Two years after washington state started tracking HIV cases by name, experts remain split on whether public health or politics is best served by the new surveillance scheme.
Critics have long argued that HIV name reporting discourages people from getting tested, out of fear that their identity could be leaked. They support a system where HIV cases are tracked by a confidential "unique identifier."
But health officials argue that a coded system blurs their snapshot of the epidemic, frustrating efforts to stay ahead of new infections. HIV, they argue, should be monitored the same as other diseases, and name reporting offers the clearest picture.
In a compromise, Washington adopted a "name-to-code" system, in which new HIV cases are first reported by name. After 90 days, the state converts the name into an encrypted code, stripped of all identifying traces. Of the 45 states that now mandate HIV reporting, three are name-to-code, 11 use unique identifiers, and the rest track by name.
According to figures provided to POZ, the number of people tested in Washington clinics fell some 10 to 15 percent since name-to-code started. In 1998, 35,533 were tested, compared to 31,682 in 1999, and 29,313 last year. While the figures are hardly scientific -- testing by private physicians and anonymous centers were not included -- name-to-code proponents have sought to spin the numbers in their favor.
"The more Draconian predictions of the great reduction in the number of people getting tested haven't proved true," says Thomas Bruner, executive director for the Cascade AIDS Project, the largest AIDS group in Southwest Washington, which backed the compromise plan.
But other advocates say the decline is disturbing, given the rise in new infections during that same period. "In my practice, I've told 10 times more people they are positive this year," says Rob Killian, MD, who has one of the state's largest AIDS practices. "And it's not because more people are getting tested."