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PubMed1992

Attitudes toward mandatory human immunodeficiency virus testing and contact tracing. A survey of intravenous drug users in treatment.

Legal initiatives and treatment policies regarding mandatory human immunodeficiency virus testing and contact tracing often are considered without the input of those groups most affected by the proposed legislation. A survey of attitudes toward the testing and tracing issues was conducted on one such group--intravenous drug users in treatment. Interview and self-report questionnaire data were collected on 196 methadone-maintained patients from two Philadelphia clinics. Data indicate that although most methadone patients supported mandatory testing, their support appears to be influenced by past testing experience. That is, significantly more untested than tested individuals were opposed to the policy. Regarding contact tracing, data indicate that most patients with seronegative results supported tracing, but of the three patients with seropositive results who were surveyed, two were opposed to it. However, most seropositive and seronegative patients reported a willingness to comply with tracing if it were to become law.

AIDS Serodiagnosis↗
PubMed2004

Québec: an outbreak of HIV/AIDS-related stigma and discrimination.

In the space of a few weeks in January 2004, actions by three different institutions in Québec combined to threaten the human rights of people living with HIV/AIDS, raise the spectre of mandatory HIV testing, and create unnecessary public fears about the spread of HIV infection. In response to what they called "the worst weeks in recent history for people living with HIV/AIDS in Québec," the Canadian HIV/AIDS Legal Network and COCQ-Sida (the Québec coalition of community-based organizations fighting AIDS) called for a province-wide campaign against HIV/AIDS-related stigma and discrimination. A victory was achieved when a Montréal catholic seminary announced that it had backed down from its initial proposal to mandatorily test all applicants for priesthood for HIV, but much more is needed to fight the rapid outbreak of mandatory-testing proposals.

AIDS Serodiagnosis↗
PubMed2000

Draft discussion paper on HIV/AIDS and immigration released.

In October 2000, the Canadian HIV/AIDS Legal Network released a 57-page draft discussion paper on HIV/AIDS and immigration, reacting to the announcement that HIV testing may become mandatory for all prospective immigrants to Canada. A final version of the paper will be released in early 2001.

AIDS Serodiagnosis↗
PubMedDate not supplied

HIV prevention in prisons and jails: obstacles and opportunities.

High rates of human immunodeficiency virus (HIV) infection among jail and prison inmates suggest that HIV prevention efforts should focus on incarcerated populations. Overcrowding, the high prevalence of injection drug use, and other high-risk behaviors among inmates create a prime opportunity for public health officials to affect the course of the HIV epidemic if they can remedy these problems. Yet, along with the opportunity, there are certain obstacles that correctional institutions present to public health efforts. The various jurisdictions have differing approaches to HIV prevention and control. Whether testing should be mandatory or voluntary, whether housing should be integrated or segregated by HIV serostatus, and whether condoms, bleach, or clean needles should be made available to the prisoners, are questions hotly debated by public health and correctional officials. Even accurate assessment of risk-taking within the institutions leads to controversy, as asking questions could imply acceptance of the very behaviors correctional officials are trying to prevent. Education and risk-reduction counseling are the least controversial and most widely employed modes of prevention, but the effectiveness of current prevention efforts in reducing HIV transmission in this high-risk population is largely undetermined.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Urinalysis drug testing within a civilian pilot training program: did attitudes change during the 1990's?

BACKGROUND: Attitudes toward fairness and effectiveness of mandatory drug testing vary within pilot populations (4,8) as well as other populations (3). This descriptive-correlational study examined civilian student pilots' attitudes toward urinalysis (UA) drug testing over a 10-yr period and the pilots' opinions regarding effectiveness, adequacy, and fairness of the testing as a deterrent for substance abuse among pilots. METHODS: A sample of three different groups of civilian aviation students (n = 314), consisted of 103 pilots studied prior to implementing a mandatory drug testing program, 113 pilots studied 1 yr after implementing a mandatory drug testing program, and 98 pilots studied 6 yr into a mandatory drug testing program. A 14-item questionnaire (alpha = 0.74), indicating degrees of agreement, was completed by the student pilots who were enrolled in a large civilian pilot training program. RESULTS: There were no significant differences among the study pilots' feelings related to anxiety of drug testing when comparing non-mandatory and mandatory groups over time. The pilots continue to believe that alcohol use by pilots within this civilian piloting training program has decreased since testing was mandated and that drug use also showed a significant decrease (p = 0.01), although not as significant (p = 0.0001) as the decrease in alcohol use. CONCLUSION: The study showed that alcohol and drug testing is more generally accepted by the pilots in the study as the decade of the 1990s came to a close.

Adult↗
PubMed2000

An ethical analysis of the mandatory exclusion of immigrants who test HIV-positive.

On 20 September 2000, Canadian newspapers reported that Health Canada recommended to Citizenship and Immigration Canada (CIC) that testing all prospective immigrants for HIV, and excluding those testing positive, constitutes "the lowest health risk course of action." Subsequently, the Minister of Citizenship and Immigration stated that CIC is indeed considering implementing mandatory HIV testing for all prospective immigrants to Canada, and excluding all those testing positive (with the exception of refugees and family-class sponsored immigrants) from immigrating to Canada on both public health and "excessive cost" grounds. This proposal was met with vehement opposition from a broad range of organizations and individuals. In particular, they pointed out that, as stated in the International Guidelines on HIV/AIDS and Human Rights (UNHCHR/UNAIDS, 1998: para 105), "[t]here is no public health rationale for restricting liberty of movement or choice of residence on the ground of HIV status." At the time of going to print, no final decision had been made about whether mandatory HIV testing for all immigrants would be implemented. There are sound ethical, legal, and public policy arguments against imposing mandatory testing and excluding those who test HIV-positive.

