Why the opposition to AIDS contact tracing?

• Author: Michelena, John, Jr.

SPECULATION ABOUNDS concerning Pres. Clinton's ability to wage a serious war on AIDS, as he promised. So long as the most effective weapon of disease control--the practice of contact tracing--remains virtually unused, doubts will persist. The fact that contact tracing still is regarded as a "controversial measure" suggests that increased funding alone will not curtail the epidemic. Health officials must be consistent and unified in their war of preventing the spread of AIDS.

Clinton's 1993 budget provided for about $4,900,000,000 for AIDS research and services, including counseling, testing, referral, and partner notification. The lion's share of AIDS money has been used in research and education, rather than for contact tracing. Even though scientists are dealing with a virus which may have no cure, the President and Secretary of Health and Human Services Donna Shalala appear committed to continue this trend of spending more Federal money to search for a cure and less in preventing the further spread of the disease using contact tracing, a method that has worked well in past years with diseases such as gonorrhea and syphilis.

The journal Sexually Transmitted Diseases (January-March 1990) explains contact tracing best: "The strategy [is] to try--with the aid of the patient--to trace as many sexual partners as possible, test them for the disease, and treat those who were positive. Each infected contact would become the starting point of a new contact tracing, until no more contacts could be found."

Surgeon General Thomas Parran promoted the use of contact tracing for sexually transmitted diseases (STDs) some 50 years ago. In the mid 1940s, with the availability of penicillin, contact tracing "emerged as a key activity in syphilis control," according to the Centers for Disease Control (CDC), and "this effort was followed by a precipitous decline (76.5%) in reported cases of early syphilis between 1947 and 1952." Federal funding of contact tracing "declined significantly between 1950 and 1955--from $16,000,000 to $3,000,000" and "a resurgence in early syphilis followed in the late 1950s."

In 1961, "a 'task force' that recommended a series of control approaches" mentioned contact tracing as "the cornerstone of these recommendations," and, by 1967, "early infectious syphilis was again on decline." By 1972, a national effort also began for the control of gonorrhea and chlamydia trachomatis infection.

In 1990, contact tracing identified 116,500 persons who had been exposed to syphilis and referred by STD program personnel for examination. This effort led to the detection of 19,600 new syphilis cases and preventive treatment of 43,200 persons exposed to syphilis. Contact tracing also resulted in...