Officials Drop AIDS Isolation Proposal

A committee of California health officials has dropped a controversial proposal that county public health officers isolate “recalcitrant” AIDS patients who seem intent on engaging in high-risk behaviors that may infect others with the AIDS virus.

The committee reversed itself after it became convinced that isolation “wouldn’t work,” said Dr. Carl Smith of Alameda County, chairman of the disease and epidemiology committee of the California Conference of Local Health Officers.

“It would really be impossible to isolate somebody for the duration of infection, which is forever,” Smith said. He added that committee members had also heeded warnings from gay rights activists that isolation could do “more overall harm than good” by driving AIDS patients underground.

Instead, the committee is now recommending that local health officers almost exclusively use voluntary methods to change behavior, such as intensive educational and rehabilitation programs for prostitutes and intravenous drug users with the deadly disease, Smith said. When a health officer feels that isolation may be necessary, the committee recommends that the courts be asked to decide the proper course of action on a case-by-case basis.

Patients Would Be Frightened

“The concern is that any move to invoke current laws (regardless of justification) would frighten all persons with AIDS/ARC, and that non-recalcitrant persons would not seek needed medical attention, fearing legal action,” according to a new draft of the committee’s proposals that was released in Sacramento on Friday.

The new draft, which was written primarily by Smith and Dr. George Wolfe of Santa Cruz County, is to be discussed at the next meeting of the disease and epidemiology committee in June.

The committee’s recommendations are based on existing state laws that empower health officials to protect the public from communicable diseases. They would affect only individuals who are actually sick with acquired immune deficiency syndrome or a related disease called ARC. The guidelines would not apply to the far larger number of people who are infected with the AIDS virus but are not ill.

Under the original proposal, recalcitrant AIDS patients would have been subject to a series of increasingly severe isolation orders if they continued to place others at risk through sexual practices or the sharing of intravenous drug equipment, including confinement to their home, a hotel, a hospital or a jail.

The new proposal suggests that public health officials take legal action against recalcitrant AIDS patients only after “careful consideration” of whether “such an action may do more overall harm than good.” Only two possible legal actions are recommended.

Checking the Facts

The first, an “order for examination,” would allow health officers to determine the facts of a case when allegedly recalcitrant patients are reported to health authorities and to attempt to persuade offenders to “voluntarily comply with risk-reduction activities.”

The second, an “order of modified isolation,” would allow authorities to prescribe required counseling or prohibit individuals from engaging in specific high-risk behaviors. But unlike an “order of strict isolation,” it would not restrict their movement.

If such measures fail, local health officers could ask the county district attorney to bring a misdemeanor charge against the recalcitrant AIDS patient for violating the state’s Health and Safety Code. If convicted, the maximum penalty would be six months in jail or a $500 fine.

As of the end of April, there had been 7,902 cases of acquired immune deficiency syndrome reported to health officials in California, including 3,088 cases in Los Angeles County. In the United States, there were 35,518 AIDS cases reported as of May 11, including 20,557 deaths. The AIDS virus is transmitted by sexual contact, through the blood, and from an infected mother to her newborn.