REPLY
Mandatory HIV Testing
Theodore C. Eickhoff, MD
15 August 1994 | Volume 121 Issue 4 | Pages 309-310
IN RESPONSE:
A common theme in the comments of Drs. Weissman and Buckingham is the need for mandatory testing of entire populations to identify HIV-infected persons and to control the AIDS pandemic. This is an opinion shared not only by many other physicians but also by many laypersons and their elected representatives. The reasons we have not adopted such an approach are adequately delineated in the position paper [1] and are briefly summarized here.
First, the discrimination encountered at all levels of society by persons known to be infected with HIV has been abundantly documented during the first decade of the AIDS epidemic. Public education and legislative actions have improved the situation, but there is still a long way to go before discrimination against HIV-infected persons ceases to be an issue. Second, mandatory population testing programs are extraordinarily resource-intensive and would add a huge incremental cost to our already constrained health care bill. Testing the 260 million persons in the United States would cost at least $10 billion each time it was done!
Finally, no evidence exists to suggest that even a single case of AIDS would be prevented by such an approach. It is significant that calls for universal testing are being heard from some quarters but not from those charged with protecting the public health.
The editorial by Cohen and colleagues [2] that accompanied the position paper does not indicate that we can interdict persecution of persons with AIDS by education of all citizens, as Dr. Weissman suggests. That is an important goal, to be sure, as we have stated [1]. Note in the editorial [2] that universal testing is not a component of the three-pronged prevention program advocated by the Global Program on AIDS and the U. S. Agency for International Development.
1. American College of Physicians and Infectious Diseases Society of America. Human immunodeficiency virus (HIV) infection. Ann Intern Med. 1994; 120:310-9.
2. Cohen MS, Dallabetta G, Laga M, Holmes KK. A new deal in HIV prevention: lessons from the global approach (Editorial). Ann Intern Med. 1994; 120:340-1.
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