HIV REPORTING: California May Join Ranks Of Other States
Legislation backed by the California Medical Association would add California to the growing ranks of states that track HIV cases by name, the Los Angeles Times reports. "In the coming months," moreover, the Centers for Disease Control and Prevention "will release HIV reporting recommendations to states, and ultimately could tie compliance to coveted federal funding." The Times further notes that several bills "are pending in Congress to make HIV surveillance mandatory."
Currently, "about 30 states keep track of cases of infection with [HIV], even if they have not progressed to AIDS." But several states "most heavily affected in the epidemic, including California and New York, have clung to a policy of tracking AIDS cases only." Support for name-based reporting is now coming from "major advocacy organizations [that] have come to a remarkable consensus with public health officials that AIDS-only surveillance puts states at risk of losing track of the changing epidemic." Gay Men's Health Crisis, which recently announced its support for HIV reporting, said tracking full-blown AIDS cases only "is endangering lives and undermining our efforts to fight the epidemic." Now, the Times reports, "the debate has shifted from whether HIV should be tracked to how it should be tracked -- by name or by identity-obscuring codes?"
The American Medical Association and the California Medical Association both favor name-based reporting, "often insisting upon both strong confidentiality protections and ties to treatment." The CMA also backs "anonymous testing sites ... in which people who do not want to reveal their identity can at least find out their HIV status." "Under this complex system," the Times reports, such patients would only be reported by name when they sought medical treatment for HIV." Meanwhile, groups that conditionally support HIV surveillance through a "unique identifier" system include AIDS Project Los Angeles, the San Francisco AIDS Foundation and the American Civil Liberties Union. These groups argue that HIV is a stigmatized disease whose "victims, once identified, still suffer evictions, firings, hate crimes and hostility." Dick Pabich, San Francisco Mayor Willie Brown's (D) AIDS policy adviser, said, "It is certainly our feeling that whatever we would gain from names reporting would be counterbalanced by the loss of people dissuaded from testing." University of California-San Francisco researchers found that name-based reporting "did not appear to help in getting patients into treatment earlier." And UC-San Francisco's Dr. Andy Bindman said the researchers found that anonymous testing increased earlier testing and treatment.
Room For Compromise?
Rep. Tom Coburn (R-OK) is sponsoring a federal bill that "leaves room for states to adopt either name-based or unique identifier systems," although Coburn believes "that unique identifiers are inferior." His bill "would not only mandate confidential HIV reporting in each state, but would require partner notification of infected people and HIV-testing for those accused of sexual offenses at the request of the victim." According to the Times, a proposed compromise on the issue would create "a nonuniform national surveillance system in which some states use identifiers and others use names." The CDC prefers a uniform system, but Coburn "is not insisting upon it." However, some believe the codes are "transitional, ultimately leading to name-based reporting." "[M]any believe that the debate has enhanced awareness that fighting a scourge in the late 20th century does not invite simple solutions, either in medicine or public policy" (Marquis, 3/15).