Lettrs
Anonymity in Tesfing for BYIV Antibodies Desired Option Starting in January 1987, the Arizona health department required that all individuals who test HIV-positive be reported by name. To encourage individuals to seek testing, the department dropped this requirement in March 1989. Later that year, I directed a survey to investigate why gay and bisexual men in the Phoenix area do or do not seek HIV testing. Questionnaires were distributed at gay bars and events and, to a more limited extent, through gay churches and friendship circles, physicians-withmanyAIDS patients, gay and bisexual men's organizations, and community AIDS organizations. The questionnaires were returned by 512 men. This translates into a conservatively estimated response rate of 29%; the true response rate probably was higher because some questionnaires may not have found their way to eligible respondents. Of the 512 respondents, 63% had been tested for HIV antlbodies. The most common reason given for not getting tested (mentioned by 50% of untested persons) was not wanting the state to learn if they tested positive. In addition, 36% mentioned fear of discrimination if others learned they had been tested. Only 37% of the untested respondents knew that they could now be tested in Arizona without having their name reported to the health
department. These data are consistent with previous research on this topic1-3 and with the state's preliminary statistics from the first 3 months after anonymous testing became available.4 During those months, requests for testing from gay and bisexual men increased 40.3% in Arizona, compared with 18.6% in New Mexico where laws have always guaranteed anonymous testing. Fear of discrimination was not the only reason why individuals avoided testing. Forty-one percent had not sought testing because they assumed they were HIV-negative and 37% because they assumed or feared they were HIV-positive. On average, men who assumed they were negative had fewer sexual partners than other untested men but were just as likely to engage in receptive anal sex without condoms (chi squareP < .05). In addition, persons who were older than 45 years;
September 1991, Vol. 81, No. 9
persons who did not consider themselves gay; and persons who knew no one who was FHV-positive, had AIDS, or had died of AIDS were more likely to assume that they were HIV-negative (chi square P < .05). These data suggest the benefits of establishing anonymous testing sites and of advertising both anonymous testing and the benefits, regardless of test results, of being tested. [ Rose Weilt, PhD Rose Weitz, PhD, is with the Department of Sociology at Arizona State University, Tempe, AZ 85287-2101.
References 1. Fehrs LI, Fleming D, Foster LR, McAlister RO, Fox V, Modesitt S, Conrad R. Trial of anonymous versus confidential human immunodeficiency virus testing. Lancet. Aug. 13, 1988; 379-382. 2. Fordyce EJ, Sambula S, Stonebumer R. Mandatory reporting of human immunodeficiencyvirus testingwould deter blacks and hispanics from being tested. JAMA.
1989;262:349. 3. Kegeles SM, Coates TJ, Lo B, Catania JA. Mandatory reporting of HIV testing would deter men from being tested. JAMA.
1989;261:1275-1276. 4. Arizona Department ofHealth Services. Impact ofAnonymous Testing Option in Anizona: Prelininary Results; Sept 26, 1989.
The NHSC Mandate The letter from Drs. Brown, Stone, and Sidel in the November 1990 issue of the Amencan Jounal of Public Health concerning the National Health Service Corps (NHSC) presents a narrow approach to the mandate the NHSC seeks to
meet.' Scholarships have been a useful tool and will continue to be. But as the sole major effort in recruitment, they created a number of problems, some of which the survey Brown et al. documented. Others are related to the length of the training pipeline. During the 6 to 7 years from sign-on to service, the scholars' family status frequently changed and/or his professional interest was no longer in primary care. In addition, there was little leeway for the NHSC to secure personnel to meet specific needs. The staff had only what was coming out ofthe pipeline. There is no way for them to influence the number of family physicians, pediatricians, and general internists that would be available.
Thus, with the current 10-year reauthorization of a revitalized NHSC, recruitment will utilize some scholarships, some loan repayment (which does allow the Corps to meet specific personnel needs), and continue the emphasis on recruitment of nonobligated health professionals to serve varying terms in areas of need. The development of health care teams (physicians, physician assistants, nurse practitioners, certified nurse midwives) is also a very important goal in meeting these needs. The issues of retention (33% of the respondents to their survey) is also receiving a great deal of attention. Very few of these health professionals are employees of the NHSC, but of community health centers, rural health centers, migrant health centers, and programs serving special populations. These clinics may be receiving federal or other governmental support, but the professionals in them are rarely employees of the federal govemment. Everyone is aware, yet needs to be reminded, that these health professionals are needed to serve in areas that have been difficult to staff because of isolation, poverty, special needs, sparse populations, or just the absence of a support network. These challenges and the approaches to their solution are under constant study by the staff of the NHSC and the National Advisory Council to the Corps. The National Advisory Council advises both the director of the Corps and the secretary of the Department of Health and Human Services. Its recommendations, with specific plans, outline approaches to these issues. Scholarships are not the sole solution to the complex issue of providing health care to the underserved. [ J. Jerry Rodos, DO J. Jerry Rodos is with Chicago Osteopathic Health Systems, 5200 South Ellis Avenue, Chicago, IL 60615. He also is consultant to the Director of the National Health Service Corps. These comments do not necessarily reflect the opinions of the US Department of Health and Human Services or the National Health Service Corps.
Reference 1. Brown JB, Stone V, Sidel VW. Decline in NHSC physicians threatens patient care. Am J Public Health. 1990;80:1395-1396. Letter to the Editor.
