From exceptionalism to normalisation: A reappraisal of attitudes and practice around HIV testing
From exceptionalism to normalisation: A reappraisal of attitudes and practice around HIV testing
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DOI：
10.1136/bmj.316.7127.290
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发表时间：
1998-01-24
影响因子：
105.7
通讯作者：
Johnson, AM
中科院分区：
文献类型：
--
作者：
De Cock, KM;Johnson, AM
在美国和英国流行病开始时，在公民自由团体、医生、公共卫生官员和其他人的支持下，当艾滋病毒/艾滋病首次被认识时，男男性行为者就反对与传统传染病控制方法不同的政策。 3-6 这一策略以前被称为“艾滋病毒/艾滋病例外论”。 3 强调临床保密和匿名监测制度，强化知情同意。当艾滋病毒抗体检测可用时，其使用受到了以前其他诊断调查中未曾见过的限制。这一最初的反应是基于对侵犯公民权利的担忧，受到受影响社区成员对艾滋病毒/艾滋病科学和政治的直言不讳的参与（艾滋病激进主义）的影响。例外主义最初对临床护理的影响有限，因为治疗对预后的影响不大。由于在工业化国家感染艾滋病毒的人中，妇女占少数，因此对妇女进行普遍产前检测的问题仍然不引人注目。当时，防止传播给婴儿的唯一措施是终止妊娠或避免母乳喂养，对歧视和强制检测的担忧成为争论的焦点。正常化是指更像对待其他传染病一样对待艾滋病毒/艾滋病，在知情同意和尊重保密的要求范围内，早期诊断对于采取适当的治疗和预防措施至关重要。
At the start of the epidemics in the United States and the United Kingdom, men who have sex with men argued when HIV/AIDS was first recognised—with the support of civil liberties groups, physicians, public health officials and others—for policies that differed from a traditional infectious disease control approach. 3–6 This strategy has previously been termed “HIV/AIDS exceptionalism.” 3 Clinical confidentiality and anonymised surveillance systems were emphasised, and informed consent was strengthened. The use of HIV antibody tests, when they became available, was restricted in a way not seen previously for other diagnostic investigations. This initial response, based on concerns about abuses of civil rights, was influenced by the vocal involvement of members of affected communities in the science and politics of HIV/AIDS (AIDS activism).Exceptionalism initially had a limited effect on clinical care because treatment had only a modest influence on prognosis. The issue of generalised antenatal testing in women retained a low profile because women accounted for a minority of people in industrialised countries infected with HIV. Concerns about discrimination and compulsory testing dominated debate at a time when the only measures to prevent transmission to infants were termination of pregnancy or avoidance of breast feeding. Normalisation then refers to treating HIV/AIDS more like other infectious diseases for which early diagnosis is essential for appropriate therapeutic and preventive measures, within the requirements of informed consent and respect for confidentiality.