Written consent for HIV testing: Time to stop perpetuating stigma

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  1. Thomas Dashwood

    Thank you for this much needed discussion! In my experience as a resident doctor, the process of obtaining written consent also presents a barrier to testing patients at all. In many cases, I think the process can be a deterrent, and patients go untested. This is a disservice to the patient, and concerning for public health. In other jurisdictions, HIV testing is routine. I think it should be here as well. With solid education and support from respectful and knowledgeable health teams, misinformation around HIV can be corrected, and stigma can be counteracted. HIV remains a significant problem in Ontario, and testing is an important part of reducing the spread of HIV.

  2. James Owen

    Completely agree. It is worth further highlighting how out of date it is for health care institutions in Ontario (where I and several of the authors reside) to expect written consent for HIV testing.

    As far back as 2008, the Ontario Ministry of Health and Long-Term Care issued guidelines for HIV Counselling and Testing (https://www.catie.ca/en/resources/guidelines-hiv-counselling-and-testing) that also indicated, following CDC guidelines, that written consent was not required. More recently, the 2014 Public Health Agency of Canada HIV Screening and Testing Guide (https://www.canada.ca/en/public-health/services/hiv-aids/hiv-screening-testing-guide.html) emphasized the importance of decreasing barriers to testing. The guideline specifically states: “Clients who understand the advantages and disadvantages of HIV testing; are able to interpret the meaning of the test result; and, who understand how HIV can be transmitted are considered capable of providing verbal consent to proceed with HIV testing. Written consent is not necessary.” The guidelines also highlights the importance of positive messaging around testing including knowing one’s status and the status of one’s partners, and the benefits of early treatment.

    In light of this, I would argue that we should not just question but actively challenge institutional policies that require written consent for HIV testing in all cases, given that this practice should have been eliminated over a decade ago. These policies are out of date, are not evidence-based, and present barriers to curbing the ongoing HIV epidemic in Canada.

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