PubMed · 2036458
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G Gillett. Ethics and HIV testing.. https://doi.org/10.1177/095646249100200103
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To investigate patterns of testing for human immunodeficiency virus (HIV) infection in tuberculosis patients, we obtained data from the tuberculosis registry and from medical records of 500 tuberculosis patients in Los Angeles County. Sixty-three percent of tuberculosis patients were tested for HIV infection, and multivariate logistic regression analysis revealed that the likelihood of testing was significantly higher among males, persons between 20 and 49 yr old, individuals with HIV risk factors, and patients treated by public health care providers. A minimum of 12% of the total sample, 2% of females, 2% of those outside the ages of 20 to 49, 7% of patients without recorded HIV risk factors, and 17% of patients treated by private practitioners were infected with HIV. These results suggest that health care providers, particularly private practitioners, do not follow national recommendations for universal HIV testing of tuberculosis patients. Instead, HIV testing is preferentially performed on patients perceived to be at high risk for HIV infection. Because HIV seroprevalence is at least 2 to 7% in "low-risk" groups, failure to test these patients may result in significant missed opportunities for diagnosis and treatment of HIV coinfection.
OBJECTIVE: To examine the risk of suicide among individuals positive for the human immunodeficiency virus (HIV) following screening for evidence of HIV infection. Prior studies have reported a 7- to 36-fold increased risk of suicide for persons with the acquired immunodeficiency syndrome. DESIGN: Prospective cohort study. SETTING: Military service applicants from throughout the United States. MAIN OUTCOME MEASURE: Death from suicide. METHODS: The National Death Index was searched for mortality among 4147 HIV-positive military service applicants and 12437 HIV-negative applicants disqualified from military service due to other medical conditions (matched 1:3 on age, race, sex, and screening date and location) identified by the US Department of Defense between October 1985 and December 1993. Death certificates were obtained from individual states. Identifiers and HIV status of living applicants were known only by the Department of Defense. RESULTS: The HIV-positive applicants were 92% male, 37% white, and 56% black. Median age was 24 years (range, 17-57 years). Median follow-up time was 70 months (range, 0-99 months). Ten HIV-positive (49 per 100 000 person-years) and 24 HIV-negative applicants (36 per 100 000 person-years) died of suicide (rate ratio [RR], 1.35; 95% confidence interval [CI]= 0.58-2.93). Suicide rates among both HIV-positive (RR, 2.08; 95% CI, 1.00-3.82) and HIV-negative (RR, 1.67; 95% CI, 1.07-2.48) applicants are marginally higher than those for the US general population, after adjustment for age, race, and sex. Time from screening to death was less than 3 months for 3 of 10 HIV-positive and 2 of 24 HIV-negative applicants who died of suicide. CONCLUSIONS: The HIV-positive individuals do not appear to have a significantly increased risk of death from suicide in the months following HIV screening in this study population. Because suicide risk is reported to be greatly increased after symptomatic HIV disease is present, clinicians should consider asking persons with HIV infection about suicide risk factors during both initial counseling and subsequent medical care.
In order to determine the prevalence of HIV in the general heterosexual population of Amsterdam, 16,709 pregnant women attending two hospitals and one maternity clinic in the period 1988-1995 were asked to undergo a HIV test, of whom 15,276 gave informed consent (91.4%). Pregnant women with a risk of HIV infection were possibly overrepresented in those who refused. The overall HIV prevalence in 1988-1995 was 0.28% and showed no significant differences over the years. In women with a known risk factor for infection the prevalence was 240:10,000, in those without 5:10,000. Whereas intravenous drug use was the most probable cause of infection before 1993, since then it was observed in only 2/20 of the HIV positive pregnant women. Heterosexual transmission appears to be increasing.