At least four times a week for the past year, Washington social worker Caitlin Ryan, accompanied by an AIDS patient, has sought to separate fact from fiction about the disease for various audiences. In recent weeks, officials at two area hospitals and one hospice requested her presentation, but told her the AIDS patient was not welcome.
In Birmingham, Ala., officials last week ended the use of prison gangs to do road work for fear that the county could be sued if a citizen caught AIDS, acquired immune deficiency syndrome, from a prisoner.
In Washington Borough, N.J., a 9-year-old boy whose sister has an AIDS-related condition went to school Thursday, only to discover that more than half of his 200 fellow students had been kept home because of his presence.
At a District weight-lifting gym, nearly all of the female members have dropped their membership in the last two months. According to the manager, several women said they feared acquiring AIDS because of the gym's many gay male members and were going to join all-female health clubs. The manager asked that the gym's name not be used, for fear of losing more customers.
"There's such generalized paranoia out there, even from trained professionals and hospital administrators," said Ryan, director of the AIDS Education Fund for the Whitman-Walker Clinic, which serves District-area homosexuals. The three health facilities that refused the AIDS lecturer all had cared for AIDS patients, she noted. "Isn't that crazy?"
Concern about AIDS is spreading throughout American life, forcing businesses, institutions and professions to confront both the fears of the fatal disease and the ways of handling those who have it. This coincides with the spread of AIDS in America -- there are 14,288 reported cases nationally -- beyond the gay male community and the world of drug addicts to the population at large.
The list of those feeling the impact is ever-expanding: Insurance companies, city councils, school boards, employers, the military, health-care professions, labor unions, churches and others who affect millions of lives are making or considering changes, small and large, in the way they conduct business.
The combination of Rock Hudson's death and the highly publicized controversies about AIDS and the schools (touching a sensitive nerve -- children) "has produced AIDS fears in new arenas," said Dr. Harold Jaffe, director of AIDS epidemiology at the federal Centers for Disease Control in Atlanta.
The need for reasonable responses is more critical than ever, experts say, as mainstream institutions suddenly find themselves forced to develop policies to deal with widespread public fears, some justified and some not.
Officials of many trade and professional associations say that they are flooded with inquiries from members on how to handle AIDS-related questions, primarily about how the disease is transmitted. Like the National Education Association, which recommended guidelines Oct. 9 calling for case-by-case evaluations of the need to exclude teachers or students with AIDS from schools, many of these groups see their mission as bringing some order to the process.
However, the general statements from the national offices of many trade groups often are so vague that they provide little help in the day-to-day situations encountered by their members.
Complicating the situation is a distrust of public authorities. "People constantly ask, 'How do we know you're not hiding something from us?' " Jaffe said. "The thought that you are covering up or lying . . . . It's very destructive."
Because medical experts cannot provide guarantees concerning AIDS, people "fixate" on the most frightening possibilities rather than on the reassuring bulk of evidence that shows the disease is hard to contract, Jaffe said.
The disease has become such a topical part of American life that it is the subject of two upcoming television movies, one Broadway play and a crop of books. Each day, the wire services report upwards of 30 stories from around the country about AIDS.
In Cleveland, Cuyahoga County officials said Friday they plan screening tests for AIDS antibodies for the 4,200 children who are wards of the county in institutions or foster homes. County commissioner Tim Hagan said the plan arose from fears that many of the children are offspring of prostitutes or intravenous drug users.
Transamerica Occidental Life Insurance Co. said Thursday it is conducting blood tests to detect AIDS exposure among people applying for large life insurance policies in jurisdictions it classifies as high risk areas: California, Florida, Illinois, New Jersey, Texas and the District of Columbia. The company said it has paid $2.5 million, 3 percent of its total death claims so far this year, to beneficiaries of people who died from the disease.
In Dallas, ENSERCH Corp., the parent company of a major Texas utility, now requires its cafeteria employes to submit to a blood test to determine if they have been exposed to the virus.
A nurse at the Alexandria jail told a prisoner he had AIDS after the prisoner, who was arrested on a drug charge, took a required blood test. Jail authorities disinfected his cell, destroyed his clothes and discarded his mattress. The man was removed from the jail and sent to the Whitman-Walker Clinic, where it was determined that he did not have AIDS, but that his blood only showed exposure to the virus.
In Valhalla, N.Y., a county jail inmate with AIDS harassed people by spitting on them. Officials were so anxious to get rid of him that he was allowed to plead guilty to a misdemeanor and released, though he had faced felony charges involving stolen property. He was not required to appear in court because court officers balked at handling him.
Institutions are setting policy at a time when there is lack of certainty among medical experts and lack of agreement among political and community leaders about how far to go in protecting the public health. The federal Centers for Disease Control has issued several sets of AIDS guidelines and is refining them.
But these tend to be technical and not easily understood by the public, which is looking for simple guidance on day-to-day activities, according to several school principals, among others.
Gay rights organization leaders say efforts to deal reasonably with AIDS are undercut by unfounded fears, which were allowed to spread because strong public education efforts were not launched earlier by public officials and the medical establishment.
"We're not starting out with a clean slate," said Jeffrey Levi, an official of the 7,000-member National Gay Task Force. "We're having to overcome a lot of irrational fear and hysteria which could have been avoided."
Many leaders of the gay community say they have been forced to shoulder the brunt of public education about AIDS.
