非真正強制？不完全自主？：臺灣愛滋篩檢法制之實證檢討與改革

Not Truly Mandatory? Not Fully Voluntary? An Empirical Study of Taiwan's Implementation of HIV Screening Laws

本文利用質性訪談公衛人員與感染者權益保障會專家，描述以人類免疫缺乏病毒傳染防治及感染者權益保障條例第15條第1項為法源依據之愛滋篩檢執行實況。本文發現：1、法律規定主管機關「應通知檢查」，實際上為受檢對象「應接受主管機關及其他機關檢查」；2、役男、軍官、士官、常備兵之強制篩檢非由法律授權之主管機關執行，藥癮、性病病人、新生兒等強制篩檢對象仰賴由健康照護者以較為尊重受檢人自主權的方式進行篩檢；3、衛生機關主要對警方查獲之毒品或性交易嫌疑犯及接觸者執行強制篩檢，但因規範體系紊亂導致執行者對法令理解多元，且有無法直接強制的現實，公衛人員為避免紛爭、達成考評目標，亦迴避以處罰鍰之間接強制手段達成目的，偏好柔性勸導策略，形成非真正強制亦不完全自主的愛滋篩檢實況。針對特定族群進行愛滋強制篩檢有利益不明、偽高風險族群、事實上不能等缺陷，並非達成重大公衛利益之適當、必要手段，建議應揚棄強制篩檢，確立公共衛生愛滋篩檢計畫以經諮商及同意之選擇加入模式為原則，並積極消除妨礙個人自願接受篩檢之因素，包括篩檢後對自我資訊控制權之喪失、遭受歧視及刑事處罰之風險，使主管機關政策性篩檢計畫能發揮發現潛在感染者之最大效益。 This article analyzes how Taiwan's HIV screening laws authorized under Article 15 of the HIV Infection Control and Patient Rights Protection Act was implemented by conducting qualitative interviews with local health officials and committee members of the Protection of Rights and Interests of Infected Persons. It finds that: first, the law stipulates that the competent authority “should notify for examination” but in reality is that the subject “should be subject to examination.” Second, mandatory screening of service men, military officers, noncommissioned officers and standing soldiers are not carried out by the competent authority authorized by law; mandatory HIV screening of drug addicts, STD patients and newborns are actually performed on a voluntary opt-in basis by health care providers. Third, local health officials mainly conduct mandatory screening on suspects of drug users or sex traders seized by the police or contacts of HIV-infected persons; however, due to regulatory flaws that cause diversified understanding of laws among local health practitioners, the reality that HIV screening cannot be directly enforced, and officials' preference of persuasion strategy rather than fining people refusing screening to avoid disputes and to achieve evaluation objectives, mandatory HIV screening is implemented in a not really mandatory nor completely autonomous manner. There is a lack of evidence about the validity of the purpose of mandatory HIV screening among certain populations; the professed public health benefits of mandatory HIV screening tend to be based on illusion. Mandatory HIV screening is not an appropriate and necessary means of reaching significant public health interests. Laws authorize mandatory HIV screening should be repealed; public health program should adopt an opt-in model and maximize the benefits of voluntary screening by eliminating the factors impeding individuals seeking testing, including losing control of personal information after receiving testing, the risk of discrimination and crimination of HIV exposure.