PUBLIC health officials grappling with how to stem the spread of AIDS should adopt a method used to combat syphilis for almost 60 years: contact tracing and partner notification.
Even Baltimore, which leads the nation in the number of syphilis cases per capita, has successfully used contact tracing for that disease. Last year, the city recorded 458 syphilis cases, down from 667 in 1997.
Contact tracing can work for AIDS, too. During the early years of fighting AIDS, it was understandable not to use such techniques. Breaches in confidentiality could make life more difficult for those infected -- especially in the gay community. Also, the benefits of being told about exposure to infection were minimal.
Now, with much improved medical weapons combating AIDS, and enhanced survival rates, it is inexcusable to do nothing.
U.S. AIDS deaths dropped 44 percent from the first half of 1996 (21,460) to the same period of 1997 (12,040).
Fear remains about public exposure from contact tracing -- the public health department practice of contacting the sexual partners of people with venereal diseases. The stigma attached to being gay still exists and fear of losing a job if one's sexual orientation is revealed is prevalent.
Consequently, this vital public health approach has been ignored for AIDS.
But contact notification is needed more than ever. Too many people don't practice safe sex. A recent Centers for Disease Control and Prevention survey reported a 9-percent increase in unprotected sex among gay men in San Francisco from 1994 to 1997.
Also, AIDS patients frequently don't tell their lovers of their plight. A study of 203 HIV-infected patients at two hospitals in Massachusetts and Rhode Island, indicated that 40 percent did not inform their partners about their AIDS infections; nearly two-thirds of those surveyed admitted that they did not always wear a condom while having sex.
Some 30 years ago, I was a public health investigator in St. Louis responsible for interviewing people with sexually transmitted diseases and contacting their sexual partners. I painstakingly located all such partners and informed them of their exposure to a serious communicable disease.
When I combed the streets of the St. Louis area -- from swanky suburbs to gritty inner-city housing projects -- searching for such people, I was often frustrated.
Neither patients nor their partners readily volunteered how they had contracted a venereal disease. After all, there's always been a stigma attached to having syphilis, just as there is for AIDS.
However, once I convinced them that their cooperation was crucial, many people would accompany me to where they thought a former sexual partner lived or places they frequented. The anonymity of the gay lifestyle, coupled with multiple contacts, made tracing members of that community especially difficult.
Increasingly, AIDS has become a disease that disproportionately affects minorities and the poor. African-Americans make up about 14 percent of the U.S. population but 45 percent of new AIDS cases. AIDS has been the leading killer of blacks between 25 to 44 for most of the 1990s.
There are an estimated 250,000 Americans who are unaware that they are infected with the AIDS virus. Since 1981, when AIDS was first reported in this country, 612,078 AIDS cases have been recorded by the CDC; some 379,258 people have died from the disease.
While no cure for AIDS exists, medical advances permit its victims to experience much prolonged and worthwhile lives. Not to inform potential sufferers, so that they can obtain care, is unthinkable.
Thomas Goldwasser is an adjunct public policy professor at the University of Maryland Baltimore County.
Pub Date: 3/02/99