"The schools and departments of medicine, the traditional routes that would have quelled a social panic, have done nothing . . . . They're still trying to figure it out themselves," said Ryan of the Whitman-Walker Clinic.
AIDS was first recognized in 1981 in this country. In its early years, it was regarded by most people as a disease that afflicted only homosexual men or drug abusers.
Public alarm increased in 1983 as the dimensions of the disease first became apparent in San Francisco and New York, where there are large concentrations of the high-risk groups. The current wave of concern was triggered by events such as Rock Hudson's death from AIDS, which re-focused public attention on the disease, experts say.
Leaders of the gay community worry that institutions and officials may be stampeded by uninformed public opinion into discriminatory policies that will unnecessarily restrict civil rights.
"You can argue 'better safe than sorry,' but you may then begin to defend many social policies that have serious, dangerous consequences," said Allan M. Brandt, assistant professor of history of medicine at the Harvard Medical School. "We could create a 'leper community' of essentially healthy individuals."
History suggests that it is common for people to respond to infectious disease in extreme ways. The U.S. Navy in World War I reacted to the threat of a syphilis outbreak by removing the doorknobs from its battleships, because it was thought that sailors might contract the disease from them, Brandt said.
In isolated cases, nurses and other health care professionals have refused to treat AIDS patients. In Oregon, a hospital custodian refused to pick up an AIDS patient's laundry. In the District, patrons deserted their hairdresser after he was fired for having AIDS.
The fear of AIDS also has prompted new health precautions that many say should have become standard years ago.
In the District's 11 city-run neighborhood health clinics, bar soap has been discarded in favor of liquid soap because of a new awareness of the need for infection control, according to Mary Breach, the clinics' nursing coordinator. Signs urging hand-washing have been posted in all bathrooms, she said.
Infectious patients, including those with AIDS, now have file cards placed on their doors at George Washington University Medical Center stating that "blood and body fluids precaution" should be taken, said Dr. Robert Shesser, chairman of the hospital's infection control committee. Technicians are taking better care in disposing of needles, wearing gloves and bagging infectious wastes, he said.
Dentists throughout the country have started wearing masks and gloves -- recommendations made years ago because of concerns about contracting hepatitis B.
"I do wear gloves if I have any nicks on my hands or if my patients are gay," said Dr. Gary Elder, a District dentist who now uses disposable needles. "I do not encourage new gay patients."
In the Los Angeles area recently, city and county officials issued hundreds of mask-like devices to emergency rescue workers, lifeguards and others who perform mouth-to-mouth resuscitation. The action followed a May car crash in which a county firefighter unsuccessfully tried to revive a man who later was found to have AIDS and hepatitis B, which is more infectious than AIDS.
The greatest concern among civil libertarians and the high-risk groups focuses on measures such as mandatory screening, which is already used by some employers, including the military, and is under consideration by others. These tests could exclude people from various areas of life even though they may never develop the disease or be infectious, they say.
Some insurance companies, trying to figure AIDS into their actuarial tables, have indicated an interest in adding questions about the disease to their application forms, according to industry officials.
Transamerica Occidental is the only one so far requiring blood tests to detect exposure to the AIDS virus. But since Oct. 1, Home Office Reference Laboratory in Shawnee Mission, Kan., has been running tests for exposure to the virus for 30 insurance companies whose blood samples it normally processes, according to company president Ken Stelzer.
Most of the giant insurance companies with plenty of financial cushion are still studying the question, according to Rob Bier, spokesman for the American Council of Life Insurance and the Health Insurance Association of America.
The industry is alarmed because AIDS has prompted the first laws saying there is some information that "insurers simply can't have," he said. California and Wisconsin have made it unlawful to use the blood tests to exclude people from insurability or employment. (The test was developed and approved by the federal government to screen blood donated to blood banks.)
The measure most feared by gay leaders and others is quarantine, which has been proposed by some politicians and medical professionals.
One recurring rumor, unsupported by facts, reflects gay fears of quarantine. As one 34-year-old gay health professional in the District, who asked not to be identified, said, "We keep hearing that the restoration of Ellis Island is not for a museum, but as a place to quarantine AIDS people.
"I worry that my doorbell will ring at 2 a.m. some morning and someone will tell me that because I slept with someone who has AIDS that I will be taken away."
Anxieties also are intensified by reports, for example, of an official in Texas who said it should be a felony for AIDS patients to have sex, and of Houston mayoral candidate Louie Welch, who in what he thought was an off-microphone comment, said one way to control AIDS would be to "shoot the queers." AIDS is a focal point of that mayoral race.
In Dade County, Fla., which has a high number of AIDS cases, commissioners have tentatively approved a law requiring the area's 80,000 food service workers to carry cards certifying they are free of communicable diseases.
In New York, Diane McGrath, the Republican mayoral candidate, has proposed screening health care workers. Republican candidate for Virginia governor Wyatt B. Durrette has said that if elected, he would propose legislation requiring that couples applying for a marriage license first have a blood test to detect exposure to the AIDS virus.
At the same time, other lawmakers are pushing for measures to ban discrimination against people with AIDS or in high-risk groups.
The only city ordinances enacted to deal with AIDS so far are in the Los Angeles area, where the problem surfaced early, according to Richard Johnson, a spokesman for the U.S. Conference of Mayors. Those laws ban discrimination against people with AIDS. In the District, a bill before the city council would prevent discrimination against high-risk groups.