The current strategy of leaving it to patients to request an HIV test is not working in the developing world, where 90 percent of those infected with the AIDS virus have no idea they are carrying it, U.N. health experts said Saturday.
The U.N. AIDS agency and World Health Organization said countries where HIV is widespread and where treatment is available should test routinely _ while allowing patients to opt out.
"The environment of AIDS is changing dramatically. Not only is there a globalization of the epidemic across Asia and Eastern Europe, but there is also a fundamental shift in the response, where treatment is becoming far more available," said Dr. Peter Piot, chief of UNAIDS.
The change in recommended police was announced ahead of Sunday's opening of the International AIDS Conference.
Patients who visit clinics "for whatever reason" and are not offered HIV tests represent missed opportunities for early diagnoses of AIDS _ or even chances to discuss prevention, Piot said.
"At the moment there are millions of missed opportunities," he said.
Routine testing would come in tandem with safeguards against discrimination. Many people have avoided HIV tests fearing stigma if people know they are infected.
"We are recommending a complete package in which testing and counseling, working on stigma, social mobilization and the offer of treatment happen simultaneously," said Dr. Jim Yong Kim, director of the WHO's HIV department.
WHO has mulled routine testing for years but has not announced it as U.N. policy until now. It got behind the idea after doctors reported seeing patients they strongly suspected were HIV positive but felt constrained by the old policy requiring patients to initiate discussion about a test.
"We thought that we had to take a much stronger stand," Kim said, adding that the test must be always be consensual, confidential and accompanied by counseling.
WHO has decided that access to lifesaving therapies outweighs the need to avoid potential discrimination, Kim said.
Botswana, which has the highest HIV prevalence in the world, shifted to routine testing in January, with the proportion of patients tested for HIV jumping from 20 percent to 80 percent.
Almost everybody who comes into a health center is given a test _ unless they object, said Dr. Ernest Darkoh, head of Botswana's national AIDS program.
"You realize very quickly that the whole paradigm of voluntary counseling and testing does not make sense at all in a country where you have a generalized epidemic," Darkoh said. "It just means that you reach people late. At that point they've already lost their livelihoods _ at the minimum _ because they are too sick to be working."
The World Health Organization aims to get 3 million sufferers in the developing world on HIV medication by the end of 2005.
Testing must be substantially ramped up to achieve that goal _ with as many as a half-million people tested per day, according to the Global Business Coalition on AIDS, a network of more than 150 companies.
"A lot of things have changed in AIDS in the last 20 years, but the testing policy has largely stayed the same," coalition executive director Trevor Neilson said.
HIV testing and counseling typically are handled in a separate building from mainstream health facilities.
To tackle stigma surrounding the tests, they should be integrated with everyday health care, said South African community activist Zackie Achmat.
"What we would like to see is integration of HIV testing across the health care system, that if someone is sick with TB they are offered an HIV test, they are counseled, their confidentiality is protected."
