Handling Cases of Willful Exposure Through HIV Partner Counseling and Referral Services

Cases of willful exposure reveal the existing and future risks to the public health (especially women) which may be presented by individuals who willfully expose others to HIV through unsafe sexual or needle-sharing behaviors. In response to a documented case of willful exposure, a PCRS counselor or other public health official may, in his or her professional judgment, decide to act to avert a legitimate public health threat to known or unknown persons in the community. Yet handling such cases raises difficult issues in law, ethics, and public health practice. Public health authorities may be unable or ill-equipped to successfully control risks of this type for several reasons: (1) they may lack sufficient resources to properly investigate these cases; (2) they may lack knowledge or jurisdiction over the individual who willfully exposes others to HIV once his behaviors extend into other communities; and (3) they are bound to maintain the confidentiality of sensitive information they obtain from PCRS. How do health care workers and public health departments balance the duty to maintain the privacy of public health information related to PCRS against their obligation to fulfill a partner\u27s right to know of their exposure to infection? What are the legal powers and duties of public health departments to protect the health and safety of individuals as part of their mission to protect the public health? What is the role of the criminal law concerning persons who may intentionally or knowingly attempt to infect others with HIV or other communicable diseases

Personal Privacy and Common Goods: A Framework for Balancing Under the National Health Information Privacy Rule

In this Article, we discuss how these principles for balancing apply in a number of important contexts where individually identifiable health data are shared. In Part I, we analyze the modern view favoring autonomy and privacy. In the last several decades, individual autonomy has been used as a justification for preventing sharing of information irrespective of the good to be achieved. Although respect for privacy can sometimes be important for achieving public purposes (e.g., fostering the physician/patient relationship), it can also impair the achievement of goals that are necessary for any healthy and prosperous society. A framework for balancing that strictly favors privacy can lead to reduced efficiencies in clinical care, research, and public health. We reason that society would be better served, and individuals would be only marginally less protected, if privacy rules permitted exchange of data for important public benefits. In Part II, we explain the national health information privacy regulations: (1) what do they cover?; (2) to whom do they apply?; and (3) how do they safeguard personal privacy? Parts III and IV focus on whether the standards adhere, or fail to adhere, to the privacy principles discussed in Part I. In Part III, we examine two autonomy rules established in the national privacy regulations: informed consent (for uses or disclosures of identifiable health data for health-care related purposes) and written authorization (for uses or disclosures of health data for non-health care related purposes). We observe that the informed consent rule is neither informed nor consensual. The rule is likely to thwart the effective management of health organizations without benefiting the individual. Requiring written authorization, on the other hand, protects individual privacy to prevent disclosures to entities that do not perform health-related functions, such as employers and life insurers. In Part IV, we examine various contexts in which data can be shared for public purposes under the national privacy rule: public health, research, law enforcement, familial notification, and commercial marketing. We apply our framework for balancing in each context and observe the relative strengths and weaknesses of the privacy regulations in achieving a fair balance of private and public interests

Zika Virus and Global Health Security

Americans are largely apathetic about the risks of Zika virus and Congress cannot agree on preparedness funding. Strategies to counter the spread of Zika by the World Health Organisation (WHO) grossly underestimate the disease’s impact. WHO and member countries lack sufficient resources to respond. Consequences of fiscal apathy can be measured in lives lost and long-term disabilities. Zika prevention is a matter of global health security. The epidemiologic brunt of Zika in South America falls largely on vulnerable women at heightened risk of exposure through mosquitoes and sexual transmission. Resulting transmission to fetuses and infants will have generational impacts in South American and Caribbean countries, as well as the U.S. Global costs to address Zika infections among infected infants will exceed hundreds of billions (U.S. dollars). WHO and some U.S. leaders, including President Obama, correctly assert that Zika threatens national and global security similar to humanitarian crises, climate change, and war. Words alone, however, are not enough. Global recognition of this public health crisis must stimulate greater investment in preventing negative repercussions

Is the United States Prepared for a Major Zika Virus Outbreak?

Zika virus has emerged as a global public health crisis with active transmission in the Americas and Caribbean. The World Health Organization (WHO) declared a Public Health Emergency of International Concern (PHEIC), and recently WHO reported there is a scientific consensus that Zika is a cause of microcephaly and Guillain-Barré syndrome (GBS). In the U.S. the Centers for Disease Control and Prevention (CDC) activated its emergency operations center at its highest capacity. President Obama requested $1.86 billion in emergency funding. Shamefully, Congress has yet to appropriate the funding needed for Zika preparedness, and the President has had to reallocate Ebola funding for Zika prevention. Although none of the continental states has reported local mosquito-borne transmission, federal authorities are amplifying the potential for Zika to affect national security. The virus already severely threatens Puerto Rico. Travelers visiting or returning to the United States could likely escalate the spread of Zika via sexual transmission. The virus may spread across a majority of US states including large cities where Aedes species mosquitos are active. Is the U.S. prepared for Zika? America\u27s highly functioning health system will help, but signs of unpreparedness remain due to insufficient resources and variable legal authorities

The Role of New Federalism and Public Health Law

To understand the impact of new federalism on the field of public health law, I explore the development of the interrelated concepts of federalism, state police powers, and public health over time. This article concentrates on the theoretical and legal meanings of these concepts in American jurisprudence. Part II further defines the concept of federalism and its relation to the field of public health law. Part III thoroughly examines the traditional nature of the states\u27 police powers as sources of state authority for public health laws and the corresponding localization of public health goals. The rise of the federal role in regulating public health and the nationalization of public health objectives is discussed in Part IV. Part V synthesizes the new federalism decisions of the Supreme Court into a discussion of the present and future impact of new federalism in the field of public health law. A brief conclusion follows

The Role of New Federalism and Public Health Law

After defendant\u27s 17-year-old son was arrested and charged with offenses that would be felonies if committed by an adult, city charged defendant with violation of municipal ordinance that held parents criminally liable if their minor child committed a delinquent act that would be considered a felony or misdemeanor if committed by an adult