HIV testing and counseling

This chapter provides a brief overview of how HIV testing and counseling evolved and the different purposes it serves. The first licensed test for HIV became available in 1985, 4 years after the initial Morbidity and Mortality Weekly Report on the epidemic that described cases of Pneumocystis carina pneumonia in Los Angeles. In this context, the HIV test emerged as much more than a purely diagnostic tool. The test process, for example, involved counseling on risk reduction and behavior change. Expansion of HIV testing, and thus growing numbers of people who were aware that they were infected with HIV, also supported political mobilization and advocacy among those infected and affected by the virus. This chapter illustrates the evolving role the HIV test has had as a prevention and care tool. The reasons for taking a test and for promoting knowledge of one's HIV status are varied, and include gaining knowledge for behavior change and future decisions, testing as a human rights issue, government planning, political mobilization, and access to treatment. Corresponding with the increased uptake of HIV testing and counseling has been a rapid increase in the number of HIV-infected patients starting antiretroviral therapy (ART). The WHO and UNAIDS provide further guidance on which health facilities should provide PITC according to the typology of the HIV epidemic and the context where the facility exists.