New CDC Definition Now in Effect, But Confidentiality Questions Remain

By Nancy Solomon

The new U. S. Centers for Disease Control (CDC) criteria for
an AIDS diagnosis -- which now add pulmonary tuberculosis,
recurrent bacterial pneumonia and invasive cervical cancer to the
previous list of 23 opportunistic infections needed for an
official diagnosis -- took effect January 1. The new criteria
also include anyone with less than 200 T-helper cells.

The CDC definition is important because it affects whether
someone with HIV is eligible for social services and also because
it alerts doctors to test for HIV when someone has a condition on
the official list. While most government and non-government
agencies use the CDC definition to determine whether or not they
provide services, the Social Security Administration will not
change its requirement that an applicant for disability benefits
must show actual physical disability.

Activists had pushed for the change because the former list
excluded many of the opportunistic infections common among women,
injection drug users and poor people. The changes represent a
compromise between the activists and the CDC.

The new definition is expected to double the number of AIDS
cases in the United States. But several thorny legal and
political issues have made the long sought changes more of a
mixed blessing. The new criteria are expected to send some state
public health officials rummaging through patient records to
boost their caseload statistics so that their states can receive
more federal funds. This pr, legal advocates say, willdermine
patient confidentiality, leading to fewer people seeking testing
and an eroding of HIV confidentiality standards.

"Despite extensive advocacy directed at the CDC requesting a
bar on name-based lab reporting of low (T-helper cell) counts, we
find that we are forced to fight this battle on a state-by-state
basis," says a memorandum from the AIDS Legal Referral Panel in
San Francisco.

Legal advocates are asking that activists fight name-based
reporting of T-helper cell counts at the local level.

The new definition also raises questions about access to T-
helper cell testing, which can cost $100-$200, beyond the means
of most people without health insurance. Lack of access to
testing will continue to perpetuate undercounting of the epidemic
and lack of HIV services among women, people of color, and the
poor. Legal advocates also ask that activists pressure local
government agencies to provide anonymous T- helper cell testing
to all who need it.

For a copy of the new definition, contact the CDC National
AIDS Clearinghouse, 800/458-5231; or for more information about
the legal and political impact, call the AIDS Legal Referral
Panel, 415/291-5454.