Whether universal testing of all U.S. health care workers (HCWs) who perform invasive procedures for HIV status is needed to prevent transmission of HIV to patients is discussed, concluding that such testing would create more problems and endanger more patients than lives would be saved. The address was given at the U.S. Conference of Mayors and the U.S. Conference of Local Health Officers in New Orleans, June 1991. 38% of the country's 2000 local health departments offer dentistry and 3% operate public hospitals. Universal body fluid precaution guidelines were adopted in 1987. Using hepatitis B virus (HBV) as an indicator, transmission of blood-bourne pathogens has been significantly curtailed since adoption. Changes that could be made to improve infection control are training, monitoring, enforcement of compliance, and use of safer barrier technologies. CDC could collect data on transmission related to specific procedures, set guidelines for management of infected HCWs, allow HCWs to elect not to perform certain procedures. Patients have the right to be informed of breakdown in the universal precautions, concern of a HCW of potential transmission, and death of a HCW of AIDS. The costs and risks of universal testing of HCWs would include prohibitive monetary costs to test and maintain confidential records of results, loss of services of some HCWs, avoidance by HCWs to treat further HIV infected people, dumping of HIV patients on public facilities and possibly wider misperception by the public that invasive procedures are dangerous. An example is the common fear that giving blood causes AIDS, which reduced numbers of blood donations. CDC estimates that the chance of contracting HIV from invasive procedures is 1:263,000 to 2.6 million from dental surgery and 1:41,000-416,000 from general surgery, based on the past decade, without universal precautions.
This directory of local acquired immunodeficiency syndrome (AIDS) task forces and coordinating bodies was prepared by the US Conference of Mayors to facilitate the exchange of ideas among localities. Cited in the directory are 142 bodies--including minority liaisons--from 37 states and the District of Columbia. Local AIDS task forces have been established as a means of organizing and coordinating community responses to AIDS in terms of health services, funding, and risk reduction health education. The Conference of Mayors AIDS program offers technical assistance on innovative and effective AIDS education programs and has been providing financial and technical guidance to such programs since 1985. This directory was prepared for the 2nd National Conference on the Prevention of Human Immunodeficiency Virus (HIV) Infection Among Racial and Ethnic Minorities in the US held in Washington, DC, in August 1988.
The Hispanic AIDS Committee for Education and Resources (HACER) was established in 1987 as an AIDS education program targeted at the Mexicano population of South Texas. The word "Mexicano" is used because "Hispanic" refers to a larger, more diversified group. "Mexicano" refers specifically to people of South Texas who are either Mexican-Americans (people of Mexican descent, born and educated in the US) or Mexicans (people born and educated in Mexico). Mexicanos constitute 56% of the population of South Texas and 54% of the population of San Antonio. Mexican-Americans, in general, speak and read English and listen to English-language television and radio. Mexicans are poorer and less educated, Spanish-speaking, and often illiterate. The Mexicanos do not constitute a high risk group for AIDS; at present there are only 64 Mexicano AIDS patients in San Antonio. AIDS education campaigns on television which are directed at the whole Hispanic community may be counter-productive when directed at the Mexicano population because they know that AIDS is not yet a serious problem among them, and scare tactics only cause hysteria. AIDS education is essential, but it must be specifically geared to the Mexicano community, which, in general, is a very conservative community, in which subjects like sex, homosexuality, condoms, or anal intercourse are not discussed in public. But it is also a community of young (median age 23) sexually active people. An AIDS education program directed at them must use simple, elementary language in standard Mexican Spanish for the Mexicans and in English for the young Mexican-Americans. The single most effective way to reach the Mexicano population would be public service announcements aired on television during the time when the telenovelas (soap operas) are on. Not only are the telenovelas widely watched, but their actors are popular heros, who will be listened to by their audience. The use of radio for public service announcements would be useful only during times when people are in their cars, and few Hispanics read newspapers in either language.
