Emerging Diseases In Communities Essay

This week, we will look into our own communities and discuss emerging diseases.

Look into health data for your community (Colorado) (either at the country, state, city, or county level). You can look at statistics from your local health department or websites such as the Centers for Disease Control and Prevention. Find a disease that is emerging in your community and discuss. Give the rates and the duration of the increase of this disease. What population does this disease affect most? Discuss what you think can be done to prevent further increase in this disease.Emerging Diseases In Communities Essay

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The health data cannot be older than 3 years (2017-2020). In the event that classmates live in the same community, do not repeat a topic that a classmate has already chosen and posted to the forum.

Reducing the burden of disease in developing countries is central to global economic development and security.1,2,3 Combatting infectious disease is crucial to improving prospects for the poor and preventing the rapid spread of infections in an interdependent world. The outbreak of SARS in the spring of 2003 led to a major rethinking of our preparedness to fight infectious diseases domestically.4 Less appreciated is the link between global and domestic control of infectious diseases and the role that individual countries can play in combatting infectious diseases worldwide through control and research.Emerging Diseases In Communities Essay

In this article we provide the rationale for an accelerated program for infectious disease research. We first review the role scientific research has played in the historic rates of decline in infectious disease mortality during the 20th century. We identify current infectious disease priorities and research gaps. Next we discuss the economic benefits of disease control, including the likely benefits of accelerated research. Finally, we provide the broad contours of an accelerated Canadian response to global infectious diseases.

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The contribution of scientific research
The 20th century saw extraordinary declines in premature mortality in both developed and developing countries. Advances in science contributed greatly to reductions in infectious disease through better control over vaccine-preventable disease, advances in antibiotic therapies and their delivery, promising new diagnostic technologies and, to a more limited extent, new technologies to fight diseases at the molecular level.Emerging Diseases In Communities Essay

In 1900 life expectancy at birth in developed countries was about 40 years and, in most developing countries, below 20 years. By 2000, life expectancy had nearly doubled in Canada and had tripled (or more) in developing countries.5 Much of these gains occurred in recent decades: between 1960 and 1995 alone, life expectancy in low-income countries improved by 22 years, as opposed to 9 years in developed countries. As a global average, the under-five mortality rate declined from 16% in the 1960s to 8% in the 1990s.6 Whereas some have attributed these gains to economic growth, overall the magnitude and rate of decline in premature mortality in both developed and developing countries in recent years have been much greater than can be directly accounted for by growth in income levels.7,8,9,10 These gains have been more rapid than the equivalent decline in mortality that occurred in the developed world during the late 19th and early 20th centuries and have affected the lives of far more people.Emerging Diseases In Communities Essay

Consider the declines in infectious disease (Table 1). Improved living conditions paired with the use of vaccines and antimicrobial agents and the ability to identify new pathogens have been central to the more than 90% reduction in communicable disease mortality in Canada and the United States.11 Today more than 30 common infectious diseases are controllable with vaccines. In 1970 perhaps only 5% of the world’s children under 5 were vaccinated against measles, tetanus, pertussis, diphtheria and polio. By 1990 the Expanded Programme on Immunization had raised this proportion to about 75%, saving over 3 million lives a year.12 Diarrhea-related deaths among children have fallen by several million a year, partly as a result of the development of oral rehydration therapy, much of which was the result of work in population research laboratories in Bangladesh. The most spectacular success in immunization is the World Health Organization’s campaign against smallpox, which culminated in the eradication of smallpox in human populations by 1979. The WHO is now engaged in an ongoing campaign to eradicate poliomyelitis by 2005.Emerging Diseases In Communities Essay

Emerging infectious diseases are infections that have recently appeared within a population or those whose incidence or geographic range is rapidly increasing or threatens to increase in the near future. Emerging infections can be caused by:

Previously undetected or unknown infectious agents
Known agents that have spread to new geographic locations or new populations
Previously known agents whose role in specific diseases has previously gone unrecognized.
Re-emergence of agents whose incidence of disease had significantly declined in the past, but whose incidence of disease has reappeared. This class of diseases is known as re-emerging infectious diseases.
credit-expose CreditEbola virus particles budding from a monkey cell
The World Health Organization warned in its 2007 report that infectious diseases are emerging at a rate that has not been seen before. Since the 1970s, about 40 infectious diseases have been discovered, including SARS, MERS, Ebola, chikungunya, avian flu, swine flu, Zika and most recently a new coronavirus.Emerging Diseases In Communities Essay

With people traveling much more frequently and far greater distances than in the past, living in more densely populated areas, and coming into closer contact with wild animals, the potential for emerging infectious diseases to spread rapidly and cause global epidemics is a major concern.

