Nova Scotia: "blood samples" legislation passed

On 18 October 2004 the Nova Scotia legislature passed the Mandatory Testing and Disclosure Act, thus becoming the third Canadian province or territory to pass similar legislation.

Medically assisted reproduction in the presence of chronic viral diseases

Teams practising medically assisted reproduction techniques try to avoid viruses as much as possible. Attitudes towards chronic carriers of viruses are rapidly changing, especially for human immunodeficiency virus (HIV) patients. We focus our attention on the legitimacy of systematic screening before assisted reproductive techniques and the need for specialized approaches including an adapted laboratory for viral hazards as well as the need for a multidisciplinary team. Specificities of HIV, hepatitis C virus (HCV), hepatitis B virus (HBV) carriers and the hypothesis of a reduced fertility potential are discussed. Are male HIV carriers a new indication for assisted reproductive techniques in order to prevent virus transmission? It is largely proven that sperm gradient preparation techniques efficiently decrease viral loads and therefore have a protective effect on contamination risk during assisted reproductive techniques. Although a few thousand assisted reproductive technique cycles were performed in the world for this indication without contamination, it is still too early to demonstrate that this technology is fully safe. Two examples of contaminations during insemination are examined. Many questions remain unresolved, such as the lack of standardized techniques for semen preparation or virus detection or the relative merits of intrauterine insemination or ICSI to prevent HIV contamination during assisted reproductive techniques. The authors plead for well-structured, separate programmes of care linked to research objectives.

Some consequences of different older driver licensing procedures in Australia

Given both the expected growth in the number of older drivers and their over-involvement in fatal and serious injury crashes, there has been a world-wide call for improved licensing procedures to manage older driver safety. In particular, licensing authorities have been urged to move from mandatory assessment of all older drivers to assessment practices targeting only those at higher crash risk. The current study examined older driver fatal and serious injury crash involvement rates across all Australian States to determine a possible association with the different licensing procedures. In particular, older driver crash involvement rates in Victoria (where there is no age-based assessment program) have been compared with rates in other jurisdictions with assessment programs. Crash involvement rates have been calculated using two denominators: per population and per number of licensed drivers. Some data limitations notwithstanding, older drivers in jurisdictions with age-based mandatory assessment programs could not be shown to be safer than drivers in Victoria. Further, there is some indicative evidence that older drivers in Victoria may have a significantly safer record regarding overall involvement in serious casualty crashes.

Botswana: Industrial Court tackles HIV testing in the workplace

The Botswana Industrial Court recently decided two cases regarding mandatory HIV testing in the workplace. One case addressed constitutional rights of HIV-infected people, expanding the reach of the Bill of Rights to the private sphere and potentially offering wide protection to people living with HIV/AIDS. Both cases highlight the glaring need for HIV-related legislation in Botswana.

Drugs, prisons, and harm reduction

The use of drugs in society raises important considerations for health and social policy. Critical health and social care issues arise when drugs are used inside prisons. This paper argues that there is an urgent need for prison drug policies to adopt the principles of harm reduction. However, current policy orthodoxy emphasises the control of drugs and punishment for drug taking. Key components of harm reduction are operationalised in this article by exploring the potential for harm reduction in prison within the context of English drug policy. Whilst the focus is on English policy debates, the discussion will have wider international resonance.

Management of HIV/AIDS transmission in health care

The risk of acquiring human immunodeficiency virus (HIV) infection following occupational exposure to HIV-infected blood is low (DoH 2000). This raises issues of how best to balance the competing demands of maximising patient safety and health, protecting nurses' health, safety and employment rights, and preventing unnecessary alarm in the general population. This article examines different aspects of dealing with the prevention and management of potential HIV/AIDS transmission in the healthcare setting.

