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Clinical Crossroads: Alcoholism and HIV Infection

Jonathan M. Zenilman, MD; Anne M. Rompalo, MD; Rosemary Jadack, RN, PhD
JAMA. 1996;275(1):32. doi:10.1001/jama.1996.03530250036015.
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To the Editor.  —The Clinical Crossroads article entitled "A Man With Alcoholism and HIV Infection"1 highlights several important public health issues. The case history described a patient with multiple episodes of high-risk sexual behavior, including anonymous unprotected sex and multiple previous sexually transmitted diseases. Despite having knowledge of human immunodeficiency virus (HIV) transmission modes, the patient describes unprotected sex with a partner whom he suspected of having Kaposi's sarcoma at the time. The patient also discusses how his alcoholism affected his ability to take appropriate precautions and reports that after his HIV diagnosis, he had repeated episodes of unprotected sexual activity associated with alcohol use.In the discussion, Dr U. and Dr Hyman only peripherally address the public health implications of this case, ie, the potential to transmit HIV to others. We raise three major concerns and submit that each of these present profound ethical dilemmas in which public


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