CMAJ 1997;157:233
© 1997 Canadian Medical Association
HIV is transmitted most effectively by direct injection of infected whole blood. Thus, it is not surprising that rates of HIV infection are high among injection drug users (IDUs). Because needles are difficult to obtain and drugs are often shared, HIV has spread rapidly among IDUs. Needle exchange programs were established in some cities to try to control transmission. Do these programs work? In this issue Michelle Gold and colleagues report an economic evaluation of a needle exchange program in Hamilton, Ont. (page 255). Limiting their analysis to the sole benefit of preventing HIV infection the authors estimate that the implementation of the needle exchange program in their area will prevent 24 cases of HIV infection over 5 years, for a cost savings to the health care system of $1.3 million after program costs are taken into account. In an accompanying editorial (page 275) Catherine Hankins reviews the current status of HIV transmission among IDUs in Canada and our experience with needle exchange programs. She argues forcefully for continued development of these programs.
Health care in Cuba used to be the envy of Latin America. In the last decade the loss of preferential trade with the Soviet bloc and the tightening of the US trade embargo on Cuba have brought Cuban health care to the brink of catastrophe. In this issue Robin Williams gives a memorable account of a fact-finding visit to Cuba, where she encountered a nation's health undermined by shortages of food and clean water and the delivery of health care crippled by a lack of essential supplies (page 291). Anthony Kirkpatrick describes in greater detail how the terms of the embargo create insuperable bureaucratic obstacles to normal and humane commerce in medical goods -- despite the US State Department's protestations to the contrary (page 281).
Ross Langley and associates at Dalhousie University examine referral patterns of family physicians in 5 geographic regions of Nova Scotia (page 265). Using case scenarios they show marked variation in referral rates (up to 7-fold for some scenarios). Most of the variation was explained by differences in access to resources, which in turn creates local styles of practice.
Lastly, Peter Wing, an orthopedic surgeon at the University of British Columbia, asks whether people seeking health care prefer to be called "clients" or "patients" (page 287). He systematically surveyed 101 people attending a back-pain clinic and found that almost 75% of them preferred the latter. Given the implicit assumptions inherent in the use of labels, he advises health care workers to ensure that preferences be respected. In a related editorial (page 286) Ken Flegel, associate editor of CMAJ, discusses the merits of the word "case" over "patient" and argues for its continued use in appropriate circumstances. -- JH
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