Additionally, there is the potential for diseases to emerge as a result of deliberate introduction into human, animal, or plant populations for terrorist purposes, as discussed in the section on Bioterrorism Agents. These diseases include anthrax, smallpox, and tularemia.Emerging Diseases In Communities Essay

Factors in the Emergence or Re-emergence of Infectious Diseases
There are many factors involved in the emergence of new infectious diseases or the re-emergence of “old” infectious diseases. Some result from natural processes such as the evolution of pathogens over time, but many are a result of human behavior and practices. Consider how the interaction between the human population and our environment has changed, especially in the last century. Factors that have contributed to these changes are population growth, migration from rural areas to cities, international air travel, poverty, wars, and destructive ecological changes due to economic development and land use.Emerging Diseases In Communities Essay

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For an emerging disease to become established at least two events have to occur – (1) the infectious agent has to be introduced into a vulnerable population and (2) the agent has to have the ability to spread readily from person-to-person and cause disease. The infection also has to be able to sustain itself within the population, that is more and more people continue to become infected.

Many emerging diseases arise when infectious agents in animals are passed to humans (referred to as zoonoses). As the human population expands in number and into new geographical regions, the possibility that humans will come into close contact with animal species that are potential hosts of an infectious agent increases. When that factor is combined with increases in human density and mobility, it is easy to see that this combination poses a serious threat to human health.

Climate change is increasingly becoming a concern as a factor in the emergence of infectious diseases. As Earth’s climate warms and habitats are altered, diseases can spread into new geographic areas. For example, warming temperatures allow mosquitoes – and the diseases they transmit – to expand their range into regions where they previously have not been found.

A factor that is especially important in the re-emergence of diseases is antimicrobial resistance – the acquired resistance of pathogens to antimicrobial medications such as antibiotics. Bacteria, viruses, and other microorganisms can change over time and develop a resistance to the drugs used to treat diseases caused by the pathogens. Therefore, drugs that were effective in the past are no longer useful in controlling disease.Emerging Diseases In Communities Essay

Another factor that can cause a disease to re-emerge is a decline in vaccine coverage, so that even when a safe and effective vaccine exists, a growing number of people choose not to become vaccinated. This has been a particular problem with the measles vaccine. Measles, a highly contagious and serious infection that was eliminated from the U.S. in 2000 and from the Western Hemisphere in 2016, has returned in certain areas due to an increase in the number of people opting to take nonmedical vaccine exemptions for reasons of personal and philosophical belief. This has been driven by an anti-vaccine movement that was founded largely on an invalid and discredited study that claimed a link between a vaccine against measles and autism. As a result of the decline in vaccine coverage, measles cases are highest by far this decade with more than 1,000 cases of measles reported in the U.S. in the first half of 2019.Emerging Diseases In Communities Essay

Examples of How Diseases Emerge
credit-expose CreditScanning electron micrograph of an HIV-infected H9 T cell.
Influenza (or flu) is an example of an emerging disease that is due to both natural and human factors. Influenza virus is infamous for its ability to change its genetic information. Large changes in the influenza virus can cause pandemics because the human immune system is not prepared to recognize and defend against the new variant. The chances of large genetic changes occurring and being passed into humans are increased when humans coexist in close proximity with agricultural animals such as chickens, ducks, and pigs. These animals are natural hosts of influenza virus and can act as mixing vessels to create novel versions of influenza that have not existed previously. Avian H5N1 influenza (or bird flu), which emerged more than a decade ago, has been limited to relatively rare instances of infection in humans who came into direct contact with diseased birds. The H5N1 virus is very deadly (more than half the cases have been fatal), but it has not acquired the ability to pass efficiently between humans. In contrast, the 2009 H1N1 influenza, which passed into humans from swine (pigs), transmitted easily from person to person. The H1N1 virus traveled around the world faster than any virus in history as a result of human activity, particularly air travel. Fortunately, it was much less deadly than the H5N1 virus. Emergence of an influenza virus that is as deadly as the avian H5N1 virus and is spread between people as easily as the swine H1N1 virus would be a very serious threat to human health.Emerging Diseases In Communities Essay

