More Than a Health Dilemma : Candidates Forced to Deal With AIDS Issue

Former Arizona Gov. Bruce Babbitt remembers the recent day when his fifth-grade son came home from school with an assignment to write an essay about AIDS.

“He turned to me and he said, ‘Daddy, what’s a condom?’ ” Babbitt recalled. “It’s lucky he came to me and not the President. Otherwise he’d still be waiting to find out.”

Babbitt’s quip, amusing as it may seem, reflects a universal feeling among Democratic presidential candidates, who strongly criticize the way the Reagan Administration has handled this virulent and lethal epidemic.

AIDS, with its unique political and social ramifications, is forcing candidates to deal directly and publicly with sensitive and divisive issues that most might prefer to keep out of the political arena.

“The kinds of issues raised by AIDS are very different” from those associated with any other medical catastrophe in history, said Dr. Sheldon M. Wolff, physician-in-chief of the New England Medical Center and co-chairman of the highly regarded Institute of Medicine panel on AIDS.

“I don’t think anything in our lifetime has had the same kinds of overtones,” Wolff said. “AIDS is a disease that afflicts people outside the midstream of America: the gay population, minorities, intravenous drug users. You can’t separate that from the equation. If we were able to look at things purely from a medical standpoint--accepting that the disease happens to occur in these people--it would be pretty simple. But nobody takes that attitude.”

Thus, the AIDS epidemic has created much more than just a public health dilemma. In the six years since the first cases appeared in this country, AIDS has become a catalyst for a public forum on a host of explosive issues, including homosexual rights, sexual behavior, morality, sex education and privacy.

“Even if you look at the epidemic only in terms of dollars and cents, the impact on the health care system will have an impact on everybody,” Wolff said. “It’s a sad commentary that this has come into the political arena in any way, shape or form--other than to try to do something about it.”

Republican candidates generally took a more hard-line approach in dealing with the epidemic than Democrats, favoring more mandatory testing as one means of combatting the epidemic with less emphasis on civil rights concerns. They generally seemed to think that any AIDS sex education should include--even stress--moral as well as medical issues. Democrats favored increased education as the most effective tool against the epidemic, supporting increased funding for that effort.

AIDS, or acquired immune deficiency syndrome, is caused by a virus that attacks the body’s immune system, rendering it helpless against rare, opportunistic infections and cancers. The virus can also invade the central nervous system, causing severe neurological problems. It is commonly transmitted by anal and vaginal sexual intercourse, the sharing of unsterilized hypodermic needles and by woman to fetus during pregnancy. As of Oct. 26, the disease had struck 44,395 Americans, of whom 25,368 had died.

The AIDS antibody test, which was introduced in 1985 to screen the nation’s blood supply, has been used increasingly for diagnostic purposes to determine if an individual has been infected by the virus and is infectious to others. Since there is neither a cure for AIDS nor a vaccine to prevent infection, education has been promoted by medical experts as the most effective way of curtailing the epidemic.

Valuable Education Tool

Thus, public health officials believe that the test, if used appropriately, can be a valuable education tool. They believe that individuals who engage in activities that put them at risk of AIDS should be tested. If they test negative, health officials believe, they will be motivated to remain that way by practicing safer behavior; if they are positive, they will act responsibly and avoid transmitting the virus to others.

At the same time, however, the test has become extremely controversial. Civil rights and homosexual rights groups and others have feared that the disclosure of test information would bring stigma and discrimination in employment, housing, education and insurance to infected individuals.

The issue of AIDS education, particularly for children, also has been the subject of intense argument with those who advocate early and explicit instruction about sex--including homosexual behavior and information about the use of condoms--pitted against those who believe that school programs should emphasize fidelity in marriage or abstinence as the only ways to protect against AIDS.

AIDS Education Supported

In written responses to questions from The Times, all of the candidates said they support AIDS education, although they expressed differences in approach. Most Republicans, echoing the President, have called for expanded routine and mandatory AIDS testing and favor more funds for education and research, although--in contrast to the Democrats--none specifically endorsed the Institute of Medicine recommendation that the federal government spend $2 billion a year, divided equally between research and education, by the end of the decade.

“Investments in AIDS research and education today will save us far more in the future--in reduced medical costs and in greater productivity from our citizens,” said Massachusetts Gov. Michael S. Dukakis, a Democrat.

Republican Rep. Jack Kemp of New York, who has outlined a program of testing and education he estimated will cost about $1 billion a year, said he supports “spending whatever sums are necessary to research the AIDS virus and find a cure.”

Kansas Sen. Bob Dole, the Senate Republican leader, said he recently introduced a bill “which declares AIDS a public health emergency and provides funding for public information programs, state and local educational programs and an international data bank.” Further, he said, the legislation contains funding for additional personnel in the Food and Drug Administration to expedite the drug review process.

‘Our Scarce Resources’

Dole said he was “committed to spending whatever is necessary to fight this disease,” adding: “However, I think we have to realize that we must do this in an environment of financial responsibility. In other words, we have to make sure our scarce resources are spent in the manner that will do the most good.”

