Subject: Debate Rages Over AIDS-Test Policy Date: Published: 6/18/87 203 lines Source: WALL STREET JOURNAL. Copyright Dow Jones & Co. Inc. Debate Rages Over AIDS-Test Policy --- Advocates See Need to Track Disease's Spread --- By Gerald F. Seib Staff Reporter of The Wall Street Journal WASHINGTON -- As Gary Bauer sees it from his office deep in the west wing of the White House, the case for broader AIDS testing is a powerful one. In the eyes of this soft-spoken presidential assistant, history, protection of the healthy, cost-effectiveness and the need for nationwide vigilance all argue for greatly expanded testing. "The burden is on those who don't want to use such time-honored procedures in this case," he says. The pro-testing argument has the Reagan administration as its chief proponent. President Reagan recently launched a policy that expands mandatory testing -- which already applied to military recruits and many foreign-service officers -- to include federal prisoners and immigrants as well. And some advisers want him to begin requiring tests for those entering Veterans Administration hospitals. More broadly, the policy aims to create an atmosphere in which AIDS testing becomes "routine" for Americans in certain situations, such as when seeking a marriage license or getting a medical checkup. The administration and its conservative allies aren't alone in supporting wider testing for the viruses that cause AIDS, or acquired immune deficiency syndrome. An eclectic group of liberals and medical professionals also backs the idea, although individuals might not agree with all details of the administration's policy. For starters, proponents argue that history is on their side. "When faced with other epidemics we've used testing," says Mr. Bauer, who cites earlier national decisions to test for tuberculosis and syphilis. Moreover, the testing for TB and syphilis began before there were cures for those diseases, as is the case with AIDS testing, notes Robert Redfield, a physician at Walter Reed Army Medical Center who helped launch an Army AIDS-testing program. More important, advocates assert, is that wider testing is the only reliable way to see how AIDS is spreading beyond the groups hit hardest so far: homosexual and bisexual males and intravenous drug users. Proponents point out that the AIDS-causing viruses can incubate in a body for nearly 10 years before developing into a full-blown case of the disease. "We have to change our focus in this country from AIDS to the virus," says Dr. Redfield. By concentrating on the disease rather than testing for its cause, he contends, the country is dealing with infections that began years ago instead of trying to prevent cases that could erupt in the decade to come. Thus, proponents argue, it is wise to test such seemingly low-risk groups as marriage-license applicants. Dr. Redfield says that in the only study of marriage-license applicants so far, undertaken last year in Oakland, Calif., eight of every 1,000 subjects were found to be carrying the AIDS virus. Similarly, Dr. Redfield asserts that the military's testing program -- the biggest case study to date -- suggests that the disease can hit married people almost as hard as it does single people. The armed forces, which have tested some 2.5 million military personnel and recruits, have found AIDS-causing viruses in roughly 1.5 of every thousand people tested. Dr. Redfield says that a surprising 40% of those who tested positive in the Army program were married. Though there isn't a cure for AIDS, proponents argue that those who test positive can be offered treatments to prolong their lives. For instance, they can take medication to prevent catching the kind of pneumonia that most commonly leads to the death of AIDS sufferers. And those who have not yet developed AIDS can take steps to guard against other diseases, such as herpes and hepatitis, that are believed to accelerate its onset. "I'd want to know" if infected with the virus, says Robert C. Gallo, chief of the laboratory of tumor-cell biology at the National Cancer Institute. "I'd want a chance of not passing it to my wife. I'd want to be near a good doctor, and I'd want AZT," or azidothymidine, an experimental antiviral drug that prolongs the survival of many AIDS patients but can produce severe side effects. Testing advocates contend that identifying carriers now is also important so that when an anti-AIDS drug is developed, it can be distributed to as many infected people as possible. (A test of AZT is now under way involving people who are infected with an AIDS virus but haven't yet developed symptoms.) Perhaps most important to many testing advocates is that most people who test positive for an AIDS-causing virus are likely to take precautions against spreading the disease to others. Even the spouse or lover of a carrier can be saved from infection if a test discloses the presence of the virus soon enough. Dr. Redfield, for instance, says that among the married AIDS patients he has treated in the military program, only about half had already infected their