Thorny issue returns: HIV name reporting

January 27, 1993|By Michael Hill | Michael Hill,Staff Writer

The Schaefer administration's insistence on having the names of people infected with the AIDS virus is again causing turmoil in Annapolis.

As it did last year, the administration is arguing that those names need to be reported to the health department if Maryland is to fight the epidemic effectively.

But critics say the measure would be counterproductive and actually hinder the state's efforts to combat the disease.

Not only has the proposal run into opposition, it has become another wedge between two groups who both claim they are trying to do what's best to stem the spread of AIDS -- the state's health agencies, on the one hand, and advocates for AIDS patients who are still smarting over Gov. William Donald Schaefer's dissolution of the state's AIDS commission.

State health officials say they need the names so they can understand better how and where the disease is spreading, thus allowing them to target prevention programs. Opponents counter that the state would actually wind up with less data -- because, fearful that their names would be disclosed, people would decline to be tested for the virus.

An administration attempt to mandate reporting the names of people testing positive for HIV -- the virus that causes AIDS -- was stymied last year in the legislature, which instructed the Department of Health and Mental Hygiene to instead come up with a coding system. Known as a unique identifier, the code would allow accurate reporting to the state agency of those carrying HIV without using actual names.

Now, however, the department is saying that it cannot come up with an acceptably accurate code, and it is again asking for the names.

"All we want is to treat AIDS just like we treat tuberculosis, syphilis, and all the other communicable diseases which have name reporting," David S. Iannucci, the governor's chief legislative officer, explains.

But opponents say that AIDS must be treated differently.

"If you have tuberculosis or even syphilis or gonorrhea, you aren't faced with loss of your health insurance -- of your job, of your home -- if that fact gets out," Dr. Joseph O'Neill, who treats AIDS patients at the city's Chase-Brexton Clinic, says. "But that is the case with AIDS."

Privacy issue

The state currently requires name reporting of those who develop AIDS but not of those who test positive for HIV. People may carry the virus for years before showing symptoms of AIDS.

Those against the by-name reporting say that it would violate the privacy of people who are not yet sick and are in no danger of passing the disease through casual contact. The state currently has 1,944 active AIDS cases, but estimates of the number carrying HIV are in the 15,000 to 18,000 range.

Administration officials say those estimates don't provide enough information.

"All we can get from the AIDS figures is a picture of how the disease was spreading seven to 10 years ago," says Robert W. Eastridge, the deputy secretary for public health.

"For instance, we know from the AIDS figures that the epidemic is spreading among people of color. When this was happening a few years ago, AIDS was still viewed as a white gay disease. That was where all our education and prevention efforts were aimed, and the spread of AIDS has leveled off in that community," he said.

"If we had known then about the spread among peoples of color, in black and Hispanic communities, often because of shared needles, we could have been targeting that population years ago.

"And, who knows, maybe now it's spreading among suburban teen-agers or something. I feel like I'm blind in trying to design prevention programs for the state."

Those fighting name reporting claim it would actually give the state less reliable figures, arguing that people would be reluctant to get tested if they knew a positive test would cause their names to be reported.

Dr. Liza Solomon of the AIDS Legislative Committee notes what happened when Illinois started requiring HIV tests for marriage licenses, with positive tests reported by name to the state.

"There was a dramatic decline in the number of people getting married and an increase in the number of people crossing state lines to get their licenses," says Dr. Solomon, an epidemiologist on the public health faculty at Johns Hopkins. "There would probably be even more people in high-risk groups who would refuse to be tested."

The result of such a requirement, Dr. Solomon and others contend, would be to keep people from learning that they have the virus, delaying their treatment and counseling and thus spreading the disease further. And epidemiologists seeking to track the disease would actually be getting worse data than they would under some sort of coded system.

Creating a code

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