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

[Onionbhajisandwich]

Hi all,

Please tell me if I’m wrong here but do the NHS require consent to test for HIV or Hepatitis?? I would have thought they did.

I attended A and E last month (sent by my GP) as I had suspected pneumonia. I received a text today stating this:

“You recently attended the Emergency Department. We are part of an NHS programme testing for HIV, Hepatitis B and C but your test wasn't processed due to technical issues. Please attend one of the walk-in blood test centres, Mon - Fri 8am- 4.30pm. We requested the repeat test electronically, so please give your NHS number on arrival. We will only contact you if the test is positive and you need care”

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.

I won’t be attending to get the tests done as it’s within work time but aibu to think this isn’t ok??

Flipping this around, do you know what they were testing your blood for? Did they specifically get your consent to test the blood for infection A and infection B etc. If not then why need consent for these specific ones but not the others?

The conditions they tried to test you for, are very often underlying the reason people contract pneumonia. They were obviously trying to find out why. If you had continued to get worse or not responded to treatment, no doubt you would of been upset if you deteriorated

Not really anymore (for at least 9y at least

In icu anyone that has an immunocompromising severe illness will be tested. If they're awake we tell them. If they're ventilated we just do it

On a ward if we think it's possible we ask consent

Many many many areas have a high enough prevelance rate that they routine screen anyone who comes into a&e as the pick up rate makes it worth it. Finding out you have hiv so it can be managed hugely increases life expectancy (actually have a better life expectancy with well managed hiv than diabetes for eg

Isn't it done as part of your initial pregnancy bloods as well? I'm sure I was tested in all 3 pregnancies (first was 12 years ago!)

No only in high pick up areas like London. It's too expensive to do it everywhere

Yup

It takes no extra time really at all to gain consent. People have the right to opt out of any testing, it's a basic principle. I'd be annoyed if I was tested for something without my knowledge, if they offered me hiv screening I'd happily take it but just tell me.

I was hospitalised with a severe case of pneumonia as an otherwise very fit and healthy 40 year old. When I was discharged, the Dr. explained they tested me for HIV because they couldn't understand why such a healthy young person could have got so sick with pneumonia. They definitely didn't ask permission for any specific tests, but I was glad they were trying to figure out why it happened. It was definitely hard to explain, I rarely get so much as a cold. It's the only year I neglected to get a flu shot though, so I never made that mistake again.

My experience when getting investigations for an unusual blood count was they asked for my permission to test for HIV. They didn't for any other blood disorder they were testing for.

At one point if I remember correctly, even a test for HIV could count against you when applying for health insurance or mortgages.

That was in the 80s/ 90s/ early 00s before the treatment was as effective as it is now. If someone is diagnosed in 2025 before HIV damages their immune system, the person's life expectancy is only about 1 year shorter than mine (non smoker, little alcohol and no chronic conditions).

Yep, I had 10 years of infertility then IVF... I have been tested a ridiculous amount of times during that process for someone in a monogamous relationship since 18 (although I did study medicine and once had an accident when the vial shattered while doing a blood test for HIV/AID's. Although I was not cut just sprayed and the patients next sample was negative anyway) but at the end of the day I know it will be negative, I have nothing to 'hide' so have no reason to object.

If it did somehow come back positive (given that accident or my DH cheating is pretty much my only real risk and the accident was over a decade ago and Ive been negative seemingly 100 times since would be a surprise) then it would be a huge shock but Id want to know rather than die of it untreated.

Yes. It’s very weird. Nobody should have any testing run without giving express consent.

Did they not mention anything about what tests would be performed?

I thought these tests were standard practice in cases of suspected pneumonia?

We generally do. In a&es that routine screen everyone theres posters everywhere letting people know. But it's equally an odd one as if I told the average Joe bloggs what blood investigations I was sending on them they wouldn't have a clue what most of them are. The life expectancy for an early picked up hiv dx is higher than average as they basically have their own private drs that investigate the hell out of any tiny symptom that would just be ignored without a diagnosis

I get that. When I discuss blood tests and screening, a lot of people aren't that bothered about knowing or understanding what it is but I need informed consent. I totally agree finding out HIV infection early is very beneficial but not everyone will want to be screened for it for various reasons and that is their right. It just doesn't sit right for me that you don't tell people what they are being tested for. Posters are good if people can read them.

why?
would you object to having your kidney function checked?

Someone older than me might be able to explain this better, but my understanding was that people used to have to actively consent to these tests because once a condition is known then people were refused things like mortgages, life insurance etc.
Obviously treatments policies and attitudes have vastly moved on but I think thats what started tests like HIV being opt-in rather than implied consent.
I guess like you wouldn't test someone now for huntingdons disease without proper consent and counciling first.

You've gone to the doctor to investigate what is wrong with you and your doctor has sent you for investigative blood tests. What is the problem? What do you want them to do, just guess?

The tests were for "infection markers"
HIV is one possible infection.

You're only thinking it's different because you think there's some stigma/implication of immorality that you associate with the very possibility of this infection.

Yeah it was predominantly stigma and insurance reasons that was opt in before, particularly since historically there wasn't really treatment but now there is

Huntingtons is a huge consent process with psych/genetic counselling etc etc as it has no known treatment and devastating

If you read my previous post.... in a&es that routine screen there's posters everywhere, opt out if you want. Hardly our fault people don't read posters, given the a&e wait times I'd have thought they'd have been read out of boredom if nothing else

In anyone we are testing on a ward, we tell them "you've got an infection that's quite outside the normal realms for your age/health issues etc, as part of our investigations for this we look for various infections such as hiv, is that OK with you?" Never had anyone say no

The only time I don't consent is when their intubated on icu, and they just get subjected to every investigation we can to try to make them survive

So... when your clinician tells you that you're having some diagnostic /investigative blood tests ... do you expect to discuss and consent to each and every one individually?

Yes, I was about to say this. When I took out my first mortgage and the associated life insurance in about 1990 one of the questions was "Have you ever been tested for HIV?". Even if the test had been negative it was highly likely that you'd be turned down as the thinking was that if you'd had the test it was only done because you were at high risk of being positive and therefore even if you weren't infected at that stage then you would be at some point before you'd paid off your mortgage! So in those days it was a test you definitely didn't want without a good reason. I think it's very different now though.
That said, as a matter of principle I do think you should be told if your blood is being taken for anything other than your particular clinical need at that visit. I can see the rationale of "You have X infection which is commoner in HIV positive people so we need to check for that" - that is related to the clinical condition and when I've had bloods taken when I've been ill I certainly haven't given specific consent for every single test. If I have asked what the different bottles are for I've always been told but nobody has ever gone through the pros and cons of every test with me, which I think is fine if it's a standard panel of tests needed to diagnose or treat a given condition. But I think if it isn't, you should be made aware. I don't think it needs to go as far as formal written consent or anything but it should be clear to patients if they're entering a screening programme. Easily accessible written info like posters is ok for most people I suppose but it does assume that everyone can see, read and understand them which isn't necessarily the case.

Back in the day your insurance would have been affected by the mere fact of having a test. And gay people couldn't get mortgages. Thankfully we live in more enlightened times and HIV is now treatable

I did read your post. My point is that posters are great if people can read them, no it everyone is literate, not everyone is able to read English etc.

I also understand that when someone is unconscious you can't get consent. I've had to be part of many debriefs with patients where we have had to discuss investigations and giving medications and blood to save lives.