The cases of SARS and MERS, severe respiratory illnesses, represent another instance of how quickly infectious diseases can spread around the globe as a result of air travel. SARS emerged in China in 2002 and spread rapidly to other countries within the region and then to Canada via air travel. An unprecedented global response halted the spread of the causative virus, but not before 8000 people had been infected and 800 died. MERS, caused by a related virus, emerged in 2012 in the Arabian Peninsula. This time the initial response was not as effective and MERS continues to spread. Travel-associated cases originating in the Middle East region have been reported in countries in Europe, Asia, Africa, and North America. A more worrisome development occurred in the late spring of 2015 when, due to a single traveler, a chain of viral transmission infected close to two hundred people in a period of about two months.Emerging Diseases In Communities Essay

An example of an emerging infectious disease that can be attributed to human practices is HIV. It is thought that humans were first infected with HIV through close contact with chimpanzees, perhaps through bushmeat hunting, in isolated regions of Africa. It is likely that HIV then spread from rural regions into cities and then internationally through air travel. Further factors in human behavior, such as intravenous drug use, sexual transmission, and transfer of blood products before the disease was recognized, aided the rapid and extensive spread of HIV.Emerging Diseases In Communities Essay

One instance of a tropical disease that has spread recently into new areas that may be due, at least in part, to changing climate is chikungunya. Chikungunya disease is caused by the chikungunya virus, a relative of the virus that causes Dengue fever. It is transmitted by the tiger mosquito, and in the past was confined to tropical regions around the Indian Ocean. In late summer of 2007, more than 100 residents of the town of Ravenna, Italy suffered from a mysterious disease that produced fever, exhaustion, and severe bone pain. The outbreak was eventually shown to be caused by chikungunya virus. By 2014, chikungunya outbreaks have been reported in countries in Europe, Asia, Africa, and the Americas (Caribbean and Central and South America). The virus arrived in the United States in the summer of 2014, although thus far local transmission of chikungunya virus has been limited to Florida and Texas. Although chikungunya virus does not usually cause a fatal disease, it serves as a warning that other, more devastating tropical diseases could follow. In fact, a more serious threat is the recently emergent Zika virus in the Americas which is associated with a birth defect known as microcephaly.Emerging Diseases In Communities Essay

Finally, the Ebola virus epidemic that emerged in 2014 in West Africa illustrates how a virus that previously affected only small groups of people, perhaps a few hundred, can sweep rapidly through an area to affect tens of thousands, and become extremely difficult to contain. A combination of factors including high population densities, increased travel, closer contact with wild animals, weak health care systems, and a slow response led to the worst outbreak of Ebola the world has ever seen.Emerging Diseases In Communities Essay

Research on Emerging Diseases
The development of vaccines and antimicrobial drugs and the remarkable eradication of smallpox had created hope that infectious diseases could be controlled or even eliminated. However, the current realization that infectious diseases continue to emerge and re-emerge (including the possibility of bioterrorism), underscores the challenges ahead in infectious disease research.Emerging Diseases In Communities Essay

To help meet this challenge, research is ongoing in the Department of Molecular Virology and Microbiology at Baylor College of Medicine on a number of emerging and re-emerging diseases, including influenza, SARS and MERS, dengue, chikungunya, Zika, tuberculosis, and HIV/AIDS. This work encompasses both basic research in trying to understand more thoroughly how these agents cause disease and how the human immune system responds to these infections, as well as more directed research in developing and evaluating vaccines and other tools to prevent infection by these agents. In addition, scientists are studying mechanisms by which bacteria can acquire antibiotic resistance and ways to combat drug-resistant infections.Emerging Diseases In Communities Essay

