The newly structured Governor's Council on HIV Prevention and Treatment appears to have moved away from supporting mandatory or voluntary AIDS testing in favor of mandatory education for all health care workers, students and the public.
The council took no formal vote last night after nearly a three-hour debate on the complex and evolving testing issues, mandatory education, universal precautions and empowering patients to ask surgeons who may be operating on them to disclose their HIV status.
Instead, the council appointed a four-member committee to draw up a statement that council members will review in November before presenting it to Gov. William Donald Schaefer.
The document will be drafted by Dr. Fred A. Gill, a Montgomery County infectious disease specialist; Curt L. Decker, an attorney and activist in the gay community; Dr. Roger L. Eldridge, director of special education programs at the University of Maryland Dental School and state Sen. Paula C. Hollinger, D-Balto. Co., who heads a Senate subcommittee reviewing proposed AIDS legislation.
Schaefer has made it clear he is for mandatory testing of many health care workers and hospital patients and is counting on the introduction of that kind of bill in the legislature in January. He also has charged the council to come up with a program that leads to "education, treatment and hope."
But last night, there was little interest in mandatory testing, despite repeated calls by Howard E. Marshall, a retired businessman, for "some kind of a limited testing plan that would have some teeth in it."
And, there were new reservations about embarking on costly testing at a time when the state has severe financial problems and a new study suggests that federal guidelines and proposed medical practice limitations will drive those infected with the virus that causes AIDS to hide their condition.
The survey, conducted by a San Francisco advocacy group for HIV-infected doctors, found that health care workers infected with HIV were reluctant to tell their employers and patients about their condition, or to restrict their practice to non-invasive procedures, because they feared for their jobs.
The new guidelines have made health care workers who believe they may be infected with the virus more reluctant to be tested to find out for sure. The finding raises the possibility that the guidelines, designed to protect patients, may in some respects leave them more vulnerable.
Mandatory or voluntary testing had been proposed for surgeons and dentists who do invasive procedures -- those that are bloody and in which the risk of exposure is high.
When Robert C. Adams Sr., a funeral director from Cumberland, quietly said, "No mandatory testing . . . we need mandatory education" about AIDS, he seemed to set the stage for a bold, new direction for the council, which is struggling to zoom in on ZZTC runaway epidemic. Studies show that increasingly the epidemic is infecting non-drug using heterosexual adolescents.
Some 30 people in the audience loudly applauded the suggestion made by Adams, a new council member. He first called for mandatory education for all health care workers, then later asked that it cover all students.
Another new member, Charles E. Wilkerson, an Anne Arundel County high school educator, said, "Let's make sure we reach the teen-agers." Last month, he told the council he was "astounded at the ignorance of teen-agers about this disease and what our school system has not done."
Gill pointed out that "teen-agers and college students are so important they should be a major entity of this committee."
But AIDS education cannot be limited to health care workers and students, said Miriam Hawtof , a nurse and an infection control practitioner, who substituted for Hollinger. Substitutes are allowed to enter discussions, but have no vote.
"We need to educate legislators, hospital administrators and hospital physicians, who did not want to admit those patients with HIV because that would stigmatize their hospitals," she said.
"We are not reaching the right people. We need to go from top to bottom on this. We need to reach the public, and that's a vast group of people."
Eldridge told the group that he believes Schaefer "will entertain an organized education plan" and that the council might want to consider not only mandatory education for health care workers but "offering the public throughout the state community meetings for education purposes."