The Washington Blade - August 20, 1999
Lou Chibbaro Jr.

Williams was scheduled to announce his decision at a press conference today, one day after he named Ivan C. A. Walks, a neuropsychiatrist and specialist in managed health care systems, as the new director of the D.C. Department of Health.

The mayor's decision on the unique identifier system came 15 months after Ron Lewis, director of the D.C. Administration for HIV/AIDS, triggered a heated controversy by urging Williams to join 32 states in adopting a system that records the names of people who test positive for HIV infection. If he had followed Lewis's advice, Williams would have broken a campaign promise to back a unique identifier system. He also would have gone against the wishes of 11 of the city's 13 D.C. Council members, who strongly favor the unique identifier method.

Under the unique identifier system, persons who test positive for HIV would be recorded as a code number based on a combination of the person's Social Security number and date of birth.

Lewis argued that a names reporting system is more accurate than a unique identifier system and is preferred by the U.S. Centers for Disease Control and Prevention. CDC has authority to cut off federal AIDS funds to D.C. if the city's HIV reporting system does not meet specific CDC criteria by 2002. Lewis said an inaccurate system would prevent the city ù and federal health officials ù from determining which population groups are being hit hardest by AIDS and how to develop the best ways to combat the epidemic.

Local Gay and AIDS activists expressed strong opposition to Lewis's recommendation, saying a names reporting system would discourage large numbers of people from coming forward to be tested. Activists accused Lewis of exaggerating problems encountered in three states, including Maryland, which had been using a unique identifier system. Activists pointed to new data showing that such a system is superior to a names reporting system because it ensures that more people will agree to be tested.

"Each and every day in our city and cities across the country, AIDS is wreaking havoc as it rips through our families and destroys innocent lives," Williams said in a statement. "The best way to track the spread of HIV is for the District of Columbia government to adopt a unique identifier system that is not only accurate and reliable but will protect the identity of everyone who seeks HIV testing."

"I recognize that fears of discrimination are real, and I want to assure all of our residents that privacy and confidentiality will be protected," he said. "I hope that this confidentiality along with an intensive education effort will encourage residents to seek HIV testing."

Gregory McCarthy, the mayor's policy director, said Williams reached his decision on the unique identifier system early this week after consulting Dr. Walks, his new health director, who supports the mayor's decision. McCarthy said the decision also came after Williams sought the views of a wide range of experts and community leaders. Although Williams has always favored the unique identifier system, and said so during his election campaign, he wanted to give "due diligence" to all information available to him before making a final decision, McCarthy said.

"The main factor was to get a system that will encourage people to be tested," McCarthy said.

McCarthy said the new system is expected to be in place sometime next year. He said the technical details have yet to be worked out and that city officials will enlist the help of experts to assist the city.

"Our system will be customized to our needs," McCarthy said. "We plan to have a system that will meet the highest performance standards."

In a telephone interview Wednesday, Walks said AHA head Lewis has pledged to fully support the mayor's decision.

"It's good to have independent-minded people," said Walks, who serves as Lewis's boss. "I don't have any problem with Mr. Lewis getting on board and working to get this system going."

Some of the city's leading Gay and AIDS activists had expressed outrage that Lewis continued to push hard for a names reporting system despite the fact that Williams stated several times that he favored a unique identifier method. Gay and Lesbian Activists Alliance President Craig Howell, for example, urged Williams to reprimand Lewis for engaging in "insubordination."

But other activists, including Ron Simmons of Us Helping Us, a group that assists African American Gay males with HIV, sided with Lewis. Simmons noted that many of the city's minority residents with HIV rely on city programs for medical care and drugs. Once such residents enter these programs, Simmons pointed out, their names are automatically recorded in city records. Simmons and other activists supporting names reporting said they believe Lewis made a compelling case that names reporting would better track the progression of AIDS in minority communities, enabling governments to respond in ways to curtail the spread of the disease in those communities.

But those backing the unique identifier system, such as Liza Solomon, director of the Maryland State AIDS office, have said improvements in that system have enabled authorities to track the effect of the disease on different population groups as thoroughly as a names reporting system. Solomon said she's convinced that a names reporting system has serious shortcomings because it's likely to discourage the most high-risk populations from getting tested.

Meanwhile, Walks said that while his background is in psychiatry and health care management rather than AIDS services, he has proven record of "bringing in skilled people" to assist him in all areas of public health.

"I'm a good listener and a good learner," he said.

He also noted that one of his specialties is "transcultural psychiatry," which he said focuses on providing care to a multicultural population which includes racial and ethnic minorities as well as Gay people.

Williams, along with top officials in other states, were forced to choose between the two systems of counting people who test positive for HIV after the CDC issued new rules requiring that the states and the District of Columbia adopt such a counting system by 2002 in order to receive federal AIDS funds. The CDC requirement represented a fundamental change in the way the government monitors the progression of the AIDS epidemic. Since the epidemic began in the early 1980s, CDC has required that local governments keep track, by name, of only the number of people with full-blown AIDS, not those who test positive for HIV infection.

Many epidemiologists have said that this original system has not been adequate to properly track the disease because there have always been many more people who were HIV infection and who had yet to develop full-blown AIDS. In recent years, the availability of new and highly effective drugs to treat HIV have added to the importance of identifying people who are HIV-positive, health experts have said, because the new treatment regimens are more effective when begun before people with HIV become ill.

Proponents of a names reporting system argue that states that have adopted names reporting have had a highly successful record of maintaining strict confidentiality of the names, just as D.C. and other states have effectively maintained the confidentiality of the names they now record of people with full-blown AIDS. But opponents say the perception that a names reporting system will lead to breaches of confidentiality will discourage large numbers of people at risk for HIV from coming forward to be tested ù even if the perceptions are not based on fact.

McCarthy, Williams's policy adviser, said the mayor decided that the best system for D.C. would be the one that results in more people being tested.

"He determined the unique identifier system would best achieve that result," said McCarthy. He said the mayor also determined that a unique identifier system would be effective in helping the city track the course of the AIDS epidemic among all population groups.

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