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Technical and Public Health Considerations

Paul D. Cleary, PhD; Michael J. Barry, MD; Kenneth H. Mayer, MD; Allan M. Brandt, PhD; Larry Gostin, JD; Harvey V. Fineberg, MD, PhD

JAMA. 1987;258(13):1757-1762.

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.

(JAMA 1987;258:1757-1762)

Footnotes
This paper is a summary of work conducted 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, Boston.

Reprint requests to Office of the Dean, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115 (Dr Fineberg).

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