public health officials that effective contact tracing, now more critical than ever because of the potential of early clinical intervention, could be undertaken only if those with HIV infection, but who were not yet diagnosed as having AIDS, could be encouraged to identify their sexual and needle-sharing partners. Despite the central and well-established role of contact tracing in venereal disease control, the notification of sexual and needle-sharing partners in the context of AIDS had been a source of ongoing conflict between gay groups and civil liberties organizations, on one hand, and many public health officials, on the other hand (Potterat et al., 1989).
Contact tracing was always predicated on the willingness of those with sexually transmitted diseases to provide public health workers with the names of their partners in exchange for a promise of anonymity, and it had been viewed by AIDS activists as a threat to confidentiality and as a potentially coercive intervention. Indeed, opponents of contact tracing, some of whom were deeply involved in AIDS policy formulation, typically denounced it as ''mandatory." The debate over partner notification also led some officials and others to challenge the conventional wisdom that had dominated public health thinking for four decades: Was contact tracing an effective way of trying to control the spread of sexually transmitted diseases? Did changing patterns of sexuality, in particular, the increase among some populations of anonymous sexual encounters with a relatively large number of partners, render such efforts ineffective (Andrus et al., 1990)?
With time and a better understanding of how contact tracing functioned in the context of sexually transmitted diseases, some of the most vocal opponents of tracing raised fewer concerns about it in principle and more concerns about the cost of so labor intensive an activity. In the late 1980s, support for voluntary contact tracing came from the Institute of Medicine (1988a), the Presidential Commission on the HIV Epidemic (1988), the American Medical Association (Abraham, 1988), and the American Bar Association (1989). The American Medical Association's support for tracing was justified by its executive director, James Sammons, as having "the potential in the heterosexual society to substantially reduce the proliferation and spread of AIDS" (quoted in Abraham, 1988:4). Most striking, however, was the fact that in 1990 a panel charged by the commissioner of health of New York City with the responsibility of making recommendations on partner notification endorsed such efforts as part of the city's overall AIDS strategy. It supported (without dissent) the use of public health workers to notify individuals placed at risk for HIV infection by their sexual and needle-sharing partners, despite the fact that the panel included representatives of a number of community-based gay organizations (New York Times, 1991).
The CDC has been the most important organization in pressing for the adoption of contact-tracing programs at the state level, where all such programs