AIDS surveillance: knowledge, attitudes, and practices of health care professionals in Washington State.

Health professionals in Washington State were surveyed in 1993 to assess acquired immunodeficiency syndrome (AIDS) reporting knowledge, attitudes, and practices. Seventy-five percent responded. Two thirds of previous reporters were informed about the 1993 AIDS case definition and reporting requirements, but 32 percent had neglected to report. Forty-eight percent were concerned about confidentiality of reported cases. Half favored human immunodeficiency virus reporting and 21 percent opposed it. In order to promote complete and timely AIDS reporting, current and future reporters need ongoing education on reporting requirements and methods. The importance of AIDS surveillance data for community planning as well as assurance of protection of confidentiality should be emphasized.

Making the health care system 'safe' for persons with HIV infection or AIDS.

If health care reform is implemented in states and nationally, the safety of this process needs to be examined for persons with human immunodeficiency virus (HIV) infection or the acquired immunodeficiency syndrome (AIDS). Reform should assure ongoing prevention and transmission control of HIV and continuous coverage of medical costs for persons ill with HIV or AIDS. These persons currently benefit from various state and federal categoric programs designed to assure access to preventive and personal care services. Washington State has passed health care reform legislation that envisions integrating these programs to provide a system of population-based and personal health care. This legislation was analyzed using existing epidemiologic and entitlement information about persons with HIV infection or AIDS in the state to assess its effect. The relationship between public health and personal care services will be a central concern for those with HIV infection or AIDS, and complete coverage of this group may be achieved relatively late in the process of implementing health care reform. Health personnel planning under health care reform will affect the delivery of HIV- and AIDS-related services. Including treatment of AIDS in the basic benefit package merits particular attention. These issues parallel those being faced by the nation as a whole as it seeks to ensure epidemic disease control and compassionate care for long-term disabling illness if health care reform is implemented.

Survival after AIDS diagnosis in Washington State: trends through 1989 and effect of the case definition change of 1987.

Survival analysis was performed for AIDS cases diagnosed in Washington state from 1982 through 1989 and reported through October 31, 1991. No difference in survival time among diagnosis years 1987, 1988, and 1989 (p = 0.29) was found. Since September 1987, survival time was longest for cases with human immunodeficiency virus (HIV) wasting syndrome and HIV encephalopathy. Adjusted risk for death was significantly lower for these cases relative to all other cases (relative risk, 0.5; 95% confidence interval, 0.4-0.6). Explanations for the absence of continuing increase in survival time between 1987 and 1989 include changes in the frequency and timing of anti-HIV therapy. Longer survival time among cases diagnosed with HIV wasting or HIV encephalopathy is likely due to diagnosis earlier in the course of HIV disease. These results emphasize how changes over time in the definition of AIDS and evolving therapeutic standards may affect assessment of survival time when using surveillance data.

Effects of increasing outpatient diagnosis on AIDS surveillance.

Using AIDS surveillance data, we analyzed trends and correlates of outpatients AIDS diagnosis in Oregon and Washington. The proportion of outpatient diagnoses rose from 24% of cases in 1987 to 51% in 1990. Case characteristics associated with outpatient diagnosis included white race, urban residence, and the exposure category of male homosexual/bisexual contact. AIDS-defining conditions associated with outpatient diagnosis included Kaposi's sarcoma, HIV wasting syndrome, and esophageal candidiasis. Completeness and timeliness of reporting was poorer for cases diagnosed as outpatients compared with inpatients. As outpatient diagnosis becomes more common, modified surveillance methods may be needed to ensure complete case finding and consequent reliability of AIDS surveillance information.

AIDS-related knowledge, attitudes, and precautionary behaviors among emergency medical professionals.

AIDS-related knowledge, attitudes, and precautionary behaviors were assessed among a random sample of Michigan-licensed emergency medical service (EMS) professionals between June and August 1988. Of 2,000 mailed questionnaires, 1,020 were returned (51 percent response), and 997 of the returned questionnaires were used in the final analysis. Survey results indicated that most respondents were able to correctly identify the transmission routes of the human immunodeficiency virus (HIV), but many respondents had misconceptions about nonviable routes, the incidence of HIV infection among health care workers, and some aspects of the natural history of HIV. More than half of the respondents (56.6 percent) believed that their chances of becoming infected with HIV were "somewhat high" or "very high," although the number of documented HIV seroconversions due to occupational HIV exposures in health care settings is low. Although only six respondents (0.6 percent) reported that they had refused treatment to patients known or suspected to be infected with HIV, 25 percent felt that EMS professionals should be allowed to refuse treatment under such circumstances. Potential exposures to HIV were assessed through respondents' reports of three activities in the 6 months prior to the survey. For each activity, use of universal precautions recommended by the Centers for Disease Control was also assessed. In general, few respondents reported the consistent use of precautions. While the majority of those attempting resuscitations (86.9 percent) reported that they always use a protective device, only 36.7 percent of those treating bleeding patients reported that they always wear gloves, and only 21.9 percent of those using needles reported that they do not recap them after use.