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PubMed1988

Anti-HIV screening of pregnant women in south-eastern Norway.

Routine anti-HIV screening of 36,053 sera from pregnant women in South-Eastern Norway yielded four (0.011%) true positive individuals. Three of these were known to be HIV-infected before pregnancy. In addition 23 women (0.064%) gave false positive results. Fifty (0.14%) women actively refused anti-HIV test. Anonymous testing of the sera from these women probably yielded one single true anti-HIV positive (2%). The prevalence of HIV-infection among pregnant Norwegian women is very low. Nevertheless, this screening programme could be instrumental in the future for the indirect monitoring of the incidence and prevalence of HIV-infection among the sexually active section of the population. False positive results were rare and caused no real diagnostic problem.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Multistate evaluation of anonymous HIV testing and access to medical care. Multistate Evaluation of Surveillance of HIV (MESH) Study Group.

CONTEXT: Infection with the human immunodeficiency virus (HIV) is the only infectious disease for which anonymous testing is publicly funded, an exception that has been controversial. OBJECTIVE: To assess whether anonymous HIV testing was associated with earlier HIV testing and HIV-related medical care than confidential HIV testing. DESIGN: Retrospective cohort. SETTING: Arizona, Colorado, Missouri, New Mexico, North Carolina, Oregon, and Texas. PARTICIPANTS: Probability sample of 835 new acquired immunodeficiency syndrome (AIDS) cases reported to the state health department's HIV/AIDS Reporting System from May 1995 through December 1996. All had responded to the AIDS Patient Survey; 643 had been tested confidentially for HIV, and 192 had been tested anonymously. MAIN OUTCOME MEASURES: First CD4+ cell count; number of days from HIV-positive test result to first HIV-related medical care, from first HIV-related medical care to AIDS, and from first HIV-positive test result to AIDS. RESULTS: Persons tested anonymously sought testing and medical care earlier in the course of HIV disease than did persons tested confidentially. Mean first CD4+ cell count was 0.427x 10(9)/L in persons tested anonymously vs 0.267x 10(9)/L in persons tested confidentially. Persons tested anonymously experienced an average of 918 days in HIV-related medical care before an AIDS diagnosis vs 531 days for persons tested confidentially. The mean time from learning they were HIV positive to the diagnosis of AIDS was 1246 days for persons tested anonymously vs 718 days for persons tested confidentially. After adjustment for the subject's age, sex, race/ethnicity, education, income, insurance status, HIV exposure group, whether the respondent had a regular source of care or symptoms at the time of the HIV test, and state residence, anonymous testing remained significantly associated with earlier entry into medical care (P<.001). CONCLUSION: Anonymous testing contributes to early HIV testing and medical care.

AIDS Serodiagnosis↗
PubMed1997

Dilemmas of anonymous predictive testing for Huntington disease: privacy vs. optimal care.

Some persons at risk for Huntington disease (HD) seek predictive testing under the protection of anonymity to reduce the risk of insurance discrimination for themselves and their families. While Canadian and European health care systems seem to limit insurance discrimination to life and disability insurance, U.S. residents do not have national health insurance and are concerned about health insurance discrimination. Two persons residing outside Canada requested predictive testing anonymously. Their primary reason for doing so was to avoid the risks of medical insurance discrimination. After a detailed preparatory session and agreement to counselling and to receipt of results in person, we agreed to provide anonymous testing to these persons. One participant, whose psychological assessment was unremarkable, coped well with the predictive testing process and did not have the CAG expansion. The other participant had considerable emotional problems prior to testing, which necesitated postponement of discussion of results and referral for psychiatric assessment and support. Both participants had difficulty maintaining anonymity. The provision of anonymous predictive testing raises several problems. With anonymous testing, clinicians cooperate with participants to exclude insurance companies from information. This may invalidate the contract with insurance companies. A policy response by insurance companies or a universal health care system to protect individuals is preferable. Individuals who request anonymous testing may be precisely those most vulnerable and in need of additional support and counselling. However, the preservation of anonymity is a burden to participants and may frustrate the clinicians' ability to establish rapport in counselling and to provide appropriate follow-up typically available through genetic counselling in predictive testing programs.

