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In an effort to respond to the large surge in COVID-19 cases in Arizona that began between May and July 2020, the Arizona State University (ASU) Student Outbreak Response Team (SORT) formed a remote, volunteer-based case investigation team that worked in partnership with a local public health department through delegated public health authority.

Competing Interests: All authors have disclosed no conflicts of interest.

At the early stage of an emerging disease, information is often insufficient for governments to determine what actions are necessary to contain its transmission. Taiwanese society was not prepared when the SARS epidemic hit in 2003. After the SARS epidemic, Taiwan began to overhaul its Communicable Disease Control Act authorising the government to act in a murky situation without the fear of violating due process. In hindsight, the new law has contributed a large part to the effective containment of Covid-19 in Taiwan. However, a new issue emerged concerning the conflict between an individual's freedom of confidential communication and the government's use of cell phone positioning to monitor self-quarantine. Although Taiwan's Council of Grand Justices previously resolved the concern over potential breaching of due-process, the legislature may have to strike a balance between public health emergency and the use of an electronic footprint to trace individual activities.

The coronavirus disease 2019 (COVID-19) pandemic has challenged the traditional public health balance between benefiting the good of the community through contact tracing and restricting individual liberty. This article first analyzes important technical and ethical issues regarding new smartphone apps that facilitate contact tracing and exposure notification. It then presents a framework for assessing contact tracing, whether manual or digital: the effectiveness at mitigating the pandemic; acceptability of risks, particularly privacy; and equitable distribution of benefits and risks. Both manual and digital contact tracing require public trust, engagement of minority communities, prompt COVID-19 testing and return of results, and high adherence with physical distancing and use of masks.

The nature of the COVID-19 pandemic may require governments to use privacy-encroaching technologies to help contain its spread. One technology involves co-location tracking through mobile Wi-Fi, GPS, and Bluetooth to permit health agencies to monitor people's contact with each other, thereby triggering targeted social-distancing when a person turns out to be infected. The effectiveness of tracking relies on the willingness of the population to support such privacy encroaching measures. We report the results of two large surveys in the United Kingdom, conducted during the peak of the pandemic, that probe people's attitudes towards various tracking technologies. The results show that by and large there is widespread acceptance for co-location tracking. Acceptance increases when the measures are explicitly time-limited and come with opt-out clauses or other assurances of privacy. Another possible future technology to control the pandemic involves "immunity passports", which could be issued to people who carry antibodies for the COVID-19 virus, potentially implying that they are immune and therefore unable to spread the virus to other people. Immunity passports have been considered as a potential future step to manage the pandemic. We probe people's attitudes towards immunity passports and find considerable support overall, although around 20% of the public strongly oppose passports., Competing Interests: The authors have declared that no competing interests exist.

Recently, there have been many efforts to use mobile apps as an aid in contact tracing to control the spread of the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) (COVID-19 [coronavirus disease 2019]) pandemic. However, although many apps aim to protect individual privacy, the very nature of contact tracing must reveal some otherwise protected personal information. Digital contact tracing has endemic privacy risks that cannot be removed by technological means, and which may require legal or economic solutions. In this brief communication, we discuss a few of these inherent privacy limitations of any decentralized automatic contact tracing system., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Medical Informatics Association.)

Competing Interests: Competing interests: The authors completed the ICMJE Unified Competing Interest form (available upon request from the corresponding author), and declare no conflicts of interest.

