Patient choice in opt-in, active choice, and opt-out HIV screening: randomized clinical trial
BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.h6895 (Published 19 January 2016) Cite this as: BMJ 2016;352:h6895
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When patients are admitted to hospital, or attend A&E, baseline bloods are often taken; for example full blood count (FBC), urea and electrolytes (U&E), and/or liver function tests (LFT). In my experience we do not consent these patients "opt in" style for these tests. Therefore I wonder could an HIV test become akin to these? A test we routinely offer to all patients, without associated stigma from the general public. In fact, could testing it in this way help to remove that stigma?
In this article several causes are hypothesised for the reason patients reject the HIV test. The fear of the stigma an HIV test could induce was one of them. I wonder if this could be somewhat nullified by bringing in this opt-out style testing. If all patients were routinely offered an opt-out style test along with their FBC for example, this, along with better general public education, could help to remove the remaining stigma about HIV. The results of this study seem to suggest this could be true, since more patients took up the test when it was presented in the style of a routine test (opt-out). By making the consent process for HIV testing different to that of other tests, do we in fact currently add to the stigma ourselves?
The CDC[1] has recommended since 2006 that all patients are tested for HIV at least once in their lives, and those with higher risk behaviours tested more often again. Interestingly it also recommends that specific written consent for an HIV test shouldn't be required either, rather general consent for medical care should suffice. If we could get to a point where this is the norm, that patients regard an HIV test as they do a full blood count, I feel this would go a considerable way to removing the stigma from HIV.
Reference:
1. Centres for Disease Control and Prevention 2006, Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm [26 January 2016]
Competing interests: No competing interests
There is still a moral fear with medical practitioners when dealing with HIV infection and patients suffering from AIDS. This fear drove patients out without being treated in the past. This fear may be due to certain facts regarding HIV infection and transmission.
It is reported that of the 22,759 patients receiving medical care from different US health care providers for HIV infection, HIV infection is a possibility but a very rare event.
An active choice by the patient for HIV screening is a positive step towards HIV infection control and may benefit the patient. The present study provides scientific proof for the same. Yet awareness through education and dissemination of true information do play a major role in combating HIV infection.
References:
Burns John F: Virus begets wretched new class of untouchables. New York Times 22 September 1996
Merchant Rashid: , A matter of life and strength. Humanscape 1996;3( 13):&l 23
Lot F, Seguier JC, Fegueux S, Astagneau P, Simon P, Aggoune M, van Amerongen P, Ruch M, Cheron M, Brucker G, Desenclos JC, Drucker J. Probable transmission of HIV from an orthopedic surgeon to a patient in France. Ann Intern Med. 1999;130(1):1
Competing interests: No competing interests
HIV screening should be made mandatory for both the patient's and health care workers' welfare!
Taking a blood donation from a subject requires mandatory HIV testing. Likewise, taking a blood sample from a patient should be with all the precautions and HIV screening should be made mandatory. More so, because of the following reasons:
1. For early diagnosis and treatment of such patients,
2. Taking more stringent precautions by the treating physician or doctor. Protection of the doctor is as ethical as not doing the test for protecting patients' feelings.
3. It will tell us the burden of HIV.
Gone are the days when HIV/AIDS had no cure, but these days because of HAART, the reaction towards this disease has changed.
Competing interests: No competing interests