Compulsory Premarital Screening for HIV

To the Editor. —Once again, Harvard scholars have shone a clarifying light on an otherwise confusing subject. The report by Cleary et al 1 examines the efficacy of premarital human immunodeficiency virus (HIV) screening. Their excellent quantitative model seems to cover almost all conceivable factors that bear on this issue. However, we do not agree with the authors' conclusion that HIV screening is not cost-effective. Output from the model depends on input assumptions. Cleary et al assumed a relatively low figure for HIV prevalence. Many localities throughout the nation have an HIV prevalence far greater than the 0.07% used in the Harvard report. One use of the model is to view it in reverse. First decide what price we are willing to pay for each case prevented and then determine what prevalence of HIV infection justifies screening. It seems to me that reasonable public health policy would call for screening