Bangkok 2004. Current issues and concerns in HIV testing: a health and human rights approach

In the rush to scale up HIV testing, partially justified by the fact that treatment is becoming more widely available, the long-held view that testing must be voluntary, and that it must be accompanied by pre- and post-test counselling, is being increasingly questioned. However, as long as stigma, discrimination, and unequal access to care and treatment continue, the individual informed decision to take an HIV test must remain an integral step in medical practice. In this article, based on her presentation at an oral abstract session of the XV International AIDS Conference in Bangkok on 14 July 2004, Sofia Gruskin describes the developments that have led some people to question voluntary testing and counselling (VTC); outlines the factors that need to be considered in analyzing whether a proposed HIV testing strategy is effective in both health and human rights terms; calls for clarity in the use of terms such as "routine testing," "opting in," and "opting out"; and provides a list of considerations that must be addressed for any scaling up of HIV testing to be successful.