HIV REPORTING AND TESTING: Overview Of State Policies

      The current issue of State Health Notes analyzes trends in mandatory HIV reporting and testing of pregnant women in the context of the challenge state policy-makers face in balancing "the defense of public health with the need to protect the privacy of people who fear social or economic repercussions if their status becomes known." On the issue of HIV reporting, State Health Notes reports that only one-third of the country's HIV and AIDS infections are reported, according to the National Alliance of State and Territorial AIDS Directors. Presently, 30 states track adult HIV cases by name, and three track cases by coded identifiers -- soon to be two since Texas "is in the process of dropping its unique identifier system," according to the National Conference of State Legislatures. "What direction the others go may turn in part on release of national HIV reporting guidelines by the Centers for Disease Control and Prevention, expected imminently," State Health Notes reports. According to Joe Posid, deputy chief of the CDC's HIV/AIDS surveillance system division, "while the guidelines have yet to be finalized, they will probably favor a names-based system on grounds that it is more accurate and efficient." He said, however, that the CDC "is likely to recognize 'states' independence' to do as they best see fit." The release of the guidelines, which was delayed in part due to lobbying by AIDS activists for the CDC "to soften its stance," is expected to impact states such as California, which has no HIV reporting policy. In the meantime, the debate over names reporting versus coded identifiers rages on. Mississippi argues that its names reporting system has enabled it to target more prevention efforts toward African Americans, which has stabilized the population's increasing number of HIV cases, while Maryland officials argue that its use of coded identifiers "has allowed linkage of HIV case reports to death records, has assisted in investigations of unusual strains of HIV and has been used to inform decisions about allocating funds for service delivery." Click here to access recent coverage of HIV reporting in the Kaiser Family Foundation's Daily HIV/AIDS Report.

Perinatal Testing
      With regard to perinatal testing, State Health Notes reviews the history of the debate from 1994 up to the latest developments and addresses arguments from both sides. According to Kathleen Stoll of the Center for Women's Policy Studies, "When we start to mandate testing and treatment (for pregnant women), we're going down a dangerous path" that could result in criminal prosecution for transmitting HIV to the fetuses. So far, only New York has a law that "mandates screening newborns for HIV antibodies," and according to the law's author, state Assemblywoman Nettie Mayersohn (D), the 1996 measure "has helped to identify 100% of HIV-positive newborns and directed 98.8% into treatment" (Guiden, State Health Notes, 11/9). Click here for previous Daily Report coverage of perinatal testing.