AIDS: facts and fears

August 07, 1991

The chances of contracting AIDS from an infected physician or dentist are 1 in 41,000. Add to that the chance of even being treated by an infected doctor, and the odds of getting AIDS from any given medical encounter are pretty slim. Nonetheless, the public is understandably panicked when it confronts even the remotest possibility of contracting AIDS. The disease is lingering and lethal, and despite a decade of information about AIDS, victims are still stigmatized by prejudice toward homosexuals.

A recent news account of a Florida woman who got AIDS from her dentist, and one revealing that a Hopkins surgeon was HIV positive, prompted a fresh round of concern. And the federal Centers for Disease Control responded with a new set of rules for voluntary testing of health-care workers engaged in high-risk procedures. But Governor Schaefer wants more stringent testing in Maryland -- not just for health professionals but also for the patients they treat. And he is considering supporting legislation in the 1992 General Assembly session that would make AIDS testing mandatory for both groups.

Schaefer surely is on solid ground in arguing that every needless infection that can be prevented should be. But such broad statements of principle tend to oversimplify the issue, and the problems. For one thing, testing health-care workers for AIDS may be little more than a salve for public fear. A doctor who tests negative on Monday, for example, may become infected on Wednesday and perform surgery the following Saturday. Unless testing occurs before each high-risk procedure, the pragmatic benefits of mandatory testing of health-care workers are probably minimal. There is also the issue of privacy. For patients, who are already tested for other communicable diseases and whose medical records are protected, this is less of a potential problem than it is for health-care providers whose HIV results would, by definition, fall into the public domain. Still, if a patient tests positive, does the state have a responsibility to notify his or her spouse? To trace and notify past lovers?

Clearly the state has an obligation to craft laws that protect the health and welfare of all its residents. But AIDS presents a unique policy-making conundrum in that it poses ethical as well medical problems, whose solutions require a delicate balance of testing, guarantees of confidentiality and protection against discrimination. Hammering out a humane set of policies with regard to AIDS is no easy task to be sure. Still, Governor Schaefer has every reason to expect the General Assembly to tackle it.

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