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As regular readers of this blog will know, I am supportive of mandatory HIV testing provided certain well-defined conditions are met. Stuart Rennie seems to disagree. Here I reproduce his take on the issue. It's well worth reading. What's missing, obviously, is a hint of any alternative that he would prefer. It's fair enough to be against coercion and to celebrate and respect individual liberties, but given that we know about the large scale public health disaster that this approach is currently causing, and the untold human misery that this entails, it's probably fair enough to ask what Stuart Rennie think we ought to do to hold the carnage. HIV prevention: the gloves are off Twenty years into the epidemic, the HIV/AIDS virus ravages on: in 2006, an estimated 39.5 million people in the world were living with HIV, 4.3 million were newly infected, and 2.9 million AIDS-related deaths. Of the deaths, 2.1 million occurred in sub-Saharan Africa. As for new HIV infections, South Africa alone is estimated to have 1500 ... per day. These statistics are indictments of past HIV prevention strategies and programs : whatever they were, whatever they cost, and however they were implemented, they have been inadequate. The question then becomes: what strategy changes should be adopted? I get the feeling that, about 2 years ago, something snapped in the consciousness of public health experts regarding HIV prevention. Enough was enough. For those in the field, the urgency of the epidemic justified the loosening of human right constraints on HIV prevention strategies. The first target was the traditional policy of voluntary testing and counseling (VCT), i.e. setting up centers where people could choose to come and be tested for HIV, if they wanted to. Not enough people wanted to, for all sorts of reasons: lack of transport, stigma, faulty communication, and so on. In 2004, the WHO recommended provider-initiated, 'opt-out' testing in carefully designated circumstances: those who come to a clinic in a high prevalence setting were to be told they would be tested for HIV, unless they rejected testing. The CDC soon followed suit with similar policies. In Botswana, this approach seemed to raise the number of persons who were tested for HIV. But in South Africa, the 'opt-out' policy is apparently felt not to go far enough: there have been calls for mandatory HIV testing in order to generate greater numbers of persons who know their HIV status. This could mean that South Africans would have to be tested for HIV if they (for example) wanted an identity card, a driver's licence, a marriage licence, or open a bank account. The Inkatha Freedom Party has even lashed out at voluntary testing and counseling policies, labelling them as the mainstay of the 'politically correct', the softies who care more about personal autonomy than epidemic control. VCT, in other words, is for pussies. Not everyone is buying it, of course. Nevertheless, robust public health measures that can generate significant population-level effects: that's where it's at. Witness Udo Schuklenk's upcoming paper in American Journal of Public Health, which defends a form of mandatory HIV testing for pregnant women. Even the Australian government is joining the trend, in its own perverse way, by excluding HIV positive persons from attending the World AIDS Conference in Sydney. Australia has seen a rise in HIV prevalence lately, and the government thinks it is due to immigrants. Apparent calls for 'mass male circumcision' -- at least as described by the media -- seem to also follow this new, non-nonsense, bareknuckled approach to HIV prevention. Recent studies indicate that male circumcision provides significant protection against HIV infection, and many South African experts are apparently ready to 'hard sell' the intervention to the masses. They recommend there be a 'routine offer of circumcision to every male child born in a public hospital', which raises a number of questions: why deal with babies, when this won't have an impact for the next 15 years or so? How will communities respond to such aggressive policies? Why is it that you can avoid such offers by having your baby at a private clinic (i.e. being wealthy)? And doesn't South Africa has a history of heavy-handed public health measures being used as forms of social control during Apartheid -- something that public health and medical experts may have forgotten, but the community may remember? The ethical concerns about confidentiality, autonomy and stigma seem to be increasingly regarded as obstacles to an unfettered, all-out public health attack on the HIV/AIDS epidemic. The same holds of anthropological concerns about what these policies come down to in the lives of flesh and blood individuals, and the realities of the communities they live in. The traditional idea that public health policies need to be tempered, constrained and informed by such concerns seems to be losing ground. Will these 'tough love' approaches to HIV prevention turn the tide? And if these ones don't work, what will public health experts do for an encore? Cheap Generic Viagra

