Statement on HIV testing services
WHO, UNAIDS highlight new opportunities and ongoing challenges
28 August 2017 – HIV testing services are an essential gateway to HIV prevention, treatment, care and support services. 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. Increased access to and uptake of HIV testing is central to achieving the 90-90-90 targets1 endorsed in the 2016 United Nations Political Declaration on Ending AIDS. However, at the end of 2016, approximately 30% of people living with HIV were still unaware of their HIV status. Young people aged 15-24, adult males and people from key populations (men who have sex with men, transgender people, sex workers, people who inject drugs and people in prisons and other closed settings) often have significantly lower access to HIV testing services, are less likely to be linked to treatment and care and have lower levels of viral suppression.
There are many advantages to being tested. People who are found to be living with HIV can be linked to immediate offer of antiretroviral therapy. Early antiretroviral therapy maximizes the benefits for an individual’s health and effective antiretroviral therapy (when viral load suppression is achieved) can prevent HIV transmission to sexual and drug injecting partners and prevent mother-to-child transmission of HIV. Knowledge of HIV status also enables people to make informed personal decisions about using a range of effective HIV prevention options, including male and female condoms, harm reduction and pre- and post-exposure prophylaxis, or undergoing voluntary medical male circumcision.
WHO and UNAIDS do not support mandatory or compulsory testing of individuals on public health grounds. HIV testing, no matter how it is delivered, must always respect personal choice and adhere to ethical and human rights principles. Public health strategies and human rights promotion are mutually reinforcing. WHO and UNAIDS continue to highlight that all HIV testing services must adhere to the WHO “5 Cs”:
- Consent. HIV testing is a choice. Everybody should be given the opportunity to test for HIV, but an individual’s decision to take an HIV test must always be voluntary. People being offered testing for HIV must give informed consent. This means that they need to be informed of the process for HIV testing and confirming the results, the services that are available depending on the results and their right to refuse testing without consequences. Mandatory, compulsory or coerced testing is never appropriate, regardless of where that coercion comes from: health-care providers, partners, family members, employers, law enforcement officials or others.
- Confidentiality. Testing services must be confidential, meaning that 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 status. It is critical that the HIV status delivered to individuals is correct. To ensure that test results are accurate, all testing should be performed in accordance with WHO or national quality assurance systems and standards, including the use of the appropriate testing strategy based on the characteristics of the local epidemic, and with a validated testing algorithm. The test results must be communicated to the person tested unless that person subsequently decides that 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.
1: Whereby, by 2020, 90% of people (children, adolescents and adults, males and females) living with HIV know their status, 90% of people living with HIV who know their status are receiving antiretroviral treatment and 90% of people on treatment have suppressed viral loads.