Minimizing the transmission of infectious diseases is a core function of public health law. The
appropriate exercise of legal powers will vary according to the seriousness of the disease, the
means of transmission, and how easily the disease is transmitted.
· Law can contribute to the prevention of infectious diseases by improving access to
vaccinations and contraceptives, and by facilitating screening, counselling and education of those
at risk of infection. Law also has a reactive role: supporting access to treatment, and authorizing
public health authorities to limit contact with infectious individuals and to exercise emergency
powers in response to disease outbreaks.Emerging Diseases In Communities Essay
· Where public health laws authorize interferences with freedom of movement, the right to
control one’s health and body, privacy, and property rights, they should balance these private
rights with the public health interest in an ethical and transparent way. Public health powers
should be based on the principles of public health necessity, reasonable and effective means,
proportionality, distributive justice, and transparency.
· Immunization is a successful and cost-effective public health strategy that saves millions of
lives each year. Governments can support vaccination coverage by ensuring that vaccination is
free or affordable, by ensuring that all children are vaccinated (with limited exceptions for medical
or religious reasons), and that vaccinations are documented.
· Screening individuals to determine if they have been infected with or exposed to an infectious
disease is a core public health strategy. Early treatment has important public health benefits; for
example, people receiving treatment for tuberculosis and HIV infection are less likely to transmit
the infection to others. Routine, voluntary HIV testing benefits both affected individuals and their
intimate partners by facilitating early access to prevention, care and treatment services.
· Health laws can improve the success of voluntary screening programmes by including
counselling requirements, ensuring the confidentiality of test results, and protecting individuals
diagnosed with particular diseases from discrimination. Public health laws should protect the
confidentiality of a person’s HIV status, authorizing disclosure to third parties only in limited
circumstances where a third party is at significant risk of HIV transmission and where other
statutory preconditions are met.
· Governments should carefully consider the appropriate role of criminal law when amending
laws to prevent the transmission of infectious and communicable diseases. For example, criminal
penalties for transmission of HIV may create disincentives to individuals to come forward for HIV
testing and treatment, or may provide the pretext for harassment and violence against vulnerable
groups. Encouraging personal responsibility and self-protection is critical, especially in countries
where rates of HIV infection are high.
· Public health laws should authorize compulsory treatment only in circumstances where an
individual is unable or unwilling to consent to treatment, and where their behaviour creates a
significant risk of transmission of a serious disease. Emerging Diseases In Communities Essay Compulsory treatment orders should restrict
individual liberty only to the extent necessary to most effectively reduce risks to public health.
Advancing the right to health: the vital role of law Page | 151
· Public health laws may authorize the isolation of individuals and groups who may have been
exposed to an infectious disease, as well as the closure of businesses and premises and the
confiscation of property. The exercise of these powers must be based on public health
considerations, without discrimination on grounds of race, gender, tribal background, or other
inappropriate criteria. Public health laws should provide for the fair compensation of those who
have suffered economic loss due to a public health order affecting their property or facilities.
Minimizing the transmission of infectious diseases is a core function of public health law. Clearlydefined legal powers are needed to respond to outbreaks of contagious and serious diseases at
national level. The appropriate exercise of legal powers will vary according to the seriousness of the
disease, the means of transmission, and how easily the disease is transmitted. Some diseases are
entirely preventable by vaccination (e.g. measles and polio), or by access to improved sanitation and
clean drinking water (e.g. diarrhoeal and parasitic diseases). Others are treatable when detected in
a timely manner (e.g. tuberculosis and malaria). The epidemic of HIV can be substantially reduced
through laws supporting access to treatment, combined with measures to educate and support
individuals and communities to implement proven strategies for preventing transmission. As
discussed in Section 11.1, States Parties to the International Health Regulations (2005) have an
obligation to assess and notify WHO of all events occurring within their territories that may
constitute a public health emergency of international concern.1
The legal framework for responding
to public health emergencies is discussed further in Chapter 11.
In circumstances where a disease or infection is transmitted by sexual contact or other forms of
human behaviour that are private and difficult to monitor, the priority for governments is to create
an enabling legal environment that supports those behaviours that are most successful in preventing
further transmission. This is the challenge of HIV and the law. High rates of infection with HIV,
particularly in sub-Saharan Africa, combined with inadequate access to treatment, have resulted in a
heavy burden of disease from AIDS, dramatically reducing average life expectancy, productivity, and
creating major obstacles to the progressive realization of the right to health (see Section 3.2(a)).
These problems have been exacerbated by a lack of resources. In 2009, the Regional HIV Prevention
Experts Think Tank and Multisectoral Stakeholder meeting convened by the East African Community
recommended that Partner States commit at least 15% of their national budgets to health, and 15%
of the national health budget to HIV and AIDS interventions – beyond the 5% currently committed.Emerging Diseases In Communities Essay

