scholarly journals 艾滋病防治中的倫理和政策問題

1998 ◽  
Vol 1 (4) ◽  
pp. 7-60
Author(s):  
Ren-Zong QIU
Keyword(s):  
Public Health ◽  
Hiv Infection ◽  
Infection Rate ◽  
Health Professionals ◽  
Ethical Issues ◽  
Casual Sex ◽  
Contact Tracing ◽  
Public Health Approach ◽  
Treatment And Prevention ◽  
Hiv Epidemic

LANGUAGE NOTE | Document text in Chinese; abstract also in English.本文討論了艾滋病在中國大陸傳播引起的倫理和政策問題。作者首先指出在預防控制艾滋病問題上中國正處在十字路口。挨著作者分析了中國會不會成為艾滋病和艾滋病病毒感染的高發國，討論了制訂有效而合乎倫理的艾滋病防治政策的理論預設和價值以及評價政策的倫理學框架，討論了艾滋病治療和預防中的倫理和政策問題。The AIDS/HIV prevention and control in China is at crossroad. At present, there are insufficient grounds for us to say that China will definitely become a country with a high HIV infection rate in the future. However, we have much less sufficient grounds for saying that China will never reach that stage. On the contrary, we have much more reason to say that it is very probable for China to become a country with high HIV infection rate if we leave the current policy unchanged. The reasons are: economic reforms associated with large scale population movements in unprecedented way; proliferation of all sorts of high risk behavior, presence of other STDs which facilitate the spread of HIV; the risk of iatrogenic spread through untested blood transfusion; the "sex revolution" with changes in patterns of sex behaviour and increased casual sex, multiple sex partners among the younger generation; most Chinese still do not know how to protect themselves; and the ethical and legal atmosphere necessary for effectively preventing the HIV epidemic has not been formed.The conventional public health approach is not sufficient to prevent or control an HIV epidemic. When the cases of HIV infection were detected one by one in China, health professionals and programmers believed that they could take a conventional public health approach to cope with HIV epidemic. But they are wrong. HIV infection is an epidemic so special that the conventional public health measures such as testing, reporting, contact tracing, isolation are inadequate or ineffective to control the epidemic. HIV is often spread among those groups who are usually marginalized or stigmatized by society through behaviours both confidential or private.An effective policy of preventing HIV cannot be insensitive to ethical issues. However, many of health professionals and programmers bypassed ethical issues emerged in the prevention of the HIV epidemic. Even some health educators, sexologists and officials believe that "AIDS is the punishment by God" or "AIDS is the punishment for promiscuity". For them suffering AIDS is not morally irrelevant, and thus the ancient conception of disease was revived. But this conception of disease has already proved wrong and harmful to the treatment and prevention of any disease, especially to HIV. The consequence entailed by this conception is that the IIIV positive and AIDS patients were discriminated against and stigmatized. When their positive serological status was disclosed, they were faced with the risk of being expelled from school or fired from working unit, even rejected for admission into hospital, and their tights to confidentiality and privacy were often infringed upon. If all these ethical issues cannot be properly treated, how can those persons in danger or risk get access to information, services, education, counselling and techniques necessary to prevent HIV infection? One Chinese adage says that "You cannot have fish and bear palm both". In the prevention of HIV epidemic we have to have the protection of public health and the safeguarding of individual rights.For controlling HIV epidemic what we need is not a repressive law, but a supportive law to build a supportive environment in treatment and prevention of AIDS/HIV. So the policy and law involving AIDS/ HIV should be reformed.DOWNLOAD HISTORY | This article has been downloaded 19 times in Digital Commons before migrating into this platform.

scholarly journals COVID-19 Pandemic & Bureaucracy: The Crisis Inside the Crisis

2021 ◽  
Vol 9 ◽  
Author(s):  
Katalyn Roßmann ◽  
Heike Wegner ◽  
Hans Stark ◽  
Gerd Großmann ◽  
Andreas Jansen ◽  
...  
Keyword(s):  
Public Health ◽  
Armed Forces ◽  
Contact Tracing ◽  
Public Health Approach ◽  
Outbreak Management ◽  
Public Health Agencies ◽  
German Armed Forces ◽  
Health Agencies ◽  
Crisis Support ◽  
Second Wave

