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February 19, 1988

Compulsory Premarital Screening for HIV

Author Affiliations

Mount Sinai School of Medicine New York

Mount Sinai School of Medicine New York

JAMA. 1988;259(7):1013. doi:10.1001/jama.1988.03720070017014

To the Editor.  —Cleary et al1 argue strongly against compulsory premarital screening for human immunodeficiency virus (HIV) seropositivity. Yet in citing an economic rationale, they rest their excellent technical and public health analysis on false grounds. According to Cleary et al, "the financial and opportunity costs of a national screening program would be enormous, probably exceeding $100 million annually." This expenditure is expected to prevent the transmission of acquired immunodeficiency syndrome (AIDS) to 1150 adults and 250 newborns, "a small yield" in the authors' words. The weakness of their economic argument is exposed by proceeding to calculate a cost-benefit analysis.The most rigorous economic analysis presented so far calculates that this disease costs society more than $240 000 per victim.2 It follows that the net benefit associated with the compulsory screening program detailed by Cleary et al is a savings of more than $160 000 for every life