• Ethan Cowan and Ruth Macklin.
• Department of Emergency Medicine, Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, NY, USA. ethan.cowan@nbhn.net
• Acad Emerg Med. 2012 Oct 1;19(10):1181-7.

AbstractPostexposure prophylaxis (PEP) has substantially reduced the risk of acquiring human immunodeficiency virus (HIV) after an occupational exposure; nevertheless, exposure to HIV remains a concern for emergency department providers. According to published guidelines, PEP should be taken only when source patients are HIV-positive or have risk factors for HIV. Initiating PEP when source patients are uninfected puts exposed persons at risk from taking toxic drugs with no compensating benefit. Forgoing PEP if the source is infected results in increased risk of acquiring HIV. What should be done if source patients refuse HIV testing? Is it justifiable to test the blood of these patients over their autonomous objection? The authors review current law and policy and perform an ethical analysis to determine if laws permitting unconsented testing in cases of occupational exposure can be ethically justified.© 2012 by the Society for Academic Emergency Medicine.

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