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Molldrem and Smith (2020) are to be commended for their insightful analysis of a public health practice that has received little attention among bioethicists: the use of molecular HIV surveillance (MHS) and cluster detection and response (CDR) for epidemiology and prevention. We agree with the authors that these methodologies raise potential issues of justice in relation to marginalized and vulnerable groups, and the essential need for meaningful, responsive community engagement around these practices and public health surveillance generally. However, we argue that their analysis underplays a number of key considerations that are important for a nuanced ethical assessment of MHS and CDR. These considerations fall under the broad categories of consent, risk/benefit, and justice.