California: Report System on HIV Cases Falters

Los Angeles County health officials say California's HIV reporting system has been hurt in its first six months by the failure of some doctors and clinics to provide the data required by law. If these problems are not resolved, officials say they will not be able to track HIV's spread. Next year, when the federal government begins linking its grants to the number of state HIV cases, California risks coming up short.

The tracking system requires medical providers and labs to report all new HIV cases and record additional information such as patient race and risk factors. Patients are given an alphanumeric code to protect their privacy. Previously, the state required reporting only of AIDS cases.

So far, the state has been informed of only a fraction of the cases officials believe exist: 9,155 through Dec. 31, compared to 80,000 cases projected by federal officials. The reporting has been uneven: Orange County (population nearly 3 million), reported 829 HIV cases, while Los Angeles County (population almost 10 million) reported just 1,064.

While most labs are reporting their results, some doctors are balking. "I'd like to help them, but I really don't have the time to do the paperwork that they're asking me, so I'm not doing it," said Dr. Bisher Akil, a Los Angeles physician with about 200 HIV/AIDS patients. Officials in Ventura County have threatened to fine several providers who did not report their cases.

The most daunting part of building an HIV reporting system comes in the first months, when public health agencies must collect information on all HIV cases -- even those that are many years old. Los Angeles County officials found the first six months more difficult than expected. Because of incomplete or nonexistent information from medical providers, the county reported fewer than 10 percent of the more than 7,000 potential cases identified by lab tests through December. Some providers say the use of codes hampers the new system. State Office of AIDS Director Michael Montgomery said reluctant doctors need to realize that the state's ability to track HIV cases will be directly tied to federal funding for services. Los Angeles County officials also plan to make timely reporting a condition of grant funding.

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