Ethical Issues In Developing The Strategy Of Scaling-up HIV Testing In Healthcare Settings

Too little,too late -that's the situation of HIV testing in China.At the end of 2007 there are 68%people were unaware of their infection,in the meanwhile, how to develop the strategy of scaling up HIV testing has become an bottleneck of combating HIV/AIDS.The fundamental goal of HIV testing is to getting more people to be tested and preventing from further spread.Based on the existing practice and policy in China,this paper emphasizes the importance of scaling-up HIV testing and systematically analyzes ethical issues in PITC recommended by WHO/UNAIDS,then,affords some practical and principle advices.To begin with,the paper pointed out the number of people who choose VCT is currently very limited while in many healthcare setting,the absence of counseling,informed consent and confidentiality are challenges to providing test to inpatients before surgery and also to compulsory screening which preferred by some local governments.According to WHO/UNIADS guidance, there is a need to conduct PITC in our Chinese context,and authorities as well as healthcare providers should have the responsibilities for promoting the public's well-being.Then,the author analyzes the concept of PITC and related concepts of Opt-in,opt-out,and discusses how to develop an approach both ethically warranted,respect for human rights and effectively achieve public health goal.In particular,the author discusses what form of consent is morally justified in PITC and under what conditions can opt-out approaches be consistent with informed consent whilst avoid becoming mandatory testing in practice.After that,the paper emphasize that HIV testing must be accompanied by universal access to HIV prevention,treatment,care and support and cannot be implemented in isolation.It also generally discusses the precondition and stakeholder analysis before implementing PITC and affords the standard model when undertaking HIV in healthcare settings.The author support scaling up of innovative VCT services for most-at-risk people,which need great involvement of NGOs/CBOs following GIPA.Finally,the author provides the ethical framework on which HIV/AIDS policy should based and affords some practical and principle suggestions to policy makers.