Guidance on Provider-InitiatedHIV Testing and Counsellingin Health Facilities, World Health Organization (2007)

Although the WHO endorses opt-out HIV testing, this guidance on provider-initiated testing in health care settings demonstrates that “opt-out” testing can have many different meanings. Unlike the CDC’s 2006 guidelines, the WHO guidelines appear to recognize that a “one size fits all” approach to HIV testing is untenable, particularly when dealing with youth and other vulnerable populations.

According to the WHO guidance to health care providers, even opt-out testing programs must include informed consent and, at a minimum, the following information:

• Pre-test information provided in the form of individual information sessions or in group health information talks.
• Informed consent, always given individually, in private, in the presence of a health care provider.
• When recommending HIV testing and counseling to a patient, the health care provider should at a minimum provide the patient with the following information:
• The reasons why HIV testing and counseling is being recommended;
• The clinical and prevention benefits of HIV testing and the potential risks, such as discrimination, abandonment or violence;
• The services that are available in the case of either an HIV-negative or an HIV-positive test result, including whether antiretroviral treatment is available;
• The fact that the test result will be treated confidentially and will not be shared with anyone other than heath care providers directly involved in providing services to the patient;
• The fact that the patient has the right to decline the test and that testing will be performed unless the patient exercises that right;
• The fact that declining an HIV test will not affect the patient's access to services that do not depend on knowledge of HIV status;
• In the event of an HIV-positive test result, encouragement of disclosure to other persons who may be at risk of exposure to HIV; and
• An opportunity to ask the health care provider questions.

Also, unlike the CDC recommendations, the WHO guidance recognizes that post-test counselling is an integral component of the HIV testing process regardless of the test result. According to the guidance, counseling for those whose test result is HIV-negative should include:

• An explanation of the test result, including information about the window period for the appearance of HIV-antibodies and a recommendation to re-test in case of a recent exposure;
• Basic advice on methods to prevent HIV transmission; and
• Provision of male and female condoms and guidance on their use.