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Critics of wide-scale testing, however, pointed out that screening 43,000 federal prisoners, 1.4 million patients a year in Veterans Administration hospitals and thousands of foreigners who annually flood immigration offices would present enormous logistical problems. Such large-scale testing is unlikely to achieve results commensurate with the huge price tag.
From past experience with infectious diseases, many health officials believe the marriage test in particular will not effectively reach the high-risk groups -- homosexual and bisexual men and intravenous drug abusers, who collectively make up 91% of U.S. AIDS cases. Indeed, researchers at the AIDS conference presented evidence of a continuing rise in the number of new infections among IV drug users in the U.S., most of them black or Hispanic, who are spreading the virus to the heterosexual community.
Still, Congress signaled its basic approval of the President's AIDS program. By a 96-to-0 vote last week the Senate amended a $9.4 billion supplemental- appropriations bill to require the testing of immigrants; entry will be denied to those found to have been exposed to the AIDS virus. The Senate also approved $77 million for anti-AIDS programs. The House is expected to pass a similar measure later this year.
Washington is not the only capital where health officials and politicians have been struggling to shape a policy to fight AIDS. So far, 51,535 AIDS cases have been reported to the Geneva-based World Health Organization by 112 countries, not including some hard-hit African countries. As many as 10 million people are believed to be AIDS carriers, and according to some estimates, 100 million could have the virus by the end of the century. Many governments, mostly in Western Europe, have responded far more swiftly and decisively than the U.S. to the deadly challenge by developing public education programs.
The Netherlands, which had 260 reported cases of AIDS as of April 1, began a government-sponsored "condom campaign" two months ago to encourage the use of prophylactics during sex, and continues to provide free sterilized needles to drug addicts. In Britain, where 750 AIDS cases had been reported by last month, the government last November allocated $32 million to produce a blitz of warnings and advice. Billboards were erected across the country that read AIDS: DON'T DIE OF IGNORANCE. Now, however, the London government has begun to question its approach. A recent study has concluded that the campaign needlessly raised general anxieties about AIDS but missed those individuals in population groups at high risk. Later this month the British government will launch another effort aimed at drug users.
Despite the protests of civil rights groups about discrimination against people with AIDS, some governments have mandated limited screening. France, for example, will soon require testing before couples are issued marriage licenses. In the Soviet Union, which has reported only 54 cases of AIDS, tens of thousands of tests have been carried out, although the government has not disclosed what segments of the population were screened.