By Stephen Smith
http://www.boston.com/news/local/massachusetts/articles/2006/11/15/state_require
s_doctors_to_identify_hiv_patients/
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  The Boston Globe

State requires doctors to identify HIV patients

  By Stephen Smith, Globe Staff  |  November 15, 2006

  Starting Jan. 1, Massachusetts doctors will be required
  to provide the state with the name of anyone testing
  positive for HIV, regulators decided yesterday.

  Proponents of the move, approved unanimously by the
  state Public Health Council, say such reporting is a
  critical component of a national campaign to more
  precisely chart the AIDS epidemic, so that prevention
  and treatment efforts can be directed where the need is
  greatest. Doctors in Massachusetts now use codes rather
  than names to identify cases.

  The state is promising to keep identities confidential
  in secure computer files, but critics have expressed
  fear that the new policy will dissuade some people from
  getting tested for the virus and that no record system
  is foolproof.

  The change, which has been under study for a year and
  was first reported by the Globe in April, emerges as
  federal health agencies increase pressure on states to
  adopt uniform HIV reporting standards, including the
  collection of names. The stakes for failing to do that
  could be substantial: The federal government is making
  financial assistance for HIV patients contingent on the
  reporting of names, and federal officials said the
  change is necessary to slow the rate of new infections.

  "We could lose as much as $15.1 million in the
  Commonwealth," said Sally Fogerty, an associate
  commissioner in the Department of Public Health. "We
  feel that the regulations incorporate the safeguards to
  address any concerns around confidentiality."

  Only five other states have yet to mandate the
  reporting of names with HIV test results, Fogerty said,
  and, like Massachusetts, all five are moving toward
  such a policy.

  Jean McGuire, former chief of the state's HIV-AIDS
  Bureau, characterized the federal government's
  arm-twisting as "most unfortunate" and said the state's
  , system provides sufficient information.

  "I felt that if we had the ability to collect good data
  and not have a name, why not do it that way?" said
  McGuire, now a visiting professor at Northeastern
  University. "We proved our ability to do that."

  In many respects, the adoption of names-based reporting
  reflects the changing landscape of HIV in the United
  States.

  Advocates of the policy maintain that the stigma
  attached to the virus has diminished, as have patients'
  fears about testing, especially with the passage of
  laws to shield people with HIV from workplace and
  housing discrimination. Also, the arrival of potent
  drug cocktails a decade ago rendered a disease once
  regarded as almost a death sentence into a treatable
  chronic condition for US patients.

  Proponents of the requirement say that it's important
  to have a standard practice for tracking HIV cases,
  rather than a patchwork of state-by-state policies.
  Standardization allows for speedy recognition of
  problem areas and fair distribution of federal aid.

  The refined tracking system in Massachusetts will keep
  records about HIV cases within a closed computer
  network at the state laboratory in Jamaica Plain that
  cannot be reached through the Internet or via other
  internal computer systems in the state, said Dr. Alfred
  DeMaria, state director of communicable disease
  control.

  Massachusetts already requires reporting by name for
  many other infectious diseases, such as syphilis and
  gonorrhea.

  Those infected with HIV but who do not have AIDS are
  the lone exception to the infectious-disease reporting
  requirement. That was a reflection of the earliest days
  of the epidemic, when AIDS progressed so rapidly that
  specialists believed that counting AIDS cases was the
  most telling measure of the disease's movement.

  Stephen Smith can be reached at stsmith@globe.com
  stsmith at globe.com

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By Stephen Smith