(2007 SZP) 'D 'CGI ,146 LZM
FBGVZF
?\KBGVZ \GKEGSN
3
2
3 ,1
NJRCN SMNB , ZPKFSENKF FKND ,
3
3 ,1
CGJ O[ NBKRE ,
ZGP ZFH
2
1
OKN[GZK ,\GBKZCF EZ[P ,ZGCKXF \GBKZC K\GZK[ ,QNKB-ZC \JKSZCKRGB ,OKJV[PN FJNGYVF ,OKN[GZK ,\GBKZCF EZ[P ,ZGCKXF \GBKZC K\GZK[ ,SEKKBG \VI[N 'IPF
KZF ,|1~ HIV-F UKDR N[ FZCTFF KMZEN TEGP NBZ[KC \GCZTP GH QKTP \KRGZM-\KPGFKH FNIPC FBGNI\FG \GYCEKFF[ \GPGEY \GTEG OKHZVGP OKEIV ,OKK\GCZ\G OKK\ZCI OKJCKF OPXT OKNGIC KVGE \NJF KEM ET ,FNIPF \SKV\ NT \GMKN[PF OKNCY\PF OKZSP KEK-NT \GPXTGPF ,GNB \G[GI\ .|2~ ,\GGPG QKP N[ OKKPKJRKB OKB[GRC OKZG[YF \ZG[Y\FP NT KZGCKX WINN NKCGFN \GNGNTG ,FNFCF \G[GI\ \B \GCNP \GJ[V\F \B ZDPN KEM FKVM KTXPBC JGYRN \GBKZCF \GKG[Z .FNIPF ,SEKKBF \NIPC \GZG[YF ,\GZG\V K\NCF \GNB[F \IB G\NIPN TEGPF HIV B[R N[ G\GKZIB QKC QGHKBF \NB[ BKF \GYCEF \TKRPN TDGRF NMC KBGVZF ESPKPF N[ G\GKZIB QKCN OKK\BF OKJCKFC BKF ZPBPC \GEYP\FF .FKKSGNMGBC \GVSGR JGTKP G\GB N[ *ODGH-KRC TGEKC OKMGZMF (NBZ[KC) OKKJV[PFG ,ODGH-KRCN OKB[R O\GKF ZCE KGNKDP TRPKFN OKZIGCF HIV KB[R HIV-C FYCEFN OKRGZIBF FNB N[ \KZ[VBF O\VK[I LG\ .QKP-KSIK \GTXPBC NBZ[KC JV[PF \MZTP N[ FPGK ZES NT F\NT GH FNB[ YKCEF KM BXPR[ ,HIV B[R EDRM OG[KB C\M \[DF LNFPC \BH ,QDGP K\NC KRKP TDP QPT OKKY[ ZIBN UKDRC OK[R ZVSP \GBMZTC QGKEF LNFPC 1.B[R G\GKF ZCEC Q\GB TEKK[ BNC \GZG[YF \GKYGIFG \GKZSGPF \GJNIFF \GCMZGP F[DEGF OB ?GDGH-QC \B TEKKN CKGIP HIV B[R OBF .SEKKBF \NIPC NT OGKBF UYKF GFP ?OKBR\ GNKBCG OKSIKF N[ CN[ FHKBC ,QM \MZTPG NNMC QGCKZF \GKGMPS \GNGCD QFPG ?ZGCKXF \GBKZC ?JZVF \TRX OGI\C OKBXPRF OKB[GRC JZVC \GBKZCF
HIV KGFKHN \GYKEC TGXKC \GCK[I FGCD QGMKSC \GBXPRF \GKSGNMGB \ZKYSN \GCK[I \TEGR OEYGP KGNKD { K[KB JCKF (1 :OKPTJ ZVSPP \GYCEKFN B[R .FNIPF N[ KRG[BZF CN[C NGVKJG CYTP \NKI\ Z[VBP GKKI \NIG\ \B LKZBFN KG[T ZKESG NKTK NGVKJN FMGHF HIV \GZIB \GNIP GB OKVSGR OKPGFKH \GI\V\F CGMKTN \GEGF HIV B[R { ZGCKXF \GBKZC JCKF (2 ;|4,3~ G\GB QMSN \GNGNTF JGYRN KGBZ[ \GDFR\FFG FTKRPF KTXPB KCDN FMZEF NCYN ZGPB \KIVP \GVGZ\C ONGF NGVKJ ,USGRC .\GVSGR \GYCEF TGRPN KEM KVGBC \GN\M ,DGHF-\C GB/G QCN BKF FRGGMF LB ,ZMH QG[NC CG\M ZPBPF .OKSIKF .("GVZS QKRT" :QNFN) (OSZGV OZJ) GVZS 'R .K.P ,1137/03 (B"\) I"V\
*
1
Key words: AIDS; Ethics committees; Partner notification; Public health;
Patients' right to privacy; Sexual relationship.
