AIDS: Clearing the Air

The appearance of sponsors of Proposition 102, the mandatory AIDS-reporting initiative, before the California AIDS Leadership Committee on Wednesday was, in the words of one of the co-chairmen, “useful and enlightening.” It served above all to expose the fundamental flaws in the initiative--flaws that have led the California Medical Assn. and most health-care and public-health officials to oppose it.

Rep. William E. Dannemeyer (R-Fullerton) and Dr. Larimore Cummins, chairman of the Santa Cruz County Medical Society AIDS Task Force, were the advocates for the initiative. They made the familiar arguments, asserting that the national and state policies now in place have failed and that the time has come to use the techniques of mandatory testing and contact tracing that have been effective in public-health campaigns against other infectious diseases, including venereal diseases. If mandatory reporting works for syphilis, which is not necessarily a fatal disease, why not for AIDS, which is all the more dangerous because there is no known cure?

The very simplicity of the argument is beguiling, but it masks fatal flaws. In the first place, the existing national and state policies are proving effective by the one test that counts: The rate of new infections is dropping in areas of high prevalence. In the second place, the voluntary reporting and contact tracing that are now in plac1696620914effectiveness of anonymous-test centers in reaching high-risk persons has been confirmed in a recent study in Oregon reported last month in the Lancet.

But the anonymous-test centers would be barred by the reporting initiative, to be replaced by a mandatory system that the state’s most senior health officer has concluded will not work. The confidential mandatory reporting system that is proposed in the initiative as an alternative already has created problems for public-health officers, committee members have reported. Their reports confirm fears of public-health officials that the mandatory program would drive away the high-risk populations that the present program has been effective in reaching. An official of the Centers for Disease Control reported that some research programs involving volunteers already are in jeopardy because those who are within the programs have said that they will quit if their HIV-positive status is reported by name, as required in the initiative. A county health officer said that his work would be paralyzed by the requirements of the initiative.

Two other flaws emerged as the committee reviewed the proposition. One is the incredible cost that is implicit in the reporting and contact tracing at a time when counties are running out of funding for basic programs, including money to provide AZT for AIDS patients. The other is the provision in the initiative that would bar any amendment by the Legislature, requiring re-submission to the voters of the state for any change, which would make adaptability to changing conditions difficult if not impossible.

The statements to the committee by Dannemeyer and Cummins were troubling in another way. They displayed significant ignorance of what has been accomplished, including the policies endorsed by the Presidential AIDS Commission, the National Academy of Sciences, the World Health Organization and virtually every health-care expert involved in the pandemic. They offered no convincing scientific evidence to support their claim that the initiative contains a better program than those in place. There was an ideological cast to some of their arguments. And their treatment of information was so casual at some points that Dr. Donald P. Francis of the Centers for Disease Control, an expert in the field, concluded: “At best I would call it a deception of facts.”

The California AIDS Leadership Committee postponed until later this month formal action on the initiative. But, significantly, it reaffirmed the stand that it took two months ago in opposing mandatory reporting of HIV-positive test results--a critical element of Proposition 102. That reaffirmation, coming after hearing the sponsors of the proposition, is significant. It represents the views of many of the most expert and best informed concerning AIDS in the state. It is a message that emphasizes the fundamental defect of Proposition 102 and the grave damage that it would do to the continuing effort to contain AIDS.