HIV antibody screening. An ethical framework for evaluating proposed programs

Abstract

We believe that the greatest hope for stopping the spread of HIV infection lies in the voluntary cooperation of those at higher risk--their willingness to undergo testing and to alter their personal behavior and goals in the interests of the community. But we can expect this voluntary cooperation--in some cases, sacrifice--only if the legitimate interests of these groups and individuals in being protected from discrimination are heeded by legislators, professionals, and the public. Yet voluntary testing is not enough. We must proceed with vigorous research and educational efforts to eliminate both the scourge of AIDS and the social havoc that has accompanied it.

KIE: The use of blood tests to identify individuals who have been infected with the human immunodeficiency virus (HIV) challenges us to protect the community from the spread of a fatal disease while preserving the values of individual liberty and equal rights. Acquired immunodeficiency syndrome (AIDS) has prompted calls for mandatory screening of various segments of society--food handlers, military personnel, health workers, prostitutes, and so on. The authors recommend a set of principles and prerequisites for evaluating the ethical acceptability of proposed screening programs. They contend that the voluntary cooperation of those at higher risk is the ideal, and that screening programs must be based on the principles of respect for persons, minimal harm, beneficence, and justice. Health insurance must be available to those who test positive for HIV, confidentiality must be preserved, counseling should be provided, and voluntary testing should be publicly funded.