Box 5.1: HIV testing and counselling: guiding principles
Consolidated ARV guidelines, June 2013
All forms of HIV testing and counselling should be voluntary and adhere to the five C’s: consent, confidentiality, counselling, correct test results and connections to care, treatment and prevention services.
Mandatory or coerced testing is never appropriate, whether that coercion comes from a health care provider or from a partner or family member.
The following key principles apply to all models of HIV testing and counselling and in all circumstances.
- People receiving HIV testing and counselling must give informed consent (verbal consent is sufficient and written consent is not required) to be tested and counselled. They should be informed of the process for HIV testing and counselling and their right to decline testing.
- HIV testing and counselling services are confidential, meaning that what the HIV testing and counselling provider and the person discuss will not be disclosed to anyone else without the expressed consent of the person being tested. Although confidentiality should be respected, it should not be allowed to reinforce secrecy, stigma or shame. Counsellors should raise, among other issues, whom else the person may wish to inform and how they would like this to be done. Shared confidentiality with a partner or family members and trusted others and with health care providers is often highly beneficial.
- HIV testing and counselling services must be accompanied by appropriate and highquality pre-test information (which can be provided as group pre-test information in some settings) and post-test counselling. Quality assurance mechanisms and supportive supervision and mentoring systems should be in place to ensure the provision of high-quality counselling.
- HIV testing and counselling providers should strive to provide high-quality testing services, and quality assurance mechanisms should be in place to ensure the provision of correct test results. Quality assurance may include both internal and external measures and should include support from the national reference laboratory as needed.
- Connections to prevention, care and treatment services should include the provision of effective referral to appropriate follow-up services as indicated, including longterm prevention and treatment support.
Quality assurance of both testing and counselling is essential in all approaches used.