ZKXY\
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
SYKZG\
HIV B[R N[ G\GMH \B TKYVFN Q\KR OBF :FCGI GB \PB
F
[MZRF KRGSKIF N[MF UKDR \RGPSK\N ZGCKXF \GSIKK\ \GNIP KVNM FJGYRF GHP FRG[ (SEKKBF \NIP QNFN) ZGCKXF CGZ[ \GZPN .QKP \GNIP \GCZN ,\GZIB \GKPGFKH .193=191 OKEGPTC \MZTP ZPBP 'Z * TGEKK ;FYK\B \GETG ;(SEKKB) [MZRF KRGSKIF N[MF \RGPSK\ :I\VP \GNKP .QKP-KSIK ;FNGIF N[ JZVF \GKGMH ;ZGCKXF \GBKZC ;DGH-QC
200
(2007 SZP) 'D 'CGI ,146 LZM
FBGVZF
SYKZG\
NGVKJN O"GBF TGZHG (O"GBF N[ ZGCKXF \GBKZCN \GRMGSF EEGTN BKF \VETGPF FVGNIF ,|8~ (UNAIDS) SEKKBF \NIPC \P[GKP QMB GH FVGNI .GPXTC OKV\G[F \B TEKKN HIV B[R EXP TGRMK[CG FRGGMFC LZGX [K OKYZVN[ UB ,OKZYPF \KCZPC BVGZF QKC QGPBF KSIK NT FZKP[ LG\ \BH NM { KBGVZF \GGXF ,GK\GEZIC ,HIV B[R N[ GK\GKG[KDZC \GC[I\F LG\G ,NVGJPN C"FZBC LZTR[ ZYIP \GBXG\ .K\GCZ\F GRTJPCG GK\GRGXZC Z\GK NKTK BXPR KBGVZF \GGXF UG\K[C IGGKE[ ,LM NT \GEKTP ZVSPN Z[BC GPXT B[RF KEK-NT DGHF-QC TGEKKN FBGG[FC ,BXPR EGT .|9~ TGEKKN [ZER[ QPHF YZVNG OKTEGKPF OKPZGDF NT EPGN YECRF GC[ ETGPF QKC ZTV OKKY OKZYPFP YNIC[ \NXGRP GH \GF[ .KBGVZ OZGDN FKKRV QKCN B[R G\GKF \ECGT ,|11,10~ FRICBF \GCYTC OKK[VR OKZC[PP \G[[GB\FN .FEGCTC \GKGMH \ZKP[NG OKRG[ OKIGJKCN \GBMH BGEKGGN QGC[IC BKCFN [K HIV \GB[R \GEGB TEKP \ZKSP NMC .KBGVZF GCXP KGNKD CYT QFKNB U[IKFN NGNT B[RF[ \GRMS QFC[ \GZCICG \GTKDV \GXGCYC NGVKJC EIGKPC CG[I ZCEF \P[BGP \GKFN FNGNT F[KBF .|13,12~ \GIR F[KBF EPTP \GPZGRFP \DZGIF ,\KRKP \GRZK\PCG FDGH-QC \YCEFC KVNM \GPKNBC BJC\FN NGNT KGNKDF .\GNCGYPF \GK\GCZ\F OZJ GN F\MH[ K\ZCIF EPTPFP FNG[KRCG F\[KJRC GB ,F[KBF .|16=14~ TEKPF \ZKSP Z\GK FIKM[ [MZRF KRGSKIF N[MF \RGPSK\[ FECGTF ,OKNBGSYSGPGF ,OKRPGYZR) \GPKGSP QGMKS \GKSGNMGB CZYC |18,17,8,6~ (\K\VDP FNIPF QFC[ \GRKEPP OKZDFPG QKP KECGT .HIV B[R \GKJZV NT FEVYFC LZGXF \B ,BGVB ,FPKXTP O\GKFN Z[Y BNN OD ,FKNVBP FNKI\MNP OKNCGS FNB OKZHDP QGNYF \GB \B YHIN NGNT HIV KB[R O\GKFN KCPGV Q\P .OKB[R FKKSGNMGB \GXGCY QKCN UKDRF \GB[R QKC FFHPF (FPDKJSF) .K\ZCIF OCGNK[C TGDVNG ,\GPKGSP "Negotiated safety" D[GPF IGGZ \KTGXYPF \GZVKSC BNG QPEHP KRKP TDPC QGMKSF OGXPKXN SKSCF \B BJCPF ,|19~ NM N[ KBGVZF GCXP \GEGB KEEF QGMEKT NNGM FH LKNF\ .QDGP ORKB[ \KEEF OKIGGEP OFKR[ OB .QKPF KSIKN OKV\G[FP EIB \INXF .OKRDGP BN QKP-KSIK OKKYN ZGICN OKKG[T OF ,HIV KB[R K\GBKZCF GCXP KCDN OKEEXFP EIB NM N[ TEKC \KR\GP LKNF\F N[MKFN FNGNT FKDJZJSBF .OKIGGEPF N[ \KEEFF O\GRKPBCG ZIGC BGF[ GB B[R BGF[ LMN TEGP GRKB DGHF-KRCP EIB Z[BM \GRKEPC GMZTR[ OKZYIP \GBXG\ .QGGM\PC \BH ZK\SFN DGHF-QCN \GNDN HIV KB[R N[ O\GRGMR NT \GTKCXP \GI\GVP \GIMGR NT DGHF-QC \B TEKKPF HIV B[R .|22=20~ OCXP \B EGTC ;TDPF \GBXG\ NT \GKZIBF \B GPKT YNGI GPEC UKDRF .GECN \GKZIBC B[GR FTKEKF \B DGHF-QCP TRGPF HIV B[R[ { \KBGVZ \GKEGS NT FZKP[F \GMH NBZ[KC KJV[PF CXPF
201
TEKPF QGKSKI NT ZGP[N KBGVZF \GGXF NT \NJGPF FCGIF 2 .G\GZKIG OEBF EGCM :EGSK YGIC \RDGTP OFKNVGJP N[ KBGVZF .("EGSKF YGI" :QNFN) 150 I"S
2
\NGMK \B OXPXP LMCG ,HIV B[R N[ KVKDRF SPGTF \B .|5~ GN[ FYCEFF EZ[P KEK-NT TXC\PF ZKE\F ZGJKRF ,\KPGBNF FPZC \GPDP KGFKHC TKKSP OK[EIF HIV KB[RN TDGRC \GBKZCF OKVGDG \GBKZCF \GKG[Z KEKC KNM [P[PG ,OEYGP CN[C FBGNI\ FZCSF KETK WGPKBN ,\GKRKEP \TKCYN NBZ[KC FNIPC OKYSGTF .|6~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
HIV B[R N[ KBGVZF GCXPC OKKRKPF OKV\G[F TGEKK :|7~ KRKPF TDPN OKV\G[F TGEKKN \GJK[ ZVSP \GZMGP \GZVKSC NKCYPC ,OKV\G[F \B TEKKPF { GPXT HIV B[R KEK-NT (1 \GKG[Z KEK-NT (2 ;KBGVZF \GGXFP NCYP BGF[ FMZEFN KMZEG QKPN GKV\G[ \GP[ \B HIV B[R ZKCTP QFKNB[ ,\GBKZCF UGVMC ,KBGVZF \GGXF KEK-NT OKTEGKP GNB { OPKT Z[YF ZGYP N[ GP[ QGKSKI NT FZKP[ LG\G HIV B[R N[ G\PMSFN EGEKTN FMGH HIV B[R { FR\GPG U\G[P IGGKE (3 ;FYCEFF LG\ OB ;KBPXT QVGBC OKV\G[N TEKPF \ZCTFN TDGRC FMZEFNG \B NJGR BVGZF ,O[GKP GRRKB LKNF\F [BZP TCYR[ QPH YZV N[ GP[ QGKSKI NT FZKP[ LG\ OKV\G[F \B TEKKPG FPHGKF .G\PMSF \B NCYN KNCPG B[RF BGF[ ,WHO) KPNGTF \GBKZCF QGDZKB \GXNPF KV-NT
(2007 SZP) 'D 'CGI ,146 LZM
NBZ[KC
HIV KB[RN TDGRC \GPEGY \GKJV[P \GJNIF
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{ \G[VR \RMS FC [K[ FNIP ZKCTFN NGNTF \GN[Z\FC ."OKR[ 7 ZSBP GRKE {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
