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Premarriage AIDS counseling.

The AIDS MOBILE has a new mission with a Post videocassette made expressly for marriage license applicants.

We listened to the many different viewpoints of legislators at the Indiana General Assembly; some of the senators want mandatory testing, others are concerned that it wouldn't be cost effective, and others worry that there would

be false positives. It became apparent to us that we certainly need more light shed on the facts.

Our "hands-on" experience in counseling and AIDS testing in the AIDS MOBILE project has convinced us that there is little or no need for controversial mandatory testing. Persons at high, medium, and low risk have all presented themselves to us to be tested voluntarily. It occurred to us that mandatory viewing of a videotape could teach the brideand groom-to-be about AIDS in the nursery and how to avoid it. AIDS babies are not a pleasant sight and they cry a great deal. They are miserable, hurting babies-often left in hospital beds because no one will take them home. They suffer during the entire course of their fulminant, always fatal, disease. No bride would wish to become pregnant if she realized how the odds are stacked against her in the event she or her intended spouse is AIDS-antibody positive.

We were convinced that almost all of the marriage-license applicants who viewed a videocassette about pediatric AIDS would want to be tested. The Saturday Evening Post reader survey revealed that 10,082 (90.1 percent) respondents believe that all marriage-license applicants should be given AIDS tests. Only 783 (7 percent) said no, and 319 (2.9 percent) didn't know.

All applicants could be required w view a videotape with such experts as Dr. James Curran of the Centers for Disease Control counseling them about AIDS. After viewing the tape they could be required to fill out a questionnaire asking if they would be wiring to take the test, offered in a convenient location and at an all inclusive fee not to exceed $5.

Hoosier lawmakers who worried about costs were told about Damon Laboratory in Boston, Massachuseas, which did 4 million tests for the U.S. Department of Defense at $4.00 per test, including the Western blot confirmatory tests after repetitive ELISA tests were positive. (Abbott, Du Pont, or Organon Teknika ELISA test kits cost $1.00 to $1.25 per test.)

The argument against testing because of false positives should be laid to rest. There is no excuse for notifying anyone of positive results on the ELISA screening tests. With the confirmatory Western blot tests, Minnesota state epidemiologist Dr. Mike Osterholm, and Dr. Brooks Jackson of the St. Paul Red Cross, reported not one false positive in more than 250,000 low-risk blood donors in Minnesota. Dr. Jackson flew to Indianapolis to testify about this to the Public Health Committee of the Indiana House of Representatives.

Dr. Robert Redfield of the Walter Reed Army Medical Center reports one false positive per 135,000 persons in low-risk populations tested by the Department of Defense. Those who have tested positive can obtain additional tests to verify results if they truly have no risk factors in their history.

At the Post, we have never suffered a breach in confidentiality, and we have discovered more than 30 AIDS positive individuals who have been helped and who do not wish to infect their loved ones. More than 1,200 tests were done to discover these AIDS-infected indMduals. We believe they were cost effective.

Some AIDS births can be prevented; we can't afford not to prevent these AIDS births from happening.

We believe legislators should make it their business to learn about the AIDS babies that have already been born in their states and the circumstances surrounding their births. In Indiana recently, an unsuspecting girl married a Purdue-graduate engineer, never realizing that he had experimented briefly with needle drugs in his undergraduate days; thus, she never suspected that he was an AIDS carrier. Upon becoming pregnant, she became ill and soon died from AIDS. So did the baby.

At our local University Hospital a young girl died from having married a bisexual and not knowing he carried the AIDS virus.

We realize we can't prevent them all, but we can help. "It's better to light one small candle than to curse the darkness."

An Indiana state senator recently introduced an amendment making it mandatory for marriage-license applicants to be shown a videotape and after the viewing to be offered the AIDS antibody test at various locations-free or for a maximum of $5 each. The amendment passed the Indiana Senate handily-35 to 15.

I wish I could tell you that it survived the House as well, but it met with some unexpected resistance. The duly elected county clerks who would be saddled with the responsibility of showing the videotapes rose up in revolt: "No time to do this, no room to do this in our one-room offices," some said. So the amendment was changed to require the county clerks to provide AIDS literature or show the videotapes.

