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To the Editor: Dr Bindman and colleagues¹ offer important information about the value of maintaining the option of anonymous testing for HIV, even in jurisdictions that move to name-based HIV surveillance. What may be lost in the focus on anonymous vs confidential testing, however, is a far more important public health and clinical issue: why HIV-positive individuals are learning their status so late in disease progression regardless of the testing site. For a disease that has an estimated 10-year window between HIV infection and a diagnosis of acquired immunodeficiency syndrome (AIDS), a median of 929 days (for anonymous testing) and 90 days (for confidential testing) between learning of one's HIV infection and an AIDS diagnosis is far too short. The average time between learning status and entering care (328 days for anonymous, 187 days for confidential) also represents a failure of posttest counseling to successfully link HIV-positive individuals with care.

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Multistate Evaluation of Anonymous HIV Testing and Access to Medical Care
Andrew B. Bindman, Dennis Osmond, Frederick M. Hecht, J. Stan Lehman, Karen Vranizan, Dennis Keane, Arthur Reingold, and and the Multistate Evaluation of Surveillance of HIV Study Group
JAMA. 1998;280(16):1416-1420.
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