Surveillance, Social Risk, and Symbolism: Framing the Analysis for Research and Policy

Abstract:     
Name-based surveillance for HIV is a useful measure that offers benefits to public health without imposing significant risks of harm upon people whose names are reported. There is little evidence that name-based surveillance directly deters individuals at risk of HIV from being tested, or exposes them to significant social risks. Yet such surveillance has been and remains controversial. Understood in a broader context of the social risks and symbolic politics of HIV, as subjectively experienced by people at risk, this opposition is rational and instructive. Although often debated, the social risks of HIV infection are poorly understood. To the extent these risks have been addressed by privacy and antidiscrimination laws, the solution has been less complete than many public health professionals appear to believe: developments in law and policy, including the increasing prevalence of criminal HIV transmission laws and proposed changes in HIV testing and counseling standards, are contextual factors that help explain why opposition to name-based surveillance persists. Rather than focusing piecemeal on specific barriers to testing and care, an appreciation of the surveillance debate as a social phenomenon suggests a positive undertaking in public health policy to provide the conditions of opportunity, information, motivation and confidence that people with HIV need to accept an effective program of early intervention.

Number of Pages in PDF File: 26

Keywords: HIV surveillance, public health, discrimination, politics

JEL Classification: I1, J7

Accepted Paper Series