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Victims May Face Discrimination : Health Workers Still Fear Treating AIDS Patients

Times Staff Writers

Despite assurances from medical experts, fear of treating AIDS patients continues to afflict the nation’s health care workers, raising fresh concerns that those who suffer from AIDS may encounter continued discrimination from the very system they turn to for help, according to several reports released Thursday at the third International Conference on AIDS.

One of the studies reported the first instance of a dentist becoming infected with the AIDS virus, apparently after contact with a patient. Another, a study of AIDS infection rates among trauma patients in a Baltimore hospital emergency room, reinforced the need for health care professionals to follow recommended precautions in handling the blood of all patients, not just those known to be infected with the AIDS virus.

These studies were released only two weeks after federal health officials reported three cases in which health care workers--who were not wearing gloves--became infected after a single, but extensive, accidental exposure to the blood of AIDS patients.

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In a third study released here Thursday, Dr. R. Nathan Link, of the New York University School of Medicine, described as “disturbing” the attitudes he found when he surveyed more than 250 physicians in the New York area in the spring of 1986.

“Twenty-five percent would choose not to continue to care for AIDS patients if given a choice,” he said. “Twenty-four percent believe it is not unethical to refuse to care for AIDS patients, and over one-third believe they should be given a choice of whether or not to care for AIDS patients.”

Link added: “We find this disturbing. It impairs the social contract between the physician and the patient community.”

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He said that 66 of his respondents reported 95 “needle-stick” exposures, and most of those in his survey described their level of concern over contracting AIDS as ranging from “mild” to “moderate.” However, he said, nearly half of those questioned “reported examining themselves for symptoms” of AIDS, such as swollen lymph nodes.

Dr. Robert S. Klein of the Montefiore Medical Center in New York reported that one dentist out of 1,231 dental health professionals tested since the fall of 1985 proved positive for exposure to the AIDS virus, believed to be the first time a dentist has become infected.

Rick Asa, spokesman for the American Dental Assn. in Chicago, said other dental professionals have been infected by the AIDS virus, but they all have been identified as members of other high-risk groups for the disease.

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‘First Such Case’

“This dentist apparently was infected directly through dental practice,” Asa said. “It is the first such case.”

Still, Klein said, “I find our results reassuring that the risk is low, even though we found some risk--in a person not following the recommendations.”

The dentist, who had practiced in New York City for 14 years, had only intermittently used gloves or other precautions while treating patients, and had never treated a patients known to have AIDS, Klein said. The man had had two accidental “inoculations” within the last year, Klein said, and 10 within the last five years.

“He frequently practiced without gloves, even though he often had obvious breaks in his skin,” Klein said. He said the dentist and his wife denied other risk factors and said they have had no other sex partners.

The Baltimore hospital study, conducted by researchers at Johns Hopkins Medical Center, found that six of 203 emergency room trauma patients, or 3%, whose blood was tested anonymously in early 1986 were infected with the AIDS virus.

Rate Could Be Higher

Further, preliminary data from an expanded study of 2,303 emergency room patients there indicate that the prevalence of infection could be twice as high as it was for those in the first group, researchers said.

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None of the 203 trauma patients in the early group was known to be an AIDS patient, or known to be infected, according to Dr. James L. Baker, author of the study. “All were actively bleeding and all required invasive procedures,” he said. The second group involved those coming into the emergency room who were “having their blood drawn for any reason,” he said.

One surprising finding from the early group, Baker said, was that only two of those who tested positive were intravenous drug users, a high-risk activity for transmitting AIDS. The hospital is located in an inner-city neighborhood. Twenty of the 203 patients, including the two who tested positive, had been identified as past or current intravenous drug users, he said.

The overall findings, Baker said, confirm that “all bleeding patients should be considered as potentially infectious” and that recommended procedures to protect against exposure should be taken.

“Young trauma victims may represent an unknown risk for (AIDS) infection,” he added.

Nurse Suspended

Earlier this week, a nurse at Johns Hopkins was suspended for three days after she refused to participate in surgery on a patient infected with the AIDS virus.

AIDS, or acquired immune deficiency syndrome, destroys the body’s immune system, leaving it powerless against certain cancers and otherwise rare infections. The virus can also invade the central nervous system, causing severe neurological disorders. It is transmitted through anal and vaginal sexual intercourse, through the sharing of unsterilized hypodermic needles, and by woman to fetus during pregnancy.

In this country, AIDS has primarily afflicted homosexual and bisexual men, intravenous drug users and their sexual partners. As of Monday, a total of 36,058 Americans had contracted AIDS, of whom 20,849 had died.

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