Screening immigrants and international travelers for the human immunodeficiency virus
Article Abstract:
The United States has the most extensive policy in the world for testing (and excluding) people who want to enter the country to determine whether they are infected with HIV (human immunodeficiency virus, the virus associated with AIDS). This approach has come under severe criticism from the standpoints of human rights and public health policy. A review is presented of the current status of immigration law regarding the entry of people who are infected with HIV. This infection is one of eight on a list of 'dangerous contagious diseases' for which aliens can be excluded from the United States; five other infections are sexually transmitted. Temporary visitors are not routinely tested for HIV, but may be tested if they trigger 'suspicion', which has been elicited by such offenses as an intention to attend a conference on AIDS. Applicants for permanent residency must undergo a medical examination, including testing for syphilis and HIV infection. If the latter test is positive, they will be denied permanent residence, with no waiver possible for visa applicants, regardless of the hardships that might surround their cases. Although the Immigration and Naturalization Service has instituted this gigantic screening program, it has no proposal for evaluating it. In addition, the program is not aimed at reducing HIV prevalence. Controlling an infection by excluding infected people makes sense when the incidence of the infection low; this is not the case for HIV incidence in the United States. HIV test frequency and accuracy are evaluated. The adverse effects of the program are enumerated; these include pressure on people to conceal behavior that puts them at-risk for HIV. The argument is made that the Immigration and Naturalization Service is acting out of xenophobia (fear of foreigners) and seriously infringes on basic human rights. The United States policy also goes against international law and world health guidelines. Fears of the potential cost of HIV infection cannot justify the exclusion of afflicted human beings; people with cancer and heart disease, which are also costly diseases, are admitted daily. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: The New England Journal of Medicine
Subject: Health
ISSN: 0028-4793
Year: 1990
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A 55-year-old man with a destructive bone lesion 17 months after liver transplantation
Article Abstract:
A 55-year-old man was admitted to a hospital with bone pain in his right shinbone. He had received a liver transplant about two years before and had developed several infections since then. An X-ray of his leg showed damage to the bone. His doctors suspected that the bone was infected with Nocardia or Cryptococcus. These organisms are both fungi. A bone biopsy confirmed that he was infected with Cryptococcus neoformans. He was treated with the antifungal drug fluconazole as well as surgery to remove diseased bone.
Publication Name: The New England Journal of Medicine
Subject: Health
ISSN: 0028-4793
Year: 1999
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