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About Just out. (Portland, OR) 1983-2013 | View Entire Issue (Nov. 21, 1997)
12 ▼ n o ven iba r 2 1 , 1907 ▼ Ju*t out local news he Oregon Health Division is proposing that the names of people who test positive for HIV be report ed to the state as well as county health departments. OHD says it plans to use the information to track statistical data about the HIV epidemic; counties will theoretically use the information to contact providers and those with HIV to offer assistance in obtaining medical and social sup port. State health officials speculate that if the pro posal were implemented it could, among other things, paint a more accurate portrait of the dis ease’s reach, as well as help make sure that more people who test positive get the care they need. “Until recently, there wasn’t much we could offer in the way of treatments, but that has shifted remarkably,” says Steve Modesitt, manager of OHD’s HIV surveillance section. “Now there is a lot of hope for people, particularly if they get care early on.” Each state must report AIDS cases. Until now, however, many states, including Oregon, have refrained from widespread reporting efforts for people with HIV. For a decade, those in Oregon who have test ed positive for HIV have been reported anony mously to OHD, and Modesitt stresses that under the new proposal anonymous testing will contin ue to be available to those who want it. However, he says, under the proposal if a person were to test positive and then seek medical care, their name would be reported automatically by health profes sionals. Currently, people’s names are reported to OHD and local health departments when they meet the criteria for an AIDS diagnosis. Cases where the names of people who merely test HIV positive are reported include children younger than age 6, and people who fall into certain “spe cial circumstances” categories, such as convicted sex offenders, and blood and tissue donors. T ot surprisingly, the state’s proposal is gen erating concerns from some who fear that names reporting will deter people from getting tested, as well as lead to an increase in dis crimination. And dialogue over the politically charged issue isn’t limited to Oregon. According to an Oct. 21 New York Times report, the federal Centers for Disease Control and Prevention is floating the idea of recom mending that states require people with HIV be reported by name to state health departments, fol lowing the same practice used for infectious dis eases like tuberculosis and syphilis. (TVventy- eight states currently have HIV names reporting to some extent.) The trial balloon is evoking response nation wide, as is the publication of an article in the Oct. N Nam ing names If OHD has its nay, people who test positive for HIV will be reported by name to state and county health authorities by Inga Sorensen 16 issue of the New England Journal o f Medicine. The piece, authored by Dr. John W. Ward, chief of the CDC’s HIV/AIDS surveillance branch, along with Lawrence O. Gostin, a direc tor of the Georgetown University-Johns Hopkins Universi-ty Program on Law and Public Health, and A. Cornelius Baker, executive director of the National Association for People with AIDS, a leading constituency group based in Washington, D.C., calls for a national system of mandatory HIV reporting. The article says the advent of more promising treatments for HIV disease makes it imperative to better track HIV infections and link people with HIV to care. And because fewer people are progressing to AIDS, proponents argue that AIDS data is no longer an accurate gauge of HIV prevalence. “Unless we revise our surveillance system, health authorities will not have reliable informa tion about the prevalence, incidence and future directions of HIV infection, the kinds of behavior that currently increase the risk of HIV transmis sion or the heightened impact on specific subpop ulations, such as racial and ethnic minorities and women. To correct these deficits, we propose all states require HIV case reporting,” the trio wrote. The CDC plans to release recommendations early next year about whether the names of peo ple with HIV should be reported to health depart ments. The CDC can’t force states and cities to com ply with its recommendations because it is not a regulatory agency. However, it provides funding for most AIDS surveillance efforts, and could include such a requirement as a condition of receiving federal funds. It is not known whether the CDC plans to incorporate a reporting require ment in its funding contracts set to begin in January. Ward told the Times there were no “immediate plans” to tie federal funding to a willingness to conduct mandatory HIV reporting. “But Ward did not rule out a change of the terms under which states and cities receive federal surveillance funds,” the paper reports. “ ‘That’s something we have to decide on,’ he said.” Before issuing its recommendations, the CDC is planning to study the effectiveness of coded identification (also called unique identifier) sys tems in two states, as well as examine public atti tudes toward HIV testing in nine other states. Many advocacy groups favor coded identifica tion over names reporting. The former would assign a random and unique alphanumeric code to each person who gets tested for HIV. Proponents say such a system would preserve confidentiality and provide better epidemiological data by encouraging testing and minimizing duplicate names. (Among others, the Gay and Lesbian Medical Association has announced its strong opposition to names reporting, and has urged the CDC to more aggressively study ways to protect patient confidentiality.) According to the Times, “Baker characterized the journal article as neutral on whether to use names or coded identification. But the article said coded identification did not provide reliable data at a reasonable cost, citing two states, Maryland and Texas, which use coded identifiers that con sist of the last four digits of the Social Security number, as well as birth date, sex and race.” Modesitt also believes a coded identification system may prove administratively cumbersome and expensive. “Plus we’re not only doing this for the num bers,” he says. “We want to make sure people are getting care.” As for privacy concerns, the journal authors argue that the names of people with HIV have already been entered into other databases, “like those of Medicaid and drug-assistance registries, in addition to being widely used by insurers, man aged care organizations and researchers.” Putting our professional to work for you is our passion. ùz&z 'p flid z ¿fit, Qtffl 'ffMte. Hea** Let our Home Team of Portland natives show you the inside moves. 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