HIV testing someone without consent is unethical and illegal. Following a report last month of a patient in Germany suing his clinic after discovering he had been tested for HIV against his will, the March 7 edition of the journal AIDS reports on non-consensual HIV testing by GPs in Belgium.
Data were recorded from 1993 to 2000 in the Belgian network of sentinel general practitioners (GPs). The network is representative of Belgian GPs, and has been a reliable surveillance system for more than 20 years. Since May 1988, every adult patient who has asked his GP for an HIV test has been recorded on a weekly registration form. Since 1993, questions about patient consent have been included.
In total, 292 GPs recorded 11,660 requests for an HIV test (52% by women). The mean age of the tested individuals was 33.2 years. Information about patient consent was available for 3628 tests. In total, 453 tests were performed without patient consent. This corresponds to 3.9% of all tests performed and 14% of the tests for which information is available about patient consent. The proportion of non-consented HIV tests decreased during the early 1990s from approximately 17% to less than 8%, but has increased since 1996 to approximately 12% in 2000. The proportion of non-consented HIV tests is 30% in the age group below 15 years, 40% in the age group above 64 years, and between 10% and 15% in the other age groups.
For 29% of the non-consented HIV tests no risk behaviour was detected, and for 43% the existence of risk behaviour was unknown. In 28% of all non-consented HIV tests the patient declared him or herself to be at risk of HIV. Eighteen per cent of the HIV tests among patients originating from an endemic region were non-consented HIV tests and 15% of the tests in gay men were non-consented HIV tests.
Twenty-three per cent of the non-consented HIV tests were performed on patients with suggestive symptoms. Non-consented HIV testing was also popular as part of a check-up (21%) or during antenatal care (13%). Eleven per cent were carried out for an administrative reason, 8% in prospect of a new relationship and 8% among patients awaiting a surgical intervention.
Belgian law states that patients should be informed about the results of an HIV test. In this context, the proportion of non-consented HIV tests is astonishing. So is the proportion of physicians performing HIV tests without informed consent. In total, 36% of all GPs performed at least one non-consented HIV test. HIV tests returned positive for 1.5% (n = 7) of the non-consented HIV tests and for 0.5% (n = 23) of the consented tests.
Instead of performing HIV tests without consent, doctors should invest more time in pre-test counselling, especially in patients with a higher risk or with suggestive symptoms of HIV. In most of these cases valuable opportunities to provide risk-reduction counselling were missed.