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Not content to wait for federal action, the Illinois legislature overwhelmingly passed a new law last week that would authorize the state's health department to notify patients when their medical-care providers are diagnosed with AIDS. The bill was prompted by the revelation that the only dentist in the town of Nokomis, Ill. (pop. 2,700), died of AIDS last October; his patients were not notified until early this month, after a state legislator threatened to make the circumstances of the dentist's death public.
Is the rush to legislate a case of hysterical overreaction? Nothing has happened to make researchers change their minds on how the AIDS virus is spread. Almost all infections occur in the expected ways: people share contaminated needles or have unprotected sex with an HIV-positive partner. "The risk of getting AIDS from your doctor is lower than the risk of dying in a car crash on the way to the hospital," says Dr. James Mason, Assistant Secretary for Health at the Department of Health and Human Services.
In fact, medical workers are more vulnerable to being infected by patients than vice versa. The CDC has documented 40 such cases -- most of them involving accidents with hypodermic needles that contained contaminated blood. "Because there is mass hysteria, and because this is a fatal disease, and because people don't know very much about this, people's common-sense reaction, including Senators', is to act first and think later," says Geri Palast, a lobbyist for the Service Employees International Union, which represents 350,000 health-care workers.
The evidence strongly suggests that good sterilization procedures will prevent doctors from endangering patients. Last year, after one of the surgeons at Johns Hopkins Hospital died of AIDS, officials at the medical center in Baltimore informed 1,800 people on whom he had operated that they may have been exposed to the virus. So far, none of them have tested positive, and all the lawsuits filed against his estate have been dismissed. Delaware health officials have offered free HIV tests to more than 1,200 patients of a Wilmington dentist who died of AIDS in March. Of the 600 who have taken the state up on its offer, none have tested positive.
The guiding principle of standard infection control is to act as if everyone and everything is infected with something -- whether it be Staphylococcus bacteria, tetanus toxins or the AIDS virus. That is why instruments should be sterilized in an autoclave, physicians should change gloves or wash hands between patients, and disposable swabs, syringes and other items should not be reused. Although the CDC's disease detectives are still not sure what went wrong in Acer's office, they are zeroing in on just such a breach in infection control.
The danger is not from the doctor but from slipshod practices, says Jack Rosenberg, a Manhattan dentist and founder of a gay and lesbian dental guild. "Asking your dentist whether or not he is gay is not going to protect you," Rosenberg says. "Instead, you should ask, 'Do you sterilize your instruments? Do you follow standard infection control?' Those are the questions that will protect you." Rosenberg caused a ruckus last week when he publicly declared that he knew several dentists who are HIV-positive and that he advises them not to tell their patients.