Galletly Carol L, Pinkerton Steven D
Center for AIDS Intervention Research, Medical College of Wisconsin.
J Law Med Ethics. 2008 Fall;36(3):577-84. doi: 10.1111/j.1748-720X.2008.306.x.
Twenty-four U.S. states have enacted HIV exposure laws that prohibit HIV-positive persons from engaging in sexual activities with partners to whom they have not disclosed their HIV status. There is little standardization among existing HIV exposure laws, which vary substantially with respect to the sexual activities that are prohibited without prior serostatus disclosure. Logical analysis and mathematical modeling were used to explore the HIV prevention effectiveness of two types of HIV exposure laws: "strict" laws that require HIV-positive persons to disclose their serostatus to prospective partners prior to any sexual activity and "flexible" laws that require seropositive status disclosure only prior to high-risk sex (e.g., unprotected anal or vaginal intercourse). These laws were compared relative to each other and to a no-law alternative. The results of these analyses indicate that, under most (though not necessarily all) circumstances, both strict and flexible exposure laws can be expected to reduce HIV transmission risk relative to the no-law alternative, with flexible exposure laws producing the greater reduction in risk. This study demonstrates how logical analysis and mathematical modeling techniques can make an important contribution to the construction of a rational basis for decisions about a highly contested public health policy issue.
美国24个州已颁布了艾滋病病毒暴露法律，禁止艾滋病病毒呈阳性者与未被告知其艾滋病病毒感染状况的伴侣进行性活动。现有的艾滋病病毒暴露法律几乎没有标准化，在未经事先血清学状况披露而被禁止的性活动方面差异很大。运用逻辑分析和数学建模来探究两类艾滋病病毒暴露法律的艾滋病预防效果：“严格”法律要求艾滋病病毒呈阳性者在进行任何性活动之前向潜在伴侣披露其血清学状况，以及“灵活”法律仅要求在进行高风险性行为（如无保护的肛交或阴道性交）之前披露血清阳性状况。将这些法律相互比较，并与无法律的情况进行比较。这些分析结果表明，在大多数（但不一定是所有）情况下，相对于无法律的情况，严格和灵活的暴露法律都有望降低艾滋病病毒传播风险，其中灵活的暴露法律能更大程度地降低风险。这项研究表明逻辑分析和数学建模技术如何能为就一个备受争议的公共卫生政策问题做出决策构建合理依据做出重要贡献。