Adult↗
PubMed1998

Comparison of the clientele of an anonymous HIV test centre and persons tested in the general population.

This study compares the clientele of a Swiss anonymous test centre with the general population tested. Information was obtained through similar questionnaires submitted to two samples of HIV-tested people aged from 17 to 45 years: the first administered in the context of a general population telephone survey (n = 245) and the second completed during face-to-face interviews of the clientele of an anonymous test centre (n = 250). The test centre sample has higher proportions of younger and single people. Attenders for anonymous testing were more likely to have acquired a new regular partner during the year preceding the interview (48.0% versus 14.4%). These differences remain when controlling for age and gender. Decision to test comes mostly from the respondent's own initiative, but suggestion from a doctor is more frequent in the general population (23.8% versus 0.8%), whereas suggestion from partner or friends is more frequent in the anonymous centre (44.4% versus 3.0%). The anonymous test centre clientele is not different from the general population tested except for the relational situation and origin of decision for testing. The test centre has become a place where the general population finds a response to a situation-specific need for HIV testing.

Adolescent↗
PubMed1994

Anonymous HIV testing: the impact of availability on demand in Arizona.

The purpose of this study was to evaluate the impact of anonymous testing availability on human immunodeficiency virus (HIV) test demand in Arizona. Testing patterns before and after the introduction of anonymous testing were compared. Client knowledge of new test policy and delay in testing until an anonymous option was available were assessed. Test numbers among men who have sex with men showed a statistically significant increase after introduction of an anonymous testing option. Arizona continues to maintain anonymous testing availability. Public health agencies should consider how test policy may influence people's HIV test decisions.

AIDS Serodiagnosis↗
PubMed1999

Detection of early HIV infection and estimation of incidence using a sensitive/less-sensitive enzyme immunoassay testing strategy at anonymous counseling and testing sites in San Francisco.

Timely estimates of HIV incidence are needed to monitor the epidemic and target primary prevention but have been difficult to obtain. We applied a sensitive/ less-sensitive (S/LS) enzyme immunoassay (EIA) testing strategy to stored HIV-positive sera (N = 452) to identify early infections, estimate incidence, and characterize correlates of recent seroconversion among persons seeking anonymous HIV testing in San Francisco from 1996 to 1998 (N = 21,292). Sera positive on a sensitive EIA but negative on a less-sensitive EIA were classified as early HIV infections; sera positive on both EIA were classified as long standing. Seventy-nine sera were from people with early HIV infection. Estimated HIV incidence was 1.1% per year (95% confidence interval [CI], 0.68%-1.6%) overall and 1.9% per year (95% CI, 1.2%-3.0%) among men who have sex with men (MSM). Early HIV infection among MSM was associated with injection drug use, unprotected receptive anal sex, and multiple sex partners in the previous year. No temporal trend in HIV incidence was noted over the study period. The S/LS strategy provides a practical public health tool to identify early HIV infection and estimate HIV incidence in a variety of study designs and settings.

Adult↗
PubMed1994

Comparison of individuals receiving anonymous and confidential testing for HIV.

We assessed the magnitude, demographics, seroprevalence, and reasons for site selection among South Carolina residents who chose to be tested in bordering states offering anonymous testing for human immunodeficiency virus (HIV). Residents tested from July 1990 through July 1991 at selected HIV testing sites in bordering states were surveyed and HIV test results were recorded. Of the 75 residents tested at these sites, 66 (88%) were white, 44 (59%) were male, and 9 (12.3%) of the 73 whose test results were recorded were HIV infected. During the same period, 57,137 individuals were HIV tested in-state by the state health department, of which 1,752 (3.1%) were positive. Residents tested outside the state were more likely to be HIV infected, male, and white than individuals tested within the state. Our findings suggest that although large numbers of South Carolinians are not HIV tested anonymously in other states, those tested anonymously out of state have a different demographic and risk profile than those tested confidentially in state.

