WASHINGTON -- The Bush administration is considering a set of changes in AIDS policy that would require all cases of HIV infection to be reported, notification of the sexual contacts of all infected individuals and expansion of federal Medicaid coverage to include all treatments for the poor from the time of HIV diagnosis until death.
The proposal has been under discreet discussion inside the Department of Health and Human Services for several months, according to well-placed sources who asked not to be identified. It recently gained momentum, they said, when a department cost-analysis showed that if tracing sexual contacts prevented only one out of 50 cases of HIV transmission it would more than counterbalance the costs of ballooning the Medicaid system.
If the administration decides to seek these changes they would be tied to the White House's request for 1994 budget appropriations, the sources said.
Currently, the federal Centers for Disease Control require all cases ofacquired immune deficiency syndrome to be reported, and nearly 250,000 cases have been logged since 1980. But no agency keeps track of the millions of the tests for human immunodeficiency virus, which causes AIDS, performed nationwide every year.
AIDS activists and civil libertarians have strongly opposed any move to require reporting of HIV infections, and only two states -- Colorado and North Carolina -- require contact tracing of the prior and current sexual or needle-sharing partners of people with AIDS.
The medical community has become increasingly convinced that early treatment can prolong the lives of those infected with HIV. But such early intervention is not covered nationally by Medicaid.
Rep. Henry Waxman, D-Calif., has introduced a bill that would mandate Medicaid coverage of early HIV treatment for the poor, and a Congressional Budget Office study released last week estimates coverage of drugs, lab tests and doctor visits would increase the 1993 Medicaid budget by $425 million.
The Department of Health and Human Services also has been grappling unsuccessfully with ways to broaden the definition of AIDS for official and Medicaid purposes. AIDS activists have charged that the current definition excludes many HIV-infected people from Medicaid coverage. The new proposal -- to simply count all HIV infections -- would simplify matters.
But AIDS advocacy representatives are likely to oppose the effort on the grounds it would violate the privacy of HIV-positive individuals and could result in discrimination. "If there's an obligation to provide early intervention treatment to poor people -- and I think there is -- it should not be linked to contact tracing and mandatory tracing," said Jeff Levy of the Washington-based AIDS Action Council. "The two issues should be treated separately."
Levy said such a move would undermine the credibility of the AIDS reporting system, leaving public health leaders with no clear idea of the size and rate of growth of the epidemic, because fewer people would agree to be tested.