New Approach to HIV Testing

For decades, required testing and reporting of infectious diseases like syphilis, hepatitis and tuberculosis have been strong public health tools in America. If physicians find cases of the sexually transmitted diseases syphilis and gonorrhea during routine blood tests, for instance, they are required to report those cases to public health officials.

The great exception has been the AIDS-causing human immunodeficiency virus, which has been exempted from testing and reporting requirements since 1985. The reasons for the exemption were many. One school district planned to use required HIV tests to identify and fire infected teachers, for instance. On a nationwide level, some officials feared that testing would drive the infected underground and thus foster the spread of the disease.

Now, however, medical advances have made early detection and treatment of HIV infection the key to reducing transmission and extending life, and laws prohibit discrimination based on HIV status. Public health experts believe that the benefits of carefully implemented HIV testing and reporting have come to outweigh the dangers.

The federal Centers for Disease Control will soon call for more coordinated and extensive monitoring of HIV, and last March the California Medical Assn. recommended that public health departments be notified when individuals test positive for HIV. The AIDS Action Council, a lobbying group for more than 1,400 AIDS service agencies, is rethinking its long opposition to mandatory HIV reporting.

Testing and reporting need to be done carefully. An example of what not to do is a bill recently introduced by Rep. Tom A. Coburn (R-Okla.), which would needlessly stoke public fears by requiring all accused sex offenders to be tested for HIV and allowing funeral homes to refuse to embalm a body if it hasn’t been tested for AIDS. There are also rational worries that HIV status, if not kept private, could result in cancellation of insurance policies and other such problems.

Nevertheless, the need is clear for state and federal agencies to exchange data on HIV infections and encourage more widespread testing. Without a system of this sort, California and other states are all but unable to track changing risk groups and begin testing and education programs. Federal funds for public health efforts are allocated based on the number of AIDS cases a state can document, so money is at issue too.

As UCLA epidemiologist Ralph Frerichs put it, the current lack of tracking and reporting in America makes “winners of the virus but losers of people.”