Ethics: Putting Aids to The Test

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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.