Tracking HIV Through Wastewater: Ethical Considerations in Public Health Surveillance

Ending the HIV epidemic requires timely identification of new HIV infections and promptly linking patients to high-quality care. Innovative methods are needed to capture real-time HIV incidence data to more effectively identify persons in need of HIV care access. Emerging advancements in wastewater surveillance (WWS) offer the potential to identify geographic areas with elevated prevalence of detectable viral loads among people who are undiagnosed or no longer receiving care, enabling more targeted interventions to reduce HIV transmission. The introduction of new public health technologies requires balancing potential risks with the significant clinical and population-level benefits of decreasing the number of people with untreated HIV. In this paper, we turn attention to public health ethics principles-such as preventing stigma and bias, protecting the public's privacy and confidentiality, and ensuring that data gathered is only used to promote the public's health-to offer useful guidance and applicability to HIV wastewater surveillance.