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. Author manuscript; available in PMC: 2019 Oct 2.
Published in final edited form as: J Acquir Immune Defic Syndr. 2018 Aug 15;78(5):e35. doi: 10.1097/QAI.0000000000001694

Individuals have the right to avoid sex with partners unwilling to test for HIV but do not have a right to force them to test for HIV

Jason J Ong 1,2,3, Chongyi Wei 4, Stephen Pan 2,5, Hongyun Fu 2,6, Joseph D Tucker 1,2,7,§
PMCID: PMC6168428  NIHMSID: NIHMS956262  PMID: 29985302

Dear Editor

We appreciate the thoughtful response and largely agree with the points raisedon serosorting for risk reduction and coercion. The focus of our paper was to point out coerced testing in the context of expanding self-testing, and the importance of promoting voluntary testing.

Negotiated safety arrangements between partners could be useful for HIV prevention.1,2Within these settings, improving effective communication skills to persuade, rather than coerce, a partner to HIV test is important. An individual has the right to self-protection when there is concern regarding a sexual partner’s HIV serostatus, and has the right to refuse sex with their partner who declines testing for HIV. However, this does not mean they can force someone else to test for HIV against their will, even if it is ultimately for that person’s benefit or good. We acknowledge that balancing an individual’s right to self-protection and another’s right to autonomy raises ethical conflicts and is not always easy to resolve.3The World Health Organization (WHO) and The Joint United Nations Programme on HIV/AIDS (UNAIDS) HIV self-testing guidelines opposescoerced HIV test in any setting, including from sexual partners.4

We acknowledge that what constitutes coercive testing is clear in its extreme manifestations butis less well-defined when it overlaps with pressured testing that may be motivated by altruism or self-protection. In order to explore the nuances of how men defined and experienced coerced HIV testing, we subsequently conducted a mixed-methods study in the same cohort. This study found that pressure to test for HIV occurs on a spectrum, with clear instances of coercion (e.g. threats to lose employment). At the same time, we also found examples where a man pressured their partner to receive an HIV test‘in the name of love’.5

The main conclusion of our letter is about highlighting the possibility for coerced testing, especially in decentralized settings. To be clear, we agree that men have the right to withhold sex as part of an HIV risk reduction strategy. Further research is needed to better understand the risk of coerced HIV testing in diverse settings.6

Kind regards,

Jason J. Ong, Chongyi Wei, Stephen Pan, Hongyun Fu, Joseph D. Tucker

Acknowledgments

sources of funding

Funding has been received from the National Institutes of Health (NIAID 1R01AI114310-01), UNC-South China STD Research Training Center (FIC 1D43TW009532), UNC Center for AIDS Research (NIAID 5P30AI050410), UCSF Center for AIDS Research (NIAID P30 AI027763), National Institute of Mental Health (R00MH093201), UJMT Fogarty Fellowship (FIC R25TW0093), Australian National Health and Medical Research Council (APP1104781) and SESH Global (www.seshglobal.org). Administrative assistance from the Guangdong Provincial Center for Skin Diseases and STI Control, UNC Chapel Hill, and UNC Project-China in Guangzhou, China.

Footnotes

Conflicts of interest

All authors declare there are no conflicts of interest.

References

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