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American Journal of Bioethics.

Reassessing the Ethics of Molecular HIV Surveillance in the Era of Cluster Detection and Response: Toward HIV Data Justice

In the United States, clinical HIV data reported to surveillance systems operated by jurisdictional departments of public health are re-used for epidemiology and prevention. In 2018, all jurisdictions began using HIV genetic sequence data from clinical drug resistance tests to identify people living with HIV in “clusters” of others with genetically similar strains. This is called “molecular HIV surveillance” (MHS). In 2019, “cluster detection and response” (CDR) programs that re-use MHS data became the “fourth pillar” of the national HIV strategy. Public health re-uses of HIV data are done without consent and are a source of concern among stakeholders. This article presents three cases that illuminate bioethical challenges associated with re-uses of clinical HIV data for public health. We focus on evidence-base, risk-benefit ratio, determining directionality of HIV transmission, consent, and ethical re-use. The conclusion offers strategies for “HIV data justice.” The essay contributes to a “bioethics of the oppressed.”

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Volume 20, Issue 10
September 2020

Target Articles.

Duties When an Anonymous Student Health Survey Finds a Hot Spot of Suicidality Arnold H. Levinson, M. Franci Crepeau-Hobson, Marilyn E. Coors, Jacqueline J. Glover, Daniel S. Goldberg & Matthew K. Wynia


We Are People, Not Clusters! Edwin J. Bernard, Alexander McClelland, Barb Cardell, Cecilia Chung, Marco Castro-Bojorquez, Martin French, Devin Hursey, Naina Khanna, Mx Brian Minalga, Andrew Spieldenner & Sean Strub