New guidance from the World Health Organisation and UNAIDS on provider-initiated HIV testing and counselling has been welcomed by leading UK charities.

An estimated 80% of people living with HIV in low and middle-income countries do not know that they are HIV-positive.

Recent surveys in sub-Saharan Africa showed on average just 12% of men and 10% of women have been tested for HIV and received their test results.

WHO and UNAIDS today issued new guidance on informed, voluntary HIV testing and counselling in the world’s health facilities, with a view to significantly increasing access to needed HIV treatment, care support and prevention services.

Increased access to HIV testing and counselling is seen as essential to promoting earlier diagnosis of HIV infection.

This can in turn maximise the potential benefits of life-extending treatment and care, and allow people with HIV to receive information and tools to prevent HIV transmission to others.

Lisa Power, Head of Policy at Terrence Higgins Trust, told PinkNews.co.uk:

“We fully support these recommendations. In the UK, this means that sexual health clinics and health services for those at particular risk of HIV should be recommending HIV testing – something which we’ve been advocating for some time.

“A third of people with HIV don’t know they have it and many of them may never have considered testing.

“We need this proactive approach to help these people as early as possible.”

Deborah Jack, Chief Executive of the National AIDS Trust, said:

“There is still much to do in the UK in order to increase the numbers of people who are diagnosed early.

“Initiatives to increase levels of HIV testing in sexual health clinics and during antenatal care in the UK have been very successful; now we need to ensure that HIV tests are now more widely offered in circumstances where there is a high risk of infection.

“We fully support the guidance that all patients diagnosed with TB or who attend sexual health clinics in the UK are offered an HIV test, which currently does not always happen.

“Healthcare workers, particularly in primary care, also need training so that they can identify symptoms of HIV as early as possible, as currently the early symptoms of the virus are often missed or misdiagnosed.”

The new guidance focuses on provider-initiated HIV testing and counselling (recommended by health care providers in health facilities).

Until recently, the primary model for providing HIV testing and counselling has been client-initiated HIV testing and counselling in which individuals must actively seek an HIV test at a health or community-based facility.

But uptake of client-initiated HIV testing and counselling has been limited by low coverage of services, fear of stigma and discrimination, and the perception by many people – even in high prevalence areas – that they are not at risk.

Current evidence also suggests many opportunities to diagnose HIV in clinical settings are being missed, even in places with serious HIV epidemics.

The new WHO/UNAIDS guidance was prepared in light of increasing evidence that provider-initiated testing and counselling can increase uptake of HIV testing, improve access to health services for people living with HIV, and may create new opportunities for HIV prevention.

Provider-initiated HIV testing and counselling involves the health care provider specifically recommending an HIV test to patients attending health facilities.

In these circumstances, once specific pre-test information has been provided, the HIV test would ordinarily be performed unless the patient declines.

“Scaling up access to HIV testing and counselling is both a public health and a human rights imperative,” said WHO HIV/AIDS Director Dr Kevin De Cock.

“We hope that the new guidance will provide an impetus to countries to greatly increase availability of HIV testing services in health care settings, through realistic approaches that both improve access to services and, at the same time, protect the rights of individuals.

“Without a major increase in HIV testing and counselling in health facilities, universal access to HIV prevention, treatment and care will remain just a noble goal.”