Dealing with patients with HIV infection

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7075.220a (Published 18 January 1997) Cite this as: BMJ 1997;314:220

Isolation is impractical and unnecessary

  1. Hilary Curtis, Executive directora
  1. a BMA Foundation for AIDS, London WC1H 9JP
  2. b Department of Genitourinary Medicine, Leeds General Infirmary, Leeds LS1 3EX
  3. c Guy's and St Thomas's NHS Trust, London SE1 7EH
  4. d Stafford District General Hospital, Stafford ST16 3SA

    Editor-After all that has been written about AIDS, I am surprised that the BMJ should publish Bernard Rabinowitz's personal view.1 In portraying current ethical standards as the result of an unprincipled cave-in to some homosexual lobby Rabinowitz distorts both those standards and the history of public health medicine. For example, as early as the first world war a British royal commission concluded that the control of sexually transmitted diseases was better served by securing the willing cooperation of those at risk-through education and voluntary, confidential testing and treatment-than by sanctions.2

    While isolation may work for diseases such as smallpox or diphtheria, which lead to death or recovery within weeks, for HIV infection it is impractical and burdensome because people remain infected but asymptomatic for many years; in addition, it is unnecessary because the virus is not spread by casual contact. The traditionalist view of infectious disease control as being focused solely on identification, isolation, and treatment of infected subjects is questionable in relation not just to HIV infection but also to more conventional diseases.3

    Obligatory premarital HIV testing has been tried and found wanting.4 People can have sex before they marry, and a medical test may be a powerful disincentive to matrimony. The idea of compulsory testing before pregnancy is even more bizarre. How could it be enforced?

    Doctors working for insurance companies have always been bound by the same rules of confidentiality as the rest of the profession. They may recommend refusal of insurance or a raised premium for someone with hypertension or HIV infection, …

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