Human rights and public health experts concur that there is an urgent need to rapidly scale up HIV testing and counseling services. However, there are concerns that provider initiated testing and counseling is being scaled up in an environment where increasingly evidence informed and rights based HIV responses are being severely undermined. For example, a presentation from the Philippines discussed how migrant workers are usually tested without consent and that punitive measures such as detention and deportation force migrants underground – limiting their access to prevention, treatment, care and support services.   Another major concern is that efforts to scale up testing are not sufficiently linked to measures to reduce stigma and discrimination and strengthen legal protections.

There is a concern that opt out approach of PITC will make it difficult to get real informed consent. Instead, it  would be better to expand routine offer of HIV testing and counseling with opt in or specific agreement.  Another major concern is that efforts to scale up testing are not sufficiently linked to prevention, treatment, care and support services. For example, migrants  are often tested and then routinely denied access to support and services.

It was clear from the presenters from Mali and Kenya that what is critical for scaling up testing and counseling is having multiple models and sites – mobile testing, VCT sites, PITC, community based testing and counseling. There needs to be political commitment for this and a conducive policy environment.  All approaches/models should respect human rights.  An HIV-positive woman from Bolivia stated that when testing is done in a manner that violates human rights – it  can lead to denial and  is counter productive. HIV testing and counseling services should take into account the gender dimensions of the epidemic  -disclosure can be problematic for women. It is important to promote couples testing counseling and also implement strategies to increase male uptake of testing and counseling services.

Finally, it was interesting to note that all presenters concurred that in scaling up HIV testing and counseling services, public health and human rights objectives cannot be at odds.

(Reported by Bechir Ndaw)

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Increasing access to HIV testing and counseling while respecting human rights

The session discussed the recent WHO and UNAIDS Guidance on Provider-Initiated HIV Testing and Counseling in Health Facilities, which under certain circumstances recommends that people in health care settings should be tested after receiving information about the HIV test, unless they specifically decline the HIV test.

The session also focused on the separate policy statements that have been developed concerning scaling up of HIV testing and counseling among some of the most vulnerable and most-at-risk populations, such as prisoners and people who use drugs.

The discussions stressed the consensus about the need to scale up access to HIV testing and counselling and the agreement of AIDS and human rights activists, public health officials and policy makers to scale up access to affordable and high-quality HIV testing. In this context, it was questioned whether the introduction of provider-initiated testing was necessary.  Evidence and suggests that many opportunities to diagnose and counsel individuals at health facilities were missed when systems rely solely on clients to initiate VCT.

Finally, the session discussed issues such as informed consent, testing and counselling and confidentiality which remain critical. However, human rights and public health should avoid introducing cumbersome procedures for pre-test counselling. Human rights and public health are not inherently in conflict around testing issues.