A Human Rights Approach to Routine Provider-Initiated HIV Testing

This paper describes the ethical, legal and public health implications of routine HIV testingthat is, testing such that individuals receive a routine offer of an HIV test whenever they come into contact with the healthcare system. In recent months, the broad international consensus in favor of voluntary testing has yielded to a debate over whether both our efforts to curb the spread of HIV and individual patients themselves would be better off if testing were initiated by healthcare providers. This paper uses the following methods: a review of the medical, legal and medical ethics literature; analysis of United States and international case law and statutes; analysis of international treaty law; analysis of international guidelines on HIV testing; and consultation with eminent experts in law, public health and medical ethics. This paper argues in favor of routine provider-initiated testing. Specifically, I argue that the benefits of routine provider-initiated HIV testing both for individual patient as well as for the public health weigh heavily in favor of shifting to routine testing, provided that certain conditions are met. Routine testing must be coupled to a promise of antiretroviral treatment for those who test positive and meet the clinical criteria for treatment. Moreover, routine testing must also be coupled to a guarantee of confidentiality as well as a rigorous standard for informed consent. If these conditions are met, it is possible to design a fair, equitable and non-coercive testing regime that protects the human rights principles of autonomy, confidentiality and voluntariness. This paper first describes the history of HIV testing policy both in the United States and internationally. It outlines the arguments in favor of routine provider-initiated testing and responds to the objections to routine testing that have been raised in the literature. Finally, it describes a proposal for an ethical routine testing regime that is consistent with both human rights principles as well as U.S. and international statutes and case law on testing. This paper also proposes model legislation that addresses the issues of counseling, confidentiality and informed consent in context of routine-offer HIV testing