Public Health Importance of Premarital HIV Screening

The fact that HIV replicates at an overwhelmingly alarming rate, combined with difficulties encountered by scientists questing for a treatment for the virus, has been a serious public health issue for years. Whether or not premarital screening for HIV and other dreadful disease should be done, has been highly contested for years, especially since the discovery that HIV can be transmitted through sexual contact. However, most experts argue that this might well be one of the surest ways to bring the spread of the virus under control. Since the discovery of the HIV, significant advances have been made into deciphering its internal structural components, especially the genome, with a view to fashioning effective antiretroviral drugs.

The vast majority of HIV-infected people across the globe live in developing countries, where access to sophisticated medical care and costly medications is far beyond the reach of nearly all of those infected. Although the spread of the disease is leveling off or even declining in most industrialized countries and a few developing nations, the epidemic is spreading dramatically in most poor countries, reflecting a gap in preventive efforts. AIDS-related death rates are also at a steady decline in industrialized countries but rising alarmingly in developing nations, underlining an enormous gap between rich and poor societies in their ability to provide life-prolonging treatment. More than 30 million people throughout the world are currently living with HIV and AIDS, with some 16,000 people been newly infected by the virus each day according to estimates by the Joint United Nations Program on HIV/AIDS (UNAIDS). The area most devastated by the disease is sub-Saharan Africa, where nearly 21 million people are living with HIV infection. Infection rates are soaring in much of Asia and Eastern Europe, with many countries tripling their AIDS rates between 1994 and 1997. Overall, about 6.4 million people in Asia and the Pacific island nations are thought to be living with HIV-more than one in five of the world’s total HIV cases.

Preventive measures have actually led to a decrease in HIV infection rates in Western Europe. In the United States new HIV diagnoses have leveled off at about 40,000 cases per year, according to a 1998 report by the Centers for Disease Control and Prevention (CDC).

Some of the public health importance of HIV includes increasing

• Structuring a preventive stealth
• Prevention of mother to child transmission
• Control of the incidences of opportunistic infection
• Early initiation of HIV vaccination
• Immediate initiation of counseling
• Reducing heterosexuality

All these will on the long run reduce the

• number of orphans and widows
• incidence and prevalence of tuberculosis and other opportunistic infection
• incidences of Kaposi’s sarcoma and other dermal complications
• other infectious diseases resulting in increased bed occupancy by HIV infected persons
• chances of trasmissibilty of the virus between unsuspecting couples

Premarital screening if holistically accepted is a strong preventive strategy for the spread of HIV. Its control of the spread of the disease can be by:

Structuring a preventive stealth

Numerous efforts to bring the prevalence of HIV under control has been quelled by some unchanging widespread social and behavioral practices that contribute to the spread of HIV. For example, women in many countries and cultures are unable to insist that a sex partner use a condom, which would help protect them from infection. To combat this problem, many public health experts support development of an effective and inexpensive “stealth” method such as a microbicide, an HIV-killing gel or cream that a woman could use with or without a partner’s knowledge. By the use of such agents, an infected partner can really delay the time for his or her spouse to get infected.

Prevention of mother to child transmission

Worldwide, the frequency of transmission of HIV from mother to child range from 11% to more than 40% of children born to HIV-infected women, with transmission rates approximately doubled in breast-fed compared to formula-fed children. Cases of mothers refusing to be consensual to antenatal HIV can be reduced to the minimum if a premarital screening test is backed with counseling and further enlightenment of HIV positive couples. A source stated that perinatal antiretroviral treatment with zidovudine can reduce mother-to-child (vertical) transmission of HIV from around 25% to 8%. Also, knowledge of the HIV positive status of a mother can help implement avoidance of breast feeding and other critical obstetric management. An established case of HIV infection in a woman before marriage may improve her responsiveness to routine antenatal checkup – a concept that is all-important in the developing world where antenatal schedules are repeatedly overlooked.

