Confidentiality May Be Reduced : Legislature Leans Toward Widespread AIDS Testing

State legislators, reacting to the public’s growing fear of AIDS, have begun approving a wide range of legislation to broaden testing for the disease while reducing the confidentiality of test results.

In a marked departure from previous legislative sessions, the AIDS agenda is increasingly dominated by a conservative Republican viewpoint that favors widespread testing for exposure to the disease and, in extreme cases, segregation of carriers of the virus.

Liberal Democrats and public health experts, who have argued that a voluntary approach to testing is the most effective way to stop the spread of the disease, appear to be losing ground to those who insist that voluntary efforts should be deemphasized in favor of greater governmental intervention.

“Members (of the Legislature) are perceiving that AIDS is no longer a homosexual disease,” said conservative Sen. John Doolittle (R-Rocklin), sponsor of many major AIDS bills. “We have to strike a better balance between the privacy rights of the victim and the right to life of the potential victim, who is all of us. . . . I am not proposing mandatory testing, but I must tell you, if we don’t get a handle on this disease, we’re probably looking at mandatory testing for everybody.”

Already the Senate, with the backing of some Democrats, has passed legislation by Doolittle that would permit testing for exposure to the AIDS virus without a patient’s written consent and weaken the confidentiality requirements for testing adopted by the Legislature two years ago.

The Senate has also approved bills that would require the testing of certain state hospital mental patients and make it a felony for carriers of the virus to donate blood or engage in prostitution.

“In some ways, we (Democrats) have let the issue slip away,” said Sen. Diane Watson (D-Los Angeles), a liberal who chairs the Senate Health Committee. “I see the Legislature rushing down a road blindly. It’s just flailing out in the dark and I think it can get us into serious trouble.”

More than 50 bills concerning acquired immune deficiency syndrome have been introduced this year, demonstrating the Legislature’s growing concern with the AIDS epidemic that has already struck more than 8,700 people in California. Health officials expect that by 1991 more than 50,000 Californians will have come down with the disease.

Liberal Democrats, who emphasize AIDS education and research along with voluntary testing, have had some success with major elements of their legislative program. Bills that would establish an AIDS education program for junior and senior high school students, expand the number of anonymous testing centers from 54 to as many as 200, and create a commission to set state policy on AIDS have all passed either the Senate or the Assembly.

Face Critical Decisions

In the coming weeks, as the various legislative proposals head toward final passage, the Legislature will face critical decisions on how best to change people’s behavior and stop the spread of the AIDS virus.

Politically, the issue of AIDS has been a difficult one for many lawmakers because the disease has primarily struck male homosexuals and intravenous drug users--two groups that find little sympathy among the general public.

In 1985, the Legislature and Gov. George Deukmejian enacted a landmark law designed to encourage the testing of potential victims for exposure to the virus by providing confidentiality to those who took the test. The law was backed by public health experts who believed that confidentiality was essential if those at high risk for the disease were to come forward voluntarily.

Now, state Health Director Kenneth Kizer and other public health experts favor changes in the confidentiality law so that doctors and other health workers can be fully informed if a patient they are treating is a carrier of the AIDS virus. Health officials say, however, that widespread testing based on a voluntary, confidential approach remains the most effective way to halt the spread of AIDS.

Some legislators are concerned that the more sweeping changes favored by conservative politicians could be the first step toward the segregation or quarantine of AIDS patients and those who have been exposed to the virus.

Seen as Moral Test

“I worry about how much fear will dictate policy and overrule wise judgment by experts,” said Democratic Assemblyman John Vasconcellos of Santa Clara. “It may well become one of the moral tests of this society’s ability to make wise and moral decisions in the face of a broad-scale threat.”

Taking the lead on the AIDS issue for Republicans this year is Sen. Doolittle, one of the most conservative members of the Legislature.

Last year, he was a vocal supporter of Proposition 64, the unsuccessful initiative sponsored by extremist Lyndon LaRouche that would have authorized quarantining AIDS patients. The ballot measure also sought to bar carriers of the disease from working in restaurants, schools and medical facilities, and would have allowed authorities to order blood tests and report the results to the state. The ballot measure was soundly rejected by voters.

Doolittle said this week in an interview that he is strongly opposed to homosexuality and believes that “it is a sin which should be repented of.”

The 36-year-old senator, who as Republican caucus chairman holds the No. 2 GOP post in the Senate, has long been controversial. In 1984, he narrowly won reelection after secretly financing a last-minute mailer for a little-known third candidate in the race in an attempt to siphon votes from his main opponent. His failure to disclose the maneuver led to a $3,000 fine by the Fair Political Practices Commission.

Televised Debates

To promote his AIDS proposals, Doolittle has taken part in televised debates around the state and, in an unorthodox move, sent an open letter to the homosexual community saying, “I need your support to get my bills passed; you need my bills to stay alive.”

