Compulsory HIV tests
CMAJ 1999;160:1286
In response to: R.W. Dunn
We agree that we should not be recommending prenatal HIV testing purely on the grounds of cost savings. Although our study did demonstrate savings for British Columbia, our discussion clearly suggested that the human benefits that accrue when we prevent neonatal infections warrant a recommendation for screening, whether or not there is a net fiscal benefit. We also commented that an early diagnosis of HIV infection most often proves beneficial to a woman's own health.
However, we cannot accept Dunn's suggestion that prenatal HIV testing should be mandatory. Our reasons for promoting informed consent and a patient's right of refusal were outlined in a letter from Patrick to Dunn, dated July 24, 1998:
My concern about ensuring that patients are informed is not born out of AIDS exceptionalism but rather [out of] real experience with adverse effects on patients who had the test done. ... [T]hese have included suicide, serious domestic violence and debilitating depression. While perhaps not as direct as drug induced anaphylaxis or exsanguinating on the operating table, these are undeniably negative consequences of ... ordering HIV testing. Accordingly, as with any other medical procedure with a possibility of significant adverse effects, I believe patients have a right to be informed that it will be undertaken.
Dunn's contribution to this debate is welcome. It is through the hard work of physicians like him that we have achieved a relatively high rate of screening in BC. We hope that this success remains coupled with respect for the rights of patients, pregnant or otherwise, to personal autonomy.
David M. Patrick, MD
David Burdge, MD
BC Centre for Disease Control
Vancouver, BC
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