Setback on AIDS

The California Medical Assn. has withdrawn its support of AIDS legislation to implement the recommendations of Surgeon General C. Everett Koop in California and now opposes the bill. It is a grave disappointment, coming just as Assembly approval of the legislation had set the stage for negotiations with Gov. George Deukmejian on the final form of the legislation.

AB 87, written by Assemblyman Art Agnos (D-San Francisco) in collaboration with Dr. Koop, is the key proposal to implement in California the recommendations of the federal public-health officers and researchers. The new opposition to the legislation from the medical community centers on confidentiality requirements, among them the need to obtain consent of the person being tested to share the test results with anyone--including other health-care providers. In fact, AB 87 would facilitate, through a simple consent procedure and provision for the establishment of separate confidential records, the sharing of test results with doctors and nurses and others directly involved in the treatment of the person.

Doctors bear a complex responsibility in the AIDS pandemic, and their tension, conflict and bewilderment are understandable. They, like other health-care providers, are at risk to the extent that they come to be exposed to body fluids of infected individuals. They obviously sense the urgency of curbing the spread of a deadly disease for which there is no known cure. Many of them have found persuasive the arguments of those who want to tear down the wall of confidentiality that has been built around those infected with the human immunodeficiency virus (HIV), arguing that existing rules jeopardize the public at large. Implicit in much of the controversy over AB 87 and in many of the attacks on the policy advocated by the surgeon general is that all of these special rules of confidentiality are contrived to protect homosexuals and intravenous drug users, the populations most affected by acquired immune deficiency syndrome.

In fact, that is not the case. There is no evidence that confidentiality rules have increased the danger of infection. Koop, with extraordinary support from virtually every other professional involved in public health, has urged confidentiality because it has been demonstrated to be the only effective way of reaching the critical population--a population that without these protections would go underground and thereby greatly increase the rate of spread of the disease. Responsible persons do not require the mandate of the Legislature to inform their spouses or other sexual partners of the existence of infection or to submit to a test for HIV before marriage. But it is the irresponsible and those who face brutal economic consequences like the loss of a job, housing and health insurance who are driven to the underground unless there are protections of secrecy.

The California doctors now plan to draw up their own AIDS legislation. Their concern is welcome. Their support of the basic intent of AB 87, including the creation of a state commission to coordinate efforts to control the disease, is appropriate. But their insistence on broad authority for doctors to share HIV test results without patient authorization is, we are convinced, unwise. It would appear that the California Medical Assn. itself, in this shift of policy, is ignoring the counsel of its most informed and expert members--those already engaged in the public-health programs dealing directly with AIDS. There clearly is need for broader debate and clearer thinking before the final decision on the legislation is taken at the end of this month by the CMA council.

The approval of AB 87 has already been delayed too long. Step by step, with each amendment, it has been made to conform with the carefully developed strategy of the surgeon general. It would place California at the forefront among states moving effectively but calmly to deal with this problem. It would end the waste so evident now in counterproductive bills and policies and conflicting, piecemeal administration of problems that beg for the central coordination of the state commission to be created under its provisions.