AIDS Serodiagnosis↗
PubMed2002

Barcelona 2002: law, ethics, and human rights. HIV testing for peacekeeping forces: legal and human rights issues.

In 2001, the United Nations Security Council established an Expert Panel to study the issue of whether the UN should institute HIV testing of peacekeeping personnel. This article, based on a 9 July 2002 presentation to the XIV International AIDS Conference (abstract TuOrG1173), reports on the findings of a paper prepared for the Expert Panel by the Canadian HIV/AIDS Legal Network. The paper examined whether it is permissible for the UN to implement mandatory HIV testing of its peacekeeping personnel, and whether HIV-positive UN peacekeeping personnel should be excluded or restricted from service on the basis of their HIV status or HIV disease progression. The article describes some of the court cases in which these issues have been considered; discusses the importance of analyzing such issues in the context of a human rights-based approach to the pandemic; and formulates a series of key principles for guiding UN decision-making. The article concludes that a policy of mandatory HIV testing for all UN peacekeeping personnel cannot be justified on the basis that it is required in order to assess their physical and mental capacity for service; that HIV-positive peacekeeping personnel cannot be excluded from service based on their HIV status alone, but only on their ability to perform their duties; and that the UN cannot resort to mandatory HIV testing for all UN peacekeeping personnel to protect the health and safety of HIV-negative personnel unless it can demonstrate that alternatives to such a policy would not reduce the risk sufficiently. In the end, the Expert Panel unanimously rejected mandatory testing and instead endorsed voluntary HIV counselling and testing for UN peacekeeping personnel.

AIDS Serodiagnosis↗
PubMed1998

A decision analysis of mandatory compared with voluntary HIV testing in pregnant women.

BACKGROUND: The benefit of antiretroviral therapy in reducing maternal-fetal transmission of HIV during pregnancy has caused a public policy debate about the relative benefits of mandatory HIV screening and voluntary HIV screening in pregnant women. OBJECTIVE: To evaluate the benefits and risks of mandatory compared with voluntary HIV testing of pregnant women to help guide research and policy. DESIGN: A decision analysis that incorporated the following variables: acceptance and benefit of prenatal care, acceptance and benefit of zidovudine therapy in HIV-infected women, prevalence of HIV infection, and mandatory compared with voluntary HIV testing. MEASUREMENTS: The threshold deterrence rate (defined as the percentage of women who, if deterred from seeking prenatal care because of a mandatory HIV testing policy, would offset the benefit of zidovudine in reducing vertical HIV transmission) and the difference between a policy of mandatory testing and a policy of voluntary testing in the absolute number of HIV-infected infants or dead infants. RESULTS: Voluntary HIV testing was preferred over a broad range of values in the model. At baseline, the threshold deterrence rate was 0.4%. At a deterrence rate of 0.5%, the number of infants (n = 167) spared HIV infection annually in the United States under a mandatory HIV testing policy would be lower than the number of perinatal deaths (n = 189) caused by lack of prenatal care. CONCLUSIONS: The most important variables in the model were voluntary HIV testing, the deterrence rate associated with mandatory testing compared with voluntary testing, and the prevalence of HIV infection in women of child-bearing age. At high levels of acceptance of voluntary HIV testing, the benefits of a policy of mandatory testing are minimal and may create the potential harms of avoiding prenatal care to avoid mandatory testing.

Anti-HIV Agents↗
PubMed2003

Mandatory reporting of HIV infection and opt-out prenatal screening for HIV infection: effect on testing rates.

BACKGROUND: Mandatory reporting of HIV infection to public health authorities, although now common, may deter people from undergoing testing. We examined HIV testing frequency in Alberta before and after mandatory reporting was implemented. We also examined the effect on testing rates among pregnant women when Alberta adopted an opt-out approach to prenatal HIV screening. METHODS: Using data from the Provincial Laboratory for Public Health, we determined the number of HIV tests done between Jan. 1, 1993, and Dec. 31, 2000, for males and females in Alberta. We used data from the Canadian Blood Services laboratories to obtain the number of tests conducted as part of the opt-out prenatal HIV testing program. Reporting of HIV infection became mandatory on May 1, 1998, and opt-out prenatal HIV testing was introduced on Sept. 1, 1998. RESULTS: Among males, the average annual percent increase in the number of HIV tests was 4.0% for the period before mandatory testing, as compared with 4.3% for the period after mandatory reporting was implemented; the difference in yearly trend was significant (p < 0.001). Among females, the average annual percent increase in the number of HIV tests was 9.2% for the period before mandatory reporting. In the month immediately following the adoption of opt-out prenatal HIV testing, the rate increased by 28%. Between 1999 and 2000, the average annual percent increase in the number of HIV tests among females was 1.4%. INTERPRETATION: The introduction of mandatory reporting of HIV infection did not appear to have a deterrent effect on rates of HIV testing. The implementation of an opt-out prenatal HIV testing policy resulted in a dramatic increase in the number of females being tested for HIV infection.

AIDS Serodiagnosis↗