Before introducing his package of 10 AIDS bills focusing on the issues of testing and confidentiality, Doolittle said he conducted opinion polls that found a high level of public concern about AIDS. He acknowledged in an interview that the issue could figure in his campaign for reelection next year and a possible bid in 1990 for a statewide office such as attorney general.

“When you’re a politician, you use the issues that can be used at the time,” he explained. “I think the AIDS issue is going to be with us for several years and will be big next year. I’m doing what I think is right.”

Doolittle’s past activities have bred distrust of his motives among many AIDS activists, including Bruce Decker, chairman of the California AIDS Advisory Committee and Deukmejian’s first openly homosexual appointee.

“The problem you have with a John Doolittle being involved is the man has demonstrated irrational homophobia and a totally irresponsible point of view around the issue of AIDS, up to and including support of the LaRouche initiative,” said Decker, a Republican who noted that he has tested positive for exposure to the AIDS virus.

Gann Case Has an Effect

Nevertheless, events of the last few months have worked in favor of Doolittle’s position. In particular, the revelation last month that anti-tax crusader Paul Gann had contracted AIDS from a blood transfusion shocked many legislators and brought home the message that the deadly disease also affects heterosexuals.

Gann has joined Doolittle at public appearances to advocate increased testing and an end to confidentiality for those who carry the disease.

“We could have a million people with AIDS that are not aware of it,” Gann said in an interview. “Let’s all become responsible and bring this thing to a screeching halt and quit spreading it.”

At the same time, two highly publicized criminal cases have intensified the public’s fear of getting AIDS from irresponsible carriers of the disease.

In Los Angeles earlier this week, Dist. Atty. Ira Reiner filed charges of attempted murder against an AIDS patient and reputed male prostitute who allegedly sold his blood to a donation center.

And in Fresno last month, police arrested a female prostitute who has AIDS and charged her with attempted murder when she refused to stop plying her trade.

Criminal Statutes

In some quarters, these episodes have prompted support for new criminal statutes. Two of Doolittle’s bills would directly affect such situations: One would make it a felony for carriers of the AIDS virus to donate blood; the second would make it a felony for anyone to engage in prostitution or other sex crimes knowing that he or she had been exposed to the AIDS virus.

But to health officials and leading Democrats, such cases are rare events that should not shift the state from its primary goal of stopping the spread of the disease by educating the public.

“What he (Doolittle) is trying to do is make it a crime to have AIDS,” Sen. Watson said. “He is trying to criminalize an illness.”

Several of Doolittle’s other bills would require the testing of specific groups of people, including new prison inmates, involuntarily committed state mental hospital patients, and prostitutes. In these cases, the measures could lead to their segregation or confinement. Doolittle is also seeking widespread testing of couples about to get married and pregnant women.

The most controversial of Doolittle’s bills, however, is the measure that would roll back the confidentiality law of 1985, allow testing for exposure to the AIDS virus without a patient’s written consent and permit disclosure of test results to county health officers for the purpose of controlling the disease.

Could Refuse Test

Under the bill, according to Doolittle, the AIDS antibody test would be treated like other normal medical procedures. Patients would be notified of their right to refuse the test, although anyone declining would have to do so in writing. In certain circumstances, however, such as when a patient is incapacitated, a guardian could authorize the test.

Doolittle said that his goal is to broaden testing and stop the spread of the disease by informing people they have been exposed to the virus. “We’re killing people by not doing increased testing,” he argued. “The disease is being spread as a result of our failure to test.”

His foes, however, maintain that testing is already being carried out on a broad basis through anonymous test centers and private physicians. In fact, they point out, the demand is so great that individuals who want the AIDS antibody test are forced to wait as long as three months to get an appointment at confidential testing centers.

Under the present voluntary system, homosexuals, intravenous drug users and others who believe that they may have been exposed to the virus are seeking the test in large numbers, health officials said. But under Doolittle’s plan, many of those in high-risk groups would be driven away out of fear they would be identified, lose their jobs and insurance, or face even worse consequences, the senator’s critics argue.

Instead of focusing on those most likely to get AIDS, the critics contend, Doolittle’s testing plan would focus on groups that are at low risk for the disease, such as people about to get married, thereby diverting scarce resources from education, research and treatment programs.

Need Broad Approach

“Testing is going to be a very large part of dealing with AIDS, but it is just one part,” said Stan Hadden, an aide to Senate President Pro Tem David A. Roberti (D--Los Angeles). “You need to look at education, counseling and putting a system in place to deal with the huge number of people who are going to become sick in the next few years.”

Hadden, who also has tested positive for exposure to the AIDS virus, said of Doolittle’s legislation, “I don’t see it as being designed to do anything but frighten a public that is already on the verge of hysteria.”

Among the bills introduced by Democrats to address the AIDS problem are a measure by Roberti that would spend $39 million on AIDS education and treatment and a bill by Assemblyman Mike Roos (D-Los Angeles) that would quadruple the number of anonymous test sites, including up to 135 on university and college campuses.

