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

I don't think my reaction is all that unusual. A great many of us remember well the scary advertising of aids. We can remember film wards of people dying on the news. We are of the time where there was a fear that did encourage the use of condoms but didn't aleviate the concern it may be passed in other ways like kissing.

One of the aids or gay charities at one point did point out that the fear generated by the aids adverts perhaps had been to succesful.

Put that into context into more recent events, a great many people have health anxiety when they hear somebody coughing in a shop today. That is despite the chances it being just the usual bugs that have always gone round, and are entirely treatable even if you get it.

😧I have no words....really you would take a step back ?!?! I cannot begin to understand this at all.

Fear of being diagnosed is exactly why more routine testing is so important.
Prejudices can't be overcome if we lean into them.

But as you know in ICU there are many things that cannot just be done without consent from the next of kin. Or a welfare decision made by the team looking after the patient if no next of kin exist.

A common example would be removing breathing tubes to see if a patient will respond. It may be decided that unless the patient can sustain breathing after a certain period in a coma, there is an unlikeliness they will recover.

"I’m a bit surprised that they can screen you without consent - as far as I knew the blood tests that they did we for infection markers and a full blood count, along with one that checks for clotting."

So you give consent for a blood test to be tested for infection markers - what exactly are you disputing? Did you want a checklist for every single marker they were going to test for? Seriously?

If people were to ask themselves, if somebody told them they were HIV positive or had Aids today, would they take a step back. For most of us, certainly over the age of 40, I believe we would. I was in that position in a social setting around 8 years ago.

Now I know the chances of infection without intimate contact border on zero, but there is still that stigma.

To pick up on your comment towards homosexuality and HIV. I have a friend who was in the gay scene in London at the height of aids. The prejudice and violence gay men faced was immense. Including being thrown out of rented houses if the landlord found out they were gay. This was happening well within living memory of a lot of us.

Perhaps some posters and the NHS need to accept that the fear of being diagnosed due to generational prejudice is still real for many middle aged people in particular.

Doesn't the GMC itself say that patients shoulf be involved in decison making abou their treatment and care "if they can". Which presumably means that in ICU or other situations where informed consent can't be sought (because the patient is not capabale of consenting) then you can go ahead. If we are going to move to a blanket "presumed consent" approach then the culture of UK medicine needs to radically change. There is far too much closing ranks and obstruction when questions are asked and complaints made in the NHS at the moment.

Errr so I just let my icu patients die cos I can't get consent to test or treat them?

It’s those vulnerable people who exactly need the tests. Those who have not followed the news and do not know about the infected blood enquiry and the thousands of people who were infected with HIV and Hepatitis.

so that these people can be informed and helped.

they’re not just collecting some public health data, they’re trying to put an end to the biggest NHS scandal in history.
which is going to rightfully pay out billions of pounds to those affected.
so doing some tests to put an end to the spread will save money long term.

I'm not against screening for these conditions but I do think that the way it sounds like it is being done raises some ethical questions.
Normally if you have blood taken, whilst you may not know the details of every test that will be done, you can generally assume that they're something to do with the reason that you're at the hospital/clinic, and that something you have said, or something they have found on examination has prompted those tests. So for instance, I had bloods taken at the GP recently and when I got the results I saw that she had requested HbA1c and cholesterol. Not absolutely specifically related to what I was there for, but I am a chubby late middle* *aged woman so definitely at risk of both diabetes and high cholesterol, hence those tests were very relevant to me. But if I'd seen HIV and Hep C had been done I would have been surprised as I don't have any particular risk factors for those. I would not have objected to being screened but would have liked to have been asked.
I can't think of any other screening programme in this country where you don't get individual information prior to being screened and where you don't make an active decision to participate. Whilst there often isn't a formal consent process, you can be pretty confident that if someone shows up for a mammogram apointment or puts their poo in the post then they do want to be screened.
I think presumed consent on the basis of posters on the wall in A&E is a bit dubious personally. There are all kinds of reasons why someone may not have been able to read, understand or retain that information and it doesn't sound as if any checks on that are then being done. I agree that from a public health perspective there is probably very useful data being collected and that some people will benefit enormously if treatable conditions can be found, but a patient's right to autonomy is fundamental. If we're going to accept "It's for your own good/the greater good and you were having blood taken anyway, you didn't need to be told specifically" in this instance then why would the same principle not apply in other circumstances? Where's the line?
It is clear from some of the posts on this thread that the current level of information being provided is inadequate. Anyone posting here is clearly at least literate and has reasonable understanding but even so there are people who have found out they've been screened without knowing it. Presumably there are many more who have not realised they've been screened at all, and vulnerable people are going to be particularly at risk of that happening. Nothing wrong with screening for blood borne viruses in my opinion but it sounds like there could definitely be a big improvement in the public information/consent side of things.

They should have told you 100%, but it's most likely an honest mistake that they forgot.. I've never worked in a trust that does routine screening but I can guarantee that if I was working in the fire fighting situation that a&e drs are having to manage atm with patients filling corridors and running from emergency to emergency... then if I patient asked what tests I was requesting, I could accidentally tell them what "I personally" was testing for, and forget that I worked somewhere where everyone is screened, as it is unlikely to be at the forefront of my mind

Hope you're better soon x

Still doesn't make any sense to me.

By not knowing you have it, doesnt mean you don't have it. It's not like the test infects you?

