There are two reasons why most public-health professionals strongly oppose Proposition 102, the AIDS reporting initiative: It would outlaw the single most effective prevention program now in place, and it would squander millions of dollars on mandated programs of limited value.
On the face of it, the initiative offers a beguilingly simplistic solution to fight AIDS, doing to this disease what has been done to other communicable diseases by insisting on complete reporting and case-by-case contact tracing. This familiar solution has an attractive ring to it. But the proposal ignores the fundamentals of AIDS, above all that it is a disease without known cure.
The initiative goes further, however. It mandates not only reporting of all who test positive to the human immunodeficiency virus (HIV) that causes AIDS, but also requires that a doctor who “has reasonable cause to believe” that a person has been infected to report his suspicions. And anyone who learns that he or she has been infected must report to the local health officer.
The effect of this will be to eliminate the anonymous test centers that have proven the most effective means of reaching persons at risk, particularly intravenous drug users and homosexuals, who fear discrimination, including job and housing loss, if their infection becomes known.
There is another awesomely negative effect: The cost, according to the official estimate by the legislative analyst, “could be as high as tens or hundreds of millions of dollars"--$765 million the first year, according to a UC Berkeley School of Public Health study. The sponsors argue that this is a small price to pay to reduce the number of infected persons. True, if it works. But they offer no evidence to support their contention that this extremely costly approach would be more effective than the existing program. In fact, the evidence points overwhelmingly in the opposite direction. A recent study in Oregon showed the extraordinary effectiveness of anonymous test sites, which would be eliminated by the initiative.
In the absence of a cure, the AIDS pandemic can be controlled only by programs that encourage testing of high-risk populations. The final report of the Presidential Commission on the Human Immunodeficiency Virus Epidemic, headed by Adm. James D. Watkins, emphasized the crucial importance of “voluntary cooperation” in a testing program, the only avenue to changing behavior that places others at risk. That very strategy, so carefully developed in California over the last five years, would be destroyed by the provisions of the initiative. And the damage would be compounded by diverting scarce resources from urgently needed current programs into a wasteful program mandated to trace every sexual contact over the last seven years of every infected person.
The last session of the Legislature adopted new laws on sharing HIV test information among health-care providers, on reporting and on contacting partners of infected persons. These measured and constructive proposals contrast with the punitive and carelessly drawn provisions of Proposition 102.
The existing AIDS program has the support of the California Medical Assn., the California Dental Assn., the California Nurses Assn., the State Health Officers Assn., the regional representative of the Centers for Disease Control, the California AIDS Leadership Committee, including top state, county and local public-health professionals. They are unanimous in their opposition to Proposition 102. And, in their opposition, they are joined by a long list of responsible civic organizations, among them the California Catholic Conference, the League of California Cities, the State Chamber of Commerce and the League of Women Voters of California. We agree with them. Vote no .