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Frerichs, R.R. UNAIDS and the Named HIV Reporting Debate in California.

SEA-AIDS Network, October 29, 1998.

R.R. Frerichs Posting

This message is meant for colleagues at UNAIDS or other international institutions who might be following viewpoints on HIV/AIDS that are moving back and forth here in the United States. 

In the past few years I have encouraged GPA and then UNAIDS to engage in a wider discussion of HIV detection issues, leaving preconceived notions behind and considering feasible and inexpensive ways to reach the majority of people in high HIV prevalence developing countries of Asia. I presented many sensitive issues including screening versus diagnostic tests, pre- and post-test counseling versus regular discussions with a physician, only reporting of HIV status to patient versus reporting to patient and health departments, and partner notification versus only subject notification. I further tried to get clarification of voluntary versus routine versus mandatory testing, so that we could determine the strategic value of each approach at identifying HIV infection and preventing further viral transmission. Yet such discussions did not take place, at least not in an open electronic mail format that others could appreciate and learn from. Instead, silence dominated and positions hardened.

In the mean time, here in the United States we continue to debate testing and disclosure issues, with CDC rather than UNAIDS taking the leadership position. California is now the pivotal state in the US debate over named HIV reporting versus unique identifiers, which if resolved for named reporting would lead to a national reporting system for those who are infected. Once this takes place, persons in developing countries will likely read about the change and want guidance from UNAIDS or other international agencies on what they should do. 

Will the guidance be left to CDC or academic consultants or will UNAIDS provide wise (i.e., practical) counsel in a leadership role similar to what the World Health Organization has done for many diseases and the World Bank is now attempting to do with selected diseases? Maybe or maybe not.

My hope is that UNAIDS will study the debate in the US, assess the applicability for developing countries of Asia, and make recommendations that safe-guard Asian populations from further viral transmission. No doubt UNAIDS is monitoring in detail the ever-growing body of open discussion, journal articles and media coverage of the crucial named HIV reporting issue. Yet the silence from UNAIDS might not be so deafening if people working in the HIV/AIDS field were invited to participate in these monitoring and interpretation efforts, with UNAIDS serving as a neutral arbitrator that encourages creative thinking and experimentation. Using electronic forums such as SEA-AIDS or the International AIDS Economics (found at would be a good place to start.

An example will appear in November when the International AIDS Economics site hosts the online discussion, "The cost-effectiveness of HIV prevention strategies." Hopefully they will address some of the broad financial constraints that now face government and NGO officials in Asia, and the benefits of HIV detection at the individual level.