U.S. Surgeon General C. Everett Koop strongly criticized key parts of Proposition 102 Wednesday, joining national AIDS researchers and prominent California health officials in assailing the measure’s approach to the epidemic as flawed.
Although he would not take a formal position on the initiative, Koop spoke about the issues raised by Proposition 102 in a telephone interview from Texas. Of the basic requirement in Proposition 102 that everyone who tests positive for the human immunodeficiency virus be reported to health authorities, Koop said: “I don’t know anybody in the public health community who thinks that’s a good idea.”
Koop, the federal government’s leading spokesman on AIDS, said any law that forces reporting of every person who tests positive for the virus will endanger research. The availability of anonymous testing, without fear of retribution, is essential to advancing science’s knowledge of AIDS, he said.
Infected College Students
For example, the surgeon general said that new study results suggested this week that infection with the virus is more common among college students than first believed. “We couldn’t have gotten that without anonymous testing,” Koop said.
Another provision of Proposition 102 would require local health officials, when they get the name of someone who tests positive for exposure to the virus, to trace the person’s sexual contacts, as is sometimes done for syphilis and other venereal diseases.
Koop agreed with California health officials that contact tracing can be helpful in some AIDS cases. But he said a rigid requirement that forces health officials to trace contacts in all cases--which Proposition 102 would do--would be wasteful, especially in California where more than 300,000 people are believed infected.
“Once we find them we have nothing to offer except counseling,” and that can be done best through doctors and public education, Koop said. “We would spend a lot of money to no good end,” he said.
Contact tracing is a key area of disagreement between Proposition 102 sponsors--Rep. William Dannemeyer (R-Fullerton), activist Paul Gann and a group of dissident doctors--and the opposition, which is led by the California Medical Assn. and virtually all major health organizations in the state. A number of university presidents, chancellors and medical school deans have also taken the unusual step of announcing their opposition.
Backers of Proposition 102 note that the American Medical Assn. endorsed contact tracing for AIDS this year. However, opponents counter that in many counties contact tracing has been suspended because a surge in new syphilis cases has swamped local officials.
L.A. County Costs
Los Angeles County health officials, in urging the Board of Supervisors to oppose Proposition 102, said the cost of investigating everyone who is infected with HIV could reach $19 million the first year. The county’s total AIDS budget is now $17.4 million, about half of which goes for medical care.
Koop, meanwhile, also said that relaxing laws which protect people who are seropositive--infected with the virus--from discrimination by employers would be a mistake. Proposition 102 would repeal a state law that bars employers from using HIV test results as a basis for employment.
“You’ve got to treat this disease in such a way that you protect the employability and bread-winning ability of people who are seropositive,” Koop said. “Otherwise you will have everyone who is seropositive be unemployed and that would be devastating.”
The nonpartisan legislative analyst in Sacramento has estimated that the costs caused by Proposition 102 could reach into the hundreds of millions of dollars. Contact tracing could run into tens of millions of dollars, and the cost of caring for AIDS patients who lose their jobs and insurance would push the tab much higher, the official estimate said.
Proponents moved Wednesday to take advantage of Gov. George Deukmejian’s surprise endorsement with a press conference at which a controversial member of the President’s Commission on Human Immunodeficiency Virus Epidemic spoke in favor of the initiative.
Dr. Theresa Crenshaw was a San Diego sex therapist and regular guest on radio and TV talk shows until taking up the AIDS cause. Since then, she has become aligned with the more conservative political thought on AIDS, at one point suggesting that the virus might be transmitted by mosquito bites.
Crenshaw said that Proposition 102 borrows key recommendations of the President’s commission and that many of the medical leaders who oppose the initiative did so out of fear of retribution. “There is not as much freedom of speech about AIDS as you would think,” she said.
Opponents promptly produced statements from other members of the President’s commission, including Chairman Adm. James D. Watkins, that were critical of Proposition 102.
“On the whole, passage of this (initiative) will hinder and not improve our ability to control the HIV epidemic,” Watkins’ statement read. Campaign spokesmen said the remarks were made in September at a Chicago meeting of the National Leadership Coalition on AIDS.
Opponents also circulated a statement attributed to Kristine Gebbie, an Oregon health official who served on the commission, that found major fault with the measure. “The anti-discrimination legislation is the basic foundation upon which all the other recommendations of the commission were based,” the statement read.
Meanwhile, campaign spending reports on file with the secretary of state show that more than $637,000 has been spent by supporters of Proposition 102. The biggest contributions were loans of $100,000 from Dannemeyer and $90,000 from the Committee to Cap the National Debt, which is controlled by Gann. Another group, California Physicians for a Logical Aids Response, has not filed any reports, although a spokesman for Gann said the group has arranged about $50,000 in radio advertising.
Opponents have spent more than $620,000, the biggest contributions being $50,000 from the American Foundation for AIDS Research and $5,000 each from such corporations as AT&T;, Pacific Telesis and Pacific Gas & Electric Co.