Gov. William Donald Schaefer's advisory panel on AIDS has endorsed his proposal to record the names of people who test positive for the disease-causing virus -- and in many cases, to trace partners they may have infected.
In voting 9-3 yesterday to support the bill, the advisers provided a rare meeting-of-minds with the governor who appointed them. The two sides have clashed far more often than agreed on major issues concerning the epidemic.
"This is not something I would have supported a few years ago," said Dr. Richard T. Johnson, a Johns Hopkins neurologist who chairs the panel. "But I think the epidemic has changed and I think the strategy has to change."
While he abstained from voting because he wanted answers to some technical questions, Dr. Johnson said that "contact tracing" could help prevent further transmission among intravenous drug users and teen-agers -- two groups, he said, that have shown widespread ignorance about the disease and how it is passed.
Dr. Johnson cited studies showing that 5 percent of teen-agers reporting to Baltimore's venereal disease clinics are infected with the human immunodeficiency virus, which causes AIDS. Half of the females, he said, never considered themselves at risk and had no idea who infected them.
Through contact tracing, he said, health officers could encourage sexual and drug-using partners to get tested themselves. Those testing positive could get treated much earlier than if they waited for the disease to take its course. Early treatment with the drug AZT has been shown to prolong the lives of some people who have contracted the virus.
The proposal is due to be submitted to the state Senate Feb. 6.
Under the bill, Maryland would maintain five clinics where patients could get tested anonymously. Their blood specimens would be identified by code number, and no one would know the names of people testing positive or negative.
Patients testing positive anywhere else -- in public clinics, hospitals or doctors' offices -- would have their names reported to health authorities. Contact tracing would then occur in two instances, according to Dr. Kathleen Edwards, director of the Maryland AIDS Administration:
* When the patient agrees to supply the names of his or her drug or sex partners.
* When the patient refuses, but the doctor believes that partners ought to be warned. In that case, a health investigator would approach the patient -- but it would still be the patient's choice to supply names.
"If the person chooses not to supply the names, there is no penalty," she said.
For every patient diagnosed with AIDS, it is estimated there are six to nine people infected with the virus. Dr. Edwards said mandatory reporting of HIV infection would give the health department a better "handle" on how many state residents carry the virus -- data that could help Maryland qualify for more federal aid.
The AIDS Administration estimates that 25,000 to 35,000 Marylanders carry the virus. Since the epidemic began a decade ago, more than 4,100 Marylanders have been diagnosed with the full-blown illness.
Many AIDS patients and advocates have voiced concerns that people would avoid getting tested out of fear of the discrimination that could occur if their names were widely known.
While the panel has no direct power, its views are considered important to the fortunes of bills confronting the General Assembly. Indeed, while the panel provided a good send-off to the "contact tracing" bill, it may have dealt a fatal blow to another gubernatorial proposal -- periodic testing of patients and health-care workers involved in "invasive" surgical and dental procedures.
The panel's 9-1 rejection came as no surprise. As long ago as August, most members branded it as wasteful because, in their view, the chances of a doctor infecting a patient during a medical procedure were remote. Doctors and dentists, on the other hand, could protect themselves by wearing gloves, gowns and masks whenever entering a bloody procedure.