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PubMed1995

Mandatory HIV testing of patients and professionals: bringing ethics into practice.

A contemporary health dilemma, that of mandatory HIV testing of patients and professionals, is used as a focus for an ethics class. Background material which is given to students is described and referenced. The interjection of ethical theory is described. The exercise has provided an effective focus for medical and health professional undergraduate and postgraduates. It combines contemporary material with ethical theory, and so brings ethics into practice for students.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

HIV serosurveillance of newborns. A clinician's perspective on legislative, political, and ethical issues.

This article reviews the complex issues surrounding the anonymous HIV testing of newborns to monitor the prevalence of HIV infection in women of childbearing age. This serosurveillance of newborns has become a topic of legislative debate focusing on disclosure of currently anonymous results of HIV antibody tests of newborns, thus revealing the serostatus of the mother. This, in effect, would mandatorily test women without their consent. The discussion includes the following topics: (a) the historical demographics of incidence rates of AIDS, (b) current political and legislative issues raised by serosurveillance, (c) professional and ethical issues confronting health care providers, and (d) why HIV testing of newborns is a mandatory testing of all women of childbearing age. It is recommended that principles of patients right of self-determination be respected, that mandatory testing would be counterproductive and would disproportionately impact on minorities. The integration of education, counseling, and voluntary testing will result in the most effective way to get both women and children into the health care system.

AIDS Serodiagnosis↗
PubMedDate not supplied

Mandatory HIV testing: a timely controversy.

Incidence of infection with the human immunodeficiency virus (HIV) has increased to epidemic proportions. Strategies are needed to prevent transmission of the virus. One strategy, mandatory HIV testing of nurses, is controversial. Both sides of this issue are debated in this article.

AIDS Serodiagnosis↗
PubMed1992

Mandatory biological testing of Spictra Cardiotomy Reservoir.

Disposable rigid Spictra Cardiotomy Reservoir is one of the units used in the extracorporeal techniques during open-heart surgery. It was designed, developed, and tested by different groups of our Institute as an indigenous product to offset the prohibitive cost of the imported one. The finished device was subjected to mandatory biological tests, such as pyrogen (in vivo rabbits and in vitro Limulus Amebocyte Lysate test) and sterility tests. It can be concluded from the case study that the device deemed to have passed the test for apyrogenicity and sterility.

Animals↗
PubMed1991

Arguments against mandatory screening for HIV in low-prevalence areas.

With heightened awareness that healthcare professionals may be a potential source of infection for the human immunodeficiency virus, calls for serial, mandatory testing and reporting are increasing. Fear and hysteria are particularly noticeable in rural settings, which are only now experiencing marked increases in the incidence of AIDS cases. While arguments for and against the merits of serial mandatory testing programs can be constructed, this paper presents support to oppose mandatory testing. Evidence for this stance is drawn from several sources, including epidemiologic, economic, and clinical research; as well as medical ethics literature.

AIDS Serodiagnosis↗
PubMed1989

Mandatory premarital testing for human immunodeficiency virus. The Illinois experience.

During the first 6 months of legislatively mandated premarital testing for human immunodeficiency virus in Illinois, 8 of 70,846 applicants for marriage licenses were found to be seropositive, yielding a seroprevalence of 0.011%. The total cost of the testing program for 6 months is estimated at $2.5 million or $312,000 per seropositive individual identified. Half of the reported seropositive individuals reported a history of risk behavior. During the same period, the number of marriage licenses issued in Illinois decreased by 22.5%, while the number of licenses issued to Illinois residents in surrounding states increased significantly. We conclude that mandatory premarital testing is not a cost-effective method for the control of human immunodeficiency virus infection.

Costs and Cost Analysis↗
PubMed1996

Cost implications of random mandatory drugs tests in prisons.