Dr. Brooks Jackson from Minnesota points out that continuously playing videotapes teaching driving laws are present in Minnesota driving license branches, and suggests that perhaps we could find an unobtrusive way to continuously play AIDS premarriage counseling information.

The Post's Premarriage AIDS Counseling tape was prepared for the AIDS MOBILE, for ministers, and for any others who have an opportunity to counsel newly engaged couples. Here is the script:

Planning a wedding is a very special time in life. It is a time when couples are making many decisions for their future together. But would anyone plan on having a baby knowing it would suffer from an incurable disease? This tragedy could happen to you if you are an AIDS carrier. Even if you have dated only the most respected men and women, what you may fail to consider is that even these trusted lovers may at one time or another have had sex with an AIDSinfected person. Even one sexual encounter could have made your future spouse an unknowing carrier of the HIV virus that causes AIDS. Today you'll learn facts about AIDS that you must know to protect yourself, your marriage partner, and your future children from an incurable AIDS infection.

World health authorities believe that AIDS will soon be the leading cause of disease-related death. The only way you can find out if you carry the AIDS virus is by having a blood test.

Who needs an AIDS test before marriage? Anyone who doesn't know the AIDS-antibody status of all of his or her sex partners for the last ten years. Any of your sexual partners from five or even ten years ago could have made you a carrier of this silent virus. It can lie dormant for seven years or longer while you are a carrier. You could spread it through sexual intercourse without knowing it. And surely you wouldn't want to hurt the one you love the most.

The second group that needs to be tested includes anyone who has had a blood transfusion after 1977. You might have been infected with AIDS from an unsuspecting blood donor.

And the last group that needs to be tested is intravenous drug users who have shared needles.

There are an estimated 1 to 1.5 million AIDS carriers in the United States. The trouble is, of those who are infected, an estimated 90 percent don't know they carry the virus.

How can you protect the person you love from AIDS if you don't know you're AIDS-antibody positive? Your first step must be an AIDS-antibody test.

This test is quite simple.

Dr. Brooks Jackson: "It only requires a needle stick in the arm; it only takes three teaspoons full of blood; the cost is minimal, depending if you get it done in a physician's office or at one of the free AIDStesting centers, The turn-around time is from two days to two weeks."

Dr. J. Brooks Jackson from the Red Cross Blood Center in St. Paul, Minnesota, has seen thousands of people get the AIDS-antibody test.

Dr. Jackson: "I recommend anybody worried about AIDS, even in the slightest, no matter how low their risk factor, get tested because it's simple and low-cost and easy to get."

Dr. Robert Redfield, who has worked extensively with the U.S. Army's testing program, explains why the quicker you have an AIDS test, the better you can protect your spouse.

Dr. Redfield: "The earlier you find out you're infected the better. The other benefit is one to the people who argue, 'Well I don't want to know if I'm infected with the AIDS virus now because I'm in a monogamous relationship, and if I was going to infect someone, I've already infected them.' We now know, as we begin to understand the way this virus interacts with the human being, that as the individual gets sicker and as the T cells go down, the ability to transmit the virus to your partner goes up. Most Americans infected with the AIDS virus today unfortunately don't know they're infected. Probably 95 to 99 percent don't know it. They're less infectious today than they will be tomorrow, and they don't know it. They really are being denied the opportunity to know and are being forced to continue to transmit this virus in ignorance, in spite of their ability to eliminate the transmission."

Dr. Redfield stresses that there are things doctors can do that will delay the deadly progression of the disease.

Dr. Redfield: "Now, I, as a doctor, can't cure the AIDS virus, but I also can't cure heart disease, diabetes, or hypertension, and yet I treat patients with heart disease, diabetes, and hypertension. Just like that, I can't cure the AIDS virus but I can treat it. I can optimize your care if I know you're infected. I can even give you an opportunity to know what your illness is doing over time rather than leave you in a great degree of uncertainty. If you can tolerate the drugs, I can prevent the leading cause of death, pneumocystis pneumonia, but I can't if I don't know you're infected with the AIDS virus and that you're now at risk for pneumocystis pneumonia. And now I have AZT therapy that I can give you to prolong your life and quality of life once your T cells are less than 200, but I can't do that unless I know that you're infected and that your T cells are less than 200."

