HIV/AIDS Surveillance Update

Steffany Perkins
Steffany Perkins is a Human Services Program Manager with the District IV AIDS Program Office.

The Centers for Disease Control and Prevention (CDC) published its first surveillance case definition for Acquired Immune Deficiency Syndrome (AIDS) in September of 1982. Starting in 1983, Florida designated AIDS as a reportable disease and an AIDS surveillance program was instituted. Reporting at that time, however, was voluntary and it was not until 1986 that the mandatory reporting of AIDS became incorporated into Florida Statues (s.384, F.S.). Currently an HIV positive patient age 13 or older meets the CDC surveillance case definition of AIDS if they have a CD4 T-lymphocyte count less than 200/ul or 14%. They also meet the criteria if they have any one of 26 opportunistic infections. Florida Administrative Code 64D directs that all AIDS cases, as defined by CDC, be reported to the local county health department by physicians who diagnose or treat AIDS.

AIDS surveillance data has provided critical information necessary for tracking this disease and targeting both prevention and treatment resources. In recent years, however, AIDS surveillance data has been less reflective of the epidemic due to the success of antiretroviral therapy. Individuals infected with HIV are doing better and the progression from HIV to AIDS is much longer. People are living longer, healthier lives. Consequently, the number of AIDS cases has dropped. With fewer cases and longer progression from HIV to AIDS it is difficult to know where new infections are occurring and where to target resources.

In 1996 legislation was passed, amending s.384, F.S. and 64D, F.A.C., authorizing the Department of Health to establish rules to require both laboratory and physician reporting of positive HIV infections. Effective July 1, 1997 HIV infection became reportable by name in the State of Florida. Laboratories are required to report within 3 working days from the date of receipt of test results and physicians are required to report within 2 weeks of diagnosis. Only confidential positive tests which diagnose HIV infection are reportable. Examples of tests to diagnose HIV infection are anti-body-based testing systems such as repeat ELISAs followed by a Western Blot, and antigen tests such as p24 antigen or polymerase chain reaction (PCR), when these are used for confirmatory purposes. Tests to determine viral load are not reportable unless done to diagnose HIV infection. Under Florida Law there is no retroactive reporting; only positive results obtained from specimens collected on or after July 1, 1997 are reportable.

HIV reporting in the state of Florida was implemented, not only to have a more accurate picture of the epidemic, but also to link patients to services. Under Florida Law a health department representative will contact the reporting physician for permission to contact the patient. This contact is for the purpose of offering and initiating follow-up services. Examples of follow-up services are: post-test counseling for persons who did not return for test results, referral for medical evaluation, case management services, and voluntary partner notification. This linking of seropositive patients to services is one reason that patient names are necessary on the reports. Another reason names are needed is to prevent duplication. Eliminating duplicates prevents the inflation of statistics and ensures that the data are as accurate as possible.

For those patients not wishing to be reported if positive, Florida Law requires that anonymous testing be readily available in all counties of the state through the county health department. Persons who test positive for HIV through the anonymous testing system will not be reported. All persons being offered an HIV test are required by law to be informed about HIV infection reporting and the availability/location of anonymous test sites. A list of anonymous test sites in your area can be obtained from your local county health department. However, once a person meets the CDC defined AIDS criteria they are reportable, regardless of whether or not they tested anonymously. Furthermore, because AIDS is still a reportable disease a new report needs to be filed for all HIV reported persons who later meet the AIDS criteria.

In Florida, there have been 71,426 reported AIDS cases through February, 1999, and since July 1997, there have been 10,234 reported HIV cases. These numbers in Duval are 3,552 and 407 respectively. It is important to remember that the new reports of HIV infection do not include those persons tested anonymously. Therefore, the HIV case numbers represent a minimum of infections. They are useful, however, in establishing where new infections are occurring. In 1998, Duval County females accounted for 31% of the reported AIDS cases while they accounted for 47% of the HIV cases. African Americans accounted for 66% of the AIDS cases and 79% of the reported HIV cases. While there are limitations to the HIV data, it is easy to see that the epidemic is evolving.

The reporting of HIV is crucial in providing insight into the "front end" of the HIV epidemic, thereby allowing a more accurate assessment of current and future needs. It also plays a vital role in linking patients to medical and psychosocial services. It is important, however, to offer patients the option of anonymous testing to ensure that they know their status and get into treatment. It is equally important to update reported HIV cases when these persons meet the AIDS criteria. This will give a more complete picture of disease progression and aid in targeting resources. Your local health department can be contacted regarding reporting and is happy to provide training and assistance in this area. For further information please call the AIDS Program Office at (904) 798-2792.

Jacksonville Medicine / August, 1999

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