A global review of legislation on HIV/AIDS: The issue of HIV testing

Objective: Critical review of worldwide legislation on HIV/AIDS, with a foc us on the issue of HIV testing, mainly in a military context. Design: Analysis of health legislation on HIV/AIDS among 121 of the 191 mem ber states of the World Health Organization (WHO), representing 85% of the world's population. Methods: The WHO Directory of Legal Instruments Dealing with HIV Infection and AIDS has been the main source consulted. Relevant findings of two globa l surveys were used to examine HIV testing in the military. Results: AIDS c ases are reportable in 60% of the 121 countries, whereas HIV infections in no more than 26%. Notifications are kept confidential by law in 20% of countries. Only 17% ha ve developed HIV-specific legislation against social discrimination, wherea s 10% have passed legislation establishing financial reimbursement to those who have acquired HIV infection after injection of HIV-contaminated biolog ic material, support for occupational risk, and/or social protection for pa tients. Only 42% of the 121 countries report having legal instruments that require screening of donated blood. Legislative measures that address, generally in a prescriptive but sometimes also in a protective way, vulnerable groups, such as commercial sex workers, men who have sex with men, injecting drug u sers, and recipients of multiple transfusions of blood or blood-derivatives , are reported in 27% of countries. Other categories considered potentially vulnerable, for which specific legislation has been passed, include immigr ants (17% of countries), prisoners (5%), and health personnel (14%). Furthe r legislative measures for HIV prevention address testing pregnant women in the prenatal period (7% of countries), supporting condom promotion (11%), measures requiring quarantine, isolation, or coercive hospitalization of HI V-infected people or AIDS patients (9%), or imposing penal sanctions for HI V-infected people who deliberately expose others to the risk of transmissio n (10%). A National AIDS Committee responsible for addressing issues relate d to HIV/AIDS has been established by law in 39% of the 121 countries. Global surveys show that 27 countries carry out compulsory HIV screening on recruitment of military personnel. Conclusions: These data represent a useful tool to make governments aware o f the problem of underreporting of legal instruments to the WHO and of the need to promote legislation in line with the idea that public health and hu man rights are complementary, not conflicting, goals.