HIV reports to
protect identities

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By Helen Altonn
haltonn@starbulletin.com

Various people in the state Health Department's Diamond Head Clinic were asked to fill out a confidential HIV Infection Case Report, and they "actually enjoyed doing it," said Peter Whiticar, chief of the HIV/AIDS Prevention Branch.

It was a test for the real thing: Laboratories, physicians and other health care providers, starting Oct. 1, must report all new and previously diagnosed HIV infections.

No names will be used.

People in the Diamond Head Clinic were asked to try filling out the report to see if they could follow the directions, how long it would take and if there were any objections, Whiticar said.

He said it is simple, easily done with little chance of error and coded to ensure confidentiality.

The unique Unnamed Test Code uses letters from the first and last names of persons testing positive for HIV and numbers from their birth date.

Most states use names in HIV-reporting, which discourages people from being tested for the infection, Whiticar said. Some use coded systems with a certain identifier, and others have no HIV-reporting.

"It is controversial across the country. Communities are in turmoil on how to report it."

AIDS cases have been reported in Hawaii with names since 1983. The accumulated total was 2,489 as of June 30.

It is estimated that 2,300 to 3,200 island residents are living with HIV, but there is no firm number since such cases have not been reported, Whiticar said.

A new Hawaii administrative rule mandating reporting of HIV infection to the HIV/AIDS Surveillance Program is the result of years of work by the Health Department with a large community advisory committee.

"Because it's such a controversial issue, we wanted the community on board," Whiticar said.

Representing all entities concerned with the issue, the committee began working in 1997 to find ways to obtain more and better information about HIV/AIDS in Hawaii.

In the past, Whiticar said, people with HIV automatically prepared to die with AIDS. Now, with new medications, HIV-infected people are living longer and may never develop AIDS.

As a result, he pointed out, "We're losing track of the epidemic; we're not getting epidemiological information."

Dr. David McEwan, chief of family medicine at the Honolulu Medical Group and one of the Life Foundation's founders, said the advisory committee recommended HIV reporting but said it must be done "in a manner that is sensitive to patient-care needs and privacy," McEwan said. "There was a lot of cordial debate about how to go about best creating this."

He said the final decision, which he believes was acceptable to everybody, was that it be done by a coded system to protect confidentiality and privacy of health information.

State Health Director Bruce Anderson said reporting HIV cases "will help provide a much clearer picture of the spread of the epidemic in Hawaii."

The information will help public health agencies and community organizations allocate limited resources more effectively for HIV prevention, care and services, he said.

Whiticar said anonymous testing still will be available at the Diamond Head Clinic and agencies doing testing under state contract, such as the Life Foundation.

People who test HIV-positive will be asked if a code can be created for them so the case can be reported. "If they don't want to, that's fine," he said, noting such cases ultimately will be reported when physicians provide treatment.

Paul Groesbeck, Life Foundation executive director, said there are arguments for and against HIV-reporting. "Even in our own office, we have a variety of opinions on it."

Some people say "there is still such stigma and fear associated with HIV and AIDS that anything at all that dissuades people from getting tested is a negative," he said. "I'm hoping that is an empty fear."

A code will be used in HIV reporting only to alert health officials to duplicate tests and ensure accurate statistics, he said.