Voluntary Screening for Human Immunodeficiency Virus (HIV) Infection
Authors: Lo Bernard
Journal: Annals of Internal Medicine (1989)

Perspective1 May 1989Voluntary Screening for Human Immunodeficiency Virus (HIV) InfectionWeighing the Benefits and HarmsLo Bernard, MD, Robert L. Steinbrook, MD, Molly Cooke, MD, Thomas J. Coates, PhD, Eleanor J. Walters, MPH, Stephen B. Hulley, MD, MPHLo Bernard, MDSearch for more papers by this author, Robert L. Steinbrook, MDSearch for more papers by this author, Molly Cooke, MDSearch for more papers by this author, Thomas J. Coates, PhDSearch for more papers by this author, Eleanor J. Walters, MPHSearch for more papers by this author, Stephen B. Hulley, MD, MPHSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-110-9-727 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptVoluntary screening for human immunodeficiency virus (HIV) infection may help prevent the spread of the HIV epidemic if persons who test positive alter behaviors that may transmit infection. Protecting persons from unknowingly being exposed to HIV infection must be balanced against respecting the autonomy of individuals being screened. Seropositive patients may feel a stigma and be subject to discrimination if confidentiality of test results is breached. In patients without high-risk behaviors, the positive predictive value of HIV testing may be substantially increased if tests are done in reference laboratories and if further confirmatory tests are run on a second blood...References1. . Final report of the Presidential Commission on the Human Immunodeficiency Virus Epidemic. 1988. Washington, DC. U.S. Government Printing Office. Google Scholar2. Public Health Service guidelines for counseling and antibody testing to prevent HIV infection and AIDS. MMWR. 1987;36:509-15. MedlineGoogle Scholar3. SackettHaynesTugwell DRP. Clinical Epidemiology: A Basic Science for Clinical Medicine. Boston: Little, Brown and Company; 1985:139-42. Google Scholar4. FletcherFletcherWagner RSE. Clinical Epidemiology: The Essentials. Baltimore: Williams & Wilkins; 1982:67-8. Google Scholar5. BayerLevineWolf RCS. HIV antibody screening: an ethical framework for evaluating proposed programs. JAMA. 1986;256:1768-74. CrossrefMedlineGoogle Scholar6. ClearyBarryMayerBrandtGostinFineberg PMKALH. Compulsory premarital screening for the human immunodeficiency virus: technical and public health considerations. JAMA. 1987;258:1757-62. CrossrefMedlineGoogle Scholar7. BelongiaVergerontDavis EJJ. Border hopping as a consequence of premarital HIV screening: the Kenosha diamond [Letter]. JAMA. 1988;260:1883-4. CrossrefMedlineGoogle Scholar8. Illinois may end premarital AIDS testing. New York Times. 1989; January 5:B7. Google Scholar9. Veatch R. A Theory of Medical Ethics. New York: Basic Books Inc.; 1981. Google Scholar10. BeauchampChildress TJ. Principles of Biomedical Ethics. 2nd ed. New York: Oxford University Press; 1983. Google Scholar11. . Confronting AIDS: Directions for Public Health, Health Care, and Research. Washington, D.C.: National Academy Press; 1986. Google Scholar12. FehrsFlemingFoster LDL. Trial of anonymous versus confidential human immunodeficiency virus testing. Lancet. 1988;2:379-82. CrossrefMedlineGoogle Scholar13. International Conference on AIDS. The impact of mandatory reporting of HIV seropositive persons in South Carolina. Proceedings of the IV International Conference on AIDS, Stockholm, June 12-16, 1988 (Abstract 6020). Google Scholar14. JudsonVernon FT. The impact of AIDS on state and local health departments: issues and a few answers. Am J Public Health. 1988;78:387-93. CrossrefMedlineGoogle Scholar15. Bayer R. Private Acts, Social Consequences: AIDS and the Politics of Social Health. New York: The Free Press; 1989. Google Scholar16. GostinCurranClark LWM. The case against compulsory casefinding in controlling AIDS—testing, screening and reporting. Am J Law Med. 1987;12:7-53. CrossrefMedlineGoogle Scholar17. GostinCurran LW. Legal control measures for AIDS: reporting requirements, surveillance, quarantine, and regulation of public meeting places. Am J Public Health. 1987;77:214-8. CrossrefMedlineGoogle Scholar18. Intergovernmental Health Policy Project. State AIDS reports. 