Adolescent↗
PubMed2000

The ethics of anonymized HIV testing of pregnant women: a reappraisal.

Seroprevalence monitoring of HIV in pregnant women by anonymized unlinked testing has been widely adopted in the UK and other countries. The scientific rationale is to eliminate participation and selection bias. The ethical justification is that the public good outweighs any harm to individuals. The assumption has been that individuals have had their autonomy respected by the offer of informed consent. In the light of new scientific evidence, it is doubtful that the public good is best served by the continuation of anonymously testing women receiving antenatal care. It is submitted that it is no longer ethical for health professionals to refrain from informing pregnant women of the benefits of voluntary named testing, or to request their consent to anonymized testing. The legal and moral concept of duty of care is examined, and the abrogation of this duty through anonymization is explained.

AIDS Serodiagnosis↗
PubMed1997

Eliminating access to anonymous HIV antibody testing in North Carolina: effects on HIV testing and partner notification.

Anonymous HIV testing may attract persons who might otherwise not be tested but may hinder partner notification. We evaluated the effects on North Carolina's HIV testing and partner notification programs of policy changes that eliminated and later restored anonymous testing in 82 counties. We used an interrupted time-series design to compare counties eliminating with counties retaining anonymous testing. We analyzed HIV testing and partner notification data from before, during, and after elimination of anonymous testing. After elimination of anonymous testing in 82 counties, the mean monthly level of testing (+/- SE) increased by 45%, or 548 (+/- 123) tests per month, while in 18 counties that retained anonymous testing, there was a 63% increase, or 802 (+/- 162) tests per month (p > .05). Among men of all races, testing increased by 16%, or 155 (+/- 35) tests per month, in counties that eliminated anonymous testing; and by 51%, or 305 (+/- 42) tests per month (p < .05), in counties that retained anonymous testing. After elimination of anonymous testing, both county types experienced similar increases in the rate of partners notified. However, partner notification was more successful if the index patient was tested confidentially; 2.7 times as many partners per index patient were notified and counseled. There was no effect on testing or on partner notification rates following restoration of anonymous testing. Substantial community opposition to eliminating anonymous testing was encountered. The policy change appeared to result in a slight decrease in testing among men and a slight increase in partners notified. Programs considering the elimination of anonymous testing should weigh these potential gains and losses, as well as the impact on relationships between the public health and advocacy communities

Confidentiality↗
PubMed1991

Anonymous human immunodeficiency virus surveillance and clinically directed testing in a Newark, NJ, hospital.

From September 1988 to August 1989, in a university hospital in Newark, NJ, 3529 serum and plasma specimens from patients with admitting conditions presumably not associated with human immunodeficiency virus (HIV) infection (Centers for Disease Control, Atlanta, Ga, Sentinel Hospital Surveillance System criteria) were tested anonymously for the presence of type 1 HIV (HIV-1) antibody. Of these specimens, 269 (7.6%) were confirmed HIV-1 seropositive. Overall, 10.3% of male patients and 4.8% of female patients were seropositive. Persons 25 to 44 years old had the highest HIV-1 seroprevalence- 20.9% for male and 7.5% for female patients. Based on this anonymous testing, the number of HIV-infected hospitalized patients discharged in 1988 was estimated. Data on hospital-confirmed HIV-infected patients tested on the basis of clinical suspicion suggest that only 40% of HIV-infected patients were actually tested for HIV-1 infection as part of their medical care in this hospital. These data demonstrate a high prevalence of HIV infection in this patient population and suggest that hospitals serving populations with a high HIV seroprevalence offer routine screening for HIV infection as part of good medical care.

Adolescent↗
PubMed1999

Name-based surveillance and public health interventions for persons with HIV infection. Multistate Evaluation of Surveillance for HIV Study Group.

