Le consentement opt-out dans l'augmentation du taux de dépistage VIH/SIDA au Québec
Is the “end of AIDS” foreseen in 2030 by the UNAIDS 90-90-90 plan possible in Quebec? The proportionate and systematic universal offer of testing with opt-out consent (presumed consent) appears to be the most relevant and equitable health policy to implement in order to identify people living with HIV who are unaware of their serological status. This seemingly restrictive approach to individual freedoms can be largely offset by the health, social, economic and structural benefits at the individual and population levels. Insofar as HIV/AIDS remains a powerful indicator of social inequalities, this approach will only be successful in the presence of a political ambition to improve access to care and universal and inclusive health coverage for individuals who do not get tested. The opt-out approach in high-prevalence groups is an ethically sound strategy for increasing screening rates. Although consent is not explicit, the presumption would take into account the “structural unfairness” to which key groups with high prevalence rates are initially subjected and that is responsible for their difficulties in accessing care and testing. This article proposes to standardize the provision of screening. The Quebec Committee on Sexually Transmitted and Blood-borne Infections currently recommends an opt-in approach for key groups and opt-out consent for the general population. I believe that this differentiation constitutes a barrier in access to testing and produces a crowding-out effect for key groups that fear stigmatization.
Copyright (c) 2022 Annie Liv
This work is licensed under a Creative Commons Attribution 4.0 International License.
The Canadian Journal of Bioethics applies the Creative Commons Attribution 4.0 International License to all its publications. Authors therefore retain copyright of their publication, e.g., they can reuse their publication, link to it on their home page or institutional website, deposit a PDF in a public repository. However, the authors allow anyone to download, reuse, reprint, modify, distribute, and/or copy their publication, so long as the original authors and source are cited.