As for all pathology testing, informed consent is required for HIV testing, except for rare occasions when a legal order is made for compulsory testing or in emergency settings, see section 3.6
Informed consent[i] for HIV testing means that the person being tested agrees to be tested on the basis of understanding the HIV testing procedures, the reasons for testing and is able to assess the personal implications. For some people with a heightened awareness of HIV, routine HIV testing may be a behavioural norm. For others with little understanding of HIV or their potential risk of exposure, HIV testing may be novel, frightening and perceived as highly stigmatising.
The person performing the test should use their professional judgement in securing informed consent. This should be based on their understanding of the context in which the test is being performed:
- the features which precipitate testing such as clinical presentation, risk exposure, epidemiology and prevalence and patient initiation;
- an assessment of the person being tested with respect to their understanding of the HIV testing process and consequences of the result, and
- patients should also be advised how the test result will be conveyed.
Relationships between health care providers and patients can be complex. General principles of professional conduct apply in the case of HIV testing. These issues should be explored in the testing site’s standard operational procedures and each testing site director should make sure that all personnel are supported in developing their professional skills.
4.1 When informed consent cannot be provided by the patient
Professional judgement should be exercised in determining whether a person has capacity to make a decision to undergo an HIV test. In cases where the patient has an appointed guardian, consent must be obtained from that person. Where no formal appointment has been made, consent should be sought from another person or agency legally authorised to make such decisions on behalf of the patient, usually their partner (provided there continues to be a relationship), carer or close relative or friend. The potential impact of the test result on the person being asked to provide consent needs to be considered.
In a life threatening situation, when no guardian or appropriate other person can be identified professional judgement should be used in requesting an HIV test. See the HIV/AIDS Legal Centre matrix[ii] for the hierarchy of responsibility in each jurisdiction.
[i] Australasian Society for HIV Medicine (ASHM). Features of informed consent for HIV testing. A resource for
health professionals. 4 August 2011. Available at: http://testingportal.ashm.org.au/resources/practitioners/Informed_Consent_resource_HIV.pdf (Cited 5 May 2015).
[ii] HIV/AIDS Legal Centre. State and Territory Guardianship matrix. April 2013. Available at http://www.testingportal.ashm.org.au/resources/TESTING_PORTAL_FactSheet_HALC_V2.pdf (Cited 5 May 2015).