We studied sources of variation between countries in per-capita mortality from COVID-19 (caused by the SARS-CoV-2 virus). Potential predictors of per-capita coronavirus-related mortality in 200 countries by May 9, 2020 were examined, including age, gender, obesity prevalence, temperature, urbanization, smoking, duration of the outbreak, lockdowns, viral testing, contact-tracing policies, and public mask-wearing norms and policies. Multivariable linear regression analysis was performed. In univariate analysis, the prevalence of smoking, per-capita gross domestic product, urbanization, and colder average country temperature were positively associated with coronavirus-related mortality. In a multivariable analysis of 196 countries, the duration of the outbreak in the country, and the proportion of the population aged 60 years or older were positively associated with per-capita mortality, whereas duration of mask-wearing by the public was negatively associated with mortality (all P < 0.001). Obesity and less stringent international travel restrictions were independently associated with mortality in a model which controlled for testing policy. Viral testing policies and levels were not associated with mortality. Internal lockdown was associated with a nonsignificant 2.4% reduction in mortality each week ( P = 0.83). The association of contact-tracing policy with mortality was not statistically significant ( P = 0.06). In countries with cultural norms or government policies supporting public mask-wearing, per-capita coronavirus mortality increased on average by just 16.2% each week, as compared with 61.9% each week in remaining countries. Societal norms and government policies supporting the wearing of masks by the public, as well as international travel controls, are independently associated with lower per-capita mortality from COVID-19.

Smartphone apps to track SARS-CoV 2 infections need to fulfill certain minimal requirements to guarantee privacy and justify their use under data protection laws., (© 2020 The Authors.)

In November 2018, the Centers for Disease Control and Prevention distributed guidance to funded agencies under its Integrated HIV Surveillance and Prevention Programs Initiative to support the implementation of the program's third strategy: HIV transmission cluster investigation and outbreak response efforts. Cluster detection seeks to identify persons infected with HIV (diagnosed and undiagnosed) who are linked to infections in single or related sexual and injection drug networks. Identifying expanding clusters allows public health personnel to intervene directly where active HIV transmissions occur.However, in the context of HIV infection where most US states have enacted criminal exposure laws, these efforts have sparked concerns about the protection of HIV surveillance data from court order or subpoena for law enforcement purposes. The Centers for Disease Control and Prevention calls for funded agencies to evaluate relevant confidentiality laws to ensure that these are sufficient to protect the confidentiality of HIV surveillance data from use by law enforcement.We present four often overlooked factors about the criminalization of HIV exposure and HIV surveillance data protections that should be considered in statutory assessments.

Objectives: The diagnosis and treatment of Chlamydia trachomatis infection is important in preventing persistent or recurrent infection. Expedited partner therapy (EPT) is the favoured and supported method for STI treatment of the Centers for Disease Control and Prevention when the provider cannot be assured that all recent sexual partner(s) will seek therapy. EPT is legally permissible in 38 states and is endorsed by healthcare organisations to decrease the rates of chlamydia and gonorrhoea infection. Our study investigated the impact of EPT legal status (permissible, potentially allowable or prohibited) on C. trachomatis infection rates for each state., Methods: Our ecological study modelled the number of reported chlamydia cases from 2000 to 2013 as a function of year, legal status and the interaction between year and legality. We used a negative binomial regression model that included state fixed effects (including the District of Columbia) to account for both the repeated measures per state and state-specific characteristics that could not be measured for inclusion in this study. The lagged number of C. trachomatis cases was included as a covariate and each state's total population for a given year was included in the model as an exposure parameter. States were designated Y (EPT permissible), N (EPT prohibited) and M (EPT potentially allowable), and the legal status of each state could vary over time., Results: Each legal category saw an increase in the incidence rate of C. trachomatis infection, but on average, the incidence rate for states with prohibitive EPT legislation grew significantly faster over time compared with the rate for the states where EPT was permissible. The average increase in predicted incidence rates per year for states with Y , N and M legal status were 14.1 (95% CI (12.0 to 16.2)), 17.5 (95% CI (15.9 to 19.2)) and 16.8 (95% CI (15.0 to 18.6)) cases per 100 000 persons per year, respectively, when controlling for state-specific effects., Conclusions: Our model suggests that a lack of EPT legislation is associated with an increase in STI rates. States with potentially allowable EPT legislation as of 2013 (n=8) should consider permitting EPT as a component of a multipronged strategy for treatment of sexual partners to prevent C. trachomatis infection., Competing Interests: Competing interests: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Objective: Effective partner notification and partner treatment are essential to prevent reinfection with Chlamydia trachomatis. For this reason we investigated the possibilities for patient-initiated partner therapy (PIPT) in the Netherlands., Design: Database research, questionnaires and interviews., Method: The current practices of partner notification and partner treatment were assessed by means of databases and questionnaires. Facilitators of, and barriers to, the introduction of PIPT were qualitatively explored among professionals at GP practices and sexual health centres. In addition, we interviewed chlamydia patients and their notified partners. Finally, the legal possibilities for PIPT in the Netherlands were explored., Results: At sexual health centres, regular partners were treated pending test results in 97% of chlamydia cases. Professionals were reluctant to hand out medication to patients for their partners; GPs indicated that they did this in 6% of cases of chlamydia. Patients also saw barriers. The interviewees indicated that the process of partner notification could be improved. Both professionals and patients had a clear preference for combining PIPT with the offer of a (home) test. If those partners notified about chlamydia were not tested, 10% of all gonococcal infections would be missed., Conclusion: Currently, the widespread introduction of PIPT does not seem to be a good option for the Netherlands. PIPT could be implemented for current regular partners and those who would otherwise not be tested. The combination of a home test kit with PIPT is then preferable. Taking current legislation into account, sexual health centres run by local public health departments are probably the best starting position for PIPT. We recommend that this be further explored.