The Medical Intelligence and Information (MI2) Unit of the German Armed Forces (Bundeswehr) is experienced in crisis support in military missions since several years. It gained additional experiences during the current coronavirus 2019 (COVID-19) pandemic on different levels of the response to crisis and was requested to share the findings and expertise with the overloaded civil public health agencies inside Germany. Since the beginning of the pandemic, the unit is constantly developing new products for crisis communication, knowledge sharing techniques in new databases, dashboards for leadership, and training for laypersons in contact tracing. Hence, trying to innovate in crisis since the first severe acute respiratory syndrome coronavirus (SARS-CoV)-2-disease wave. During the second wave, the unit was requested to evaluate the outbreak management of different national civil public health agencies in southern Germany, and to support the development of dashboards in a comprehensive public health approach as a necessary start toward digitalization.

scholarly journals Measuring the scientific effectiveness of contact tracing: Evidence from a natural experiment

2021 ◽  
Vol 118 (33) ◽  
pp. e2100814118
Author(s):  
Thiemo Fetzer ◽  
Thomas Graeber
Keyword(s):  
Public Health ◽  
Large Scale ◽  
Natural Experiment ◽  
Controlled Trial ◽  
Contact Tracing ◽  
Public Health Approach ◽  
The Public ◽  
Random Breakdown ◽  
Randomized Controlled ◽  
Health Authorities

Contact tracing has for decades been a cornerstone of the public health approach to epidemics, including Ebola, severe acute respiratory syndrome, and now COVID-19. It has not yet been possible, however, to causally assess the method’s effectiveness using a randomized controlled trial of the sort familiar throughout other areas of science. This study provides evidence that comes close to that ideal. It exploits a large-scale natural experiment that occurred by accident in England in late September 2020. Because of a coding error involving spreadsheet data used by the health authorities, a total of 15,841 COVID-19 cases (around 20% of all cases) failed to have timely contact tracing. By chance, some areas of England were much more severely affected than others. This study finds that the random breakdown of contact tracing led to more illness and death. Conservative causal estimates imply that, relative to cases that were initially missed by the contact tracing system, cases subject to proper contact tracing were associated with a reduction in subsequent new infections of 63% and a reduction insubsequent COVID-19–related deaths of 66% across the 6 wk following the data glitch.

scholarly journals Health Policy Issue Brief: COVID-19 in Mexico, an imperative to test, trace, and isolate.

2020 ◽  
Author(s):  
Daniel Bernal-Serrano ◽  
Hector Carrasco ◽  
Lindsay Palazuelos ◽  
Joel M. Mubiligi ◽  
Catherine Oswald ◽  
...  
Keyword(s):  
Public Health ◽  
Mass Communication ◽  
Respiratory Infections ◽  
Current Trend ◽  
Policy Issue ◽  
Contact Tracing ◽  
Public Health Approach ◽  
Health Strategy ◽  
The Government ◽  
The Impact

The Mexican government’sapproach to COVID-19 is failing. The strategy—to care for those that require hospitalization (20% of all cases), deliver mass communication messages, and regulate social distancing following a stoplight system for the rest of the population-is not aggressive enough for prevention. An anemic public health approach with scarce testing and no contact tracing or quarantine, has led to a sky-rocketing number of new infections and deaths. If the current trend continues, Mexico will see around 130 thousand deaths by December and a 53% annualized rate of decrease in the GDP. The government must implement a clear federal strategy to stop the spread of the virus: widespread testing, isolation of symptomatic cases; tracing, and quarantiningof their contacts. This comprehensive public health strategy with targeted social support to protect the vulnerable is a proven approach. Through evaluating other countries’ programs and extrapolating lessons for the Mexican context, we demonstrate thatimplementing testing and contact tracing for all acute respiratory infections is feasible with Mexico’s current resources. A strategy where symptomatic patients are tested and isolated and contacts are quarantined, can suppress community spread, save lives, reduce suffering, decrease the burden on hospitals, and restart the economic activity earlier and in a safer way. The more we wait to implement comprehensive testing and tracing to suppress the epidemic, the more people will become infected, and the impact of this measures will decrease.

scholarly journals Identification of Priority Areas for Increased Testing Using Geospatial Mapping of Incident HIV Cases Near Charleston, South Carolina