Options are

Testing

1. You were negative. Test negative... zilch change to your life
2. You were positive and didn't know it. You're life has pretty much been saved

No testing

1. No impact on your life as per first case
2. You remain ignorant and at risk of immunocompromise diseases and early death

By not testing, doesn't mean you don't have it in option 2, it just means you're ignorant of the fact that you have it, which helps noone

Spose the only reason that might appeal is if you think its highly likely you have it and you want to buy life insurance before making it official, but that's prob borderline insurance fraud tbh

Despite modern changes in treatment or attitudes, would I want eg my employer to know I have had a test for HIV. Probably not.

They know I'm a regular blood donor. Therefore they could work out I've been tested many times (I've made over 50 donations.) I don't remember when they first started testing for HIV, but it's been many years. (They also test for syphilis, more than one type of hepatitis, and a couple of other things - anyone interested can check on their website.)

The relevance of times when there was no treatment for AIDS is only that there were more people who did not want testing for HIV, especially if they were asymptomatic, because they thought it would be better to be ignorant of a fatal illness for as long as possible.

But that’s not where the need for consent comes from. Informed consent is needed, when possible, for all healthcare testing and treatment. It is a bedrock of ethical practice.

The NHS does not have a stellar record on consent. They fudge things for all sorts of reasons. But that makes them unethical - not consent unreasonable.

OP I totally get what you are saying. In many aspects of healthcare, consent and patients' wishes go totally out the window. I find this wrong but staff and the system in general become desensitised to why it might be an issue and the power imbalance is huge. Just because some people prefer not to see the issue doesn't mean it isn't real. The best thing we can do is complain and gradually processes change some of this. What happened to you the way you describe it, I believe is wrong.

The tainted blood scandal is an ongoing decades long national disgrace.
It is connected to treatment nowadays because people are still fighting for justice because HIV leading to AIDS and also Hepatitis was inflicted and then they were told to get lost and insulted, died without medical care. You might feel well taken care of but what’s ongoing needs to be said and compensation paid. It’s so shocking what people went through and are still going through as are their descendants.

It's routinely often 'opt out' in A&E, and there are posters publicising this in the waiting room.

From a public health point of view it's great. The idea of needing consent for an HIV test dates back to when there was no treatment for HIV. Thankfully there are excellent treatment options now.

All tests or treatments of any description should always and only be done after informed consent is given, when the person has capacity. Anything else is highly unprofessional and unethical.

The government has acknowledge that compensation should be paid and is in the process of doing this https://www.gov.uk/infected-blood-compensation-estates.
Compensation for the infected blood scandal is a separate thing to the HIV care that we receive

No. Because as I said previously HIV test is not just another trivial detail of healthcare. It’s something that carries an enormous amount of weight/ stigma; although physiologically the disease is not what it once was, an hiv diagnosis can still still have profound/ life changing social and psychological consequences. Healthcare that has such significant consequences should always be carried out in the basis of patient knowledge and informed consent . This is a basic principle of an ethical healthcare system.

Then everyone should read every single opt-in / opt-out policy in UK health care and act accordingly. AFAIK organ donation has been changed to implied consent and people can choose to opt out of this should they wish.
I imagine there are many other policies i am unaware of.

But if they've already got it without knowing it's already been imposed upon them!!

The testing and diagnosis shouldn’t be imposed on them.

Im absolutely for HIV testing, but it should be with a person’s knowledge and consent.

But if they've already got it without knowing it's already been imposed upon them!!
Id take 100 hiv tests if it meant 1 person not catching it (i haven't got it I'm talking hypothetical). I've been tested for it plenty of times when pregnant and probably in other blood tests, always thought it was a good thing, and i wouldn't give a shit if my employer or anyone else knew id been tested for it. Until I read this thread it would have never occurred to me.
If you go to a&e with medical problems surely you would want to find out about any potential unknown underlying serious conditions, because the sooner you get a dx the sooner you get treatment.
Whether or not there's "no chance" you could have it its worth being tested, as pp have said there has been plenty of people who were convinced they had "no chance" and turned out they had it. Blanket testing is an amazing idea and the results have proved themselves.
If people are funny about stuff like this then maybe read up on every single NHS policy before using the services or go Private?

I don’t believe until you told us in your post anybody knew of your background except for your parents having only slept with each other.
So I don’t believe anyone was picking on you for your background.
but I stand by what I said originally and that others agree with, that your views (especially for someone in their 30s who should know better) are incredibly judgmental and wrong. you made it sound like you are better than those with HIV because those people only have it because they had sex or did drugs.
There are so many people still living with infection that they just don’t know about from transfusions, procedures or partners who also didn’t know etc etc. or from a tattoo parlour or just unknown blood contact - all good people too going about their lives peacefully.
so there absolutely should be testing for everyone even if you think you are negative. To save money in the long run by stopping any unnecessary spread and heartache. It’s not a waste of money and if you have seen the effects of HIV firsthand you should be keen for all to be tested to ensure correct medication can be given.

I don’t care if you thought you had it or not - but I do care that there are still people in this country with attitudes like yours proclaiming the reasons people get HIV and making it out to be a bad, wrong life choice or something. Those views belong in the bin.

Yes but HIV isn’t just another blood test. Although it’s not the disease it once was, it still carries a huge amount of stigma from its history- the very recent past, and for that reason a diagnosis can be life changing. It’s not something that should be imposed on someone without their knowledge or consent.