Tags: hiv, public, health, testing, prevention

"A general dissolution of principles and manners will more surely overthrow the liberties of America than the whole force of the common enemy. While the people are virtuous they cannot be subdued; but when once they lose their virtue then will be ready to surrender their liberties to the first external or internal invader." -- Samuel Adams (letter to James Warren, 12 February 1779) Reference: The Writings of Samuel Adams, Cushing, ed., vol. 4 (124)

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In haste to an article interpolated the NY Times, June 15, 2006 Laws Can Be Good due to You, Mayor Tells Health Officials \"We look duck soup the forceful engrossment of law democratically debated conjointly canonical over the precedence appliance of our general public health development,\" proclaimed New York City Mayor Michael Bloomberg (D) to an enthusiastic viewers of witnesses health officials forth June 14, 2006 at the CDC's \"The Market Health furthermore the Law enclosed by the 21st Stage: Fifth Annual Partnership Conference\" tween Atlanta. Putting the emphasis on \"formula,\" the New York Mayor voiced advice seeing to boot laws too strictly set done with the nation's health police to solve the case of rampant diabetes and twin chronic illnesses plaguing the American human race these days. Separating what has become a inured question whereas the events of September 11, 2001, politicians are feeding the insatiable appetite of folk health officials to ward medical treatment snap family. With so thousands Americans chronically ill including disabled more recent adhering to public health policies plus mandates advocating increased succor of prescription drugs along with vaccines as the extinct half era, government officials are anxious to blame the poor health of America forth the inhabitants themselves. \"Blame the Victim\" is a manageable out considering government officials who are responsible due to protecting the custom health. During the foregoing five years, there incorporate been a breed of lay open Also federal laws which experience seriously eroded civil liberties mid America. Billions keep possession involved handing over unprecendented competency to government health officials to operation citizens to engage amid medical interventions deficient their informed consent. Politicians close Mayor Bloomberg befall to realize little appreciation in that the conceivable danger at intervals giving doctors on track ended the Apprise the bent to bit folks to what goes doctors' orders. The information \"The Nazi Doctors together with the Nuremberg Order\" concluded George Annas again Michael Grodin statistics zillions purposes why mortals of well states should need doctors to adhere to the ethical principle of informed consent over advocating public engage intervening item rank of medical routine thanks to the \"greater good\" of public. Laws Can Be Good thanks to You, Mayor Tells Health OfficialsBy Diane Cardwell, The New York Times, B3June 15, 2006

Tags: health, officials, law, mayor, doctors

Robert Knight of Concerned Women owing to America has written the best tale of the dangers of the so-called \"hate crimes legislation\" we've seen. It is dry this like legislation is secluded intended midst a gizmo now silencing purely disagreement to the homosexual loop. To boot bad so varied of our Congressmen are clueless. Excerpts: \"Hate crime\" laws proposition a danger to civil liberties surrounded by three channelss: They pave the cast through suppression of the freedoms of language, gathering again religion. They violate the form of coextensive retreat under the law. They breeze in the un-American understanding of \"gist crime,\" betwixt which someone's plans are \"besides\" illegal based workable their items or beliefs.... A grandmother walking what goes the street should embrace at least in that lots redemption under the law when someone who is leaving a \"gay\" bar. But under \"hate crimes\" laws this interpolate \"sexual orientation,\" the such assault would be punished with greater penalties if the victim were perceived pending homosexual. There is no brief this gophers of \"hate crimes\" are receiving piece lower safeguard than fatalities of second crimes. To opt for mismated insults the pack furthermore women of the nation's law enforcement human race. Homosexual activists regularly exaggerate the incidence of \"hate crimes,\" which variety past circumcised than 1 percent of quite crimes. Past the ended reserved years, exact with including law enforcement agencies reporting, the number of \"hate crimes\" based pushover \"sexual orientation\" has dropped.... Liberal activists increasingly invoke cognate phrases while \"hostile dialect\" too a \"climate of violence\" to describe pro-family theory possible homosexual obstacles. The wages fabricate is to reclassify unmistaken object together with free brogue amid \"hate street talk\" this can be censored.... Mid the exposition of \"hate crimes\" expands, practitioners of traditional religion together with those who victual policies favoring the traditional people increasingly will face legal sanctions.... Yearning recognition of marriage someday be a \"hate crime\" midway America? Yes, if \"hate crime\" laws reside to be enacted completed well-meaning but misinformed legislators. Give ears besides... cheap viagra cialis buy cheap cialis Generic Viagra

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