AIDS, Politics: Seeking a Safe Stand : President Seen as Taking Middle-of-the-Road Position; Debate Could Be an Important Issue in the Coming Primary Elections

“There’s no reason for those who carry the AIDS virus to wear a scarlet A,” President Reagan told guests at a fund-raising dinner for AIDS research this week in Washington.

Yet, in light of reactions to his speech, it appears that candidates in the coming primaries will carry brands of their own when it comes to the AIDS debate.

“The issue is like molten lava running down a hillside,” Washington Democratic pollster Peter D. Hart said. “It’s red hot and its going to destroy anything in its way.”

‘In a Fear Stage’

Hart added: “It’s hard to know what will happen. We’re in a fear stage, and not much else. The public knows it wants something done . . . I don’t think anyone has figured out the balance point between civil liberties and the public health threat.”

Response to the President’s speech--and his advocacy of increased testing to identify potential carriers of AIDS--ranged from praise to outrage and demonstrated the potential divisiveness of the issue.

Still, despite the heated criticism that Reagan and Vice President George Bush inspired with their comments on AIDS this week, the President did not damage himself politically, according to one political expert.

“Reagan is not in trouble with the public in general,” said William Schneider, a scholar at the American Enterprise Institute in Washington and political analyst for The Times. “Everything he said, the public supports in the polls. The public wants him to do something about AIDS. Anything. Testing, research, sex education, whatever it takes.

“The public supports mandatory testing,” Schneider said. “It also supports sex education in the schools. Explicit sex education.”

Instead of using the word mandatory , the President substituted routine, saying the government would test immigrants and federal prisoners, and later perhaps patients of federal hospitals. He suggested states “routinely” test marriage applicants, and patients of sexually transmitted disease clinics and drug clinics.

In his talk, only his second major speech about AIDS since it was discovered six years ago, Reagan took what many political observers and AIDS experts believe to be a middle-of-the road approach in the debate of what to do about AIDS and how to do it.

The President essentially tried to stake out a position somewhere between these prevailing attitudes:

--Most public health officials do not support increased testing because they believe it is a waste of money and inconclusive. They believe the additional federal funds should go toward AIDS research seeking a vaccine and eventually, a cure, and toward an intensive national AIDS education program.

Said one international AIDS expert, who asked to remain anonymous: “From the beginning this Administration has played with AIDS like a bunch of amateurs. They haven’t listened to the health care experts. There’s no national AIDS policy or education program. They can’t even talk about sex. In Great Britain, they don’t even have 1,000 cases (of AIDS), and they sent safe sex pamphlets to every home in the country. And here, the Administration’s realization that they have to do something comes when elections are around the corner, not when people are dying.”

--Gay activists and civil libertarians fear routine testing will become mandatory testing for certain designated groups, violating their civil rights, causing discrimination and breaches of confidentiality.

“I am outraged and depressed,” said Ben Schatz, an attorney with the National Gay Rights Advocates in San Francisco and West Hollywood. He said he feared the speech forecast a “dangerous direction” for the subject of testing. “All those who test positive are going to get their insurance canceled and go on Medicaid, possibly lose their jobs, their apartments. We’ve already been through a lot of that in the gay community.”

--Right-wing political organizations and many religious groups oppose increased sex education for the public, especially in the schools, as advocated by many public health care professionals. One of their targets has been Surgeon General C. Everett Koop, who has urged AIDS sex education in the schools, as early as elementary grades.

Barraged With Hate Mail

Koop was barraged with hate mail from fundamentalist Christians after his report calling for sex education in schools to curb the spread of AIDS.

One of the most vocal critics of Koop’s policies on AIDS has been conservative Rep. William Dannemeyer (R--Fullerton), who favors “testing some groups on a mandatory basis,” but is opposed to sex education in the elementary schools about AIDS.

Dannemeyer, reached by phone in his Washington office, said: “I commend President Reagan for the modest steps he took in developing a needed response to this public health epidemic in America, that mandatory testing will take place for those people under the jurisdiction of the federal government, immigrants seeking to enter this country, prisoners, employees of the government. We already are testing (for AIDS antibodies) in the military.”

Dannemeyer reiterated that he still believes “certain groups of people” should be mandatorily, not routinely, tested for the virus. Among those groups he cited are patients in hospitals, persons applying for marriage licenses, prostitutes and the prison population. “I believe routine testing is a cop out,” he said. “It’s another illustration of treating the issue as a civil rights issue instead of a public health issue.”

The congressman added that he currently has offered an amendment to the congressional health care bill, stating that states that wish to get health care money from the federal government must institute “mandatory testing and reportability of those groups I have mentioned.”

On sex education, Dannemeyer said that if we are going to have sex education, it shouldn’t begin in the elementary schools, but in junior high. And in the sex education, “we should reaffirm the heterosexual ethic of our society and we should tell them that the homosexual life style is a very unhealthy life style.”

In May, a Media General-Associated Press survey found that AIDS now rivals cancer as the most feared disease in America and that six of 10 Americans favor mandatory AIDS tests as a requirement for holding certain jobs.

On the sex education issue, a March Gallup poll found that 71% of those surveyed favored sex education classes in grades four through eight in the public schools, while 21% were opposed. More than 90% of those favoring sex education in the elementary schools wanted the curriculum to include discussions of AIDS.

“The one thing not controversial is the need for more spending for AIDS. The public is solidly behind that,” political analyst Schneider said. “But the two issues that are controversial are testing and sex education. There are different pressure groups on the left and the right. The gay activists and civil libertarians object to mandatory testing . . . they fear discrimination, lack of confidentiality.

“The groups on the right, especially those affiliated with the religious right, oppose sex education, are critical of mentioning condoms and birth control.”

Schneider said he believed that the AIDS debate would be an important issue in the coming primary elections.

