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Abstract
Routine testing: Are we ready to throw human rights out of HIV testing policy?
J. Csete, R. Elliott
Canadian HIV/AIDS Legal Network, Toronto, Canada
Issues: Calls are increasingly made for expanding provider-initiated “opt-out” HIV testing as a routine part of health services. Some such proposals would set aside internationally accepted practices that protect the rights of those tested, including pre- and post-test counselling and specific informed consent; commitment to confidentiality of test results may also be compromised. Some support for provider-initiated “opt-out” approaches is motivated by a singular desire to increase the number of people tested, but this may not always be the right goal. A focus on more HIV tests alone may overlook the consequences of testing people who are not ready to be tested or who have not had a chance to ask questions about how to understand and disclose their HIV status.
Description: In 2005, an international meeting on HIV testing asked the Canadian HIV/AIDS Legal Network to develop a human rights-based analysis of routine-testing proposals.
Lessons learned: Depression, suicide, abandonment and violence have been documented linked to HIV testing and disclosure in many settings, especially among women. The relationship of these outcomes to the absence of counselling and informed consent has been little studied. Tolerance for any level of abuse as a result of HIV testing without human rights protections should be questioned, particularly if there are reasonable alternatives to meet public health goals. The voluntary counselling and testing (VCT) model developed in the first decade of global HIV/AIDS programs was inadequately funded in many countries. It is unclear whether the alleged inadequacies of VCT are a result of underinvestment in its implementation or an ill-conceived model.
Recommendations: Research is urgently needed on the real experience of both VCT and provider-initiated models. This research must meaningfully involve people living with HIV and others who have experienced HIV testing, especially womem tested in antenatal care.
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