spouses. At a minimum, testing advocates assert, the spouses or lovers of virus carriers have the right to know that their partners are infected. And Mr. Bauer contends that medical professionals who treat virus carriers have the right to know as well, which is why he favors testing in VA hospitals. Mr. Bauer argues, too, that it would be "extremely helpful" if people infected with the AIDS-producing virus carried identification cards -- like those carried by people with other medical conditions -- so that doctors and nurses would know when treating them in emergencies. If nothing else, proponents say, testing should become common enough to stop the spread of AIDS to its most innocent victims: unborn infants who get the disease from their mothers' blood. Expanding AIDS testing along the proposed lines would be relatively cheap now and clearly cost-effective in the long run if it does nothing more than slow the spread of the disease, advocates say. According to government officials, the initial screening test costs just a few dollars. A subsequent test used to confirm the presence of the virus is more expensive, but that test isn't required in most cases and is dropping in price as testing expertise grows. The military, for example, has found that the cost of the follow-up test has dropped from as high as $300 to about $75, a Pentagon spokesman says. Overall, Dr. Redfield adds, the cost of the military program is less than $5 per person tested. This estimate is lower than that cited by some testing critics because it is for a large-scale program and doesn't include the follow-up counseling or overhead costs that might be incurred in other programs. In any event, Mr. Bauer asserts, it is far cheaper to use tests to check the spread of AIDS in such places as federal prisons and hospitals than to pay the estimated $75,000 to $100,000 it costs annually to treat each victim of the disease. Testing proponents argue that AIDS-test results can be kept confidential in the same way the medical community has always kept other medical information secret. In some cases -- when it comes to informing spouses or the nurses and doctors who must treat infected patients, for example -- the results of a test shouldn't remain confidential, they contend. Nor will there be a stigma attached to those who undergo AIDS tests if the government succeeds in making testing a truly routine practice, administration aides insist. "If everyone's being tested," says Dinesh D'Souza, a White House policy analyst, "you don't have a funny feeling about standing in line." (See related story: "Opponents Cite Privacy, Costs, Testing Errors" -- WSJ June 18, 1987) --- 'Do you think people should be tested for the AIDS virus before they can get a marriage license? ' Yes ..................... 82% No ...................... 14% Not sure ................. 4% 'Do you think employers should test new employees to see if they have the AIDS virus? ' Yes ..................... 42% No ...................... 48% Not sure ................ 10% Source: Wall Street Journal/NBC News poll of 2,304 adults nationwide, conducted April 12-14, 1987 Who Has AIDS? Percentages of reported cases Homosexual and bisexual men .................... 65.9% Intravenous drug users ......................... 16.6% Homosexual intravenous drug users ............... 7.6% Heterosexuals* .................................. 4.0% Transfusion recipients, hemophiliacs ............ 2.9% Undetermined cause .............................. 3.0% Disease contracted by sexual contact with infected partner Source: Centers for Disease Control How Testing Works AIDS testing is designed to spot the antibodies developing in persons infected with the human immunodeficiency viruses that cause acquired immune deficiency syndrome. The antibodies show that a person has been infected even though he or she doesn't display symptoms of the disease itself. As many as four tests may be required on each individual to obtain results with a high degree of certainty. An initial screening is performed with a test known as Elisa (for enzyme-linked immunosorbent assay), which is suited for relatively cheap, large-scale use. A negative response on the first try usually means no further testing. But because the test tends to err on the side of false positives, a positive result is normally followed by a second or even third Elisa. If the result is again positive on one of the follow-up tests, a final test -- the Western blot -- is given, using a very different immunology. Only if that, too, shows positive is a person regarded as infected. Medical researchers say that the latest studies indicate that nearly 80% of those infected with the viruses will develop symptoms of the disease itself within seven years. Infection lasts for life, and anyone infected is capable of transmitting the disease to others. [This article is made available here by Dow Jones Co. for the personal and non-commercial use of callers to this bbs, in the hope that it will be of some help to those who are suffering from the disease and others who are seeking to help them.]