Should AIDS Infection
Status Remain Secret?
By Dr. Cary Savitch, MD <>
Public health authorities have never waged a legitimate public health battle against the spread of HIV. Instead, they have engaged in political wars over rights, privacy and sexual freedom. The AIDS virus has been a mere spectator.
Over a million Americans have already become HIV-infected by this killer virus. More than 300,000 gay men in our nation have so far died of AIDS. What is left are the dying, the sick, the about-to-become-sick, and the about-to-become-infected.
Before Randy Shilts died of AIDS, he left the world a gift. Unwrap his book, "And The Band Played On," and learn from his message: "AIDS didn't just happen to America. Instead, it was allowed to happen by an array of public institutions."
The Centers for Disease Control and U.S. Surgeon General David Satcher, recommend reporting HIV by name to public health officials in order to optimize partner notification. A Brown University study points out that over 40 percent of HIV-infected individuals do not alert their sexual partners.
A bill passed by the Legislature and sent to the governor, AB 103 by Assemblywoman Carol Migden, D-San Francisco, prohibits physicians from confidentially reporting HIV by name to public health authorities.
Health care providers in California would be required to report HIV cases by a cryptic code, hiding the virus and preventing authorities from knowing who is HIV-infected. Any physician who elects to report HIV by name to public health authorities, as is required for 52 other communicable disease, could be subject to a $10,000 fine, six months in jail, and civil litigation. The choice is to endanger the public or go to jail.
Oakland and Los Angeles counties have already declared AIDS a medical emergency. But Migden and other San Francisco officials are still debating whether to classify HIV as a communicable disease. In the Bay Area, partner notification is in shambles, and the body count continues to climb. Contact tracing is desperately needed to halt the spread of the deadly AIDS virus and assist those already infected into earlier treatment and counseling.
AIDS is now the leading cause of death among black males between ages of 18 and 45. Black women are not far behind.
AIDS has killed more gay men in the past two decades than the next four leading causes of death combined. By one estimate, the life expectancy of a gay man in America is now 42 years. This is unacceptable.
The role of public health services is to save lives, not to be bean counters. America is already 400,000 people deep (dead) into this epidemic. The additional 600,000 to 900,000 Americans who are already HIV-infected will eventually meet the same fate.
Around the globe, 16,000 people become newly infected each day -- one woman becomes infected every 12 seconds. If U.N. AIDS statistics are accurate, 50 million people will have become infected by the year 2000. The HIV cure rate locks in at zero, and the miracle AIDS vaccine has yet to arrive. At what number do our public health officials become humbled?
Doctors are never handed lists by their HIV-infected patients of contacts who need to be notified, nor are they trained in the delicate task of partner notification. Contact tracing requires the skills of well-trained public health officials.
Public health services have an outstanding record of confidentiality. The time-honored rule of public health is to not disclose persons' names. When contact tracing is done, the source case is never mentioned, whether relating to HIV or any other disease. When the name of someone who is HIV-infected is publicly disclosed, it is invariably by the patient, their friends, or family, and not by public health officials.
Late-stage HIV infection (AIDS) is already reported by name in all 50 states, and with no objection. Once health authorities are given a name, partner notification must start promptly.
But, if officials have to wait for the diagnosis of AIDS, which may take 10 years from onset of disease, a decade of prevention is dangerously lost. This is why the CDC now urges all states to report HIV by name and initiate early partner notification Further, a CDC study conducted in six states demonstrated there was no drop off in HIV-testing once name reporting was adopted.
As soon as an opportunistic infection strikes or an AIDS-related tumor appears -- health authorities will rush to classify HIV disease as AIDS. This is usually eight to 10 years into the disease. Another way HIV magically becomes AIDS is if the CD4 count (a measurement of the protein structure on the surface of a human cell that allows HIV to infect a cell) of an infected person drops below 200, regardless of symptoms. With no other illness on this planet are such arbitrary definitions used to define and report disease.
When HIV-infected persons go to the pharmacy to pick up AZT or other anti-retrovirals, the pharmacist is aware that these people are HIV-infected. The pharmacists also knows what they look like, and records his or her name, address and telephone number. In all of my years in medical practice, no patient has complained to me about this.
When my HIV-infected patients go to the laboratory for their HIV viral load tests and CD4 counts, the lab technicians certainly know the patient's diagnosis. Again, no complaints.
When insurance claims are filed total strangers are clued in. All the while California public health workers are kept out of the loop.
When people die of AIDS, there is one last stop -- the AIDS Quilt. Founded by the "Names Project" of San Francisco, the pictures and names of those infected are proudly and lovingly displayed to the entire world. The eternal message is that "we, who have died from AIDS, are people with real faces and real names."
Savitch , an assistant clinical professor of medicine specializing in infectious diseases and tropical medicine at UCLA, is president of Beyond AIDS. He can be reached via e-mail at