AIDS Infection Must Be Reportable : Traditional Policies on Communicable Diseases Are in Order

Epidemiologic evidence suggests that time is the only “co-factor” for death from AIDS. Most reports of new AIDS cases are accompanied by reports of deaths of people previously diagnosed, and most reports of AIDS-related complex (ARC) are accompanied by reports of new cases of AIDS. There is very little to keep us from believing that every AIDS infection will ultimately result in death.

Of course, the “very little” keeping us from certifying this conclusion is the lack of information about those at the beginning of the cycle: asymptomatic, infected carriers. Given that the trend of this chain points to death, it seems a rational thought for the public at large, in a desire to collect data on this missing epidemiologic link, to recommend that infection with the virus be made reportable.

Historically, communicable diseases have been reported for three reasons: to determine the magnitude of the problem, to administer a cure or a vaccine, and to halt its spread. The issue of AIDS currently involves two out of the three.

You would think that traditional public health precedents, like judicial precedents in a court of law, would provide a governor for future epidemics. For example, in California 58 communicable diseases (including those sexually transmitted) are listed by the Public Health Department as being reportable. AIDS has been added to this list, but not the equally infectious state of carrying the virus for AIDS. Also, AIDS carriers are not included in the statute that makes it a crime for anyone to knowingly expose another to a venereal disease.

This duplicity is unrivaled, though the vigor with which it is defended is matched only by the unfounded fears of breaches in confidence from hypothetical unauthorized revelations of patient records. Once and for all the gauntlet must be dropped and the critics of reportability challenged to provide evidence that substantiates their claim to override the traditional practices of public health guardianship.

Reportability does not mean that everyone and his brother need to know who is a carrier. That is the business only of the individual, his or her physician and the state Public Health Service. What reportability does is secure the carrier’s accountability. In turn, the carrier secures his or her right to privacy by honoring the trust that he or she will not spread the disease.

If a carrier abrogates that trust to society by knowingly transmitting the virus, then the right to privacy is ethically limited. At this point the state Public Health Service is authorized to pursue routine procedures to control this type of individually irresponsible behavior.

It is argued that only education can work as an effective control measure. We have public health reports from San Francisco of changes in sexual behavior. Homosexual men in that city seemingly are curbing their sexual appetites. However, a strong case can be argued that the male homosexual community in San Francisco is already saturated with the virus. If this is true, reported cases would involuntarily be on the decline.

I don’t believe that the rest of the nation can afford this same procrastination and temerity. We need to divest ourselves of the delusion that education alone will raise the social consciences of known high-risk groups: homosexually active men and intravenous drug users. While a reasoned AIDS education could be effective among our mainstream population, in today’s culture current educational efforts have little chance against the primal yearnings of our two highest-risk vectors’ appetites.

In concert with regular public-school sex education programs, AIDS education carries with it some parallel moral concerns. Drug-abuse and alcoholism clinics don’t counsel their clients that, because drugs and alcohol are socially pervasive, they can drink or take drugs in ways that are “safe.” Neither should a school program on AIDS advise students on how to have “safe sex” because sexual activity is pervasive.

To arrest the spread of AIDS, this nation must resurrect the traditional public health policies and procedures that it has used effectively in the past to control communicable venereal diseases. Our system’s safeguards for confidentiality already exist to a great extent, and whatever is lacking can be added by new laws. However, it makes no sense to accommodate new laws or fiscal allocations in an effort to create an “AIDS industry” without first laying the cornerstone of traditional public health policy--the reportability of communicable disease.