By STEVEN K. WAGNER

To many people, including homosexuals, intravenous drug users and the relative "few" who contract the deadly disease through other means, there is nothing so ominous as AIDS.

Except, perhaps, AIDS antibody testing.

That's because AIDS testing has, since the disease was first identified in the early 1980s, typically raised fears of ostracism, discrimination and invasion of privacy.

Things are changing, however. A new willingness to undergo "voluntary diagnostic screening," as some call it, has emerged from San Francisco to New York City.

The prime mover has been AZT, the only drug approved by the Food and Drug Administration to treat AIDS symptoms and help fight progression of the disease.

The big news came in mid-August, when federal health officials announced that the antiviral drug has been shown to delay the onset of AIDS in certain groups of infected patients who previously have not shown signs of the disease. In other words, it's now to the advantage of anyone suspected of HIV infection to undergo testing and get started with AZT.

For years, physicians have been urging just that. Such a vast medical problem cannot be solved, they contend, with anything other than a public health policy that identifies the infected and protects the uninfected.

Health and Human Services Secretary Louis W. Sullivan made headlines when he said, in announcing the AZT breakthrough, "We are indeed entering the period when AIDS may become a treatable disease."

That announcement came just weeks after another study showed that AZT arrests the progression of AIDS in patients experiencing initial symptoms of infection.

In late August there was more good news. Dr. Davie M. Kornhauser, an AIDS researcher at the Johns Hopkins University Division of Clinical Pharmacology, announced that AZT apparently remains in the body longer when combined with a drug commonly used to treat gout, allowing AIDS patients to use smaller doses of the costly drug.

To top it all off, the word "vaccine" is again creeping into the vocabularies of researchers, physicians and infectious disease specialists.

Combined, the findings announced in August could benefit some 40 percent of the estimated 1.5 million people infected with the AIDS virus in this country, health officials believe.

It's not surprising, then, that homosexual and AIDS organizations nationwide have begun calling for voluntary HIV testing of people who believe they may have been exposed to the AIDS virus. Early detection could significantly prolong the onset of symptoms--perhaps, some feel, until an effective treatment or cure is found.

"Routine testing is what we've been urging for some time," said Dr. John Dietrich, and AIDS specialist in Reno, Nev. "Who should be tested? In my opinion, anyone who thinks he or she may have been infected."

He added, "There's been much unwillingness to embrace that belief in light of the social and legal consequences that could result"--to put it bluntly, getting fired or getting evicted.

Since AIDS was first identified, homosexual and AIDS organizations have resisted supporting routine testing. With no effective treatment and no medical means to alleviate their plight, why, they ask, would infected persons risk having positive HIV test results released irresponsibly?

Now, with strong evidence that early detection could be lifesaving, and that prolonged use of AZT may not be as costly as once feared, more and more homosexuals are willing to take that risk. Groups that have joined the movement for voluntary AIDS testing include the Gay Men's Health Crisis, in New York City; the San Francisco AIDS Foundation; and AIDS Project Los Angeles, Southern California's largest AIDS organization. These three cities have among the highest rates of AIDS infection in the country.

"It's a very complex problem, even without gay rights," Dr. Dietrich said. "We're repeating the consequences of the freedoms we enjoy in our culture."

W. Shepherd Smith, Jr., president of Americans for a Sound AIDS Policy, in Washington, D.C., agreed that early diagnosis is essential. Equally important, he said, is that Christians encourage a "compassionate response" to those found to be infected wit the AIDS virus.

It must be treated as a medical problem, not a civil rights problem," he said.

Smith pointed to the U.S. military's successful program of AIDS testing--albeit mandatory--in an effort to protect its internal blood supply and offer its personnel optimal medical care. To date, millions of servicemen have been tested without significant problems.

At the same time, Smith suggested that certain other groups be tested, including those seeking treatment at STD clinics, prisoners who re-enter society, persons who enter health-care systems in heavily infected areas, and, perhaps, engaged couples.

(In recent years, Foreign Service personnel and Job Corps applicants have been required to undergo AIDS antibody testing. And, hospitals routinely require blood and urine testing upon admission for other diseases--a form of mandatory testing.)

Smith also dismissed as weak the argument that AIDS testing is largely ineffective based on the six-week to six-month gap between exposure to the virus and development of detectable antibodies in the blood.