They also recommended that Partner States scale up by at least 50% the allocation of the total HIV
and AIDS budget devoted to HIV prevention interventions.3
Page | 152 Advancing the right to health: the vital role of law
10.1 Building ethical principles into infectious
disease legislation
Public health laws can support the control of infectious diseases in two important ways. Firstly, law
has a proactive or preventive role: improving access to vaccinations and contraceptives, together
with screening, education, counselling and other strategies that aim to minimize exposure to
disease. Secondly, law has a reactive role: supporting access to treatment, and authorizing health
departments and health care providers to limit contact with infectious individuals and to exercise
emergency powers in response to disease outbreaks. Because infectious disease control and
prevention laws may involve interference with freedom of movement, the right to control one’s
health and body, and with privacy and property rights, public health laws should embody a decisionmaking process that balances these personal rights with the public’s health in an ethical and
transparent way. Table 10.1 identifies a set of ethical principles that are relevant and sets out what
they mean in terms of the exercise of coercive power over individuals, within a legal framework for
control of infectious diseases.4
Table 10.1: Building ethical principles into legislation that restricts personal rights and freedoms
Ethical principle Putting the principle into practice
Public health necessity Coercive powers should be exercised on the basis of a demonstrable threat
to public health. Mandatory physical examination, treatment or isolation Emerging Diseases In Communities Essay
should require a reasonable suspicion that the person is contagious or could
pose harm to others.
Reasonable and
effective means
The specific measures adopted by governments must be appropriate to
prevent or reduce the threat. Governments should monitor the
effectiveness of public health interventions and ensure that they are based
on sound science.
Proportionality Governments must strive to ensure that there is a reasonable fit between
the coercive measures imposed on individuals, and the public health benefit
that they seek to achieve. Governments should adopt the least
burdensome measure from among the measures that are available and
reasonably appropriate to mitigate the risks in question. Restrictions that
are “gratuitously onerous or unfair” may “overstep ethical boundaries”.5
Distributive justice The risks, benefits and burdens of public health interventions should be
shared fairly. For example, vulnerable populations should not be targeted
with restrictive measures, nor excluded or given lower priority in the
allocation of treatment, vaccines, or other benefits.
Advancing the right to health: the vital role of law Page | 153
Trust and transparency The public should have an opportunity to participate in the formulation of
public health policies, and governments should give reasons for policies and
decisions that restrict individual freedoms. Openness and accountability
are essential to generating public trust, and are likely to improve public
health decision-making. Without public trust and voluntary cooperation,
governments will find it harder to achieve their goals and to act in the
public interest.
10.2 Preventing the transmission of infectious
diseases
(a) Immunization
“Overwhelming evidence demonstrates the benefits of immunization as one of the most successful
and cost-effective health interventions known”.6
Immunization avoids about 2–3 million deaths
each year, as well as serious disability from vaccine-preventable diseases including Yellow fever,
diphtheria, tetanus and pertussis, rubella, rotaviruses, polio, pneumococcal diseases, mumps,
measles, human papillomavirus, polio, hepatitis B, and Haemophilus influenzae type b.7
To maximize Emerging Diseases In Communities Essay
immunization coverage, national vaccination plans should provide for free or affordable
immunizations that are available from most health care providers, public education campaigns to
illustrate the importance and safety of vaccinations, monitoring of vaccination rates and their impact
on health outcomes, and limited exceptions for individuals who for medical or religious reasons wish
to avoid vaccinations.
Belize’s Public Health Act 2000 illustrates some important features of a national vaccination strategy:
all children are to be vaccinated, vaccinations are to be documented, any person (including any
adult) may be vaccinated free of charge, and public health officials may require any person to be
vaccinated or revaccinated if an outbreak occurs (Box 10.1). Governments may determine that
certain highly infectious diseases warrant compulsory vaccination, although such a requirement may
be subject to constitutional protections relating to the right to be free from non-consensual medical
treatment, or to freedom of religion.
Box 10.1: National requirements for child vaccination in Belize
Public Health Act8
Section 150. Child to be vaccinated within three months.
(1) Every parent of a child in Belize shall, within three months after the birth of the child, or within
three months after receiving into custody the child, take or cause the child to be taken to a public
vaccinator of the district in which such child is then resident, to be vaccinated according to this Act,
unless the child has been previously vaccinated by a [medical practitioner].
Section 151. Inspection after vaccination.
Page | 154 Advancing the right to health: the vital role of law
(1) On the eighth day after the vaccination, the parent shall again take or cause the child to be taken
to the public vaccinator for inspection at such time and place as may have been appointed by him at
the time of vaccination.Emerging Diseases In Communities Essay

