HIV testing should be widely accepted, without conventional voluntary counselling and testing

HIV testing should no longer be accorded any special status, argue two senior doctors in this week's BMJ.

Voluntary HIV counselling and testing has been accepted practice for more than 10 years, but uptake has been poor, even among those at high risk, resulting in late diagnosis and ongoing spread of infection.

Unless further initiatives are undertaken the epidemic will worsen, they warn.

They believe that HIV testing should be widely accepted, without conventional voluntary counselling and testing, as patients at risk of cancer do not receive voluntary counselling and testing before chest x rays, or patients with chest infections do not receive voluntary counselling and testing before investigations are carried out.

The current combination of a lack of time for pre-test counselling and denial by patients has resulted in late diagnoses and ongoing spread of infection, they say. They propose that if a patient freely consents to be investigated, a doctor can initiate tests aimed at excluding serious diseases without an in-depth discussion of all possible results, provided that the test result, positive or negative, should benefit the patient.

Routine voluntary counselling and testing was appropriate to the 1980s, but times have changed and the benefits of early diagnosis of HIV are multiple. HIV testing should now not be accorded any special status. Doctors should now undertake the test by using the same approach as used in any other test with serious implications, they conclude.