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Objectives: We examined the effect of New York's HIV Reporting and Partner Notification law on HIV testing levels and on the HIV testing decisions of high-risk individuals., Methods: In-person interviews were administered to 761 high-risk individuals to assess their knowledge, attitudes, and behaviors regarding HIV testing and reporting. Trends in HIV testing were also assessed in publicly funded HIV counseling and testing programs, Medicaid, and New York's Maternal Pediatric Newborn Prevention and Care Program., Results: High-risk individuals had limited awareness of the reporting and notification law, and few cited concern about named reporting as a reason for avoiding or delaying HIV testing. HIV testing levels, posttest counseling rates, and anonymous-to-confidential conversion rates among those who tested HIV positive were not affected by the law. Medicaid-related HIV testing rates also remained stable. HIV testing during pregnancy continued to trend upward following implementation of the law. Findings held true within demographic and risk-related subgroups., Conclusions: HIV reporting has permitted improved monitoring of New York's HIV/AIDS epidemic. This benefit has not been offset by decreases in HIV testing behavior, including willingness to test among those at high risk of acquiring HIV.

Notification of sexual partners of HIV-infected individuals has become a focus of debate at local, state, and national levels. Issues of confidentiality and ethical concerns continue to pose challenges to state and local health departments addressing this issue. We conducted a telephone survey with physicians in Syracuse, New York to ascertain opinions about HIV partner notification and the role of public health agencies in that notification process. In general, physicians mostly relied upon the HIV-infected individuals to notify their own partners but were supportive of enhanced efforts regarding partner notification.

In New York City in 1993, there were some 18,000 positive HIV tests but only 350 partner notifications completed by the New York City Health Department. The bleak disparity between these two numbers should haunt us all. We will never know for certain how many lives could have been saved by universally available notification services, but looking at the results of current, obstructive New York State notification law and policy, we have to know we are facing an enormous public health failure. In states and cities with well-established notification programs, between 50 and 90% of HIV-positive clients cooperate voluntarily with notification and, typically, 90% of partners contacted seek HIV-testing and preventive counseling. There are no differences in cooperation based on race, gender or sexual orientation. In New York, urgently required reform means legislation to mandate that notification services are offered to all people who test positive and to require the state to supply enough trained personnel to undertake sensitive notification and counselling. With Black and Latina women--most of whom are mothers--now at the highest risk for sexual HIV infection, New York's refusal to undertake the life-saving policies common elsewhere has not only resulted in a horrible abandonment of a very vulnerable population, but also accelerated the orphaning of children at unprecedented rates.

The paper examines the controversy surrounding legislative proposals in New York State that would require amending the public health law's stringent confidentiality provisions; the legislation calls for "unblinding" the results of a 7-year old statewide HIV seroprevalence study that tests newborns for HIV antibodies in order to track the incidence of HIV infection among parturient women. The pivotal point is made that mandatory disclosure of the test results is tantamount to mandatory testing of the mother, since presence (or absence) of HIV antibodies conclusively reveals the mother's HIV status. The author presents the history of the epidemiological study and documents the ongoing discussion of mandatory testing, within the medical, bioethical and public health community. Citing numerous papers, including the report of the Subcommittee on Newborn Screening of the New York State AIDS Advisory Council, the author--a member of both the council and its subcommittee--argues against the principle of mandatory testing in general and "unblinding" of the seroprevalence survey in particular. Besides making a strong argument from the ethical viewpoint, the paper provides ample medical data to support the argument that mandatory testing of newborns is poor public health policy that would be essentially ineffectual in the effort to stem the spread of HIV.