Abstract

PIP: The logistics of contact tracing for human immunodeficiency virus (HIV) are daunting, given that 1-1.5 million people are infected in the US. Early infection is often asymptomatic; the incubation period is uncertain; there is no effective treatment for asymptomatic disease; and diagnosis confers few benefits and several disadvantages on the individual, while the benefits to society depend on the individual's subsequent sexual restraint. In the US, clear guidelines have emerged on contact tracing. The Centers for Disease Control has recommended contact tracing since 1985. An examination of why contact tracing has not developed in Britain inevitably starts to coalesce with the arguments about the benefits and disadvantages of screening. Should infected people be sought when there is no treatment and when a positive test result may lead to anxiety, stigmatization, and discrimination? There is a tension between the interests of the individual and those of the public. Those who represent individuals mostly oppose contacft tracing. Those who believe that the balance must be towards the public health and breaking the chain will argue for it. They also suggest that tested individuals will benefit by learning how to adopt safe sex techniques and altering sexual behavior as a result of their antibody status. 2 factors should sharpen our thinking: the law and therapeutic developments. What will the law say if a patient refuses to tell a contact or allow a health advisor to do so? Most genitourinary physicians would not inform a 3rd party because it would breach confidentiality and drive the disease underground. The law, however, might take a different stance and support spouses or partners who brought a case against doctors, arguing that because they were not informed they became infected. Soon we may also need to consider the increasing complexity of prognostic markers and of treatment of the antibody positive patient to prevent progression of AIDS. This might make doctors think that it would be unethical not to be able to offer such treatments to the unidentified partner.