Scaling up HIV Testing: Ethical Issues

Abstract

H 1IV testing is not an end in itself. It is instead a means to an end, in which the ethically acceptable ends are care and access to treatment for people found to be infected and access to adequate preventive means for those who are uninfected. It is obvious that testing is required in order to know who is eligible for treatment. Critical to the testing process, however, is systematically linking testing with existing or planned treatment or prevention programs. Failure to do so would be to treat the individuals tested merely as a means, which would be a violation of the ethical principle of respect for persons. When individuals consent to undergo HIV testing, and their consent appears to be both voluntary and properly informed, the situation seems to be one in which they are serving their own ends by agreeing to be tested. In principle, that may well be true, but additional conditions have to be met. These include adequate information provided in pretest counseling; full voluntariness of consent to be tested; and accurate understanding and expectations on the part of individuals tested. If these conditions are fulfilled, then individuals are serving their own ends in agreeing to be tested. These conditions are necessary for testing to be ethically sound, but they are not sufficient. The major benefit to individuals' learning that they are HIV-positive is access to anti-retroviral therapy (ART), if they meet the medical eligibility criteria and if ART is available. Without the likelihood of receiving treatment, however, being informed of an