New York governor signs bill to track HIV cases by name

Senate Bill 4422-B, a partner notification bill that uses name-based reporting to track HIV cases, was signed by New York Governor George Pataki on July 7, 1998. The new legislation requires physicians to report the names of all HIV-positive patients to the State Department of Health so that public officials can notify spouses, sexual partners, and needle-sharing partners of possible exposure. This information will become part of a State-wide case surveillance system. Patient advocacy and civil liberties groups did not support the bill, stating that it would erode the physician-patient relationship by breaching confidentiality. The new legislation does not apply to anonymous testing sites, although once individuals begin HIV-related medical treatment, their name will be sent to the State.     

Coburn presses HHS to enforce spousal notification law. Department of Health and Human Services

Representative Tom Coburn of Oklahoma is demanding that the Department of Health and Human Services (HHS) investigate whether States are making good-faith efforts to comply with the spousal notification programs mandated by the Ryan White CARE Act amendments. Coburn is threatening legal action to compel enforcement of the provision. When Congress reauthorized the notification program in 1996, they added language that barred HHS from awarding grants to a State unless it attempted to notify spouses when their partners tested positive. Coburn's contention is that States like New York, California, and New Jersey, which have about 40 percent of the total HIV cases in the country, do not notify spouses without the express voluntary consent of the HIV-positive person. The Centers for Disease Control and Prevention interprets the language of the notification program differently and is working to improve both data collection and prevention services directed toward spouses.     

New York issues draft rules for notification, surveillance

New York's rules for partner notification and HIV case surveillance have been condemned by HIV policy advocates. The proposed rules require diagnostic laboratories or physicians to inform State or local health departments of the names of people whose HIV antibody or viral load tests are positive. Anonymous testing remains a choice, but the initiation of medical care for HIV would trigger the name reporting. Names and addresses of partners would be requested, but patients would be given the opportunity to notify their partners voluntarily. Failing this, physicians and the health department could proceed with notification. Advocacy groups denounce the proposed rules, while counties voiced concern that the State is not bearing more of the program's expense. The governor has asked the State legislature to allocate funding to reimburse the counties. The imposed regulations' backers argue that notification is more cost-effective and direct than HIV prevention messages.     

Mandaled life versus mandatory death: New York's disgraceful partner notification record

In New York City in 1993, there were some 18,000 positive HIV tests but only 350 partner notifications completed by the New York City Health Department. The bleak disparity between these two numbers should haunt us all. We will never know for certain how many lives could have been saved by universally available notification services, but looking at the results of current, obstru tive New York State notification law and policy, we have to know we are facing an enormous public health failure. In states and cities with well-established notification programs, between 50 and 90% of HIV-positive clients cooperate voluntarily with notification and, typically 90% of partners contacted seek HIV-testing and preventive counseling. There are no differences in cooperation based on race, gender or sexual orientation.In New York, urgently required reform means legislation to mandate that notification services are offered to all people who test positive and to require the state to supply enough trained personnel to undertake sensitive notification and counseling. With Black and Latina women — most of whom are mothers — now at the highest risk for sexual HIV infection, New York's refusal to undertake the life-saving policies common elsewhere has not only resulted in a horrible abandonment of a very vulnerable population, but also accelerated the orphaning of children at unprecedented rates.Chris Norwood is Director of Health Force: Women Against AIDS. She is the author ofAdvice for Life: A Woman's Guide to AIDS, Pantheon, 1987.Presented as part of a symposium, Turning Points: Key Policy Debates on HIV in the Inner City, held on April 8, 1994 at the State University of New York, Health Science Center at Brooklyn.     

Texas not immune from suit over nonconsensual disclosure

The Texas Court of Appeals upheld a lower court ruling that the Texas Department of Health is not immune to prosecution for violating the confidentiality of a pregnant woman's HIV status. While participating in a research project the plaintiff discovered the researcher had seen medical records indicating she was HIV-positive. The Code Construction Act of the Health and Safety Code provides for accountability of individuals, corporations and government agencies to adhere to the confidentiality of HIV test results. The Department of Health's motion to dismiss the charges was denied.     

Iowa to impose HIV name reporting, end anonymous tests

Iowa is about to enact legislation requiring names reporting for HIV cases and ending anonymous testing in public health facilities. Senate File 2161 will also authorize physicians to initiate partner notification without the patient's consent and to provide the State Health Department with any relevant information about sex or needle-sharing partners. Iowa was 1 of 20 States where HIV reporting was not mandatory. The bill will also make it a felony for people with HIV to engage in sex or share needles without their partner's consent.     

