Putting Aids to The Test

By Amy Wilentz

For David Souleles, 21, a psychology student at the University of California at Irvine, the issue of whether to be tested for exposure to the AIDS virus is a simple one. Souleles, a homosexual, openly acknowledges the possibility that he may have been infected with the virus through previous sexual contact. But now he practices what has become known as "safe sex," and, he says, "the information that I'll receive from the test is not going to help me become more safe. If I find out I'm positive, there's nothing I can do about it anyway. It's kind of pointless."

Today the decision is up to Souleles. But as the AIDS toll continues to mount, a number of state and local politicians around the country are calling for widespread, mandatory AIDS antibody testing. These demands have spurred vigorous opposition from gay-rights activists, civil rights lawyers and public-health officials. They urge, instead, voluntary testing that includes what have been called the "three Cs": informed consent, confidentiality and counseling. This week both views will be represented in Atlanta as medical experts from across the nation gather for a conference sponsored by the Centers for Disease Control to debate the value of mass AIDS testing. Among the questions to be discussed: How far should the Government go in supporting and even requiring the test? How effective would mass testing really be in containing the spread of the virus?

Hundreds of thousands of Americans are already required by the Federal Government to submit to AIDS testing. By the end of this year, the military will have screened 3 million service members. Last month the State Department began testing its more than 8,000 Foreign Service personnel, and in March, the Labor Department plans to begin administering the test to some 60,000 young Job Corps applicants. A few states may be moving toward mandatory testing. Some examples: in Georgia, a committee of the legislature has approved a bill that proposes permitting the exchange of information regarding AIDS victims among health-care professionals. In Illinois, legislation is pending that would require state officials to withhold marriage licenses if a prospective spouse tests positive for the AIDS antibody.

Although a recent poll indicates the general public seems to favor compulsory testing, especially of those in high-risk groups, experts question its wisdom. "For both sound public-health reasons and civil rights reasons, we are very much opposed to any type of mandatory testing," says Dr. Stephen Joseph, New York City's health commissioner. Experience with other diseases, he says, shows that without an effective cure for AIDS, such a policy would be useless. "Until treatment was available, mandatory testing and ((sexual)) contact tracing did nothing to stem the spread of syphilis."

Then, too, gay-rights activists question whether the record keeping and identification that testing would entail could remain confidential. Concern about being publicly branded positive for AIDS antibodies is so great among high-risk groups that mandatory testing would probably force such people into hiding. Thus those most likely to carry the disease would be least likely to find out whether they had been infected.

Civil liberties lawyers are also concerned about the threat of discrimination based on compulsory-testing results. (For this reason, most voluntary AIDS tests offered today are done anonymously.) Once identified as a carrier of the AIDS virus, an individual runs the risk of losing friends, employment, housing and insurance. In New York City, 314 AIDS discrimination complaints were filed in 1986 alone. Says Nan Hunter, a staff attorney for the American Civil Liberties Union: "The antibody test is not like other medical blood tests. People don't lose their jobs because they have B-positive blood."

Another and more immediate reason mandatory testing will not work, according to many researchers, is that the results of the blood test most commonly administered can be misleading. A positive result on the ELISA (for enzyme- linked immunosorbent assay) screening test means that an individual has been exposed to the AIDS virus and has developed antibodies to it, not necessarily that a person has -- or will fall victim to -- the disease. Scientists assume, but have not proved, that those who test positive are still carrying the virus and can transmit it. Moreover, additional testing is needed to confirm a positive result. Negative results can also be deceiving. Since the virus apparently takes from six to twelve weeks to provoke antibody production, an individual may have been exposed and still not show antibodies.

The annual cost of all this testing, including the ELISA, confirmation tests and counseling, would probably be counted in the billions. But the personal and emotional costs of testing are immeasurable. "The test tends to rip people's lives apart," says Dooley Worth, who leads a support group of high- risk women, many of them former intravenous drug users, in Manhattan. "I've even seen couples who are both negative break up because of questions raised from just getting the test." For those who test positive, the psychological effect is devastating. And critics of mass testing question the ethics of informing people who are practicing safe sex, like Student Souleles, that they have been exposed. "You're handing people an explosion in their lives," says Judith Cohen, a University of California at San Francisco epidemiologist. Says Souleles: "The risks outweigh the benefits of finding out. I can deal with it fine on this level."

A more positive approach, and one that will do more to stop the spread of the AIDS virus, say critics of testing, is education. "Our problem is not finding out who's infected," says New York Commissioner Joseph, "but educating everyone about the risks. Everyone -- young, old, gay, straight -- has to consider AIDS as a personal message." Pat Christen of the San Francisco AIDS Foundation agrees. "It's not up to me to test everyone to see that you don't get infected. It's up to you to protect yourself."

With reporting by Scott Brown/Los Angeles and Christine Gorman/New York