HIV testing and counselling: Focusing on PITC

What are the widely recognised models of HIV testing?

1) Voluntary counselling and testing

• This is a form of testing whereby the client approaches a testing centre out of their own initiative to find out their HIV status.  Pre-testing counselling may be provided either on an individual basis or in group settings with individual follow-ups.

2) Diagnostic HIV testing

• This is a test conducted whenever a person shows signs or symptoms that are consistent with HIV-related disease or AIDS.This includes HIV testing for all tuberculosis patients as part of their routine management.

3) Mandatory HIV screening

• This is a procedure that is especially necessary prior to all procedures involving transfer of bodily fluids or body parts, such as artificial insemination, corneal grafts and organ transplant.

4) Provider Initiated Testing and Counseling (PITC)

• This is initiated by health care providers as part of the patient’s routine clinical management.  Provider-initiated HIV testing and counselling presents an opportunity for early diagnosis of HIV in health care facilities and facilitates access to prevention, treatment, care and support services
• PITC is offered all patients being assessed in the following settings:

(1) A sexually transmitted infection clinic or elsewhere for a sexually transmitted infection
(2) In the context of pregnancy - to facilitate an offer of antiretroviral prevention of mother-to-child transmission
(3) In clinical and community based health service settings where HIV is prevalent and antiretroviral treatment is available

According to UNAIDS, in 2003, it was estimated that only 0.2% of adults in low- and middle-income countries received voluntary HIV counselling and testing services. In addition, surveys in sub-Saharan Africa have shown that a median of just 12% of men and 10% of women had been tested for HIV and received their results. What are some of the main reasons for people failing to get tested for HIV?