In "D.C. Won't List HIV Patients by Name" [Metro, Aug. 21], it was stated that city health officials plan to travel to states using "unique identifiers" (UIs) to study how their systems work. Because only two states, Maryland and Texas, have actually used UIs over an extended trial period and because Texas has published a thorough report on the results of its trial, one hopes that department officials will have the opportunity to visit Texas to get a firsthand view of the problems they experienced in attempting to use this system.
The UI system in Texas was found to be "unifunctional," at best capable of providing information for epidemiologic monitoring of HIV and incapable of supporting patient referral and disease intervention efforts. Even for epidemiologic monitoring, omissions and errors made the system inadequate, with 30 percent of the reports rejected because of item incompleteness.
The disease intervention efforts not supported by UIs included the all-important partner notification and referral services. Partner notification is especially important to women of childbearing age who do not perceive a personal risk of infection. Beyond that it is the only system, short of mass screening, that can find the growing number of asymptomatic infections out in the community before they develop into AIDS and before others become infected.
As a result of its disappointing experience with UIs, Texas now requires confidential name reporting for new HIV infections as do 33 other states. One hopes that after a review of the Texas experience the District will elect to use confidential name reporting for its new HIV infections.
FRED J. PAYNE, M.D.
The writer is a medical adviser at the Children's AIDS Fund.