Maryland lawmakers moved yesterday to protect $26 million in AIDS grants that the state could otherwise lose if the federal government requires it to record the names of those with new infections.
Under budget language adopted by a House subcommittee, the state health department could require laboratories to report the names of people who test positive for HIV, the virus that causes AIDS.
"We think this moves in the right direction of safeguarding federal funding," said Del. John L. Bohanan Jr., a Southern Maryland Democrat who chairs the health appropriations subcommittee.
The state would switch to name-based reporting only if Congress passes legislation tying AIDS funding to the number of newly infected people whose names are reported to health authorities. Congress is considering such a change as it moves to reauthorize the Ryan White CARE Act, its mechanism for funding AIDS programs nationwide.
For a dozen years, Maryland has asked laboratories to report only a 12-digit code identifying people who test positive for HIV. The system, backed by AIDS activists and service providers, was designed to encourage testing of people who feared a stigma if their names were reported.
Over the past year, the Bush administration has pushed name-based reporting to prevent the double-counting of patients tested in two states. Maryland is one of eight states that don't identify new HIV cases by name.
Some patients and activists still fear people will be scared away if their names aren't kept private.
"It would have a negative effect on people's willingness to get tested because, you know, there is still a stigma attached to that diagnosis," said Deborah Hunter of Windsor Mill, who tested positive two years ago. She sits on the advisory council of a clinic affiliated with University of Maryland Medical Center. "There are a lot of people who are positive and haven't even informed their families."
But Dr. Joshua Sharfstein, Baltimore's health commissioner, said authorities can devise a reporting system that ensures confidentiality.
"There are clear public health advantages to name-based reporting if it is done safely and securely," Sharfstein said. "If we know who is testing positive, we can take steps to make sure they have access to health care and offer services."
Currently, the city cannot reach out to people who test positive unless they come forward for services, he said. That anonymity ends when their infection progresses to full-blown AIDS, at which time doctors must report their names.
With the Ryan White reauthorization pending, the amount any state would lose remains uncertain.
Naomi Tomoyasu, acting director of the Maryland AIDS Administration, estimates the potential loss at $26 million, about 55 percent of the money it gets for treatment, counseling, testing and other services.
The potential loss includes $10 million to provide medicine to people who can't afford it, according to a February report by the U.S. Government Accountability Office.
The language adopted yesterday will go before the full budget committee this week. If adopted, it must be approved by the full House and then the Senate.
"The bottom line is that we don't want to lose any of this funding because it's so important," said Del. Peter A. Hammen, a Baltimore Democrat who has been involved in discussions with AIDS activists.
Liza Solomon, president of the AIDS Legislative Coalition and former director of the state AIDS Administration, said she objects in principle to the change but realizes that it might be a necessity.
She said the names of people with other reportable illnesses such as syphilis and tuberculosis are expunged once the patients are cured. But there is no cure for AIDS, so the names would presumably remain on the books for many years.
David Haltiwanger, a psychologist with the Chase Brexton Clinic in Baltimore, said testing rates overall have not declined in states that have switched to name-based reporting. But declines have been seen among two risk groups: gay men and intravenous drug users.
Dr. Michelle A. Gourdine, deputy state health secretary for public health services, said the state has made progress in reducing the stigma of the disease. "We cannot afford to lose $26 million," she said. "If the federal government passes the requirement, we will clearly do what is needed to be done."