Philipsburg: ----The number of people using HIV testing and counseling services has quadrupled in the past five years. However, worldwide, only 12% of people who want to be tested are currently able to do so. In 2003, it was estimated that only 0.2% of adults in low- and middle-income countries received voluntary HIV counseling and testing services. People fail to be tested for HIV for many reasons: lack of access to testing services, fear of stigma and discrimination, fear the test will be positive, and lack of access to treatment. These facts mean thousands of opportunities for increased access to treatment, care, support and prevention have been, and are being, missed. The number of people using HIV testing and counseling services has quadrupled in the past five years. However, worldwide, only 12% of people who want to be tested are currently able to do so. In 2003, it was estimated that only 0.2% of adults in low- and middle-income countries received voluntary HIV counseling and testing services. People fail to be tested for HIV for many reasons: lack of access to testing services, fear of stigma and discrimination, fear the test will be positive, and lack of access to treatment. These facts mean thousands of opportunities for increased access to treatment, care, support and prevention have been, and are being, missed. In light of the need for individuals to have earlier access to treatment, care, support and prevention, UNAIDS and WHO are supporting a major expansion of access to HIV testing and counseling through the scaling up of client-initiated testing and counseling services and through the expansion of provider-initiated testing and counseling services in health care settings. Such efforts are not only necessary to improve the health of individuals, they are also necessary to achieve universal access to prevention, treatment, care and support and to mount effective responses against HIV. UNAIDS does not support mandatory testing of individuals. All testing, whether client or provider-initiated should be conducted under the conditions of the "Three Cs": involve informed consent, be confidential, and include counseling. Recognizing the urgency of connecting HIV positive people to prevention, treatment, care and support, UNAIDS and the World Health Organization released in May 2007 operational guidance on provider-initiated HIV testing and counseling in health facilities. The guidance is in line with the 2004 UNAIDS/WHO Policy Statement on HIV testing and recommends that traditional voluntary testing and counseling be supplemented by provider-initiated testing in all health settings in generalized HIV epidemics, and in selected health facilities (such as tuberculosis, sexual health or antenatal health clinics) in areas with low or concentrated HIV epidemics. Implementation of this guidance must be informed by an understanding of social and epidemiological context in which testing is taking place. Where there are high levels of stigma and discrimination and low capacity to implement testing and counseling under the Three Cs, these issues should be addressed before expansion of access to provider-initiated testing and counseling in health facilities. Though access to anti-retroviral treatment is not a prerequisite, there should be some realistic expectation of such access within the context of the country's plan to achieve universal access by 2010. Furthermore, there should be access to a basic package of prevention, care and support, as the cornerstone of expanded access to HIV testing and counseling to achieve beneficial health outcomes.