Background: Young adults, including college students, have higher rates of chlamydia than the general population. Patient-delivered partner therapy (PDPT) is a partner treatment option for sex partners of individuals diagnosed with chlamydia or gonorrhea. We examined college health center use of PDPT in a national sample of colleges., Methods: During 2014 to 2015, we collected data from 482 colleges and universities (55% of 885 surveyed), weighting responses by institutional characteristics abstracted from a national database (eg, 2-year vs 4-year status). We asked whether the school had a student health center and which sexual and reproductive health (SRH) services were offered. We also assessed the legal and perceived legal status of PDPT in states where schools were located. We then estimated PDPT availability at student health centers and measured associations with legal status and SRH services., Results: Most colleges (n = 367) reported having a student health center; PDPT was available at 36.6% of health centers and associated with perceived legality of PDPT in the state in which the college was located (odds ratio [OR], 4.63; 95% confidence interval [CI], 1.17-18.28). Patient-delivered partner therapy was significantly associated with availability of SRH services, including sexually transmitted disease diagnosis and treatment of STI (56.2% vs 1.1%), gynecological services (60.3% vs 12.2%), and contraceptive services (57.8% vs 7.7%) (all P < .001). Compared with schools taking no action, PDPT was more likely to be available at schools that notified partners directly (OR, 8.29; 95% CI, 1.28-53.85), but not schools that asked patients to notify partners (OR, 3.47; 95% CI, 0.97-12.43)., Conclusions: PDPT was more likely to be available in colleges that offered SRH services and where staff believed PDPT was legal. Further research could explore more precise conditions under which PDPT is used.

The rate of sexually transmitted infections in the United States increased in 2015 for the second year in a row. Adolescents bear an undue portion of this burden because of increased physiologic susceptibility, higher rates of reinfection, and developmental age. Despite expedited partner therapy (EPT) being legalized in 39 states, health care providers still report infrequently providing EPT to their adolescent patients. Patients who benefit most from EPT include those with high-risk sexual behavior, a steady relationship status, higher education level, or an established relationship with the provider. This article will review the barriers to providing EPT and factors associated with patient acceptance or refusal, highlight current legal issues, and discuss the role of the pediatric nurse practitioner addressing specific strategies for implementation in practice. EPT is a valuable tool for the pediatric nurse practitioner to promote treatment and prevent reinfection with sexually transmitted infections., (Copyright © 2017 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.)

