Voluntary screening for human immunodeficiency virus (HIV) infection. Weighing the benefits and harms

Voluntary screening for human immunodeficiency virus (HIV) infection may help prevent the spread of the HIV epidemic if persons who test positive alter behaviors that may transmit infection. Protecting persons from unknowingly being exposed to HIV infection must be balanced against respecting the autonomy of individuals being screened. Seropositive patients may feel a stigma and be subjected to discrimination if confidentiality of test results is breached. In patients without high-risk behaviors, the positive predictive value of HIV testing may be substantially increased if tests are done in reference laboratories and if further confirmatory tests are run on a second blood specimen. For persons with high-risk behaviors, HIV testing can be recommended to those who want to reduce uncertainty about their HIV status or whose medical care would change if they were seropositive. Health care workers can maximize benefits of screening and minimize harm by educating and counseling patients before HIV testing, discussing the confidentiality of HIV test results, urging patients to disclose positive test results to sex partners, and advising patients on how to reduce high-risk behaviors.