TABLE 2.1 Comparison of HIV Surveillance Approaches

Surveillance Approach

Timeliness (re: HIV infection)

Representativeness

Acceptability

HIV case reporting by name

Dependent on HIV testing behaviors

Bisiased based on who tested; includes only those tested confidentially

Possibility of stigma, discrimination, and deterrence from testing

HIV case reporting by unique identifier (ID)

Dependent on HIV testing behaviors

Less test avoidance to avoid reporting to authorities

Reduced possibility of stigma, discrimination, and deterrence from testing

Population-based incidence estimation

Can estimate new infections

Relatively unbiased

Minimal risk of stigma and discrimination because testing is blinded

NOTE: Because the Committee is concerned with identifying an optimal surveillance method, the Committee does not consider in this analysis whether these approaches fulfill case-finding objectives, such as linking individuals to care or conducting partner notifica tion.

The Centers for Disease Control and Prevention create a surveillance system that can provide national population-based estimates of HIV incidence. The recommended surveillance system would estimate new HIV infections using blinded serosurveys of well-characterized sentinel populations (e.g., drug users in treatment, people attending sexually transmitted disease clinics and tuberculosis clinics, clinics serving women of reproductive age), surveys that characterize the populations served by those sites, and advanced testing technologies that are able to identify recent HIV infections.

The Committee is aware that previous attempts to do HIV surveillance have been controversial (Bayer, 1997), particularly before effective therapies became available. In the 1980s, some groups perceived the “public health” responses to AIDS as being aimed at identifying HIV carriers and protecting the blood supply, without any regard for the rights or protection of those infected. In the 1990s, legislation to mandate HIV testing of newborn children without the consent of their mothers (whose HIV antibodies were actually being tested) added to the distrust of public health officials that was already felt by some groups (IOM, 1999). Thus, in



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