BOSTON -- Amid signs that opposition is softening, a senior editor of a prestigious medical journal is calling for routine AIDS testing for all hospital patients, health care workers, pregnant women and newborns.
The recommendation comes in an editorial in today's issue of the influential New England Journal of Medicine by its executive editor, Dr. Marcia Angell. Her position reflects a shift in public attitudes in favor of tougher measures to fight the decade-old epidemic, another authority reports in the same issue.
Dr. Angell said that until now, concerns about discrimination and confidentiality have made public health authorities reluctant to use traditional disease-control tactics, such as tracing sexual contacts or routine testing of newborns and pregnant women for infection with the human immunodeficiency virus, or HIV, which causes AIDS.
This reluctance, she said in the editorial and in an interview, stems from confusing the social and epidemiological issues. Tracing sexual contacts, she said, is an effective way to control the spread of infection and is required for other sexually transmitted diseases, but it has been opposed in the AIDS epidemic on the grounds that it could breach confidentiality and lead to discrimination against people with the virus.
In the editorial, Dr. Angell also called for a national program to bear the costs of treating AIDS, combined with strict guarantees against discrimination, to ease the social burdens on HIV-positive patients while permitting more effective ways to fight the epidemic.
"I think the days are over" when secrecy and confidentiality should be the only ways to protect people who test positive for the virus, Dr. Angell said in an interview.
Larry Kessler, who heads the Boston-based AIDS Action Committee and who is a member of a national AIDS commission, agreed that there had been a change in attitudes, but he said he opposed widespread testing.
"There's clearly a drift going on, and one that many of us are concerned about," he said. Mr. Kessler said discrimination hadn't gone away, making it impossible for his group and other organizations to endorse widespread testing.
"We have strongly opposed testing doctors and dentists, and we will continue to do so," he said. "It could lead to health workers' not wanting to get involved on the front lines" of treating patients infected with the virus.
In the interview, Dr. Angell said that recent cases of patients' acquiring HIV infection from dentists "is rightly worrying" to the public and that routine testing of health workers would help protect the public.
Ronald Bayer, a public health expert at Columbia University in New York, wrote in a companion article that recommendations such as Dr. Angell's were becoming more common. He said they reflected a shift away from the view that AIDS is an exceptional epidemic requiring unique public health approaches.
Lately, he said, gay and civil rights groups have begun to soften their opposition to traditional public health measures, such as reporting the names of infected people to confidential registries.