Harmful Impasse on AIDS

An impasse threatens important AIDS legislation in Sacramento. But there is a final opportunity today for compromise.

The controversy centers on long-needed legislation to relax the state’s confidentiality rules regarding the results of testing for the human immunodeficiency virus that causes AIDS. There is no question about the importance of confidentiality. It requires amendment, however, to facilitate the work of doctors and other health-care providers caring for those with the virus or with full-blown AIDS.

There is little disagreement about the need to relax the rules. But there is sharp disagreement about a proposal that this relaxation be linked to legislation mandating that all health-care providers care for AIDS patients. The California Medical Assn., representing most of the state’s doctors, has reaffirmed the moral and ethical responsibility of its members to care for AIDS patients, but it is strongly resisting the legislative mandate. We share the CMA’s concern that the mandate could do more harm than good, and that it would invite a veto when the legislation reached Gov. George Deukmejian. Indeed, there is no overwhelming evidence to support the need for the legislative mandate. The great majority of health-care providers appear to be acting responsibly in providing care to AIDS patients. The commitment of the CMA leadership to encourage an ethical response from all health-care providers seems more likely to encourage continued cooperation than a new law would.

The time has come to act on the single central issue of confidentiality. The issue of access to care can be addressed if and when there is a demonstrated need.

The other most important piece of AIDS legislation of this session already has cleared the Legislature and awaits the governor’s signature. It is AB 3795, authored by Assemblyman John Vasconcellos (D-Santa Clara), affirming protections against discrimination for those with the AIDS virus. It would implement one of the central recommendations of the Presidential AIDS Commission, which argued that anti-discrimination protections are essential to an effective public-health program. Without these safeguards, those at risk would inevitably be driven underground and beyond the reach of the public-health system.