Incorrect Location
JAMA · 1999
counseling and testing data system was begun, and 1 (Florida) began HIV reporting very recently and not enough time has elapsed to have adequate data for analysis.The year-to-year median percentage changes in total number of HIV tests during 1992 through 1996 for areas with and without HIV reporting were similar in magnitude and trend. 2 Although we showed no large declines in testing among MSM and other risk groups after HIV reporting, we agree with Arago ´n and Myers and Dr Woods and colleagues that trends in some subgroups-for example, in a small number of MSM concerned with reporting issues-could be hidden within the larger community of MSM.Because there will always be individuals concerned about these issues, we emphasized the importance of making anonymous testing available to promote knowledge of HIV status among at-risk people.The approval by the US Food and Drug Administration of home sample collection tests for HIV expands the availability of anonymous testing in all areas. 3oods et al also state that, except for New Jersey, we included only low-prevalence states.This is incorrect.Louisiana (acquired immunodeficiency syndrome [AIDS] rate of 33.7 per 100 000 in 1997) and Tennessee (25.1 per 100 000) have high AIDS incidence, comparable with their own state of California (29.8 per 100 000) 1 and are considered moderateprevalence states.Dr Solomon and colleagues are concerned that the study design was ecological and subject to the fallacy inherent in such studies, ie, that ecological correlations cannot be validly substituted for individual correlations.However, to demonstrate the impact of a policy change on a large population, ecological methods may be the most practical design.In an individual-level study, each individual's awareness of the change in policy would be determined.On a population basis, this would be a difficult study to conduct, especially if attitudes of high-risk persons were to be assessed.Although our study cannot distinguish between people who were aware ("exposed") and unaware ("not exposed") of the change in reporting policy, the important fact remains that no large changes in testing behavior were observed in the population.Our results are supported by a recent study of more than 2500 people in high-risk groups (MSM, IDUs, and attendees of sexually transmitted disease clinics) in 9 states. 4In this study, more than 60% of participants were unaware of their state's HIV reporting policy and, of those avoiding testing, only 2% stated that reporting was a main factor for not being tested. 4urthermore,