In addition, some states permit the testing of prisoners and persons accused of sex crimes.
Connecticut and New York also require mandatory HIV testing of newborns,(22,23) which indirectly reveals maternal HIV status.
In recognition of these circumstances and to encourage testing, special procedures were adopted for obtaining consent for an HIV test, such as pretest counseling and specific informed consent.(17) Special protections for confidentiality of HIV test results also were enacted.(18-21)For the most part, these special requirements remain in effect.
Accordingly, determining HIV status may be of limited benefit.
Moreover, such determination could subject women to risk of physical harm or loss of housing and support.(36,37) The benefits of testing will increase as prenatal antiretroviral prophylaxis, along with support services, becomes increasingly available.(38)Early in the U. epidemic, before antiretroviral therapy was developed and shown to be effective, HIV infection often quickly progressed to a terminal illness.
This chapter examines ethical issues related to HIV/AIDS testing, treatment, and research.
Key issues analyzed include confidentiality, informed consent, end of life, research design, conflict of interest, vulnerable populations, and vaccine research. and international legal statutes, regulations, and guidance documents provide the context for the analysis and recommendations.
Nor are they absolute; exceptions to the principles may be appropriate in particular cases. Accordingly, these ethical principles must be interpreted in the context of specific cases.(1,2) Although appeal to these three principles is the dominant approach in American bioethics, other approaches have been suggested(1,2) and vary dramatically according to different trains of philosophic thought: The application of these principles to cases outside the United States has been the subject of considerable debate.(4-6) In particular, the emphasis on individual autonomy has been criticized as representing an Anglo-American perspective that may not be shared by other cultures that may place greater importance on community.(5) Nevertheless, widely accepted international ethical guidelines(7,8) do embrace the fundamental principles of autonomy, beneficence, and justice.
These principles therefore provide an appropriate ethical framework both inside and outside the United States.
It often is understood to require that the risks of research be minimized and that the risks be acceptable in light of the potential benefits of research.(1-3) Finally, justice requires that people be treated fairly.
It is often understood to require that benefits and burdens be distributed fairly within society.(1-3)Although the ethical principles are useful guidelines that help to focus discussion, they cannot be mechanically or rigidly applied.
The ethical concerns surrounding prenatal HIV testing are different in developing countries.
To date, the cost of antiretroviral prophylaxis has been prohibitive and therefore, for the most part, pregnant women do not receive it.(33,34) Although knowing their HIV status may be helpful in guiding decisions concerning breastfeeding, in many circumstances, bottle-feeding is not a feasible option because of cost and lack of access to clean water(35).
Although many examples are drawn from the United States, these issues are also explored from a global perspective. There are three widely recognized principles in American bioethics that apply to both clinical and research ethics: respect for persons, beneficence, and justice.(1-3) Respect for persons entails respecting the decisions of autonomous persons and protecting persons who lack decisionmaking capacity and therefore are not autonomous.