2019 ◽  
Vol 12 ◽  
pp. 117863371987075
Author(s):  
Ryan Gedney ◽  
Kimberly Butler Willis ◽  
Aaron O’Brien ◽  
Michael Luciano ◽  
Katherine J Richardson ◽  
...  
Keyword(s):  
Public Health ◽  
South Carolina ◽  
Environmental Control ◽  
Disease Incidence ◽  
Public Health Approach ◽  
Hiv Incidence ◽  
Metropolitan Regions ◽  
Hiv Epidemic ◽  
Resource Limited ◽  
Geospatial Mapping

Analysis of disease incidence using geospatial mapping techniques can enhance targeted public health efforts in resource-limited settings. While data for HIV incidence are readily available for some metropolitan regions, there is no existing resource that maps HIV incidence geospatially for Charleston, South Carolina and surrounding counties. To facilitate the public health approach to address the HIV epidemic in this region, we used data collected by the South Carolina Department of Health and Environmental Control (SC-DHEC) from 2014 to 2015 to generate local geospatial maps of disease incidence and identify specific areas that may benefit from increased testing and educational efforts. We identified specific zip codes in which there were a high number of cases from patients residing in those areas, but a low number of providers reporting new cases, and we describe ongoing efforts to address this disparity. This analysis identifies a local, collaborative approach to address the HIV epidemic using routinely collected surveillance data.

HIV Infection in Sexually Transmissible Disease Practice in Sydney: The Effects of Legislation, Public Education and Changing Clinical Spectrum

1990 ◽  
Vol 1 (1) ◽  
pp. 21-27 ◽  
Author(s):  
Basil Donovan ◽  
Robert J Finlayson ◽  
Kieran Mutimer ◽  
Ross Price ◽  
Mark Robertson ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Disease Surveillance ◽  
Care Service ◽  
Contact Tracing ◽  
Hiv Epidemic ◽  
Health Services Planning ◽  
Immunodeficiency Virus ◽  
Private And Public ◽  
And Control ◽  
Antibody Tests

The experience with human immunodeficiency virus (HIV) infection of a private inner-city sexually transmissible diseases (STD) clinic in Sydney was quantified. Between February 1984 and March 1988, 2073 of the Clinic's patients were tested for antibodies to HIV on 5095 occasions. Of those tested, 538 (26%) were positive for antibodies to HIV: 532 (98.9%) of the seropositives had practised male homosexual intercourse. This is the highest reported seroprevalence of HIV for any primary care service in Australia. Those individuals seropositive because of other risk behaviours were detected by voluntary contact tracing rather than by screening. Female prostitution was not found to be a risk factor for HIV. In general, rates of first HIV antibody tests were adversely affected by threatening legislation, and temporarily stimulated (among lower-risk persons) by a national television campaign. These data suggest that much of the counselling, detection and management of HIV infection in Australia is occurring in private practice, and that STD services (private and public) are at the forefront of the HIV epidemic. This has implications for disease surveillance and control, health services planning and medical education.

scholarly journals Multilevel Integrated Model with a Novel Systems Approach (MIMANSA) for Simulating the Spread of COVID-19

2020 ◽  
Author(s):  
Arpita Welling ◽  
Abhilasha Patel ◽  
Padmaj Kulkarni ◽  
Vinay G. Vaidya
Keyword(s):  
Public Health ◽  
Infection Rate ◽  
Systems Approach ◽  
Contact Tracing ◽  
Control Mechanisms ◽  
Virus Spread ◽  
Asymptomatic Patients ◽  
The Usa ◽  
Public Health Officials ◽  
The Impact

AbstractDue to the spread of the coronavirus, public health officials grapple with multiple issues such as recommending a lockdown, contact tracing, promoting the use of masks, social distancing, frequent handwashing, as well as quarantining. It is even more challenging to find the optimal combination of these factors without the use of a suitable mathematical model.In this paper, we discuss a novel systems approach to building a model for simulating the spread of COVID-19. The model, MIMANSA, divides an individual’s in-person social interactions into three areas, namely home, workplace, and public places. The model tracks the in-person interactions and follows the virus spread. When a new silent carrier is created, the model automatically expands and builds a new layer in the network.MIMANSA has four control mechanisms, namely the exposure, infection rate, lockdown, and quarantining. MIMANSA differentiates between virus-infected patients, silent carriers, and healthy carriers. It can consider variations in virus activity levels of asymptomatic patients, varying the exposure to the virus, and varying the infection rate depending on the person’s immunity. MIMANSA can simulate scenarios to study the impact of many different conditions simultaneously. It could assist public health officials in complex decision making, enable scientists in projecting the SARS-CoV-2 virus spread and aid hospital administrators in the management of beds and equipment.MIMANSA is trained and validated using the data from the USA and India. Our results show that MIMANSA forecasts the number of COVID-19 cases in the USA, and India within a 3% margin of error.

