Comment on Name-Based Reporting

Tesoriero et al.1 report data from multiple data-bases that address the impact of name-based reporting and partner notification on HIV testing in New York State. The authors note several limitations to the data bases underlying their study, but a common and significant limitation is not mentioned. Specifically, none of the databases provides unbiased population-based estimates of changes over time in the size of the at-risk population. The observed pattern of no change in HIV testing over time may, in fact, represent either a decline in testing (at-risk population has increased over time), or an increase in testing over time (at-risk population has declined over time). For instance, population-based data from studies conducted between 1996 and 2003, albeit outside of New York State, illustrate that the size of the population of men who have sex with men exhibiting risky sexual behavior has increased over time.2–4 Among men who have sex with men, it would be reasonable to expect that the size of the population obtaining HIV testing should have increased over time, but according to the data gathered by Tesoriero et al., that has not occurred. Furthermore, the data may in part be based on problematic research conditions that are not easily rectified. That is, the study appears to be confronted with the problem of examining the behavioral impact of an HIV testing policy change in settings wherein anonymous testing already exists and continues to exist. This may send a confusing message to test seekers that, in fact, nothing has really changed. Consequently, it may not be surprising that those concerned may already be using anonymous testing, and continue to do so. Moreover, given that the respondents to Tesoriero et al. either did not know about, or misunderstood, name-based reporting, it is also not surprising that the policy changes had no impact on participants’ test-seeking behavior. However, rather than concluding that name-based reporting has had no impact, we would be concerned that we have failed to adequately inform the population of the implications of this policy change. This failure raises ethical concerns in regard to transparency and respect for personal privacy. Lastly, it may be that the stigma of HIV testing and the virus itself have decreased over time, which could result in name-based reporting being a nonconcern. Unfortunately, that is not an unequivocal conclusion.