Voluntary human immunodeficiency virus testing, recidivism, partner notification, and sero-prevalence in a sexually transmitted disease clinic: a need for mandatory testing

Article Abstract:

Among the issues that affect voluntary testing for human immunodeficiency virus (HIV, the cause of AIDS) are whether testing should be universal or aimed at target groups, whether it should be anonymous, and who should notify sexual partners. Another issue not always addressed is mandated reporting of infected individuals. The Missouri Department of Health now mandates reporting of individuals according to name, demographics, and risk factors. This article reports the results of voluntary counseling and testing which began in 1988 in Kansas City, and discusses the results with reference to establishing a mandatory testing program. Between 1988 and 1989, up to 97 percent of clients at the sexually transmitted disease (STD) clinic accepted HIV testing, and the rate of positivity for HIV ranged from 0.35 to 2.2 percent during that interval. Pre-test counseling focused on correcting misconceptions, and this was associated with changes in admitted risk factor status. Twenty percent of identified HIV-positive clients returned for further STD evaluation or treatment; HIV-positive individuals with behavioral risks are subject to potential legal action in Missouri and are therefore monitored. Individuals who tested positive were observed to be nonreceptive to further medical testing, such as for tuberculosis, for instance. Forty-two percent of sexual needle-sharing contacts were positive for HIV. The results suggest that testing is well accepted by STD clinic clients. It is suggested that HIV testing to be made mandatory, as is testing for syphilis. This is advocated as it should lead to better use of resources and a more holistic approach to treatment of STDs. Cost-savings are thought to accrue from this approach, and more personnel would be freed to intensively counsel high-risk HIV-positive subjects who persist in risky behaviors. Such a program should allow identification of HIV-positive individuals, a fairly large number of whom may be in the group that refuses voluntary testing. The study concludes that the small group of people who decline the services of the STD clinic due to mandated testing will likely be able to obtain health care from other public and private health care providers. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Missouri, HIV seroprevalence

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Hospital-based study of sexually transmitted diseases at Murewa rural District Hospital, Zimbabwe 1991-1992

Article Abstract:

The incidence of HIV infection appears to be high among rural residents of Zimbabwe. A group of 285 women and 215 men attending a sexually transmitted disease (STD) clinic serving a large district of rural Zimbabwe were interviewed, examined, and blood and other specimens were analyzed for HIV, syphilis, gonorrhea, and chlamydia. Almost half of the group tested positive for HIV. Among men, 64% had genital ulcers and 62% had difficulty urinating. Among women, 91% had vaginal discharge and 79% had lower abdominal pain. Fifteen percent of men and 19% of women had syphilis, and 18% of men and 10% of women had gonorrhea. Eight percent of both sexes had chlamydia. There appeared to be no relationship between infection with HIV and infection with other STDs.

Health aspects, Sexually transmitted diseases, Zimbabwe

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Human immunodeficiency virus partner notification in a low incidence urban community

Article Abstract:

Contacting the sexual partners of HIV-positive sexually transmitted disease (STD) patients may provide them with information about their risks and HIV status, and help control the spread of HIV. Researchers in Kansas City, Missouri, an urban area with a low incidence of HIV, tested 61,464 STD patients over a four year period. They identified 366 new cases of HIV, and these people identified 662 sex or drug injection needle-sharing partners. Of these, 447 partners were located and confidentially interviewed and offered HIV testing. Thirty-three new cases of HIV were found among the partners. Educating people at risk for HIV infection and their partners may prevent transmission and promote early medical care for those found to be infected.

Social aspects, HIV patients, Disease reporting

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