Testing for HIV infection in STD clinics: How aggressive should we be?

Article Abstract:

Although initially there was debate among some physicians and by the public about the use of tests that detect exposure to HIV (human immunodeficiency virus, the cause of AIDS) to prevent further infection, most people in the field of sexually transmitted diseases (STD) were in agreement as to test usage. Professionals in this field, generalizing on experience with other STDs, felt that safer sexual behavior would follow counseling in conjunction with results of patients' tests. This has been supported by research results, and prevention of HIV transmission by extensive counseling and testing is now well accepted. The consensus in the public health field is that voluntary, rather than mandatory, testing is best, as mandatory testing frightens away the people in greatest need and would result in less of an overall behavioral change. This has now been challenged by Lee et al. in an article in the Oct-Dec 1990 issue of Sexually Transmitted Diseases. They assert that voluntary HIV testing was accepted by over 90 percent of clients at an STD clinic. These researchers also cite data from studies that suggest that people who refuse voluntary testing are more likely to be HIV-infected, and also claim that personnel would be freed from pre-test counseling for other duties by using printed and video materials. However, scrutiny of their data reveals that the true prevalence of HIV infection in people refusing voluntary testing is unclear due to variability among studies. Intensive counseling of people who refuse voluntary testing is likely to be more effective than mandatory testing. In addition, mandatory testing is likely to produce more concern and emotional reactions, requiring more counseling or intervention. Coercive policies are exactly opposite to what has been effective in STD clinics, and extension of the logic used by Lee et al. to other STDs such as syphilis or gonorrhea suggests that mandatory testing is, at the very least, counterproductive. The authors of that article strongly advocate HIV testing and notification of sexual and needle-sharing partners at risk. However, best results are achieved by routine but voluntary, rather than mandatory, testing. (Consumer Summary produced by Reliance Medical Information, Inc.)

Sexually transmitted diseases, Evaluation, Services, Testing, Prevention, HIV infection, HIV infections, HIV patients, Disease transmission, Sexually transmitted disease prevention, Public health administration, editorial

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Acyclovir should not be approved for marketing without prescription

Article Abstract:

The rationales for making acyclovir available without prescription for treating genital herpes do not hold up. Proponents argue that severely affected persons will gain greater access to the medication. However, difficulty in obtaining the drug does not appear to be a problem. Proponents argue that more wide-spread treatment would reduce transmission because acyclovir reduces viral shedding. However, viral shedding still occurs, and persons might be inclined to take fewer precautions because they believed they were not contagious. Proponents argue that resistant viral strains will not develop. However, resistant strains, though rare, have been documented, and uncontrolled use would be the optimal environment to foster them. Proponents argue that few people would self-treat syphilis or chancroid because they thought they had genital herpes. However, although probably rare, delayed diagnoses would occur. Finally, the drug manufacturer has promised to finance a public education campaign. However attractive, there can be no guarantees of how broad or lengthy such a campaign would be.

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Over-the-counter acyclovir: an idea whose time has come

Article Abstract:

The Food and Drug Administration should allow acyclovir to be sold without prescription. Acyclovir is used to treat genital herpes. Opponents worry about safety. However, the research reports only mild side-effects and no increases in miscarriages or birth defects. Opponents worry that persons will self-medicate other genital symptoms in the mistaken belief they have herpes and that persons with herpes will incorrectly think they are noncontagious. However, this is unlikely to occur except with first episodes. Appropriate package warnings about seeing a physician and viral shedding in the absence of symptoms should minimize this. Opponents worry about developing acyclovir-resistant viral strains. Projections based on the research data predict that the risk of a resistant strain becoming a problem is extremely low. In any case, nonprescription availability is unlikely to increase acyclovir usage by much. In addition, an incentive to approving nonprescription purchase is that the drug company has promised a public education campaign and a monitoring program.

Nonprescription drugs

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