1989 February-March pt. 2. George Washington University 2011 I Street N.W., Suite 200, Washington D.C. 20006. Google Scholar19. BurkeBrandtRedfield DBR. Diagnosis of human immunodeficiency virus infection by immunoassay using a molecularly cloned and expressed virus envelope polypeptide: comparison to Western blot on 2707 consecutive serum samples. Ann Intern Med. 1987;106:671-6. LinkGoogle Scholar20. WittekPhelanWells AMM. Detection of human immunodeficiency virus core protein in plasma by enzyme immunoassay. Ann Intern Med. 1987;107:286-92. LinkGoogle Scholar21. Wilber J. Serologic testing of human immunodeficiency virus infection. Clin Lab Med. 1987;7:777-91. CrossrefMedlineGoogle Scholar22. OuKwokMitchell CSS. DNA amplification for direct detection of HIV-1 in DNA of peripheral blood mononuclear cells. Science. 1988;239:295-7. CrossrefMedlineGoogle Scholar23. The Consortium for Retrovirus Serology Standardization. Serological diagnosis of human immunodeficiency virus infection by Western Blot testing. JAMA. 1988;260:674-9. CrossrefMedlineGoogle Scholar24. SchwartzDansKinosian JPB. Human immunodeficiency virus test evaluation, performance, and use: proposals to make good tests better. JAMA. 1988;259:2574-9. CrossrefMedlineGoogle Scholar25. van der PoelReesinkTersmetteLelieHuismanMiedema CHTPHF. Blood donations reactive for HIV in Western blot, but non-infective in culture and recipients of blood [Letter]. Lancet. 1986;2:752-3. CrossrefMedlineGoogle Scholar26. Gainesvon SydowSönnerborg HMA. Antibody response in primary human immunodeficiency virus infection. Lancet. 1987;1:1249-53. CrossrefMedlineGoogle Scholar27. BiberfeldBredberg-RadenBöttiger GUB. Blood donor sera with false-positive Western blot reactions to human immunodeficiency virus [Letter]. Lancet. 1986;2:289-90. CrossrefMedlineGoogle Scholar28. SackettHaynesTugwell DRP. Clinical Epidemiology: A Basic Science for Clinical Medicine. Boston: Little, Brown and Company; 1985:47-138. Google Scholar29. Weinstein M. Clinical Decision Analysis. Philadelphia: W.B. Saunders Company; 1980. Google Scholar30. KleinmanFitzpatrickSecordWilke SLKD. Follow-up testing and notification of anti-HIV Western blot atypical (indeterminant) donors. Transfusion. 1988;28:280-2. CrossrefMedlineGoogle Scholar31. Update: serologic testing for antibody to human immunodeficiency virus. MMWR. 1988;36:833-45. MedlineGoogle Scholar32. BurkeRedfield DR. False-positive Western blot tests for antibodies to HTLV-III [Letter]. JAMA. 1986;256:347. CrossrefMedlineGoogle Scholar33. LewisFreemanKaplanCorey CHSC. The impact of a program to enhance the competencies of primary care physicians in caring for patients with AIDS. J Gen Intern Med. 1986;1;287-94. CrossrefMedlineGoogle Scholar34. Human immunodeficiency virus infections in the United States: a review of current knowledge and plans for expansion of HIV surveillance activities. MMWR. 1987;36:1S-48S. MedlineGoogle Scholar35. LandesmanMinkoffHolmanMcCallaSijin SHSSO. Serosurvey of human immunodeficiency virus infection in parturients: implications for human immunodeficiency virus testing programs of pregnant women. JAMA. 1987;258:2701-3. CrossrefMedlineGoogle Scholar36. KelenFritzQaqish GSB. Unrecognized human immunodeficiency virus infection in emergency department patients. N Engl J Med. 1988;318:1645-50. CrossrefMedlineGoogle Scholar37. AllainDaniels JR. Compulsory premarital screening for HIV [Letter]. JAMA. 1988;259:1011-5. CrossrefMedlineGoogle Scholar38. BurkeBrundageRedfield DJR. Measurement of the false positive rate in a screening program for human immunodeficiency virus infections. N Engl J Med. 1988;319:961-4. CrossrefMedlineGoogle Scholar39. SteckelbergCockerill JF. Serologic testing for human immunodeficiency virus antibodies. Mayo Clin Proc. 1988;63:373-80. CrossrefMedlineGoogle Scholar40. RankiValleKrohn ASM. Long latency precedes overt seroconversion in sexually transmitted human-immunodeficiencyvirus infection. Lancet. 1987;2:589-93. CrossrefMedlineGoogle Scholar41. MossBacchettiOsmond APD. Seropositivity for HIV and the development of AIDS or AIDS related condition: three year follow up of the San Francisco General Hospital cohort. Br Med J [Clin Res]. 1988;296:745-50. CrossrefMedlineGoogle Scholar42. Moss A. Predicting who will progress to AIDS. Br Med J. 1988;297:1067-8. CrossrefMedlineGoogle Scholar43. Steinbrook R. FDA will speed use of key AIDS treatment. Los Angeles Times. 