1. UNAIDS/WHO POLICY ON HIV TESTING June 2004

2. The Context critical opportunity to expand access
to HIV prevention and treatment
currently only 10 % of those who
need VCT have access to it
stigma and discrimination continue
to prevent people from having an
HIV test.

3. Khayelitsha: Availability of decentralized antiretroviral therapy (ART) access, advocacy, and multi-disciplinary support services dramatically increases demand for testing and counselling
HIV tests
Support groups
15,000 25
12,000 20
9,000 15
6,000 10
3,000 5
1998
2002
1998
2002
Before ART
ART started
Source: WHO, 2004 (courtesy of Dr. Fareed Abdullah)

4. Underpinning principles: 3 C’s
confidential
accompanied by counselling
only be conducted with informed consent, i.e. both informed and voluntary.

5. UNAIDS/WHO recommend that the following four types of HIV testing be clearly distinguished:
Client initiated
Voluntary counselling and testing (VCT)
Provider-initiated
Routine offer of HIV testing by health care providers
Diagnostic HIV testing
Mandatory testing

6. Client-initiated voluntary counselling and testing
effective promotion of knowledge of HIV status among any population that may have been exposed to HIV through any mode of transmission
pre-testing counselling: on an individual basis
or in group settings with individual follow-up
use of rapid tests; results are provided in a
timely fashion for both HIV-negative and
HIV- positive individuals.

7. Provider-initiated diagnostic HIV testing
Indicated whenever a person shows:
signs or symptoms that are consistent with HIV-related disease or AIDS
to aid clinical diagnosis and management.
This includes offering HIV testing to all tuberculosis patients as part of their routine management.

8. Provider-initiated routine offer of HIV testing
in sexually transmitted infection clinics – to permit counselling tailored to HIV status
in the context of pregnancy - to facilitate an
offer of antiretroviral prevention of mother-to-child transmission
in clinical and community based health service settings where HIV is prevalent and antiretroviral treatment is available

9. Essential conditions for provider-initiated HIV testing
referral to post-test counselling services emphasising prevention
referral to medical and psychosocial support, for those testing positive.
basic conditions of confidentiality, counselling and consent

10. Minimum information required in order to be able to give informed consent to provider-initiated HIV testing:
clinical and prevention benefits of testing
right to refuse
follow-up services offered
in the event of a positive test result, anticipating the need to inform anyone at ongoing risk who would otherwise not suspect they were being exposed to HIV infection

11. Mandatory HIV screening
all blood destined for transfusion or manufacture of blood products
all procedures involving transfer of bodily fluids or body parts
UNAIDS/WHO do not support mandatory
testing of individuals on public health grounds.
Voluntary testing is more likely to result in
behaviour change to avoid transmitting HIV to
other individuals

12. Mandatory HIV testing
Mandatory testing for immigration or military purposes should be conducted only when accompanied by counselling for both HIV-positive and HIV-negative individuals and referral to medical and psychosocial services for those who receive a positive test result.

13. UNAIDS/WHO HIV Testing Policy
The 3 Cs
4 types of testing
Client –initiated (VCT)
Provider-initiated
Diagnostic
Routine (universal; systematic) offer
Mandatory

14. That’s all folks…..