To think consent is required to do a HIV or hepatitis blood test??

I had some bloods takin in December. I have just looked on patient access and for the FBC (full blood count) this is what they tested. And that's just for one thing. I have diabetes and an underactive thyroid so they check those levels.

I can't imagine everyone taking blood having to list all of these.

Haemoglobin estimation

Total white cell count

Platelet count

Red blood cell (RBC) count

Haematocrit

Mean corpuscular volume (MCV)

Mean corpusc. haemoglobin(MCH)

Mean corpusc. Hb. conc. (MCHC)

Nucleated red blood cell count

Neutrophil count

Lymphocyte count

Monocyte count

Eosinophil count

Basophil count

I actually treated some one who caught Hep B sharing a razor, there are studies fron Brazil suggesting snorting cocaine can spread Hep C. But yes most are sexually transmitted.

Diabetes has similar life long cosequences, people are tested for diabetes literally all the time, not always with explicit consent - no one objects to this.

I can also say as a A&E nurse, i have never seen mandatory screening of any kind within the department. Ive never added a blanket test on to blood draws. Ive ran HIV and hep tests when clinically relevent, but screening i have never seen. All our bloods are ran as urgent, as we need the results asap in order to treat, diagnose or discharge the patient, a screening test on top would cost the department an absolute fortune. We have already had some tests removed from what we initially request due to the costs of them, and they are now only ordered as add ons if clinically needed. Hoiwever, If a screening was added after as an add on by an outside agency within the hospital to everyone meeting a criterea who visited the department, then i agree, patients should be informed of screening and consent obtained. This is possible i guess. But in my experiences, that isnt something being done in the A&E itself, therefore they wouldnt know to consent the patient.

Edit to add, ive been looking online and certain trusts do have an opt out screening, if this is the case, it just be publically visable and communicated to patients who dont wish to have the screening. Looking at the trusts involved, im suprised it isnt the case in my trust, however until now it wasnt something i was even aware of happening.

Current treatment for HIV reduces the virus to an undetectable level in the body therefore that person is no longer able to pass it on via blood or body fluid exchange. ( not infectious)

Without the treatment the viral level is high and easily transferred by body fluids and blood. ( infectious)
If everyone with HIV was treated you could pretty much eradicate the virus.

Speaking as an A&E nurse, theres often little point in explaining what blood tests are being ran at the point of drawing. I will go to a patient, order "routine" bloods, generally a full blood count, liver function, coagulation, CRP (infection marker) and urea and electrolytes, label, and send off to the lab which process in around an hour. These tests use the 3 most common bottles. However, for 8 hours following that, a Dr, or myself, can add on tests to those already taken samples if needed and the lab with run further tests on the samples already sent. So what i tell the patient at the time of drawing the bloods, isnt always what they end up being tested for. Some tests also need repeating 2-3 hours after the first one, again, im often the one to draw label and send to to the lab, but by the time a repeat is required, they have been seen by a Dr who will add on more specifics tests.

Its not as simple as gaining consent for specific tests at the point of draw, as the nurse or phlebotomist taking the bloods doesnt necessarily know every diagnostic test being ran on the sample.

No,I was a bit surprised to be prescribed B12, as I hadn't realised it was part of what they were testing when I had bloods taken one time, but I didn't mind.

Or you just aren’t aware of all the facts because you haven’t been given them all. Some people don’t know how infections are passed on. Or maybe aren’t having penetrative sex so think they don’t need condoms. Not everyone is foolhardy.

Surely most times that you get a blood test you’re not told every thing they’re testing? E.g. no one has ever specifically said to me that they’re testing my liver and kidney function but that’s standard with a blood test. I can’t really see how this is different?

''My attitude is not draconian, it is evidence based and supported by organisation's the world over. It was my literal job for years.''

The WHO appear to disagree with you and even argue that doing so without ensuring consent may border on illegal.

www.who.int/news/item/30-05-2007-who-and-unaids-issue-new-guidance-on-hiv-testing-and-counselling-in-health-facilities

If someone feels so strongly that they can't possibly endure a HIV test they should obviously be able to opt out.

Right! And how can they they opt out if it’s done without their knowledge?

You would expect a blood test to be testing for everything, no. ?

Having unprotected sex with a partner you don't know is clean of anything is foolhardy.

Routine is not a synonym for mandatory.
If someone feels so strongly that they can't possibly endure a HIV test they should obviously be able to opt out.
My attitude is not draconian, it is evidence based and supported by organisation's the world over. It was my literal job for years.

Yes absolutely I agree with all of these points. We need HIV testing- it should be as accessible , available and widespread as possible. Only done above board, with proper education, knowledge and informed consent. This is what will help to end stigma, stop spread and protect the wellbeing and safety of people affected by HIV.

But if they are with a partner and on the pill they might choose not to wear condoms. That is their right. Yet they may not know they are infected.

They also can't pass it on if they or their partners partake in safe sex.

They are not wrong.
they are pointing out that the stigma is what is slowing down finding all the cases in the U.K. in order to give them the care they need.
point number 8 in the 12 recommendations from the infected blood enquiry is “finding the undiagnosed”
about 2000 people who still don’t know they were infected. So this helps find some and avoid them infecting others - they can’t avoid passing it on if they don’t know they have it!

To have a child and then breastfeed. One must first have sex. If you decide to have unprotected sex or have a child then surely the onus is on you to ensure neither you nor your partner have any communicable disease. The responsibility for that should not be laid at the door of testing people without their knowlegde or consent.

It can be the underlying cause of something like pneumonia, and can make it harder to treat. So that's why.

Mandatory / sleuth testing without informed consent does nothing to end stigma. Pretending stigma doesn’t exist does not end stigma. Testing people without their knowledge or consent - potentially traumatising them with an Unexpected positive diagnosis, does absolutely nothing to ensure they will conform to treatment pathways , or behave in ways to avoid passing it on.
you are wrong sorry and your attitudes are draconian.
We will just have to agree to disagree.

Sex, pregnancy, childbirth, intravenous drug use, breastfeeding. Surely you know this by now?

When I had pneumonia they asked me a few times if I could have HIV/hepatitis and they definitely tested me for it too when taking my bloods. I think it must be standard.

Tell us how it spreads in untreated people?

From what I have garnered they should have sought your consent to test for HIV. It sounds like yet another case of the health service using their get out clause of implied consent where no consent was actually given.