For the third time in two years, the foot soldiers and generals in the war against AIDS are fighting a California ballot initiative that would force doctors and health officials to drastically alter their tactics--in part by investigating the sex lives of possibly a million or more people.
This time the appeal to voters is not being offered by extremist Lyndon LaRouche, whose two initiatives flopped at the polls. The latest measure, Proposition 102, has more formidable roots in Rep. William Dannemeyer (R-Fullerton), a vocal critic of AIDS policies and homosexuals who was the only major elected official to endorse LaRouche, and tax crusader Paul Gann, who contracted AIDS through a blood transfusion.
Nonetheless, the lineup of major figures in the state and the issues in the campaign are similar to the controversy over the LaRouche initiatives, which first surfaced in 1986. The sponsors are betting that voters are unhappy about AIDS being given special handling under public health laws, while opponents say Proposition 102 would dismantle a system that took five years to build and that seems to be slowing the epidemic’s spread.
The major health organizations in California, representing physicians, nurses, hospitals and county health officers, have all attacked Proposition 102 as a serious threat to AIDS research and control. Some medical leaders have said they would destroy patient records if voters pass the initiative, which would require that anyone who has tested positive for the human immunodeficiency virus that leads to AIDS be reported to authorities. Gay and civil rights organizations and a bipartisan list of political leaders are also opposed.
But unlike LaRouche, Dannemeyer and Gann have managed to pick up a smattering of support from dissident physicians and conservative politicians who complain that the prevailing medical and legal view of AIDS is wrong.
Proposition 102 would toss out the strategy of anonymous testing and mass education that most AIDS experts in California have adopted as the only step available to stop such a widespread and fatal disease.
In its place, state and local authorities would be required--even against their own wishes and prevailing medical advice--to collect the names of everyone who has tested positive for the AIDS virus and compile information on their sexual contacts as far back as 1979.
Physicians would be required to report any patients who test positive, employers would no longer need consent to test workers for the AIDS virus, and state laws that protect people with AIDS from losing their jobs and insurance would be repealed.
It would become a crime to knowingly spread the virus or to refuse to give the names of sexual partners to health authorities after a positive AIDS test.
The nonpartisan legislative analyst in Sacramento has estimated the costs of Proposition 102 at “possibly tens or hundreds of millions of dollars,” and a UC Berkeley study conducted for opponents said it would cost at least $765 million--10 times the current state AIDS budget--and might go as high as $1.7 billion the first year. The tab includes not only the costs of investigating what could be more than a million people, but also increased spending on welfare and public hospitals that might be necessary if a large number of people carrying the virus lose their jobs or health insurance.
Dannemeyer and Gann say the changes are needed to force health officials to approach AIDS the same way that other sexually transmitted diseases, such as syphilis, are handled. The current system was set up to avoid angering the gay community and not to follow established public health practices, some Proposition 102 supporters say. “You can’t deny there is politics in organized medicine,” said Brett Barbre, special assistant to Dannemeyer.
A mailing to physicians is bringing in dozens of favorable responses, Barbre said, and the ballot arguments in favor were signed by a former president of the California Medical Assn. (which as a group is actively fighting Proposition 102) and by the leader of a fledgling group called California Physicians for a Logical AIDS Response.
Dannemeyer aides say Proposition 102 has won the backing of 12 other GOP congressmen from California and Republican women’s clubs in the state, but the list does not include the top Republicans in California. U.S. Sen. Pete Wilson came out against Proposition 102. Gov. George Deukmejian has yet to take a position, but he took a stand against the LaRouche measures and opponents said they expect him to oppose Proposition 102 on the advice of his chief health advisers. Most top Democrats in the state, and presidential candidate Michael Dukakis, have announced their opposition.
Neither side has managed to raise much money and it appears unlikely that either side will have enough to tell its side on television. In early polls, the measure has been leading among those voters who have made up their mind, but there remains a large voter segment that has yet to decide.
Opponents are less concerned about Dannemeyer, the chief sponsor of Proposition 102, a conservative who is not well known outside Orange County and who may be remembered for campaigning vocally on behalf of Proposition 64, the 1986 LaRouche initiative.
But Gann and the emotional appeal of his predicament has the medical community worried. Gann, who is 76, was diagnosed as having AIDS in 1987 and held a press conference shortly afterward to announce his ill fortune.
Since his heyday in 1978 as the sponsor, with Howard Jarvis, of Proposition 13, Gann’s influence on California politics has gradually faded. But his People’s Advocate organization is still a grass-roots force in the state, and it is his role that could prove decisive on Proposition 102.
Gann contracted the virus in a 1982 blood transfusion during surgery. Since then, blood banks and health authorities credit screening and anonymous testing with virtually removing the threat of blood being contaminated with the virus that leads to AIDS. But Gann contends that the protection will be greater if laws that guarantee confidentiality are relaxed in favor of more reporting.
Health officers already have the power to trace the sexual histories of AIDS patients and in many California counties the health authorities use it on a limited basis. The prevailing view is that contact tracing, as the practice is called, is of little importance in stopping the spread of a disease such as AIDS.
Unlike other infectious diseases, where health officers may use their judgment, Proposition 102 would take the decision whether to trace sexual and drug contacts away from the doctors and health officers and make it a requirement of state law. This is unnecessary, according to many AIDS experts, because most people at risk of contracting the disease already know who they are.
The majority of AIDS patients contracted the virus through sexual relations, mainly with gay or bisexual men, or from tainted blood received in transfusions, or from unsterilized drug needles previously used by someone else carrying the virus. Through the education efforts that have made most people in the United States familiar with AIDS and its peculiarities, people in these high-risk groups have already been reached and urged to change their risky behavior and get tested, according to the California Medical Assn. and other groups.
But more than unnecessary, Proposition 102 would also impede efforts to slow AIDS, the opponents say.
In California, where more than 300,000 people may already be exposed to the virus, the medical officials opposed to Proposition 102 say it would take time and millions of dollars away from AIDS research and patient care and require it to be spent gathering unusable files on sexual experiences.
Investigators could be required to go back to 1979, when scientists believe the virus may have first surfaced on the West Coast. But the further back in time that investigators try to probe, the less accurate people’s memories may be about their sexual experiences.
The problem could be worst among gay men, the part of society most affected by AIDS. Before the epidemic was fully detected and publicized, many gay men were promiscuous, some having multiple partners, whom they barely knew, on the same night. However, studies in San Francisco have found that the sexual behavior of gay men has changed in the face of the AIDS threat, and nearly all of the bathhouses in California that offered a secure place for anonymous sex have closed.
Opponents also say that Proposition 102 would destroy AIDS research in California by forbidding the anonymous testing that now provides the base for many studies.
Dannemeyer and Gann say that confidentiality of test results will remain protected by public health laws, and that only people with a need to know, such as medical personnel and spouses, would be notified. But opponents contend that voluntary testing by high-risk people such as gay men has dropped off wherever anonymous testing has been discontinued. In addition, they say people will avoid testing for fear they will lose their health insurance or job.