The role of HIV counseling and testing in the developing world

The role of voluntary HIV counseling and testing is still under debate, especially in the developing world. HIV counseling-and-testing (HIV CT) services are a major component of HIV and AIDS control programs in the industrialized world and are increasingly being advocated in the developing world. In the United States, voluntary HIV CT has been a major component of HIV prevention efforts since the HIV antibody test became available in 1985. Yet even in the United States, questions about the management, cost, and effectiveness of voluntary HIV CT services continue to be raised. Because HIV CT has multiple goals, the evaluation of its effectiveness is a complicated task. Worldwide, a broad range of ethical, social, policy, technical, and economic issues encompass this HIV prevention activity. This article identifies the substantial barriers and serious concerns that are raised about HIV CT services and attempts to highlight the potential advantages of providing HIV CT as part of a developing country's comprehensive HIV prevention strategy.