Changes in HIV testing after implementation of name-based HIV case surveillance in New Mexico.

Abstract

Name-based HIV case surveillance was implemented in New Mexico on January 15, 1998. The objective of the present study was to assess changes in HIV testing patterns after implementation of HIV case surveillance. The timing of the HIV Testing Survey (HITS), developed to gather data on HIV testing patterns among persons at risk for infection through the use of anonymous, cross-sectional surveys,1 offered a natural experiment in New Mexico: HITS-I took place in 1996, before implementation of HIV case surveillance, and HITS-II took place in 1998, after implementation. Participants were men who had sex with men (recruited from gay bars), injection drug users (recruited through street outreach), and heterosexual adults (recruited from a sexually transmitted disease clinic). Participants were required to be 18 years or older and to have been residents of New Mexico for at least 1 year. Study methods have been described in detail elsewhere.2 Fisher exact tests or χ2 tests were conducted to determine whether categorical variables differed significantly in comparisons of HITS-I and HITS-II. Most participants had been tested for HIV at least once: 233 (84%) in HITS-I and 226 (82%) in HITS-II. The percentage of participants tested anonymously was higher in HITS-II (56%) than in HITS-I (45%; P = .001). Concern about confidentiality (as indicated by the statement “You were worried your name would be reported to the government if you were positive”) was cited as a reason for not undergoing testing by 10 (23%) of 44 untested individuals in HITS-I and by 2 (4%) of 49 untested individuals in HITS-II (P = .01). Participants’ most common reasons for not being tested were fear of learning they were HIV positive and the belief that they were HIV negative. The percentage of participants who correctly identified the current HIV surveillance policy was higher in HITS-II (10%) than in HITS-I (3%; P = .001). The proportion of participants who had been tested did not differ among those who knew the policy and those who did not. Overall, reporting policies seemed to be a minor factor in the HIV testing decisions of individuals at risk. The present results help to allay concerns about whether implementing name-based HIV case surveillance serves as a deterrent to HIV testing. Our findings also support the recommendation that states offer anonymous testing to encourage people to learn their HIV serostatus.3 Ongoing assessment of the effect of surveillance policies on HIV testing is needed as more states implement HIV case surveillance.