If you have issues viewing or accessing this file contact us at NCJRS.gov. .7 -- " U.S. Department of Justice National Institute of Ju~tice ASQH~Z . All'V<£Y' ill n 1f 4- at t f J t~W\l&7'tJ:~~INr.'8.fjl . 1iJ) Na t·ll.onal .llmill\,l U e 0 us Ice "." Bulletin October 1988 lHIKV AlThtibody T~§ting~ JPIroce((}lulres 9 lIIDlteIrlPHret~tiolTIi9 2InHdl ReRiabnHnty of lReslUlfits Theodore M. Hammett, Ph.D., Abt Associates, Inc. Introduction The test was originally developed to screen In addition, a few States instituted the blood supply and it has virtually In 1983 ar.d 1984, scientists at the screening of all inmates in their correc­ eliminated transfusion-associated HIV in­ Institut Pasteur in Paris and at the tional institutions. fection. Quickly, however, requests were National Institutes of Health identified In the spring of 1987, calls for mass made for use of the test to screen groups of and isolated the cause of AIDS: a virus screening-and, increasingly, for people. The most widely publicized early now generally known as the human mandatory mass screening-began to be application was the Defense Department's immunodeficiency virus (HIV). In early heard. Pursuant to Presidential directive, screening of all potential military recruits. 1985, a commercial test for antibodies to the screening of all Federal prisoners and HIV became available. immigrants was begun. Subsequently, From the Director continue to perfonn their duties in a safe published and widely disseminated. A and professional manner. third report has just been published that Acquired Immunodeficiency Syndrome­ addresses AIDS as it impacts probation AIDS-has been called the most serious Since 1985, the National Institute of Justice and parole services. public health problem in the United States has worked with the Centers for Disease and worldwide today. Since it ftrst Control and other public health officials to President Reagan has said that the AIDS appeared in 1981, there has been an provide important authoritative medical crisis "calls for urgency, not panic ... enonnous amount of uncertainty and fear infonnation about AIDS to criminal justice compassion, not blame. .. understanding, about this fatal disease. Because they may professionals. not ignorance." The National Institute of be in contact with intravenous drug users Justice is working to ensure that criminal and others at high risk for the disease, This AIDS Bulletin is part of a new series justice professionals have the accurate criminal justice professionals understand­ designed to infonn criminal justice infonnation they need to understand and ably are concerned about becoming professionals about the disease and its deal with the risks created by AIDS. Until infected with the AIDS virus While implications for criminal justice agencies. medical science can bring this deadly carrying out their duties. Future bulletins will summarize agency disease under control, our best defense is a policies relating to AIDS, education well-infonned citizenry. Until a vaccine or cure for AIDS is found, programs, and legal and labor relations education is the cornerstone of society's issues. response to this deadly disease. Accurate James K. Stewart infonnation can help dispel misinfonna­ In addition, two special reports on AIDS­ Director tion about the disease and its transmission, as AIDS relates to corrections and law thus enabling criminal justice personnel to enforcement agency procedures-have been there has been a proliferation of propos­ === nonmandatory, or less extensive, testing als for screening State prisoners, mar· ~ .. before deciding to conduct progr2:.'!1. If policymakers cannot clearly riage license applicants, persons admitted mandatory screening in any reach these determinations, they ought to to hospitals, and other populations. decide against mandatory screening population, policymalcers should programs. The position of the Centers for Disease determine (1) the precise objec­ Control (CDC) on testing underwent a This AIDS Blllietin will not discuss the subtle-but important-change during tives of the screening program, debate over mass screening in any further 1987. The CDC shifted from advocating (2) exactly how the test results detail. The interested reader will find the voluntary counseling and testing of will be used to reduce transmis­ issues of concern well covered in an persons and their sexual contacts who sion of the virus, and (3) that it extensive and rapidly growing literature.2 have engaged in high-risk behaviors, to would be impossible to achieve Instead, this Bulletin summarizes some of favoring "routine" counseling and testing the key technical issues surrounding mv of such individuals.! "Routine" means the same objectives through a antibody testing: What is an mv anti­ that testing will be performed as part of nonmandatory, or less extensive, body test? What do the test results mean? normal medical procedures unless the testing program. §9 What methods are used in the basic and individual specifically declines to be .. confirmatory tests? How much do the tested. In other words, CDC has shifted tests cost? How