Implementation of expedited human immunodeficiency virus testing of women delivering infants in a large New York city hospital

OBJECTIVE

Since August 1999, New York has required expedited human immunodeficiency virus (HIV) testing of pregnant women in labor or their newborns, with results available within 48 hours if no intrapregnancy test result was available. We documented the frequency and circumstances of expedited HIV testing, the time required for a result to be available, and hospital factors associated with different intervals.

METHODS

We conducted chart reviews for women listed in the expedited HIV testing logbook between October 1, 2000 and December 31, 2000, abstracting prenatal care history and the dates and times of hospital admission, blood specimen collection, expedited HIV testing result availability, and the infant's birth.

RESULTS

Of 1115 women admitted for labor and delivery during this period, 13.6% were tested under the expedited HIV testing procedure, and none were found to be HIV positive. Twenty-seven percent of women having expedited HIV testing had documentation of testing during prenatal care that was unavailable or overlooked during admission. Expedited HIV testing results were available at 48 hours or less time for 96% of the women, although results for women admitted Friday to Sunday took longer than weekday results (mean +/- standard deviation, 30.4 +/- 11.7 hours versus 21.3 +/- 9.3 hours, P <.001). Expedited HIV testing results were available before delivery for 3.3% of women and less than 12 hours after birth for 31.7% of infants.

CONCLUSION

We found excellent compliance with the 48-hour time limit for expedited HIV testing but report lapses in access to prenatal HIV testing documentation, resulting in frequent duplicative testing. Further, the potential for optimal neonatal prophylaxis within 12 hours of birth was limited, as the turnaround time for HIV results exceeded 12 hours for two thirds of the infants in our sample.

Male prisoners and HIV prevention: a call for action ignored

US prison inmates are disproportionately indigent young men of color. These individuals are severely affected by HIV/AIDS, largely owing to the high-risk behavior that they engage in prior to incarceration. Researchers and practitioners have issued a call for the importance of offering HIV prevention services in prison settings. However, this call has largely been ignored. In this article, we outline reasons why these recommendations have been largely ignored, discuss innovative HIV prevention programs that are currently being implemented in prison settings, and offer recommendations for securing support for HIV prevention services in correctional settings.

Gaps between HIV/AIDS policies and treatment in correctional facilities

In this article the authors examined correctional policy and its impact on the incidence of HIV/AIDS in prison population. Using data from the Florida Correctional System, they find that HIV/AIDS is still the leading cause of death. Improved treatment and care may have led to declines in AIDS-related mortality but the prison population continues to experience a much higher risk of mortality than he general population in spite of changes in the treatment and provision of care to infected patients. The dominance of HIV-related deaths indicates that treatment and voluntary testing policy have been ineffective. The authors argue that the persistence of HIV infections and AIDS-related deaths is largely attributable to continuing unequal distribution of health care resources between identified and unidentified HIV-infected inmates. Their analysis suggests that future changes in HIV/AIDS policy ib testing and treatment can contribute to improvement in health conditions of infected inmates.

HIV testing among pregnant women--United States and Canada, 1998-2001

Since 1994, the availability of increasingly effective antiretroviral drugs for both the prevention of perinatal human immunodeficiency virus (HIV) transmission and maternal treatment has resulted in a greater emphasis on prenatal HIV testing and substantial increases in prenatal testing rates. In 2000, preliminary data indicated that 766 (93%) of 824 HIV-infected women in 25 states knew their HIV status before delivery (CDC, unpublished data, 2002). However, an estimated 280-370 perinatal HIV transmissions continue to occur in the United States each year. The primary strategy to prevent perinatal HIV transmission is to maximize prenatal HIV testing of pregnant women. States and Canadian provinces have implemented three different prenatal HIV-testing approaches. To assess their effectiveness, CDC reviewed prenatal HIV-antibody testing rates associated with these approaches. Medical record data suggest that the "opt-in" voluntary testing approach is associated with lower testing rates than either the "opt-out" voluntary testing approach or the mandatory newborn HIV testing approach.