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??

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.

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

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

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?

''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

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?

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.

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.

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.

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.

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.

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 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.

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

“No one objects to this”.

Right. Ask yourself why that is.

None of these things are a test for a specific diagnosis with the kind of consequences that HIV diagnosis has. They might simply be a first step in identifying an area for further investigation.

Many of these tests might provide some evidence of cancer, for example, but look at the guidance on informed consent to cancer screening and diagnosis : https://assets.publishing.service.gov.uk/media/5c126d6040f0b60c8d6019e8/consent_to_cancer_screening.pdf

Informed consent is a very basic and essential component of an effective and ethic healthcare system.

Stigma and outdated views as evidenced by this thread.

Or because it's not a communicable disease. You don't catch diabetes from sleeping around. (You might not catch HIV that way, either, but getting it sexually is the most common way, and it's what people will generally assume)

Right, ok. Do you therefore accept that an HIV diagnosis could therefore be an extremely difficult diagnosis to receive from the perspective of the individual receiving it? And that it could have profound consequences for a person socially, for their relationships , and for their psychological health? Do you therefore not think it’s important to provide that person information and an opportunity to consent to testing , before bombarding them with a potentially traumatic and life changing diagnosis?

Nobody said they’d be bombarded with the results. If screening detected the virus, then it would be sensitively handled. Same process practiced if someone was giving blood and it came up in their screening.

When you are giving blood you are aware you are being tested!. That’s the whole point.

Of course informing any person of a diagnosis can be handled sensitively. But the point is they are receiving a diagnosis for a test they didn’t even know they were having. This provides the individual no time to process/ prepare themselves for a potentially devastating and life changing result. This is not ethical .

I have never said anything should be done without consent. Making something routine is not the same as mandatory or enforced. I know very well what the WHO say about it. (FIY, that is from 2007, AKA a long time ago).

Yes, I've encountered HIV being transmitted by reusing razor blades at a barbers before. Not in the UK though.
Fascinating about the cocaine! Never heard that before!

Fair enough, I don’t disagree with you at all then.
I don’t have an issue with HIV tests being done as “routine” - eg routine part of pregnancy screening. I was objecting to them being done without people’s knowledge/ consent as that was the issue in the OP

Maybe depends where you live? Opt out testing, after being found successful in a few A&Es (mostly in London) has been rolled out across 46 A&Es in 33 areas in England with extra funding made available. This is being done with guidance on signposting and support in place in collaboration with HIV charities in the event of someone being diagnosed with HIV.

This will save the NHS money in finding people unaware of having HIV before it progresses to them becoming poorly and needing further treatment, passing it on to others and potentially save lives.

https://www.england.nhs.uk/long-read/emergency-department-opt-out-testing-for-hiv-hepatitis-b-and-hepatitis-c-the-first-100-days/

https://www.england.nhs.uk/blog/hiv-testing-is-essential-in-preventing-ill-health-onward-transmission-and-even-premature-death/