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PubMed2003

Mandatory HIV testing used to bar potential immigrants.

Last year Canada turned away 75 people with HIV/AIDS because the federal government said that they would place excessive demands on publically funded services. Another 207 people with HIV/AIDS were allowed to enter Canada, mainly because of exemptions to the excessive-demand provisions. HIV/AIDS organizations have objected to the government's policy of mandatory HIV-antibody testing of potential immigrants and have expressed concerns about the way in which excessive demand is calculated.

AIDS Serodiagnosis↗
PubMed2002

HIV testing policy and serious mental illness.

OBJECTIVES: Using opinion data from experts, we examined the context of the argument for mandatory testing of psychiatric patients. METHODS: Vignettes were distributed to experts on HIV and mental illness. Respondents were asked to provide appropriateness ratings for different hypothetical clinical decisions regarding HIV management. RESULTS: Respondents were reluctant to impose testing without informed consent in most circumstances. The presence of risk factors or danger to another increased appropriateness ratings modestly. CONCLUSIONS: Despite experts' tendency to emphasize individual rights, public reluctance to mandate testing is unlikely to extend to people with serious mental illness. No argument for mandatory testing can be persuasive if improved voluntary testing can achieve adequate detection rates. Voluntary testing protocols should be studied to determine which successfully identify infected individuals.

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↗
PubMed2002

Mandatory HIV testing of newborns in New York State: what are the implications?

This paper presents an analysis of a public health law (Maternal-Pediatric HIV Prevention and Care Program) enacted by New York State in 1997 and how it strives to reduce the vertical transmission of AIDS. This policy is twofold. First, it strongly encourages voluntary HIV testing of all pregnant women. Secondly, it mandates HIV testing for all newborns. Those found to be positive are referred for medical care. This paper analyzes the State's implementation of this law to determine if it will: exert control over poor, mostly minority women; provide health care for infected woman and infants; protect public health; prevent the spread of HIV/AIDS; or sacrifice a woman's privacy. The potential benefits and shortfalls of this policy are discussed as other states may consider adopting similar legislation.

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↗