Le consentement opt-out dans l'augmentation du taux de dépistage VIH/SIDA au Québec

Abstract

Is the "end of AIDS" foreseen in 2030 by the UNAIDS 90-90-90 plan possible in Quebec? The proportionate and systematic universal offer of testing with opt-out consent (presumed consent) appears to be the most relevant and equitable health policy to implement in order to identify people living with HIV who are unaware of their serological status. This seemingly restrictive approach to individual freedoms can be largely offset by the health, social, economic and structural benefits at the individual and population levels. Insofar as HIV/AIDS remains a powerful indicator of social inequalities, this approach will only be successful in the presence of a political ambition to improve access to care and universal and inclusive health coverage for individuals who do not get tested. The opt-out approach in high-prevalence groups is an ethically sound strategy for increasing screening rates. Although consent is not explicit, the presumption would take into account the "structural unfairness" to which key groups with high prevalence rates are initially subjected and that is responsible for their difficulties in accessing care and testing. This article proposes to standardize the provision of screening. The Quebec Committee on Sexually Transmitted and Blood-borne Infections currently recommends an opt-in approach for key groups and opt-out consent for the general population. I believe that this differentiation constitutes a barrier in access to testing and produces a crowding-out effect for key groups that fear stigmatization. ; «La fin du SIDA» prévue en 2030 par le plan 90-90-90 de l'ONUSIDA est-elle possible au Québec? L'offre universelle proportionnée et systématique de dépistage avec consentement opt-out (consentement présumé) apparait comme la politique sanitaire la plus pertinente et équitable à mettre en place en vue d'identifier les personnes vivant avec le VIH ignorant leur statut sérologique. Cette démarche à première vue contraignante vis-à-vis des libertés individuelles peut être largement compensée par des ...