The Texas state health commissioner said yesterday that he plans to seek authority to quarantine individual AIDS patients involuntarily, most likely in a hospital, if they appear to pose a public health threat.
In what is thought to be the first such effort by a state health official, Dr. Robert Bernstein said he is preparing a request to the state board of health next month that would add AIDS to the list of communicable diseases, such as cholera and yellow fever, already covered under Texas quarantine law.
But he emphasized in an interview that he was not proposing widespread quarantine, only state-ordered isolation in "extraordinary cases" in which an "unmanagable person" with AIDS poses a public threat by engaging in activities, particularly sex, that could spread the disease to others.
"All it would do is give us another tool in our armamentarium to control an individual who warrants it in the interest of protecting the public," Bernstein said. The AIDS epidemic "is really the start of something that we know is going to get worse before it gets better. I would rather have it in my medicine bag to use if we need it."
He cited a recent highly publicized case in Houston in which a male prostitute with AIDS continued to engage in sex with strangers, until he was finally persuaded to check into a hospital for treatment.
Bernstein's proposal comes amid growing national debate about appropriate public health actions to control the growing AIDS epidemic versus the civil liberties of individuals with the disease.
It drew criticism from the director of the Texas Civil Liberties Union, Gara LaMarche: "Quarantine is not an appropriate means of dealing with AIDS . . . . The nature of the disease and the draconian nature of quarantine mean that we need to very carefully scrutinize what he intends to do."
LaMarche and other public health authorities noted that, in the past, quarantine was generally invoked for diseases thought to be spread through casual transmission. In contrast, experts say that AIDS, or acquired immune deficiency syndrome, which has struck more than 14,000 Americans, is spread only through intimate contact with bodily fluids, mainly through sexual relations or use of contaminated needles.
Kristine Gebbie, Oregon state health administrator and AIDS task force director for the Association of State and Territorial Health Officials, said that Bernstein was taking the first public action on an issue privately under discussion by many health officials. She said many laws, including the one in her state, already allow health officials "to take action to isolate an individual who presents a public health threat" without specifying the diseases involved.
"Most of us believe that most citizens are very responsible," she said, but "public health people have talked about the possibility of isolating selected individuals who appear not to be using good judgment."
Both Gebbie and Bernstein, as well as other experts, stressed that more widespread use of quarantine or isolation to slow the spread of AIDS was unwarranted and impractical, since about 1 million Americans already may be carriers of the AIDS virus.
Gebbie said that Bernstein, a former commander of Walter Reed Army Medical Center here and a recent president of the health officials association, is well-respected in the health field. Bernstein said his staff will prepare a recommendation to present to the 18-member appointed state health board on Nov. 16.