Background: The outbreak of Ebola Virus Disease in West Africa in 2014-2015 was unprecedented in terms of its scale and consequence.  This, together with the emergence of Zika virus as a Public Health Emergency of International Concern in 2016, has again highlighted the potential for disease to spread across international borders and provided an impetus for countries to review their Port Health preparedness. This report reviews the legislative framework and actions taken under this framework in advancing and improving Port Health preparedness in Ireland, in response to the declaration of the Public Health Emergency of International Concern for Ebola Virus Disease in August 2014., Findings: Infectious disease Shipping and Aircraft Regulations were brought into force in Ireland in 2008 and 2009, respectively. Preparatory actions taken under these and the International Health Regulations necessitated significant levels of cross disciplinary working with other organisations, both within and beyond traditional healthcare settings. Information packs on Ebola Virus Disease were prepared and distributed to airports, airlines, port authorities and shipping agents, and practical exercises were held at relevant sites. Agreements were put in place for contact tracing of passenger and crew on affected conveyances and protocols were established for the management of Medical Declarations of Health from ships coming from West Africa., Conclusions: The outbreak of Ebola Virus Disease in West Africa resulted in significant strengthening of Ireland's Port Health preparedness, while also highlighting the extent to which preparedness requires ongoing and sustained commitment from all stakeholders, both nationally and internationally, in ensuring that countries are ready when the next threat presents at their borders.

HIV care providers in the United States must counsel clients about disclosure to sexual partners and report anyone who is suspected of noncompliance. This study compared provider attitudes and practices in relation to counseling clients about mandatory disclosure in North Carolina and Alabama, the 2 states with similar HIV epidemiology but different laws for HIV control. Personal interviews were conducted with 20 providers in each state (n = 40). The results were analyzed in a qualitative, cross-comparison method to identify patterns of convergence or difference. Providers in both states believed that clients often failed to notify sexual partners and were secretive if questioned about disclosure. Differences in counseling styles and procedures for each state were noteworthy. Compared to Alabama, North Carolina had harsher penalties for nondisclosure, stricter and more standardized procedures for counseling, and providers expressed greater support for HIV criminalization. Although most North Carolina providers viewed the stricter standards as beneficial for HIV care and control, Alabama providers were likely to view such standards as a barrier to patient care. These results indicated a direct relation between state HIV law, provider attitudes, and counseling procedures for mandatory disclosure.

For the past three decades, legislative approaches to prevent HIV transmission have been used at the national, state, and local levels. One punitive legislative approach has been enactment of laws that criminalize behaviors associated with HIV exposure (HIV-specific criminal laws). In the USA, HIV-specific criminal laws have largely been shaped by state laws. These laws impose criminal penalties on persons who know they have HIV and subsequently engage in certain behaviors, most commonly sexual activity without prior disclosure of HIV-positive serostatus. These laws have been subject to intense public debate. Using public health law research methods, data from the legal database WestlawNext© were analyzed to describe the prevalence and characteristics of laws that criminalize potential HIV exposure in the 50 states (plus the District of Columbia) and to examine the implications of these laws for public health practice. The first state laws were enacted in 1986; as of 2011 a total of 67 laws had been enacted in 33 states. By 1995, nearly two-thirds of all laws had been enacted; by 2000, 85 % of laws had been enacted; and since 2000, an additional 10 laws have been enacted. Twenty-four states require persons who are aware that they have HIV to disclose their status to sexual partners and 14 states require disclosure to needle-sharing partners. Twenty-five states criminalize one or more behaviors that pose a low or negligible risk for HIV transmission. Nearly two-thirds of states in the USA have legislation that criminalizes potential HIV exposure. Many of these laws criminalize behaviors that pose low or negligible risk for HIV transmission. The majority of laws were passed before studies showed that antiretroviral therapy (ART) reduces HIV transmission risk and most laws do not account for HIV prevention measures that reduce transmission risk, such as condom use, ART, or pre-exposure prophylaxis. States with HIV-specific criminal laws are encouraged to use the findings of this paper to re-examine those laws, assess the laws' alignment with current evidence regarding HIV transmission risk, and consider whether the laws are the best vehicle to achieve their intended purposes.

