Kavanagh, M. M., Baral, S. D., Milanga, M., & Sugarman, J. (2018). Biometrics and public health surveillance in criminalised and key populations: policy, ethics, and human rights considerations. The Lancet HIV.
Summary
Widespread public health surveillance efforts focused on key populations (men who have sex with men, sex workers, people who inject drugs, and others) gather data on population sizes, HIV prevalence, and other information for planning and resource allocation. Biometric identification might improve this data gathering. However, in the context of extensive criminalisation of these populations, the use of biometrics such as fingerprints raises concerns that are insufficiently addressed in current policies. These concerns include infringing privacy, exposing participants to risks of legal action or violence, biasing surveillance results, and undermining trust in the health system. We set out key ethics and human rights considerations regarding the use of biometrics in HIV surveillance among these populations, and outline a typology of jurisdictions wherein such methods might be considered, based on data about legal, political, and social environments. In this Review, we suggest that the biometrics approach is not currently likely to be appropriate in many jurisdictions.
Introduction
The global strategy to end the public health threat of the HIV pandemic is increasingly based on target setting for HIV testing, treatment, and prevention programming, with marked specificity of geography, population, and age to maximise effects on mortality, morbidity, and transmission.1, 2, 3 The gathering of data to enable such targeting necessitates robust public health surveillance efforts, including among key populations: gay men and other men who have sex with men, sex workers, transgender people, prisoners, and people who inject drugs.4, 5 Availability of services for these groups can depend on estimates of population size and HIV prevalence. However, in many contexts, the populations, occupations, and practices among those at the highest risk of HIV infection are stigmatised or criminalised, making ascertainment of these estimates challenging. Use of biometric identifiers has been proposed as a means of enhancing the accuracy of HIV surveillance, but is associated with hazards related to stigmas and punitive legal frameworks in many jurisdictions. Current policies insufficiently address the use of biometrics in HIV surveillance; neither WHO nor the major global funders of surveillance activities, such as the US President's Emergency Plan for AIDS Relief (PEPFAR) and The Global Fund to Fight AIDS, Tuberculosis, and Malaria, have publicly issued policies on the use of biometrics for this purpose.6 In this Review, we set out key ethics and human rights considerations regarding the use of biometric identifiers in HIV surveillance among criminalised and key populations, and delineate policy recommendations for their appropriate use.