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California and the West

Bill Creating System to Track HIV Is Vetoed

Health: Wilson says there is a need for such records but objects to using codes instead of names. He calls privacy concerns 'irrational.'


Gov. Pete Wilson on Wednesday vetoed a bill that would have required the state to begin tracking cases of HIV as well as full-blown AIDS, sending legislators and lobbyists back to the drawing board to improve California's slipping surveillance of the fast-changing epidemic.

Wilson acknowledged that a human immunodeficiency virus reporting system is sorely needed in the state--one of a dwindling minority in the country without one--but he objected to tracking cases by alphanumeric code rather than by name. He sided with critics who believe that a coded approach would confound health officials' efforts to notify sexual and needle-sharing partners of people who are infected.

"Irrational concerns over privacy should not interfere with what must be our highest priority, interrupting the chain of HIV transmission," he said.

Wilson's veto came despite the bill's endorsement by two powerful lobbies, the California Medical Assn. and a coalition of AIDS organizations. The two groups had reached a hard-won compromise, attempting to balance the desire for improved surveillance with concerns for patients' privacy. Still, the proposed bill bucked a national trend: Thirty-two states--including AIDS-battered New York--have decided to track HIV with confidential name-based systems. Just two now track by code--and one, Texas, probably will switch to names.

Wilson's veto was hailed by the bill's increasingly vocal opponents--a cluster of doctors, public health officials and mostly Republican legislators who believe that HIV should be tracked by name like any other infectious disease. Full-blown AIDS is already tracked by name in California.

"This would have been a horrible step in the wrong direction," said Dr. Cary Savitch, a Ventura County physician who organized Beyond AIDS, a group of health care providers opposed to the bill. "Thank goodness [Wilson] was able to sort through the politics and choose public health."

AIDS activists expressed outrage, saying that they worked hard to fashion a bill that would not threaten patients' privacy and deter them from testing and treatment.

"The result of him vetoing this particular bill is that California now has no HIV reporting system," said Eileen Hansen, co-chairwoman of the California HIV Surveillance Coalition, made up of 40 agencies. "That's the choice he made, to allow California to continue having no reporting system versus a system which . . . we believe would protect the public health."

Craig Thompson, executive director of AIDS Project Los Angeles, said HIV surveillance is needed immediately to direct resources to the right people in the right places. The delay in implementing HIV tracking could mean lost services and lost lives, Thompson said. The bill's opponents vowed to return in the next legislative session with a proposal similar to the one that recently passed in New York, which provides for name-based reporting that is linked with contact tracing of infected partners. They argued that it is nearly impossible for public health officials to follow up with infected people and trace their partners without knowing names.

California and New York are considered significant models because they collectively have accounted for a third of the nation's AIDS cases since 1981.

Proponents of name collection may be in for a fight. Representatives of the state's two major AIDS organizations, AIDS Project Los Angeles and the San Francisco AIDS Foundation, signaled Wednesday that they could not support names-based reporting--at least, not without better privacy protections.

Wilson, in his veto message, said the state's current privacy and antidiscrimination protections are sufficient to protect people with HIV.

But Thompson said California is "uniquely susceptible" to a referendum process in which patients' security could be threatened. He said an initiative could be passed, for example, to identify everyone who is HIV-positive and works in health care or teaching, derailing careers and livelihoods.

Other AIDS activists have expressed concern about another bill, signed into law by Wilson on Wednesday, that will make it a felony punishable by up to eight years in prison to knowingly expose an unwitting person to the virus. Some critics worry that people will refrain from identifying themselves and their contacts under a name-based system for fear of being prosecuted under this law.

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