STAURT, FLA. — STUART, Fla. -- It has been nearly 15 months since Dr. David J. Acer died of AIDS and perhaps doomed Kimberly Bergalis, one of his patients, to live -- and die -- as a poignant symbol of that disease.
For all the medical investigations, intensive studies and heated debates about AIDS and AIDS testing that the case has generated, much remains unknown about how Bergalis and four other patients of Acer (pronounced ACK-er) came to be infected. Scientific certainty in the case has proved as elusive as a consensus over the value and need for widespread AIDS testing of health professionals.
But one thing is clear: Residents of this Florida town are frightened and wary. In the words of one dentist, Stuart has become "the Chernobyl of dentistry," where effects of disclosures about Acer and the infection of the five patients have lingered longer than anyone expected.
While no one describes the city of 16,000 people as being in the grip of hysteria, Jack P. Cooper, a retired engineer here, said there was a simmering fatalism and pervasive anxiety in some quarters, as if "our consciousness about this thing is higher, but we don't know what exactly to do about it."
Barely half of Acer's patients at the time he was known to be infected have responded to letters and telephone calls notifying them to go to the local health department or elsewhere for tests.
Some have asked what good it would do since there is no cure for the disease, says Linda Ryan, a supervising nurse with the Martin County Public Health Unit who last year helped notify the more than 2,000 patients by mail. Others express fear about how they would be viewed by family, friends and the community if they did turn out to have HIV, the virus that causes AIDS.
"You know, not all of the AIDS sufferers have been supported and treated well like Kimberly Bergalis has, and people know that," said Ms. Ryan. "There is a stigma for some."
Betty Kroessen, administrator of the health unit, said there had been an increase in tests among heterosexuals generally, but "we assume that in spite of the ongoing publicity, many of Acer's patients made up their minds early on whether they wanted to get tested or not and that's not going to change much."
Investigators for the Federal Centers for Disease Control and Florida health officials are retracing some of their steps as they try to pin down exactly how the five patients were infected. They are reinterviewing scores of people, from former patients to former employees of Acer.
But whether Acer did infect the five is still an open question for some health professionals. While the probability is high that he -- did, say federal health investigators, those same investigators, in the absence of proof of how the infection was transmitted, continue to qualify their pronouncements by saying that the dentist "apparently" infected his patients.
Since the AIDS epidemic began to be documented in the early 1980s, 6,436 health-care providers have been found to have the AIDS virus, said Kay Golan, a spokesman for the Centers for Disease Control. About 140 of these have been dentists.
Currently, said Golan, the agency is aware of about 70 "lookback investigations" nationally of HIV-infected health care workers that are similar to the Acer case. About 9,000 patients have been tested in these investigations, she said, and so far they have found 60 people infected with HIV. But she emphasized that investigations are still trying to determine whether any of these infections were contracted from the health providers.
At one point in the Acer case, investigators were considering employing a behavioral psychologist in an attempt to determine whether the 40-year-old dentist was capable of deliberately infecting five patients. But Thomas Liberti, the deputy director of the Florida AIDS program, said that Acer's family, employees and others convinced them that he would not do such a thing.
Area dentists say they have been fighting to maintain, and in some cases, regain their patients' confidence. Some have gone so far as to get tested and then advertise the negative results.
"The fact is that the last few months have been slower than ever for dentists here and when we get to gether we all can tell stories about patients who were scheduled for six month check ups calling in to say they were canceling until this 'AIDS thing' is cleared up," said Dr. Sorrell Strauss of the Tri-County Dental Society here. "We've become the Chernobyl of dentistry here, and many of us wonder whether this thing can ever be cleared up."