"The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) endorse and encourage universal access to knowledge of HIV status."
Scaling up HIV testing services is key to meeting one of the targets set out by UNAIDS's 90-90-90 strategy to help end the AIDS epidemic: by 2020, 90% of all people living with HIV will know their HIV status. However, at the end of 2016, approximately 30% of people living with HIV were still unaware of their HIV status. To address this gap, this joint statement from the WHO and UNAIDS articulates key principles that ensure a human rights-based and public health approach to HIV testing.
WHO and UNAIDS continue to highlight that all HIV testing services must adhere to the "5 Cs":
- Consent: Everybody should be given the opportunity to test for HIV, but an individual's decision to take an HIV test must always be voluntary.
- Confidentiality: The test results and the content of discussions between the person tested and the testing provider, counsellor, and/or other health-care workers will not be disclosed to anyone else without the consent of the person tested.
- Counselling: Appropriate and high-quality brief pre-test information and post-test counselling tailored to the person and the test results must be available.
- Correct results: All testing must be performed in accordance with WHO or national quality assurance systems and standards and with a validated testing algorithm. The test results must be communicated to the person tested unless that person subsequently decides they do not wish to receive the results.
- Connections: Linkage to HIV prevention, treatment and care and support services should be supported through concrete and well-resourced patient referral, support, and/or tracking systems.
It is recommended that HIV testing services be available through a wide range of service delivery models and approaches tailored to the epidemiological context in order to reach all populations, especially populations currently being underserved by existing services. These include facility-based testing approaches - i.e., provider-initiated testing and counselling (PITC) - and community-based testing approaches delivered by community members with certified training in HIV testing (lay and peer providers). WHO also recommends two new HIV testing services approaches:
- HIV self-testing, which can be performed accurately and has been shown to increase the uptake and frequency of testing without increasing risk behaviours, social harm, or adverse events. Good linkage to treatment and prevention services following HIV self-testing can also be achieved, especially when supported by and integrated into community-based systems. Some communication-related considerations include:
- HIV self-testing kits must have appropriate, validated, clear, and concise instructions that should be supplemented by additional accessibility support tools, including demonstrations, and audiovisual aids to meet the needs of people with different levels of education, literacy, and disability.
- All people who have a reactive (positive) HIV self-testing result should to be provided with clear information that they need further HIV testing by a person trained in HIV testing in either a community or facility-based setting to confirm their test results. (People who have a nonreactive (negative) HIV self-testing result should be informed that they can consider their result as negative.)
- Clear information should be provided about what to do if a person is unable to complete the HIV self-testing or if they are in doubt or unable to interpret the result. In such cases, individuals should be provided with information on where and how to access alternative HIV testing services and encouraged to seek testing at community- or facility-based HIV testing services.
- Pre-test information and post-test counselling, including linkage to clinical services and community support groups, must be accessible and available to all people who use HIV self-testing kits.
- HIV testing through voluntary assisted partner notification, which aims to increase access to HIV testing for the sexual and drug injecting partners of people living with HIV. Some communication-related considersations include:
- Partner notification must be voluntary, and confidentiality must be ensured. It is important to protect the privacy and personal and health information of every person living with HIV.
- People living with HIV should be given options for how to notify their partners, and partner notification services should be offered to people living with HIV regularly.
All providers of HIV testing services should have codes of conduct, a regulatory framework, and systems in place for redress for patients whose rights are infringed.
The statement explores issues including quality of testing and HIV testing services policies. It is noted that the expansion of voluntary HIV testing services should include improved protection from stigma and discrimination related to HIV-positive status and HIV risk behaviours. HIV testing services should also facilitate linkage to HIV prevention, treatment, care, and support services, in an environment that guarantees confidentiality of all medical information.
The statement concludes by reiterating that WHO and UNAIDS do not support mandatory or compulsory testing of individuals on public health grounds. The only exceptions are: screening for HIV and other bloodborne infections of all blood destined for transfusion or for the manufacture of blood products, and screening of donors prior to all procedures involving the transfer of bodily fluids or body parts.
UNAIDS website, September 27 2017.