Name-based surveillance of HIV infection is the law in 31 U.S. states but remains controversial. This policy can be advocated solely to support surveillance of the epidemic, but a frequent argument is that it also provides a public health benefit by allowing follow-up of HIV-infected persons. These persons can then receive timely medical care and can be assisted with notifying sex and needle-sharing partners. Few comparative data are available to evaluate the outcomes of these interventions. In five states with name-based surveillance of HIV infection, the Multistate Evaluation of Surveillance for HIV Study Group surveyed a cross-sectional probability sample of persons with AIDS who tested positive for HIV before the date of their AIDS diagnosis. Health department follow-up of a reported HIV infection was not associated with more timely receipt of medical care after a positive HIV test result. Only 8.6% of persons who delayed medical care after their first positive HIV test result gave concern about being reported by name as a reason; no person gave it as the main reason. Persons who were tested anonymously and those who were tested confidentially did not differ in the mean number of sex and needle-sharing partners notified: Those tested anonymously reported personally notifying 3.85 sex and needle-sharing partners, and those tested confidentially reported notifying-personally and through the health department-3.80 partners. Many researchers and policymakers believe that name-based surveillance of HIV infection will have positive or negative effects on partner notification and access to health care. These results suggest that the potential for such effects has been exaggerated.

Anonymous Testing↗
PubMed1994

[Perception of anxiety in patients requesting anonymous HIV testing].

To determine the manifestations of anxiety in subjects seeking anonymous HIV testing and the aptitude of professionals to perceive it, we administered a semi-structured questionnaire to 481 persons, 281 before and 200 after instructing the practitioners to better decode anxiety during the consultation. The perception of anxiety by the care-givers was analyzed using the Covi scale. The results show that subjects requesting an HIV test often report stressful relational events. Their anxiety its often underestimated by the care-givers, and aptitude to recognise the patient's emotions can be improved. Prevention and quality of counselling depend on correct perception of the emotions which prompt the subject to request a test.

AIDS Serodiagnosis↗
PubMed2000

Monitoring of HIV-1 infection prevalence and trends in the general population using pregnant women as a sentinel population: 9 years experience from the Kagera region of Tanzania.

In the Kagera region of Tanzania, a population-based study was initiated in 1987 followed by the establishment of antenatal-clinic-based sentinel surveillance system in the town of Bukoba in 1990. Repeat studies in both populations in Bukoba in 1993 and 1996 made it possible to study the dynamics of HIV infection prevalence and incidence in the area. This study aims at comparing the findings from this sentinel surveillance system with those of cross-sectional studies in the general population to assess its validity in estimating HIV prevalence and their trends in the general population. A multistage cluster sampling technique was used in the population-based studies whereas the antenatal-clinic-based population was obtained by consecutively recruiting antenatal care attenders coming for the first time during a given pregnancy. Antibodies against HIV infection were tested using two independent enzyme-linked immunosorbent assay (ELISA) antibody detection tests. Unlinked anonymous testing strategy was adopted for the sentinel population. Age-adjusted prevalence among antenatal care attenders decreased from 22.4% (95% confidence interval [CI], 20.6-25.2) in 1990 to 16.1% (95% CI, 15.9-18.8) in 1993 and further to 13.7% (95% CI, 11.8-14.3) in 1996. These results closely resemble those of the general population of adult women in the clinic's catchment area (the town of Bukoba) where the age-adjusted prevalence of 29.1% (95% CI, 24.4-34.6) in 1987 showed a decrease in the studies in 1993 18.7% (95% CI, 15.1-23.0) and in 1996 14.9% (95% CI, 12.0-17.1). The study indicates that general population trend estimates can be generated using sentinel surveillance data based on pregnant women visiting an antenatal clinic for the first time during a given pregnancy. The benefits of using this group outweigh its limitations that are brought about by possible selection bias. Continued surveillance of the epidemic based on antenatal care patients as a sentinel population is therefore recommended.

Adolescent↗
PubMed1991

Prevalence of HIV infection in childbearing women in the United States. Surveillance using newborn blood samples.

