HIV Tests Must Stay Anonymous : AIDS: If a positive diagnosis becomes known, it invites discrimination that can mean loss of work, home, insurance.

The California Medical Assn. wants the names of people who test positive for the HIV virus to be reported and all of their sexual partners contacted.

On the face of it, this sounds reasonable. But it is not.

Proponents of the measure, which the organization endorsed last week, argue that HIV/AIDS should be dealt with like any other sexually transmitted disease. But this scourge is different in two important respects. While most STDs can be cured, AIDS cannot. And an HIV diagnosis that becomes known too often invites discrimination that can leave a person without a job, a home or insurance.

The doctors who voted for this measure must know that it flies in the face of the public-health strategy for fighting the AIDS epidemic--a strategy based on encouraging people to come forward for HIV testing. It’s in the public’s best interest to steer HIV-positive people toward systems of monitoring and care and into counseling to help prevent the further transmission of the virus. If people aren’t tested, that won’t happen.

Over a three-year period, 65% of the positive HIV cases in California have been found through anonymous testing, in which the person tested is known only by a code number. In the other 35%, the identity of the person tested was known but confidentiality was promised. There is no doubt that anonymity is the key to voluntary testing: 60% of those tested in one California county said they would not have had the test if they had to give their names.

The HIV antibody test does not occur in a vacuum. Medically, it is a blood test to determine the presence of antibodies to the AIDS virus. But it is also a test of the strength of a person’s family, relationships, job security and insurability. Everything is at risk when an HIV test is taken. The environment for taking the test and obtaining the result needs to be a safe one. If it is not, or if it is perceived to be unsafe, people will not come forward to be tested.

Before legislators consider any proposal to make reporting names mandatory, it is vitally important for them to understand the psychology and culture of the primary population affected by this epidemic. The gay community does not trust large institutions. The government does not allow gays to marry, the church scorns them, schools and employers discriminate against them. Why, then, should gay men at risk for AIDS or injection drug users suddenly trust a government entity with their names? In fact, it is the same fiscal conservatives who say we shouldn’t trust government with our tax dollars saying that we should trust them with our names.

Latinos, who now make up almost half of the new AIDS diagnoses in Los Angeles County, have particular reason, after the chilling impact of Proposition 187, to doubt that this would be in their best interests.

It becomes difficult, if not impossible, for the HIV at-risk community to take even the best-intentioned public health officer seriously when everyone knows that what is confidential today could be public tomorrow, given the conservative shift in political winds.

As the epidemic spreads beyond the gay white community, it raises doubt whether proposals like this are truly aimed at public-health concerns.

HIV testing sites in the state and prevention efforts aimed at reducing transmission of AIDS are underfunded. The state does not have money to back the systems that do work well, much less throw money at those that don’t. Contact tracing of people infected would be prohibitively costly. Imagine the personnel that would be needed to track down, inform and test all of the sexual contacts of each of the thousands of individuals in the state who test positive.

In the end, it boils down to what AIDS experts and the public-health community have always said about this proposal: It is just plain bad medicine.

We can only hope that at its next meeting, the CMA doesn’t ask for a return of the use of leeches.