• U.S.

Aids Moves in Many Ways

5 minute read
Anastasia Toufexis

For medical experts, steering the public through an epidemic is a precarious balancing act: they must maintain a healthy level of fear in people and yet keep them from slipping into either complacency or terror. That job is especially difficult in these days of the AIDS plague, which has become the most frightening and confusing health problem since the polio panic of the 1950s. While some Americans have smugly assumed they are perfectly safe, others have mistakenly fretted that they could pick up HIV (the AIDS virus) from toilet seats or mosquito bites. Throughout the crisis, specialists have offered strong reassurance: if people are careful about sex and avoid shooting drugs with dirty needles, their chances of contracting AIDS are extremely small. But now a series of incidents is renewing public nervousness about the ease with which the virus can be transmitted.

The latest tremor came last week when the American Red Cross announced it was totally revamping its facilities and procedures for handling blood donations — an admission that the current system is not as safe as it should be. Confidence in the U.S. blood supply has been shaky since the early days of the AIDS epidemic when there were frequent reports that hemophiliacs and other patients were being infected from transfusions. To date, more than 4,100 blood recipients have contracted AIDS. Fearful Americans increasingly are banking their own blood in advance of scheduled operations or giving donations earmarked for family and friends. The caution is understandable: in the past few years the Food and Drug Administration has cited the Red Cross, which provides half the U.S. blood-bank supply, for not following safety procedures designed to guard against the use of HIV-infected blood, for inadvertently releasing blood contaminated with hepatitis and for failing to report accidents and errors.

The Red Cross announcement followed by days word that the FDA and the Centers for Disease Control (CDC) are tracking down recipients of organs and tissues taken from a Virginia man infected with the AIDS virus who was killed during a robbery in 1985. His organs and tissues, which had tested negative for the virus, were distributed among 56 patients in 16 states. Six of them have tested positive for HIV.

While the public may have been disturbed by such news, there is in fact little danger from transfusions and transplants. Blood and donated organs and tissues are routinely screened for the AIDS virus. Still, there is no way to remove all threat from these procedures. One problem is that there is a lag of up to six months from the time a person is infected with HIV until blood tests can detect antibodies. Since blood banks began screening for the virus in 1985, 15 people of the estimated 24 million who have had transfusions have been infected from blood that had passed all the tests. Some 3 million transplants have been performed during that time; only one patient has developed AIDS and eight others have tested positive for the virus.

Far more troubling are indications that some doctors and hospitals may be lax in protecting patients against exposure to the AIDS virus. Chicago’s Illinois Masonic Medical Center has temporarily closed its adult clinic following two alarming incidents. In April a physician taking a Pap smear from a woman unwittingly used a swab that had previously been used to take a culture from an HIV-positive patient. The doctor thought the testing kit, which had been left out unlabeled on a table in the hallway, had been prepared for his use. Just weeks later, two toddlers who had accompanied a woman into a clinic examining room pricked themselves with a syringe that is believed to have been used on an AIDS patient. The youngsters plucked the needle from the covered red bucket into which dirty syringes are tossed; the pail was on an open shelf under a sink.

Public anxiety about medical professionals is already running high. The CDC reported earlier this year that a Florida dentist with AIDS had somehow infected three patients. Undoubtedly, precautions need to be tightened, but the possibility of contracting AIDS through mishaps or from infected doctors remains remote. Only 3 of 1,000 cases involving jabs with contaminated needles result in HIV transmission, according to the National Institutes of Health. And medical professionals face a greater risk of getting AIDS from patients than vice versa. About 40 workers have been infected by patients’ blood. The three patients who caught the virus from the Florida dentist are the only documented cases of worker-to-patient transmission.

That is not likely to mollify the public, which craves absolute safety, not just in medicine but in all facets of life. “People have to think of the alternatives,” says Dr. David Sutherland, a transplant surgeon at the University of Minnesota. “If your heart is failing and you’re given one month to live without a heart transplant, are you going to say, ‘I’m not going to have it because there’s a 1-in-10,000 chance I’ll get AIDS’? I doubt it.” One positive side effect of AIDS is that it has forced major improvements in the U.S. health-care system. The strange truth is that most Americans may be safer now than they were before the coming of AIDS.

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