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(2) If on inspection it is ascertained that the vaccination has been unsuccessful, the parent shall, if
the vaccinator so directs, cause the child to be forthwith again vaccinated and afterwards inspected
as on the previous occasion.
(3) If the vaccination has been successful the public vaccinator or surgeon forthwith shall give to the
parent a certificate … and within seven days shall transmit a certified copy of the certificate to the
Registrar of the district within which the child’s birth was registered … or if the birth of the child has
not been registered, then he shall give it to the Registrar of the district where the child resides.
Section 152. Where child is unfit
(1) If any public vaccinator or surgeon is of opinion that the child is not in a fit and proper state to be
successfully vaccinated, he shall forthwith deliver to the parent a certificate under his hand
according to the form of the Sixth Schedule or to the like effect, that the child is then in a state unfit
for successful vaccination, which certificate shall remain in force for two months only but shall be
renewable for a like period from time to time, until a public vaccinator or surgeon thinks the child to
be in a fit state for successful vaccination, when the child shall with all reasonable dispatch be
vaccinated and a certificate of successful vaccination according to the form of the Fifth Schedule
duly given if warranted by the result and a certified copy sent to the Registrar of the district where
the child resides.
S 154. Public Vaccination gratis.
(1) Any public vaccinator shall, on application, vaccinate or re-vaccinate without charge any person
at any time and place appointed for the attendance of such public vaccinator, and on the performing
of the same the public vaccinator shall appoint a time and direct such person to attend at the same
place, the time being as far as practicable the eighth day after vaccination.
National vaccination strategies should include contingency plans for outbreaks of highly contagious
or serious diseases (e.g. pandemic influenza). In these circumstances, shortages of vaccine may
occur. Priority of access to limited supplies of vaccine should occur in accordance with regulations Emerging Diseases In Communities Essay
developed through a transparent process that provides the opportunity for meaningful public
discussion about the principles of fair allocation. In many cases, priority is likely to be given to health
care workers, emergency responders (e.g. fire and police personnel) and others responsible for
ensuring the continuation of key services and societal functions.9
(b) Screening
Screening individuals to determine if they have been infected with or exposed to an infectious
disease is a core public health strategy. Screening enables health care providers to begin treatment
in a timely manner, to manage co-morbidities more effectively, to encourage patients to reduce
high-risk behaviour and, in certain cases, to identify the need for compulsory treatment. In addition
to reducing the severity of illness, early treatment may also reduce transmission rates. For example,
early treatment with antiretroviral drugs lowers the viral load of people with HIV and significantly
Advancing the right to health: the vital role of law Page | 155
reduces the risk of sexual transmission.10 WHO supports the expansion of HIV testing and
counselling in order to identify people with HIV early on in their infection and to “link them
successfully to prevention, care, and treatment services”.11
In addition to authorizing screening, including mandatory screening in appropriate circumstances,
public health laws can improve the success of screening programmes by including counselling
requirements, by ensuring the confidentiality of test results, and by protecting individuals diagnosed
with particular diseases (e.g. HIV) from discrimination. Laws drafted in accordance with human
rights principles increase the likelihood that individuals will voluntarily seek out testing and
treatment services.12
Global strategies for controlling infectious diseases advise against placing heavy reliance on criminal
laws and penalties. For example, the Joint United Nations Program on HIV/AIDS has advised against
the criminalization of unintentional HIV transmission and non-disclosure of HIV infection to sexual
partners,13 and the HIV and AIDS Prevention and Management Bill, passed in 2012 by the East
African Legislative Assembly, integrates human rights principles into law in the region14 (Box 10.2).
Box 10.2: Incorporating human rights principles into infectious disease screening policies in the
East African Community
The East African Community HIV and AIDS Prevention and Management Bill15
9. HIV and AIDS education and information as a health care service.Emerging Diseases In Communities Essay
(1) The provision of HIV and AIDS education and information shall form part of the delivery and
