In an effort to control the spread of AIDS, D.C. Public Health Commissioner Reed V. Tuckson has approved a plan to distribute vials of bleach to be used by addicts to clean needles and has ordered a dramatic expansion in the city's AIDS testing program.

Beginning this month at most of the city's 19 health centers, women of child-bearing age and persons who seek treatment for drug and alcohol abuse or sexually transmitted diseases will be urged to have their blood tested for the Human Immunodeficiency Virus, which causes AIDS. Now only two clinics offer anonymous testing.

Outreach workers who approach addicts on the street and in shooting galleries will distribute bleach along with instructions on using it safely to flush out needles and syringes, a procedure that kills the virus.

Although Tuckson had opposed bleach distribution, he said he changed his mind after officials in San Francisco and New York City, where such programs are under way, reported no injuries and after a drug counselor told him that even addicts who know about AIDS often clean their needles by dipping them in toilet bowls or in rainwater puddled on the hoods of cars.

"This disease is progressing and we are in the middle of the worst epidemic of drug abuse in the history of our city," said Tuckson. "This is a natural evolution of our program . . . . I want to make it easier for people to know their antibody status and to put in place a system that might help people change their behavior.

"Bleach is not the answer and not a panacea," he said. "I know that some people are still going to use dirty needles, but this gives us the chance to break the chain of infection and we must give people the tools with which to do that." He said that the bleach distribution program had been approved by police officials and should present no legal problems.

"I've never heard that it is illegal to possess bleach," he said.

So far the Washington metropolitan area has not seen the explosion in cases of AIDS among intravenous drug users that has occurred in New York and New Jersey. The Washington area, which has recorded 1,719 cases -- 1,020 in the District -- ranks fifth nationally, according to figures compiled by the federal Centers for Disease Control.

Intravenous drug use is the bridge to the heterosexual community and accounts for many cases among women, who contract the disease from their sexual partners, then transmit it to their children at birth. Currently IV drug users account for about 15 percent of the city's AIDS cases, but officials expect the percentage to increase as people who are infected but show no apparent symptoms develop the disease.

Tuckson said he was particularly alarmed by a study released last month showing that 1 in 41 babies in certain New York City neighborhoods tested positive for exposure to the virus, which is transmitted in blood and semen. That study prompted New York state officials to reverse their opposition to an experimental needle exchange program that permits addicts to trade dirty needles for clean ones. Similar programs have been underway in Europe for several years.

Officials of AIDS and drug agencies applauded the decision here to distribute bleach and expand HIV testing.

"If nothing else, distributing bleach is going to raise public consciousness about the IV problem and remind {users} that this is a way of transmitting the disease," said Allen Grooms, AIDS coordinator of the Washington Area Council on Alcohol and Drug Abuse. "This is not just a ghetto problem, it's a problem for every race in every part of the city."

Jim Graham, director of the Whitman-Walker Clinic, the area's primary AIDS service organization and the city's largest testing site, said he believed that "permitting greater access to the test for those interested in having it is certainly a good idea."

"Whether it is a good idea to actively encourage people to be tested is the subject of continuing debate," he said. "I'm definitely supportive of bleach distribution as a step in the right direction. I think the city should look very closely at the idea of needle exchange."

Tuckson said he opposes a needle exchange, which he believes would send an "inappropriate message at a critical time in the history of our city." Distributing bleach along with an message of AIDS prevention "is at least a minimum service we must provide while we continue to get people off drugs and into treatment," he said.

Tuckson said health officials are designing a study similar to New York's that would survey the HIV status of babies born at various District hospitals. A study of inmates confined to the D.C. Jail also is "under active discussion" with corrections officials. In addition, the city will award a $900,000 multimedia contract for a public education campaign in March.

"I want access to the same technology that sells Nikes to poor black youth," Tuckson said.

In preparation for the expanded HIV testing, doctors at city clinics have recently undergone training sessions in AIDS testing and counseling. Tuckson said that informed consent will be required in advance and that testing will be conducted anonymously or on a confidential basis in which the name is shielded, depending on the wish of the person tested.

Tuckson said he did not know how much the expanded testing would cost or how many people might agree to be tested.

Officials in AIDS organizations say that although the District's response to the disease has been commendable, the city has been slow to mount a general education campaign and lacks drug treatment programs essential to curbing AIDS.

"The policy commitment is certainly there on the part of Reed Tuckson and the mayor and money is not a problem," said Don Edwards, head of the National Minority AIDS Task Force. "But you can't wait for a crisis and create institutions to deal with it. The institutions have to be in place. And the truth is that AIDS is not the epidemic in the community, it's one of four or five" -- among them drug abuse, youth violence and teen-age pregnancy.

The lack of drug treatment facilities remains a major problem, counselors and city officials say. D.C. officials estimate there are 16,000 heroin addicts in the District, but only 4,000 drug treatment slots and about 50 outreach workers, many of them volunteers. Drug users must wait about a month for a place in a treatment program.

"To an addict, 48 hours is a long time, and by two weeks the incentive to get into treatment is gone," said Pat Hawkins, a psychologist who works with Damien Ministries, which provides housing for AIDS patients who have histories of drug abuse.

Some drug counselors say the disappearance in April of a log book thought to contain the names of those tested for HIV at the city's Alcohol and Drug Abuse Services Administration may cause people to shun testing. The book has never been recovered, leading to speculation it was accidentally thrown out.