Ethical Considerations in HIV and STD prevention research, program, and policy

Prevention of HIV and sexually transmitted diseases (STDs) raises ethical considerations given the need to prevent and control infections in communities while also protecting affected and infected individuals. We present examples of how ethics at CDC has been applied to prevention of HIV and STDs in research, program, and policy. Regarding research, we addressed ethical considerations in using respondent-driven sampling, a participant-driven method to recruit drug users to HIV prevention research. Ethical considerations included concerns about peers' coercion in the referral process, use of remuneration for unhealthful behaviors, and investigators' responsibility for informing participants of their HIV discordant partnerships. Regarding program, we evaluated ethical considerations in partner management services and expedited partner therapy, which represent public health strategies for prevention and control of specific bacterial STDs. Relevant concerns included threats to privacy of patients and partners, potential for breakdown in relationships between partners, medical responsibility of clinical providers, and potential side effects of medications provided to partners without medical evaluation. Regarding policy, ethical considerations in recommending universal HIV screening in health care settings included benefits of screening for HIV prevention and treatment, benefits of written informed consent versus verbal opt-out, and benefits of universal screening in reducing stigma associated with targeted screening. We discuss the three examples, provide a summary of relevant scientific, ethical, and regulatory literature, and highlight the use of safeguards pertinent to the ethical principles of beneficence, respect for autonomy, and justice. Our presentation focuses on enhancing the compatibility of public health practice, research, and ethics.