BACKGROUND: Compulsory urine testing of prisoners for drugs, a control initiative, was introduced in eight prisons in England and Wales early in 1995. Despite no evidence of effectiveness, testing was extended to all prisons in England and Wales by March 1996. We consider the cost of testing. METHODS: We combined the costs of refusals, confirmatory tests, punishment of confirmed positives for cannabis or for class A drugs to estimate the average costs of random compulsory drugs testing. These costs were then compared to: i) the healthcare budget for a prison; and ii) the cost of putting in place a credible prisons' drugs reduction programme. We then used Scottish data on incarceration and regional prevalence of injecting drug users to estimate the extent of the injecting drug use problem that prisons face. FINDINGS: Costs per 28 days of the random mandatory drugs testing control initiative in an establishment for 500 inmates where refusal rate is a) 10% or b) nil; and 35% of urine samples test positive, one tenth of them for class A drugs were estimated at between a) 22,800 UK pounds and b) 16,000 UK pounds per 28 days [a) $US35,100 and b) $US24,600]. This cost was equivalent to twice the cost of running a credible drugs reduction and rehabilitation programme, and around half the total healthcare expenditure for a prison of 500 which averaged 41,114 UK pounds per 28 days [$US64,860]. Major cost-generating events were the punishment of refusals--over one third of cost a)--and testing positive for cannabis--over 50% of cost a). In Scotland, around 5% of injecting drug users (IDUs) are incarcerated at any time: 5% of Lothian's drugs care, treatment and prevention costs and 2.5% of its HIV/AIDS prevention budget in 1993-94 amounted to 101,300 UK pounds per annum--or 7770 UK pounds per 28 days ($US11,970)--and about 35% of monthly MDT costs. INTERPRETATION: We suggest that 5% of current resources for drugs prevention and treatment and for IDU-targetted HIV/AIDS prevention should be directed towards the prisons because in the prisons, where 5% of the clients are at any time, injectors have less access to harm reduction measures than on the outside.

Costs and Cost Analysis↗
PubMedDate not supplied

State dental boards and mandatory HIV testing.

Public and professional debate over what, if any, action should be taken by state regulatory agencies regarding AIDS and the HIV status of dentists has increased in recent months. To determine if state boards had workable policies in place or were considering such policies, a telephone survey of all state boards was undertaken. All boards participated, although three provided only limited information. As of early 1992, only two boards required evidence of immunity to HVB for relicensure and none require evidence of seronegativity to HIV for relicensure. Twelve percent of the boards anticipate such requirements within two years. None have mandatory HIV testing, but 13 percent anticipate such requirements in the near future. The authors conclude that while few agencies have taken more than tentative steps toward rigorous HIV testing or restrictions, most are aware of much closer public scrutiny. More restrictions seem likely as these agencies attempt to balance public and professional rights and responsibilities.

AIDS Serodiagnosis↗
PubMed1988

The new AIDS virus--ineffective and unjust laws.

Public alarm about the spread of AIDS leads to public demand for drastic laws to contain the epidemic and to punish those who spread it. In this paper, attention is drawn to the limitations of the law in achieving the modification of human behavior. Successes and failures in public health education campaigns, directed to the same end, are mentioned. The author cautions against putting too much trust in the law to achieve containment of the AIDS virus. However, there are three reasons for optimism about the developing laws on AIDS. These are the necessity of a rare degree of international cooperation, the encouragement of attention to fresh approaches to laws on human sexuality and drug taking, and the vital importance of attention to the neglected issues of efficiency and cost effectiveness in the design of new laws. This last point leads to a suggestion that AIDS has produced three new viruses called "HIL" (highly inefficient laws). HIL-I is the mandatory testing of the entire population for HIV antibodies. HIL-II is the mandatory testing of specially vulnerable groups, especially foreigners. HIL-III is the mandatory requirement of HIV-free certificates at the frontier. The ineffectiveness and potential for injustice of such laws are exposed. The lesson derived is that there is no "quick fix" either for the AIDS virus itself or for the social and legal problems presented by it.

AIDS Serodiagnosis↗
PubMed1988

AIDS and South Africa--towards a comprehensive strategy. Part II. Screening and control.

In this, the second of a three-part series of articles in which we propose steps towards a comprehensive strategy for the control of HIV infection, we consider controversies relating to screening for HIV, the indications for and desirability of mandatory testing of certain groups at risk, and the place of voluntary testing in the control of HIV transmission and infection. Key recommendations are that mandatory testing of donors of blood and other vital tissues, patients on haemodialysis and haemodialysis unit staff is justified, and that children put up for adoption may require testing. We make further recommendations regarding HIV testing as a prerequisite for life insurance and recommend that voluntary testing be offered, supported by adequate pre- and post-test counselling. We consider that all health care workers should accept as their moral obligation the care and management of HIV-infected individuals, and that they should be adequately educated and skilled in such work. These recommendations were reached largely by consensus, although there were occasions when individual authors condoned recommendations with which they did not personally agree.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Clinicians and HIV infections: social policies and professional issues.

The human immunodeficiency virus (HIV) is a deadly infectious virus. Relatively hard to contract, it is the causative agent of acquired immunodeficiency syndrome. Nurses and other clinicians have an important role to play in influencing national and local management of the HIV infection through review and comment on policy. Policies recommending quarantine, isolation, mandatory testing of certain populations, and vigorous public education are explored. Quarantine, isolation of seropositive individuals, and mandatory testing of certain groups are explicated in the article as unethical, unmanageable or both. Some recommendations for vigorous, specific public education are made. The importance of the participation of health professionals in public policy debates is emphasized.

Acquired Immunodeficiency Syndrome↗