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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 July 14; 335(7610): 60.
PMCID: PMC1914510

HIV exceptionalism must end

Martin F Brewster, retired general practitioner

The need for HIV policy reform has again been highlighted,1 reinforcing earlier claims that HIV testing should not have special status as knowledge about HIV status can be lifesaving.2 Such opinions are seemingly ignored by the UK government and medical establishment, whereas in the United States reform is under way.

Last week's BMJ featured the cases of two apparently healthy babies who presented later with established HIV. The mothers' infection had escaped detection.3 Abolishing exceptionalism would prevent such failure by restoring named feedback. Few mothers realise the importance of this information; namely, the drastic consequences of withholding positive results. Full understanding usually arouses incredulity and anger.4

Reform must come soon—litigation costs, stigma, and fear of exposure are probably stemming a tide of legal questioning among relatives unnecessarily bereaved by late HIV diagnosis.

Such trouble was predicted in 1998,5 yet nine years of General Medical Council and BMA inaction have passed since this well argued case to progress “from exceptionalism to normalisation.”

Less well known is a high court judgment ruling that an infant's human rights to HIV testing outweigh parental rights of choice. Another court could soon find that the right to be born free of HIV infection outweighs all other considerations.

Doctors and politicians failing to take note do so at their future peril. Waiting for cost effectiveness evidence is unethical.


Competing interests: None declared.


1. Hamill M, Burgoine K, Farrell F, Hemelaar J, Patel G, Welchew DE, et al. Time to move towards opt-out testing for HIV in the UK. BMJ 2007;334:1352-4. (30 June.) [PMC free article] [PubMed]
2. Manavi K, Welsby PD. HIV testing. BMJ 2005;330:492-3. [PMC free article] [PubMed]
3. Jayasuriya A, Allan PS. HIV and pregnancy: are we doing enough? BMJ 2007;334:1287-8. (23 June.) [PMC free article] [PubMed]
4. De Zulueta P. The ethics of anonymizing HIV testing of pregnant women: a reappraisal. J Med Ethics 2000;26:16-21. [PMC free article] [PubMed]
5. De Cock KM, Johnson AM. From exceptionalism to normalisation: a reappraisal of attitudes and practice around HIV testing. BMJ 1998;316:290-3. [PMC free article] [PubMed]

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