Health Officials Push Broader AIDS Testing

San Diego County health authorities are calling for a dramatic loosening of the legal limits on AIDS testing to make possible the widespread testing and informing of people who may have been exposed to the deadly virus.

Under the recommendations, to be submitted to the Board of Supervisors, health authorities would be able to mandate testing of certain people suspected of spreading the virus, and medical facilities would be able to test some patients without elaborate assurances of informed consent.

Results Would Be Reported

All positive test results would be reported confidentially to the local health officer and to the person’s physician. Physicians would be able to inform a person’s sexual contacts that they may have been exposed--but without identifying the carrier.

“The public health (authorities) have absolutely had their hands tied,” said Dr. J. William Cox, director of the Department of Health Services, who intends to ask the supervisors to support changes in state law that would facilitate his recommendations.

“The results of the (AIDS antibody) test are not even reportable to the health officer,” Cox said. “So we don’t know what’s out there. If we do learn something, we can’t reveal it to protect anybody else. And we can’t go out after individuals who are contacts or known risks.”

Some of Cox’s recommendations, to be presented in mid-July, are likely to be opposed by the county’s task force on AIDS, which is charged, among other things, with advising the Health Services Department on policy and legislative issues affecting the spread of AIDS.

The task force has insisted that testing must be voluntary to ensure maximum public cooperation. It is also urging that all so-called “contact tracing” be done only with the acquiescence and assistance of the person who has tested positive.

‘Highly Controversial’

Cox predicted that several of his proposals will be “highly controversial.”

Acknowledging public concerns about discrimination against people who have been infected, he said he is recommending support for legislation barring discrimination in employment, housing, schooling and medical care against people who have been infected.

The AIDS virus test, which looks for the presence of antibodies in the blood, indicates whether a person has been infected with the virus. Authorities say people who test positive are capable of spreading the virus, though they may not come down with the disease.

The virus is spread largely through sexual contact and contaminated blood products. There is currently no cure for the disease.

Cox said he is not recommending support for legislation that would mandate antibody testing for generic groups, such as people applying for marriage licenses. He said such testing would be prohibitively expensive and could set a dangerous precedent.

“If you start going to generic groups, where do you stop?” Cox asked in an interview. “It’s an economic argument and a resource argument: It’s an unnecessary waste of effort and money to mandate mass testing.”

Cox said his proposals will come in the form of a “policy set” that he will ask the supervisors to approve as official county policy. County staff would then have the authority to support legislation to bring about the changes.

Cox said a draft of the proposals was approved two weeks ago by the San Diego County Medical Society. It has also been submitted to the task force and other medical and public health authorities for their reactions.

According to Cox, he is asking the supervisors for approval to support state legislation that would:

- Reduce to “a reasonable level” the requirements for consent to antibody testing so doctors and medical centers could administer the test, if necessary, without having to have the explicit written consent currently required.

As an example, Cox said a hospital might test a woman about to deliver a child so hospital personnel could take precautions to avoid exposure to amniotic fluid and blood. He said hospital might simply “inform (the patient) that this was a procedure.”

However, he stressed that physicians would be encouraged to counsel patients appropriately before and after testing.

- Allow positive test results to be made available “on a confidential basis” to a patient’s personal physician and to the local health officer. Cox noted that health officers receive reports of other communicable diseases.

- Allow doctors to report “to an endangered third party that they may have been exposed to an infected patient.” Under current law guarding the confidentiality of AIDS test results, such a doctor would be liable for fines and up to a year in jail, Cox said.

- Allow blood banks and health departments “to share information for purposes of locating and informing people who have any transmissible blood-born infections, including HIV (Human Immune Deficiency Virus).”

- Allow the county health officer “after appropriate judicial review” to mandate testing of individuals “when there is good reason to believe they may have exposed another individual.”

Cox said the officer would seek a court order to conduct the test, as it occasionally does, to override a family’s religious objections to certain medical treatments. He said such a step might be appropriate for someone “in a high risk group . . . known to have continued in the high-risk life style and activities.”

- Allow a conservator or guardian to give consent to antibody testing when his or her charge is unable to give it knowingly.

- Allow antibody testing without consent for scientific studies when the results are anonymous and cannot be linked to individuals. Cox said such a policy would enable researchers to measure the distribution of the virus among different groups.

Cox said the loosening of restrictions on antibody test data would assist public health officials in understanding the extent of the virus and disease. It would provide epidemiological data on such things as risk factors, incidence and latency.

Cox intends to make several other recommendations, which include supporting legislation to:

- Where appropriate, encourage medical care in hospices, nursing homes and convalescent facilities for people infected with the virus. He said officials should seek “less confining and less expensive sites of treatment” where possible.

- Ensure that people who have become disabled through exposure to the virus be eligible for Medi-Cal, where they meet the criteria.

- Increase public education about the transmissibility of the virus and prevention of infection. He said that should include efforts in Spanish and the languages of Southeast Asian immigrants.