Medical Screening; AIDS, Rights, and Health Care Costs

Article excerpt

Medical Screening

AIDS, Rights, and Health Care Costs

The epidemic of acquired immune deficiency syndrome (AIDS) is the most dramatic, pervasive, and tragic medical event in recent history. AIDS has caused a reassessment of our society's approaches to public health strategy, health care resource allocation, medical research, and sexual behavior. It has affected virtually all of our institutions and our culture. Sadly, those effects will continue to be felt for the foreseeable future.

The first cases of AIDS were identified in 1981, but after ten years there will have been at least 270,000 cases of AIDS in the United States, causing more than 179,000 deaths. There are currently one to two million people in the United States infected with the human immunodeficiency virus (HIV) associated with AIDS and most of these people will probably die of AIDS-related causes. Indeed, the "null hypothesis" postulates that all who have HIV will eventually succumb to AIDS.

Three distinct conditions after infection with HIV are the seropositive state, AIDS-related complex (ARC), and clinical or "full blown" AIDS. In the seropositive state, blood tests reveal the presence of antibodies to HIV, indicating infection with that virus. Most people become seropositive within two or three months of infection. As many as ten million people worldwide are estimated to be seropositive. Although a seropositive person does not show symptoms of ARC or AIDS and may not develop such symptoms for many years, he or she does carry the virus and can transmit it to others.

A person who is seropositive may develop ARC or AIDS. ARC causes moderate damage to the immune system and is characterized by nonspecific symptoms of illness. Under the Centers for Disease Control (CDC) definition for ARC, at least two of the following clinical signs lasting three or more months must be present: fever, weight loss, lymphadenopathy, diarrhea, fatigue, and night sweats. There must be two laboratory findings; a low number of T-helper cells and a low ratio of T-helper to T-suppressor cells. Additionally, there must be at least one of the following: low white blood cell count, low red blood cell count, low platelet count, and elevated levels of serum globulins.

Clinical AIDS represents a major collapse of the immune system, which allows opportunistic infections and Kaposi's sarcoma (a rare dermal malignancy) to invade the body. About half of all patients die from pneumocystis carinii pneumonia, which is extremely rare in persons whose immune systems are working properly. The incubation period for the disease--the time between the initial infection by the virus and the onset of AIDS--has so far been reported to be up to seven years, with the average being four and a half years. AIDS is fatal, on average, two years after diagnosis.

The virus spreads from infected persons either by anal or vaginal intercourse or by the introduction of infected blood (or blood products) through the skin and into the bloodstream, which may occur in intravenous (IV) drug use, blood transfusion, or treatment of hemophilia. In addition, it can spread from an infected mother to her infant during pregnancy or at the time of birth. Studies show no evidence that the infection is transmitted by so-called casual contact--that is, contact that can be even quite close between persons in the course of daily activities. Thus, there is no evidence that the virus is transmitted in the air, by sneezing, by shaking hands, by sharing a drinking glass, by insect bites, or by living in the same household with an AIDS sufferer or an HIV-infected person.

Because HIV is transmitted almost exclusively in certain narrow circumstances, the CDC has been able to classify almost all people with AIDS into six groups: (1) sexually active homosexual and bisexual men (seventy-four percent); (2) heterosexual intravenous drug abusers who share injection needles (seventeen percent); (3) heterosexuals who have intercourse with people who are seropositive or at high risk (four percent); (4) hemophiliacs who have received contaminated blood-clotting factor products (one percent); (5) other people who have received transfusions of contaminated blood (two percent); and (6) newborn infants of infected mothers (one percent). …