Research is the Key, Prop. 102 the Roadblock : If We Report Those With HIV Infection, The Fight to Find AIDS Cure Will Be Doomed

Before deciding how to vote on the Dannemeyer initiative, Proposition 102, voters should first understand how AIDS can be cured.

This epidemic won’t end suddenly with a startling laboratory discovery or scientific breakthrough. There have been many already, yet AIDS is still a fatal disease. It won’t be like penicillin vanquishing rheumatic fever or like the Salk vaccine making polio disappear nearly overnight.

AIDS can be solved only by a painfully slow process of methodical medical research. This process will be impossible to complete without the cooperation, commitment and trust of thousands of volunteers --all of them people who are infected now with HIV, the human immunodeficiency virus. Trust has been carefully fostered so far by protection of confidentiality. Proposition 102, if passed on Nov. 8, will be a powerful disincentive for HIV-infected individuals to cooperate in this effort. Without their cooperation, the quest for an AIDS cure is doomed.

AIDS is caused by HIV infection, and virtually all people infected with HIV eventually develop AIDS. Unlike the polio virus, HIV is a virus with a novel and awesome strategy for self-preservation. Soon after infection occurs, and long before a person is symptomatic, HIV nests inside the control cells of the immune system. HIV barricades itself inside the genetic machinery of these key immune cells and starts reproducing, making new virus particles that infect other immune cells.

There are a number of promising new anti-HIV drugs that can slow and may even stop the virus from reproducing and infecting new immune cells. But the parent virus remains barricaded inside previously infected cells. Thus these drugs must be given for the HIV-infected individual’s lifetime in order to keep the virus from reactivating and destroying the rest of the immune system.

The more we learn about this virus, the more improbable it seems that someone will find a single magic bullet that eliminates HIV from the body without harming other essential cells or causing serious side effects.

Despite these limitations, AIDS researchers are optimistic that effective therapy for HIV infection and AIDS itself eventually can be developed. It will take time, and it will require many large trials of different combinations of anti-HIV drugs and varying dosages and medication schedules to achieve the most effective and least toxic treatment. There is no short cut when dealing with potentially toxic medications and when the differences in efficacy between drugs may be small but meaningful. We don’t expect to find a miracle drug cure, but we hope to hone and refine drug combinations that increasingly prolong life for HIV-infected people. A more realistic goal, achievable in the next generation, is to transform AIDS into a disease like diabetes--one in which people must take medication but for the most part can lead long, full, productive lives. However, if anti-HIV drugs are not studied in a methodical, carefully controlled manner, we will never be able to improve survival in this disease.

The key to this realistic solution is having large numbers of HIV-infected individuals willing to participate in trials of anti-HIV drug treatments, willing to assume the risk of taking untested medications and willing to commit the extra time that such studies require.

Proposition 102 would require that researchers report to public-health officials the names of all individuals testing positive for HIV infection. Thus HIV-infected people entering anti-HIV drug trials would have to risk the disclosure of their identity and HIV status, which would mean risking their jobs, insurance and personal privacy. This would create a powerful deterrent and could bring anti-HIV research in California to a dead halt. All of the state’s leading medical organizations--the California Medical Assn., the California Nurses Assn., the Health Officers Assn. of California and the Hemophilia Council--and most state political leaders, including the Republican and Democratic candidates for the U.S. Senate, oppose Proposition 102 as unnecessary and expensive. More ominously, Proposition 102 looms as the most serious roadblock that we have faced yet in developing therapies to control AIDS.

Proposition 102 must be soundly defeated. We need to send a clear message to HIV-infected people that participating in research will not ruin their lives. We need their continued cooperation to cure this disease.