- 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
- 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
- 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
- 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 firstname.lastname@example.org