HIV Testing After Implementation of Name-Based Reporting

To the Editor: Dr Nakashima and colleagues,¹ interpreting data from their multistate study, concluded that name-based reporting does not appear to affect the use of HIV testing by MSM or IDUs. Their conclusion is premature. First, their data were collected in areas with low rather than high prevalence of HIV and, second, the degree to which testers engaged in high-risk behavior was not measured. Proximity to high-prevalence areas not only increases the chance that risky behavior will lead to infection, but it also affects attitudes and other behaviors of people in risk groups. Among these may be attitudes and behaviors related to name-based reporting. Previous studies^2- 4 in high-prevalence areas found that MSM and IDUs would not test with name-based reporting. In the study by Nakashima and colleagues, only low-prevalence states were represented, with the notable exception of New Jersey. But even in New Jersey, confounding data could explain the increase in testing, eg, an expansion of testing programs and the implementation of name-based reporting within a month of Earvin "Magic" Johnson's November 1991 announcement. Both MSM and IDUs are heterogeneous in terms of degree of risk. The authors cannot rule out the possibility that their results mask an actual decline among MSM and IDUs who engaged in high-risk behavior; ie, an increased use of testing by low-risk-taking members of these groups may have offset a decline among high-risk-taking members. Only by assessing degree of risky behavior can the authors know that high-risk takers continued to test with name-based reporting.