Tracing of Those Exposed to AIDS Tried by County

For two years, San Diego County health authorities have used on a limited scale the controversial practice of “contact tracing”--tracking down people who had sexual contact with AIDS victims or who donated blood that later proved to be tainted.

Dr. Donald Ramras, deputy director of the county Department of Health Services, said this week that his agency has tried contact tracing in a half-dozen AIDS cases. He and others describe the program as successful but sharply limited by resources and logistics.

The single health worker conducting the tracing and who requested anonymity, said, “My standard for success is to see that the person is receptive to testing (for exposure to the AIDS virus) and does follow through. It does work. I assure you, it does work.”

The agency has tried tracing in cases involving two types of AIDS transmission: When people in the past were infected through contaminated blood transfusions, it tried to find the donors, and when men with AIDS have had contact with women, it tries to find the women.

But it has not used tracing in the vast majority of all AIDS cases in San Diego County--gay and bisexual men who have had numerous sexual partners.

“The problem there is that these usually involve many, many contacts and they go back over many years,” Ramras said. “And what do you do about it if you find them? With a woman, it’s pretty obvious that what you’re doing is looking after the future generations.”

AIDS, a fatal disease for which there is no known cure, can be transmitted from a mother to a fetus during pregnancy and birth. Women who have been exposed to the virus are often encouraged not to become pregnant and risk the life of a child.

Ramras added, “I can well see tracing men, also. It’s just harder to do. It’s next to impossible if they have had many, many contacts. With the staff we have, frankly, we wouldn’t have the time to do that kind of work.

“So basically, staff every place is limited, and you have to think where you’re going to get the greatest good for the money you invest. Which translates to personnel time.”

Supporters of contact tracing believe it might slow the spread of AIDS from high-risk groups such as homosexuals to less-affected groups such as heterosexuals. The aim is to notify people that they have been exposed, giving them the opportunity to avoid exposing others.

Critics of the practice call it a waste of resources that they believe would be better spent on widespread public education. Contact tracing in the case of other sexually transmitted diseases carries the prospect of a cure, but there is currently no cure for AIDS.

Health officials in Los Angeles and New York City have criticized the practice. San Francisco has the largest program in the country.

“I feel if I were exposed to a communicable disease this significant, I would want to know about it,” Ramras said. “I think you’re going to hear a lot of other people say they don’t want to know and the doctor can’t do anything (if they have been exposed).

“But it might make you change your life style. If you’re already infected, I would have to say you have to think seriously about your responsibility to others.”

In San Diego, just one employee is assigned to the project and works on it only part-time. Because he believes his success depends on his ability to ensure confidentiality, he declined to discuss details of cases and said he preferred that his name not be used.

He said tracing contacts in a single case can take a work week, depending on the number of contacts and the time elapsed since contact. He only informs contacts if he can meet them face to face and offer counseling and support.

He has found people receptive to his message, willing to submit to anonymous testing for exposure to the AIDS virus. He stressed that the entire transaction is confidential and that tracing of sexual contacts occurs only with the AIDS victim’s consent.

Since April, 1985, blood banks have been able to accurately test donated blood for AIDS. Though the test is not 100% reliable, Ramras said, there have not been tainted transfusion cases since then.

“If we had more of these high-priority cases (in which men have exposed women), we would try to get funds to handle this,” Ramras said. “With money in short supply, basically the priorities are somewhere else--including such things as education of the general public and trying to get the high-risk groups to be tested.”