ETHICAL POSITION PAPER

Ethical Position Paper

Abstract

Mandatory Testing HIV infection and substance use disorders are chronic diseases with complex contributions to health-related quality of life (HRQOL). We conducted a cross-sectional survey of 951 HIV-infected adults receiving care at 14 HIV Research Network sites in 2003 to estimate associations between HRQOL and specific substance use among HIV-infected patients. HRQOL was assessed by multi-item measures of physical and role functioning, general health, pain, energy, positive affect, anxiety, and depression. Mental and physical summary scales were developed by factor analysis. We used linear regression to estimate adjusted associations between HRQOL and current illicit use of marijuana, analgesics, heroin, amphetamines, cocaine, sedatives, inhalants, hazardous/binge alcohol, and drug use severity.

Ethical Position Paper

Introduction

Health-Related Quality Of Life (HRQL) is an essential health care indicator for persons who live with chronic illnesses. Studies consistently show two major dimensions of HRQOL: physical and mental.1,2 HIV infection and substance use disorders are chronic diseases with overlapping morbidity and complex contributions to decreased HRQOL. Greater understanding of how substance use affects HRQOL may identify targets for improving HRQOL in persons living with HIV. Compared with general population norms, physical and mental HRQOL are lower among persons living with HIV infection. (Lorenz, 2006, 952)

Discussions about why mandatory testing was imposed on prospective marriage partners evoked many emotions and feelings of sympathy among some participants. There was a general consensus that a sincere desire to prevent innocent brides and grooms from contracting the deadly virus was the main motivation for imposing mandatory testing on church members. As indicated by the following comments, participants agreed that the whole notion of mandatory HIV testing evolved when the churches realized the HIV/AIDS pandemic was showing no indications of improvement.

In a national probability sample of HIV-infected Americans, physical and mental HRQOL were poorer compared to persons with other chronic diseases. 4 Both mental and physical HRQOL decrease with more advanced stage of disease3,4 and lower socioeconomic status.7 The number of HIV-related symptoms and the presence of comorbid mood disorders have been shown to be strongly associated with lower HRQOL.5,8 In a cohort of HIV-infected men who have sex with men, patients who were asymptomatic with preserved cellular immunity reported mental HRQOL comparable to the general population, but lower physical scores.3 In contrast, other research shows that asymptomatic HIV-infected patients have relatively high physical functioning but lower emotional wellbeing, compared with the general population.( Burnam, 2001, 732)

The persistent HIV/AIDS pandemic has resulted in a number of desperate measures in several countries. Despite the apparent consensus that mandatory HIV testing and related activities are infringements on human rights, health authorities and other organizations in several countries operate mandatory testing programs, mostly for pregnant women and prison populations (e.g., Danziger (1996) R. Danziger, Compulsory testing for HIV in Hungary, Social Science & Medicine 43 (1996) (8), pp. 1199-1204. Abstract | PDF (593 K) | View Record in Scopus | Cited By in Scopus (10)Danziger, 1996; Stone, 1998). Advocates argue that under certain conditions, mandatory testing, as well as other unorthodox measures ...