Roos, arguing for passage of his measure during the Assembly debate, told his colleagues: “This only frankly lowers the chances of anyone on this floor getting the disease sometime in their lifetime. And I would urge you, for your own self-interest, to vote ‘aye’ on this measure.”

Assemblyman Art Agnos (D-San Francisco) who has long been a leader on the AIDS issue, said Doolittle’s bills have made gains in the Senate because politicians feel increasing pressure to respond to the AIDS crisis. Unfortunately, he noted, there is no immediate solution; most of those who will come down with AIDS during the next five years have already contracted the virus.

Urges State Commission

Agnos himself is carrying a bill that would adopt the recommendations of U.S. Surgeon General C. Everett Koop and establish a state commission to set policy on AIDS, removing it a step from the politically charged atmosphere of the Legislature.

“Doolittle’s bills offer an attractive package for politicians who want to demonstrate they are doing something,” Agnos said. “I’m hoping the Legislature gets a grip on itself and looks at this in terms of what is in the best interest of public health.”

1987 AIDS LEGISLATION BILL / AUTHOR AB 87 by Assemblyman Art Agnos (D-San Francisco) PROVISIONS Would create a state commission to set policy on AIDS and implement the recommendations of U.S. Surgeon General C. Everett Koop. STATUS Passed Assembly; pending in Senate Health Committee. BILL / AUTHOR AB 250 by Assemblywoman Teresa P. Hughes (D-Los Angeles) PROVISIONS Would allow doctors to inform a spouse that a patient has tested positive for exposure to the AIDS virus. STATUS Passed Assembly; pending in Senate Judiciary Committee. BILL / AUTHOR AB 563 by Assemblyman Johan Klehs (D-San Leandro) PROVISIONS Would provide a 55% state income tax credit for private donations to AIDS research. Sponsors estimate it would raise $200 million a year. STATUS Recently amended; awaiting first hearing in Senate Revenue and Taxation Committee. BILL / AUTHOR AB 2650 by Assemblyman Mike Roos (D-Los Angeles) PROVISIONS Would expand the number of anonymous AIDS test centers from 54 to as many as 200, including 11 at blood banks and up to 135 at state university and college campuses. STATUS Passed Assembly; pending in Senate Health Committee. BILL / AUTHOR SB 136 by Sen. Gary K. Hart (D-Santa Barbara) PROVISIONS Would require schools to provide AIDS prevention instruction to students in grades 7 through 12. STATUS Passed Senate; pending on Assembly floor. BILL / AUTHOR SB 942 by Sen. John Seymour (R-Anaheim) PROVISIONS Would allow disclosure of AIDS antibody test results on organs donated for transplant; would allow disclosure to health officials of positive test results at blood banks when efforts to reach donors are unsuccessful; would specify that written consent for testing is not needed when test results are not linked to the identity of the subject. STATUS Passed Senate; pending in Assembly Health Committee. BILL / AUTHOR SB 1000 by Sen. John Doolittle (R-Rocklin) PROVISIONS Would alter the existing confidentiality law for AIDS antibody testing and allow the test to be conducted without a patient’s written consent. Would allow test results to be given to county health officers for the purpose of controlling the disease as well as to health professionals and researchers. STATUS Passed Senate; pending in Assembly Health Committee. BILL / AUTHOR SB 1001 by Sen. Doolittle PROVISIONS Would require that the AIDS test be offered and recommended to all applicants for marriage licenses. STATUS Passed Senate; pending in Assembly Health Committee. BILL / AUTHOR SB 1002 by Sen. Doolittle PROVISIONS Would make it a felony for a person who has tested positive for exposure to the AIDS virus to donate blood. STATUS Passed Senate; pending in Assembly Public Safety Committee. BILL / AUTHOR SB 1004 by Sen. Doolittle PROVISIONS Would add three years to the prison sentence of a person who committed rape or other sex crimes knowing he or she had tested positive for the AIDS virus. Would make it a felony, rather than a misdemeanor, for a person to engage in prostitution knowing he or she had tested positive for exposure to the AIDS virus. STATUS Passed Senate; pending in Assembly Public Safety Committee. BILL / AUTHOR SB 1005 by Sen. Doolittle PROVISIONS Would require that all new inmates at state prisons be tested for exposure to AIDS and would allow testing of all other inmates already imprisoned. Would provide for segregation of those who test positive for the disease. STATUS Pending in Senate Judiciary Committee. BILL / AUTHOR SB 1006 by Sen. Doolittle PROVISIONS Would require testing of all state mental hospital patients committed involuntarily. Would provide for segregation of those who test positive for the disease. STATUS Passed Senate; pending in Assembly Health Committee. BILL / AUTHOR SB 1007 by Sen. Doolittle PROVISIONS Would require AIDS antibody testing for all convicted prostitutes. STATUS Passed Senate; pending in Assembly Public Safety Committee. BILL / AUTHOR SB 1323 by Senate President Pro Tem David A. Roberti (D-Los Angeles) PROVISIONS Would provide an additional $39 million for AIDS education and patient care. STATUS Passed Senate; pending in Assembly Health Committee.