Physician Advocates Mandatory AIDS Testing

Dr. Cary Savitch leans over the podium at Temple Adat Elohim in Thousand Oaks and hoarsely delivers the same grim AIDS talk he has given at churches, schools, medical groups, service clubs--any place with folding chairs and people to fill them.

“Our AIDS policy is the biggest public-health blunder of our lifetime,� he says, his voice rising. “All we do in public health is count the people when they’re dead.�

An infectious-disease specialist in Ventura, Savitch has seen 40 patients before this evening’s talk. He hasn’t had time to eat. He looks rumpled, exhausted. But before a crowd of fidgeting teenagers and their rapt parents, he pours himself into an unremittingly bleak account of the epidemic.

“I have never cured anyone of AIDS,� he says. “I’m batting zero.� No cure exists, he points out, and despite a series of new drugs, there might never be one; safe sex isn’t.

He delves into an arsenal of dismal statistics: In the U.S., a new HIV case crops up every 10 minutes. In the next nine days, new cases from around the world could fill the Rose Bowl. AIDS is now the leading cause of death among American men 25 to 44 years old. Yet, he says, the death machine grinds on indiscriminately--fueled by doctors, politicians, public health officials and some AIDS patients themselves.

“Most of my patients are honorable but a few have killed more people than Jeffrey Dahmer,� Savitch says.

Politically incorrect? What about Savitch’s praise for Cuba’s practice of detaining and quarantining people with HIV: “Placing political ideology aside, Cuba has behaved more responsibly than most other nations. . . . It is more than just a Communist idea; it is a humane gesture to prevent needless suffering and death.�

His approach has put him at odds with many AIDS activists, who say it smacks of the prejudice that has long shrouded the disease.

“I can’t believe someone like this is still treating AIDS patients 17 years into the epidemic and that he is still so misguided,� said Doug Halter, a Ventura contractor who consulted Savitch when he learned he was HIV-positive about 10 years ago.

Savitch inspires a strong reaction largely because he has a strong sense of mission. In addition to dozens of local speeches and an appearance on the “Politically Incorrect� TV talk show, Savitch wrote a book called “The Nutcracker Is Already Dancing� and paid to print 10,000 copies.

His message is as simple as it is controversial: Everyone--�from the 3-year-old in Montecito to the 25-year-old in San Francisco�--must be periodically tested, no exceptions. HIV infections must be immediately reported to local health officials. Sex partners of those infected must be sought by health workers and told they are at risk--a practice now voluntary.

Savitch says this approach would save countless lives and limit the ability of people such as New York’s Nushawn Williams, accused of spreading the disease to scores of partners, to do so unchecked.

“If I had TB, the health department would be all over me,� Savitch said. “But they don’t do that with AIDS. We have yet to practice the infection control measures I was taught as a medical student.�

Offering Hopelessness to the Afflicted

Many AIDS activists are less than thrilled with Savitch and his crusade.

“He’s taken the trauma that comes with this tragedy and amplified it,� Halter said. “If it was his family or friends dying, he wouldn’t dare say that we’d never find a cure.�

Marge Richey, facilitator of an AIDS support group in the Conejo Valley, said she refused to buy Savitch’s book but read it only when it was given to her. She said she wouldn’t recommend it to anyone with acquired immune deficiency syndrome.

“It takes away all chances of offering hope to anyone,� said Richey, who runs infection control programs at Columbia Los Robles Hospital in Thousand Oaks.

Doug Green, president of a Ventura-based advocacy group called AIDS Care, also criticized Savitch.

“His approach has alienated the HIV community, and that’s exactly what we don’t need right now,� Green said.

Savitch, a mild-enough, 49-year-old father of three, isn’t surprised by such blasts, but he says they still hurt.

“My position has almost become a definition of homophobia and that disturbs me a lot,� he says. “My critics would like nothing more than for me to be some conservative kook. They’d love for me to be Jesse Helms’ right-hand man. I’ve become demonized.�

So why go so vigorously public with such provocative views? Why risk the wrath of AIDS leaders when 10% to 15% of your practice involves AIDS patients? Why clobber patients with a book whose first paragraph is etched in despair: “No person or pill will save you. Every god has been approached. Every prayer has gone unanswered.�

Savitch’s detractors paint him as a mean-spirited grandstander, but he points to his children, ages 13 to 17.

“AIDS is a train wreck,� he says, “and my family is on the train. My choice was to go along with the pap and perpetuate phony hope or to tell the truth.�

Public Has Accepted Living With It

The truth according to Savitch:

“This is a tropical virus, a rain-forest virus that’s escaped. We’re so worried about Ebola that we’ll quarantine airports, but AIDS is the killer and we’ve become accustomed to it. It’s unbelievable! We’re practicing public health on the honor code and it’s been a total failure.�

From the time it surfaced in the early 1980s, AIDS has been treated differently from other contagions because of the fear surrounding it. When a patient was diagnosed, he or she not only had to grapple with a deadly disease but also risk job loss, eviction, insurance problems, all kinds of social and financial exile.

Because of those consequences, health care providers have never routinely tested the general public, or even high-risk groups such as gay men. Military personnel and federal prison inmates are tested. In New York, newborns are tested--a practice put in place only after a four-year legislative battle for a law allowing hospitals to tell mothers their babies are infected.

Doctors, labs and hospitals report HIV infections to local health officials in only 28 states. Many are reported without the names of the patients. In the 22 other states, including California, the disease is not reported until the infection has blossomed into full-fledged AIDS--an average period of eight years. Even then, there is not necessarily a requirement that partners by contacted. Some 36 other diseases, such as tuberculosis and gonorrhea, must be reported immediately.

