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Transmission of the human immunodeficiency virus in the health care setting - time for action

Article Abstract:

In recent years, a few highly publicized cases focused public attention on the problem of HIV infection among health care workers. (HIV infection causes AIDS.) It is unfortunate that the relationship a patient has with nurses and physicians should be affected by concerns of AIDS. The social and ethical problems are many and complex, however. It might be argued that it would be inappropriate to insist on testing doctors for HIV infection when doctors are not permitted to test patients without their consent. Others may point out that one infected doctor may place many patients at risk; the same is not true for one infected patient. Physicians are also considered by some to shoulder a moral burden somewhat greater than that of the average person, and that the dedication of physicians to health should require testing and abstinence from patient contact by HIV-infected physician. It is not yet clear how the burdens associated with HIV infection should be shared. A physician may well have acquired infection during the course of patient care, but this would be difficult or impossible to prove, and therefore it would be equally difficult to use litigation to compel a hospital to share in the burden of a lost occupation. Six basic points are suggested as an agenda for dealing with the problems of HIV infection among health care workers. First, there does not seem to be enough benefit from routinely testing patients for HIV infection to insist upon it. Second, prevention policies at hospitals must be strictly followed. Third, hospital workers should be tested, policies should be formulated about what procedures may be performed by HIV-infected workers, and encouragement should be provided for the voluntary warning of patients. Fourth, policies should be implemented to help infected workers find alternative jobs. Fifth, hospitals should cooperate with patients who believe they have been infected with HIV in the course of treatment, and testing of the individuals involved should be conducted. Lastly, hospitals should find ways to insure their staff against occupationally-transmitted HIV infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, HIV (Viruses), HIV, Medical personnel, Disease transmission, Patients, editorial

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Screening for HIV infection - benefits and costs

Article Abstract:

Early diagnosis of HIV infection may be increased by voluntary programs for HIV testing at hospitals and medical clinics. The number of individuals infected with HIV is growing, as is the number diagnosed with AIDS every year. The incidence of HIV infection is growing especially fast among women and urban minority populations. Early diagnosis and treatment of HIV infection may delay the onset of AIDS, but many individuals are not diagnosed until after the onset of symptoms. Many HIV-positive individuals do not receive early antiviral treatment or preventative treatment for pneumonia. Voluntary HIV-testing at hospitals and medical clinics may increase the number of individuals who receive early treatment. Voluntary HIV testing at 20 urban hospitals identified HIV infection among individuals with a wide variety of symptoms. Some experts believe that HIV-testing programs should be targeted to high-risk groups, rather than to the general population.

Editorial, Planning, HIV testing, HIV tests

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Proposed revisions to the Declaration of Helsinki -- will they weaken the ethical principles underlying human research?

Article Abstract:

Some proposed changes to the Declaration of Helsinki may eliminate some protections afforded to patients who participate in clinical trials. The Declaration of Helsinki was created in 1964 partly as a result of the trial of Nazi scientists at Nuremberg in 1946. One proposed change would waive the right of the patient to give informed consent. Another would offer patients the best treatment available in their location rather than the best treatment overall. Some of these changes were prompted by AIDS studies carried out in developing countries. However, the changes will affect all medical research.

Ethical aspects, Human experimentation in medicine, Human medical experimentation

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