In a sharp policy shift, members of the California Medical Assn. voted Monday to ask for state legislation that would require anyone testing positive for the AIDS virus to be reported to county health authorities.
California law now requires anyone with full-blown AIDS to be reported to health authorities, but proposals for similar reporting of people carrying the human immunodeficiency virus have previously drawn strong opposition, even from some in the CMA.
The resolution calls for mandatory reporting of HIV infections by health care providers "for the purpose of partner notification and disease control" only.
The action, on a voice vote by 450 physicians attending the annual CMA convention in Anaheim, surprised leaders of the powerful lobbying group. A CMA policy review committee had urged the delegates to continue the traditional policy of opposing mandatory reporting of people who carry HIV.
But other physicians said it was time to change the policy.
Dr. Brian Johnston, an emergency room physician at White Memorial Medical Center in Boyle Heights, said mandatory reporting would give public health officials a new method of tracking the AIDS virus.
"As it is now, we are tracking what happened 10 years ago because all we are looking at is AIDS," he said.
"A mandatory reporting law would give us more information to track the epidemic, and to find out where these cases are coming from, if it's being spread by homosexuals or through drug addicts," Johnston said.
The association's vote was attacked by Michael Weinstein, director of the AIDS Healthcare Foundation in Los Angeles, who called the action "a victory for ignorance and phobia."
"It will exacerbate the epidemic," said Weinstein, one of Los Angeles County's most vocal proponents of anonymous testing.
Weinstein said estimates are that half of all people with HIV do not know they have been infected.
"The reality is we have to convince people that their confidentiality is going to be protected, and this kind of action does not contribute to that," he said.
But Dr. Eugene S. Ogrod of Sacramento, the new CMA president, defended the action by the physicians group.
"It's a complex situation," Ogrod said. "We have to balance some rights. You have individuals with a disease who have to have a certain level of confidentiality. You also have individuals who are exposed to the disease who have some rights to get their lives in order and to take steps to manage their disease early and hopefully improve their quality of life."
Dr. Jonathan B. Weisbuch, a physician with the Los Angeles County Department of Health Services, said a mandatory reporting law would allow public health authorities to track HIV the way they do syphilis and other sexually transmitted diseases.
Weisbuch said the county would be able to protect a person's confidentiality if such a law were passed. He said he did not know of any case in which county public health authorities had revealed the identity of a person carrying a sexually transmitted disease.
CMA officials said 24 states require reporting the names of people with HIV infections to health authorities. Ten states require reporting of cases but do not require the individual's name. Two states require reporting of "symptomatic HIV infections." Fourteen states, including California, have no reporting requirements for HIV.
The wording of the proposed legislation will be worked out over the next several months, CMA officials said.
Just before approving the HIV resolution, the CMA delegates rejected a resolution calling for mandatory testing of pregnant women for HIV.