New HIV reporting plan proposed for Washington state

The Seattle-King County Board of Health in Washington State has endorsed HIV surveillance via coded identifiers. The plan is a compromise between two opposing approaches. It calls for cases to be tracked by name for a maximum of 90 days for epidemiological tracking. However, eventually the names would be converted to unique identifiers and the name documents would be destroyed. People testing positive would have the option of notifying their partners themselves or having the health department assist them. The board is also recommending that State lawmakers strengthen confidentiality laws. The plan is based on recommendations from the Common Ground Task Force.     

Florida investigates breach of confidentiality in HIV records

The Florida Department of Health and Rehabilitation Services inadvertently allowed copies of a computer database with the names of nearly 4,000 HIV-positive persons to be sent to newspaper reporters. The incident may discourage people to get tested for HIV antibodies and will reinforce opposition to mandatory name reporting of HIV cases. The computer disks were sent anonymously to the Tampa Tribune and St. Petersburg Times with a note alleging that William B. Calvert III, a Florida public health worker, helped customers in gay bars use the database disk to determine the HIV status of potential dates. Calvert denied allegations that he violated the Florida confidentiality statute, an action punishable by a $500 fine and up to 60 days in jail. The State plans to use the same personnel, procedures, and computer software to track HIV as they do AIDS cases, but it delayed implementing mandatory HIV name reporting.     

From a single case, investigators discover a web of HIV infection

A partner notification project was deemed successful when investigators at the Pennsylvania Department of Health were able to track down a network of 124 people after the initial index patient (a prison inmate) provided just four names. Investigators located the first four people, who all tested positive, and who identified other partners, who identified additional persons. Overall, forty-four people tested positive. Nearly all individuals had shared injection drugs or sex. Officials say the program was successful because of the precautions they took to ensure confidentiality and trust. Counseling was given to all people who were contacted; and all but three of the 121 people located agreed to HIV-antibody testing. The cooperation which the contacts gave health officials belies the popular belief that drug users or prisoners do not care about themselves or others. Health department staff took 2.5 to 10 hours to locate and interview each contact. The estimated cost was $13,969 or $583 for each case of newly discovered HIV infection.     

Notification scrapped

The Health Department of Puerto Rico aborted plans to require individuals who test positive for HIV to report names of their sex partners to public health workers. The partner notification proposal will be converted to a voluntary program. The controversial provision would have required anyone who tested positive for HIV antibodies to give a list of their sex partners, including addresses and phone numbers, to the health department. Failure to comply would be punishable by fines up to $5,000. AIDS advocates and legal experts predicted that this proposal would have been unenforceable, and a disaster for HIV prevention and treatment efforts.     

New York's partner notification rules to be ready soon

The New York Department of Health expects to issue draft regulations in March explaining the provisions of the State's new partner notification law. After a 45-day period for public comment, the regulations will go into effect. Senate Bill 4422-B requires that public health officials notify spouses, sex partners, and needle-sharing partners that they have been exposed to HIV. Community-based AIDS organizations opposed the law, but most are now resigned to working with notification of partners and names-based HIV reporting. A number of questions remain, including whether the rules will apply only to new cases. Administering the program may take 120 additional health workers, and computer systems in many counties will need to be upgraded.     

Partner notification

The Association of State and Territorial Health Officials (ASTHO) supports partner notification, but is troubled by the methods advocated by the HIV Partner Protection Act (H.R. 4431). H.R. 4431 is a "one-size-fits-all" solution that requires all states to adopt programs to notify the sex or needle-sharing partners of people with HIV. ASTHO believes that states are already improving their existing notification programs, and H.R. 4431 does not allow for the individual needs of each state.     

Washington starts new reporting plan over some protests

In spite of protests and a lawsuit, Washington State has implemented a hybrid name-to-code HIV case reporting system. Under this system, health-care providers will report the names of HIV-infected patients to local health departments, which will convert each name to a code. This code will get passed on to the Department of Health. Within 90 days of completing each case, the local health departments will discard the names. A group of HIV-activists filed suit to block name-to-code implementation because this could potentially create a risk for confidentiality breaches. In addition, the suit complains it forces people with HIV to choose between disclosing their names to health officials or going without medical care, and that HIV-positive individuals have both a liberty and property interest in retaining sensitive information about their private lives. Although the suit has little support among several AIDS organizations, the name-to-code approach is viewed as the best compromise available.     

Ohio Health Department faces police probe, discrimination lawsuit

State police in Ohio are investigating allegations that the HIV unit of the Ohio Department of Health breached State confidentiality laws. In August of 1995 it was reported that a list containing the HIV status and sexual orientation of community volunteers was faxed to an AIDS organization. The HIV unit was disbanded and director Brenda Thomas was reassigned. Subsequently, an employee of the unit filed a discrimination complaint alleging that a supervisor left confidential information about his HIV status on a fax machine.     

