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| health > AIDS > story page |         |
Reporting HIV status may not improve public healthNovember 15, 1999
By Sylvia Westphal 
(WebMD) -- Contrary to the arguments of many researchers and policy makers, a study released Monday shows that reporting HIV-infected persons to public health authorities does not seem to affect how quickly the patients seek medical care, or how many partners they notify of their HIV status. The study -- funded by the Centers for Disease Control and Prevention and published in the current issue of the Annals of Internal Medicine -- is likely to stir up the highly controversial issue of whether names of HIV-positive people should be released to public health departments in order to facilitate surveillance of the disease. Currently all 50 states mandate that people with AIDS be reported by name to local public health departments. However, only 31 states have adopted a similar policy for reporting people who are HIV-positive and haven't developed AIDS. HIV is the virus that causes AIDS.
In states such as California that don't have the policy, the issue is under consideration -- and not without intense debate. Many argue that reporting HIV-infected people by name not only supports surveillance of the disease, but also allows efficient follow-up of infected individuals -- a potential opportunity for public health officials to help people notify sex and needle-sharing partners, and to help get people into care faster, the argument goes. But opponents contend that name reporting deters high-risk people from being tested or from seeking further care -- so as to "hide" from the system. What the new study shows is that many of the arguments both in favor and against name reporting have been exaggerated, says Dennis Osmond, Ph.D., lead author of the study. "The bottom line is that within the realm of public issues about partner notification and getting people into care earlier, name reporting did not help public health departments," says Osmond, a researcher in the department of epidemiology and biostatistics at the University of California, San Francisco (UCSF). The team of researchers, from the CDC, UCSF and the University of California, Berkeley, analyzed data from surveys done in 1995 and 1996 in nine states with different laws for name reporting. Notifying partners and seeking care The surveys revealed that the percentage of people seeking medical care within two months of learning their HIV status was similar in states with and without name reporting (66 percent vs. 67 percent respectively). People contacted by health departments were no likelier to get medical care within the first three to six months of a positive HIV test, according to study results. Name reporting also did not deter many people from seeking care once they knew their HIV status. Most respondents said their major reason for not seeking care was that they felt healthy or did not want to think about HIV. None of the respondents said fear of being reported to the health department was the major reason for avoiding care -- and less than 9 percent of people surveyed mentioned it as a reason at all. The researchers also analyzed partner notification in states with name reporting. They compared people who had taken an anonymous test with those who had taken a confidential one (so that their name was unknown). The average number of partners personally notified by those who had taken an anonymous test was the same (about 3.8 partners) as that for people who had taken a confidential test and had been assisted with notification by the health department. Those results are distressing because one of the purposes of name reporting is to help notify partners who might be infected, says Jeffrey Levi, Ph.D., of George Washington University's School of Public Health in Washington, D.C. "This should be read as something of a wake-up call to health departments," Levi says. But the concern remains that the policy of reporting names may deter some from getting tested in the first place, Osmond says. The study also found that, in states with the policy, more gay men delayed testing for fear of having their names revealed. And that is one reason why many AIDS advocacy groups are fighting the establishment of the measure in states like California. "People have not understood how different HIV is, how great the stigma is, how scared people are," says Fred Dillon, state policy director of the San Francisco AIDS Foundation. But author Stan Lehman, M.P.H., from the CDC, says surveillance is based not on monitoring people, but on reporting a test result. A name is used because that's the way things have traditionally been done in public health for all diseases, he added. "To do old-fashioned public health you got to have information on a person," Lehman says. "But HIV has always been a much more political than normal disease."
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