Sharing AIDS Information

The American Medical Assn. has struck an appropriate balance in its proposal for new regulations and laws to permit the sharing of AIDS test results with persons potentially at risk. Those who draw up the laws will be well advised to heed the nuances of the AMA proposal.

The AMA has made a clear case for breaching the traditional confidentiality between doctor and patient when a patient refuses to inform sexual partners that they are at risk because he or she tests positive to the human immunodeficiency virus. This is a deadly disease. Unsuspecting persons being placed at risk of infection have a right to know.

The AMA House of Delegates reached this recommendation: “Ideally, a physician should attempt to persuade the infected party to cease endangering the third party; if persuasion fails, the authorities should be notified, and, if the authorities take no action, the physician should notify and counsel the endangered third party.”

An example of a case in which there is virtually unanimous support for informing the third party is that of a wife who is unaware that her husband has become infected through bisexual or prostitute contacts. Her husband could be free of symptoms of AIDS for seven or more years, but she would be exposed to the infection for the entire time.

Some people will take the proposal of the AMA as justification for requiring the reporting of all test results to public-health officers and for mandating partner notification by the physician or public-health authorities, including partner tracing, as is done with other sexually transmitted diseases. That would require an immense investment in scarce public-health funds that are desperately needed for education and treatment. One expert, for example, suggested that the cost of partner search and notification in the homosexual community in California alone would cost more than $800 million. The AMA argues for discretion. That is correct.

The presidential AIDS commission also recognized the importance of discretion and outlined priorities to determine how limited resources could best be used for partner notification. The commission also emphasized the importance of guarding the confidentiality of the test results even when notification is given. The name of the person who tests positive is not to be communicated to the person exposed to infection. That rule of confidentiality has facilitated partner-notification programs already in place for venereal diseases.

Public-health workers have not yet been able to demonstrate that partner-notification programs are effective in encouraging modified behavior to minimize the risk of HIV infection.But that uncertainty need not counter the wisdom of informing, on a priority basis, those who are unaware that they are being exposed to the AIDS virus. California already has enacted legislation that permits doctors to inform spouses, but the State AIDS Leadership Committee has opposed the mandatory reporting of test results.