While the two organisations emphasise that all testing still needs consent, should be confidential and offered with appropriate counselling, they now say a variety of approaches to testing should be embraced, in addition to voluntary counselling and testing. Adopting the definitions proposed by a group of researchers from the Centers for Disease Control in a 2003 article in the influential medical journal The Lancet, UNAIDS/WHO now offers the following guidelines for HIV testing:
1. Voluntary counselling and testing
Client-initiated testing offered in conjunction with pre- and post-test counselling. Pre-test counselling may be provided in a group or individual setting, but results and follow-up must be given on an individual basis. UNAIDS/WHO recommend the use of rapid tests so that patients can learn their status immediately and post-test counselling can be administered in a timely manner.
2. Diagnostic HIV testing
A routine offer of testing should be offered to any patient showing signs or symptoms of an HIV-related disease or of AIDS as part of standard health management. This offer should be extended automatically to all tuberculosis patients.
3. Routine offer in select health-care settings
HIV tests should be offered to all patients assessed for sexually transmitted infections (in specially designated clinics or elsewhere), to any patient seen in the context of pregnancy, and to all patients seen in clinical and community-based health service settings where HIV is prevalent and anti-retroviral treatment is available – even if the patients are asymptomatic.
4. Mandatory testing
UNAIDS/WHO support the mandatory screening of donated blood for HIV and other blood-borne viruses and the mandatory screening of donors of body fluids or body parts. They do not support the mandatory testing of individuals on public health grounds, but emphasise that countries requiring HIV tests for immigration purposes or for enrolment in the military should conduct such testing only with appropriate counselling.
