HIV/AIDS: House Panel Looks At Names-Based Reporting
The House Commerce subcommittee on health and environment yesterday held a hearing on the HIV Partner Protection Act, H.R. 4431, sponsored by Reps. Tom Coburn (R-OK) and Gary Ackerman (D-NY), and patterned after New York's recently enacted names-based reporting law. Some of the outstanding issues considered during the hearing were:
- the necessity of mandating names reporting;
- how names reporting will improve public health;
- the advantages and effectiveness of names reporting over a coded-identifier system;
- exemptions from civil and criminal penalties for "good faith" errors;
- how the bill will impact anonymous testing;
- should insurers be prohibited from taking "adverse actions" against HIV-positive policyholders?
- how the change in medical technology and federal law has altered the perspectives of those working in the area of HIV partner notification and counseling.
The legislation expands the Ryan White funding requirement to include "past and present partner" notification. It requires physicians to "confidentially" report "positive test results ... and any other information necessary for carrying out a system of partner notification, as is presently done for diseases such as syphilis," to their state's public health department. Public health workers are required to contact any partners to "offer referral for testing and counseling," and to obtain names of other partners potentially infected with HIV. The bill does not impose criminal or civil penalties for non-compliance, and authorizes $10 million for state implementation (Subcommittee memorandum, 9/25).
Testifying before the subcommittee, Coburn said he believed that "this legislation is long overdue" and "may be the only bill passed by Congress this year that actually saves lives." He pointed out that new drug developments allow HIV-positive individuals to "lead longer and healthier lives," which has caused "many who initially opposed" partner notification to "reconside[r]." Coburn noted that partner notification is "standard public health procedure for curtailing the spread of virtually all other sexually transmitted diseases," and stressed that it "is extremely important to disease control because it is the only timely way to alert those in danger of infection," especially women (Coburn statement, 9/29). Ackerman said that the bill's purpose "is not to penalize but to protect the infected and their partners." He added that he "believe[d] that we can take the same sober, pragmatic approach to treating HIV as we do with other diseases without harming anybody's privacy or inviting discrimination" (Ackerman statement, 9/29).
Guidelines Vs. Legislation
Dr. Helene Gayle, director of the Centers for Disease Control and Prevention's National Center for HIV, STD and TB Prevention, testified that the CDC has recently released "updated guidance" on HIV partner counseling and referral services (PCRS). The proposed legislation and the updated guidance "share important goals of notifying partners," Gayle noted. However, she asserted that the legislation would deter and "drastically reduce" anonymous testing. "Our goal is to prevent HIV infection by reducing behaviors likely to transmit the virus and assisting individuals at risk or already infected in gaining access to prevention services, medical care and other needed services" as part of a "comprehensive strategy," Gayle said. Anonymous testing "is integral" to that strategy, she said, because people are more likely to be tested earlier, while they are still asymptomatic. She also noted that trust in the public health system is a key issue for maintaining the viability of a comprehensive anti-HIV effort and expressed concern that such trust might be undermined if potentially infected persons knew that partner notification would be mandatory. She pointed out that because HIV is a "life-long issue" for infected individuals, "PCRS for HIV differs from partner services for other STDs" (Gayle testimony, 9/29). Gayle said that while she did not oppose the bill, she felt that CDC guidelines should be implemented prior to enacting any laws (Kaiser Daily Reproductive Report sources, 9/29).
Not So Fast
The bill was strongly denounced, however, by AIDS Action as "a bureaucratic scheme that could act as a disincentive to HIV testing at a time when there are as many as 300,000 HIV positive people in America who are unaware of their status." AIDS Action Executive Director Daniel Zingale said, "We don't need lists and HIV police force. We need an effective plan to encourage people at risk for HIV to get tested" (AIDS Action release, 9/29).