Background: Expedited partner therapy (EPT) is a potential partner treatment strategy. Significant efforts have been devoted to policies intended to facilitate its practice. However, few studies have attempted to evaluate these policies., Methods: We used data on interviewed gonorrhea cases from 12 sites in the STD Surveillance Network in 2010 (n = 3404). Patients reported whether they had received EPT. We coded state laws relevant to EPT for gonorrhea using Westlaw legal research database and the general legal status of EPT in STD Surveillance Network sites from Centers for Disease Control and Prevention's Web site in 2010. We also coded policy statements by medical and other boards. We used χ tests to compare receipt of EPT by legal/policy variables, patient characteristics, and provider type. Variables significant at P < 0.10 in bivariate analyses were included in a logistic regression model., Results: Overall, 9.5% of 2564 interviewed patients with gonorrhea reported receiving EPT for their partners. Receipt of EPT was significantly higher where laws and policies authorizing EPT existed. Where EPT laws for gonorrhea existed and EPT was permissible, 13.3% of patients reported receiving EPT as compared with 5.4% where there were no EPT laws and EPT was permissible, and 1.0% where there were no EPT laws and EPT was potentially allowable (P < 0.01). Expedited partner therapy was higher where professional boards had policy statements supporting EPT (P < 0.01). Receipt of EPT did not differ by most patient characteristics or provider type. Policy-related findings were similar in adjusted analyses., Conclusions: Expedited partner therapy laws and policies were associated with higher reports of receipt of EPT among interviewed gonorrhea cases.

In England, Wales and Scotland, those who unintentionally transmit HIV through sexual intercourse are at risk of criminal prosecution, and furthermore may be at risk of imprisonment under the Offences Against the Person Act 1861. These sentences have ranged between 1 and 10 years. There has been a long debate on whether this is an acceptable use of the law, and indeed whether those who transmit HIV in this manner should be subjected to legal proceedings. Previous debate has embraced the rhetoric of shared responsibility and public health. In this paper, we wished instead to apply traditional justifications for sentencing (including retribution, deterrence, rehabilitation, incapacitation and reparation) to imprisonment for non-intentional transmission of HIV through consensual sexual intercourse. We argue that when these principles are applied to imprisonment for this 'crime', we are unable to justify imprisonment sufficiently, and therefore, that imprisonment is a misguided response to HIV transmission.

Potential legal liability for practicing expedited partner therapy is a common concern among providers, although it has been uncertain how these concerns translate into clinical practice. This study suggests that providers are more likely to practice expedited partner therapy in more favorable legal environments.

Sexually transmitted diseases (STDs), with special emphasis to HIV infection, involve legal and ethical issues regarding informed consent to submit to a diagnostic, observance of professional secrecy in regard to partner(s) and community; legal troubles of particular difficulties are related to STD involving minors; lastly, physicians must be able to recognize the state of so called medical necessity. Knowledge and awareness of these related obligations are crucial to STD in medical practice; it is also important to allow for proper protection of victims of suspected sexual abuse under observation of healthcare. With regard to this aspect should be emphasized that violence against women and minors is a worldwide problem that has not yet been sufficiently acknowledged. Italian legislation (Law n. 96/1996) against rapes finally gave significant relevance to sex crimes. When sexual abusers have to be evaluated some obstacles may arise for lack of appropriate interdisciplinary approach, with insurance of the collection of biological samples, also related to STD diagnosis and alerts of legal authorities. Personal preconceptions may interfere with investigation if the biological evidences in children are few. In this regard, rules of document "Carta di Noto" drafted in 1996 and reviewed in July 2002 include some specific indications aiming to grant the reliability of the results of technical investigations and authenticity of the statements of the alleged victims.

Research has shown that HIV-positive patients sometimes refuse to take precautionary measures against sexual transmission as well as to notify their sexual partner(s) of their status. Faced with such a situation, physicians find themselves in a dilemma as they are forced to choose between honouring their duty of professional confidentiality and protecting their patients' partner(s). Recent advice from the Belgian Medical Council (BMC) for the first time accepts that physicians can exceptionally, and under certain conditions, invoke necessity to breach confidentiality and inform usual and occasional sexual partners of HIV-infected patients who refuse to take precautions against transmission. This article sketches the ethical evolution of this position from 1987 up to now in Belgium, and examines whether or not the BMC's opinion on the matter corresponds to the applicable substantive criminal law provisions and whether or not partner notification could also be defended for other sexually transmissible infections (STIs). A case study of the situation in Belgium illustrates how discussions about STIs can deeply influence the evolution of legal and ethical rules about medical confidentiality.

