A gubernatorial proposal that would allow investigators to trace the partners of people carrying the AIDS virus is drawing sharp rebukes from both patients and their advocates.
They say the proposal would simply scare people from getting tested in the first place.
They also call the proposal, a part of Gov. William Donald Schaefer's legislative package, a waste of staff and money at a time when people suffering the ravages of AIDS are having trouble getting appointments at clinics, finding decent housing or gaining social acceptance.
Typical was the response of Bill Urban, an AIDS patient who publishes the Baltimore Alternative, a gay newspaper. He said activists already are fighting hard to overcome the suspicions of people who delay getting tested because they fear a positive test will lead to discrimination.
"The disease is shifting into a community that has spent a whole life trying to avoid government agencies -- the intravenous drug users," Mr. Urban said last week. "When someone says, 'Hi, I'm from the state, and I'm going to try to help you,' they're going to run the opposite way."
Paul Kelly, a recovering addict who tested positive for the AIDS-causing human immunodeficiency virus eight years ago, said it's foolish to think investigators would receive cooperation from the myriad drug users who may have shared needles with an addict who tested positive for the virus.
"What are you going to do, get someone from the health department to walk into a shooting gallery and say to everyone, 'Guess what?You all need to get tested,' " said Mr. Kelly, who counsels people about drug abuse and HIV infection.
"If he gets away with his head, he's good."
Described as a way to curb the epidemic by warning people who may unknowingly be placing themselves as risk, Governor Schaefer's bill would put HIV infection on the same footing as syphilis, gonorrhea and several other communicable diseases.
Laboratories would report the names of all infected people to local health departments, which would dispatch investigators to ask each patient about his or her sex or drug contacts. The investigators could then contact all partners, warning them about their risk while encouraging them to get tested.
Partners would not learn who referred the investigator to them, said Robert Eastridge, deputy health secretary. They would simply be told that someone who carries the virus
may have placed them at risk.
Under existing law, contact-tracing occurs only after someone is diagnosed with full-blown AIDS or earlier symptoms of infection. But Governor Schaefer's proposal would expand tracing to a far greater number of people -- those who test positive for HIV but show no symptoms.
"We want to treat [HIV] like any other communicable disease and do the contact-tracing much earlier to cut down the geometric progression through the community," Mr. Eastridge said.
He acknowledged that authorities can only ask people to divulge the names of their partners, but he predicted that investigators will most often succeed in gaining their cooperation.
"It's more of an art and a skill -- how you approach someone and gain their confidence. This is an old science. Contact-tracing is not new."
Mr. Eastridge said contact-tracing for HIV will cost $80,000 in salaries for "a few investigators" and that the entire cost would be borne by the national Centers for Disease Control.
Liza Solomon, a health-policy expert at the Johns Hopkins School of Hygiene and Public Health, said she "couldn't believe" the department could possibly trace thousands of sexual and drug contacts a year on that budget -- much less overcome their suspicions.
"For any individual who says he has three sex partners and 20 shooting partners, someone has to go out in the field to trace them down," saidMs. Solomon, who also works with the AIDS Legislative Committee, a lobbying group. "You may only have a first name; you may only have a nickname."
Like many advocates, Ms. Solomon said she worried most that the measure would accomplish the opposite of its intended goal -- that for every partner warned, there would be many people who would delay getting tested.
Said Garey Lambert, of AIDS Action Baltimore: "There's fear of discrimination. The possible loss of your home, your job and everything. There's an enormous amount of fear in the minds of people who are minorities, who may have suffered, whether they are gays or African Americans."