When AIDS is reported in California, health workers urge patients to disclose the disease to their sex partners. They also offer to break the bad news for them. In Ventura County, they are taken up on that offer about once every three months, according to Diane Seyl, the AIDS nursing coordinator for the county’s Public Health Services Department.

“If we decided that syphilis was a major problem in our community, we’d have more legal ability to go out there and find contacts and test people,� she said.

That perplexes some health workers.

“We’re putting blinders on,� said Linda Doyle, infection control coordinator at St. John’s Regional Medical Center in Oxnard.

“If someone in the emergency room is diagnosed with chlamydia, I have to report it right away to Public Health. They go out and talk to the patient, they follow [up with] partners, they make sure the person is treated.

“But with HIV, there are a huge number of cases we have no way of contacting and there’s a boatload of information we can’t access that might help us get a handle on the disease.�

Savitch is fed up.

“Why is AIDS an exception?� he asks. “We’re contributing to the stigma by making it different. Yes, we have to make sure people don’t lose their jobs because they have AIDS. Yes, we have to make sure they don’t lose their insurance. But how many more people have to die at the altar of privacy?�

That question has struck Felice Jones more than once.

Jones, a model and former “Soul Train� dancer who lives in Thousand Oaks, was infected 14 years ago by her late husband, who had been diagnosed months before they were married and first had sex.

“Nothing was ever said about it,� she recalls. “He never brought it up, and I don’t know how much he knew about what he had. Nobody ever said anything at the hospital or anywhere else. Maybe they told him to tell me--I don’t know.�

At 37, Jones calls herself lucky. Aside from a bout with meningitis, she has maintained her health. She appears in occasional commercials, including several for AIDS awareness. She remarried 10 years ago. She said she and her husband have never engaged in sexual intercourse.

But as well as things have gone for her so far, she echoes Savitch’s conviction that the notion of AIDS prevention is topsy-turvy.

“If someone at Public Health were doing the job right, I would have been contacted,� she said.

Commitment of Health-Care System

But some suspect that an aggressive public health campaign would make the lives of the infected even worse.

Doug Halter is blunt.

“A lot of people I know have committed suicide when they learned their HIV status,� said Halter, a candidate in Ventura’s recent City Council election. “It’s not up to the government to force that kind of knowledge on people.�

Besides, no testing can be thorough, he said, contending that some of those most at risk are the most likely to dodge the test.

Then there is the practicality of the universal testing Savitch supports.

“There’s no evidence that the health system in America is prepared to care for the vast numbers of people who would test positive,� said AIDS Care’s Doug Green. “It’s disingenuous for people to call for universal testing unless they also call for universal health care, with universal access to very expensive drugs.�

Others raise similarly difficult questions: How often would tests be done? Who would pay for them? Would the person tested be identified by name?

Savitch says a saliva test for the HIV virus is given in the military and costs just $4. He admits, however, that he is short of specifics on just how universal testing would work.

“The details should be up to Public Health,� he said. “I told the State Office of AIDS: I’m not a public health specialist but I know enough public health to know that you’re not doing your jobs.�

Wayne Sauseda, the director of that office, disputes that.

“I don’t know of another disease that has been and remains as stigmatized,� he said. “Given the times, there was a lot to be lost in trying to enforce a system of disease prevention that was going to drive away the very individuals we were trying to seek out.�

Even so, times are changing, though not as dramatically as Savitch would like.

“We need to rethink our surveillance practices,� Sauseda said, adding that legislators are likely to confront the problem in their next session.

New drugs keep infected people healthier for a longer time, he said--which means the infection can be transmitted for a longer time without advancing into AIDS and being reported. That leaves epidemiologists tracking the path of infections that spread years before.

Some AIDS leaders are also rethinking their opposition to more aggressive tracking measures.

“People feel we’ve made a great deal of progress on confidentiality and discrimination,� said Michael Weinstein, president of the AIDS Healthcare Foundation in Los Angeles. “People are wondering whether more emphasis should be placed on treating and identifying new patients--although what I fear is there might be more interest in identifying than treating them.�

Whatever the case, change can’t come fast enough for Savitch, who will continue traipsing from talk to talk, conference to conference, pounding his bully pulpit.

“It’s not asking too much for people not to take each other’s lives,� he said.

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

Profile of Dr. Cary Savitch

A Ventura physician arguing forcefully for more aggressive AIDS prevention measures, including mandatory universal HIV testing. His book, “The Nutcracker is Already Dancing,� has upset many in the gay community.

Age: 49

Occupation: Infectious disease specialist

Education: B.S. degree from UCLA, 1969; M.D. from UC San Francisco, 1973; fellowship in infectious diseases, UC San Francisco, 1977-80

Background: First treated AIDS patients in San Francisco as epidemic surfaced in early 1980s. Works on various AIDS task forces. Has tested negative seven times for possible exposure to the virus in his practice. Past president of Ventura County chapter of Physicians for Social Responsibility. Member, International Physicians for Prevention of Nuclear War.

Family: Married to Pamela Jo Newsom, who helped him write “Nutcracker.� Three children, 13 to 17. Beachside resident north of Ventura for 16 years.

Quote: “During my early years of medical training, if anyone had ever told me that there would someday exist a new contagious disease that would be universally lethal and kill millions of people, and that efforts would be made not to identify those infected, I would have thought that situation insane. Today I am witness to this insanity. Sadly, I am also a participant.