Emergency rules requiring doctors and hospitals to report all cases of AIDS to public health officials are within days of adoption in Virginia and the District of Columbia. Their actions follow those of Maryland, which added Acquired Immune Deficiency Syndrome (AIDS) to its list of reportable diseases earlier this month.
Failure to report the cases in any of the jurisdictions would be a misdemeanor. In the District, for example, this carries a $300 fine or 90 days in jail.
The mandatory reporting comes at a time when public fear about the devasting disease, which has no known cure, is growing. A national Washington Post-ABC News poll has found 36 percent of those polled feared that AIDS will spread to the general public, although there is no evidence to suggest that it will. At present, the majority of the disease's victims have been homosexuals, Haitian refugees or drug addicts who used needles. The poll, which was taken June 15-19, surveyed 1,501 people by telephone.
Under the proposed rule in Virginia, which was drafted this week by the Attorney General's office, the names and addresses of AIDS victims must be reported to the State Department of Health. The state routinely shares disease information with federal authorities, according to Dr. Robert Stroube, assistant health commissioner.
Maryland also requires the name and address of AIDS victims be reported.
District health officials require only that an AIDS patient's initials, as well as sex and date of birth, be reported. The city will not reveal the initials to federal authorities, said Health Commissioner Ernest Hardaway, "because a number of individuals in the gay community have some discomfort that the national government is on a witch hunt against gay people."
He added, "We've gained some confidence with the gay community and we don't want to jeopardize that."
Local governments historically require medical personnel treating people with communicable diseases to report all cases to health authorities. For most diseases, local jurisdictions require the names of the afflicted patient. In the District, however, there is a special rule regarding venereal diseases that states that a case number, rather than a name, may be used.
To date, there is no specific evidence that shows that AIDS is a communicable disease. Despite that, local health officials say they need mandatory reporting rules to get a firm idea of the scope of the problem and to protect doctors and hospitals who fear legal retaliation from patients if they report individual cases of AIDS.
"We need to know if it's reaching new proportions, so we would have to take some kind of extra precautions," said Dr. Hardaway.
Doctors have reported 19 AIDS cases in the District, 17 in Virginia and 15 in Maryland. Of these 51 cases, 15 have died, according to state and federal officials.
All three local jurdictions have written the new rules under emergency provisions, which do not allow for public comment. In Virginia, once the emergency rule is approved by the governor, it can stay in effect up to one year before a permanent version is required.
The District rule is expected to go into effect July 1 and will last for 120 days. Hardaway said some of the $25,000 his department had allocated for public education on AIDS will be spent on printing bulletins to doctors and hospitals on the new rule, as well as brochures and a possible AIDS hotline to calm the fears of the public.
"We're getting many, many more calls," said Hardaway. "The dentists are concerned about it, the nurses. I tell them it's not going to happen through casual contact."
To dispel unwarranted fears, Hardaway said he made a point of dining with an AIDS victim in a restaurant in April and talked to a barber who was worried about speaking to gay customers face-to-face. "I do what I can to stop the hysteria," Hardaway said.
The department also has received "lots" of letters criticizing the District for spending money on AIDS education, Hardaway said. "There are a lot of people with very, very ill feelings toward homosexuals."
Unlike New York, the Washington area has not faced the refusal of funeral home directors to handle the bodies of AIDS victims. Dr. Michael Bray, deputy medical examiner for the District, said he has been asked by funeral directors whether special precautions are necessary. "I said to follow the same precautions as those bodies with hepatitis, such as wearing gloves and avoiding needle sticks. There are plenty of people in the area dying of known infectious diseases like tuberculosis and hepatitis. I personally can't see that AIDS is even as much of a problem."
Robert Chambers, the vice president of the area-wide Chambers Funeral Homes, said he spoke with the embalmers on his staff about taking normal precautions when handling the bodies of AIDS victims. "There really isn't any conclusion as to whether it's contagious," he said. "When a person dies, the organism usually does, too. We're not overly concerned about catching any disease.