Control of the incidences of opportunistic infections

Prior to the widespread use of potent combination antiretroviral therapy (ART), opportunistic infections (infections taking advantage of the immunosuppression in HIV-infected persons) were the principal cause of morbidity and mortality in this population. In the early 1990s, the use of chemoprophylaxis, immunization, and better strategies for managing acute opportunistic infections contributed to improved quality of life and improved survival. However, the widespread use of potent ART starting in the mid-1990s has had the most profound influence on reducing OI-related mortality in HIV-infected persons in those countries in which these therapies are accessible and affordable.

Despite the availability of ART, opportunistic infections have continued to cause considerable morbidity and mortality. Although hospitalizations and deaths have decreased dramatically due to ART, opportunistic infections remain a leading cause of morbidity and mortality in HIV-infected persons. This raises a great public health concern as to how the spread of these infections can be curbed. A profound knowledge of the HIV status of two ultimate couples would go a long way to achieve the control of co-infections in HIV AIDS.

Early initiation of HIV vaccination

In a case where two people claim to love each other in such a blind manner as not to bother about their seropositivity to HIV, early vaccination can be initiated to mitigate the risk of transfer of the virus to the uninfected partner. This measure in recent times is pivotal as it respects the right of the people to choose life partners irrespective of limitations posed by the knowledge of the disease. Also, Sexual partners of individuals with acute HIV infection may be candidates for post-exposure prophylaxis

Control of incidence of maternal and child mortality

In as much as the disease is suffered by the woman, the chances of other obstetric complication in case of pregnancy is increased – also implying a higher chance of children becoming orphans within few years. This is of huge public health concern as the necessary parental care may be lost to the fatal effect of the disease.

Immediate initiation of counseling

Premarital HIV screening may help initiate counseling of couple, should laboratory investigations reveal the presence of HIV. This is because, many may attempt suicide or other ills probably because of the mere fact that the love that bounds their relationship together may fade overtime or due to fear of abandonment, discrimination, violence, upsetting family members, and fear of accusations of infidelity. By such counseling, intending couples may be made to appreciate each other once again.

Reducing heterosexuality

Heterosexuality (sexual relationship between too many people of opposite sex) can be brought under control if intending couples get to know their HIV status beforehand. This is because, couples who are both negative before marriage would ordinarily remain faithful and as well be careful as any foul play may jeopardize the integrity of their relationship. In a case where there is knowledge of HIV positive status, motivation toward safe sex behaviors to protect a partner can be upheld. Persons who are infected by HIV infection have a need to be, and are said to be, aware of the ethical ramifications of exposing their sex partners and to assume responsibility to protect their partners. To this end, HIV positive partner will predict lower sex risks in a relationship because the HIV positive person will want to protect the partner.

Conclusion

Premarital screening for HIV and associated antibody is of great public health importance, and in fact has been viewed by researchers as one of the key ways to reduce the spread of AIDS, especially mother to child transmission. It is also envisaged that it is of great social importance for couples as it checks the activities of otherwise heterosexual partners. Control of HIV infection, particularly in the developing countries has defied strategies devised by WHO and other international organizations like USAID and CDC. However, emphasis should be centered on the public awareness aspect of controlling the spread. This implies, to a great extent the education of couples on the need to ensure utmost faithfulness to one another and to avoid discrimination should results reveal seropositive status.

In the early responses to the HIV epidemic, prevention and control strategies were based on previous experiences in the successful control and prevention of many other infectious diseases. Health educational campaigns on the seriousness of the disease and mode of transmission were conducted to raise public awareness. Unfortunately, these methods apparently did not work well because HIV/AIDS is not an acute infectious process and it has complex social implications. Also, the way people get HIV infection relates to individual behavior and legal issues in some cases (i.e. drug use and prostitution). Mechanical barrier intervention has been repeatedly stressed on; a 100% condom use campaign may be intensively promoted among the high-risk sexual behavior groups, with collaboration across many governmental ministries.