Advancing population and public health ethics regarding HIV testing among young men

Background: Despite the epidemiological and clinical rationale supporting a shift from voluntary approaches to HIV testing (e.g., in which a patient seeks an HIV test) towards the expansion of more routine approaches (e.g., in which a clinician routinely offers patients testing), a set of rather polarized ethical debates has remained somewhat unresolved. And, within these discussions, considerations of young men’s experiences and health care needs have remained conspicuously absent. Objectives: This dissertation aims to: (1) Systematically investigate the status of ethical debate and discussions within the peer-reviewed literature in the realm of voluntary and routine HIV testing, with a particular emphasis on understanding the structural and agentic factors associated with testing experiences (e.g., HIV-related stigma); (2) Examine and identify the social processes associated with voluntary and routine testing that attenuate or exacerbate HIV-related stigma among young men; and (3) Describe how ‘public’ values (e.g., solidarity; reciprocity; health equity) may influence the ‘autonomous’ decisions and/or HIV testing practices of young men. Results: The findings highlight a set of social processes that can provide transformative opportunities for young men to reconceptualise expectations pertaining to HIV and HIV-related stigma within routine testing practices. These findings also distil the extent to which young men ‘take up’ relational values (e.g., solidarity; reciprocity), as well as individual reasons (e.g., obligations to the Self) in their HIV testing practices. Discussion: Empirical-normative approaches to advancing population and public health ethics regarding HIV testing may be most usefully pursued as an iterative project (rather than as a linear project), in which the normative informs the empirical questions to be asked and new empirical evidence constantly directs conceptualizations of what constitutes morally robust public health practices. This dissertation provides a set of methodological considerations regarding research techniques that may be useful in advancing future empirical-normative inquiry regarding HIV-related population health interventions.Graduate and Postdoctoral StudiesGraduat