health care services by all health care providers at public and private health care facilities.
15. Prevention of mother-to-child transmission. In order to prevent or reduce the risk of motherto-child transmission of HIV, the Minister shall ensure that –
…
(b) HIV counselling and testing is made available and offered to all pregnant women and their
partners, as part of ante-natal care services.
19. Contents of post-test counselling.
…
(3) Where the result of a test is HIV positive, a counsellor shall –
(a) provide post-test counselling which shall include at a minimum –
(i) the medical consequences of living with HIV;
(ii) the modes of prevention and transmission of HIV and other opportunistic infections;
(iii) the importance of disclosure of the person’s status to the person’s spouse or spouses or sexual
partner or partners;
(iv) the medical treatment and other social facilities available;
(v) the need to continuously seek professional services relating to HIV; and
Page | 156 Advancing the right to health: the vital role of law
(b) refer the tested person to an appropriate health service provider for follow up testing or
treatment.
21. Provision of testing facilities. The Minister shall ensure that facilities for HIV testing are made
available –Emerging Diseases In Communities Essay
(a) free of charge, to persons who voluntarily request an HIV test in respect of themselves; and
(b) to persons who are required to undergo an HIV test under this Act or any other written law.
22. Prohibition of compulsory testing.
(1) Subject to this Act, no person shall compel another person to undergo an HIV test.
(2) Unless otherwise provided under this Act, every HIV test shall be confidential.
(3) Without prejudice to the generality of subsections (1) and (2), no person shall compel another to
undergo an HIV test as a precondition to, or for continued enjoyment of –
(a) any employment;
(b) marriage;
(c) admission into any educational institution;
(d) entry into or travel out of a Partner State; or
(e) the provision of health care, insurance cover or any other service.
23. Consent to testing.
(1) Unless otherwise provided by this Act, the informed consent of the person to be tested shall be
obtained prior to any HIV test.
Under the East African Community law, which applies within Burundi, Kenya, Rwanda, Uganda and
the United Republic of Tanzania, HIV screening remains voluntary and routine, meaning that all
patients are offered an HIV test when they come into contact with the health system. This approach
has become the norm within infectious disease control strategies and settings where antiretroviral
drugs are available and accessible,16 and is a proven way of both increasing uptake of screening and
increasing the number of women who are aware of their HIV status and receive interventions to
reduce mother-to-child transmission.17 Where access to treatment is limited, HIV screening policies
should not require routine testing, but rather require health care providers to screen symptomatic
patients, patients who request testing, and all blood collected for transfusion or for the manufacture
of blood products.18 The East African Community bill provides that the results of HIV tests shall be
confidential and encourages persons diagnosed with HIV to voluntarily disclose their status to
spouses or sexual partners. The disclosure of a person’s HIV status to a third party without consent
is authorized in strictly limited circumstances where a third party is at significant risk of HIV
transmission and where other statutory preconditions are met (Box 10.3).Emerging Diseases In Communities Essay
Advancing the right to health: the vital role of law Page | 157
Box 10.3: HIV test results, post-test counselling and disclosure of HIV status in the East African
Community
The East African Community HIV and AIDS Prevention and Management Bill19
Section 24. HIV test results.
(1) Subject to subsection (3) and (4), the result of an HIV test shall be confidentially and directly
communicated to the person concerned …
(2) A person providing treatment, care or counselling services to a person living with HIV shall
encourage that person to inform the person’s spouse … or sexual partner or partners or any other
third party who is at significant risk of HIV transmission from the person living with HIV, of the
person’s HIV status.
(3) Except where subsection (4) is applicable, a person providing treatment, care or counselling
services to a person living with HIV may notify a third party of the HIV status of that person only
where the notifying person is requested by the person living with HIV to do so.
(4) A person providing treatment, care or counselling services to a person living with HIV may notify
a third party of the HIV status of that person if –
(a) In the opinion of the person providing treatment, care or counselling services, after
discussion of the matter with the person living with HIV, that person is not at risk of serious harm
