U.N. Urges HIV Testing for All Patients in Hard-Hit Nations

A nurse takes blood samples to be sent away for testing at the Project Phidisa, in Pretoria, South Africa, Aug. 15, 2005. Phidisa, provides AIDS drugs to 834 defense force members and their dependents.
A nurse takes blood samples to be sent away for testing at the Project Phidisa, in Pretoria, South Africa, Aug. 15, 2005. Phidisa, provides AIDS drugs to 834 defense force members and their dependents. (Denis Farrell - AP)
By Craig Timberg
Washington Post Foreign Service
Thursday, May 31, 2007

JOHANNESBURG, May 30 -- U.N. health officials on Wednesday called on nations with severe AIDS epidemics to offer routine, confidential HIV tests to all patients at health-care facilities in hopes of dramatically expanding the number of those who know they have the virus.

Patients would retain the right to refuse the test, but the new guidelines mark a significant departure from the common practice of relying on patients to seek tests for HIV, the virus that causes AIDS. U.N. officials estimate that nearly 80 percent of the people with HIV in poor and developing countries do not know they have it. In Africa alone, they said, nearly 20 million people with HIV are not aware they have the virus.

The new guidelines will not immediately alleviate the problem. Individual nations must first decide whether to adopt them and allocate money to expand testing.

That is likely to prove difficult in sub-Saharan Africa, where a severe shortage of doctors and nurses already is straining health systems, medical experts said. The new guidelines also call for mandatory counseling to accompany the HIV testing. No new U.N. funding has been set aside for the initiative.

"I see difficulty in following those guidelines in our circumstances," said Derek von Wissell, head of Swaziland's national AIDS council, speaking from the capital, Mbabane. "It's going to take an hour per patient. And I don't think we have that kind of resource available to us."

The guidelines also call for physicians anywhere in the world to offer testing to patients who exhibit symptoms of AIDS. But in the several dozen nations where infection rates exceed 1 percent, everyone seeking medical care should be offered an HIV test, regardless of their symptoms or the reason for seeking care, the U.N. officials said. Malawi, Botswana, Kenya and Uganda already have similar policies.

The officials said they were seeking to formulate guidelines that would expand testing while respecting individual rights. Other approaches to testing, including at stand-alone facilities, also would be encouraged.

"People need to know their HIV status, and there are many different ways to achieve that," Kevin De Cock, director of the HIV/AIDS department for the World Health Organization, said in a conference call with journalists.

The heavy stigma that long has accompanied AIDS has made testing a sensitive issue, especially in Africa, where there have been well-publicized cases of violence against people who have tested positive. But the lack of adequate testing has hampered efforts to provide the sophisticated antiretroviral treatment that increasingly is available even in the poorest nations.

Many people discover they have HIV only when they become gravely ill, making it more difficult, and far more costly, to effectively treat them.

Zackie Achmat of the Treatment Action Campaign, an activist group in South Africa, told reporters on the conference call that the new guidelines respected the rights of those with HIV while also improving their chances of accessing medical services.

"These guidelines are long, long overdue," Achmat said.

The U.N. officials said expanded testing may also improve efforts to prevent new infections, but the research on that is unclear. There is scant evidence that people who test negative for HIV change their sexual behavior. And there is no proven correlation between high rates of HIV testing in nations and falling rates of new infections.

Human Rights Watch also questioned whether the move toward more extensive testing would lead to the trampling of individual rights. The new U.N. guidelines say that spoken consent, rather than written, is sufficient for HIV testing.

"The concern I have is that not enough is being done to monitor HIV testing programs to make sure that consent is granted and testing is confidential and counseling is offered," Joseph Amon, head of the group's AIDS program, said from New York.

© 2007 The Washington Post Company