April 8, 2003
As in other jurisdictions across Canada, prenatal testing for HIV infection had been performed inconsistently in Alberta, with the result that children continued to be born to HIV-infected women who had not received prophylactic treatment to prevent vertical transmission. Therefore, on Sept. 1, 1998, Alberta adopted an opt-out strategy for prenatal testing for HIV infection. Under this policy, HIV testing is done routinely for all pregnant women seeking prenatal care unless they specifically choose not to be tested.
In this study, the authors evaluated the effect of mandatory reporting of HIV infection and routine screening for prenatal HIV infection on requests for HIV testing in Alberta. The authors obtained data from the Provincial Laboratory for Public Health on the number of males and females in Alberta who were tested for HIV infection between Jan. 1, 1993, and Dec. 31, 2000. They obtained the number of females screened for HIV infection between Sept. 1, 1998, and Dec. 31, 2000, under the opt-out prenatal HIV screening program from the Canadian Blood Services laboratories, and the number of confirmed positive test results from the Provincial Laboratory for Public Health. The authors calculated average annual percent increases in the number of HIV tests performed before and after mandatory reporting was instituted.
Mandatory reporting of HIV infection remains a controversial issue largely owing to concerns about personal and social problems related to breaches in confidentiality. This study shows a clear trend toward increased HIV testing in Alberta despite the introduction of mandatory reporting of HIV infection to public health authorities. These results are consistent with other studies showing that reporting of HIV infection does not provide a distinct disincentive to testing. The authors also found a dramatic and sustained increase in rates of prenatal HIV testing after the opt-out policy was introduced.
The finding that mandatory reporting of HIV infection has not adversely affected the number of HIV tests done in the province is reassuring. It is unclear, however, whether reporting has had a differential effect by deterring people who may be at higher risk of HIV infection, such as men who have sex with men, injection drug users and recent immigrants to Canada, from undergoing testing and seeking treatment and prevention services. Continued monitoring and evaluation are required to ensure that surveillance policies do not adversely affect HIV testing.
Canadian Medical Association Journal
03.18.03; Vol. 168; No. 6: P. 679-682; Gayatri C. Jayaraman; Jutta K. Preiksaitis; Bryce Larke