Testing Considerations

Resource issues

It is important for programs to decide whether HIV testing is the best use of the resources available to address the HIV/AIDS epidemic in a specific setting. Since treatments are costly and often unavailable in low-resource settings, an ethical dilemma exists about offering HIV testing in settings where nothing can be done for those who test positive for the infection.

While knowing one’s HIV status can presumably lead to stronger prevention efforts, there are also questions about whether knowing one’s test results leads to behavior change (this is discussed further in the “Preventing HIV Infection” module of this course).

Preparing providers to feel competent and comfortable counseling clients about HIV testing issues, particularly about handling positive results, is another resource concern. Sites must be adequately staffed by providers with high-quality training in counseling and testing.

Tests that yield rapid results enable programs to deal with one of their main problems—clients who do not return for results. In settings where clients face considerable obstacles for repeat visits to services (cost of transportation, loss of income due to job absence, etc.), rapid-results tests can eliminate the need for extra visits. Several recent research studies and programs in Africa have reported success with implementing HIV counseling and testing in low-resource settings, particularly through the use of rapid-testing techniques.

Confidentiality issues

In addition, there are concerns about maintaining confidentiality of test results, in part because of the stigma attached to HIV infection in many settings and the potential for discrimination against, violence toward, and community rejection of individuals who test positive. Also, coercion into test taking is a concern in some settings. That is why testing must always be voluntary and based on the informed consent of clients. As such, counseling is an integral component of testing.

It is essential to prevent the exposure of personal information regarding clients’ test results (or even that fact that they had an HIV test) to unauthorized persons. Private client information must not be made accessible to other clients or community members through careless record storage, lack of private space for confidential counseling, or inappropriate discussion of client information inside or outside the clinic setting.

Course Home | Module Home Index | Glossary | Help | Next Page

© 2007 EngenderHealth