Kimberly Bergalis had no way of knowing she'd risked her life by having her wisdom teeth pulled, or that she would be subjected to such cruel cynicism, or that her plight would lead to new national guidelines for health-care workers with AIDS.
The 23-year-old Fort Pierce woman did know she had to speak out. Now Bergalis, the first person in the country to report catching acquired immune deficiency syndrome from a health-care worker, said she's grateful she lived to see some results from her public struggle."There was still a lot of fear," she said. "I was afraid for my little sister, afraid I would come home at night and see our tires slashed. But I realized I had to do it. If it happened to me, it will happen again unless changes are made."
The national Centers for Disease Control disclosed Bergalis' case six months ago, and investigators then seemed skeptical that she could have contracted the fatal virus from her dentist, Dr. David Acer of Stuart, Fla., who pulled two of her teeth in 1987. Acer died of AIDS-related cancer in September.
But this month, the CDC released another report after genetic tests showed a 99 percent probability that Acer infected Bergalis and two other patients. Now the medical profession has begun revising rules on AIDS in the operating room.
The American Dental Association and the American Medical Association recommended that infected doctors tell patients or give up surgery. The AMA also said doctors who risk infection through exposure to patients' blood should be tested.
About 5.3 percent, or 5,000, of all health-care workers are reported to have AIDS, the CDC said.
Last week, Acer's insurance company, CNA Insurance, agreed to award Bergalis $1 million, the full value of the late dentist's policy. Bergalis still seeks monetary damages from CIGNA Dental Health of Florida, which sent her and hundreds of others to Acer.
Bergalis, the only one of the three infected patients to speak out, savors the victory over medical experts whom she said were initially more interested in her sex life than in examining their own policies. AIDS is commonly transmitted sexually or intravenously; Bergalis said she was a virgin who did not use drugs.
"I'm glad to be alive to see these changes are being made," she said. "I never realized how loudly my voice would be heard."
She suffered AIDS symptoms and side effects from drugs, including persistent fevers and infections, hair loss and acne that covered her entire body. For now, she's doing better.
"I would walk into the bathroom and not turn on the light because I didn't want to look at myself," Bergalis said. "It hasn't been easy, but you can live with it."
After dropping from 132 to 98 pounds, Bergalis stopped taking the drug AZT and is up to 112 pounds.
"I'm not saying anyone with AIDS should be stuffed into a closet . . . there's going to be a great need for doctors to treat AIDS patients," she said. "It's a two-way thing. I'm not advocating only that patients know about their doctors. It has to work both ways."
AIDS advocates condemned the AMA and ADA guidelines, saying they would violate the privacy rights of infected health-care workers without improving patients' safety.
Before he died, Acer said he followed infection-control guidelines, including sterilizing his equipment. He said he recalled no blood-to-blood contact with patients.
However, the CDC report said Acer, a bisexual who treated about 1,700 patients after contracting AIDS in 1986, had assistants treat AIDS-related sores in his mouth with his dental tools. It said he reused suction tubes on multiple patients and reused disposable gloves.
CDC guidelines ban doctors with chicken pox or the measles from surgery, but health-care workers with full-blown AIDS face no such prohibition, said Dr. Jacqueline Polder, an epidemiologist with the CDC's Hospital Infections Program.
CDC officials are to meet in Atlanta next month to discuss toughening federal guidelines, including recommending AIDS tests for health-care workers and restricting those who test positive.