Compulsory premarital screening for the human immunodeficiency virus. Technical and public health considerations
P. D. Cleary, M. J. Barry, K. H. Mayer, A. M. Brandt, L. Gostin and H. V. Fineberg
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.
