The World Health Organization (WHO) today issued new HIV testing guidelines that recommend routinely offering HIV screening to all patients visiting health clinics in countries where HIV is widespread. Elsewhere, HIV testing should be routinely offered to all patients in targeted facilities, including prenatal and sexual health clinics.

To date, most testing has been "client-initiated," but WHO wants more "provider-initiated" HIV testing programs, where screening is the norm unless the patient declines. WHO said universal, voluntary HIV testing should occur in countries where HIV prevalence among pregnant women is consistently above 1 percent. More targeted testing could occur in countries with lower HIV prevalences.

"This is radical in the sense that things have to change," said Kevin De Cock, WHO's HIV/AIDS director. "Across the world, people with HIV are flowing through the health care settings, not being diagnosed and not being offered the advantages of knowing their status." People unaware they have HIV cannot access life-saving drugs and are more at risk for infecting others. At about $1 per rapid test, De Cock said price should not be an insurmountable barrier to testing.

Less than 20 percent of HIV-infected people in low- and middle-income countries know their infection status, said WHO. In the United States, about 25 percent of HIV-infected people do not know their status, and in Europe the proportion is about one-third.

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