\GBKZCF \GKG[Z KRVC ZD\B FCKXP (AIDS) SEKKBF \NIP .GH \YCEKP FNIP \TKRPCG FZCSFC ,NGVKJC OKYSGTF OKVGDFG LG\ ,NVGJPF OT \GFEHFNG \G[KDZ KGNKDN [ZER OKNVJPF \GGX FNIPC \GMGZMF \GK\BG \GK\ZCI \GKDGS NT \EIGKP [DE \PK[ FNGIN BVGZ QKC K[K 'Z N[ GZVSC \BCGP G\KXP\[ NKNDFG YPTF NM QKKRT 8 .50=45 (I"R[\) .2504 (3)97 IP-Y\ NBZ[K \RKEP 'R FKSRNV 560/96 (["C) V"T 9 .864 I"S 10 .3 FZTF NKTN 11
,\KBGVZ \GKEGSN \GMHF \B HIV KB[RN FRYP GH EGSK \GMH QKB" :YGIN 8 UKTSC[ KBR\F OKKY\FC YZ ZVFN Q\KR F\GB[ \KNM\N ETGR[ ... YGIC BNB ,FH EGSK YGI KVN[ \GKGMHC OKTDGV YGI KV-NT[ ,QBMP ."[ZERF NT FNGT FRKB[ FEKPCG ,FKGBZ FVGVM \GKJZVN HIV B[R N[ G\GMHC FTKDVF \GZ[VB ,EGSKF EPNR FH QGZYKT .(Proportionality principle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
SYKZG\
Z\GGN QMGP GRKB HIV B[R GNKBG ,\GJ[V\FF \TKRPN KRGKI 'D EX .ONGF EGTK\C LKNF\F KGGKN LG\ \BH NMG ,\GKEGSF \GMH NT FYK\B \ETG ZG[KBN 1996 \R[P FNGIF \GKGMH YGI \[KZE ,\MPSGP Z[BG ,JVG[ EPGT F[BZC[ ,SEKKBF B[GRN \KEGTKK NFGRC KGJKC KEKN FBC ,HIV KB[R N[ DGH-KRC TEKKN ,ZB[F QKC NVJPF KBGVZF \GGXF NT NKJP NFGRF .|24~ \GBKZCF EZ[P \TKRPN OKTXPBC JGYRN NVGJPF \B LKZEFN HIV B[RC B[R QKB KM ,NVJPF \GGXN TEGR OB .UKDRC OKZIB N[ O\YCEF OK[RB YKCEFN KG[TG \GZKFHF KNNM NT FZKP[C EKVYP HIV Z[B ,FYK\B \ETGGN \GRVN \GGXF KRVC \GMHF FZGP[ ,OKZIB .G\PMSF BNC UB GCXP \GEGB GDGH-KRC TGEKK \B Z[BN F\GMPSC
FBGVZF
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|23~ \GHGIPF BVGZ GB HMZPF NFRP KB[Z...\KBGVZF \GKEGSF NT Z\GGP GB ZGCKXC TGEKN ,DGHF-QCN UKDRF \GBXPKF NT TKEGFN...HGIPF OT ZIB GB KRKP TDP CYT UKDRC YCEKFN KG[T G\TEN[ OEB NMN TGEKK ,NVJPF BVGZF \TEN[ ,LMC F\R\GF GH FB[ZF ."B[RF .("\GKJZVF \RDF YGI" :QNFN) 129 I"S .("K\MNPP \GBKZC IGJKC YGI" :QNFN) 156 I"S .("FNGIF \GKGMH YGI" :QNFN) 327 I"S .("FEGYVF" :QNFN) 239 (B) 191 (T) 1 'SG\ Z"T .218 'T ,I"P[\ V"K ,\RMGSP \YCEKP FNIP NT FTEGF
3 4 5 6 7
202
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2. 3. 4. 5. 6. 7. 8. 9. 10. 11.
12. 13. 14. 15. 16.
