From VCT to ‘routine testing’?
Why we should oppose a return by stealth to the days of mandatory HIV testing
It is time to raise the alarm about HIV testing. In addition to fighting HIV and AIDS, we now must return to an issue that many of us thought had been settled years ago: voluntary versus mandatory testing.
No-one who believes in enhancing treatment access can question the need to scale up HIV testing. The expression “routine testing” has been often used at the XV International AIDS Conference to describe this. On the surface, it may seem perfectly reasonable to choose the word “routine” to describe a procedure that is to be done systematically in a health setting.
However, given the past history of the responses to HIV/AIDS, there is an ominous subtext taking form. Early in the AIDS epidemic, members of affected communities and human rights activists argued that the HIV test must be voluntarily, because consent was central to encouraging testing and creating a climate of confidence and mutual trust between the person tested and service providers. Most public health professionals eventually recognized this.
The mounting pressure towards making HIV testing mandatory was curbed at that time. HIV testing with pre- and post-test counselling, often referred to as VCT (voluntary testing and counselling), became a central part of the global response to HIV/AIDS.
The experience of the last 20 years has clearly established that VCT remains the approach of choice to enhancing HIV/AIDS prevention, care and treatment, and today no one would dare claim mandatory testing in the health-care setting is an acceptable option. But with increasing frequency in recent months other terms have begun to creep into the dialogue gradually overshadowing VCT – most notably “routine testing.”
Why does this matter? Because the vagueness of this term hides the underlying intent and a range of practices, some of which with greatly damaging potential.
Much of the momentum behind the shift in terminology can be attributed to the urgency of scaling up access to antiretroviral (ARV) treatment throughout the world in particular where coverage of VCT remains low. Since many of the people who could benefit from ARVs do not currently know their HIV status, an enormous testing campaign must accompany any scale-up efforts. However, the rhetoric of “routine testing,” obscures a central issue – whether HIV tests are being routinely offered or routinely imposed, and whether in either case the individual has a true informed choice to opt in or opt out of being tested.
“Opt in” testing commonly refers to a situation in which patients are offered an HIV test by the service provider and make an informed decision to be tested. “Opt out” testing refers to a situation in which patients are systematically given an HIV test unless they take the initiative to decline.
If the world of HIV is to move forward we cannot afford vagueness in such critical concepts surrounding the key entry point to ART scaling-up. While every effort should be made to increase the practicality of VCT, the principle of voluntariness remains central to sound public health practice.
HDN Key Correspondent
Email: correspondents@hdnet.org
(July 2004)
It is time to raise the alarm about HIV testing. In addition to fighting HIV and AIDS, we now must return to an issue that many of us thought had been settled years ago: voluntary versus mandatory testing.
No-one who believes in enhancing treatment access can question the need to scale up HIV testing. The expression “routine testing” has been often used at the XV International AIDS Conference to describe this. On the surface, it may seem perfectly reasonable to choose the word “routine” to describe a procedure that is to be done systematically in a health setting.
However, given the past history of the responses to HIV/AIDS, there is an ominous subtext taking form. Early in the AIDS epidemic, members of affected communities and human rights activists argued that the HIV test must be voluntarily, because consent was central to encouraging testing and creating a climate of confidence and mutual trust between the person tested and service providers. Most public health professionals eventually recognized this.
The mounting pressure towards making HIV testing mandatory was curbed at that time. HIV testing with pre- and post-test counselling, often referred to as VCT (voluntary testing and counselling), became a central part of the global response to HIV/AIDS.
The experience of the last 20 years has clearly established that VCT remains the approach of choice to enhancing HIV/AIDS prevention, care and treatment, and today no one would dare claim mandatory testing in the health-care setting is an acceptable option. But with increasing frequency in recent months other terms have begun to creep into the dialogue gradually overshadowing VCT – most notably “routine testing.”
Why does this matter? Because the vagueness of this term hides the underlying intent and a range of practices, some of which with greatly damaging potential.
Much of the momentum behind the shift in terminology can be attributed to the urgency of scaling up access to antiretroviral (ARV) treatment throughout the world in particular where coverage of VCT remains low. Since many of the people who could benefit from ARVs do not currently know their HIV status, an enormous testing campaign must accompany any scale-up efforts. However, the rhetoric of “routine testing,” obscures a central issue – whether HIV tests are being routinely offered or routinely imposed, and whether in either case the individual has a true informed choice to opt in or opt out of being tested.
“Opt in” testing commonly refers to a situation in which patients are offered an HIV test by the service provider and make an informed decision to be tested. “Opt out” testing refers to a situation in which patients are systematically given an HIV test unless they take the initiative to decline.
If the world of HIV is to move forward we cannot afford vagueness in such critical concepts surrounding the key entry point to ART scaling-up. While every effort should be made to increase the practicality of VCT, the principle of voluntariness remains central to sound public health practice.
HDN Key Correspondent
Email: correspondents@hdnet.org
(July 2004)
posted by AIDS-Care-Watch at 7:26 pm
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