New York Times
Opinion

Editorial

AIDS Tests, Everywhere
http://www.nytimes.com/2006/10/13/opinion/13fri4.html

Published: October 13, 2006
At the beginning of 2004, AIDS treatment in Botswana --
a country with the world's second-highest rate of H.I.V. cases --
was stagnating.

The country was providing free antiretrovirals,
but only one in 10 who needed the drugs was taking them.

   Then Botswana made a simple change in the
rules for AIDS testing that allowed the program to soar.

Previously, Botswanans could get tested only after providing
written consent and accepting extensive counseling.

Now, unless they object, all patients entering a clinic or
hospital are routinely given an AIDS test.

The rate of testing has quadrupled.

A third of Botswanans now know their H.I.V. status, and
85 percent of those who need treatment get it.

   The American Centers for Disease Control and Prevention
recommended late last month that such routine AIDS testing --
called opt-out -- become the standard in the United States.

This is an important reform.

It is even more crucial for poor countries,
where 90 percent of those infected do not know it.

   Unaids and the World Health Organization should
move quickly to endorse opt-out AIDS testing.

Their guidance is followed worldwide and will help
rally needed help from outside donors.

   The current protocols for testing --
with their strong emphasis on privacy and consent --
were designed when little could be done to
help people with H.I.V.

Now antiretrovirals are being rolled out in every country.

But without easy access to testing, people may find out
they have AIDS only when it is too late to save their lives.

They will also have spent years unknowingly
passing on the infection.

   Where opt-out testing has been used,
few patients decline tests.

Treating H.I.V. like any other disease could also help
lessen the stigma.

People who have been tested before they feel sick also
start AIDS treatment earlier, and do better on it.

And studies show that those who know their status are only
half as likely to infect someone else, when compared with
an H.I.V. carrier who is still in the dark.

   Governments need to follow Botswana's lead and
make AIDS testing routine in every health clinic and hospital.

And donors should ensure that every clinic
has a reliable supply of AIDS tests.
http://www.nytimes.com/2006/10/13/opinion/13fri4.html