco Health Department.
Today’s pilot AIDS tracing programs share a focus on stopping the disease’s spread into relatively uninfected segments of the population, but they vary widely due to differences in state law, target groups and resources.
In Colorado and Minnesota, health workers try to notify partners both of AIDS patients and of people who test positive for AIDS antibodies--but San Francisco officials, limited by a state law keeping antibody test results confidential, are able to notify only AIDS patients’ partners.
And Minnesota, with a relatively small pool of infected individuals, traces both homosexual and heterosexual contacts. But in San Francisco--where an estimated 50% to 70% of the male homosexual population already is believed to be infected with the AIDS virus--officials trace only heterosexual contacts, said George Lemp, the program epidemiologist.
With “tens of thousands” of contacts in the gay community, tracing is not practical, Lemp said. But, he added, “since the number of heterosexual cases in San Francisco was still fairly small, it was a manageable program.”
Since the start of the San Francisco program in mid-1985, staff members have identified 114 AIDS patients who seemed likely to have had heterosexual partners. They compiled names of 93 of these contacts but were able to find and test only 27. Seven of those notified and tested--26%--appeared to be carrying the virus.
Many patients are relieved to have the department’s help in notification because of the stigma attached to the disease, San Francisco health officials said.
“It’s difficult for people to tell their partners or former partners,” Lemp said. “Only a certain proportion would be willing to do the education we’ve been doing.”
In five San Francisco cases, AIDS patients refused to cooperate with the program at all. Some said they didn’t want the government interfering with their personal life. In such cases, there is little health workers can do.
Try to Justify Actions
“What gets me is when they try to justify why they don’t want to contact them,” said Dennese Neal, who together with Geoghegan does the notification. “They say, ‘She didn’t give (the virus) to me,’ or, ‘She’s married now; I don’t want to disturb her.’ ”
One AIDS patient “blew up” at Geoghegan when she and the man’s doctor pressed him about notifying his current lover.
“He said he had AIDS and was going to die and that she wanted to go with him,” Geoghegan said. “I tried to get her on the phone but she refuses to talk and he refuses to bring her to a doctor’s appointment.”
Neal and Geoghegan both are veterans at contact tracing, having worked in the department’s sexually transmitted diseases unit before joining the AIDS program. Each received several days’ training for the work, including seminars with AIDS patients and specialists.
Work Is Confidential
Even more than the earlier venereal disease tracing programs, their AIDS tracing work is confidential. When Geoghegan calls a contact’s workplace, she leaves only her name--no Health Department identification, so as not to raise questions among co-workers. In hopes that she will not be recognized when she arrives at a contact’s home, Geoghegan shies away from media attention; she refused to be photographed for this story and, in a recent television interview, her face was kept in shadow.
In telling people that they have been exposed to AIDS, Geoghegan and Neal are careful not to give the name of the AIDS patient.
“You really have to stress the confidentiality, and that we’re here to protect the patient and to protect them,” Neal said.
To further ensure confidentiality, Geoghegan and Neal destroy the lists of contact names once they have been notified.
Nan Hunter, an American Civil Liberties Union attorney who specializes in AIDS-related civil rights issues, praised such measures but remains opposed to contact tracing.
“From what I know of the San Francisco program, it’s run with a great deal of sensitivity” to the rights of AIDS patients and their sexual partners, Hunter said in a telephone interview from New York. “But other programs may not be as sensitive. We are concerned about the potential for coerciveness.”
While their co-workers tally the growing San Francisco AIDS caseload each month, Geoghegan and Neal take encouragement from each individual they are able to reach. They share the relief of those who test negative for the virus, as most have, and they have the satisfaction of knowing that many will not return to unsafe sex practices.
“They’re relieved, but they’ve learned a lesson,” Geoghegan said. “They’re going to really know what’s happening next time.”
Still, they acknowledge with frustration, others refuse to change. Neal described one woman who tested positive for the virus but whom she “lost.”
“She was just too busy trying to cope with her everyday life,” Neal said. “Coping with AIDS wasn’t a priority. I don’t know where she is now. I’m afraid she’s out there in San Francisco infecting people.”
Can’t Leave Jobs Behind
But Neal and Geoghegan find that their jobs are not ones they can leave behind at 5 p.m.
“I’m on a soapbox,” Neal said. “If I get into talking about AIDS with my girlfriends, I get hysterical. I start talking loud.”
“People outside wonder if you’re overreacting,” Geoghegan said. She becomes nostalgic for the days when the most serious concern in her business was herpes.
“I think I look at death a little differently, (because) so many I know have come and gone,” Geoghegan said. “You get a little tired. You think, when’s it going to stop? Are we ever going back to a different age?”