愛滋篩檢與告知後同意──愛滋例外主義轉向趨勢與臺灣法制之檢討

HIV Screening and Informed Consent: An Analysis of the Changing Paradigm of HIV Exceptionalism and HIV Screening Laws in Taiwan

國際間受「愛滋例外主義」（HIV Exceptionalism）思維影響，向來認為愛滋篩檢應取得受檢人事前經告知的、自願的、特定的同意，不同於一般血液檢驗係以病人之推定同意及例行進行為原則。近來為發現更多感染者，美國疾病管制局與世界衛生組織及聯合國愛滋病規劃署主張降低測前諮商及取得明確同意之要求，改採由照護者對病人（physician-initiated）例行性提供檢驗、但病人得拒絕（opt-out）之篩檢模式，引發是否損及受檢人告知後同意權利之論辯。本文藉由文獻整理及分析，檢討愛滋例外主義之興起背景、轉向因素及論辯之證據基礎，與愛滋條例篩檢規範之正當性。本文發現，目前尚無充足證據顯示降低測前諮商與明確同意之要求可提高受檢率，增進重大公共利益，且愛滋條例已允許廣泛的強制篩檢，自願性篩檢之諮商與同意要件也相當寬鬆，不具備進一步放寬受檢人權利保護要求之條件。為平衡兼顧愛滋篩檢發現感染者之公共衛生需求及受檢人選擇接受篩檢與否之自主權，衛生主管機關應增加例行性提供篩檢服務之對象範圍，推動在特定場域由照護者啟動篩檢流程、測前提供資訊、取得個人告知後同意之選擇加入篩檢（opt-in），在尊重受檢人自主權之前提下，增加愛滋篩檢之可近性。

Owing to the influence of the HIV Exceptionalism perspective, HIV testing—unlike other blood tests—is not being conducted with presumed consent of the patient. Instead, it is required that people should be tested for HIV only with their informed voluntary and specific consent. Recently the US Centers for Disease Control and Prevention (CDC) , the World Health Organization (WHO) , and the Joint United Nations Programme on HIV/AIDS (UNAIDS) jointly released new guidelines for HIV testing which expand access to HIV testing in healthcare settings and extend the benefits of antiretroviral therapy to the infected. The current revisions to HIV testing guidelines, however, have raised new debates on the role of consent and counseling in the HIV testing process. To assess the necessity of adopting newly international guidelines, this study aims to discuss how HIV Exceptionalism has impacted HIV testing and screening law and policy, analyze evidence for the guideline revisions, and examine the current state of Taiwan’s HIV screening regulatory scheme under the HIV Infection Control and Patient Protection Act. It is suggested that there exists insufficient evidence to conclude that reducing pretest counseling or affirmative agreement requirements will be significantly beneficial to achieving public health goals. In addition, the HIV Act has allowed extensive mandatory screening under Article 15, paragraph one while at the same time adopted loose consultative and consent requirements under Article 15-1. To balance public health needs with an individual’s right to self-determination, public health authorities should increase access to routine physician-initiated, pre-testing information provision, and opt-in HIV screening.