1989 February 1 (pt I) 1. Google Scholar44. Tramont E. Syphilis in the AIDS era [Editorial]. N Engl J Med. 1987;316:1600-1. CrossrefMedlineGoogle Scholar45. Recommendations for diagnosing and treating syphilis in HIV-infected patients. MMWR. 1988;37:600-2, 607-8. MedlineGoogle Scholar46. Diagnosis and management of mycobacterial infection and disease in persons with human T-lymphotropic virus type III/lymphadenopathy-associated virus infection. MMWR. 1986;35:448-52. MedlineGoogle Scholar47. CoatesStallKegelesLoMorinMcKusick TRSBSL. AIDS antibody testing: Will it stop the AIDS epidemic? Will it help people infected with HIV? Am Psychol. 1988;43:859-64. CrossrefMedlineGoogle Scholar48. StallCoatesHoff RTC. Behavioral risk reduction for HIV infection among gay and bisexual men: a review of results in the United States. Am Psychol. 1988;43:878-85. CrossrefMedlineGoogle Scholar49. CatesHandsfield WH. HIV counseling and testing: does it work? [Editorial]. Am J Public Health. 1988;78:1533-4. CrossrefMedlineGoogle Scholar50. Partner notification for preventing human immunodeficiency virus (HIV) infection—Colorado, Idaho, South Carolina, Virginia. MMWR. 1988;37:393-6, 401-2. MedlineGoogle Scholar51. ToomeyCahillBloutHavlakCates KKJGW. AIDS: politics and science [Letter]. N Engl J Med. 1988;319:441-3. CrossrefMedlineGoogle Scholar52. WeissThier RS. HIV testing is the answer—what's the question? [Editoral]. N Engl J Med. 1988;319:1010-2. CrossrefMedlineGoogle Scholar53. GoldSeymourSahl MNJ. Counseling HIV seropositives. In: McKusick L, ed. What to Do About AIDS. Berkeley: University of California Press; 1986: 103-10. Google Scholar54. Hermann D. Torts: private lawsuits about AIDS. In: Dalton HL, Burris S, the Yale AIDS Law Project, eds. AIDS and the Law. New Haven: Yale University Press; 1987: 153-72. Google Scholar55. BlendonDonelan RK. Discrimination against people with AIDS: the public's perspective. N Engl J Med. 1988;319:1022-6. CrossrefMedlineGoogle Scholar56. Osborn J. AIDS: politics and science. N Engl J Med. 1988;318:444-7. CrossrefMedlineGoogle Scholar57. MeyerPauker KS. Screening for HIV: can we afford the false positive rate? N Engl J Med. 1987;317:238-41. CrossrefMedlineGoogle Scholar58. DawsonCynamonFittie DMJ. AIDS knowledge and attitudes: provisional data from the National Health Interview Survey: United States, August 1987. NCHS Advancedata. 1987;146:1-10. Google Scholar59. Ingelfinger F. Arrogance. N Engl J Med. 1980;303:1507-11. CrossrefMedlineGoogle Scholar60. Siegler M. Sounding boards: confidentiality in medicine—a decrepit concept. N Engl J Med. 1982;307:1518-21. CrossrefMedlineGoogle Scholar61. BelitskySolomon RR. Doctors and patients: responsibilities in a confidential relationship. In: Dalton HL, Burris S, the Yale AIDS Law Project, eds. AIDS and the Law. New Haven: Yale University Press; 1987:201-9. Google Scholar62. Dickens B. Legal limits of AIDS confidentiality. JAMA. 1988;259:3449-51. CrossrefMedlineGoogle Scholar63. California Health and Safety Code, Amendment to Section 199.25 and repeal of Section 199.27. 1988. Google Scholar64. New York Public Health Law, Chapter 584, section 27F. 1988. Google Scholar65. HearstHulley NS. Preventing the heterosexual spread of AIDS: are we giving our patients the best advice? JAMA. 1988;259:2428-32. CrossrefMedlineGoogle Scholar66. Koop C. Physician leadership in preventing AIDS [Editorial]. JAMA. 1987;258:2111. CrossrefMedlineGoogle Scholar67. Goedert J. What is safe sex? Suggested standards linked to testing for human immunodeficiency virus. N Engl J Med. 1987;316:1339-42. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: From the University of California at San Francisco, and San Francisco General Hospital, San Francisco, California; and the Los Angeles Times, Los Angeles, California. For current author addresses, see end of text. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byPerspectives on Medical Research Involving Men in Schizophrenia and HIV-Related ProtocolsAIDS Psychiatry: Psychiatric and Palliative Care, and Pain ManagementGenetic Exceptionalism in Medicine: Clarifying the Differences between Genetic and Nongenetic TestsMichael J. Green, MD, MS and Jeffrey R. 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Peter Drotman, MD 1 May 1989Volume 110, Issue 9Page: 727-733KeywordsAIDSBehaviorDrug abuseHIVHIV infectionsHIV preventionHematologic testsPositive predictive valuePsychiatry and mental health ePublished: 1 December 2008 Issue Published: 1 May 1989 Copyright & Permissions©1989 American College of PhysiciansPDF downloadLoading ...