Advancing population and public health ethics regarding HIV testing: a scoping review

Abstract

Recently, scholars have called for more robust population and public health ethical frameworks to inform how the health of populations and individuals ought to be improved through various approaches to HIV testing practices. Our objective is to examine the breadth, range and foci of a variety of ethical issues pertaining to HIV testing approaches within the peer-reviewed literature, and how these issues address population and/or individual interests. We identify potential tensions between individual and collective approaches as well as other concerns, including equity, justice and distribution of health and risk – hallmarks of the emergent field of population and public health ethics. Based on our review, we suggest that additional theoretical work and empirical research are required in order to inform more ethically robust debates related to population HIV testing practices. Specifically problematic were consequentialist arguments that deem testing approaches as either morally permissible or impermissible without sufficient robust empirical and/or theoretical underpinnings and about how a particular approach would unfold among individuals and populations. The current review underscores the need to continue to articulate an evidence- and theory- informed population and public health ethics pertaining to HIV testing.

Keywords:

• HIV testing
• scoping review
• population and public health ethics

Acknowledgements

Lead author Knight is supported by a doctoral Canada Graduate Scholarship funded by the Canadian Institutes of Health Research and the Canadian Association for HIV Research and he holds a Bridge Fellowship from the Bridge Programme.

Notes

1. For a recent example (outside of the field of HIV testing) of a critical interrogation of the population and public health ethical considerations related to available individual- and population-level evidence, see Thompson’s (2013) discussion of an human papillomavirus vaccination programme in a Canadian-based school.