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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.
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1. |
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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.
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2. |
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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.
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3. |
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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.
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4. |
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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.
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5. |
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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. |