The centrality of antiretroviral therapy for people with human immunodeficiency virus (HIV) infection is an established feature of the clinical response to HIV–AIDS. Now there is compelling evidence that such treatment can have a profound impact at the population level by reducing viral loads and hence infectivity.1 As a consequence, important ethical and operational questions about the relationship between clinical medicine and public health are surfacing. Perhaps the most fundamental of these centers on the uses of surveillance.
More than two decades of battles over HIV surveillance yielded a comprehensive public health surveillance system — along with robust firewalls to protect confidentiality. Many surveillance personnel and advocates for people with HIV asserted that such registries should be used for epidemiologic purposes only — that data should go in but not come out.
Despite such deep resistance, pressure began to mount to ensure that surveillance data were used to serve public health ends. In 2007, a report from the Centers for Disease Control and Prevention (CDC) bluntly stated that “once the data are in hand it is the failure to use those data for public health purposes that must be justified.”
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[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]
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