Serological testing for the human immunodeficiency virus (HIV) as part of premarital screening

1992 
Existing theoretical and practical evidence indicates that mandatory prenuptial HIV screening would be an impractical inefficient and costly public health measure. Because of the limitations of existing serological tests their positive and negative predictive value increase with the prevalence of infection in the population. Mexicos seroprevalence rate in the general population is estimated at 4/10000. In countries with such low seroprevalence individuals with positive screening tests have a slight chance of truly being infected but the negative predictive value exceeds 99%. For each 100000 persons tested in such a population 39 of the 40 seropositive would be correctly identified and one would not. There would be 200 false positives. Only 39 of the 239 testing positive (16.3%) would actually be positive while 99760 of the 99761 testing negative (99.9%) would in fact be seronegative. A program of prenuptial screening depends for success on the compliance of engaged couples. But during a 6-month period when HIV screening was a requirement for marriage in the state of Illinois the number of marriages declined by 22.5% and in some parts of the state the decline exceeded 50%. The number of marriages in neighboring states increased. The numbers of cases detected in places where obligatory testing has been imposed have been significantly lower than expected. In Illinois 8 seropositive cases were detected in 6 months whereas at least 80 cases annually had been expected. There is no report indicating the expected seropositivity rate of persons planning to marry in Mexico. Indirect evidence including the seroprevalence rates of 3.23/10000 for men and 1.4/10000 for women in Illinois during the 14.3 months of its testing program suggests that the number of cases detected would be low. The logistics of required testing would involve informing the population training personnel assuring the quality of the laboratory procedures and communication of results and providing counseling and psychological support where needed. The cost of the program would be high. The program in Illinois cost approximately 2.5 million dollars in the 6 months during which 8 cases were detected.
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