“It can get candidates on both sides in trouble,” Schneider said. “Republicans are going to be in trouble with the right if they talk about sex education. Democrats will get in to trouble with the left if they support mandatory AIDS testing. The presidential candidates will see more of that.”

For their part, most AIDS experts interviewed by The Times had kind words and applause for Reagan for finally talking about AIDS and governmental policy, and for appealing in his speech for treatment of AIDS patients with compassion and dignity.

Other health care officials bristled at his failure to talk about counseling in conjunction with testing, considered a must, and for not calling for a federal commitment to laws ensuring confidentiality with AIDS testing. Some questioned whether Reagan’s use of the word routine simply meant mandatory in disguise.

Most seemed encouraged by the President’s praise of Surgeon General Koop’s educational efforts in the AIDS crisis; others felt Reagan should have made a policy commitment to a specific national AIDS education program.

“I would have liked for him to say a great deal more,” said Mark Madsen, director of the department of continuing medical education for the California Medical Assn. “But I appreciate him coming out and talking about it. Considering this was his first major talk on AIDS, I’d give him a B+ for the effort.”

Madsen continued: “But if you’re talking about increased voluntary testing, you should be talking about counseling. HIV (the AIDS antibody) testing should be part of counseling, not the other way around.”

Reagan’s recommendations that states should begin premarital testing also caused Madsen some concern: “He said that states could follow their own guidelines, but problems arise from that. In California, for instance, one-third of the marriages (of Californians) take place outside the state . . . If we were to institute premarital testing, what about the states around us?

“There are a lot of people getting married in Arizona, Nevada, Washington, Idaho--and don’t forget the the ones who go to Mexico. It’s an absurd sort of policy. It should be either all or nothing, so we either have it or not. This way it sets up discrimination. And people will just figure out what state doesn’t have the test and go there.”

‘Raises a Red Flag’

“He started off quite nicely,” said Dr. Mathilde Krim, one of the co-founders of AmFAR, “talking about using compassion and taking care of people and not discriminating against them. But then he talked about knowing that promiscuity causes AIDS. That raises a red flag with people.

“When he talked about caring for people with dignity and kindness, that was fine,” she added. “But then he mentioned the final judgment being up to God. That implied a lot to a lot of people.”

“It is the worst we could have expected, except for him to say go quarantine people,” said Jean O’Leary of Los Angeles, executive director of the National Gay Rights Advocates. “He says he wants AIDS education or any sex education to be “value neutral.” That’s a buzz word. That means homosexual neutral . . . .

Dr. Neil Schram, a Kaiser physician and former head of the now-defunct Los Angeles City/County AIDS Task Force, said he was angered by Reagan’s speech. “If I can summarize it in a few sentences, the Reagan Administration has failed to spend money on AIDS education in the last few years to stop the spread of the virus, so now it’s trying to make up for that by proposing legislation that will not have an impact on this disease.

“Keeping immigrants out who test positive will not do anything, testing prisoners will not do anything to slow it down,” Schram said. “None of his proposals will do anything to significantly control this epidemic. If you put the money they will spend on testing--and he didn’t mention counseling with that--into education and research, you’d be far better off.”

Schram added: “Routine testing means that the individual has the right to say no. Well, just say no will take on new meaning now, not Reagan and Nancy’s anti-drug campaign. ‘Just Say No’ will mean do not take the AIDS test.”

David Mixner, a Los Angeles businessman and AIDS activist, said: “In many parts, the speech was insensitive and offensive to anybody who has ever known somebody who died of AIDS. I have lost over 40 friends. This man has been responsible for people dying needlessly. So little has been done by the Administration, and now talking about testing. You can’t talk about testing without talking about tough protections of civil rights, confidentiality. Numerous people already have lost jobs, apartments, insurance. Children have had to go to court to go to school. Without laws to protect them, you’re going to drive people underground.”

Robert M. Saltzman, administrator of AIDS programs for the Los Angeles County Department of Health Services: “With any kind of testing, it is important to remember the two aspects that have to go along with it, counseling and protecting the confidentiality of the patient. We feel quite strongly about those.

“To some extent, we are begining to do what might be called routine testing of individuals in our own health system, in IV drug clinics and sexually transmitted disease clinics. We’re planning also to propose offering testing of high-risk women in our prenatal clinics. The medical professional talks with the person if they’re a high risk and discusses the availability of the test. It’s not mandatory, it’s done in individual circumstances and offered to the person.”

Bruce Decker, a gay who is chairman of the California AIDS Advisory Committee appointed by Gov. Deukmejian: “As long as what the President has said is implemented in the spirit of what he said, if testing is routine as compared with mandatory, then I would support the direction in which he is moving. It represents a change in the direction the right wingers have been pushing him to go, to make testing mandatory.”

Decker, who has been proposed as a candidate for the new Presidential AIDS Commission by Sen. Pete Wilson (R-Calif.) added: “Those of us on the civil liberties and public health side of this struggle need to redouble our efforts to influence the Administration’s policies . . . Anytime you are developing public policy, it’s always a matter of two extremes tugging at each other.”

Dr. Michael Gottlieb, the Los Angeles immunologist who published the first report about AIDS on June 5, 1981: “It didn’t even have a name six years ago. It was five gay male patients (at UCLA Medical Center) with cases of pneumocystis carinii pneumonia . . . Sure, I wish the President had made a speech about AIDS three years ago. I wish in this one its implications had been recognized and addressed. But I am grateful for the President’s remarks on this occasion.

“He said a lot of affirmative things about compassion and lack of discrimination and the research agenda which had been largely overlooked. But to some extent, the call for testing was more responsive to political than medical reality . . .”

for the President’s remarks.

--Dr. Michael Gottlieb, writer of the first AIDS report