Compulsory premarital screening for the human immunodeficiency virus. Technical and public health considerations

Abstract

The effectiveness of a mandatory premarital screening program was examined as a means of curtailing the spread of the human immunodeficiency virus (HIV) infection in the United States. The epidemiology of the HIV, the technical characteristics of tests for antibodies to HIV, and the logistic, economic, and legal implications of such a program were considered. In one year, universal premarital screening in the United States currently would detect fewer than one tenth of 1% of HIV-infected individuals at a cost of substantially more than +100 million. More than 100 infected individuals would be told that they were probably not infected, and there would likely be more than 350 false-positive results. Public education, counseling of individuals, and discretionary testing can be important tools in reducing the spread of HIV infection, but mandatory premarital screening in a population with a low prevalence of infection is a relatively ineffective and inefficient use of resources.

KIE: The effectiveness of a mandatory premarital screening program to curtail the spread of human immunodeficiency virus (HIV) infection in the U.S. was examined by a subgroup of the Study Group on Acquired Immunodeficiency Syndrome and Public Policy in the Division of Health Policy Research and Education at Harvard University. In one year such screening would detect fewer than one-tenth of one percent of HIV-infected individuals at a cost of more than $100 million with more than 100 false-negative and more that 350 false-positive tests. The authors maintain that screening statutes that significantly restrict marriage would be constitutional only if they were the least restrictive policy to achieve a compelling public health purpose. They conclude that public health education, individual counseling, and discretionary testing of populations with a moderately high prevalence of infection would be a more effective and efficient use of resources to reduce transmission of HIV.