reliable are confirmed the individual's responsibility from results? requesting the test to declining the test. infected individuals underground and subject those who are tested to significant In reality, however, it is impossible to There continues to be widespread discrimination. Opponents also argue separate these technical issues from the controversy surrounding all policies and that the essential educational messages ethical and legal issues surrounding HIV proposals to conduct mandatory screen­ and prevention strategies remain the antibody screening. Thus, decisionmakers ing for HIV antibodies. Proponents same, regardless of antibody status. They in the criminal justice system and else­ generally argue that effective prevention feel that differentially targeted educa­ where must consider all areas as they seek measures and medical care depend upon tional programs may tend to create a fEtlse to develop rational and effective AIDS identifying infected individuals. They sense of security in seronegative popula­ policies. point to the value of targeted educational tions and undermine the essential efforts; the utility of segregating infected message that everyone must be careful. The nature and meaning persons in hospitals, correctional institu­ Precautions against unprotected exposure of HIV antibody testing tions, and other custodial facilities; the to blood and body fluids should be taken importance of health care, correctional, by all persons, regardless of antibody There appears to be significant confusion and custodial staffs knowing the HIV status. Opponents of mandatory mass about the nature and meaning of HIV antibody status of the persons with whom testing fear that incomplete information antibody testing. Although terms such as they have regular contact; and the on HIV status may undermine consistent "AIDS testing" are often used, and possible benefits of antibody status application of these precautions. Finally, individuals are commonly said to have information to diagnosis and medical there is no effective therapeutic treatment "tested positive for AIDS," the fact is that intervention. for persons infected with HIV who there is no test for AIDS. The available tests do not determine whether or not all Opponents counter that mandatory remain asymptomatic. The available individual has AIDS; rather, AIDS can screening will be counterproductive drugs are generally only prescribed when only be diagnosed through identification because it will drive many potentially symptoms appear. Clinical trials regard­ ing the benefit of AZT in treating asymp­ of opportunistic infections or malignancies tomatically infected persons are currently indicating an underlying immune defi­ Points of view or opinions expressed in this ciency caused by HIV infection, or central publication are those of the author and do not in progress but the results will probably not be known until 1990. nervous system disorders now known to necessarily represent the official position or be caused directly by HIV infection. policies of the U.S. Department of Justice. In general, before deciding to conduct mandatory screening in any population, Readily available tests do not even detect The Assistant Attorney General, Office of the presence of HIV itself-only the Justice Programs, coordinates the activities of policy makers should determine (1) the the following program Offices and Bureaus: precise objectives of the screening presence of antibodies to the virus. National Institute ofJustice, Bureau ofJustice program, (2) exactly how the test results Antibodies in the blood are evidence of Statistics, Bureau ofJustice Assistance, Office will be used to reduce transmission of the the immune system's attempt to fight off of Juvenile Justice and Delinquency Preven­ an infection. Actual culturing of the virus tion, and Officefor Victims of Crime. virus, and (3) that it would be impossible to achieve the same objectives through a (i.e., growing the virus from a specimen of 2 body fluid or tissue) is very difficult, time consuming, and expensive. It is currently perfonned only in a small number of What is an HIV antibody test? How much do the tests cost? research laboratories. However, antigen Antibody tests detect the presence of anti­ Testing costs vary considerably, depending tests, which detect a part of the virus, bodies to the AIDS virus-they do not de­ on how the testing is conducted. When may be available within the year. termine whether or not an individual has buying test kits in high volume, testing may AIDS. There is no test/or AIDS. cost as little as $2 to $3 per subject, which A properly confirmed positive result (see would include ELISA tests and any Western below) for HIV antibodies means that the What do the test results mean? Blot confirmatory tests necessary. Other­ wise, the reported range for ELISA testing individual was infected at some time in A properly confirmed positive result for the past, although the test cannot pinpoint is from $5 to $40, depending on whether the HIV antibodies means that the individual agency draws the blood and sends it out to a the date of infection.