HIV Antibody Screening : An Ethical Framework for Evaluating Proposed Programs

This article, authored early in the epidemic, focuses on the use of blood tests to identify individuals who have been infected with the HIV virus through individual testing and population screening efforts. The authors argue that proposed screening programs should be subjected to ethical analysis and provide a framework for that task. Ethical evaluation is necessary but not sufficient for decision making; it should be performed in conjunction with other types of evaluation, such as legal and economic analyses, before screening is instituted. In addition, those who consider screening should consult with members of affected populations, since these individuals are best able to identify the potential hazards of proposed programs. The article identifies seven prerequisites for population screening programs, including acceptable goals, means, transparency, counseling, and confidentiality. It then considers the acceptability of specific screening proposals, including proposals for mandatory screening. Finally it explores the potential and importance of voluntary (as opposed to mandatory) testing. The article argues 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 only if the legitimate interests of these groups and individuals in being protected from discrimination are heeded by legislators, professionals, and the public