The authors analyzed the results of the forensic medical expertise of the cases of sexual assaults and covert sexual abuse. Special attention is given to the peculiarities of forensic-medical expertise in the cases of veneral diseases and HIV-infection, injuries to sexual organs in women and men. The specific approaches to the examination of corpses in the cases of atypical sexual behavior or a murder supposedly committed for sexual motives are considered.

Objectives: To assess whether public health nurses adhered to Dutch guidelines for tuberculosis contact investigations and to explore which factors influenced the process of identifying contacts, prioritizing contacts for testing and scaling up a contact investigation., Methods: A multiple-case study (2010-2012) compared the contact investigation guidelines as recommended with their use in practice. We interviewed twice 14 public health nurses of seven Public Health Services while they conducted a contact investigation., Results: We found more individuals to be identified as contacts than recommended, owing to a desire to gain insight into the infectiousness of the index case and prevent anxiety among potential contacts. Because some public health nurses did not believe the recommendations for prioritizing contacts fully encompassed daily practice, they preferred their own regular routine. In scaling up a contact investigation, they hardly applied the stone-in-the-pond principle. They neither regularly compared the infection prevalence in the contact investigation with the background prevalence in the community, especially not in immigrant populations. Nonadherence was related to ambiguity of the recommendations and a tendency to act from an individual health-care position rather than a population health perspective., Conclusions: The adherence to the contact investigation guidelines was limited, restraining the effectiveness, efficiency and uniformity of tuberculosis control. Adherence could be optimized by specifying guideline recommendations, actively involving the TB workforce, and training public health nurses.

Objectives: Public health officials and health providers need to be aware of the legislation documenting contact tracing in their jurisdiction to advise HIV positive clients of their rights, and to systematically perform their duties. The objective is to outline and compare the contact tracing laws in 13 jurisdictions in Canada, and to provide policy recommendations., Methods: A systematic review was performed to outline and compare the laws in Canadian jurisdictions regarding HIV contact tracing. Specific manual searches were done in websites of Canadian provincial and territorial departments of health., Results: For thirteen provinces and territories within Canada eleven laws were found. No laws directly pertaining to partner notification or contact tracing were found in Newfoundland and Labrador or Quebec., Conclusions: Public health officials should ensure that contact tracing practices and policies accurately reflect the current regulations without compromising their patients' confidentiality. It is recommended that each province/territory would benefit from standardized contact tracing regulations which are imbedded in communicable disease legislation. Regulations with provisions for informed consent, confidentiality, multiple counselling sessions, clear procedures in duty to warn cases, and domestic violence screening would be considered best practice., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Household contacts of hepatitis B (HBV) are at risk of infection, and guidelines advise vaccination of these contacts in addition to sexual partners (along with traditional high-risk groups). We present a case of intrafamilial transmission of acute hepatitis B virus (HBV) following failure to self-disclose status to family members. Complex confidentiality issues can arise following a diagnosis of HBV infection.

Expedited partner therapy is the clinical practice of treating the sex partners of patients, in whom sexually transmitted infections are diagnosed, by providing prescriptions or medications to the patient to take to his or her partner(s) without the health care provider first examining the partner(s). The American College of Obstetricians and Gynecologists supports expedited partner therapy in the management of gonorrhea and chlamydial infections when the partner is unlikely or unable to otherwise receive in-person evaluation and appropriate treatment. The legality of expedited partner therapy is ambiguous in some states and overt legal impediments exist in others; analysis suggests that the practice is permissible in 27 states. Clinicians practicing in states where expedited partner therapy is legal should use it for eligible patients. In states, territories, and other jurisdictions where expedited partner therapy is not legal or the legal status of expedited partner therapy is unclear or ambiguous, clinicians are encouraged to advocate for its legality and implementation and work with their health departments to develop protocols for the use of expedited partner therapy. All health care providers should advocate for greater availability of sexually transmitted infection services.

