July 27, 1997 Vol.4, No.30

Front page & page 15


AIDS strategy stirs storm, would ostracize 'spreaders'

A physician who is influential in AIDS-prevention policy has become the focus of a growing movement in the medical community to crack down on men and women who spread the HIV virus sexually.

Dr. Hodes' tough comments have attracted much attention because of his credentials and his position as chief of the infectious-diseases division of the pediatrics department at the Mount Sinai School of Medicine. He also serves on a panel that advises the state of New York on AIDS policy.

But some advocates for AIDS patients are gunning for him.

Leaders of ACT UP, a homosexual advocacy group, recently demonstrated against him in New York, urging Gov. George E. Pataki, who appointed Dr. Hodes to the AIDS advisory panel, to replace him with someone who is HIV-positive and not so "insensitive to the nature of the AIDS epidemic."

Dr. Hodes, who argues that HIV-positive patients should engage in sexual intercourse only with persons who are themselves HIV-positive, has not retreated. He even recommends mandatory HIV testing, anathema among homosexual-advocacy groups, "as a last resort."

Dr. Hodes and other critics of current HIV policy, such as Dr. Sanford Kuvin, vice chairman of the National Foundation for Infectious Diseases, argue that current policy protects civil rights at the expense of public health.

The American Medical Association has taken no position on Dr. Hodes' approach to dealing with the epidemic, but the AMA strongly endorses legislation sponsored by Rep. Tom Coburn, Oklahoma Republican, who is a physician, that would "refocus public-health efforts on HIV prevention by using proven public-health techniques designed for communicable diseases"

Mr. Coburn's bill would require states to inform those who may have been exposed to HIV; require states to report HIV infections to the federal health officials (only diagnosed AIDS cases now must be reported) mandate HIV testing of sex offenders; and encourage states to establish policies for HIV testing of health care providers who perform invasive procedures, such as surgery, and of patients who undergo such procedures.

Dr. Yank D. Coble, an internist in Jacksonville, Fla., and an AMA trustee, says the Coburn measure would "treat those infected with HIV and AIDS in the same manner as other infectious and contagious diseases."

State medical associations in Arkansas, Virginia, Maine, Texas and Illinois have endorsed Mr. Coburn's bill, and the AMA previously endorsed mandatory testing of all pregnant women for HIV.

He notes that a decade ago, a top AIDS researcher at the National Cancer Institute (NCI)—Dr. James J. Goedert, now chief of viral epidemiology at NCI — preached much the same message. In 1987, he wrote that the "elimination" of sexual contact between an HIV-infected person with someone not infected or whose HIV status is unknown must be the "primary emphasis of [HIV] education" programs.

W. Shepherd Smith Jr., founder of Americans for a Sound AIDS/ HIV Policy, says the HIV policy positions taken by the AMA and some state health agencies "clearly show we're moving toward a more rational response to the epidemic."

The federal Centers for Disease Control and Prevention is now considering strengthening what it calls "minimal" guidelines on the issue of partner notification — the effort to contact current or former sex partners of those diagnosed with HIV, CDC spokeswoman Tammy Nunnally says.

And Mr. Smith anticipates the CDC will recommend an expansion of "HIV name-reporting surveillance," which would require that names of persons testing positive for HIV be reported confidentially to state health departments.

Twenty-seven states now have such reporting systems, he says, but he notes that some of the largest — and the ones with the biggest HIV problems such as New York, California and Texas — do not.