UNAIDS
Policy on HIV testing and counselling
Voluntary
HIV testing accompanied by counselling has a vital role to play
within a comprehensive range of measures for HIV/AIDS prevention
and support, and should be encouraged. The potential benefits
of testing and counselling for the individual include improved
health status through good nutritional advice and earlier access
to care and treatment/prevention for HIV-related illness; emotional
support; better ability to cope with HIV-related anxiety; awareness
of safer options for reproduction and infant feeding; and motivation
to initiate or maintain safer sexual and drug-related behaviours.
Other benefits include safer blood donation.
UNAIDS
therefore encourages countries to establish national policies
along the following lines.
1.
Make
good-quality, voluntary and confidential HIV testing and counselling
available and accessible. Reliable HIV testing should be made
available on a voluntary and confidential basis. Voluntary testing
should be provided in a non-stigmatizing environment, and the
services should include pre-test counselling (where possible
and if desired), informed consent, and post-test counselling.
In
designing these services, countries should give special consideration
to increasing women's voluntary acess to them. Women should
be offered information on reproductive and infant feeding options
and on the use of antiretroviral treatment to reduce the risk
of mother-to-child (vertical) HIV transmission. Regardless of
the presence of risk factors or the potential for effective
intervention to prevent transmission, women should not be coerced
into testing, or tested without consent. Instead, they should
be given all relevant information and allowed to make their
own decisions about HIV testing, reproduction and infant feeding.
HIV
testing and counselling for couples is effective, and their
voluntary participation should be encouraged. Special consideration
should also be given to offering voluntary HIV testing and counselling
to people thought to engage in high-risk sexual or drug-related
behaviour.
2.
Ensure
informed consent and confidentiality in clinical care, research,
the donation of blood, blood products or organs, and other situations
where an individual's identity wll be linked to his or her HIV
test results. In situations of linked HIV testing, the individual
should be informed of the potential benefits and risks of an
HIV test; the principles of voluntary testing including informed
consent and confidentiality should be respected; and post-test
counselling should be provided.
3.
Strengthen
quality assurance and safeguards on potential abuse before licensing
commercial HIV home collection and home self-tests. HIV home
collection tests (in which specimens are collected at home and
sent off for analysis) and home self-tests offer the advantages
of enhanced access and anonymity. However, these tests may have
serious negative consequences, especially if they are not connected
with confirmatory testing, and with counselling and care services,
or if they are applied coercively to spouses, sex partners,
and people seeking employment, entitlements or services. Licenses
for commercial "home" tests should be continuously reviewed
and test uses monitored.
4.
Encourage
community involvement in sentinel surveillance and epidemiological
surveys. HIV testing conducted for these purposes is usually
anonymous and unlinked, and may not require individual consent.
However, the findings of such surveys are of great community
concern, and so communities need to have a sense of "ownership"
of the process. Community consent should be secured before surveys
are conducted, and the community should be involved in the survey
and have access to the results.
5.
Discourage
mandatory testing. HIV testing without informed consent and
confidentiality is a violation of human rights. Moreover, there
is no evidence that mandatory testing achieves public health
goals. UNAIDS therefore discourages this practice. HIV testing
in which the individual's identity is linked to the test result
must not be done without the individual's informed consent.
In addition, he or she should receive post-test counselling,
and have the assurance that all results - including the fact
that a test was performed - will be kept confidential.
This
statement summarizes UNAIDS' position on HIV testing and on
counselling issues related to HIV testing. It is addressed to
national authorities and is meant to facilitate the development
or strengthening of national policies on the subject.