HIV and the mentally ill: an approach to the legal issues

HIV testing policy and serious mental illness

OBJECTIVES

Using opinion data from experts, we examined the context of the argument for mandatory testing of psychiatric patients.

METHODS

Vignettes were distributed to experts on HIV and mental illness. Respondents were asked to provide appropriateness ratings for different hypothetical clinical decisions regarding HIV management.

RESULTS

Respondents were reluctant to impose testing without informed consent in most circumstances. The presence of risk factors or danger to another increased appropriateness ratings modestly.

CONCLUSIONS

Despite experts' tendency to emphasize individual rights, public reluctance to mandate testing is unlikely to extend to people with serious mental illness. No argument for mandatory testing can be persuasive if improved voluntary testing can achieve adequate detection rates. Voluntary testing protocols should be studied to determine which successfully identify infected individuals.