Who and How To Test for AIDS?

June 01, 1991

The deaths of two dentists who worked on Maryland penitentiary system inmates brought to the front burner two questions that have simmered in the background of public debate on AIDS: What to do about a prison population believed to have as many as 10 percent of its members infected with the human immunodeficiency virus; and what to do about health-care workers suffering from AIDS.

No one knows exactly how many inmates are infected. Corrections officials have resisted testing all inmates, fearing the costs to be incurred in treating large numbers of infected inmates. And some inmate groups believe testing will result in stigmatizing those infected.

Such obstacles are crumbling, however. Disclosure that dentists Victor Luckritz and H. Dale Scott together treated nearly 1,900 inmates before succumbing to AIDS has forced officials to begin counseling and testing their former patients. State officials contend that Correctional Medical Systems, the company which employed the dentists, should pay the costs.

The AIDS death of Johns Hopkins surgeon Rudolph Alvaraz and the revelation that deceased Florida dentist David Acer passed the disease to three of his patients had already brought the second issue to a boil. Thus, the prison dentists' cases added impetus to calls for routine testing of medical personnel. The Atlanta-based Centers for Disease Control report that, of 170,000 AIDS cases nationwide up to March 31, only 6,436 of those sufferers were medical personnel.

That's 4.8 percent of the cases, and of these only 40 health-care workers got infected on the job. In the same 10-year period, just three patients, Dr. Acer's, have ever been found infected through medical care. The scant risk represented by that infinitesimal percentage of AIDS cases is poor comfort to those three patients and their families, however. Any proven risk intensifies public anxiety.

The bottom line is that, as the New England Journal of Medicine recently advocated, stronger, more traditional public-health measures will have to be taken, as much to quell public uncertainty as to stop the spread of HIV.

It is not yet time for routine testing of all health-care workers and hospital patients, but clearly it is time to invoke remedies which have controlled many other kinds of epidemic. Speculating on prison inmates' HIV infection rate is pointless unless authorities have plans to do something, and real plans cannot be developed without real knowledge. The dentists' deaths underscore the urgency of new guidelines to determine when medical workers must inform patients and institutions of HIV infection. Continued secrecy helps no one in the end.

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