Objectives: We seek to identify and analyze, from a group of participants experienced with HIV screening, the perceived challenges and solutions to the ethical, financial, and legal considerations of emergency department (ED)-based HIV screening., Methods: We performed a qualitative analysis of the focus group discussions from the ethical, financial, and legal considerations portion of the inaugural National Emergency Department HIV Testing Consortium conference. Four groups composed of 20 to 25 consortium participants engaged in semistructured, facilitated focus group discussions. The focus group discussions were audiotaped and transcribed. A primary reader identified major themes and subthemes and representative quotes from the transcripts and summarized the discussions. Secondary and tertiary readers reviewed the themes, subthemes, and summaries for accuracy., Results: The focus group discussions centered on the following themes. Ethical considerations included appropriateness of HIV screening in the ED and ethics of key elements of the 2006 Centers for Disease Control and Prevention HIV testing recommendations. Financial considerations included models of payment and support, role of health care insurance, financial ethics and downstream financial burdens, and advocacy approaches. Legal considerations included the adequacy of obtaining consent, partner notification, disclosure of HIV results, difficulties in addressing special populations, failure of not performing universal screening, failure to notify a person of being tested, failure to notify someone of their test results, liability of inaccurate tests, and failure to link to care., Conclusion: This qualitative analysis provides a broadly useful foundation to the ethical, financial, and legal considerations of implementing HIV screening programs in EDs throughout the United States., (Copyright © 2011. Published by Mosby, Inc.)

This article examines the dynamic role of law as a tool, and potential barrier, to public health interventions designed to ameliorate the negative impacts of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) globally. Law impacts the lives of persons living with (and at risk of) HIV/AIDS in many ways. Laws may: (1) help to ensure that public health authorities are empowered to provide effective prevention and treatment programmes; (2) effectuate the human rights to life, health, work, education and property ownership of persons living with, or at risk of, HIV/AIDS; and (3) protect persons living with HIV/AIDS from social risks, stigma and other harms by respecting privacy and prohibiting unwarranted discrimination. However, laws can also create legal barriers in many countries that impede effective HIV/AIDS interventions by penalizing those with HIV/AIDS through criminal sanctions or other policies. As a result, it is recommended globally that laws should facilitate the prevention and treatment of HIV/AIDS consistent with scientific and public health practices and with a human rights framework. Effective use of existing laws that promote the public's health, and reforms of laws which impede it, contribute to improved individual and communal health outcomes concerning HIV/AIDS.

Objectives: We examined the effect of New York's HIV Reporting and Partner Notification law on HIV testing levels and on the HIV testing decisions of high-risk individuals., Methods: In-person interviews were administered to 761 high-risk individuals to assess their knowledge, attitudes, and behaviors regarding HIV testing and reporting. Trends in HIV testing were also assessed in publicly funded HIV counseling and testing programs, Medicaid, and New York's Maternal Pediatric Newborn Prevention and Care Program., Results: High-risk individuals had limited awareness of the reporting and notification law, and few cited concern about named reporting as a reason for avoiding or delaying HIV testing. HIV testing levels, posttest counseling rates, and anonymous-to-confidential conversion rates among those who tested HIV positive were not affected by the law. Medicaid-related HIV testing rates also remained stable. HIV testing during pregnancy continued to trend upward following implementation of the law. Findings held true within demographic and risk-related subgroups., Conclusions: HIV reporting has permitted improved monitoring of New York's HIV/AIDS epidemic. This benefit has not been offset by decreases in HIV testing behavior, including willingness to test among those at high risk of acquiring HIV.

The emergence of the HIV/AIDS pandemic has added to the tension between patients' private interests and public health interests regarding medical confidentiality. Many people become infected with HIV because they are unaware of the positive serostatus of their sexual partners. Informing or warning the sexual partners of HIV-positive patients of the patients'serostatus could assist in curtailing the spread of HIV/AIDS because sexual partners can thereby choose to avoid having unprotected sex with infected persons. By law, however, doctors have a duty to their patients to protect their medical confidentiality. Doctors, therefore, face a dilemma concerning which should prevail: patients' right to privacy and confidentiality or the importance to society of controlling the spread of the pandemic. Most medical regulatory bodies do not take clear-cut positions on the issue, leaving the decision to the discretion of individual doctors. The question of whether doctors should be legally empowered to breach the confidence of patients to protect the patients' sexual partners is discussed here with reference to the existing laws of Canada, the United States, and Nigeria.