AIDS ‘Tracing’ Raises Ethical Issue : Specialists’ Views May Challenge Confidentiality Laws

A top AIDS specialist predicted Wednesday that medical records increasingly will list the fact that a person has been exposed to the AIDS virus--a controversial practice currently barred under California law as a violation of confidentiality.

Dr. Paul Volberding, chief of medical oncology and AIDS activities at San Francisco General Hospital, spoke here Wednesday at a cancer symposium attended by about 700 cancer specialists from throughout the world.

Also at the meeting, sponsored by the Cancer Center of Scripps Memorial Hospital, a bioethicist called for widespread “contact tracing” to notify the sexual partners of infected people--a policy that has been opposed by some civil libertarians and groups representing AIDS patients.

A ‘Failure of Nerve’

“That this, with some few exceptions, has not been done across the country represents a failure of nerve and a dereliction of professional responsibility on the part of public health departments,” said Ronald Bayer, a bioethicist with the Hastings Center in New York.

Their comments appeared to challenge the efficacy of current public-health practices in California and elsewhere, in light of what they described as the increasingly complex problem of controlling the spread of AIDS.

Traditionally, researchers who have worked most closely with AIDS patients and experts who have studied the ethical questions posed by AIDS have been among the strongest advocates of measures to ensure the protection of the confidentiality of people infected with the AIDS virus.

“We are at a critical point in the epidemiological curve of AIDS in America,” said Bayer. “There can be no doubt that the rising toll . . . will place great strains on our commitment to the principles that define a liberal democracy.”

Sees Change in Law

Volberding called the prohibition against listing exposure to the AIDS virus on medical records “a temporary aberration.” Later, he predicted that the state law barring a physician from listing a patient’s AIDS-test status would be changed.

Volberding also said he is “evolving my position . . . in favor of much more (AIDS antibody) testing in the hospital.”

The AIDS antibody test identifies whether a person has been exposed to the virus and is carrying antibodies to it. People who have been exposed are capable of spreading the virus, even though they may not be ill with the disease.

Advocates for AIDS patients and civil liberties groups have expressed concerns about the use and abuse of AIDS test results, noting that the test can produce false positives and people can be subject to discrimination if confidential test results become public.

Bayer and Volberding both stressed the need for federal and state laws barring discrimination against people who test positive--the absence of which Volberding called “frankly appalling.”

Vital Health Issue

Bayer called it “a matter of the highest moral and public health importance” that public health departments begin trying to contact the sexual partners of infected people.

He further contended that, in some cases, private physicians may have to violate the confidentiality of an infected patient if that person refuses to inform his spouse or sexual partner or to change his or her sexual behavior.