AIDS: Going to Extremes

President Reagan’s adviser for domestic policy, Gary L. Bauer, has endorsed broader mandatory testing for AIDS and a stripping away of some of the regulations designed to guard confidentiality. He is not alone. Other politicians and officials are responding to the growing peril by proposing other extreme measures. If they have their way, they will do much more harm than good, and will weaken the programs most likely to be effective.

Testing can be useful both to the person being tested and to the epidemiologists tracing the spread of this disease. But the minute that testing is made mandatory, it will become less effective because critical populations will avoid it at all costs.

The principal barrier at this time is the absence of effective federal and state guarantees against discrimination. Once those guarantees were in place, there would be a new readiness from people at risk to cooperate in voluntary testing programs because they would know that their health insurance, their housing, their jobs would not be denied them as a result of the findings. There is a curious contradiction in that many of the people who are most aggressively advocating mandatory testing programs are also opponents of the very anti-discrimination guarantees that would facilitate testing.

One area of mandatory testing favored by Bauer is for those intending marriage. There is no question that people who have had promiscuous sexual activity should have themselves tested for the AIDS antibody before marriage, and without exception before pregnancy. But if that test is made mandatory, those most at risk are most likely simply to avoid it, according to public health experts, and the very people whom one would hope to be warned would be excluded.

That is why the Centers for Disease Control has recommended against mandatory testing. There is a strong a consensus of support for that view among state public health officials as well. A committee of five experts in California recommended making voluntary AIDS testing centers widely available. That makes sense.

AIDS testing cannot be done in isolation from effective counseling, however. Those who test positive to the presence of the virus need immediate and often continuing psychological support. This need for support is becoming clearer with the accumulation of statistics now demonstrating that more than half those who test positive will, over succeeding years, develop either AIDS or the AIDS-related complex, ARC.

Surgeon General C. Everett Koop remains opposed to the extreme measures being talked about within the White House domestic-policy staff. Dr. Koop is supported by the Centers for Disease Control. The President will be wise to heed the professionals.