HIV This Week

Rennie S, Turner AN, Mupenda B, Behets F. Conducting unlinked anonymous HIV surveillance in developing countries: ethical, epidemiological, and public health concerns. PLoS Med. 2009 20;6(1):e4.

Data collected from HIV surveillance are crucial to guide public health interventions, planning, and prevention efforts. The practice of unlinked, anonymous HIV testing, an important form of HIV surveillance, raises ethical, epidemiological, and public health challenges in low-income countries. Some ways of conducting unlinked, anonymous HIV testing in the field violate the spirit and/or the letter of international ethical guidelines. Vulnerable populations, such as sex workers, may be subject to unjust treatment by local health authorities during HIV surveillance initiatives. Conducting unlinked, anonymous HIV testing in ethically and epidemiologically sound ways in low-income countries requires a multifaceted approach including local capacity building, community engagement, and increased access to HIV and testing for sexually transmitted infections.

Editors' note: When Canada began anonymous unlinked HIV studies of leftover dried blood spot specimens in 1988, ethical requirements included public gazetting to raise community awareness and access to free, confidential, voluntary HIV counselling and testing for those who wished to learn their HIV status. The quality of HIV surveillance is not compromised by attention to ‘implementation ethics’ and can be enhanced through strengthened in-country capacity for the conduct of ethical epidemiological surveillance. Reviews of the methodological and ethical justifications for anonymous unlinked surveillance should be undertaken by key local stakeholders and ethics review boards to ensure that there are no breaches of confidentiality, there is access to HIV testing and counselling, unintended consequences are minimised, and there is a clear understanding among professionals, opinion leaders, and the public about the differences between case finding and public health surveillance.