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1、The Police Power And HIV/STDs In The Elderly,2,Overview,HIV/STDs As A Special CaseHIV-Especially Dangerous To The ElderlyGeneral Problem of Communicable DiseasesDriven By Changing DemographicsDemands A Public Health ApproachPolice Powers To Protect the CommunityPersonal Health Services for Individua
2、ls,3,Risk Factors For HIV/STDs,Drug UseSharing NeedlesTrading Sex For DrugsSexual ActivityFrequencyNumber Of PartnersPracticesCore Group Dynamics,4,Why Are The Elderly At Risk?,Elderly Have Always Been At RiskSmall NumbersSocial Stigma Hides CasesChanges in Community DemographicsIncreasing The Risks
3、Increasing The Numbers,5,Traditional Health Status,Death Came EarlierLess Time RetiredLess Time WidowedSmaller Population Of ElderlyNot As HealthyUnderestimated By Life ExpectancyGeneral HealthSexual Dysfunction,6,Current Health Trends,Longer Life SpanLonger RetirementLonger WidowedLarger Elderly Po
4、pulationBetter HealthMasked By Static Life ExpectancyImprovements In General HealthImprovements In Sexual Function,7,Traditional Demographics,No Distinct Elderly CommunityPoorSmaller NumbersUnorganizedDispersed Through The CommunityIntegrated With Extended FamilyBetter Social Support Networks,8,Cont
5、emporary Demographics,Elderly Only CommunitiesSun City-the AffluentSupervised LivingElderly GhettosBenefits of Homogenous CommunitiesCritical Mass for Special ServicesCrime and Violence are for the YoungNo StigmatizationSelf-Quarantine,9,Risks of Elderly Communities,Better Niche for Communicable Dis
6、easesConcentration of HostsMore Susceptible PopulationIncreases Social Interaction Spreads DiseaseIgnorance of Larger World ProblemsThe Elderly Do Not See STDs As Their ProblemPhysicians Do Not Look for STDs in the Elderly,10,Why Do Doctors Miss HIV/STDs In The Elderly?,Mistaken Social PerceptionsEl
7、derly Do Not Have SexElderly Do Not Have STDs Even If They Have SexElderly Are Not Drug AbusersMisleading Medical CuesElderly Already Have Weak Immune SystemsHIV Dementia Looks Like Other Dementias,11,Implications of Missing HIV,Elderly Die,On Average,30 Days From DiagnosisIncreased SusceptibilityEv
8、idence Of Very Delayed DiagnosisRisks To OthersSharing Needles(Not Just Illegal DrugsSexual Activity,Strategies To Prevent HIV/STDs,Personal Health Services ApproachPublic Health Police Power,13,Personal Health Services Approach,EducationSafe SexAvoid Sharing NeedlesImportance Of Getting TestedRole
9、Of Health Care ProvidersMust Recognize DiseaseMust Counsel All Patients,14,Public Health Approach,Same Personal Health EducationRecognizes That Education Often FailsDoes Not Reach EveryoneSome Do Not Understand ItSome Do Not Think It Applies To ThemSome Do Not Care About Risks To Others Public Healt
10、h Adds Active Case Finding And Intervention,15,The Public Health Police Power,The liberty secured by the Constitution of the United States to every person within its jurisdiction does not import an absolute right in each person to be,at all times and in all circumstances,wholly free from restraint.T
11、here are manifold restraints to which every person is necessarily subject for the common good.On any other basis organized society could not exist with safety to its members.”Jacobson v.Massachusetts,197 U.S.11(1905),quoted in Hendricks at 356-367.,16,Disease Reporting,Unquestionably,some individual
12、s concern for their own privacy may lead them to avoid or to postpone needed medical attention.Nevertheless,disclosures of private medical information to doctors,to hospital personnel,to insurance companies,and to public health agencies are often an essential part of modern medical practice even whe
13、n the disclosure may reflect unfavorably on the character of the patient.Requiring such disclosures to representatives of the State having responsibility for the health of the community,does not automatically amount to an impermissible invasion of privacy.”Whalen V.Roe,429 U.S.589,602(1977),17,Case
14、Finding,Contact Tracing/Partner NotificationVoluntary Most People Want To HelpWorks Because Of Core Group DynamicsSmall Subset Accounts For Most TransmissionContact Networks Are RedundantInterview Enough People And You Get All The Nodes,18,InterventionsNewly Identified Contacts,Important Because HIV
15、 Is Hard To CatchWarn That They Have Been ExposedCounsel About The Disease And PrecautionsHelp Them Get Tested And Medical CareInterview Them About Their ContactsAdd To Surveillance Database,19,Infected Contacts Who Continue Unsafe Activities,Tuberculosis Is The Best ModelWarn And CounselIncreasing
16、RestrictionsNo Myth Of Self-ProtectionWhat About HIV?Mental Health Confinement If Demented?Megans Law Approach?Prosecution For Reckless Endangerment?,20,Community Ethics,The Constitution And The United States Supreme Court Support Broad Public Health PowersHow Do We Decide When We Should Use These P
17、owers To Protect The Vulnerable?Have Individual Rights Undermined Public Health?,21,Population Ethics,The Constitution And The United States Supreme Court Support Broad Public Health PowersHow Do We Decide When We Should Use These Powers To Protect The Vulnerable?Have Individual Rights Undermined Public Health?,
