HIV: Pubblicazioni scientifiche della DIREZIONE GENERALE SANITA' MILITARE

Nel 2001 il dott. Sergio NATALICCHIO, l'allora Direttore Generale
della Sanita' Militare italiana, pubblicava un articolo scientifico
che parlava di TEST HIV IN AMBITO MILITARE.



Gia allora veniva preso in considerazione quanto ribadito da UNAIDS
ovvero IL DIVIETO DI TESTARE TUTTI I MILITARI poiche' NON PORTAVA A NULLA!

L'intervento era e doveva essere "preventivo"...proprio come asserisco io da qualche tempo!

Bisogna PARLARE DI HIV E DI PREVENZIONE SESSUALE e non fare UN TEST OGNI 5 ANNI!


Per gli esercenti professioni sanitarie o particolarmente a rischio veniva detto chiaramente che L'UTILIZZO CORRETTO DEI DISPOSITIVI DI PREVENZIONE tutelava tutti!

Ma cosa e' cambiato da allora?

VE LO DICO IO!

E' CAMBIATO IL DIRETTORE GENERALE DELLA SANITA' MILITARE!



Lo scandalo è che NESSUNO, in ambito militare, E' INFETTIVOLOGO!
A decidere delle sorti dei dipendenti dell'Amministrazione Difesa
infatti sono specialisti in altre branche mediche!

OVVERO IGNORANTI DELLA MATERIA!

Otorini, oculisti, dermatologi, radiologi...MA NON INFETTIVOLOGI!

Sembra uno scherzo! MA NON LO E'!




Vi riporto quanto nel 2001 la Direzione Generale della Sanita' Militare aveva pubblicato nel JAIDS Journal.

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MILITARY CONTEXT

The military represents a population at special risk of contracting STDs, both at home and in the course of foreign deployment. Prevalence of STDs has in fact been two to three times higher in among U.S. military troops than among their civilian counterparts and up to one hundred times higher in wartime (34). The special vulnerability of the military to STDs has again been recently demonstrated in a large epidemiologic analysis in the U.S. Army (35-36). This consideration makes the military a natural target for HIV containment policies, through different approaches, such as HIV testing, training, condom promotion, and research. Moreover, the military has unique characteristics in terms of well organized and disciplined population, so that reliable epidemiologic studies may easily be performed and the relevance of public health strategies to reduce HIV prevalence (37) may more easily be evaluated than in other at-risk populations.

During the 1980s, mandatory testing was only performed during recruitment by the U.S. Army, on the premise that protection of individual and public health required the diagnosis of HIV infection as early as possible. The rationale was also based on certain military-specific concerns: administration of live vaccines (38); potential exposure to exotic infections; maintenance of a safe walking blood bank; military readiness; and world-wide deployability. Introduction of mandatory testing was stimulated by the death of a seropositive recruit due to generalized vaccinia after smallpox vaccination (39). A survey carried out among North Atlantic Treaty Organization (NATO) countries in 1991 (40) showed that some other countries were then performing mandatory screening, but only for specific categories of military personnel, such as pilots.

Two more recent independent surveys gave information on the HIV screening on recruitment in the military context. The first was carried out on 119 countries by UNAIDS and the Civil-Military Alliance to Combat HIV and AIDS in 1995 and 1996, and 63 replies were received (41). The second was administered by WHO on 107 countries in 1996 and 1997, and 52 countries replied, representing 58% of the world's population (42). These studies showed that mandatory HIV testing on recruitment was performed by the armed forces of at least 27 countries, representing 44% of the world's population. The dramatic increase in the number of countries performing HIV testing from only one in the second half of 1980s to at least 27 in the second half of 1990s probably depends on the following factors.

First, the burden of high HIV seroprevalence in the military of some African countries, eroding the ranks of officers and conscripts alike, reducing readiness in key battalions, and making heavy demands on the military health care budget, has compelled a number of African ministries of defense to consider excluding those who test positive during recruitment procedures.

Second, the practice of some armed forces is to test and exclude those who are HIV-positive from certain occupations and activities that have high performance requirements (43). Among these, the most frequently reported are piloting aircraft, combat duties, and peacekeeping operations.

There is accumulating evidence of subtle cognitive impairment in early HIV infection, as measured by neuropsychologic tests, even before the onset of AIDS. Some studies (44,45) report the appearance of subsyndromic neurocognitive impairment in a median of 35% of HIV-infected individuals, compared with a median of 12% among appropriately matched, HIV-uninfected controls. In high performance duties, such as piloting an airplane, it is recommended that HIV-positive individuals undergo neurocognitive evaluation on a periodic basis, such as every 6 months (46).

The actual or potential presence of HIV-positive individuals in the ranks becomes more important in conflict situations. It calls into question the safety of the walking blood bank supplies in field circumstances.

The management of United Nations peacekeeping operations has renewed debate on the testing question, as recently reported (47). These operations bring with them the particular demands of a community of soldiers coming from different countries, which may differ widely in the level of HIV seroprevalence. Peacekeeping missions also must face delicate relationships with the local population. The potential risk of HIV infection being transmitted from peacekeepers to the local population, or from the local population to the peacekeepers (48), has fueled debate on the testing question once again. However, the realization that HIV testing is not an effective prevention measure, even in this setting, means that intensive prevention education with the peacekeepers and with the local population deserves renewed and greater attention.

In the late 1990s, debate on these issues within UNAIDS suggested that, to justify mandatory testing (invasion of an individual's right to privacy) and its consequences (discriminatory treatment), in the military or in other particular circumstances, one should have to:

Demonstrate compelling aspects of the workplace concerned (military or otherwise) that make it different from other workplaces (where mandatory testing is unacceptable);

Show that mandatory testing (together with its consequences of rejection, limitation on employment options, dismissal) is the least restrictive means available, and that it will actually achieve the goals being sought, that is, achieve those goals more effectively than voluntary testing, counseling and prevention programs; and/or

Show that HIV/AIDS is not being singled out for such treatment as compared with similar diseases that raise comparable issues.

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