Eavesdropping does not violate HIV confidentiality law

The Connecticut Supreme Court rejected an appeal of a class action lawsuit led by prison inmate Kenneth Washington. The Court ruled that the State prisons do not violate State HIV confidentially laws when officials eavesdrop on inmates' phone conversations. Inmates challenged regulations that allowed recording of and listening to phone conversations, stating it violated their privacy, and in the case of HIV-positive inmates, broke HIV confidentiality laws. The trial court and the Supreme Court concurred that HIV-positive inmates are not compelled to discuss their HIV status during a telephone conversation.     

North Carolina decides against ban on home test kits

The North Carolina Health Department is dissatisfied with the currently-available home HIV specimen-collection kits, but enthusiastically supports confidential HIV antibody testing. Unless the State Supreme Court overturns the State's plan to eliminate anonymous testing, these home kits will be the only means N.C. residents have to avoid disclosure of their names. Health officials believe that the telephone-based counseling that augments the home kits is unacceptable and that these kits will impede the State's partner notification program.     

High-risk sexual behavior by HIV-positive men who have sex with men--16 sites, United States, 2000-2002

The majority of persons living with human immunodeficiency virus (HIV) in the United States are men who have sex with men (MSM). High-risk sexual behavior by HIV-positive MSM exposes sex partners to HIV. The risk for transmitting HIV from an infected partner to an uninfected partner through unprotected insertive anal intercourse (UIAI) is greater than the risk for transmission through receptive anal intercourse or oral sex. Differences in sexual risk behavior might be associated with the perceived HIV serostatus of the partner (i.e., HIV positive, HIV negative, or unknown serostatus), as well as with the sex partner type (i.e., steady or nonsteady). During May 2000-December 2002, HIV-positive MSM were interviewed in a behavioral surveillance survey at surveillance sites in 16 states. This report describes insertive anal intercourse practices reported by these MSM; findings indicated that a large percentage of HIV-positive MSM were sexually abstinent, practiced safer sexual behavior by having protected insertive anal intercourse, or had UIAI with an HIV-positive partner. However, a small percentage of HIV-positive MSM reported UIAI with partners who were HIV negative or whose serostatus was unknown; for this group, more intensive and comprehensive HIV-prevention efforts are needed to eliminate this risk behavior.     

Tracking sexual contacts of HIV patients: a study of physician practices.

Notification of sexual partners of HIV-infected individuals has become a focus of debate at local, state, and national levels. Issues of confidentiality and ethical concerns continue to pose challenges to state and local health departments addressing this issue. We conducted a telephone survey with physicians in Syracuse, New York to ascertain opinions about HIV partner notification and the role of public health agencies in that notification process. In general, physicians mostly relied upon the HIV-infected individuals to notify their own partners but were supportive of enhanced efforts regarding partner notification.     

Florida public health workers maintained illegal HIV lists

The Florida Department of Health and Rehabilitative Services ordered the Pinellas County public health office to stop keeping illegal lists of individuals who are HIV-positive. Under State law, public health departments are only authorized to maintain lists of people who develop AIDS, not those who test positive for HIV antibodies. The problem surfaced when an anonymous person sent copies of a computer disk containing the names of nearly 4,000 HIV-positive individuals to the Pinellas County Health Department and two newspapers. The tipster claimed the disk came from a Pinellas public health worker who mislaid it in a gay bar. A Tampa newspaper also reports that health workers in other Florida counties are maintaining illegal lists of people who are HIV-positive. This leak of confidential information is likely to complicate the January 1997 Florida legislation that approved name reporting of HIV cases.     

State wrongfully fired AIDS educator, high court says

A consultant for the Idaho Department of Health was terminated for testifying on behalf of a convicted felon whom she was recruiting as a peer educator for an HIV prevention program. The State Department of Education had a history of concern with consultant Joy D. Hummer who had previously been reprimanded for inappropriate behavior. Hummer believed that Stephen Thomas, a heterosexual inmate who became HIV-positive would be an excellent peer educator because he was articulate, intelligent, and personified the typical young adult who was ignorant about HIV transmission. However, Thomas was a convicted sex offender. Hummer was subpoenaed to testify at Thomas' sentence reduction hearing and she used departmental letterhead to offer her personal viewpoints. A District Court judge ruled that she was wrongfully terminated and the State appealed. The Supreme Court ruled that an employer may not fire an employee based on that employee's compliance with a subpoena. Hummer's $60,100 damage award was reduced to $10,349 in lost wages.