Reducing the Odds Preventing Perinatal Transmission of HIV in the United States (1999) / Chapter Skim
Currently Skimming:
2 Public Health Screening Programs
2 Public Health Screening Programs
Pages 21-35
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 21... ...
This chapter was prepared to provide background information on the terminology and generally accepted principles that should guide public health screening efforts, and to provide a historical and social context for implementation of HIV screening programs. The chapter begins with a discussion of screening as a public health paradigm, reviews a series of historical examples of perinatal screening programs in this context, and summarizes some of the issues associated with HIV testing in the United States.
|
From page 22... ...
This report concentrates on HIV screening for the purpose of identifying and treating individual pregnant women for their own health and preventing transmission of HIV to their infants, that is, case finding. Testing of selected individuals and screening for surveillance purposes are important efforts, but not directly related to the committee's charge.
|
From page 23... ...
Screening programs need not be cost-saving, but their costs must be reasonable in relation to the anticipated benefits, and to other opportunities for public health programs. Various legal and ethical principles should also apply to public health screening programs (Faden et al., 1991~.
|
From page 24... ...
In a conditionally mandatory program, either government or a private institution makes access to a designated service or opportunity contingent upon participation in the screening program. A prenatal care provider, for instance, could require women to undergo certain tests as a condition of receiving prenatal care.
|
From page 25... ...
In Texas, providers are required to test all women in prenatal care and their newborns unless a woman objects in writing, and to notify them about the testing and their right to refuse. EXPERIENCE WITH SELECTED PUBLIC HEALTH SCREENING PROGRAMS2 Pregnant women are routinely tested for many conditions.
|
From page 26... ...
sickle cell disease, (4) neural tube defects, and (5)
|
From page 27... ...
is an autosomal recessive hemolytic anemia occurring most frequently in African Americans, but also in persons of Mediterranean origin and others. Sickle cell disease, the homozygous condition, is estimated to occur in as many as one in 400 African-American newborns, and approximately 8% of African Americans are carriers of the sickle cell trait, the heterozygous condition.
|
From page 28... ...
The lack of attention to the eugenic implications of informing someone that he carries sickle cell trait led to charges of racism and growing opposition to screening programs. Most of the laws that were passed in the 1970s lacked confidentiality provisions, and, as a result, there were many documented cases of job discrimination, especially in the military, even for those having asymptomatic sickle cell trait.
|
From page 29... ...
ACOG did not, at this time, change its recommendation that the test not be used routinely. Two years later, ACOG, citing greater understanding of MSAFP and improvement in follow-up tests, and new findings about the association of MSAFP with Down's syndrome, concluded: MSAFP screening for neural tube defects detection should now be undertaken in United States communities having expertise in ultrasound, genetic counseling, and amniocentesis.
|
From page 30... ...
but the implications are not carefully thought through (Jos et al., 1995~. To date there has been little outcry about prenatal and newborn substance abuse screening programs, perhaps because the interests of the affected women are not well reflected in policy decisions, but the history of other screening programs suggests that this approach may not serve public health goals well.
|
From page 31... ...
made serum HIV tests attractive public health measures. Tests also became available at this time for individuals, but stigma and discrimination associated with homosexuality, drug use, and AIDS itself, coupled with the fact that there were no measures available to alter the disease process in HIV-infected individuals, limited their acceptability.
|
From page 32... ...
This history explains why HIV testing was, and still is, thought by many to differ from other clinical testing and public health screening programs, part of a phenomenon often labeled "AIDS exceptionalism" (Bayer, 1991~. As this report was being prepared in 1998, an increasing number of states are requiring positive HIV test results to be reported to state health departments with names or other personal identifiers (Gostin et al., in press)
|
From page 33... ...
In the mid-199Os New York State legislators and others argued, in the interest of the HIV-positive children whose status was not known to their parents or guardians, that the results should be "unblinded," as described in Appendix L, and CDC soon discontinued the Survey of Childbearing Women nationally. New York statutes now require notification of parents and health care providers of all infants with positive HIV tests, so what was a surveillance activity became a case finding program.
|
From page 34... ...
Much of the voiced African-American opposition to HIV testing programs must be understood in the context of historical perceptions of mistrust and fear toward the public health and medical research establishment. This underlying
|
From page 35... ...
Without adequate protection such as anonymous testing, case reporting without name identifiers, voluntary partner notification, and strong confidentiality regulations, those people at greatest risk who already feel significant distrust of the public health/government system may not seek HIV testing services. Consequently, there may continue to be a growth in numbers of unknowingly infected individuals, higher mortality rates than among those whose infection is detected early, tremendous budgetary strains on the health care delivery system, and more HIV-infected babies.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.