Washington Blade - July 7, 2006
Lou Chibbaro Jr.

"What people are saying is it is time now to do this," said Marsha Martin, director of the D.C. Administration for HIV Policy and Programs.

Leaders of public health and gay advocacy organizations, including the Whitman-Walker Clinic and the Gay & Lesbian Activists Alliance, reviewed a draft of the proposed regulatory change during the past month and have agreed to support it.

The proposed switch to a name-based reporting system in the District comes less than three months before a Sept. 30, 2006, deadline set by the federal government that could result in the loss of millions of dollars in federal AIDS funds if D.C. fails to adopt the new reporting system.

The proposed regulation also comes shortly after city public health officials, led by Martin, launched a new program to encourage HIV testing for all D.C. residents between 14 and 84.

Martin disputed reports by at least one source familiar with the AIDS office that she hoped to downplay publicity surrounding the names reporting proposal out of concern that it could discourage people from getting tested.

"The increase in testing will come about whether we use the unique identifier system or names reporting," she said.

The District, Maryland and Massachusetts currently are the only jurisdictions in the nation that have not adopted a full HIV names reporting system.

Martin said the change would be published in the District of Columbia Register within the next two weeks, which will open the proposal to a 30-day public comment period.

She said city attorneys determined that existing public health law allows the Department of Health, on behalf of Mayor Anthony Williams, to adopt the changes following that review period.

However, Martin said DOH would invite the D.C. Council to review the proposed change upon the Council's return from its summer recess in September. The department would consider the Council's advice and input on the matter, she said.

"This is the official beginning of this process," Martin said. "We are engaging the community in a open and honest process."

The draft proposal states that all physicians licensed to practice in D.C. "shall report all diagnosed cases of HIV and AIDS to the director [of the Department of Health] within [48] hours of diagnosis and furnish information the director deems necessary to complete a confidential case report."

It adds that "any provider, laboratory, blood bank, or other entity or facility that provides HIV testing shall report all cases of HIV infection to the director or his or her designee."

The draft says the reported information must include "the patient's name, address of residence, including city, state, and zip code, gender, race, date of diagnosis or HIV or AIDS and opportunistic infections, the name and telephone number of the person making the report, and the name of the entity providing health or medical services."

It concludes, "Information reported under this section shall be used for epidemiological and surveillance purposes only."

Kim Mills, a spokesperson for the Whitman-Walker Clinic, said the "clinic supports what the city is trying to do with names reporting."

Among the other organizations that have expressed initial support for the proposal are Metro Teen AIDS, La Clinica Del Pueblo, the D.C. Primary Care Association, and the Family Medical Counseling Service, according to people familiar with the proposal.

"The writing has been on the wall on this for some time," said Rick Rosendall, spokesperson for the Gay & Lesbian Activists Alliance, which has backed the unique identifier system in the past. "Just about everybody that has opposed names reporting has changed, mostly because of the threat of the loss of funds."

'It's a mistake'

D.C. Councilmember Phil Mendelson (D-At-Large), who pushed through legislation more than five years ago that established the unique identifier system as the city's method of keeping track of HIV, said he remains opposed to a names reporting system.

"I think it's a mistake," Mendelson said. "Reducing the perception of confidentiality may mean that fewer people will come forward to be tested," he said. "No public health program is any good if people don't come forward for testing."

Public health officials in New York and California, which recently changed from a coded system to names reporting, have said the number of people coming forward for HIV testing did not drop after the names reporting system took effect.

The U.S. Centers for Disease Control & Prevention has cited studies showing that coded, unique identifier systems have failed to accurately count the number of people who test positive for HIV. The most common problem, CDC officials have said, is a duplication of names for people for which the unique identifier system is unable to detect.

An accurate count and a complete demographic breakdown of people who have HIV are needed to develop policies and allocate funds to fight AIDS, the CDC has said.

Earlier this year, a bipartisan coalition in Congress agreed to link the allocation of funds under the Ryan White AIDS CARE Act to states and cities based on the number of people with HIV. In the past, the allocation was based on the number of full-blown AIDS case. All states and D.C. have reported the names of people with AIDS itself since the beginning of the epidemic.

If D.C. were to continue with its unique identifier system, federal AIDS funds under the Ryan White Act would be tied to the number of full-blown AIDS cases rather than the far larger number of people in the city who have HIV.

"That is just not an option for us," said Martin. "So now, the question is how do we develop the best way of making this transition."

Martin said attorneys at the Department of Health wrote the proposed regulation so that it adds "HIV" into the existing regulations that govern all other diseases that require names reporting, including AIDS and cancer.

She noted that under existing public health law, names of individuals with reportable diseases must be kept confidential, and criminal penalties exist for violations of the law and regulations.

"D.C. has never had a breach in a public health reporting issue for any disease, ever," she said.

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