American Joumal of Public Health 1213
Anonymity in Tesfing for BYIV Antibodies Desired Option Starting in January 1987, the Arizona health department required that all individuals who test HIV-positive be reported by name. To encourage individuals to seek testing, the department dropped this requirement in March 1989. Later that year, I directed a survey to investigate why gay and bisexual men in the Phoenix area do or do not seek HIV testing. Questionnaires were distributed at gay bars and events and, to a more limited extent, through gay churches and friendship circles, physicians-withmanyAIDS patients, gay and bisexual men's organizations, and community AIDS organizations. The questionnaires were returned by 512 men. This translates into a conservatively estimated response rate of 29%; the true response rate probably was higher because some questionnaires may not have found their way to eligible respondents. Of the 512 respondents, 63% had been tested for HIV antlbodies. The most common reason given for not getting tested (mentioned by 50% of untested persons) was not wanting the state to learn if they tested positive. In addition, 36% mentioned fear of discrimination if others learned they had been tested. Only 37% of the untested respondents knew that they could now be tested in Arizona without having their name reported to the health
department. These data are consistent with previous research on this topic1-3 and with the state's preliminary statistics from the first 3 months after anonymous testing became available.4 During those months, requests for testing from gay and bisexual men increased 40.3% in Arizona, compared with 18.6% in New Mexico where laws have always guaranteed anonymous testing. Fear of discrimination was not the only reason why individuals avoided testing. Forty-one percent had not sought testing because they assumed they were HIV-negative and 37% because they assumed or feared they were HIV-positive. On average, men who assumed they were negative had fewer sexual partners than other untested men but were just as likely to engage in receptive anal sex without condoms (chi squareP < .05). In addition, persons who were older than 45 years;
September 1991, Vol. 81, No. 9
persons who did not consider themselves gay; and persons who knew no one who was FHV-positive, had AIDS, or had died of AIDS were more likely to assume that they were HIV-negative (chi square P < .05). These data suggest the benefits of establishing anonymous testing sites and of advertising both anonymous testing and the benefits, regardless of test results, of being tested. [ Rose Weilt, PhD Rose Weitz, PhD, is with the Department of Sociology at Arizona State University, Tempe, AZ 85287-2101.
References 1. Fehrs LI, Fleming D, Foster LR, McAlister RO, Fox V, Modesitt S, Conrad R. Trial of anonymous versus confidential human immunodeficiency virus testing. Lancet. Aug. 13, 1988; 379-382. 2. Fordyce EJ, Sambula S, Stonebumer R. Mandatory reporting of human immunodeficiencyvirus testingwould deter blacks and hispanics from being tested. JAMA.
1989;262:349. 3. Kegeles SM, Coates TJ, Lo B, Catania JA. Mandatory reporting of HIV testing would deter men from being tested. JAMA.
1989;261:1275-1276. 4. Arizona Department ofHealth Services. Impact ofAnonymous Testing Option in Anizona: Prelininary Results; Sept 26, 1989.
The NHSC Mandate The letter from Drs. Brown, Stone, and Sidel in the November 1990 issue of the Amencan Jounal of Public Health concerning the National Health Service Corps (NHSC) presents a narrow approach to the mandate the NHSC seeks to
meet.' Scholarships have been a useful tool and will continue to be. But as the sole major effort in recruitment, they created a number of problems, some of which the survey Brown et al. documented. Others are related to the length of the training pipeline. During the 6 to 7 years from sign-on to service, the scholars' family status frequently changed and/or his professional interest was no longer in primary care. In addition, there was little leeway for the NHSC to secure personnel to meet specific needs. The staff had only what was coming out ofthe pipeline. There is no way for them to influence the number of family physicians, pediatricians, and general internists that would be available.
Thus, with the current 10-year reauthorization of a revitalized NHSC, recruitment will utilize some scholarships, some loan repayment (which does allow the Corps to meet specific personnel needs), and continue the emphasis on recruitment of nonobligated health professionals to serve varying terms in areas of need. The development of health care teams (physicians, physician assistants, nurse practitioners, certified nurse midwives) is also a very important goal in meeting these needs. The issues of retention (33% of the respondents to their survey) is also receiving a great deal of attention. Very few of these health professionals are employees of the NHSC, but of community health centers, rural health centers, migrant health centers, and programs serving special populations. These clinics may be receiving federal or other governmental support, but the professionals in them are rarely employees of the federal govemment. Everyone is aware, yet needs to be reminded, that these health professionals are needed to serve in areas that have been difficult to staff because of isolation, poverty, special needs, sparse populations, or just the absence of a support network. These challenges and the approaches to their solution are under constant study by the staff of the NHSC and the National Advisory Council to the Corps. The National Advisory Council advises both the director of the Corps and the secretary of the Department of Health and Human Services. Its recommendations, with specific plans, outline approaches to these issues. Scholarships are not the sole solution to the complex issue of providing health care to the underserved. [ J. Jerry Rodos, DO J. Jerry Rodos is with Chicago Osteopathic Health Systems, 5200 South Ellis Avenue, Chicago, IL 60615. He also is consultant to the Director of the National Health Service Corps. These comments do not necessarily reflect the opinions of the US Department of Health and Human Services or the National Health Service Corps.
Reference 1. Brown JB, Stone V, Sidel VW. Decline in NHSC physicians threatens patient care. Am J Public Health. 1990;80:1395-1396. Letter to the Editor.
American Joumal of Public Health 1213
