The UN World Health Organization (WHO) and the Joint UN Programme Against HIV/AIDS (UNAIDS) called for increased health care provider-initiated testing and counselling.

The prevailing model now is voluntary testing and counselling, where individuals actively seek diagnosis. But experts say this system is impeded by the fear of stigma and discrimination, limited accessibility to services and the perception of many – even in areas with high rates of HIV infection – that they are not at risk.

Roughly 80 per cent of people living with HIV in low and middle-income countries are unaware that they have been infected with the disease. In sub-Saharan Africa, recent surveys demonstrate that only 12 per cent of men and 10 per cent of women have been tested for HIV and have received their results.

Increasing access to testing and counselling is crucial in encouraging earlier diagnosis of HIV infection, which could maximize the potential benefits of treatment and care and also arm those with HIV with information and tools to prevent transmission of the virus.

“If we are going to get ahead of this epidemic, rapidly scaled up HIV treatment and prevention efforts are critical – and increased uptake of HIV testing will be fundamental to making this a reality,” said Paul De Lay, Director of Monitoring and Evaluation at UNAIDS.

The WHO/UNAIDS guidance recommends that in generalized HIV epidemics, HIV testing and counselling should be recommended to all patients in all health facilities, while in concentrated and low-level epidemics, countries should recommend testing to all patients seeking treatment in certain areas, such as antenatal care and tuberculosis.

Other key recommendations of the two agencies include ensuring that all HIV testing is voluntary, confidential and undertaken with the patient’s consent; recognizing that patients have the right to decline tests; and linking testing to prevention, treatment, care and support.

“We hope that the new guidance will provide an impetus to countries to greatly increase availability of HIV testing services in health care settings, through realistic approaches that both improve access to services and, at the same time, protect the rights of individuals,” said WHO HIV/AIDS Director Kevin De Cook.

WHO and UNAIDS stressed that HIV testing and counselling initiated by health care providers is not, and should not be construed as, an endorsement of coercive or mandatory HIV testing.