Utah hospitals are not routinely testing patients for AIDS.
But a local medical specialist said that policy may change, with the advent of new information, treatment, laws and mounting public fear of the global disease."It could happen within several years that routine screening could be in place," said Dr. Jay Jacobson, of the Division of Infectious Diseases at the University of Utah Medical Center and LDS Hospital.
That's already happening in New York City, which has the highest population of AIDS victims.
Jacobson said that in certain New York hospitals, physicians have found it reasonable to screen all patients for the deadly disease. Because 10 to 15 percent of patients test positive for the human immunodeficiency virus, a precursor to AIDS, it's difficult for physicians there to find time to provide adequate information and counseling to all people tested.
That's not the case in Utah, which has significantly fewer cases. There have been 131 cases reported in Utah since 1983, when the first Utah case was reported. Eighty-three people have died of AIDS since then.
Because the disease poses a lesser threat in Utah than in New York, the Utah Hospital Association, in conjunction with the Utah Medical Association and the Utah Department of Health, has adopted a policy that AIDS testing in hospitals be done voluntarily. And, when it is conducted, that there be counseling before the test - and after, unless the patient refuses.
Intermountain Health Care, which owns 20 Utah hospitals, including LDS, Primary Children's, Cottonwood and Alta View, has implemented a new policy that requires written, informed consent before patients can be tested for the AIDS virus. There are exceptions - such as cases of an emergency or if a patient is unable to give informed consent.
AIDS testing of blood donors and organ donors is mandatory.
The IHC policy says the consent should be clearly documented on a separate and distinct form.
Most other Utah hospitals have implemented similar AIDS policies.
"It has never been the routine practice to test patients for the (IDS) antibody without informing them," Jacobson said. But he speculated that it's possible that at LDS Hospital and other hospitals, some patients may have been tested without being fully informed.
"Basically, if the patient has signs and symptoms characteristic of HIV infection or has engaged in high-risk behavior or has had a known exposure, it would be reasonable to test that patient," he said.
Some physicians have expressed an even stronger sentiment. Some want mandatory testing, without consent, because, according to one who declined to be named, "we don't want to risk our lives and those of our loved ones for someone who is going to die anyway."
Jacobson said there are benefits of AIDS testing: the rate of transmission could be reduced, and if the person tests positive, he can be treated accordingly.
However, the specialist is concerned that policies regarding this disease are often dictated by emotion and fear, rather than facts.
"It's worth noting that we have a `policy' for this disease and we don't for hepatitis B, or other communicable diseases," he said. There are infection-control practices for infectious diseases, but not policies, per se.
Jacobson said medical personnel manage diseases generically. "If a disease is spread by the respiratory route or particles in the air, we recommend wearing a mask. If it's spread by blood, we recommend wearing gloves.
"But we don't write extensive policies for each disease; this is an exception," he said.
Jacobson acknowledged that the IHC policy was developed because of mounting public panic over the communicable disease and because, as yet, hospitals have been given no direction from the courts or Legislature as to who should be tested for AIDS.
"The policy was developed to fill the void and react to an overreaction from the public," he said.