Two Republican hopefuls, former Delaware Gov. Pierre S. (Pete) du Pont IV and Pat Robertson, did not respond to the AIDS questions.

Kemp and former Secretary of State Alexander M. Haig Jr. called for the strongest testing measures, including mandatory testing for couples seeking marriage licenses. Kemp also said he supports testing those arrested on sex and drug charges, “since they are in a known high-risk group,” and patients admitted to hospitals “so that health care workers can provide proper care and take necessary precautions.”

All of the Democrats said they support wider testing but urged that such testing be voluntary and accompanied by counseling and ironclad protections of confidentiality and against discrimination. Enforced testing and lack of such protections, they argued, would drive “underground” those individuals who need help the most.

Confidentiality Stressed

Vice President George Bush was the only Republican who stressed confidentiality of test results, adding: “If society feels compelled in some circumstances to test its citizens, then it is absolutely imperative that help be made available to those who test positive.”

However, the Reagan Administration, which has advocated greatly expanded routine and mandatory testing in certain instances, has stated that confidentiality and anti-discrimination statutes should be legislated by the states, rather than the federal government.

Most of the Democrats attacked the Reagan Administration’s AIDS proposals.

“Three months ago the President finally addressed the issue of AIDS for the first time in his Administration,” said Tennessee Sen. Albert Gore Jr. “Public health experts recommended that he focus attention on expanded research and public education. But instead, the President made testing a goal in itself--doing more to set back AIDS policy by that one action than he had already done in six years of silence.”

Policy Called Disgrace

Babbitt agreed. “The Administration and its soul mates in the conservative movement have given us a policy that is a disgrace,” he said in a speech before the Harvard School of Public Health last summer. “It’s a concoction of irrationality and prejudice that we should have left behind long ago.”

Democratic Rep. Richard A. Gephardt of Missouri called the Administration’s current level of funding for AIDS education “woefully inadequate,” saying: “Much of the fear and panic surrounding the disease and resulting discrimination points to a profound lack of understanding of the disease. In other words, education of the general public has been a low priority.”

Most of the candidates said they opposed the quarantining of AIDS victims, although Bush said he believes that “questions regarding restrictions on AIDS patients are best left to the states.” The Rev. Jesse Jackson, on the other hand, called quarantine “a barbaric, medieval concept which should have no place in modern discussion.”

None of the candidates offered new or novel solutions for the complicated and frustrating problem of reaching intravenous drug abusers, which Gore described as “the most rapidly growing and most resistant group of AIDS cases.” But nearly all stressed the need to enhance existing drug abuse programs and find ways to enable more addicts to receive treatment.

Gore Attacks Reagan

Gore attacked President Reagan for first signing drug legislation, “promising new opportunities for care and counseling,” then reducing available money for drug programs, “not only undermining our efforts to combat drug abuse but crippling our best hope of stopping the spread of AIDS among (intravenous) drug abusers.”

Gore, acknowledging that it is not known whether providing addicts with sterile needles will help reduce transmission of the AIDS virus among drug users, suggested that--”given the seriousness” of the problem--”we shouldn’t rule out experimenting with public policies to encourage the use of sterile needles.”

Kemp, on the other hand, vehemently opposed such a proposal, saying: “I do not support providing clean needles to drug users--this would be sanctioning behavior that is both criminal and destructive.”

All of the candidates support early AIDS education for children, although many said that they believe decisions about the contents of such programs should be made on the local level.

‘System Has Worked Well’

“Parents and the community should control what goes on in their schools,” Bush said. “That system has worked well for more than 200 years and I don’t want to change it. I don’t want the federal government to mandate some insensitive educational program.”

Most of the Republican candidates stressed that AIDS education should emphasize “traditional morality,” as Bush put it.

Haig said: “Our children should know that abstinence before marriage and fidelity after it are the surest defense against AIDS. We should tell them that casual sex, even with condoms, is very risky.”

Democratic Sen. Paul Simon of Illinois proposed that AIDS education begin at the kindergarten level “with progressively more complex and explicit information disseminated to students as they progress through school.”

Gephardt said: “All educational efforts should be age-appropriate and culturally sensitive to teach, not offend--and to reach, not defend--the sensibilities of the targeted group.”

Protecting Children

Jackson said education should begin “as soon as children can understand. . . . They are entitled to know how to protect themselves. I believe they must also be taught to respect themselves, their bodies--and their futures.”

All of the candidates but Kemp supported the right of gays to become involved in the political process, particularly as their activities relate to the AIDS epidemic.

“The AIDS crisis is not an opportunity for political activism by any segment of society,” Kemp said. “Rather, it is a public health problem which must be dealt with in a way that minimizes political posturing.”

Dukakis, on the other hand, responded: “There is no such thing as too much political activity.”