scholarly journals Contact tracing apps for COVID-19 pandemic: Challenges and potential

2020 ◽  
Author(s):  
Alex Akinbi ◽  
Mark Forshaw ◽  
Victoria Blinkhorn
Keyword(s):  
Public Health ◽  
Ethical Issues ◽  
User Behavior ◽  
Contact Tracing ◽  
Privacy Rights ◽  
User Privacy ◽  
Health Crisis ◽  
Liberal Societies ◽  
Public Health Authorities ◽  
User Data

The COVID-19 pandemic has spread with increased fatalities around the world and has become an international public health crisis. Public health authorities in many countries have introduced contact tracing apps to track and trace infected persons as part of measures to contain the spread of the Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2). However, there are major concerns about its efficacy and privacy with affects mass acceptance amongst a population. This review encompasses the current challenges facing this technology in the fight against the COVID-19 pandemic in neo-liberal societies. We explore and discuss the plausibility for abuse of user privacy rights as such apps collect private user data and can be repurposed by governments for surveillance on their citizens. Other challenges identified and discussed include ethical issues, security vulnerabilities, user behavior and participation, and technical constraints. Finally, in the analysis of this review, recommendations to address these challenges and considerations in the use of less invasive digital contact tracing technologies for future pandemics are presented. For policy makers in neo-liberal societies, this study provides an in-depth review of issues that must be addressed, highlights recommendations to improve the efficacy of such apps, and could facilitate mass acceptance amongst users.

Screening, Brief Intervention, and Referral to Treatment (SBIRT) as a Public Health and Prevention Strategy to Address Substance Misuse and Addiction

2019 ◽  
pp. 77-94 ◽  
Author(s):  
Alexandra Nowalk ◽  
Janice Pringle
Keyword(s):  
Public Health ◽  
Substance Use ◽  
Brief Intervention ◽  
Substance Misuse ◽  
High Risk Patient ◽  
Public Health Approach ◽  
Medical Settings ◽  
Risk Levels ◽  
Treatment And Prevention ◽  
Increasing Risk

SBIRT (screening, brief intervention, and referral to treatment) is a comprehensive and integrated public health approach that aims to address hazardous and harmful substance use in patients through universal screening for substance misuse risk and the subsequent delivery of appropriate evidence-based interventions to reduce this risk. SBIRT has been implemented throughout all 50 states in a wide variety of medical settings. Thus far, over one million people across the country have been screened for substance use using SBIRT practices. SBIRT has also been implemented internationally. SBIRT is predicated on the premise that, like other chronic diseases, substance use falls along a clinical spectrum ranging from low to high risk. Patient substance use can be stratified across increasing risk levels that correlate with an appropriate disease state extending from abstinence to a diagnosable substance use disorder. Implications for treatment and prevention programs are discussed.

Ethical Issues and Acquired Immunodeficiency Syndrome (AIDS)

1989 ◽  
Vol 23 (4) ◽  
pp. 523-528
Author(s):  
F. K. Judd ◽  
B. A. Biggs ◽  
G. D. Burrows
Keyword(s):  
Informed Consent ◽  
Hiv Infection ◽  
Hiv Testing ◽  
Acquired Immunodeficiency Syndrome ◽  
Ethical Issues ◽  
Medical Attention ◽  
Treatment And Prevention ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome

Acquired Immunodeficiency Syndrome (AIDS) has received much publicity and medical attention. Interest has focused on education, epidemiology, treatment and prevention of the syndrome. This paper raises other issues for consideration, including problems associated with HIV testing, confidentiality, informed consent and the dilemmas facing those involved in the treatment of patients suffering from HIV infection.

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