"The people who manufacture automobiles inspect them, and they don't catch every problem," he said. "But that doesn't mean they shouldn't inspect them. This is not a perfect world."

He also challenged the issue of confidentiality.

"The HIV epidemic has already gone underground," he said. "Less than 10 percent of infected people know it. New York has a new super-confidentiality law, and still there's no increase in the number of people coming forward to be tested. So, we must focus more on the benefits of knowledge of infection."

Who should be privy to the rolls of people infected with the AIDS virus?

"Apartment owners, high school classmates, firefighters--these are examples of people who don't need, and shouldn't have, knowledge," Dr. Dietrich said. "Instead, those infected need to know, and I would argue their spouses, sexual partners, public health officials, epidemiologists and physicians should have access.

"Right now society needs to decide this issue."

Would being labeled as HIV positive send people infected with the virus underground, where they could continue to spread the disease? Are the 90 percent who are unknowingly infected already underground? How accurate is HIV testing? Would testing help slow the spread of the disease? Does anyone really want to know whether he or she has been exposed to an inevitably fatal disease?

Despite those questions, Bill Hausler, Ph.D., director of the state Hygienic Laboratory at the University of Iowa in Iowa City, is excited about the progress achieved fighting AIDS. And, he's encouraged by movements supporting AIDS antibody testing.

"Medical science has made great progress treating the disease, and I say hallelujah. It's been a long time coming, but in another sense, it's been a short time coming. If you look at the epidemic and the fact that we're dealing with a very new disease, there's been a very rapid response. And, for that I'm very grateful."

Hausler added, "I know (testing) is going to cause a lot of personal group problems. But (success treating the disease) is what we've been waiting for. And now we're seeing treatments that can delay the progression of symptoms."

Whether AIDS antibody testing will significantly help stop the spread of the disease is anybody's guess; much depends upon the degree to which exposed homosexuals respond. Dr. Hausler, in fact, would not speculate on its impact.

He would say, however, the recent shift toward testing is a positive beginning.

"It's like climbing a mountain or building a home. You take one step at a time and see more progress along the way. I'm very grateful for what's been accomplished so far."

Even with AIDS antibody testing, most experts agree the pandemic will get worse before it gets better. Predictions are that more than a quarter million cases will have been diagnosed in the U.S. by 1991.

As the number of AIDS cases grows, so will the cost of medical care. The Public Health Service's executive task force on AIDS has predicted that medical costs will rise to between $8 billion and $16 billion in 1991. And, the prospects in Third world countries are even bleaker.

A shift in attitudes toward testing may provide opportunities to fight the epidemic at its roots. But first, physicians must overcome fear and hopelessness.

Erick Stone, M.D., an emergency physician at Kaiser Fontana Hospital in Fontana, Calif., had hoped to exchange his glasses for contact lenses. But the glasses provide at least some protection from the bodily fluids expelled by the patients he treats, some of whom he knows little or nothing about when he begins treating them in the emergency department. The contact lenses for the moment are on hold.

Dr. Stone welcomes AIDS antibody testing. If he knew more about his patients--whether they've tested positive for the AIDS virus--he could more efficiently treat everyone.

"It would help us be aware of required special handling procedures," he said, adding that each patient must be considered a potential carrier of the virus.

Despite the danger, Dr. Stone believes his primary purpose is to obey and faithfully serve God--and that as a physician under God's protection he is doing just that.

Although he shares the concern that positive HIV testing can result in discrimination against some homosexuals, Dr. Stone does not feel AIDS should be treated differently than other infectious diseases.

"I think it is wrong to put AIDS in a special category. I understand the issue of privacy, but the major issue is the public health. That's where as a doctor I feel frustrated."

What's the answer?

"Education is not the ultimate solution," said Dr. Dietrich, the AIDS physician in Reno. "It's proper and right to educate. But more than information is required to change behavior, and to embrace education as a solution is shortsighted.

"It seems we want to have our drugs and sex and not suffer the consequences, and that won't work. Obedience to Christ causes behavioral change, and behavioral change is essential."
Dr. Stone agreed, carrying it a step further.

"I think the solution is a combination of educational, medical, legislative and spiritual," he said. "These people need spiritual, emotional, physical and psychological healing. Only God can provide that."