from the third party or from other persons as a consequence of such notification;
(b) The third party to be notified is at significant risk of HIV transmission from the person living
with HIV;
(c) The person living with HIV, after appropriate counselling, does not personally inform the
third party at risk of HIV transmission; and
(d) The person providing treatment, care or counselling services has informed the person living
with HIV of the intention to notify the third party;
or
(e) The person living with HIV is dead, unconscious or otherwise unable to give consent to the
notification and is unlikely to regain consciousness or the ability to give consent; and
(f) In the opinion of the person providing treatment, care or counselling services, there was a
significant risk of transmission of HIV by the person living with HIV to the third party.
Routine HIV testing services are likely to be most effective when combined with outreach
programmes that target those populations most at risk of transmission. These include sex workers,
men who have sex with men, injecting drug users, military personnel, transport workers, and
prisoners. For example, Thailand’s National AIDS Committee adopted a strategy targeting
commercial sex workers, which resulted in an increase in condom use by sex workers by over 70% in
three years20 and a fivefold decrease in new HIV infections.21
Page | 158 Advancing the right to health: the vital role of law
(c) Criminal law and mandatory disclosure laws
The appropriate role of criminal law in national efforts to prevent transmission of HIV and other
sexually transmissible infections is often controversial. Public health laws often contain penalties for
failing to comply with public health orders made by authorities, or for engaging in behaviours that
place public health at risk. However, policy-makers should not ignore the potential for unintended
consequences arising from laws that create criminal offences for recklessly exposing another person
to HIV, or for failing to disclose one’s HIV status to a sexual partner (mandatory disclosure laws).22
Laws like these may be intended to encourage personal responsibility in the hope that individuals
will modify their behaviour in order to avoid criminal penalties. They may also be motivated by the
belief that those who fail to protect others from HIV transmission, or from the risk of transmission,
deserve punishment. On the other hand, the broader impact of these laws on transmission rates
and public health can be negative. The final report of the Global Commission on HIV and the Law
pointed out that criminal laws against HIV in many countries are overly broad, carry draconian
penalties, and are “virtually impossible to enforce with any semblance of fairness”.23 For example,
sex workers and women in abusive relationships may face violence if required to disclose their HIV
status to sexual partners.24 To the extent that criminal penalties have any effect on sexual behaviour
at all,25 they may create disincentives to individuals to come forward for HIV testing and treatment,
for fear of criminal penalties or official investigation. This is counter-productive, since it is important
to encourage individuals to monitor their HIV status and to seek treatment as soon as they are
diagnosed, both because those who acquired the virus recently will have a higher viral load and will
be more likely to transmit it,26 and because effective treatment with antiretroviral therapy lowers
viral load and makes it less likely that HIV positive individuals will pass on the virus to others.27
An additional concern that relates to mandatory disclosure laws is the potential for such laws to
subtly undermine disease control efforts by weakening the assumption that individuals are primarily
responsible for protecting themselves from the risks of transmission of HIV and other sexually
transmissible diseases. In countries where large numbers of the population are infected, relying on
voluntary disclosure by sexual partners is unrealistic. Individuals may not know their status, or may
be ashamed, fearful, or otherwise unwilling to reveal information about themselves. In these
circumstances, personal responsibility and self-protection remain critical.Emerging Diseases In Communities Essay
The Joint United Nations Programme on HIV/AIDS (UNAIDS)28 and, more recently, the Global
Commission on HIV and the Law, have recommended that countries should only prosecute HIV
transmission in cases of intentional and actual transmission, and require a high standard of evidence
and proof. The Global Commission recommended that countries repeal provisions that explicitly
criminalise HIV transmission, and rely on existing laws against assault, laws against causing bodily
harm, or laws that permit public health officials to intervene when a person’s behaviour creates a
serious risk of transmission of communicable disease.Emerging Diseases In Communities Essay