AIDS testing is also an important factor when couples are planning to have children. Dr. Jim Curran, the director of the AIDS program at the Centers for Disease Control, warns that women who carry the AIDS virus face two grave risks from pregnancy.

Dr. Curran: "There's dual concern here. Some preliminary information suggests that women who are infected with the AIDS virus are more likely to become sick themselves if they become pregnant. Pregnancy itself is suppressive to the immune system. You sort of have a dual shot when you have the AIDS virus, plus pregnancy. The second concern-the concern that all of us have-is that women may transmit the virus in utero or maybe at the time of birth to the infant."

What are the chances that they will transmit it?

Dr. Curran: "The data are not complete on that, but available information would suggest that about 20 to 65 percent of babies born to infected mothers are infected themselves."

Dr. Curran offers a practical solution to women who want to make sure that they avoid the tragic consequences of pregnancy and AIDS.

Dr. Curran: "All women at increased risk of HIV infection or who have sexual contact with people at increased risk should be voluntarily counseled and tested for the virus. If they are not pregnant they should be strongly advised to consider avoiding pregnancy. I think now that we know even more about pediatric AIDS and the very high risk of infection to the newborn from the pregnant woman, we can change the words 'consider avoiding pregnancy' to 'very, very, very strongly consider avoiding pregnancy,' because pediatric AIDS is a horrible disease. Often the mother herself will have a terminal illness, and the child will wind up parentless even if he or she does not become infected."

Dr. Beny Primm, a member of the President's national AIDS commission, stresses that once people know they carry the AIDS virus they can begin to practice certain behaviors that will prevent them from developing a full-blown case of AIDS.

Primm: "I tell them that they must stop smoking, stop drinking, stop taking drugs of any kind, get proper rest, and eat a proper diet. I also tell them to get a lot of exercise, get some sunshine, and certainly practice everything good in terms of hygiene so that they don't expose themselves to any infectious process unnecessarily. If they follow that, I think they can live for a very long time being infected with the virus and perhaps have a long-lasting life. They may remain among the 60 or 70 percent of people who are positive for the antibod but don't develo AIDS."

The benefits of having an AIDS-antibody test before marriage are many:

1. You can take the steps necessary to avoid infecting your husband or wife.

2. You can make lifestyle changes that will strengthen your body's resistance to the AIDS disease.

3. You can prevent another innocent baby from paying an awful price: needless suffering from incurable AIDS. If you take the precaution of being tested before taking on the responsibility of marriage, this cruel catastrophe from your union could be avoided.

Should ou be worried that your AIDS test will come out positive even though you don't really carry the virus?

If you are ever told your test is AIDS-antibody positive, the first thing you should ask the person who tells you is:

Was my serum also tested by the confirmatory Western blot test? If you didn't have the confirmatory test, you shouldn't have been told you were positive.

Jackson: "We tested over 600,000 samples representing donations from 250,000 people and we found not one false-positive result."

If you have even the slightest risk of exposure to the virus that causes AIDS, before you walk down the aisle, you should first walk out and be tested for AIDS. The test is simple and easy, and it could very well save your life or the life of the baby that you might bring into the world-the baby who depends upon you for protection and loving care.

Once you know you are safe from any risk for AIDS, donate blood to the Red Cross blood bank or the blood bank nearest you. Giving blood to the Red Cross or to your independent blood bank may be one of the most important contributions you will ever make-the gift of life! Dick Schubert, the president of the American Red Cross explains.

Schubert: "My sense from speaking to volunteers across the country is that volunteer involvement is possibly the most exciting, rewarding part of their lives. They have become involved because they want to give of themselves.

They find in an organization like the Red Cross the opportunity to reach out to desperately needy peopleand to realize that they are change agents; they're making a difference. So my guess is that if you had interviews with the great majority of the 1.5 million American Red Cross volunteers, you'd find very satisfied, very excited people."

Yes, here comes the bride. And here come the wedding vows to take your betrothed loved one for better or for worse. With a simple AIDSantibody test before the wedding, that "worst" will not include the AIDS virus.

Best wishes for a long and fruitful marriage.
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Copyright 1988 Gale, Cengage Learning. All rights reserved.

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Title Annotation:includes various experts' opinions
Publication:Saturday Evening Post
Date:Apr 1, 1988
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