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In April of last year, when the identification and mass production of the AIDS virus was announced in Washington, Health Secretary Heckler vowed that blood-screening tests would be available in record time. Medical scientists made good on that promise within nine months. Still, the fact that the test kits, manufactured by Abbott Laboratories, Electro-Nucleonics and Litton Bionetics, were produced in crash programs prompted many fears about the reliability and precision of the tests. Of particular concern was the chance that too many blood samples would register an incorrect positive reading, falsely suggesting the presence of AIDS antibodies. Last week, an NIH conference on the blood tests brought reassuring news: in the first three months of use around the country, the tests have proved 99.8% accurate. Screeners have found that most of the false positive results could be eliminated simply by repeating the test. Says Curran: "We've pretty much solved the problems of transfusion-related AIDS."
However, the tests have created a few problems of their own. Because they merely detect the presence of antibodies to AIDS (which proves only that exposure has occurred), they cannot determine if a person currently has the live virus, is capable of spreading it or is likely to develop the disease. Nonetheless, the perception persists that the tests can be used for diagnosis. Health officials fear that homosexuals and other high-risk individuals will volunteer to give blood simply to get themselves tested. This would increase the chances that AIDS-contaminated blood could enter the donor supply through a slipup or a faulty test reading.
To keep tainted blood away from the donor centers, the CDC is setting up alternative sites where people at high risk for AIDS can take the test with assurance that the results will remain confidential. Whether tests are administered there or at donor centers, one dilemma remains: how to relate the frightening news to someone whose blood has tested positive, and to interpret that finding for him.
Homosexuals and other high-risk groups have further concerns about the AIDS tests: that the results may fall into the wrong hands and be used to discriminate in hiring or insurance decisions. Some of those fears were realized in April, when the city of Hollywood, Fla., announced that it would use the AIDS test as a routine part of screening job applicants. "Candidly, we're not looking to hire somebody who may have an adverse impact on our health insurance," said Herbert Chernov, Hollywood's personnel director. "To consciously hire someone who may be dying would be foolish from a financial point of view." The city backed down when its plan was criticized by newspapers, doctors and gay leaders.
AIDS victims and people associated with them experience widespread discrimination, some of it heartless, some of it phobic. In New York City, Dr. Joseph Sonnabend was served with an eviction notice by the co-op board in the building where he practiced. "I treated people with AIDS," he explained. "People in the building didn't like AIDS patients walking through the lobby." In New Orleans, Johnny Greene, a writer, was fired from an editing job with McDermott International Inc. after writing an article for PEOPLE magazine about his own suspected case of AIDS. "They just walked in and said, 'Get the hell out,' " he recalls. "I hope they were acting out of panic or confusion, not belligerence or homophobia."
After months of battling AIDS-related illness, Ryan White, the Kokomo school boy with hemophilia, was eager to get back to Western Middle School and his friends this fall. Unfortunately, school officials do not want the seventh-grader in class. Though doctors believe that AIDS is not communicated through casual contact, School Superintendent J.O. Smith fears that Ryan poses too much of a risk to other students. He points to warnings from the Indiana board of health about the risks of exposure to AIDS-infected saliva and body fluids. "What are you going to do about someone chewing pencils or sneezing or swimming in the pool?" he asks.