HIV/AIDS Newsroom: December 27, 2000
Surveillance and Privacy
12/08/00 Vol. 290, No. 5498, P. 1898; Bayer, Ronald; Fairchild, Amy L.
Today's public health officials are facing ethics battles over whether they are stepping out of bounds in maintaining a watchful eye over what many consider private health matters. The controversy surrounding the issues stems from the policy of name-based reporting methods and whether it infringes on privacy rights. This method of medical recording was started in the late 19th century, when it was used by health officials to order the quarantine, isolation, or vaccination of patients believed to have contagious diseases, such as tuberculosis. The issue has resurfaced in recent years due in large part to the AIDS epidemic. The issue of HIV reporting has been controversial, with much debate over the use of patient's names or unique identifiers. For vaccines, meanwhile, the privacy issue reared its head when the National Vaccine Advisory Committee (NVAC) recommended last year the formation of a nationwide network of state and community immunization registries. The decision sparked fear in immigrant communities, as well as among parents who choose not to have their children vaccinated. Thus, the NVAC report said that registries should at least tell parents about the existence and content of the registry, but parents should be able to choose whether or not their children would be included on the lists. Authors Ronald Bayer and Amy L. Fairchild of the Mailman School of Public Health at Columbia University conclude that "the central ethical question posed by name-based reporting is whether an abrogation of medical privacy can be justified by public health benefits. Although medical privacy is a fundamental value, it is not absolute."
The advent of antiretroviral drugs in the United States and other wealthy nations has helped to extend many HIV patients' lives, but very few people benefit from the treatments in Africa. While an estimated 25 million Africans are infected with HIV, only about one-tenth of 1 percent receive antiretroviral therapy. This year has seen calls to action and pledges of assistance from governments and the pharmaceutical industry. A review by the Washington Post, however, indicates that, fundamentally, not much has changed, as only one of the five drug companies that promised deep price reductions has disclosed the actual cuts. In addition, Pfizer agreed to provide its antifungal Diflucan free of charge to AIDS patients in South Africa, but the drug has not yet been delivered. Moreover, no one has taken up the White House's offer of $1 billion, which is available in the form of Export-Import loans with commercial interest rates. Some drug makers are apparently concerned that deep price discounts in Africa could have far-reaching implications, such as the re-export of cheaper drugs from poor to wealthy nations, or a possible backlash if the price cuts then focused attention on high profit margins in developed nations. Harvard economist Jeffrey Sachs notes, "Like most things in the world, it comes down to money, and nobody has been willing to commit money to this."
Prisons Release Record Numbers of Ex-Convicts: Communities Are Scrambling to Set Up 'Re-Entry' Programs
USA Today (www.usatoday.com)
12/27/00 P. 1A; Locy, Toni
Throughout the United States, individuals arrested during the anti-crime crackdown of the past two decades are now returning home. Statistics show that 585,000 felons will be released from state and federal prisons in 2000, a figure approximately three times the number released in 1980. As a result, communities are rushing to establish "re-entry" programs to help the ex-convicts, particularly as some law enforcement officials and health analysts issue dire predictions about the offenders' return. The predictions include possible increases in now record-low crime and unemployment rates. In addition, public health expenses could rise, because many offenders have diseases like HIV and tuberculosis, and many felons who were drug addicts did not receive treatment while incarcerated. U.S. Attorney General Janet Reno has called on 17 jurisdictions to launch re-entry efforts, and Congress has cleared almost $100 million in funding for the upcoming fiscal year.
Estimates from the Florida Department of Health indicate that nearly 1,000 people in Sarasota, Manatee, and Charlotte counties have HIV or AIDS. For the 12 months ending October 31, 2000, the counties recorded 130 new HIV infections, up 28 from the same period in 1999. Manatee County saw the greatest increase, with 66 new infections, compared to 43 in the previous year. Ken Walsh, head of Charlotte AIDS Network, notes that there are probably many more HIV-infected individuals in Southwest Florida; however, many have not been tested, some mistakenly believing that HIV is no longer deadly. Officials hope that new needleless or bloodless HIV testing methods will persuade more people to come in for testing.
In a study published in the December 1 issue of AIDS (2000;14:2731-2740), researchers report that aggressive measures have helped to control HIV's spread in Thailand's Chiang Rai province. In 1991, the prevalence of HIV infection among female sex workers at brothels in the province was 62 percent, and approximately four-fifths of young male military conscripts reported having sex with these individuals that year. The Thai government launched an effort to promote condom use, distributing 1.2 million free condoms in the province each year, and also sanctioned police action against sex establishments with workers or customers who were infected. As a result of the prevention program, many brothels closed, the number of conscripts who reported visiting female sex workers had declined significantly by 1995, and reported sexually transmitted disease rates in Chiang Rai dropped from 726 per 100,000 in 1990 to 12 per 100,000 in 1999.
An 18-month study recently conducted in Malawi concluded that nearly 90 percent of African children infected with HIV do not survive beyond their third birthday. Researchers from the Johns Hopkins University in Baltimore found that 89 percent of the 190 HIV-infected children who were alive at six months of age died by age three, while a European study concluded that less than 20 percent of HIV-infected children died by three years of age and an American study reported that three-quarters lived to age five. According to the authors, the number of deaths among HIV-infected children in Africa could be reduced by improving medical attention to persistent diarrhea and chronic middle-ear infections. The research is published in the December issue of Pediatrics (2000;106).
Bangledesh, with the assistance of the World Bank, plans to deploy a $52 million program to battle HIV, according to a report in the Daily Star newspaper. The four-year program is an attempt to stop the increase of HIV before it reaches epidemic proportions in the region and destroys any hope of further economic development. Infection rates are fairly low in Bangladesh overall, but certain populations are predicted to show an increase over time. Factors that have raised concern about the spread of HIV in Bangladesh include needle sharing among drug users and low condom use by prostitutes. The immediate mission of the program will be to educate and promote safer sexual behavior among high-risk groups.
In an effort to raise awareness and reassure the public about the health and well being of their leaders, African politicians with intentions of seeking office are being strongly urged to take voluntary HIV tests. The call came from former Zambian ruler Kenneth Kaunda, who has become a strong advocate in the fight against HIV. He heads the Kenneth Kaunda Children of Africa Foundation in Johannesburg, which seeks to not only fight HIV but also to better the lives of children orphaned by the disease.
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.