A national, population-based survey was initiated in 1988 to measure the prevalence of human immunodeficiency virus (HIV) infection in women giving birth to infants in the United States. Following standardized procedures, residual dried-blood specimens collected on filter paper for newborn metabolic screening were tested anonymously in state public health laboratories for maternal antibody to HIV. As of September 1990, annual survey data were available from 38 states and the District of Columbia. The highest HIV seroprevalence rates were observed in New York (5.8 per 1000), the District of Columbia (5.5 per 1000), New Jersey (4.9 per 1000), and Florida (4.5 per 1000). Nationwide, an estimated 1.5 per 1000 women giving birth to infants in 1989 were infected with HIV. Assuming a perinatal transmission rate of 30%, we estimate that approximately 1800 newborns acquired HIV infection during one 12-month period. Preventing transmission of HIV infection to women and infants is an urgent public health priority.

Anonymous Testing↗
PubMed1998

Anonymous unlinked testing as a sentinel approach: experience in Germany.

STUDY OBJECTIVE: To establish a laboratory sentinel as a supplementary instrument for monitoring the seroprevalence of HIV among childbearing women as a proxy to the heterosexually active population. DESIGN/SETTING: Anonymous unlinked testing of neonatal dried blood spots has been performed in central laboratories of three federal states since 1993. The survey uses residual dried blood spots collected on Guthrie cards for screening of infants for metabolic disorders. These are eluted and tested for HIV antibodies. Data retained with the specimen are only district of residence along with year and month of birth. PARTICIPANTS: Because maternal IgG crosses the placenta before birth, the presence of antibodies in newborns reflects the infection status of the mother. Childbearing women are fairly representative for the heterosexually active general population. MAIN RESULTS: The observed HIV prevalence in childbearing women of less than 1 per thousand confirms the assumption of a low rate of HIV infection in the general population. Significant time trends could not be detected, but HIV prevalence was higher in metropolitan compared with rural areas. CONCLUSIONS: Laboratory sentinels in general and the anonymous unlinked testing of neonatal dried blood spots in particular can supply additional information on HIV seroprevalence. This surveillance system could be expanded to utilise residual samples of other sources as well as to monitor the immunity against specific vaccine preventable diseases and other infectious diseases of public health relevance.

Adolescent↗
PubMed1998

Sexual practices among men attending an anonymous HIV testing site in Singapore.

This study was undertaken to provide an empirical basis for planning safer sex interventions in Singapore by examining the sexual practices of men attending an anonymous HIV testing site. All male clients attending the testing site from January, 1996 to January 1997 were asked to complete an anonymous questionnaire concerning oral and anal sex with men as well as vaginal, oral and anal sex with women within the past year. Questionnaires were obtained from 251 male clients, ranging in age from 17 to 70 years (mean = 30.3). Of these 50.6% reported sex with women only, 39% with men only, 7.2% with both men and women and 3.2% with no one. Condom use was moderately high for anal and vaginal sex but low for oral sex. A risk index based on the riskiness of specific activities showed that bisexuals were the most likely to engage in high risk behaviour whereas homosexuals were the least likely. One factor in the greater riskiness of bisexuals' behaviour appeared to be a higher frequency of unprotected sex with women. These findings provide a preliminary portrait of sexual risk-taking among men in Singapore and suggest the need for continued emphasis on consistent condom use for penetrative sex as well as appropriate precautions for oral sex. The results also suggest the need to develop targeted interventions for bisexuals, particularly with respect to unprotected sex with women.

Adolescent↗
PubMed1991

Voluntary antenatal HIV testing--results of a pilot study.

Voluntary testing for antibody to human immunodeficiency virus (HIV) was offered to 4929 antenatal patients attending two hospitals in South Manchester during a 12 month period in 1989/90 in order to assess the feasibility of obtaining seroprevalence data by this method. Of these patients, 1728 (35%) agreed to a named test, 1396 (28%) to an unlinked anonymous test and the remaining 37% declined to be tested. The proportion of women tested increased from 22% to 88% over the period, and was similar in those with and without an identified risk factor for infection. One HIV antibody positive patient was found; she was tested anonymously and had no identified risk. The substantial cost in time and money required to establish the universal voluntary testing programme and the incomplete patient compliance confirm the importance of the unlinked anonymous surveys currently being established in the UK to monitor seroprevalence in sentinel populations.

AIDS Serodiagnosis↗