HIV testing programmes aim to reach people with HIV who are unaware of their status or people who are most at risk of getting HIV.
HIV testing is the first step in the HIV treatment cascade so it is very important. To end the AIDS epidemic by 2030, all countries are aiming to make 95% of people with HIV aware of their status by 2025.
To increase access, HIV tests are now provided using rapid tests in a range of community settings, not just clinics. In addition, self-testing kits are enabling people to test for HIV at home.
But many at-risk people still do not test for HIV. Making testing available in lots of different places and using different approaches to suit people’s needs is the best way to ensure HIV testing reaches the people who need it the most (known as ‘differentiated service delivery’).
HIV testing and counselling in a clinical setting, such as:
ante- and postnatal care clinics, offered to pregnant people and sometimes their partners (couples testing)
family planning clinics
sexually transmitted infection clinics
youth friendly corners
People can either ask for an HIV test or they can be offered one (called ‘provider initiated’). They have the right to decline a test.
Sometimes, health workers will go into communities and use a referral or voucher scheme to encourage people to come to a clinic for an HIV test.
To make people feel more comfortable, some clinics work with peer educators or other community volunteers who can accompany people to clinics to test.
The existence of rapid diagnostic tests (or ‘point of care tests’) means HIV testing can now be done in lots of different places, not just clinics. It can be done outside clinic hours, at times that suit people better, and in more convenient locations.
Rapid tests don’t have to be done by nurses or doctors. Trained community health workers, peer workers and others can do them.
All these things make community-based testing very effective for reaching groups that are less likely to test in clinics, such as young people, men, and people from marginalised communities for example people who use drugs, sex workers, LGBTI people and men who have sex with men.
mobile clinics/vans: near places where people socialise, live, study or work
door-to-door outreach: HIV testing is systematically offered to people in their homes
event-based testing: people get tested as part of a wider social event
community health campaigns: encourage people to test for a number of conditions, including HIV (to minimise HIV-related stigma)
HIV self-testing is done by taking a pin-prick of blood from the finger or through a saliva swab. The kits have clear and simple instructions that people can do at home. If someone gets a positive result they need to get an HIV test in a clinic to confirm it.
Because self-testing is discreet and convenient, it can appeal to people who experience stigma and discrimination and those who are particularly at risk of HIV and need to test regularly. Self-testing is also useful for people who live far away from health facilities or community-based testing schemes.
in clinics and pharmacies (for free or at a low cost)
through website or apps, to be delivered to a home address or a somewhere discreet nearby, such as an NGO
to women attending antenatal clinics to give to their partner/s
in workplaces, schools, universities, churches, community meetings, bars and other social settings
in places where people most at risk of HIV are found, such as injecting ‘hot-spots’ or areas where people sell sex.
Self-testing kits should be provided with information on what to do if someone receives a positive result, plus information on HIV prevention services, and even prevention commodities such as condoms.
Assisted partner and contact notification
This is a voluntary process that aims to provide HIV tests to the close contacts of someone with HIV (normally their sexual or injecting partners but sometimes their children, relatives or social contacts, depending on the situation). It can be done in a number of ways but must only be carried out with that person’s permission.
Partner notification: contact referral: A person with HIV agrees to tell their sexual and/or injecting partners they have HIV and suggest they test. If these people do not test within an agreed period, a health provider has permission to contact them directly to offer testing.
Partner notification: provider-patient referral: A trained provider goes with the person with HIV to support them to tell their partners. The provider then offers HIV testing.
Index case finding: HIV testing is made available to the children and other family members of someone with HIV as well as sexual and injecting partners.
Social network testing: If someone at high risk of HIV comes for an HIV test, regardless of their result, they will be asked to invite people in their sexual, injecting or social networks to test. Or the provider may give self-testing kits to the person to pass on to people in their networks.
Which groups are not testing for HIV and why?
harmful gender norms: for example, worries around being seen as ‘weak’
HIV testing being mainly available through antenatal services, so seen as ‘for women’.