Faber Francisca, Abeler-Dörner Lucie, Johnson Stephanie, Johnson Tess, Jamrozik Euzebiusz
Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria.
Ethox Centre and Pandemic Sciences Institute, University of Oxford, Oxford, UK.
Bioethics. 2025 Oct;39(8):762-771. doi: 10.1111/bioe.70011. Epub 2025 Jul 22.
Molecular HIV surveillance, involving the collection and analysis of HIV genome sequences, has become an integral part of public health programmes in high-income countries. By employing phylogenetic analysis, molecular HIV surveillance can identify individuals and their positions within networks of HIV transmission. While the primary aim of molecular surveillance is to yield public health benefits, such as linking people to care and reducing transmission, it also poses risks and potential infringements on individual privacy and liberty. This paper examines the ethical implications of using phylogenetics to identify individuals involved in multiple transmission events in high-income countries. Although public health responses tailored to such individuals can significantly reduce further transmission, these individuals often face multiple intersecting vulnerabilities and bear the greatest risks associated with molecular surveillance. We analyze the risks related to privacy, stigma, mistrust, criminalization, and liberty infringements, alongside the benefits of preventing further transmission and increasing healthcare engagement for people living with HIV. We conclude by outlining plausible and ethically acceptable policy options for molecular surveillance practice.
分子HIV监测，包括收集和分析HIV基因组序列，已成为高收入国家公共卫生项目的一个组成部分。通过系统发育分析，分子HIV监测可以识别个体及其在HIV传播网络中的位置。虽然分子监测的主要目的是产生公共卫生效益，如让人们获得治疗和减少传播，但它也带来了风险以及对个人隐私和自由的潜在侵犯。本文探讨了在高收入国家利用系统发育学识别参与多次传播事件的个体所涉及的伦理问题。尽管针对此类个体的公共卫生应对措施可以显著减少进一步传播，但这些个体往往面临多种相互交织的脆弱性，并承担与分子监测相关的最大风险。我们分析了与隐私、污名化、不信任、刑事定罪和自由侵犯相关的风险，以及预防进一步传播和增加HIV感染者医疗参与度的益处。我们通过概述分子监测实践中合理且符合伦理的政策选择来得出结论。
