Perceptions about HIV testing and their access to HIV tests. Formal social control can significantly affect HIV testing uptake. Most relevant are laws and policies that influence individuals’ decisions to be tested (e.g., anonymous testing, case reporting, partner notification) and laws and policies that address the consequences of an HIV-positive test result (e.g., anti-discrimination, access to treatment). HIV-related laws to protect individual privacy and prohibit discrimination against GGTI298 biological activity persons living with or affected by HIV addressed perceived barriers to testing such as fears about these repercussions.NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptAIDS Behav. Author manuscript; available in PMC 2011 December 1.Latkin et al.PageThese rights-protective laws encouraged persons at risk to seek testing voluntarily, which, by increasing testing rates, in turn required that resources be allocated for more HIV testing.NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptNew science and technologies, including the advent of effective treatment and rapid HIV testing technologies as well as research pointing to a disproportionate number of infections attributed to individuals unaware of their HIV positive status,75 lead public health leaders to reformulate the national approach to HIV testing. Relying on individuals to seek HIV testing services proved insufficient to increase the number of identified cases to significantly reduce HIV incidence.78 Consequently, the CDC began to recommend that most adults be routinely tested.94 Because this approach does not require individuals to initiate the testing process, motivational interventions to increase HIV testing may play a lesser role in achieving national HIV testing objectives than increasing access to HIV tests (e.g., efforts to mitigate the effect of competing priorities on provider ability and willingness to offer patients HIV tests and to recruit and train additional testing personnel).79,94,95 From a structural systems perspective it is important to assess how national HIV testing guidelines may lead to unanticipated changes at the macro, meso, and micro levels. It is also important to examine how the reallocation of resources to support increased testing may impact other HIV prevention programs and organizations and to assess whether policy changes alter norms regarding pre- and post-test counseling. One potential unanticipated outcome may be the altering of social interconnectedness through greater serosorting behaviors. Ethical Issues with Structural-level HIV Interventions Although structural interventions make fewer demands on individual resources, the ethical implications of attempting to manipulate structural-level factors to affect individual behavior can be quite serious. As described above, structural forces are broad, external to the individual, and beyond individual control. Structural interventions may leave some individuals pursuing goals that they did not choose with methods that they CPI-455 web cannot avoid. Such programs can compromise individual autonomy by burdening or eliminating behavioral options, thereby reducing individual choice. For example, criminal laws that require persons living with HIV to disclose their serostatus to prospective sexual partners effectively preclude infected individuals from legally exercising other options, such as practicing safer sex or engaging in alternatives to penetrative sex.96 The option to allow.Perceptions about HIV testing and their access to HIV tests. Formal social control can significantly affect HIV testing uptake. Most relevant are laws and policies that influence individuals’ decisions to be tested (e.g., anonymous testing, case reporting, partner notification) and laws and policies that address the consequences of an HIV-positive test result (e.g., anti-discrimination, access to treatment). HIV-related laws to protect individual privacy and prohibit discrimination against persons living with or affected by HIV addressed perceived barriers to testing such as fears about these repercussions.NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptAIDS Behav. Author manuscript; available in PMC 2011 December 1.Latkin et al.PageThese rights-protective laws encouraged persons at risk to seek testing voluntarily, which, by increasing testing rates, in turn required that resources be allocated for more HIV testing.NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptNew science and technologies, including the advent of effective treatment and rapid HIV testing technologies as well as research pointing to a disproportionate number of infections attributed to individuals unaware of their HIV positive status,75 lead public health leaders to reformulate the national approach to HIV testing. Relying on individuals to seek HIV testing services proved insufficient to increase the number of identified cases to significantly reduce HIV incidence.78 Consequently, the CDC began to recommend that most adults be routinely tested.94 Because this approach does not require individuals to initiate the testing process, motivational interventions to increase HIV testing may play a lesser role in achieving national HIV testing objectives than increasing access to HIV tests (e.g., efforts to mitigate the effect of competing priorities on provider ability and willingness to offer patients HIV tests and to recruit and train additional testing personnel).79,94,95 From a structural systems perspective it is important to assess how national HIV testing guidelines may lead to unanticipated changes at the macro, meso, and micro levels. It is also important to examine how the reallocation of resources to support increased testing may impact other HIV prevention programs and organizations and to assess whether policy changes alter norms regarding pre- and post-test counseling. One potential unanticipated outcome may be the altering of social interconnectedness through greater serosorting behaviors. Ethical Issues with Structural-level HIV Interventions Although structural interventions make fewer demands on individual resources, the ethical implications of attempting to manipulate structural-level factors to affect individual behavior can be quite serious. As described above, structural forces are broad, external to the individual, and beyond individual control. Structural interventions may leave some individuals pursuing goals that they did not choose with methods that they cannot avoid. Such programs can compromise individual autonomy by burdening or eliminating behavioral options, thereby reducing individual choice. For example, criminal laws that require persons living with HIV to disclose their serostatus to prospective sexual partners effectively preclude infected individuals from legally exercising other options, such as practicing safer sex or engaging in alternatives to penetrative sex.96 The option to allow.