Changes in HIV Testing After Implementation of Name-Based HIV Case Surveillance in New Mexico

New Mexico implemented name-based HIV case surveillance on Jan. 15, 1998. The current study undertook to assess changes in HIV testing patterns after HIV case surveillance was implemented. The timing of the HIV Testing Survey (HITS), developed to gather data on HIV testing patterns among at-risk persons through anonymous, cross-sectional surveys, offered a natural experiment in New Mexico. HITS-I took place in 1996 (pre-surveillance), and HITS-II took place in 1998, after the state implemented HIV case surveillance.

Researchers surveyed men who had sex with men, whom they recruited from gay bars; injection drug users, recruited through street outreach; and heterosexual adults, recruited from an STD clinic. Participants were persons age 18 or older who were New Mexico residents for at least 1 year. Researchers used Fisher exact tests or chi-square tests to compare categorical variables to see if they differed significantly between HITS-I and HITS-II.

Eighty-four percent of HITS-I participants and 82 percent of HITS-II participants had been tested at least once for HIV. The percentage of participants who had been tested anonymously was higher in HITS-II (56 percent) than in HITS-I (45 percent). Yet concerns about confidentiality were cited as a reason not to be tested by only 23 percent of HITS-1 untested respondents and 4 percent of HITS-II untested participants. Participants most commonly cited the fear of finding out they were HIV-positive or the belief that they were HIV-negative as reasons for not being tested.

The proportion of participants being tested did not differ among those who knew the state's surveillance policy and those who did not. Ten percent of HITS-II participants correctly identified the current HIV surveillance policy. Three percent correctly identified the state's surveillance policy in HITS-I.

"Overall, reporting policies seemed to be a minor factor in the HIV testing decisions of individuals at risk," the authors concluded. "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. Ongoing assessment of the effect of surveillance policies on HIV testing is needed as more states implement HIV case surveillance."

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