February 2004
BMJ-British Medical Journal
Should compulsory screening of immigrants be part of UK public health policy?Compulsory screening of immigrants for tuberculosis and HIV BMJ Volume 328, pp 298-300The UK government may be considering compulsory screening of immigrants for tuberculosis and HIV, yet compulsory screening is not based on adequate evidence and has practical and ethical problems, argues a senior doctor in this week's BMJ.
Little evidence exists to show that early detection of tuberculosis in foreign born individuals conveys appreciable public health benefit to those born in the host country, writes Richard Coker of the London School of Hygiene and Tropical Medicine.
Indeed, what little evidence exists suggests that the introduction of compulsory measures may mean that some patients may delay seeking care and pose a greater public health threat.
HIV raises several important practical and ethical questions, he adds. For instance, would such a policy focus on all migrants, immigrants from high prevalence countries, asylum seekers, or some as yet unspecified population? And what about people from within the European Union who are able to move freely?
Furthermore, if a positive HIV status excludes an individual from entry (as has been proposed) then might such a screening policy create incentives to avoid legal routes of entry?
The United Kingdom has an enviable reputation in international public health, says the author. It would be a shame if this reputation was tarnished through an ill considered conflation of immigration control and communicable disease control.
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