Seventeen years into the epidemic, some things remain confoundingly elusive:
A sure-fire cure, of course. And a vaccine that will arrest the spread of the AIDS virus.
But not all the questions surrounding the epidemic are scientific. They remain as elemental as: What responsibility do you have to inform your sex partners once you know you carry the AIDS virus? And what power should society have to force you to tell?
Those questions have had newfound urgency since a New York man was accused in late October of having unprotected sex with teenage girls and young women even though he knew he was infected with the AIDS virus.
For a nation weary of discussing the disease, the revelations sounded a new alarm, a reminder that we have yet to resolve the matter of responsibility and revelation.
“That,” said Paul Akio Kawata, executive director of the National Minority AIDS Council, “remains the million-dollar quagmire. There’s not a clear answer for this one. In the ideal world, you should tell everyone because to knowingly pass HIV on is immoral.”
In a sense, these issues are more relevant than ever because, for people infected with HIV, there’s greater hope than ever. Potent drug cocktails, anchored by the medicines known as protease inhibitors, have squashed the virus beyond detection in some patients.
But to a significant extent, their success depends on introducing them early during the course of infection. It’s vital that people exposed to the AIDS virus find out soon after being infected.
People testing positive can notify former partners themselves. The task also can be given to state workers trained to search out partners, give them the news in person and explain what they should do.
When someone comes to a Florida state clinic for testing and the result is positive, the person is invited back for counseling. Among the matters discussed: sharing the news with sex partners.
“It works like this,” said Tom Liberti, chief of the Florida’s Bureau of HIV/AIDS. “I would say, `I’m now telling you it’s important to get this primary care because if your immune system is in relatively good shape we now have some drugs that can help.’
“Then, at some point, I’m saying, `One of the things we’ve got to talk about is any partners you’ve been with and how to handle them.’ And you say, `I’ve had about 10.’ And then we talk about what’s the best way to notify them.”
It’s a process known as partner notification or contact tracing, and it has been the job of public-health workers in Florida for a half-century. They began their work in the years after World War II when the enemies were sexually transmitted diseases such as syphilis and gonorrhea. Back then, the cure was as simple as a shot of penicillin.
So state health workers had four decades of experience with partner notification when they began tracking people who might have been exposed to AIDS. But this was a different enemy, branded with a stigma that burned deeper and cursed with a prognosis far grimmer.
People infected with the virus worried about confidentiality–theirs and that of their sex partners.
“But I think we’ve come a long way,” said Dr. Margaret Fischl, a leading AIDS researcher at the University of Miami. “I think there is an increasing confidence in the system for confidentiality. Yet, as we see publicized cases like this one in New York, it always raises concerns with our patients. They discuss it, and they view it as a breach in confidentiality.”
The identity of Nushawn Williams, 20, was revealed when prosecutors in New York’s Chautauqua County prevailed on a judge to release the man’s identity, maintaining that his threat to the community’s well-being surmounted his right to privacy.
It was a decision lambasted by a medical sleuth who was among the vanguard of epidemiologists to discover AIDS’ first victims in early 1980s.
“This is a terrible mistake,” said William Darrow, the former federal disease detective who is now a professor at Florida International University. “That trust has been violated by the Chautauqua County case.”
Something else was betrayed by that case: the notion that we had stopped demonizing the disease and the people made ill by it.
“It pictured the person with HIV as this person who loses all control and who’s this devil out there who’s infecting everyone,” said Angela Gaetano, who presides over educational services at Health Crisis Network, South Florida’s biggest AIDS service agency. “What people forgot is that you can still have partner notification without telling who the partners are, you can still maintain confidentiality.”