National survey on Knowledge, Attitudes, Behavior and Practices (KABP) regarding AIDS and other sexually transmitted infections in Israel. XIV International AIDS Conference, Barcelona, 2002: 124 [WePeC6172]. Burkholder GJ, Harlow LL & Washkwich J, Social stigma, HIV/ AIDS knowledge and sexual risk. J Applied Biobehav Res, 1999; 4: 27-44. Palella FJ, Delaney KM, Moorman AC & al, Dramatically declining morbidity and mortality in ambulatory HIV-infected patients. N Engl J Med, 1998; 338: 853-860. Mocroft A, Vella S, Benfield TL & al, Changing patterns of mortality across Europe in patients infected with HIV-1. Lancet, 1998; 352: 1725-1730. King JT, Justice AC, Roberts MS & al, Long-term HIV/AIDS survival estimation in the highly active antiretroviral therapy era. Med Decis Making, 2003; 23: 9-20. Chemtob D & Grossman Z, The epidemiology of adult and adolescent HIV infection in Israel, a country of immigration. Int J STD AIDS, 2004; 15: 691-696. Hawkes S, Macey D & Mayaud P, Partner notification for the control of sexually transmitted infections. BMJ, 2003; 327: 633634. Guidance on encouraging beneficial disclosure, ethical partner counseling, and appropriate use of HIV case reporting. UNAIDS and WHO, August 2000. Macke BA & Maher JE, Partner notification in the United States: An evidence based review. Am J Prev Med, 1999; 17: 230242. Pealer LN & Peterman TA, When it comes to contact notification, HIV is not TB. Int J Tuberc Lung Dis, 2003; 7 (Suppl 3): S337-41. Centers for Disease Control and prevention, Incorporating HIV prevention into the medical care of persons living with HIV. Recommendation of the CDC, the Health Resources and Services Administration, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Morb Mortal Wkly rep, 2003; 52: 1-24. Hildesheimer GM, AIDS, partner notification and gender issues. Med Law, 2002; 21: 165-77. Mathews C, Coetzee N, Zwarenstein M & al, A systematic review of strategies for partner notification for sexually transmitted diseases, including HIV/AIDS. Int J STD AIDS, 2002 ; 13: 285300. Gielen AC, O'Campo P & al, A women's disclosure of HIV status: experience of mistreatment and violence in an urban setting. Women's Health, 1997; 25: 19-31. Temmerman M, Ndinya-Achola J, Ambani J & al, The right not to know HIV test results. Lancet, 1995; 345: 969-970. Rosenberg KH & Paskey J, The risk of domestic violence and women with HIV infection: implication of partner notification, public policy and the law. Am J Public Health, 1995; 85: 15691576.
ZG[Y OKRPEHPG OKTGCY DGH-KRC QKC FRICFN USGR OTJ OKGGFP OKRPEHP DGH-KRCP OKNBKXRJGV OKYCER :OKK[TP OKEEXN OZKFHFNG OZ\BN KGMKSFG ,\ZEDGP K\NC FXGCY NNM-LZEC TDGV HIV KB[R KRVP ZGCKXF \ZFHB N[ OKCZC OGSZKV .[GNY \NJGP OGSZKVF \ZJP \D[F[ EGTC ,O\GKJZVC F[Y QVGBC ,QBMP .\GK\EKPF QICPC EGPT\ BN[ KBEGGN CGZYG ,YVSC OT OKPKKYPF FNBN \PXPJXP DGH-KRC N[ TGEKKF \GZ[VB[ .|12~ TGCY KRKP Z[Y HIV B[R N[ QKPN OKV\G[ TGEKKN \GJK[ ONGTC \GZMGP ,ZGPBM QKCN ORKC OKPKKYF OKZ[YF KDGS QKC QKICFN KNCP HIV KB[R \GKRMG\ N[ Q\NTVFN FCKSF ,OKZCIPF \TEN .GNB OKB[R HIV KB[R N[ OKRPEHP DGH-KRC N[ KNNM ZG\KBN \KNNM FRGGM CGZ-KV-NT BKF (Contact tracing programs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17. Perez-Saleme LM & Hernandez-Tepichin G, Epidemiology of HIV infection: twenty-years of experience. Rev Invest Clin, 2004; 56: 134-42. 18. Golden MR, Hopkins SG, Morris M & al, Support among persons infected with HIV for routine health department contact for HIV partner notification. J Acquir Immune Defic Syndr, 2003; 32: 196-202. 19. Kippax S, Crawford J, Davis M & al, Sustaining safe sex: a longitudinal study of a sample of homosexual men. AIDS, 1993, 7: 257-26. 20. Greene K & Serovich JM, Appropriateness of discloser HIV testing information: the perspective from PLWAs. J Applied Comm Res, 1996; 24: 50-65. 21. Stempel RR, Moulton JM & Moss AR, Self-discloser of HIV-1 antibody test results: the San Francisco general hospital cohort. AIDS Educ & Prevent, 1995; 7: 116-125. 22. Wolitzki RJ, Rietmeijer CAM, Goldbaum GM & al, HIV serostatus disclosure among gay and bisexual men in four
23. 24.
American cities: general patterns and relation to sexual practice. AIDS Care, 1998; 10: 599-610.
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25. HIV/AIDS and Human Rights International Guidelines, New York and Geneva, 1998, HR/PUB/98/1. 26. The Role of Name-Based Notification in Public Health and HIV Surveillance, UNAIDS, Geneva, 2000. 27. .2003 ,\GBKZCF EZ[P ,SEKKBG \VI[N FYNIPF ,FZCSF QGNT
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