The spate of AIDS-related action in the Illinois legislature, including a call last week for tracing the sex partners of people with the deadly disease, is part of an escalating nationwide trend to strengthen the hands of health departments in their efforts to combat the disease.
Legislative moves to deal with AIDS, such as bills requiring partner-tracing, mandatory testing and quarantines, have stirred a storm of protest from some health officials, who say the measures could backfire and drive AIDS victims underground, making it even more difficult to deal with the disease.
And civil-liberties activists fear that many of the proposed measures would violate privacy laws and undermine the civil rights of AIDS patients.
Nevertheless, the legislation continues to pile up.
In Springfield, for example, the House last week passed bills that would require local health departments to report to school officials the identities of children infected with AIDS; require people convicted of sex offenses such as prostitution or criminal sexual assault to be tested for the virus; require health workers to tell their employers if they have AIDS; require state health officials to trace the past sexual partners of people infected with AIDS; and make it a felony for an AIDS carrier to donate blood.
The Senate passed bills mandating that AIDS victims disclose the names of sexual partners; require the forced isolation of AIDS carriers who continue to engage in acts that could transmit the disease; and require schools to teach pupils about AIDS beginning in the 6th grade.
And both chambers voted overwhelmingly in favor of bills that would require marriage-license applicants to be tested for AIDS.
”The flurry of bills is what we refer to as the third epidemic,” said Dr. Bernard Turnock, who is awaiting reconfirmation as director of the Illinois Department of Public Health.
”First was the disease, then the hysteria and now the legislation.”
Turnock said the debate in Illinois reflects concern about the disease and the pressure legislators feel to do something about it.
And it is a debate that is being carried out nationwide.
AIDS is the ”hottest health issue” being considered by state lawmakers this year, and it has joined welfare reform and liability insurance as top issues, said Kate Farrell, a research analyst with the National Conference of State Legislatures.
At least 366 AIDS-related bills have been introduced in state legislatures this year, said Connie Thomas of George Washington University`s Intergovernmental Health Policy Project. There have been 57 bills dealing with AIDS introduced in Illinois, the most for any state, she said.
Nationwide, bills are designed to strengthen the rulemaking authority of state health departments, Thomas said. Many would allow health departments to classify AIDS as a sexually transmitted disease, enabling them to invoke infection-control measures such as tracing victims` partners and isolating AIDS-virus carriers who are a threat to the public, she said.
Illinois and Colorado are proposing the toughest legislation ”in terms of empowering health departments to restrict the activities of AIDS sufferers and to require testing,” Farrell said.
”Everybody is trying to move as carefully as possible,” Thomas said.
”There are many things we don`t know about this disease. We don`t know how easily transmissible it is. We have civil liberties to protect. And there is a lot of concern about confidentiality.”
Legislative activity is expected to continue because it reflects the public`s frustration at the medical profession`s failure so far to stop AIDS, medical and legal authorities said.
A recent poll sponsored by the American Medical Association showed that only 27 percent of Americans trust scientific knowledge about AIDS. A poll by the Associated Press earlier this month showed that AIDS now rivals cancer as the most feared disease in the nation, though cancer claims many more lives.
”People are worried and afraid of this disease,” said Judith Erwin, press secretary to Senate President Philip Rock (D., Oak Park). ”Last year, most people here still thought it was just a gay problem. They don`t think that anymore.
”I fully expect much of the testing and tracing legislation to pass, even if some of it conflicts with medical advice.”
The Illinois Senate bill on partner-tracing calls for physicians to report to the public health department the names of people diagnosed as having AIDS or ARC, AIDS-related complex, a milder form of AIDS that can also be deadly. The public health department would then contact the patient and ask for the names of sex or drug partners. Providing the names would be voluntary. The bill also would let the public health department go into court to require a person located through partner-tracing to be tested for AIDS or to isolate a person who was infected with AIDS until he promised to change his sexual or drug-use behavior, a provision raising serious civil-rights questions.
And forced partner-tracing could discourage those in high-risk groups from being tested voluntarily. ”If people don`t come forward for the test, they won`t be identified, and our ability to counsel them to modify their behavior will be lost,” Turnock said.
Turnock recently dropped his opposition to partner-tracing, despite reservations, after conservative lawmakers threatened to withhold support on his reconfirmation for his state post.
”Politicians have to represent the viewpoints of their constituents,”
Erwin said. ”If you are from the Bible Belt in southern Illinois, you may have a different view than if you are from the 46th Ward in Chicago.” That ward has a large, influential homosexual population.
AIDS, or acquired immune deficiency syndrome, destroys the body`s immune system, leaving it prey to various cancers and infections. It is spread through sexual intercourse, shared needles or other contact with infected blood. As of May 18, 35,769 cases had been diagnosed nationwide and 20,683 people had died. The great majority of victims to date have been homosexual or bisexual men or intravenous drug users.
Some federal health officials are calling for a return to time-tested public health measures for controlling infectious diseases, such as partner-tracing.
”Whether it was the syphilis campaigns of the `40s, `50s, and `60s or the gonorrhea campaigns in the `70s, partner notification has been a very effective way of getting exposed people in for treatment and thereby preventing spread within a community,” said Dr. Willard Cates, director of the sexually transmitted diseases control branch of the U.S. Centers for Disease Control in Atlanta.
The centers and other health experts are concerned that some people with AIDS and many who do not even know they have been infected are spreading the diease.
But there are major differences between AIDS and traditional sexually transmitted disease, some experts note. There is no effective treatment or cure for AIDS, which has contributed heavily to the widespread fears.
In such a climate, AIDS test results and other information might not remain confidential, the experts say, and victims could face discrimination and harassment.
Among the most controversial legislative proposals for dealing with AIDS is the call for quarantining some victims, which was included in the bill approved last week by the Illinois Senate. Sen. Aldo De Angelis (R., Chicago Heights), the bill`s sponsor, said the quarantine provision would be used to force people whom health officials consider to be ”portable epidemics” to be tested and possibly quarantined.
”Let`s say in the course of contact (partner) tracing, one name shows up 12 times,” De Angelis said. ”Or you have someone you know is a prostitute or a very active homosexual. We could force that person to be tested and isolate them if they refused to change their behavior.”
That provision, experts say, may be unconstitutional.
