|
A. Voluntary testing and screening It follows from the above that public health authorities are recommended to : a) in relation to counselling and voluntary testing - ensure that voluntary testing is easily accessible at sites such as STD clinics, primary health care services, in particular general practitioners' practices, as well as drug treatment centres; that such services respect confidentiality, are always accompanied by counselling and are free of charge (or covered by social security through a confidential system); - provide training for counselling allowing for the acquisition of the necessary skills by large numbers of health care and social workers especially at primary health care level and by health care volunteers; - ensure that counselling services are consensual and confidential, provide for continuing psychological and practical support, are respectful of the dignity and autonomy of individuals and assist them in understanding their rights and responsibilities in relation to HIV infection; - promote and regularly evaluate information and education strategies for the general public and those likely to engage in risk behaviour and promote research on behaviour and attitudes associated with HIV transmission, factors favouring behaviour change and its maintenance; - intensify targeted health information and education programmes for those who are potentially exposed, stressing the importance of risk behaviours; - ensure that those population groups most difficult to reach (eg. ethnic minority groups, the sensorily deprived, those with learning difficulties, etc.) are effectively informed through targeted outreach campaigns; - consider seriously non-coercive pragmatic approaches (eg. the availability of sterile syringes and needles for drug misusers, the provision of instructions on methods of cleaning needles and the availability of condoms in prison), to reduce probabilities of transmission in relation to high-risk situations; such measures should be part of a comprehensive preventive policy including information, counselling and treatment; - promote the adoption of non-discriminatory policies in all settings concerned and ensure their implementation (see below under V). b) In relation to systematically offered screening - carefully examine the advisability of introducing systematically offered screening programmes as a preventive measure in the light of various issues, namely :
- the population to be screened, - specific prevalence rates, - the test method to be used, - the intended use of data obtained from screening, - how results are to be communicated to the person tested and how pre- and post-test counselling is to be accomplished, - the social impact of screening, - legal and ethical considerations raised by the proposed screening programme. - delegate to health care staff the task of identifying, in the light of specific prevalence rates, groups and individuals to whom targetted testing should be offered, respecting informed consent and confidentiality of data; - ensure that in order to fulfil the preventive objective of systematically offered screening programmes, counselling services are offered to all individuals to be screened. c) In relation to systematic screening (routine) - in the light of present knowledge and in the absence of curative treatment, consider systematic screening unethical and contrary to the rights of individuals, if carried out automatically on population groups without informed consent and without counselling, because it overrides the principles of autonomy and physical integrity, affects the privacy of the individual, and is likely to have serious psychological, social and financial consequences for the individual; - ensure that such procedures are not carried out by drawing the attention of health care staff and services on ethical unacceptability of these measures. d) In relation to mandatory screening - fully implement mandatory screening in respect of donations of blood, and those donating mothers' milk, organs, tissues, cells and semen donation in compliance with the usual strict requirements of informed consent and regulations for confidentiality of data; - carefully examine how results are to be communicated to the person tested and how pre- and post- test counselling is to be accomplished. e) In relation to compulsory screening - consider, in the absence of curative treatment and in view of the impossibility of imposing behaviour modification and the impracticability of restrictive measures, compulsory screening as being unethical, ineffective, unnecessarily intrusive, discriminatory and counterproductive; - ensure that compulsory screening is not introduced for any population group and especially for any given population group such as "captive" populations e.g. prisoners, immigrants and military recruits; - make available information and counselling to such groups.
|