Fewer AIDS cases than expected were reported in Utah from July to October. But Utah health officials say this doesn't mean the disease is on the decline.
Their concern is that doctors and laboratories are failing to report names of people diagnosed with AIDS - a lapse that can result in civil or criminal proceedings.Since 1982, physicians, hospitals, laboratories, nursing homes, dentists and nurses have been required to report AIDS cases to the state health department. Legislators next year will likely seek to make the regulation more stringent as the disease continues to take the lives of more Utahns.
The Bureau of Epidemiology has projected that at least 60 new AIDS cases among Utah residents will be reported during 1988. If the minimum projected level is reached, an increase of 14 cases (30 percent) over the 46 cases reported in 1987 will have occurred.
State epidemiologist Craig R. Nichols said the steady increase in new cases parallels national estimates of increasing morbidity until the 1990s. The U.S. Public Health Service recently projected a cumulative total of 365,000 AIDS cases diagnosed by the end of 1992, with 263,000 cumulative deaths.
"It is unlikely that a true decrease in the disease (in Utah) is occurring, since the incidence of AIDS reflects HIV infection acquired several years ago, and there is no evidence that viral transmission was effectively altered in the early 1980s," Nichols said. "This suggests under-reporting and/or delayed reporting of cases."
Especially distressing to the health department is the fact that many of the recent AIDS cases were not detected until death. Many cases were detected by the AIDS Control Section through review of death records, obituaries, medical examiner files and requests for state payment of medical claims, rather than reporting by physicians and hospitals.
Although the reasons the cases go unreported are unclear, some health officials speculate that some private physicians don't report cases because they want to "protect" their patients.
But Nichols is emphatic that surveillance of AIDS cases and accurate reporting is necessary to project the need for services, treatment and long-term care, as well as to plan prevention services.
In addition, he said, federal funds for AIDS prevention and treatment activities are expected to be allocated to states in 1989 based partly upon reported morbidity rates. Utah could lose substantial grants if reporting continues to decline.
Some legislators don't want to see that happen.
Legislation will be introduced in January that will require the reporting of HIV infection, in addition to the reporting of AIDS. The Utah Department of Health has opposed the bill, primarily because they feel it will have a chilling effect. People at greatest risk of infection, they fear, will refuse to be tested for the virus if they know their names will be reported to the state.
Nichols emphasized that records held by the Bureau of Epidemiology are strictly confidential and protected by state law. The bureau encourages telephone reporting of confirmed and suspected AIDS cases to the AIDS Control Section, 538-6191.