Bennett Advocates Mandatory Testing In Battle on AIDS
WASHINGTON--Acquired immune deficiency syndrome poses such a threat to the general population that even "low risk'' groups should be required to undergo screening for the AIDS virus, Secretary of Education William J. Bennett said last week.
Speaking at Georgetown University here, Mr. Bennett said such testing should be mandatory for anyone entering a hospital, receiving treatment at a clinic, applying for a marriage license, seeking to enter the United States, or entering or leaving prison.
Also, he advocated the disclosure of positive AIDS-test results to spouses or other sexual contacts who are at risk of contracting the disease--whether the AIDS carrier consents or not.
"There are strong arguments for more testing, both for the sake of acquiring epidemiological knowledge and for the sake of protecting individuals,'' Mr. Bennett said."And there are strong arguments for considering superseding, in certain circumstances, the principle of confidentiality.''
While "discrimination against those who have contracted AIDS ... is simply not acceptable,'' he added, carriers of the AIDS virus have "a moral obligation'' to avoid infecting others.
"Already, AIDS has spread from its primary risk groups--homosexuals and intravenous drug users,'' he said. "Now it is attacking the unborn and the newborn as well. Within the next 48 months, 4,000 new babies will have contracted AIDS by being exposed to the virus while in the womb.''
"This danger to our children makes it all the more urgent that we do everything in our power to protect the uninfected members of our society,'' he continued.
According to an Education Department spokesman, Secretary Bennett is the first Reagan Administration official to call for mandatory AIDS testing--an issue of controversy within the White House Domestic Policy Council. Mr. Bennett said the White House had cleared his speech.
The council, which is headed by Gary L. Bauer, a former undersecretary of education, has been giving "high priority'' to formulating recommendations on AIDS policy for President Reagan, Mr. Bennett said. He declined, however, to predict how soon any decisions would be made.
Following the Secretary's speech, a question-and-answer session was disrupted by two gay activists--one reportedly an AIDS victim--who identified themselves as part of the Lavender Hill Mob, a New York-based group. Chanting "We are dying'' and "Test drugs, not people,'' the protesters were hustled away by security guards.
In response, Mr. Bennett said that, by speaking out on AIDS testing, he had chosen to "face the risk of being thought of as intolerant or mean spirited'' because of the importance of the issue. Unfortunately, he argued, the fear of appearing insensitive "has had a chilling effect on open, honest, public debate on AIDS.''
"Such a debate would have to weigh competing principles and considerations, taking into account the claims of individual privacy and the health of the public,'' he said.
But Mr. Bennett left no doubt about his belief that public-health considerations should come first. For example, he criticized a California law that protects the confidentiality of AIDS-test results, arguing that it would allow a woman with AIDS to conceal her disease even though it would affect her newborn baby.
Also, he said, the law requires the consent of an AIDS carrier before positive test results may be released to former sex partners who may have been exposed.
Public-health professionals, however, took sharp issue with Mr. Bennett's positions, both on confidentiality and mandatory testing.
Surgeon General C. Everett Koop and Dr. Richard E. Windom, head of the Public Heath Service, continue to believe in "voluntary testing ... the rights of the individual, and the importance of confidentiality,'' according to James Brown, an agency spokesman.
The AIDS-testing issue remains under discussion within the Department of Health and Human Services, Mr. Brown said.
Leon Eisenberg, a professor of social medicine at Harvard Medical School and a panelist in a National Academy of Sciences study of AIDS last year, said, "There are a number of things that make the Secretary's recommendations absurd.''
"Making testing mandatory,'' he argued, "endangers voluntary testing programs directed at high-risk populations,'' because of fears that privacy would be violated.
Also, Dr. Eisenberg said, "routine testing in groups like those who apply for marriage--who are low risk--would yield a high rate of false positives, with terrible consequences for the people who are falsely labeled.''
False negatives, on the other hand, could be misleading for members of high-risk groups and end up fostering the spread of AIDS, he argued, adding that "anybody who engages in high-risk behavior ought to assume that he or she is affected'' and take the necessary precautions to protect others.
Dr. Eisenberg added that hospitals could easily gather epidemiological evidence about the spread of AIDS anonymously, without violating patients' confidentiality.
In addition, he said, the cost of the kind of testing program proposed by Mr. Bennett would be very large.
"It would be far better to spend that money to provide public education--something Mr. Bennett and the Administration he represents have not been willing to do,'' Dr. Eisenberg said. "Right now, we spend less as a country on this serious public-health problem than a toothpaste company does in plugging a new product.''
This year, the federal budget for AIDS education is $79.5 million. The Reagan Administration has requested $104 million for that purpose in 1988.
Secretary Bennett said the federal government has an obligation to provide to schools "the best scientific and medical information about this disease. ... If schools do teach sex education, such courses should include a discussion of what is known about AIDS and about the threat it poses.''
But decisions on how and when to teach children about AIDS should be left to states, school boards, and local communities, he argued.
Mr. Bennett reiterated his frequent emphasis on sexual abstinence, rather than "safe sex'' instruction, as a way of avoiding AIDS. He criticized what he called "condom-mania'' as "an evasion [because] condoms are not 100 percent reliable, and their prospective users are not 100 percent reliable, either.''
"The facts are that abstinence, restraint, and fidelity are the best means of guarding against AIDS that we currently know,'' he said.
While advocating an expansion of voluntary AIDS testing in general, Mr. Bennett said school sex-education classes were not an appropriate mechanism for doing so.
Responding to a reporter's question, the Secretary said he had never taken a test for AIDS, but would consider doing so at his next physical examination.