CANDIDATES AND THE ISSUES: AIDS

The Institute of Medicine has recommended that $1 billion a year be spent on AIDS research and $1 billion on education by 1990. Do you agree on the amount and on the balance between research and education? To help control the spread of AIDS, do you favor mandatory testing of any segment of the population, such as prisoners or pregnant women? If so, which group or groups? The sharing of needles by intravenous drug users is a major way the AIDS virus is transmitted. What kind of preventive program would you recommend to reduce the risk of transmission by this means? At what age should AIDS education begin with children? How explicit should the educational material be that is aimed at teen-age or adult high-risk groups such as homosexuals? REPUBLICANS

Vice President George Bush Does not endorse the IOM proposals. Supports the Reagan Administration funding levels, which he said totals $766 million this year and $1 billion next year. Supports mandatory testing of military personnel, Foreign Service employees, immigrants and prisoners. Supports voluntary testing for marriage license applicants and those seeking treatment at clinics for sexually transmitted diseases and drug abuse. Believes AIDS education materials should include information for drug abusers. Supports existing programs to curb drug abuse. Believes education is a local matter. Believes AIDS education should be “non-threatening” and teach “traditional morality.” Did not discuss explicitness for teen-agers or adults. Kansas Sen. Bob Dole Does not endorse IOM proposals but said he is committed “to spending whatever is necessary to fight this disease.” Believes testing should be available “to anyone who wants to be tested on a voluntary basis.” Supports mandatory testing of immigrants, prisoners and the military. Supports education of drug users and believes young people should be educated “before they become involved in drugs.” Believes education should begin at an early age. Believes state and local governments should determine educational materials. Did not discuss explicitness for teen-agers or adults. Former Secretary of State Alexander M. Haig, Jr. Does not endorse the IOM proposals. Said the funding should be “adjusted to the pace of the research.” Supports mandatory testing of prisoners, blood donors, immigrants and marriage license applicants. Would warn drug users about AIDS but does not specify how.Believes AIDS education should begin at the same age as other sex education, stressing abstinence before marriage and fidelity after. Did not discuss explicitness for teen-agers or adults. New York Rep. Jack Kemp Does not endorse the IOM proposals. Has proposed that testing and education be funded at $1 billion a year and that the government spend “whatever sums are necessary” to find a cure. Supports mandatory testing of blood donors, military personnel, individuals arrested on sex and drug charges, prisoners, immigrants, couples seeking to marry and hospital patients. Supports programs to curb illegal drug use. Opposes providing addicts with clean needles. Believes decisions about AIDS education should be made at the local level. Believes AIDS education should stress morality. Did not discuss explicitness for teen-agers or adults. Former Delaware Gov. Pierre S. (Pete) du Pont IV and Pat Robertson did not respond. DEMOCRATS

Former Arizona Gov. Bruce Babbitt Does not endorse IOM proposals. Said that he is not prepared to offer budget figures but that conversations with health officials have led him to believe research funding is adequate. Opposes mandatory testing but would support testing of prisoners and immigrants if it is backed by “the wider public health community.” Supports increased voluntary testing with counseling and confidentiality. Supports increased programs for drug treatment. Supports outreach programs that use former addicts to “talk to drug abusers about bad needles and unsafe sex.” Believes education should begin as early as possible. Believes the degree of explicitness for teen-agers and adults “must depend . . . on the findings of social science studies.” Massachusetts Gov. Michael S. Dukakis Does not endorse IOM proposals. Believes that the proportion of funding should depend “in part on the progress that is made in research.” Supports mandatory testing of military personnel and immigrants. Supports confidential voluntary testing. Supports drug education and rehabilitation. Supports comprehensive health education for children, reflecting “the age of the children involved.” Did not discuss explicitness for teen-agers or adults. Missouri Rep Richard A. Gephardt Endorses the IOM proposals. Opposes all forms of mandatory testing. Supports voluntary testing with counseling and confidentiality. Supports educational efforts specifically geared to drug users. Supports increased efforts to curb illegal drug use. Supports drug rehabilitation and treatment programs. Believes AIDS education should bre “age-appropriate.” Did not discuss explicitness for teen-agers or adults. Tennessee Sen. Albert Gore Jr. Endorses the IOM proposals. Supports mandatory testing of immigrants and prisoners. Opposes testing of marriage license applicants. Believes voluntary testing and counseling should be available. Supports increased treatment programs for drug users. Supports giving addicts clean needles. Believes education should start in grade school. Content should be decided at the local level. Did not discuss explicitness for teen-agers or adults. Rev. Jessee Jackson Committed to increased spending but believes specific decisions for fiscal 1990 “must be made closer to the time.” Believes “large-scale mandatory testing is both unnecessary and counterproductive.” Supports voluntary confidential testing. Supports curbing illegal drug use through education “in and out of the school” and efforts “to cut down the supply.” Believes education should start “as soon as children can understand.” Did not discuss explicitness for teen-agers or adults. Illinois Sen. Paul Simon Endorses the IOM proposals. Supports mandatory testing of immigrants and prisoners. Supports voluntary confidential testing. Supports educating drug users through “large-scale public awareness campaigns” conducted by the federal government in cooperation with state, local and voluntary agencies. Believes education should begin at the kindergarten level or earlier. Did not address explicitness for teen-agers or adults.