Encouragement on AIDS

Gov. George Deukmejian has promised the new California AIDS Leadership Committee that his Administration will be “totally committed” and “totally supportive” of its efforts--an encouraging commitment that will facilitate the difficult task that lies ahead for the group. His remarks were a highlight of the inaugural session of the committee Tuesday in Sacramento.

California has committed more resources to AIDS than has any other state, and has led in many innovations in seeking to control the pandemic. That is appropriate, given the grim fact that one-fourth of all cases in the nation have occurred in this state. At the same time, however, the state effort has lacked an overall strategy and appropriate coordination of local, state and federal programs for prevention and treatment. The governor recognized the critically important role that the committee can play.

The committee demonstrated two important qualities as it initiated its work: It was decisive on two issues of consequence, and its discussion of the complexities of the disease reflected the expertise and depth of the 33 members.

Committee members unanimously supported a decision of the state Department of Health Services not to require the reporting of persons who test positive to the human immunodeficiency virus that causes AIDS, or of those with AIDS-related complex. The negative aspects of broader mandatory reporting--including political controversy, red tape for physicians and the risks of driving underground the very people whom public-health workers need to reach--outweigh any possible usefulness that would flow from the increased reporting, committee members agreed. The one state that does require reporting has strong anti-discrimination laws in place, and even with those protections it finds many people using pseudonyms when submitting to testing.

In a second action the committee endorsed a framework for local planning in AIDS treatment and prevention, officially sanctioning a state strategy that relies heavily on the 61 county and local health agencies to adopt tactics appropriate for their diverse situations while better coordinating local programs.

Many of the most difficult problems inevitably lie ahead. There will almost certainly be the need to speak out on the AIDS initiatives that will likely be on the ballot on November, including one that is contrary to the position adopted Tuesday on the reporting of HIV-positive test results. There are serious problems in winning political support for effective education programs involving explicit materials offensive to some segments of the public. There are as yet no clear guidelines concerning when testing or reporting of test results to third parties should be mandatory. The recent international AIDS conference in Stockholm heard reports of programs to supply clean needles to intravenous drug users that were successful in reducing AIDS infection rates and did not increase drug use, but no such program has been tried in California.

The committee is the creation of Dr. Kenneth W. Kizer, director of the state Department of Health Services. He will serve as a co-chairman with Dr. Marcus A. Conant, a clinical professor of dermatology at UC San Francisco who had been the chairman of the AIDS Task Force supplanted by the new committee. The membership includes many of the state’s experts on the disease. Their first priority is to draw a new state plan by November. It is a task in the interest of each of us. It is, as the governor recognized, “a very important assignment.”