KHOPOTSO: The policy was first introduced in the United States as far back as 1992. But what is routine HIV testing, and why is it gaining popularity as an alternative to voluntary counselling and testing? Judith Auerbach is Vice-President for Public Policy with the American Foundation for AIDS Research in Washington, D.C.
JUDITH AUERBACH: In any context including the United States, there’s a very large proportion of people who are HIV infected but don’t know it. So, in our case the policy has been sort of shifting from a focus on aiming our prevention efforts at uninfected people and how to protect themselves from infection towards addressing infected persons: Firstly, finding out their HIV status, so that then we can talk about HIV prevention from their end as well as determining where they fit in the treatment arena. It’s important for people to understand, I think that the shift has to do with the availability of treatment, and so the inter-section of prevention and treatment is now very real.
KHOPOTSO: Dr Ron Valdisseri is with the Centres for Disease Control and Prevention (CDC) in Atlanta, Georgia, United States.
DR VALDISSERI: We estimate in the United States (that) as many as 25% – one quarter of the nearly one million people we have in our country who are infected with HIV – don’t know it. And so, we’re very concerned from a medical point of view that if as many as 250 000 persons in the U.S. have HIV and don’t know it, they cannot take advantage of antiretroviral therapy. And we’re equally concerned that persons who are infected with HIV and don’t know it are more likely to spread the virus to their partners. So, a major focus of the United States’ prevention policy in the recent past has been to really try to reach out to those nearly quarter of a million people who are infected with HIV and don’t know it: to get them diagnosed early; and into care; and, equally important, to make sure that they have on-going prevention. And part of that strategy is a greater emphasis on routine HIV testing.
KHOPOTSO: Routine HIV testing, what is it, is it compulsory testing?
DR VALDISSERI: When we say ‘routine testing’ we are still talking about voluntary testing. What we mean for instance, a very good example is that, persons who encounter the health care system, whether that’s in an emergency room, or an out-patient clinic, or a private doctor’s office, really should have HIV testing routinely offered and provided to them.
KHOPOTSO: Say, for instance I present at a clinic, will I be given a form to fill out that (says) ‘look, we are going to run test A, B, C on you. You can tick which tests you agree to and which tests you do not agree to?’
DR RON VALDISSERI: ‘¦In the same way that the U.S continues to support voluntary testing, we also support the importance of informed consent, meaning that a person understands that they are being tested. However, having said that the way that the laws work in the United States is that laws related to testing and medical procedures are developed at an individual state level and vary from state to state. So, in some states for instance, there is a requirement that persons actually have to sign a piece of paper saying that ‘I give consent to be tested.’ But it varies from state to state.
KHOPOTSO: People in human rights might argue that this is actually in contravention of patients’ rights’¦ It would seem that there is not so much of the pre-test counselling that should go into that. Does that fly out the window with this policy?
DR RON VALDISSERI: No, it doesn’t’¦ We do believe that in the best possible situation that every person who is going to receive testing, receives pre-test counselling. But we also recognise that in some circumstances providers might not have time to do extensive pre-test counselling’¦ For instance, in an emergency room or in a doctor’s office setting, we’ve gone on record with the policy that the US CDC has said that ‘everyone who’s being tested should know that they are being tested; they should give consent to the testing; and they should have basic information about what the test results mean.’ But if the health care provider doesn’t have time to go into lengthy pre-test counselling, that’s okay – it’s permissible. Actually, what’s more important is the post-test counselling. Once the patient gets his or her results, whether those are positive or negative – that’s really where the energy needs to be spent.
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