Sexually transmitted disease: shadow on the land, revisited
The phrase 'shadow on the land' harks back to the 1930s, when Surgeon General Thomas Parran initiated a campaign to wipe out syphilis. One of the key features of the program was the dogged tracing of sexual contacts, often back to a single index case. Similar methods have been proposed for controlling the recent epidemic of acquired immunodeficiency syndrome (AIDS). Objections have been raised to the tracing and notification of sexual partners, primarily on ethical grounds. Is it a violation of privacy or confidentiality to trace and notify sexual partners? More pragmatic questions that are unanswered include whether partner notification discourages individuals from seeking treatment, and do these programs actual discover significant numbers of new cases. Somewhat surprisingly, there has been little objective evaluation of the effectiveness of partner notification programs in the control of sexually transmitted disease. In an article in the April 1, 1990 issue of the Annals of Internal Medicine, researchers have examined the effectiveness of partner notification in the control of epidemic syphilis in Oregon. Several factors suggest that the technique, which may have been effective in the 1930s and 1940s, will contribute little to the control of AIDS. The number of likely sexual contacts has increased, and the chances of providing sufficient information for contact notification has decreased. The transmission of AIDS among intravenous drug users is even less likely to be effectively traceable. Tracing the contacts of those who have traded sex for money or drugs may be impossible. There can be no doubt that the identification of individuals exposed to human immunodeficiency virus (HIV), the AIDS virus, is an important priority for public health. However, before strident calls are made for the routine notification of sexual contacts, there should be some careful analysis of whether such a program could actually accomplish the desired goal. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Annals of Internal Medicine
Improved AIDS surveillance through laboratory-initiated CD4 cell count reporting
Laboratory-initiated CD4 reporting is effective in identifying many HIV patients who would not be identified through other means. In Oregon, health laboratories can report patients who have low CD4 cell counts to the state health department. This is a very cost-effective way of identifying HIV patients, especially those who live in rural areas.
Publication Name: Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology
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