Cover Stories: Tracing a Killer

By Anastasia Toufexis

"Good afternoon. This is a disease specialist at the department of public health. Can you talk privately? The reason I'm calling is because one of your previous sexual partners has a sexually transmitted disease. Would you mind & coming in to undergo a few tests to see if you've been exposed?"

"What type of tests? What kind of sexually transmitted disease?"

"One of your previous sexual partners has AIDS."

It is a chilling phone call, still rarely made but likely to become more common as the disease spreads and more and more public-health authorities begin tracing the sexual intimates of AIDS victims. Calls of this kind, known in public-health jargon as contact notification, have long been accepted as part of the effort to curb the spread of sexually communicable diseases like syphilis and gonorrhea. But when used to battle AIDS, the practice has aroused a storm of criticism and has raised some thorny ethical issues.

Untangling the skein of someone's sexual contacts can be a time-consuming and onerous process. San Francisco's public-health department, for example, has been tracing the partners of heterosexual AIDS victims since April 1985. (Tracing would serve little purpose among San Francisco's estimated 90,000 bisexuals and homosexuals; 50% to 70% are thought to be infected with the virus.) Of 114 heterosexuals with AIDS, the department was able to interview 50, who identified 93 other people with whom they had been intimate. Of the 93, only 42 were located in the Bay Area, and of these, 27 agreed to be interviewed, counseled and tested. Seven proved positive for the AIDS virus.

Though such numbers may seem small, proponents claim that contact tracing will help contain the spread of the disease, primarily among heterosexuals and in communities where it is not already prevalent. Those with AIDS, they say, have a moral duty to warn those they have put at risk. Critics of mandatory tracing charge that it may feed panic and hysteria. They stress that, unlike syphilis or gonorrhea, AIDS is so far incurable. Indeed, says Dr. Kevin Cahill, a member of New York City's board of health, some people who were told that they had been exposed to the virus have attempted suicide -- even though they showed no symptoms of the disease.

Opponents of tracing also fear that breaches in the confidentiality of contact lists could lead to greater discrimination in housing, jobs and insurance. Some places -- San Francisco and Minnesota, for example -- protect privacy by destroying the lists, but Colorado's health department is preserving its files on all contacted partners. "You can't do this stuff anonymously," explains Beth Dillon, manager of Colorado's AIDS-education , program. "If I could have contacted, traced and counseled the 150 gay men in Denver in 1981 who tested positive, we wouldn't have 20,000 infected in 1986." Yet critics counter that such actions may send AIDS victims underground, thus undercutting the effectiveness of programs that still rely on voluntary cooperation. Says Nan Hunter, an American Civil Liberties Union attorney: "You can't torture people for names."

Instead, Hunter and other foes of tracing insist that mass educational programs are the answer. But even with the extensive publicity about AIDS and safe sex, many heterosexuals who risk exposure are apparently indifferent to the danger and feel no need to change their ways. Contact notification accompanied by counseling, say its proponents, might bring home the message to such people and spur them to take the AIDS test. Then those who test positive might feel a responsibility to their sexual partners and adopt safer practices. Those with negative results, having been given a scare, might be encouraged to moderate their activities. Either way, the spread of AIDS would be slowed. Says Michael Osterholm, a Minneapolis epidemiologist: "Only those people who have been given a personal sense of vulnerability seem to be willing to make changes in their sexual habits."

With reporting by Scott Brown/San Francisco and Elizabeth Taylor/Chicago