UNAIDS, WHO Release New HIV Testing Guidelines
The World Health Organization and UNAIDS on Wednesday released new HIV testing guidelines that advise health care workers in countries with an HIV prevalence greater than 1% to routinely offer confidential, voluntary HIV tests to all patients seeking treatment at clinics or hospitals regardless of why they initially sought care, the Washington Post reports (Timberg, Washington Post, 5/31). Earlier WHO and UNAIDS guidelines advised health workers to offer HIV tests only if treatment was available, and health workers often administered the tests only when requested, according to the New York Times (LaFraniere, New York Times, 5/31).
According to the Post, people would be allowed to decline testing under the guidelines. In addition, the guidelines require that everyone who receives an HIV test also receive counseling. The guidelines also advise physicians worldwide to offer testing to patients who show signs of HIV infection (Washington Post, 5/31). The guidelines also suggest HIV testing for anyone whose medical histories suggest possible HIV infection, including children of HIV-positive women and people with tuberculosis (New York Times, 5/31). Botswana, Kenya, Malawi and Uganda already have implemented testing policies similar to the new guidelines (Washington Post, 5/31).
Prevention, Treatment Efforts
Expanded testing might improve prevention efforts, although research has not found a correlation between high rates of testing and decreasing numbers of new HIV cases, according to the Post (Washington Post, 5/31). According to the Times, four out of five HIV-positive people in low- to middle-income countries are unaware of their HIV-positive status, and officials estimate that 20 million people in sub-Saharan Africa are unaware of their status (New York Times, 5/31). In addition, the new recommendations underline the need to identify the millions of HIV-positive people worldwide who need treatment access. Almost five million people in sub-Saharan Africa do not have access to treatment. Identifying more HIV-positive people in need of treatment in countries with limited means might create a larger backlog of people with no access to treatment, according to the AP/Forbes. However, some experts say that increased HIV testing would still be helpful, the AP/Forbes reports. "No one wants a situation where people find out they're HIV positive and can't get anti-retroviral treatment," Jennifer Kates, vice president and director of HIV policy for the Kaiser Family Foundation, said, adding, "But if we waited until everything was perfectly aligned, we would never respond."
In addition, not everyone who tests positive for HIV will need drugs immediately. Previous studies also have also shown that once people are aware of their HIV-positive status, they tend to practice safer sex (Cheng, AP/Forbes, 5/30).
Kevin De Cock, head of WHO's HIV/AIDS Department, said that HIV diagnosis is "an essential first step" to curbing the spread of the virus (New York Times, 5/31). He added, "If we are serious about ensuring universal access to drugs, there has to be a fundamental change in the approach to HIV testing" (AP/Forbes, 5/30). Zachie Achmat, an HIV/AIDS advocate in South Africa, said the guidelines are "long, long overdue and require rapid implementation," adding, "It would be entirely substandard medical practice not to recommend that any person in a high-burden country be tested for HIV." According to the Times, some human rights advocates have said that because of stigma associated with HIV/AIDS, no one should be pressured to receive an HIV test if it could lead to job loss or abandonment by families (New York Times, 5/31).
Individual nations will decide whether to implement the new guidelines and allocate funding to expand HIV testing, according to the Post. No new funding from the United Nations has been allocated to the initiative. Derek von Wissell, head of Swaziland's national AIDS council, said that the country likely does not have the resources necessary to implement the new guidelines (Washington Post, 5/31). According to De Cock, the cost of expanding HIV testing is low when compared with the overall cost of HIV prevention and treatment. De Cock added that the new guidelines likely will depend on hiring and training low-level health workers because most low-income countries do not have enough physicians and nurses to handle expanded testing (New York Times, 5/31).
The guidelines are available online.